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Background and objectivesThe evidence base on health services use and cost burdens associated with transition to severe cognitive impairment (SCI) and dementia is underdeveloped. We examine how the change in cognitive impairment status influences nursing home use, hospitalizations, and out-of-pocket (OOP) expenditures.Research design and methodsWe use prospective data from the Health and Retirement Study (2007/2008-2015/2016) on adults 70 years and older meeting research criteria for cognitive impairment not dementia (CIND) at baseline (unweighted n = 1,692) to fit 2-part models testing how reversion to normal cognition, stability (CIND maintenance), and transition into SCI/dementia influence change in yearly nursing home use, hospitalizations, and OOP expenditures.ResultsOver 8 years, 5.9% reverted, 15.9% remained CIND, 14.9% transitioned to SCI/dementia, and 63.3% died. We observed substantial increases in the propensity of any nursing home use which were particularly pronounced among those who transitioned or died during follow-up and similar but less pronounced differences in patterns of inpatient hospitalizations. Average baseline OOP spending was similar among reverters ($1156 [95% confidence interval = 832-1,479]), maintainers ($1,145 [993-1,296]), and transitioners ($1,385 [1,041-1,730]). Individuals who died during follow-up spent $2,529 (2,101-2,957). By the eighth year of follow-up, spending among reverters increased to $1,402 (869-1,934) and $2,188 (1,402-2,974) and $8,988 (5,820-12,157) for maintainers and transitioners, respectively. Average spending at the wave preceding death was $7,719 (4,345-11,094). Estimates were only partly attenuated through adjustment to covariables.Discussion and implicationsA better understanding of variations in health services use and cost burdens among individuals with mild cognitive impairment can help guide targeted care and financial planning.

El presente estudio tiene como objetivo explorar la asociación entre discriminación laboral y salud en Andalucía (España). Este estudio se basa en una muestra de 1200 individuos. El indicador de discriminación laboral fue diseñado a través de una pregunta abierta que se refería a otros tipos de discriminación. Aunque la categoría discriminación laboral no se incluyó inicialmente en el cuestionario, el 65% de los participantes se consideraron sujetos a discriminación laboral mientras que solo el 35% informaron otras causas habituales de discriminación. Las medidas de propensión muestran que las personas que reportan discriminación laboral presentan un mayor uso de servicios de salud primaria, un resultado que podría estar relacionado con la mayor prevalencia de trastornos depresivos en grupos socioeconómicamente desfavorecidos. Aunque se necesita profundizar en esta materia, la orientación futura de las políticas sociales y de salud de la UE deberían incluir como objetivo la reducción del impacto social del desempleo y la precariedad laboral a fin de reducir la discriminación y promover la equidad en salud., The present study aims to explore the association between employment discrimination and health in Andalusia (Spain). This study is based on a sample of 1200 individuals. The employment discrimination indicator was designed is through the results of an open-ended question that refers to other types of discrimination. Although the category ‘employment discrimination’ were not initially included in the questionnaire, 65% of participants perceived themselves as subject to employment discrimination while only 35% reported other usual causes of discrimination. Employment discrimination has been found similarly associated to poor health outcomes. Propensity scores show people reporting employment discrimination present a higher use of primary health services, a result that might be related with the higher prevalence of depressive disorders of socioeconomically disadvantaged groups. Although additional research is needed, the future orientation of EU social and health policies should aim to reduce the social impact of unemployment and insecure jobs in order to reduce discrimination and promote health equity., Fundación Pública Centro de Estudios Andaluces, Depto. de Sociología: Metodología y Teoría, Fac. de Ciencias Políticas y Sociología, TRUE, pub

El presente estudio tiene como objetivo explorar la asociación entre discriminación laboral y salud en Andalucía (España). Este estudio se basa en una muestra de 1200 individuos. El indicador de discriminación laboral fue diseñado a través de una pregunta abierta que se refería a otros tipos de discriminación. Aunque la categoría discriminación laboral no se incluyó inicialmente en el cuestionario, el 65% de los participantes se consideraron sujetos a discriminación laboral mientras que solo el 35% informaron otras causas habituales de discriminación. Las medidas de propensión muestran que las personas que reportan discriminación laboral presentan un mayor uso de servicios de salud primaria, un resultado que podría estar relacionado con la mayor prevalencia de trastornos depresivos en grupos socioeconómicamente desfavorecidos. Aunque se necesita profundizar en esta materia, la orientación futura de las políticas sociales y de salud de la UE deberían incluir como objetivo la reducción del impacto social del desempleo y la precariedad laboral a fin de reducir la discriminación y promover la equidad en salud., The present study aims to explore the association between employment discrimination and health in Andalusia (Spain). This study is based on a sample of 1200 individuals. The employment discrimination indicator was designed is through the results of an open-ended question that refers to other types of discrimination. Although the category ‘employment discrimination’ were not initially included in the questionnaire, 65% of participants perceived themselves as subject to employment discrimination while only 35% reported other usual causes of discrimination. Employment discrimination has been found similarly associated to poor health outcomes. Propensity scores show people reporting employment discrimination present a higher use of primary health services, a result that might be related with the higher prevalence of depressive disorders of socioeconomically disadvantaged groups. Although additional research is needed, the future orientation of EU social and health policies should aim to reduce the social impact of unemployment and insecure jobs in order to reduce discrimination and promote health equity., Fundación Pública Centro de Estudios Andaluces, Depto. de Sociología: Metodología y Teoría, Fac. de Ciencias Políticas y Sociología, TRUE, pub

Purpose: The objective of this study was to investigate the effect of a local promotional campaign on preconceptional lifestyle changes and the use of preconception care (PCC). Material and methods: This quasi-comparative study was carried out between February 2015 and February 2016 at a community midwifery practice in the Netherlands. The intervention consisted of a dual track approach (i) a promotional campaign for couples who wish to conceive and (ii) a PCC pathway for health care providers. Questionnaires were collected from a sample of women who received antenatal care during the pre-intervention (n = 283) and post-intervention (n = 257) period. Main outcome measures were preconceptional lifestyle changes and PCC use (defined as searching for information and/or consulting a health care provider). Results: Women who were exposed to the intervention were significantly more likely to make at least one lifestyle change during the preconception period [adjusted OR 1.56 (95% CI 1.02–2.39)]. Women were especially more likely to preconceptionally reduce or quit [adjusted OR 1.72 (95% CI 1.05–2.83)] their alcohol consumption after exposure to the intervention. Although non-significant, it appeared that women who were exposed to the intervention more often prepared themselves for pregnancy by means of independently searching for preconception health information [adjusted OR 1.13 (95% CI 0.77–1.65)] or consulting a health care provider regarding their wish to conceive [adjusted OR 1.24 (95% CI 0.81–1.92)]. Conclusions: Exposure to a local promotional campaign targeted at preconceptional health was associated with improved preconceptional lifestyle behaviours, especially with regard to alcohol consumption, and has the potential to improve the use of PCC.

Older people with complex health issues and needs for functional support are increasingly living in different types of residential care environments as alternatives to nursing homes. This study aims to compare the demographics and health-care expenditures of Medicare beneficiaries by the setting in which they live: nursing homes, residential care settings, and at home using data from the 2002 to 2010 Medicare Current Beneficiary Study (MCBS), a nationally representative survey of the Medicare population. All Medicare beneficiaries aged 65 years or older who participated in the fall MCBS interview (years 2002-2010) and were alive for the full year (N = 83,507) were included in the sample. We found that there is a gradient in health status, physical and cognitive functioning, and health-care use and spending across settings. Minority elderly are overrepresented in facilities and underrepresented in alternative living settings.

Older people with complex health issues and needs for functional support are increasingly living in different types of residential care environments as alternatives to nursing homes. This study aims to compare the demographics and health-care expenditures of Medicare beneficiaries by the setting in which they live: nursing homes, residential care settings, and at home using data from the 2002 to 2010 Medicare Current Beneficiary Study (MCBS), a nationally representative survey of the Medicare population. All Medicare beneficiaries aged 65 years or older who participated in the fall MCBS interview (years 2002-2010) and were alive for the full year (N = 83,507) were included in the sample. We found that there is a gradient in health status, physical and cognitive functioning, and health-care use and spending across settings. Minority elderly are overrepresented in facilities and underrepresented in alternative living settings.

Background: Self-rated health is a subjective measure that has been related to indicators such as mortality, morbidity, functional capacity, and the use of health services. In Spain, there are few longitudinal studies associating self-rated health with hospital services use. The purpose of this study is to analyze the association between self-rated health and socioeconomic, demographic, and health variables, and the use of hospital services among the general population in the Region of Valencia, Spain. Methods: Longitudinal study of 5,275 adults who were included in the 2005 Region of Valencia Health Survey and linked to the Minimum Hospital Data Set between 2006 and 2009. Logistic regression models were used to calculate the odds ratios between use of hospital services and self-rated health, sex, age, educational level, employment status, income, country of birth, chronic conditions, disability and previous use of hospital services. Results: By the end of a 4-year follow-up period, 1,184 participants (22.4 %) had used hospital services. Use of hospital services was associated with poor self-rated health among both men and women. In men, it was also associated with unemployment, low income, and the presence of a chronic disease. In women, it was associated with low educational level, the presence of a disability, previous hospital services use, and the presence of chronic disease. Interactions were detected between self-rated health and chronic disease in men and between self-rated health and educational level in women. Conclusions: Self-rated health acts as a predictor of hospital services use. Various health and socioeconomic variables provide additional predictive capacity. Interactions were detected between self-rated health and other variables that may reflect different complex predictive models, by gender.

Background: Self-rated health is a subjective measure that has been related to indicators such as mortality, morbidity, functional capacity, and the use of health services. In Spain, there are few longitudinal studies associating self-rated health with hospital services use. The purpose of this study is to analyze the association between self-rated health and socioeconomic, demographic, and health variables, and the use of hospital services among the general population in the Region of Valencia, Spain. Methods: Longitudinal study of 5,275 adults who were included in the 2005 Region of Valencia Health Survey and linked to the Minimum Hospital Data Set between 2006 and 2009. Logistic regression models were used to calculate the odds ratios between use of hospital services and self-rated health, sex, age, educational level, employment status, income, country of birth, chronic conditions, disability and previous use of hospital services. Results: By the end of a 4-year follow-up period, 1,184 participants (22.4 %) had used hospital services. Use of hospital services was associated with poor self-rated health among both men and women. In men, it was also associated with unemployment, low income, and the presence of a chronic disease. In women, it was associated with low educational level, the presence of a disability, previous hospital services use, and the presence of chronic disease. Interactions were detected between self-rated health and chronic disease in men and between self-rated health and educational level in women. Conclusions: Self-rated health acts as a predictor of hospital services use. Various health and socioeconomic variables provide additional predictive capacity. Interactions were detected between self-rated health and other variables that may reflect different complex predictive models, by gender.

Studies on the socioeconomic impact of fibromyalgia (FM) have shown the high health services use done by these patients. These data indicate the challenge of dealing with these people, their treatment and rehabilitation, as well as the need of changes in actions and implementation of cost-effective approaches. In this study we reviewed the literature on the health care use behavior in FM. The data shows that the emotional state and catastrophizing are relevant factors in the onset of seeking health care, and within the system, higher self-efficacy, attributions of symptoms to external factors, the perception of good health and lower comorbidity is associated with less use., Estudios sobre el impacto socioeconómico de la Fibromialgia (FM) han evidenciado el alto uso de los servicios sanitarios por parte de estos pacientes. Estos datos expresan el reto que supone el abordaje de estas personas, su tratamient o y rehabilitación, y la necesidad de cambios de actuación coste-efectivas. En este estudio revisamos la literatura existente sobre la conducta de uso de servicios médicos en la FM. Los datos muestran que el estado emocional y el catastrofismo son factores relevantes en el inicio de la búsqueda de asistencia sanitaria; dentro del sistema, mayor autoeficacia, la atribución de los síntomas a factores externos, la percepción de un buen estado de salud y la menor comorbilidad se asocia a un menor uso del mismo .