Multimorbidity and health-related quality of life (HRQoL) in a nationally representative population sample: implications of count versus cluster method for defining multimorbidity on HRQoL

Background: No universally accepted definition of multimorbidity (MM) exists, and implications of different definitions have not been explored. This study examined the performance of the count and cluster definitions of multimorbidity on the sociodemographic profile and health-related quality of life (HRQoL) in a general population. Methods: Data were derived from the nationally representative 2007 Australian National Survey of Mental Health and Wellbeing (n = 8841). The HRQoL scores were measured using the Assessment of Quality of Life (AQoL-4D) instrument. The simple count (2+ & 3+ conditions) and hierarchical cluster methods were used to define/identify clusters of multimorbidity. Linear regression was used to assess the associations between HRQoL and multimorbidity as defined by the different methods. Results: The assessment of multimorbidity, which was defined using the count method, resulting in the prevalence of 26% (MM2+) and 10.1% (MM3+). Statistically significant clusters identified through hierarchical cluster analysis included heart or circulatory conditions (CVD)/arthritis (cluster-1, 9%) and major depressive disorder (MDD)/anxiety (cluster-2, 4%). A sensitivity analysis suggested that the stability of the clusters resulted from hierarchical clustering. The sociodemographic profiles were similar between MM2+, MM3+ and cluster-1, but were different from cluster-2. HRQoL was negatively associated with MM2+ (β: −0.18, SE: −0.01, p < 0.001), MM3+ (β: −0.23, SE: −0.02, p < 0.001), cluster-1 (β: −0.10, SE: 0.01, p < 0.001) and cluster-2 (β: −0.36, SE: 0.01, p < 0.001). Conclusions: Our findings confirm the existence of an inverse relationship between multimorbidity and HRQoL in the Australian population and indicate that the hierarchical clustering approach is validated when the outcome of interest is HRQoL from this head-to-head comparison. Moreover, a simple count fails to identify if there are specific conditions of interest that are driving poorer HRQoL. Researchers should exercise caution when selecting a definition of multimorbidity because it may significantly influence the study outcomes

Transitional safeguarding: Presenting the case for developing Making Safeguarding Personal for Young People in England

Purpose: The purpose of this paper is to set out the similarities and differences between the legal frameworks for safeguarding children and adults. It presents the case for developing a Transitional Safeguarding approach to create an integrated paradigm for safeguarding young people that better meets their developmental needs and better reflects the nature of harms young people face.  Design/methodology/approach: This paper draws on the key principles of the Children Act 1989 and the Care Act 2014 and discusses their similarities and differences. It then introduces two approaches to safeguarding: Making Safeguarding Personal (MSP); and transitional safeguarding; that can inform safeguarding work with young people. Other legal frameworks that influence safeguarding practices, such as the Mental Capacity Act 2005 and the Human Rights Act 1998, are also discussed.  Findings: Safeguarding practice still operates within a child/adult binary; neither safeguarding system adequately meets the needs of young people. Transitional Safeguarding advocates an approach to working with young people that is relational, developmental and contextual. MSP focuses on the wishes of the person at risk from abuse or neglect and their desired outcomes. This is also central to a Transitional Safeguarding approach, which is participative, evidence informed and promotes equalities, diversity and inclusion.  Practical implications: Building a case for developing MSP for young people means that local partnerships could create the type of service that best meets local needs, whilst ensuring their services are participative and responsive to the specific safeguarding needs of individual young people.  Originality/value: This paper promotes applying the principles of MSP to safeguarding practice with young people. It argues that the differences between the children and adult legislative frameworks are not so great that they would inhibit this approach to safeguarding young people

A Systematic Review of Cost-of-Illness Studies of Multimorbidity

Objectives: The economic burden of multimorbidity is considerable. This review analyzed the methods of cost-of-illness (COI) studies and summarized the economic outcomes of multimorbidity. Methods: A systematic review (2000–2016) was performed, which was registered with Prospero, reported according to PRISMA, and used a quality checklist adapted for COI studies. The inclusion criteria were peer-reviewed COI studies on multimorbidity, whereas the exclusion criterion was studies focusing on an index disease. Extracted data included the definition, measure, and prevalence of multimorbidity; the number of included health conditions; the age of study population; the variables used in the COI methodology; the percentage of multimorbidity vs. total costs; and the average costs per capita. Results: Among the 26 included articles, 14 defined multimorbidity as a simple count of 2 or more conditions. Methodologies used to derive the costs were markedly different. Given different healthcare systems, OOP payments of multimorbidity varied across countries. In the 17 and 12 studies with cut-offs of ≥2 and ≥3 conditions, respectively, the ratios of multimorbidity to non-multimorbidity costs ranged from 2–16 to 2–10. Among the ten studies that provided cost breakdowns, studies with and without a societal perspective attributed the largest percentage of multimorbidity costs to social care and inpatient care/medicine, respectively. Conclusion: Multimorbidity was associated with considerable economic burden. Synthesising the cost of multimorbidity was challenging due to multiple definitions of multimorbidity and heterogeneity in COI methods. Count method was most popular to define multimorbidity. There is consistent evidence that multimorbidity was associated with higher costs

Protecting the Mental Health of Small-to-Medium Enterprise Owners: A Randomized Control Trial Evaluating a Self-Administered Versus Telephone Supported Intervention

OBJECTIVE: Small-medium enterprises (SMEs) are under-represented in occupational health research. Owner/managers face mental ill-health risks/exacerbating factors including financial stress and long working hours. This study assessed the effectiveness of a workplace mental health and wellbeing intervention specifically for SME owner/managers. METHODS: Two hundred ninety seven owner/managers of SMEs were recruited and invited to complete a baseline survey assessing their mental health and wellbeing and were then randomly allocated to one of three intervention groups: (1) self-administered, (2) self-administered plus telephone, or (3) an active control condition. After a four-month intervention period they were followed up with a second survey. RESULTS: Intention to treat analyses showed a significant decrease in psychological distress for both the active control and the telephone facilitated intervention groups, with the telephone group demonstrating a greater ratio of change. CONCLUSION: The provision of telephone support for self-administered interventions in this context appears warranted

Depression-related presenteeism: Identifying the correlates, estimating the consequences, and valuing associated lost productive time

Background: Employed individuals reporting depression can take a sickness absence (absenteeism) or continue working when ill (presenteeism‚ÄövÑvp); either decision has potential benefits and harms. Whilst absenteeism has received considerable attention from researchers, presenteeism is a newer concept. Understanding of its causes and consequences, particularly amongst individuals reporting depression, is less established. Aims: This thesis aimed to determine the socio-demographic, financial, work and health-related correlates of depression-related presenteeism, in the Australian workforce generally and in the under-researched small-to-medium enterprise (SME) sector. It systematically compared the costs and health outcomes of depression-related presenteeism and absenteeism. Finally, it explored managers‚ÄövÑvº understanding of sickness presenteeism, and validated the Team Production Interview‚ÄövÑvp method for valuing related productivity loss. Methods: Population-based data was used to identify correlates of presenteeism amongst employed Australian adults reporting lifetime major depression (Chapter 3), and used in state-transition Markov models to estimate the costs and health outcomes of depression-related absenteeism versus presenteeism (Chapter 6). A systematic review aimed to determine the prevalence and correlates of depression, psychological distress, related absenteeism and presenteeism, and the associated health and economic outcomes, in SMEs (Chapter 4). Baseline data from a RCT designed to evaluate a mental health promotion program for SME owner/managers was used to identify the proportion reporting high/very high psychological distress, the prevalence and correlates of associated absenteeism and presenteeism, and estimate the subsequent productivity loss (Chapter 5). Cognitive interviewing data with managers was used to validate the Team Production Interview‚ÄövÑvp (Chapter 7). Results: Work and health factors had little influence on presenteeism behaviour over and above socio-demographic and financial factors. Significant factors were marital status, housing tenure and co-morbid mental disorders (Chapter 3). The systematic review found a dearth SME-specific information regarding the prevalence and correlates of depression, related absenteeism and presenteeism, and the associated health and economic outcomes (Chapter 4). Approximately 30% of SME owner/managers reported high/very high psychological distress, of which 90% reported past month presenteeism and reduced productivity. No SME-specific factors were associated with presenteeism (Chapter 5). Absenteeism was more costly than presenteeism and offered no improvement in health (Chapter 6). Finally, managers misunderstood concepts of presenteeism and chronic disease, and reported an inability to answer Team Production Interview items due to perceived inexperience managing workers with chronic disease, or difficulty applying questions to their workplace (Chapter 7). Conclusions: Presenteeism reporters may be milder cases of depression, and benefit from arrangements that allow absence for treatment and recovery whilst maintaining work attendance and the potential benefits of social support. As better self-rated health was associated with presenteeism amongst SME owner/managers, flexible work arrangements may also benefit the SME sector. Employers benefit from continued employee productivity and reduced long-term sickness absence. The finding that absenteeism costs more than presenteeism and offers no additional health benefit provides support for such measures. Modifying the Team Production Interview will improve managers‚ÄövÑvº understanding of chronic illness and presenteeism, and ensure precise valuation of presenteeism-related lost productive time to inform employers, and relevant decision makers, of the relative efficiency of the aforementioned strategies

Understanding first year university students: personal epistemology and learning

Whilst participation in higher education has increased dramatically over the last two decades, many universities are only now beginning to pay more attention to the learning experiences of first year students. It is important for universities to understand how first year students conceive of learning and knowing in order to promote effective approaches to learning. Even though an extensive body of research demonstrates that beliefs about learning and knowing influence student approaches to learning and learning outcomes, there has been no Australian research that has investigated this critical learner characteristic across first year university students. This paper reports on preliminary data from an ongoing longitudinal study designed to investigate first year students’ beliefs about knowing and learning (epistemological beliefs). Students from teacher education and creative industry faculties in two Australian universities completed the Epistemological Beliefs Survey (EBS) in the first week of their first semester of study. A series of one-way ANOVA using key demographics as independent variables and the EBS factor scores as dependent variables showed that epistemological beliefs were related to the course of study, previous post-school education experience, family experience at University, gender and age. These data help us to understand students’ beliefs about learning and knowing with a view to informing effective learning in higher education

Presenteeism: Implications and health risks

Background: Presenteeism – or working while ill – is commonly seen as just an economic indicator of disease burden. Emerging evidence suggests it may best be conceptualised as a behaviour that has implications for the person and their employer, and one that can be clinically managed. Objective/s: This article presents an overview of the phenomenon of presenteeism in the workforce and its clinical implications. It focuses on evidence relevant to the management of day-to-day, short term decisions on whether an individual should go into work while sick or take a day or more of work absence. This discussion is separate to the management of compensation and return to work issues. Discussion: Certain patients will be at risk of presenteeism, even when absence may be clinically advisable, due to personal or job characteristics. Presenteeism behaviour has potential positive and negative consequences for the patient’s own health, their job performance and tenure and their workplace, and these should be weighed up when helping patients to manage their work responsibilities. As presenteeism behaviour can be a precursor to work disability, it is important to understand its clinical significance and how it might manifest in general practice, in order to identify early warning signs for future long term disability