Associations of homelessness and residential mobility with length of stay after acute psychiatric admission

Background: A small number of patient-level variables have replicated associations with the length of stay (LOS) of psychiatric inpatients. Although need for housing has often been identified as a cause of delayed discharge, there has been little research into the associations between LOS and homelessness and residential mobility (moving to a new home), or the magnitude of these associations compared to other exposures. Methods: Cross-sectional study of 4885 acute psychiatric admissions to a mental health NHS Trust serving four South London boroughs. Data were taken from a comprehensive repository of anonymised electronic patient records. Analysis was performed using log-linear regression. Results: Residential mobility was associated with a 99% increase in LOS and homelessness with a 45% increase. Schizophrenia, other psychosis, the longest recent admission, residential mobility, and some items on the Health of the Nation Outcome Scales (HoNOS), especially ADL impairment, were also associated with increased LOS. Informal admission, drug and alcohol or other non-psychotic diagnosis and a high HoNOS self-harm score reduced LOS. Including residential mobility in the regression model produced the same increase in the variance explained as including diagnosis; only legal status was a stronger predictor. Conclusions: Homelessness and, especially, residential mobility account for a significant part of variation in LOS despite affecting a minority of psychiatric inpatients; for these people, the effect on LOS is marked. Appropriate policy responses may include attempts to avert the loss of housing in association with admission, efforts to increase housing supply and the speed at which it is made available, and reforms of payment systems to encourage this

Persuading children: a framework for understanding long-lasting influences on children's food choices

Journal non répertorié dans les bases de données internationales.International audienceIn this paper, we present a framework for understanding long-lasting influences on children's food purchase choices and consumption. The framework interacts the characteristics of agents (i.e., children and parents/caretakers) with marketing related effects to explain how these agents make short- and long-term decisions in the food category. We develop each of the components of our framework with different theories and multiple empirical examples, focusing on how children develop their food preferences and how their understanding of and resistance to persuasion and marketing messages may influence choices. Overall, the presented approach suggests firms, consumers, and parents can benefit from taking these factors into account when making choices that affect children and when allowing children to make their own choices