Job loss from poor health, smoking and obesity: a national prospective survey in France

Background and objectives: Health selection into unemployment may be either direct or operate by reference to health-related behaviours rather than health per se (indirect selection). Panel data are desirable to investigate selection effects, and the two types of selection processes may be concurrent. We examine jointly the roles of health and health-related behaviours as precursors of unemployment, in order to disentangle direct from indirect selection processes. Design: The data of a multi-round nationally representative health survey in France were analysed longitudinally, based on three data collection rounds: 1992–5, 1996–8 and 2000–2. Following employees salaried in the private sector and aged 30–54 years at baseline, we explored through logistic regression the influence of non-optimal self-rated health, smoking and obesity on the risk of being found unemployed 4 years later. Results: After adjustment for self-rated health, obesity was found to be a significant precursor of unemployment in women, and heavy smoking had that role in men. After adjustment for smoking and obesity, poor health at baseline was found to be a significant precursor of unemployment in both genders. Conclusion: Those findings confirm the intrinsic role of poor health and of health-related behaviours as precursors of unemployment, with gender-specific patterns for the latter. Public policy prescriptions regarding employees’ protection from job insecurities should integrate appropriate accommodations of health limitations, and the personal factors underlying unfavourable work and health behaviours should be investigated, in order to thwart indirect selection phenomena.ou

Faire valoir ses droits à l'Aide Complémentaire Santé: Les résultats d'une expérimentation sociale

L'Aide complémentaire santé (ACS) ou « chèque santé » a été mise en place en 2005 pour inciter les ménages dont le niveau de vie se situe juste au-dessus du plafond CMU-C à acquérir une couverture complémentaire santé grâce à une subvention. Même si le nombre de bénéficiaires a lentement progressé depuis son introduction, le recours à l'ACS reste faible. Deux hypothèses peuvent expliquer cet état de fait : (1) le défaut d'information sur l'existence du dispositif, son fonctionnement et sur les démarches à entreprendre pour en bénéficier ; (2) un montant d'aide insuffisant, la complémentaire resterait trop chère même après déduction de l'aide. Afin de tester la validité de ces deux hypothèses, une expérimentation sociale contrôlée a été mise en place par l'université Paris-Dauphine à Lille auprès d'un échantillon de 4 209 assurés sociaux potentiellement éligibles à l'ACS. Un montant majoré d'aide ainsi qu'un accès différencié à l'information sur le dispositif ont été proposés de manière aléatoire à certains assurés. Les résultats montrent de manière robuste que la majoration du montant du « chèque santé » améliore légèrement le taux de recours à l'ACS et permet de mieux cibler les personnes effectivement éligibles. Toutefois, l'ACS reste un dispositif compliqué qui touche difficilement sa cible : au total, seuls 17 % des assurés ont fait une demande d'ACS. Seuls 9 % des assurés invités à participer à une réunion d'information y ont effectivement assisté, et l'invitation à cette réunion a largement découragé les autres assurés, annulant ainsi l'effet de la majoration du chèque. Enfin, seuls 55 % des assurés ayant déposé une demande ont reçu l'aide, les autres s'étant vu refuser l'aide en raison, le plus souvent, de ressources trop élevées. La difficulté à cibler la population éligible et l'incertitude importante sur l'éligibilité qui en résulte sont certainement des freins s'ajoutant à la complexité des démarches

Household crowding, social mixing patterns and respiratory symptoms in seven countries of the African meningitis belt.

OBJECTIVES: To describe the variation in household crowding and social mixing patterns in the African meningitis belt and to assess any association with self-reported recent respiratory symptoms. METHODS: In 2010, the African Meningococcal Carriage Consortium (MenAfriCar) conducted cross-sectional surveys in urban and rural areas of seven countries. The number of household members, rooms per household, attendance at social gatherings and meeting places were recorded. Associations with self-reported recent respiratory symptoms were analysed by univariate and multivariate regression models. RESULTS: The geometric mean people per room ranged from 1.9 to 2.8 between Ghana and Ethiopia respectively. Attendance at different types of social gatherings was variable by country, ranging from 0.5 to 1.5 per week. Those who attended 3 or more different types of social gatherings a week (frequent mixers) were more likely to be older, male (OR 1.27, p<0.001) and live in urban areas (OR 1.45, p<0.001). Frequent mixing and young age, but not increased household crowding, were associated with higher odds of self-reported respiratory symptoms (aOR 2.2, p<0.001 and OR 2.8, p<0.001 respectively). A limitation is that we did not measure school and workplace attendance. CONCLUSION: There are substantial variations in household crowding and social mixing patterns across the African meningitis belt. This study finds a clear association between age, increased social mixing and respiratory symptoms. It lays the foundation for designing and implementing more detailed studies of social contact patterns in this region

Cost-effectiveness of HBV and HCV screening strategies:a systematic review of existing modelling techniques

Introduction: Studies evaluating the cost-effectiveness of screening for Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) are generally heterogeneous in terms of risk groups, settings, screening intervention, outcomes and the economic modelling framework. It is therefore difficult to compare cost-effectiveness results between studies. This systematic review aims to summarise and critically assess existing economic models for HBV and HCV in order to identify the main methodological differences in modelling approaches. Methods: A structured search strategy was developed and a systematic review carried out. A critical assessment of the decision-analytic models was carried out according to the guidelines and framework developed for assessment of decision-analytic models in Health Technology Assessment of health care interventions. Results: The overall approach to analysing the cost-effectiveness of screening strategies was found to be broadly consistent for HBV and HCV. However, modelling parameters and related structure differed between models, producing different results. More recent publications performed better against a performance matrix, evaluating model components and methodology. Conclusion: When assessing screening strategies for HBV and HCV infection, the focus should be on more recent studies, which applied the latest treatment regimes, test methods and had better and more complete data on which to base their models. In addition to parameter selection and associated assumptions, careful consideration of dynamic versus static modelling is recommended. Future research may want to focus on these methodological issues. In addition, the ability to evaluate screening strategies for multiple infectious diseases, (HCV and HIV at the same time) might prove important for decision makers

Analysing Spatio-Temporal Clustering of Meningococcal Meningitis Outbreaks in Niger Reveals Opportunities for Improved Disease Control

Meningococcal meningitis (MM) is an infection of the meninges caused by a bacterium, Neisseria meningitidis, transmitted through respiratory and throat secretions. It can cause brain damage and results in death in 5–15% of cases. Large epidemics of MM occur almost every year in sub-Saharan Africa during the hot, dry season. Understanding how epidemics emerge and spread in time and space would help public health authorities to develop more efficient strategies for the prevention and the control of meningitis. We studied the spatio-temporal distribution of MM cases in Niger from 2002 to 2009 at the scale of the health centre catchment areas (HCCAs). We found that spatial clusters of cases most frequently occurred within nine districts out of 42, which can assist public health authorities to better adjust allocation of resources such as antibiotics or rapid diagnostic tests. We also showed that the epidemics break out in different HCCAs from year to year and did not follow a systematic geographical direction. Finally, this analysis showed that surveillance at a finer spatial scale (health centre catchment area rather than district) would be more efficient for public health response: outbreaks would be detected earlier and reactive vaccination would be better targeted

Is There an Association between Long-Term Sick Leave and Disability Pension and Unemployment beyond the Effect of Health Status? – A Cohort Study

Background: Studies have shown that long-term sick leave is a strong predictor of disability pension. However, few have aimed to disentangle the effect of sick leave and of health status. The objective of this study was to investigate whether there is an association between long-term sick leave and disability pension and unemployment, when taking health status into account. Methods/Principal Findings: The study was based on the Stockholm Public Health Cohort, restricted to 13,027 employed individuals (45.9 % men) aged 18–59 in 2002 and followed until 2007. Hazard ratios (HR) with 95 % Confidence Interval (CI) were estimated by Cox regression models adjusting for socio-demographic factors and five measures of health status. Having been on long-term sick leave increased the risk of disability pension (HR 4.01; 95 % CI 3.19–5.05) and longterm unemployment (HR 1.45; 95 % CI 1.05–2.00), after adjustment for health status. The analyses of long-term sick leave due to specific illness showed that the increased risk for long-term unemployment was confined to the group on sick leave due to musculoskeletal (HR 1.70 95 % CI 1.00–2.89) and mental illness (HR 1.80 95 % CI 1.13–2.88) and further that there was an increased risk for short-term unemployment in the group on sick leave due to mental illness (HR1.57 95%CI 1.09–2.26). Conclusions/Significance: Long-term sick leave increases the risks of both disability pension and unemployment even when taking health status into account. The results support the hypothesis that long-term sick leave may start a process o

Migrant health in French Guiana: Are undocumented immigrants more vulnerable?

<p>Abstract</p> <p>Background</p> <p>Few data exist on the health status of the immigrant population in French Guiana. The main objective of this article was to identify differences in its health status in relation to that of the native-born population.</p> <p>Methods</p> <p>A representative, population-based, cross-sectional survey was conducted in 2009 among 1027 adults living in Cayenne and St-Laurent du Maroni. Health status was assessed in terms of self-perceived health, chronic diseases and functional limitations. The migration variables were immigration status, the duration of residence in French Guiana and the country of birth. Logistic regression models were conducted.</p> <p>Results</p> <p>Immigrants account for 40.5% and 57.8% of the adult population of Cayenne and St-Laurent du Maroni, respectively. Most of them (60.7% and 77.5%, respectively) had been living in French Guiana for more than 10 years. A large proportion were still undocumented or had a precarious legal status. The undocumented immigrants reported the worst health status (OR = 3.18 [1.21-7.84] for self-perceived health, OR = 2.79 [1.22-6.34] for a chronic disease, and OR = 2.17 [1.00-4.70] for a functional limitation). These differences are partially explained by socioeconomic status and psychosocial factors. The country of birth and the duration of residence also had an impact on health indicators.</p> <p>Conclusion</p> <p>Data on immigrant health are scarce in France, and more generally, immigrant health problems have been largely ignored in public health policies. Immigrant health status is of crucial interest to health policy planners, and it is especially relevant in French Guiana, considering the size of the foreign-born population in that region.</p