Psychosocial working conditions and the utilization of health care services

<p>Abstract</p> <p>Background</p> <p>While there is considerable theoretical and empirical evidence on how job stress affects physical and mental health, few studies have examined the association between job related stress and health care utilization. Using data from the Canadian National Population Health Survey from 2000 to 2008, this paper examines the association between stressful working conditions, as measured by the job strain model, and the utilization of health care services.</p> <p>Methods</p> <p>A zero inflated negative binomial regression is used to examine the excess health care utilization due to job strain. Separate regressions are estimated for both males and females since studies have shown gender differences in health care utilization.</p> <p>Results</p> <p>Estimates for the whole population show that high or medium job strain has a positive and statistically significant association with the number of visits to both a general practitioner (GP) and a specialist (SP). On average, the number of GP visits is up to 26% more (IRR = 1.26, 95% CI = 1.19-1.31) for individuals with high strain jobs compared to those in the low job strain category. Similarly, SP visits are up to 27% more (IRR = 1.27, 95% CI = 1.14-142) for the high strain category. Results are quantitatively similar for males and females, save for medium strain. In general, findings are robust to the inclusion of workplace social support, health status, provincial and occupational-fixed effects.</p> <p>Conclusion</p> <p>Job strain may be positively associated with the utilization of health care services. This suggests that improving psychosocial working conditions and educating workers on stress-coping mechanisms could be beneficial for the physical and mental health of workers.</p

Gravitational Waves From Known Pulsars: Results From The Initial Detector Era

We present the results of searches for gravitational waves from a large selection of pulsars using data from the most recent science runs (S6, VSR2 and VSR4) of the initial generation of interferometric gravitational wave detectors LIGO (Laser Interferometric Gravitational-wave Observatory) and Virgo. We do not see evidence for gravitational wave emission from any of the targeted sources but produce upper limits on the emission amplitude. We highlight the results from seven young pulsars with large spin-down luminosities. We reach within a factor of five of the canonical spin-down limit for all seven of these, whilst for the Crab and Vela pulsars we further surpass their spin-down limits. We present new or updated limits for 172 other pulsars (including both young and millisecond pulsars). Now that the detectors are undergoing major upgrades, and, for completeness, we bring together all of the most up-to-date results from all pulsars searched for during the operations of the first-generation LIGO, Virgo and GEO600 detectors. This gives a total of 195 pulsars including the most recent results described in this paper.United States National Science FoundationScience and Technology Facilities Council of the United KingdomMax-Planck-SocietyState of Niedersachsen/GermanyAustralian Research CouncilInternational Science Linkages program of the Commonwealth of AustraliaCouncil of Scientific and Industrial Research of IndiaIstituto Nazionale di Fisica Nucleare of ItalySpanish Ministerio de Economia y CompetitividadConselleria d'Economia Hisenda i Innovacio of the Govern de les Illes BalearsNetherlands Organisation for Scientific ResearchPolish Ministry of Science and Higher EducationFOCUS Programme of Foundation for Polish ScienceRoyal SocietyScottish Funding CouncilScottish Universities Physics AllianceNational Aeronautics and Space AdministrationOTKA of HungaryLyon Institute of Origins (LIO)National Research Foundation of KoreaIndustry CanadaProvince of Ontario through the Ministry of Economic Development and InnovationNational Science and Engineering Research Council CanadaCarnegie TrustLeverhulme TrustDavid and Lucile Packard FoundationResearch CorporationAlfred P. Sloan FoundationAstronom

Meta-analyses identify DNA methylation associated with kidney function and damage

Chronic kidney disease is a major public health burden. Elevated urinary albumin-to-creatinine ratio is a measure of kidney damage, and used to diagnose and stage chronic kidney disease. To extend the knowledge on regulatory mechanisms related to kidney function and disease, we conducted a blood-based epigenome-wide association study for estimated glomerular filtration rate (n = 33,605) and urinary albumin-to-creatinine ratio (n = 15,068) and detected 69 and seven CpG sites where DNA methylation was associated with the respective trait. The majority of these findings showed directionally consistent associations with the respective clinical outcomes chronic kidney disease and moderately increased albuminuria. Associations of DNA methylation with kidney function, such as CpGs at JAZF1, PELI1 and CHD2 were validated in kidney tissue. Methylation at PHRF1, LDB2, CSRNP1 and IRF5 indicated causal effects on kidney function. Enrichment analyses revealed pathways related to hemostasis and blood cell migration for estimated glomerular filtration rate, and immune cell activation and response for urinary albumin-to-creatinineratio-associated CpGs

Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases

The production of peroxide and superoxide is an inevitable consequence of aerobic metabolism, and while these particular "reactive oxygen species" (ROSs) can exhibit a number of biological effects, they are not of themselves excessively reactive and thus they are not especially damaging at physiological concentrations. However, their reactions with poorly liganded iron species can lead to the catalytic production of the very reactive and dangerous hydroxyl radical, which is exceptionally damaging, and a major cause of chronic inflammation. We review the considerable and wide-ranging evidence for the involvement of this combination of (su)peroxide and poorly liganded iron in a large number of physiological and indeed pathological processes and inflammatory disorders, especially those involving the progressive degradation of cellular and organismal performance. These diseases share a great many similarities and thus might be considered to have a common cause (i.e. iron-catalysed free radical and especially hydroxyl radical generation). The studies reviewed include those focused on a series of cardiovascular, metabolic and neurological diseases, where iron can be found at the sites of plaques and lesions, as well as studies showing the significance of iron to aging and longevity. The effective chelation of iron by natural or synthetic ligands is thus of major physiological (and potentially therapeutic) importance. As systems properties, we need to recognise that physiological observables have multiple molecular causes, and studying them in isolation leads to inconsistent patterns of apparent causality when it is the simultaneous combination of multiple factors that is responsible. This explains, for instance, the decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference

Meta-analyses identify DNA methylation associated with kidney function and damage

Chronic kidney disease is a major public health burden. Elevated urinary albumin-to-creatinine ratio is a measure of kidney damage, and used to diagnose and stage chronic kidney disease. To extend the knowledge on regulatory mechanisms related to kidney function and disease, we conducted a blood-based epigenome-wide association study for estimated glomerular filtration rate (n = 33,605) and urinary albumin-to-creatinine ratio (n = 15,068) and detected 69 and seven CpG sites where DNA methylation was associated with the respective trait. The majority of these findings showed directionally consistent associations with the respective clinical outcomes chronic kidney disease and moderately increased albuminuria. Associations of DNA methylation with kidney function, such as CpGs at JAZF1, PELI1 and CHD2 were validated in kidney tissue. Methylation at PHRF1, LDB2, CSRNP1 and IRF5 indicated causal effects on kidney function. Enrichment analyses revealed pathways related to hemostasis and blood cell migration for estimated glomerular filtration rate, and immune cell activation and response for urinary albumin-to-creatinineratio-associated CpGs.Many genetic loci have been identified to be associated with kidney disease, but the molecular mechanisms are not well understood. Here, the authors perform epigenome-wide association studies on kidney function measures to identify epigenetic marks and pathways involved in kidney function.</p

Genetic associations at 53 loci highlight cell types and biological pathways relevant for kidney function.

Reduced glomerular filtration rate defines chronic kidney disease and is associated with cardiovascular and all-cause mortality. We conducted a meta-analysis of genome-wide association studies for estimated glomerular filtration rate (eGFR), combining data across 133,413 individuals with replication in up to 42,166 individuals. We identify 24 new and confirm 29 previously identified loci. Of these 53 loci, 19 associate with eGFR among individuals with diabetes. Using bioinformatics, we show that identified genes at eGFR loci are enriched for expression in kidney tissues and in pathways relevant for kidney development and transmembrane transporter activity, kidney structure, and regulation of glucose metabolism. Chromatin state mapping and DNase I hypersensitivity analyses across adult tissues demonstrate preferential mapping of associated variants to regulatory regions in kidney but not extra-renal tissues. These findings suggest that genetic determinants of eGFR are mediated largely through direct effects within the kidney and highlight important cell types and biological pathways

Analysis of economic efficiency of decentralized versus centralized reprocessing of patients' beds and practical consequences for a maximum-care hospital

Problem: The documentation of hospital services in terms of secondary services is suboptimal. Technical hygiene is one of the secondary services of a hospital. As one aspect of technical hygiene whose realisation is currently a topic of debate, the reprocessing of beds should be analyzed under economic points of view, because up to now no thorough cost analysis exists. The following aspects should be considered: The analysis must include the legal requirements on reprocessing of beds. In addition to statements on output, i.e., on the benefit of the given procedure to the patient, the input is measured with a cost analysis to identify the procedure with the best cost:benefit ratio. Moreover, options for cost reduction based on the cost-cutting potential of a given procedure are emphasized. Additionally, in terms of bed reprocessing, continuing aspects for reducing costs should be indicated Method: The three types of reprocessing performed in Germany were analyzed: decentralized, centralized-manual, and centralized-mechanical reprocessing of beds. First, a literature search was done to determine the legal requirements. The analysis of the actual situation was based on plant-site inspections at manufacturers of reprocessing equipment, inspections in hospitals, interviews with manufacturers, operators, and persons responsible for equipment at central bed reprocessing facilities, interviews with those performing the work in and persons responsible for various management areas in the hospital. For the cost analysis, essential cost categories were examined. The cost calculation was based on the fictive description of a maximum provider. If possible, real data were used. The used prices refer to list prices without considering discounts or cash discounts. The data acquired were compared and evaluated in terms of output and input. Results and discussion: Expert opinions in medical hygiene show that each type of reprocessing leads to the necessary reprocessing result, for which the motivation of the worker performing the job is a requirement; i.e., in terms of hygienic certainty, the three processes are equivalent relative to output. The essential cost categories are construction, investment, service and maintenance, material, operating resources, personnel costs, and bed-transport costs; however, every type of reprocessing causes different cost categories. In Germany, bed reprocessing is chiefly performed by the janitorial, delivery, and nursing professions. In each of the three processes examined, personnel costs make up the largest share of the total cost of reprocessing (up to 89%). In terms of bed reprocessing at a central facility, the personnel resources spent on round-trip bed transport are decisive. Relative to the centralized-mechanical processing, operating resources must be considered in addition to personnel costs as decisive for the total expenses (up to 42%). With regard to cutting costs, personnel and operating resources hold the greatest potential. The former can be reduced by selecting the right trade guild for the job. With identical reprocessing results, the costs for the central-manual or -machine reprocessing are greater than those of decentralized bed processing by about 2.9 and 4.5 times, respectively. Conclusion: Costs for bed reprocessing are incurred for every hospitalization, meaning they are considerable. As a typical secondary service in technical hygiene, bed reprocessing has a great cost-cutting potential. In terms of both economics and medical hygiene, decentralized bed reprocessing has been shown to be suitable. Because personnel costs make up the greatest percentage of the total costs - independent of reprocessing method - potential savings of 61% result if the most cost-effective trade guild, janitorial services, performs the work, given clear guidelines on the risk classification of the bed after patient release or transfer and the concomittant requirements for bed reprocessing.Problemstellung: Der Ausweis von Krankenhausleistungen in Bezug auf Sekundärleistungen ist suboptimal. Zur Sekundärleistung eines Krankenhauses zählt die technische Hygiene. Als eine in ihrer Lösung unterschiedlich diskutierte Aufgabenstellung der technischen Hygiene sollte die Bettenaufbereitung unter ökonomischen Gesichtspunkten analysiert werden, da hierzu keine umfangreiche Kostenerhebung in der Literatur existiert. Dabei sollten folgende Aspekte berücksichtigt werden. 1. Die Untersuchungen mussten die Anforderungen seitens des Gesetzgebers an die Hygieneleistungen im Krankenhaus berücksichtigen. Neben Aussagen zum Output, d.h. zum Nutzen des jeweiligen Verfahrens für die Patienten, wird der Input über eine Kostenanalyse gemessen, um das Verfahren mit der besten Kosten-Nutzen-Relation zu identifizieren. 2. Daneben werden Optionen zur Kostenreduzierung auf Basis der Kostensenkungspotenziale der jeweiligen Verfahren verdeutlicht. 3. Zudem sollen im Zusammenhang mit der Bettenaufbereitung weiterführende Aspekte zur Kostenreduzierung aufgezeigt werden. Methode: Es wurden die drei in Deutschland angewendeten Verfahren zur Bettenaufbereitung analysiert, die dezentrale, die zentral-manuelle und die zentral-maschinelle Bettenaufbereitung. Zunächst erfolgte die Literaturrecherche, um anhand der gesetzlichen Auflagen das Soll zu ermitteln. Die Ist-Erhebung stützt sich jeweils auf Betriebsstättenbesichtigungen bei Herstellern von Aufbereitungsanlagen, Begehungen in Krankenhäusern, Interviews mit Herstellern, Betreibern und Verantwortlichen von Bettenaufbereitungsanlagen in Bettenzentralen, Interviews mit Ausführenden und Verantwortlichen diverser Managementbereiche im Krankenhaus. Für die Kostenanalyse wurden die wesentlichen Kostenarten untersucht. Die Kostenkalkulation basiert auf der fiktiven Beschreibung eines Maximalversorgers. Soweit möglich, kamen Echtdaten zum Ansatz. Die verwendeten Preise beziehen sich auf Listenpreise, ohne Rabatte und Skonti zu berücksichtigen. Das recherchierte Datenmaterial wurde in Bezug auf Output und Input vergleichend gegenübergestellt und bewertet. Ergebnisse und Diskussion: Hygienisch-medizinischen Expertisen kann entnommen werden, dass jede Aufbereitungsform zum notwendigen Aufbereitungsergebnis führt, wofür die Motivation der Ausführenden eine Grundvoraussetzung darstellt, d.h. bezüglich der hygienischen Sicherheit sind die drei Verfahren als gleichwertig anzuordnen. Die wesentlichen Kostenarten sind Bau-, Investitions-, Wartungs- und Instandhaltungs-, Material-, Betriebsmittel-, Personalkosten sowie Kosten durch Bettentransporte, wobei jede Aufbereitungsform unterschiedliche Kostenarten verursacht. Die Bettenaufbereitung erfolgt in Deutschland vornehmlich durch die Berufsgruppen Reinigungs-, Hol- und Bring- sowie Pflegedienst. Bei den drei untersuchten Verfahren machen die Personalkosten jeweils den größten Anteil an den Gesamtkosten der Aufbereitungsprozesse aus (bis zu 89%). Hinsichtlich der Aufbereitung der Betten in einer Bettenzentrale sind die für den Hin- und Rücktransport der Betten verbrauchten Personalressourcen respektive -kosten maßgeblich. In Bezug auf die zentral-maschinelle Aufbereitung müssen die Kosten für Betriebsmittel neben den Personalkosten als bestimmend für die Gesamtkosten angesehen werden (bis zu 42%). Hinsichtlich der Kostensenkung bieten die Personal- und Betriebsmittelkosten die größten Potenziale. Erstere können durch die Wahl der für die Tätigkeit verantwortlichen Berufsgruppe reduziert werden. Bei identischen Aufbereitungsergebnissen betragen die Kosten für die zentral-manuelle bzw. -maschinelle Aufbereitung im Vergleich zur dezentralen Bettenaufbereitung das rund 2,9- bzw. 4,5fache. Schlussfolgerungen: Die Kosten für die Bettenaufbereitung fallen für jeden Krankenhausfall an. Damit sind sie nicht vernachlässigbar. Die Bettenaufbereitung ermöglicht als typische Sekundärleistung auf dem Gebiet der technischen Hygiene große Kostensenkungspotenziale. Als unter ökonomischen und hygienisch-medizinischen Gesichtspunkten geeignetes Verfahren hat sich die dezentrale Bettenaufbereitung gezeigt. Da Personalkosten unabhängig vom Aufbereitungsverfahren den prozentual größten Anteil an den Gesamtkosten des Aufbereitungsprozesses darstellen, ergibt sich durch Einsatz der kostengünstigsten Berufsgruppe, dem Reinigungsdienst, in Verbindung mit klaren Vorgaben zur Risikoeinstufung des Betts nach Patientenentlassung oder -verlegung und der damit verbundenen Anforderungen an die Bettenaufbereitung ein Einsparpotential um bis zu 61%