Pollen is known to cause allergic reactions and affect cognitive performance in around 20% of the population. Although pollen season peaks when students take high-stakes exams, the effect of pollen allergies on school performance has received nearly no attention from economists. Using a student fixed effects model and administrative Norwegian data, this paper finds that increasing the ambient pollen levels by one standard deviation at the mean leads to a 2.5% standard deviation decrease in test scores, with potentially larger effects for allergic students. There also appear to be longer-run effects. The findings imply that random increases in pollen counts reduce test scores for allergic students relative to their peers, who consequently will be at a disadvantage when competing for jobs or higher education. This paper contributes to the literature by illuminating the interplay between individual health and human capital accumulation, which in turn can impact long-run economic growth.
Recent research shows an increased concern with well-being at school and potential problems associated with students' use of socio-digital technologies, i.e., the mobile devices, computers, social media, and the Internet. Simultaneously with supporting creative social activities, socio-digital participation may also lead to compulsive and addictive behavioral patterns affecting both general and school-related mental health problems. Using two longitudinal data waves gathered among 1702 (53 % female) early (age 12-14) and 1636 (64 % female) late (age 16-18) Finnish adolescents, we examined cross-lagged paths between excessive internet use, school engagement and burnout, and depressive symptoms. Structural equation modeling revealed reciprocal cross-lagged paths between excessive internet use and school burnout among both adolescent groups: school burnout predicted later excessive internet use and excessive internet use predicted later school burnout. Reciprocal paths between school burnout and depressive symptoms were also found. Girls typically suffered more than boys from depressive symptoms and, in late adolescence, school burnout. Boys, in turn, more typically suffered from excessive internet use. These results show that, among adolescents, excessive internet use can be a cause of school burnout that can later spill over to depressive symptoms.
Cites: Dev Psychol. 2008 Jan;44(1):195-204 PMID 18194017
Health Economics & Management, Institute of Economic Research, Lund University, Box 117, 22100, Sweden; Health Economics Unit, Department of Clinical Sciences, Medicon Village, Lund University, Lund, Sweden. Electronic address: Gawain.firstname.lastname@example.org.
We introduce a general decomposition method applicable to all forms of bivariate rank dependent indices of socioeconomic inequality in health, including the concentration index. The technique is based on recentered influence function regression and requires only the application of OLS to a transformed variable with similar interpretation. Our method requires few identifying assumptions to yield valid estimates in most common empirical applications, unlike current methods favoured in the literature. Using the Swedish Twin Registry and a within twin pair fixed effects identification strategy, our new method finds no evidence of a causal effect of education on income-related health inequality.
Large-scale assessments are valuable in identifying primary factors controlling total mercury (THg) and monomethyl mercury (MeHg) concentrations, and distribution in aquatic ecosystems. Bed sediment THg and MeHg concentrations were compiled for >16,000 samples collected from aquatic habitats throughout the West between 1965 and 2013. The influence of aquatic feature type (canals, estuaries, lakes, and streams), and environmental setting (agriculture, forest, open-water, range, wetland, and urban) on THg and MeHg concentrations was examined. THg concentrations were highest in lake (29.3±6.5µgkg(-1)) and canal (28.6±6.9µgkg(-1)) sites, and lowest in stream (20.7±4.6µgkg(-1)) and estuarine (23.6±5.6µgkg(-1)) sites, which was partially a result of differences in grain size related to hydrologic gradients. By environmental setting, open-water (36.8±2.2µgkg(-1)) and forested (32.0±2.7µgkg(-1)) sites generally had the highest THg concentrations, followed by wetland sites (28.9±1.7µgkg(-1)), rangeland (25.5±1.5µgkg(-1)), agriculture (23.4±2.0µgkg(-1)), and urban (22.7±2.1µgkg(-1)) sites. MeHg concentrations also were highest in lakes (0.55±0.05µgkg(-1)) and canals (0.54±0.11µgkg(-1)), but, in contrast to THg, MeHg concentrations were lowest in open-water sites (0.22±0.03µgkg(-1)). The median percent MeHg (relative to THg) for the western region was 0.7%, indicating an overall low methylation efficiency; however, a significant subset of data (n>100) had percentages that represent elevated methylation efficiency (>6%). MeHg concentrations were weakly correlated with THg (r(2)=0.25) across western North America. Overall, these results highlight the large spatial variability in sediment THg and MeHg concentrations throughout western North America and underscore the important roles that landscape and land-use characteristics have on the MeHg cycle.
The aim of the present study was to gain a deeper understanding of eldercare users' strategies for dealing with problems in the quality of care and care satisfaction in relation to home help services. Based on earlier research and evaluations, it was assumed that users would express satisfaction and gratitude, and also be unwilling to complain. The specific research questions were: (i) What, if any, quality of care problems do the users mention? (ii) How do the users explain the reasons for these problems? and (iii) What strategies do the users employ to deal with these problems? A total of 35 interviews were conducted in November 2013 with 15 men and 20 women (66-92 years). The data were analysed using thematic and qualitative content analysis. The results showed that almost all users expressed overall satisfaction with their care. However, all but one also mentioned problems. The users stated very clearly and explicitly the reasons for these problems, and in most cases, they referred to the work conditions, work organisation and lack of other resources in the eldercare organisation. Two strategies were commonly used to deal with these problems: trivialisation and adaptation. A third strategy was expressed dissatisfaction, where the problem led to actions or plans to take action. One interpretation of the findings is that what is actually measured in official quality assessments and follow-ups may be care users' understanding of the work conditions and work organisation of eldercare. The understanding attitude may prevent care users from complaining because it lowers their expectations.
Healthcare policies often state that complex conditions are to be treated outside hospital in various forms of public-private partnership. Chronic obstructive pulmonary disease (COPD) is a progressive illness that includes episodes of serious acute exacerbations characterised by extreme breathlessness. There is limited knowledge about COPD exacerbations from the perspective of family caregivers and implications of the changing boundary between hospital care and care at home. In this paper, we explore how caregivers negotiate their role as caregivers with patients and healthcare professionals during acute exacerbations. We conducted 10 qualitative interviews with family caregivers of COPD patients in 2011, all were spouses over the age of 60. The participants were recruited through the patient pool of ambulatory pulmonary services of two hospitals in Oslo, Norway. Data were interpreted using thematic analysis. The caregivers described a lack of understanding and support from health professionals in some situations. They shouldered considerable responsibility, but were not always acknowledged as competent carers by professionals. Caregivers had to balance their involvement. They noted that they could lose the professionals' co-operation if their involvement was perceived as interfering or preventing the professionals from exercising their expertise. However, by not sharing their personalised knowledge about the patients, they risked that the professionals would not understand the severity of the exacerbation, which could undermine their own ability to maintain a sense of safety and control. The negotiations caregivers participated in and the uncertainty they experienced shed new light on the complexity of their role, and the discrepancy between practice and ideals in healthcare policy regarding collaboration of care. It is crucial to develop further knowledge about structural, interactional and communicational facilitators and barriers for reaching shared understandings and facilitating mutual trust in these demanding situations.
To determine which self-management factors and psychosocial work factors were associated with disclosing diabetes to colleagues, line managers and occupational health personnel among workers with Type 1 diabetes.
A total of 767 working-aged respondents with Type 1 diabetes completed a Finnish cross-sectional survey named 'People with Type 1 Diabetes in Worklife'. Factor analysis was carried out, followed by logistic regressions to estimate the associations between self-management factors, psychosocial work factors and the likelihood of disclosure separately to colleagues, line managers and occupational health personnel. The models were adjusted for sociodemographic, diabetes-related and work-related variables.
A total of 52% of the respondents had disclosed their diabetes to their colleagues, 45% to occupational health personnel and 28% to their line manager. Receiving social support and having good psychosocial work ability were significantly associated with disclosure to colleagues, line managers and occupational health personnel. Relations at work were associated with disclosure to colleagues and the line manager. Furthermore, opportunity to self-manage diabetes at work was associated with disclosure to colleagues.
Line managers and colleagues have a remarkable role to play in providing workplace support to workers with Type 1 diabetes. Disclosure of Type 1 diabetes should be encouraged as line managers can provide workers with the right support, implement work adaptations and facilitate job retention. As only half of respondents disclosed their Type 1 diabetes at work, further research is required into the reasons for and consequences of not disclosing a diagnosis.
The purpose of this study was to examine the association between diabetes with or without other comorbid somatic diseases and depression and anxiety, and to explore the mediating role of sense of mastery and social support.
Data were obtained from a cross-sectional health survey conducted in Norway (n=6827). People with diabetes alone or with simultaneous comorbid somatic diseases were compared to a group with no known somatic diseases.
Among people with diabetes alone, 16.3% reported having depression and anxiety. Having diabetes was associated with 3 times greater odds for anxiety compared to the control group, and 2 times greater odds for depression. Among individuals with diabetes and comorbid somatic diseases, 17.4% reported depression and 11.6% reported symptoms of anxiety. The odds for both were approximately 2 times greater than in the control group. Sense of mastery, but not social support, protected against depression in both groups and against anxiety in the diabetes with comorbidity group.
Comorbidity between diabetes and other somatic diseases seems to be related to depression to a larger degree, whereas having diabetes alone relates more to anxiety. This can possibly be explained by the overall burden in the comorbidity group and the related absence of sense of mastery.
The present study sought to compare 4 groups of age- and gender-matched children-(a) those reared in institutions for children without parental care in Russia; (b) those raised by their biological parents in Russia; (c) those adopted to the United States from Russian institutions; and (d) those born in the United States and raised by their biological parents-on indicators of cognition, language, and early learning. In addition, we aimed to compare the effects of the length of time spent in an institution, the age of initial placement in an institution, the age at adoption, and pre-institutional risk factors (i.e., prenatal substance exposure and prematurity and low birth weight) on the above-mentioned outcomes in the 2 groups of children with institutionalization experiences. Our results confirm previous reports demonstrating negative consequences of institutionalization and substantial ameliorating effects of adoption. They also underscore the complexity of the effects of institutionalization and adoption, showing that they are intertwined with the effects of pre-institutional risk factors. (PsycINFO Database Record
Recent health care consolidation trends raise the important policy question whether improved emergency medical services and enhanced productivity can offset adverse quality effects from decreased access. This paper empirically analyzes how geographical distance from an emergency hospital affects the probability of surviving an acute myocardial infarction (AMI), accounting for health-based spatial sorting and data limitations on out-of-hospital mortality. Exploiting policy-induced variation in hospital distance derived from emergency hospital closures and detailed Swedish mortality data over two decades, results show a drastically decreasing probability of surviving an AMI as residential distance from a hospital increases one year after a closure occurred. The effect disappears in subsequent years, however, suggesting that involved agents quickly adapted to the new environment.
To compare metabolic control between males and females with type 1 diabetes during adolescence and as young adults, and relate it to microvascular complications.
Data concerning 4000 adolescents with type 1 diabetes registered in the Swedish paediatric diabetes quality registry, and above the age of 18years in the Swedish National Diabetes Registry was used.
When dividing HbA1c values in three groups; 9.3% (78mmol/mol), there was a higher proportion of females in the highest group during adolescence. In the group with the highest HbA1c values during adolescence and as adults, 51.7% were females, expected value 46.2%; in the group with low HbA1c values in both registries, 34.2% were females, p
To determine the mortality rate in a Danish cohort of children and adolescents diagnosed with Type 1 diabetes mellitus compared with the general population.
In 1987 and 1989 we included 884 children and 1020 adolescents aged 20 years and under, corresponding to 75% of all Danish children and adolescents with Type 1 diabetes, in two nationwide studies in Denmark. Those who had participated in both investigations (n = 720) were followed until 1 January 2014, using the Danish Civil Registration System on death certificates and emigration. We derived the expected number of deaths in the cohort, using population data values from Statistics Denmark to calculate the standardized mortality ratio. Survival analysis was performed using Cox proportional hazards model.
During the 24 years of follow-up, 49 (6.8%) patients died, resulting in a standardized mortality ratio of 4.8 (95% confidence interval 3.5, 6.2) compared with the age-standardized general population. A 1% increase in baseline HbA1c (1989), available in 718 of 720 patients, was associated with all-cause mortality (hazard ratio = 1.38; 95% confidence interval 1.2, 1.6; P
To assess the causes of death and cause-specific standardized mortality ratios in two nationwide, population-based cohorts diagnosed with Type 1 diabetes during the periods 1973-1982 and 1989-2012, and to evaluate changes in causes of death during the follow-up period.
It is a central feature of current Norwegian health and social care policy to see informal carers as active partners. However, research has revealed that carers often experience a lack of recognition by professionals. In 2010, the Norwegian Directorate of Health initiated a web-based competence-building programme (CBP) for health and social care practitioners aimed at facilitating collaboration with carers. The programme comprised case presentations, e-lectures, exercises and topics for discussion, and was introduced in 2012. It was flexible and free of charge. This article is based on a study (2012-2013) that followed the piloting of this CBP in four settings. The study aimed to explore factors that influenced the implementation of the programme and whether or not using it affected health and social care practitioners' attitudes and perceived capacity for collaboration with carers. The study employed a mixed-methods design. A questionnaire was distributed to all staff before and 5 months after the CBP was introduced, followed by focus group interviews with a sample of staff members and individual interviews with the leadership in the involved settings and those who introduced the programme. The quantitative data were analysed using descriptive statistics, which subsequently formed the basis for the focus group interviews. The qualitative data were analysed by means of content analysis. The programme's introduction was similar across all research settings. Nevertheless, whether or not it was adopted depended to a large extent on leadership commitment and engagement. In settings where the programme's use was monitored, supported by management and formed part of on-the-job training, there seemed to be a positive impact on staff attitudes concerning collaboration with carers. Participant staff reported that their awareness of, motivation for and confidence in collaboration with carers were all strengthened. In contrast, the programme was of minimal benefit in settings with low leadership engagement.
Purpose This research analysed general pain intensity, hand pain at rest and hand pain during activity in women and men in early rheumatoid arhtritis (RA). Method Out of the 454 patients that were recruited into the Swedish early RA project "TIRA" the 373 patients (67% women) that remained at 12 months follow-up are reported here. Disease activity 28 joint score (DAS-28), disability (Health Assessment Questionnaire?=?HAQ) and pain (VAS) were recorded at inclusion and after 3 (M3), 6 (M6) and 12 (M12) months. General pain, hand pain during rest, hand pain during test of grip force as assessed by Grippit™, prescribed disease-modifying anti-inflammatory drugs (DMARDs) and hand dominance were recorded. Results DAS-28 and HAQ scores were high at inclusion and improved thereafter in both women and men. There were no significant differences between sexes at inclusion but women had higher DAS-28 and HAQ at all follow-ups. Women were more often prescribed DMARDs than were men. In both women and men all pain types were significantly lower at follow-up compared to at inclusion and women reported higher pain than men at follow-ups. The pain types differed significantly from each other at inclusion into TIRA, general pain was highest and hand pain during rest was lowest. There were no significant differences in hand pain related to hand dominance or between right and left hands. Conclusions Disease activity, disability and pain were high at inclusion and reduced over the first year. Despite more DMARDs prescribed in women than in men, women were more affected than were men. General pain was highest and not surprisingly hand pain during active grip testing was higher than hand pain during rest that was lowest in both sexes. Although our cohort was well controlled, it was evident that hand pain remains a problem. This has implications for rehabilitation and suggests potential ongoing activity limitations that should continue to receive attention from a multi-professional team. Implications for Rehabilitation General pain and hand pain remain a problem in RA despite today's early intervention and effective disease control with new era biologics. The extent of hand pain evidenced in our work gives a more detailed and comprehensive account of pain status. Higher hand pain during active grip testing than that during rest indicates a potential relationship to ongoing activity limitation. Hand pain assessment can help guiding multi-professional interventions directed to reduce hand pain and thereby probably reduce activity limitations.
Adult Ixodes persulcatus were collected in highly populated districts in Irkutsk city, Russia, and in popular recreational and professional areas in its neighboring territories. Borrelia miyamotoi infection in I. persulcatus was examined using multiplex Taqman-PCR targeting 16S rDNA, and nested PCR and sequencing analyses targeting flaB and 16S rDNA. B. miyamotoi and Lyme disease Borrelia species were detected in 13 (infection rate, 2.9%) and 77 (17.3%) out of 445 I. persulcatus ticks, respectively, collected from 4 sites around the Baikal Lake. The 16S rDNA and flaB sequences of these amplicons were closely related to those of B. miyamotoi detected and/or isolated from I. persulcatus in Japan and Far Eastern Russia, and clustered separately from those of Europe and North America. These results indicate that additional surveillance for B. miyamotoi infection is needed in order to determine how it affects human health in Irkutsk City and its neighboring territories.
Review on the problem of sanitary-epidemiological welfare of the population in the Siberian Federal District (SFD) was conducted based on literature data and authors own research in the period of 2002-2014. Authors provided broad information on the health and demographic and epidemiological characteristics of SFD population. SFD in comparison with other regions of the Russian Federation overcomes one of the most adverse situations including mortality rates from external causes. SFD population’s infectious and somatic morbidity rates were analyzed. Analysis demonstrated that the situation relating to priority epidemiologically and socially important infections (HIV-infection, parenteral viral hepatitis, tuberculosis etc.) on the territory of the SFD remains tense. Authors provided information on the increase in the level of the actual for Siberian regions natural-foci tick-borne infections. Detailed analysis for the environment anthropogenic pollution impact for the epidemic, infectious and vaccine induced processes. Authors suggest that anthropogenic (biological) environmental pollution is one of the most important factors influencing the epidemiological welfare of the Siberian population. A new strategic direction in epidemiological research associated with the problem of comorbid diseases is planned.
The quality of pediatric healthcare is a cornerstone for good maternal and infant health.
To evaluate the quality of healthcare in secondary and tertiary regional pediatric hospitals in the Russian Federation.
Healthcare quality assessment was performed in 21 pediatric hospitals (tertiary, n=5; secondary, n=16) of four regions. The WHO recommendations were used.
In all regions, similar traits of inpatient pediatric healthcare determining a poor quality were observed. These included low preparedness for emergent care at admission departments; a high rate of unjustified hospitalization due to lack of clear indications for inpatient care; a widespread polypharmacy and unnecessary painful procedures and treatment; inadequate unjustified antimicrobial and parenteral therapy.
The revealed identity of problems in different regions of the country allows to consider a common strategy to overcome them, which, obviously, should primarily involve education of medical personnel, restructuring of hospital beds to increase day care beds, increasing the clinical expert work in hospitals.