An exploration of the subjective social status construct in patients with acute coronary syndrome

Abstract Background Perception of low subjective social status (SSS) relative to others in society or in the community has been associated with increased risk of cardiovascular disease. Our objectives were to determine whether low SSS in society was associated with barriers to access to care or hospital readmission in patients with established cardiovascular disease, and whether perceptions of discordantly high SSS in the community modified this association. Methods We conducted a prospective cohort study from 2009 to 2013 in Canada, United States, and Switzerland in patients admitted to hospital with acute coronary syndrome (ACS). Data on access to care and SSS variables were obtained at baseline. Readmission data were obtained 12 months post-discharge. We conducted multivariable logistic regression to model the odds of access to care and readmission outcomes in those with low versus high societal SSS. Results One thousand ninety patients admitted with ACS provided both societal and community SSS rankings. The low societal SSS cohort had greater odds of reporting that their health was affected by lack of health care access (OR 1.48, 95% CI 1.11, 1.97) and of experiencing cardiac readmissions (1.88, 95% CI 1.15, 3.06). Within the low societal SSS cohort, there was a trend toward fewer access to care barriers for those with discordantly high community SSS though findings varied based on the outcome variable. There were no statistically significant differences in readmissions based on community SSS rankings. Conclusion Low societal SSS is associated with increased barriers to access to care and cardiac readmissions. Though attenuated, these trends remained even when adjusting for clinical and sociodemographic factors, suggesting that perceived low societal SSS has health effects above and beyond objective socioeconomic factors. Furthermore, high community SSS may potentially mitigate the risk of experiencing barriers to access to health care in those with low societal SSS, though these associations were not statistically significant. Subjective social status relative to society versus relative to the community seem to represent distinct concepts. Insight into the differences between these two SSS constructs is imperative in the understanding of cardiovascular health and future development of public health policies

Pediatric growth hormone therapy in Greece: analysis of the Hellenic cohort of the GeNeSIS study

Purpose: To describe the data from the Greek cohort of the Genetics and Neuroendocrinology of Short Stature International Study (GeNeSIS). Methods: GeNeSIS was a prospective, open-label, multinational, observational study collecting information on clinical outcomes and treatment safety of children with growth disorders treated with growth hormone (GH), according to national indications. After informed consent, 305 patients (143 females), including 255 patients with growth hormone deficiency (GHD) and 30 with Turner syndrome (TS), from eight investigational sites, were enrolled in Greece. Demographic data, treatment efficacy, and adverse events were reported at the discretion of attending physicians. Results: Treatment with GH was undertaken for 247/255 patients with GHD and 29/30 with TS. The majority of patients treated with GHD (73.7%) and TS (84%) with recorded Tanner stage were prepubertal at enrolment. Among patients treated with GHD and TS, 70.45% and 55% were GH-naïve at study entry, respectively. Height standard deviation score (SDS), height velocity SDS, and height SDS-target height SDS numerically improved during the 4-year observation period. The effect of GH treatment was more prominent in the first year of treatment, especially in the GHD group. Conclusions: In the Greek cohort of GeNeSIS, GHD is the most frequent indication for GH treatment, followed by TS. While the latter is diagnosed somewhat earlier, GH treatment is not as efficacious as for patients with GHD. No major safety issues were reported during follow-up. The results, which are in accordance with the international literature, should be interpreted in the context of observational studies. © 2019, Hellenic Endocrine Society

Exploring the return-on-investment for scaling screening and psychosocial treatment for women with common perinatal mental health problems in Malawi: Developing a cost-benefit-calculator tool

<p><strong>Abstract</strong></p> <p>This study sought to develop a user-friendly decision-making tool to explore country-specific estimates for costs and economic consequences of different options for scaling screening and psychosocial interventions for women with common perinatal mental health problems in Malawi. We developed a simple simulation model using a structure and parameter estimates that were established iteratively with experts, based on published trials, international databases and resources, statistical data, best practice guidance and intervention manuals. The model projects annual costs and returns to investment from 2022 to 2026. The study perspective is societal, including health expenditure and productivity losses. Outcomes in the form of health-related quality of life are measured in Disability Adjusted Life Years, which were converted into monetary values. Economic consequences include those that occur in the year in which the intervention takes place. Results suggest that the net benefit is relatively small at the beginning but increases over time as learning effects lead to a higher number of women being identified and receiving (cost‑)effective treatment. For a scenario in which screening is first provided by health professionals (such as midwives) and a second screening and the intervention are provided by trained and supervised volunteers to equal proportions in group and individual sessions, as well as in clinic versus community setting, total costs in 2022 amount to US$0.66 million and health benefits to US$ 0.36 million. Costs increase to US$1.03 million and health benefits to US$ 0.93 million in 2026. Net benefits increase from US$35,000 in 2022 to US$ 0.52 million in 2026, and return-on-investment ratios from 1.05 to 1.45. Results from sensitivity analysis suggest that positive net benefit results are highly sensitive to an increase in staff salaries. This study demonstrates the feasibility of developing an economic decision-making tool that can be used by local policy makers and influencers to inform investments in maternal mental health</p> <p> </p> <p><strong>Description of data set</strong></p> <p>Iteratively, information was gathered from desk-based searches and from talking to and exchanging emails with experts in the maternal health field to establish a model structure and the parameter values. This included the development of an information request form that presents a list of parameters, parameter values and details about how the values were estimated and the data sources. We collected information on: Intervention’s effectiveness; prevalence rates; population and birth estimates; proportion of women attending services; salaries and reimbursement rates for staff and volunteers; details about training, supervision, intervention delivery (e.g., frequency, duration); unit costs, and data needed to derive economic consequences (e.g. women’s income, health weights). Data were searched from the following sources: published randomised controlled trials and meta-analyses; WHO published guidance and intervention manual; international databases and resources (WHO-CHOICE, Global Burden of Disease Database; International Monetary Fund; United Nations Treasury, World Bank, Global Investment Framework for Women’s and Children’s Health). We consulted two groups of experts: one group included individuals with clinical, research or managerial expertise in funding, managing, delivering, or evaluating screening of common mental health problems and PSIs; the second group included individuals from the Malawi Government, Ministry of Health Reproductive Health Unit and Non-Communicable Disease Committee and Mental Health Unit. The first group of experts provided information from research and administrative data systems concerned with implementing and evaluating screening for maternal mental health and the delivery of interventions. The second group of experts from the Malawi Government provided information on unit costs for hospital use and workforce data, as well as information on how training and supervision might be delivered at scale. Individuals were identified by colleagues of this team based or part-time based in Malawi, which included a psychiatrist specialising in perinatal mental health (co-author RS) and the coordinator of the African Maternal Mental Health Alliance (co-author DN), an organisation concerned with disseminating information and evidence on perinatal mental health to policy makers and influencers, and the wider public.</p&gt

Faculty Attitudes About Caring for People Living With HIV/AIDS: A Comparative Study

Background: People living with HIV/AIDS (PLHIV) experience stigma and discrimination. Negative attitudes of nursing faculty about caring for PLHIV can adversely affect student perceptions and their nursing care. The study purpose was to describe nursing faculty attitudes and beliefs about caring for PLHIV. Method: The HPASS (Healthcare Provider HIV/AIDS Stigma Scale), Spanish version, was delivered to nursing faculty in Colombia and Peru. Results: The HPASS was completed by 98 nursing faculty. The overall mean score was 2.41 (SD = 0.69), with subscale scores: stereotypes, 2.55 (SD = 0.84); discrimination, 2.28 (SD = 0.74); and prejudices, 2.41 (SD = 0.63). Peruvian faculty had the highest scores, statistically correlated with the importance of religion, whereas Colombia had the lowest. Conclusion: Nursing faculty attitudes toward PLHIV were slightly positive in Colombia to slightly negative in Peru; however, both countries had negative stereotypes. Knowledge deficiencies about HIV persist and attitudes appear to be influenced by culture and religion