Variations in healthcare utilization for mental health problems prior to suicide by socioeconomic status: a Norwegian register-based population study.

BACKGROUND: Suicide poses a major public health challenge, claiming around 650 lives annually in Norway. There is limited understanding of mental healthcare utilization patterns preceding suicide, particularly relating to socioeconomic status (SES). This study analyzes mental health service use among Norwegian citizens aged 20-64 from 2009 to 2021, emphasizing disparities related to SES. METHODS: This is a population-wide registry-based study. We include mental health consultations with both primary and specialist healthcare services, and investigate patterns of service use regarding educational attainment, employment status and income and compare this to the population in general. All suicides in the period (N = 4731) are included in the study. The aim is to investigate potential discrepancies in service use the year and month preceding suicide, seeking to enhance targeted preventive interventions. RESULTS: Our results show significant variations in healthcare use for mental health problems the last year preceding suicide, according to the components of SES, for both men and women. Those with higher education utilize the mental healthcare services prior to suicide to a higher degree than men and women with high school education or less, whereas employed men and men with high income level have significantly lower mental healthcare usage prior to suicide both the last year and month compared to the non-employed men and men with low-income level. Employed women also had a lower mental healthcare usage, whereas the results regarding income are not significant for women. CONCLUSION: Mental healthcare use prior to suicide varies across the SES components. Notably, the SES groups exhibit heterogeneity, with gendered patterns. Targeted interventions for low consultation rates among employed men, and men with high income and lower education are needed, while women, and men in at-risk groups, such as the non-employed and those with low income, demonstrate higher mental healthcare utilization, warranting comprehensive suicide prevention measures.

Variability in Reproductive Choices: A Comprehensive Analysis of Women's Working Status and Fertility Behavior in Pakistan.

The relationship between women's working status and fertility behavior has been a topic of interest for researchers and policymakers. The societal shifts over time, particularly the increasing participation of women in the workforce, have transformed traditional roles. Women, once primarily perceived as caregivers, are now assuming roles of economic independence. This transformation prompts a re-evaluation of the traditional association between women's working status and fertility behavior. This study aims to investigate the impact of women's working status on fertility behavior using a multistage stratified sampling design. A total of 408 women aged 15 to 49 years were recruited from 2 strata: working and non-working women. The data were collected through face-to-face interviews using a structured questionnaire. Descriptive statistics, cluster analysis, and generalized additive models were used for in-depth analysis of the dataset. An examination of fertility patterns indicates that, on average, working women bear 2.90 live children, while their non-working counterparts have an average of 3.52 children. Stillbirth was reported in 13% of housewives and 15.1% of working women. However, further analysis revealed that the relationship between women's employment status and fertility behavior varied depending on Social and Cultural Norms, Reproductive Rights, Workplace Policies, Economic Independence, Age, and Life Stage. Our findings suggest that promoting access to family-friendly policies and services, as well as challenging gender norms and cultural values, could help address the impact of women's employment on fertility behavior.

Long working hours and self-rated health in the national Brazilian working population: gender and employment status differences, 2019.

BACKGROUND: The regulation of working hours is governed by legal standards in formal employment. While the association between long working hours and various health outcomes has been extensively studied, there is limited evidence regarding Brazil. The objective of this study was to investigate the association among working hours, employment status, and self-rated health (SRH), taking into account differences between men and women in a national representative sample of the working population in Brazil. METHODS: A cross-sectional study was conducted among a representative sample of 33,713 workers in Brazil to assess self-rated health (SRH). We examined the associations between working hours and employment status, categorizing working hours as standard (40-44 h per week) or long (> 44 h per week), and employment status as formal or informal. Logistic regression models were employed, adjusting for sociodemographic, occupational characteristics, and health behaviors. Probabilities of negative SRH were calculated for men and women in different exposure profiles. Results were stratified by gender, and 95% confidence intervals (CIs) were applied to the findings. RESULTS: The prevalence of long working hours was higher among informal workers for both men and women. Adjusted odds ratio (AOR) results revealed that informal employment (AORwomen = 1.53; 95% CI: 1.13-2.07 and AORmen = 1.55; 95% CI: 1.22-1.96) and long working hours (AORwomen = 1.23; 95% CI: 1.06-1.43 and AORmen = 1.14; 95% CI: 1.00-1.30) were independently associated with negative SRH. Significant interactions between long working hours and informal employment were observed. Among individuals with the same exposure profile, women who engaged in long working hours had a higher probability of reporting negative SRH compared to men. CONCLUSIONS: The results of this study are in line with the literature, as differences between men and women in the likelihood of negative self-rated health were observed. The adverse health effects underscore the importance of implementing intersectoral actions to inform the revision of regulations concerning weekly working hours and the expansion of informal employment in low- and middle-income countries.

Associations between SARS-CoV-2 infection and subsequent economic inactivity and employment status: pooled analyses of five linked longitudinal surveys.

Introduction: Following the acute phase of the COVID-19 pandemic, record numbers of people became economically inactive (i.e., neither working nor looking for work), or non-employed (including unemployed job seekers and economically inactive people). A possible explanation is people leaving the workforce after contracting COVID-19. We investigated whether testing positive for SARS-CoV-2 is related to subsequent economic inactivity and non-employment, among people employed pre-pandemic. Methods: The data came from five UK longitudinal population studies held by both the UK Longitudinal Linkage Collaboration (UK LLC; primary analyses) and the UK Data Service (UKDS; secondary analyses). We pooled data from five long established studies (1970 British Cohort Study, English Longitudinal Study of Ageing, 1958 National Child Development Study, Next Steps, and Understanding Society). The study population were aged 25-65 years between March 2020 to March 2021 and employed pre-pandemic. Outcomes were economic inactivity and non-employment measured at the time of the last follow-up survey (November 2020 to March 2021, depending on study). For the UK LLC sample (n=8,174), COVID-19 infection was indicated by a positive SARS-CoV-2 test in NHS England records. For the UKDS sample we used self-reported measures of COVID-19 infection (n=13,881). Logistic regression models estimated odds ratios (ORs) with 95% confidence intervals (95%CIs) adjusting for potential confounders including sociodemographic variables, pre-pandemic health and occupational class. Results: Testing positive for SARS-CoV-2 was very weakly associated with economic inactivity (OR 1.08 95%CI 0.68-1.73) and non-employment status (OR 1.09. 95%CI 0.77-1.55) in the primary analyses. In secondary analyses, self-reported test-confirmed COVID-19 was not associated with either economic inactivity (OR 1.01 95%CI 0.70-1.44) or non-employment status (OR 1.03 95%CI 0.79-1.35). Conclusions: Among people employed pre-pandemic, testing positive for SARS-CoV-2 was either weakly or not associated with increased economic inactivity or non-employment. Research on the recent increases in economic inactivity should focus on other potential causes.

Risk Factors, Presentation, and Outcome in Acute Stroke according to Social Position Indicators in Patients Hospitalised in a Referral Centre in Bogotá 2011-2019.

INTRODUCTION: Treatment of stroke is time-dependent and it challenges patients' social and demographic context for timely consultation and effective access to reperfusion therapies. OBJECTIVE: The objective of this study was to relate indicators of social position to cardiovascular risk factors, time of arrival, access to reperfusion therapy, and mortality in the setting of acute stroke. METHODS: A retrospective analysis of patients with a diagnosis of ischaemic stroke in a referral hospital in Bogotá was performed. A simple random sample with a 5% margin of error and 95% confidence interval was selected. Patients were characterised according to educational level, place of origin, marital status, occupation, duration of symptoms before consultation, cardiovascular risk factors, access to reperfusion therapy, and mortality during hospitalisation. RESULTS: 558 patients were included with a slight predominance of women. Diagnosis of diabetes was more common in women and smoking in men (n = 68, 28.4% vs. n = 51, 15.9%; p = 0.0004). Rural origin was associated with higher prevalence of hypertension, diabetes, and dyslipidaemia (hypertension n = 45, 73.8% vs. n = 282, 57.4%; p = 0.007; diabetes n = 20, 33.3% vs. 109, 19.5%; p = 0.02; dyslipidaemia n = 19, 32.7% vs. n = 93, 18.9%; p = 0.02). Mortality was higher in rural patients (n = 8, 14.2% vs. n = 30, 6.1%; p = 0.03). Lower schooling was associated with higher frequency of hypertension and dyslipidaemia (hypertension n = 152, 76.0% vs. n = 94, 46.3%; p ≤ 0.0001; dyslipidaemia n = 56, 28% vs. n = 35, 17.0%; p = 0.009) as well as with late consultation (n = 30, 15% vs. n = 59, 28.7%; p = 0.0011) and lower probability of accessing reperfusion therapy (n = 12, 6% vs. n = 45, 22%; p ≤ 0.0001). Formal employment was associated with a visit to the emergency department in less than 3 h (n = 50, 25.2% vs. n = 58, 18%, p = 0.04 and a higher probability of accessing reperfusion therapy (n = 35, 17.6% vs. n = 33, 10.2%; p = 0.01). Finally, living in a household with a stratum higher than 3 was associated with a consultation before 3 h (n = 77, 25.5% vs. n = 39, 15.6%; p = 0.004) and a higher probability of reperfusion therapy (n = 57, 18.9% vs. n = 13, 5.2%; p ≤ 0.0001). CONCLUSION: Indicators of socio-economic status are related to mortality, consultation time, and access to reperfusion therapy. Mortality and reperfusion therapy are inequitably distributed and, therefore, more attention needs to be directed to the cause of these disparities in order to reduce the access gap in the context of acute stroke in Bogotá.

Influence of financial strain on intimate partner violence and the moderating role of employment status among wives in Nigerian military homes.

This study examines the influence of financial strain on intimate partner violence (physical and psychological) experienced by wives of military personnel in Nigeria. The moderating role of employment status was also sought. Data was collected using a structured questionnaire made up of standardized scales with appropriate psychometric properties. Participants of the cross-sectional survey were purposively sampled and comprised 284 female spouses of military personnel in South-Western Nigerian. Results indicated a significant difference in the level of physical [t(282) = 6.775; p < .05] and psychological violence [t(282) = 8.388; p < .05] reported by participants with high and low financial strain. Employment status did not moderate the influence of financial strain on both dimensions of intimate partner violence (ß1 = 0.027; p > .05; ß2 = 0.052; p > .05) and accounted for an insignificant R2 increase of 0.01% and 0.08%, respectively. The practical implications of findings for intervention and future studies were discussed.

Trends in socioeconomic inequalities in cervical, breast, and colorectal cancer screening participation among women in Japan, 2010-2019.

BACKGROUND: It is known that socioeconomic status (SES) influences the outcome of cancer treatment and this could partly be explained by decreased use of cancer screening services by people of lower SES. Many studies have indicated that low SES, including low educational attainment or unstable employment, was related to nonparticipation in cancer screening. However, studies investigating trends in SES inequalities within cancer screening participation are limited. Our objective was to examine trends in SES inequalities in cervical, breast, and colorectal cancer screening participation among women in Japan between 2010 and 2019. METHODS: We analyzed 189,442, 168,571, 163,341, and 150,828 women in 2010, 2013, 2016, and 2019 respectively, using nationally representative cross-sectional surveys. The main outcome variables are participation in each cancer screening. We used educational attainment and employment status as measures for SES. Multivariable logistic regression analysis, adjusted for age, marital status, educational attainment, and employment status was performed to evaluate the associations between SES and nonparticipation in each cancer screening. RESULTS: Overall participation rates in each cancer screening increased between 2010 and 2019. Low educational attainment and non-permanent employment status were related to nonparticipation in each cancer screening and inequality according to employment status increased within each screening participation during the study period. For example, dispatched workers were more likely to not participate in cervical cancer screening than permanent workers: in 2010, [aOR 1.11 95 %CI: 1.01 -1.21], and in 2019, [aOR 1.46 95 %CI: 1.34-1.60]. The inequality was greatest in colorectal cancer screening nonparticipation, followed by breast and cervical screening. CONCLUSIONS: Although the participation rates in each cancer screening have increased, inequality in participation in terms of employment status widened among women in Japan between 2010 and 2019. Reducing inequalities in cancer screening participation is essential for cancer screening intervention policies.

Direct and indirect costs for families of children with autism spectrum disorder in China.

LAY ABSTRACT: This is the first comprehensive national study to explore the direct and indirect costs for families of children with autism spectrum disorder in China. The increasing prevalence of autism spectrum disorder highlights a growing need for resources to provide care for families of children with autism spectrum disorder. The medical and nonmedical costs and parents' productivity loss have caused a serious burden on their families. Our objective is to estimate the direct and indirect costs for the families of children with autism spectrum disorder in China. The target population was parents of children with autism spectrum disorder. We analyzed the costs using cross-sectional data from a Chinese national family survey with children aged 2-6 years (N = 3236) who were clinically diagnosed with autism spectrum disorder. Family data from 30 provinces in China were obtained. Cost items included direct medical costs, direct nonmedical costs, and indirect costs. In this study, we found that the largest part of family costs for autism spectrum disorder are nonmedical costs and productivity loss. Autism spectrum disorder has imposed a huge economic burden on parents having children with autism spectrum disorder in China, who need more support than the current health care system provides.

High socioeconomic status is associated with stroke severity among stroke patients in the National Brain Centre Hospital, Jakarta, Indonesia.

Rapid economic growth has widened the gap between the rich and the poor, contributing to inequalities in socioeconomic status (SES) in Indonesia and possibly inequalities in health care. Here, we aimed to assess the potential association between SES and stroke severity in Indonesia, one of the largest low- and middle-income countries. Patients diagnosed with stroke at National Brain Centre (NBC) Hospital, Jakarta, Indonesia, in 2020 were included in the study. SES was measured based on marital status, occupation, education level, source of payment, and hospitalized class with smoking status and sex as confounder. Stroke severity was classified based on the National Institutes of Health Stroke Scale score into minor stroke (Adams et al., 1993, Amarenco et al., 2014, Andersen and Olsen, 2018, Austin and Steyerberg, 2017) and moderate to severe stroke (>4). A total of 2,443 patients with moderate to severe stroke (58%) were analyzed. Currently employed patients had a lower adjusted OR (aOR) of 0.65 (95% confidence interval [CI], 0.51-0.83) than unemployed patients. Patients with the highest education level, at least a diploma degree, had a lower aOR of 0.67 (95% CI, 0.49-0.92) than those with an elementary or no education. Our findings showed that patients with a higher SES had a lower risk of more severe stroke than those with a lower SES. Hence, we must focus on improving SES as part of stroke management.

The association of employment status and unwanted job loss with maternal oral health experiences: findings from the pregnancy risk assessment monitoring system.

BACKGROUND: Oral health is an essential component of a healthy pregnancy. While most women work full-time while pregnant, research has overlooked the impact of occupational status and job loss on oral health experiences during pregnancy. To examine the impact of employment status and job loss on oral health experiences during pregnancy in the United States. DATA: Data are from eight sites (Georgia, Massachusetts, Minnesota, Missouri, North Carolina, New York State, New York City, and Wisconsin) of the Pregnancy Risk Assessment Monitoring System (PRAMS) for the years 2016-2020 (n = 31,362). Multiple logistic regression is used to assess the relationship between occupational status (including employment status and unwanted job loss) during pregnancy and oral health. FINDINGS: Women who experienced an unwanted job loss in the prenatal period were at elevated risk of not having dental insurance, not receiving a dental cleaning during pregnancy, having an oral health problem, and having unmet dental care needs. CONCLUSION: Experiencing unwanted job loss around the time of pregnancy is an important life event that corresponds to worse oral health experiences. There is a need for greater focus on adverse life events, such as job loss, especially during pregnancy, as a mechanism for oral health issues and challenges with proper access to dental health systems.

Multiple jobholding and part-time work among nurses in long-term care homes compared to other healthcare sectors: Evidence from Ontario.

About two-thirds of Canadian COVID-19 related deaths occurred in long-term care homes (LTCHs). Multiple jobholding and excessive part-time work among staff have been discussed as vectors of transmission. Using an administrative census of registered nurses (RNs) and registered practical nurses (RPNs) in the Canadian province of Ontario, this paper contrasts the prevalence of multiple jobholding, part-time/casual work, and other job and worker characteristics across health sectors in 2019 and 2020 to establish whether the LTCH sector deviates from the norms in Ontario healthcare. Prior to COVID-19, about 19% of RNs and 21% of RPNs in LTCHs held multiple jobs. For RPNs, this was almost identical to the RPN provincial average, while for RNs this was 2.5 percentage points above the RN provincial average. In 2020, multiple jobholding fell significantly in LTCHs after the province passed a single site order to reduce COVD-19 transmission. Although there are many similarities across sectors, nurses, especially RNs, in LTCHs differ on some dimensions. They are more likely to be internationally educated and, together with nurses in hospitals, those who work part- time/casual are more likely to prefer full-time hours (involuntary part-time/casual). Overall, while multiple jobholding and part-time work among nurses are problematic for infection prevention and control, these employment practices in LTCHs did not substantially deviate from the norms in the rest of healthcare in Ontario.

Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research.

STUDY OBJECTIVES: This review aims to assess the association between socioeconomic status (SES) and sleep health in the general population and the mediating effects of lifestyle and mental and physical health in this relationship. METHODS: Observational studies testing the independent association between objective or subjective SES indicators and behavioral/physiological or clinical sleep health variables in the general population were included. PubMed/MEDLINE was searched for reports published from January 1990 to December 2019. The direction of effect was used as the primary effect measure, testing the hypothesis that low SES is associated with poor sleep health outcomes. Results are presented in the form of direction effect plots and synthesized as binomial proportions. RESULTS: Overall, 336 studies were identified. A high proportion of effects at the expected direction was noted for measures of sleep continuity (100% for sleep latency, 50-100% for awakenings, 66.7-100% for sleep efficiency), symptoms of disturbed sleep (75-94.1% for insomnia, 66.7-100% for sleep-disordered breathing, 60-100% for hypersomnia), and general sleep satisfaction (62.5-100%), while the effect on sleep duration was inconsistent and depended on the specific SES variable (92.3% for subjective SES, 31.7% for employment status). Lifestyle habits, chronic illnesses, and psychological factors were identified as key mediators of the SES-sleep relationship. CONCLUSIONS: Unhealthy behaviors, increased stress levels, and limited access to health care in low-SES individuals may explain the SES-sleep health gradient. However, the cross-sectional design of most studies and the high heterogeneity in employed measures of SES and sleep limit the quality of evidence. Further research is warranted due to important implications for health issues and policy changes. CITATION: Papadopoulos D, Etindele Sosso FA. Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research. J Clin Sleep Med. 2023;19(3):605-620.

Single and combined effects of marital status, education attainment, and employment status on suicide among working-age population: A case-control study in South Korea.

Background: Suicide in the working-age population is an important public health issue. This group is heterogeneous regarding marital status, education level, and employment status, which are generally important socioeconomic factors for suicide, and has a wide age range. This study aims to explore the individual and combined effect of these socioeconomic factors on suicide in different age groups among the working-age population. Methods: This study utilized a population-based case-control design for the working-age population in South Korea. Suicide cases were identified in Korean Governmental Death Registry from 2008 to 2017, and eight controls from Korea Community Health Survey were matched to each case by gender, age group, and year of suicide. Conditional logistic regression models estimated the relationship between marital status and socioeconomic status (SES) including educational attainment and employment status and suicide and examined the combined effect of the SES indicators and marital status on suicide. Results: Low education, single status, and unemployment or economically inactive status were associated with suicide, but their magnitude varied across SES indicators. The association between SES and suicide was more pronounced in younger adults. The suicide risk was highest among divorced women aged 25-34 years (OR = 7.93; 95% CI: 7.21-8.72). Individuals experiencing two social adversities among SES or marital status had a significantly increased suicide risk. Those who are divorced and unemployed or economically inactive have the highest suicide risk, specifically among men aged 24-35 years (OR = 17.53; 95% CI: 14.96-20.55). Conclusions: Marital status, education attainment, and employment status have a separate and combined impact on suicide among the working-age population. Specifically, the divorced and unemployed or economically inactive status amplified suicide risk, predominantly among young adults. Monitoring and intervention for those young adults should be considered for suicide prevention.

Is the criminalization of informal payment a good idea? The role of the free choice of physician in the elimination of the phenomenon / Jó ötlet-e a paraszolvencia kriminalizálása?

In Hungary, the new act on the employment status of health workers aims at the elimination of informal payments by the strict separation of public and private care, by a significant increase of the salary of medical doctors and with the criminalization of giving and accepting informal payments. In this study, which is based on our former research, an analysis of the Hungarian judicial practice and an internet research focused on obstetrics, we examine whether the chosen tools are appropriate to achieve this goal, and if not, how the provisions of law should be modified. Both the theoretical considerations and the empirical evidence suggest that the approach the act took is wrong, because the majority of patients are not paying to compensate the doctors for their low salary. Patients pay because they think that they will not get the necessary care without it. This fee-for-service type informal payment is not corruption and it originates from health system shortages, which is not addressed by the act. On the contrary, the full implementation of the provisions of the act might even increase these shortages, which paradoxically can lead to the amplification of the phenomenon. According to the international experiences, long-term measures aiming at the easing of shortages, in themselves, are not sufficient to roll back this undesirable phenomenon, if they are not coupled with a short-term quick fix intervention, which creates a formal substitution mechanism allowing patients to buy the services associated with informal payments legally. The free choice of doctor is perceived to be an additional service to be paid for by the majority of patients and doctors, despite that, according to the current regulations, it is part of the public benefit package and should be available free of charge. Hence, informal payments could be formalized in the frame of the free choice of doctor and health care provider by making it a chargeable service. Such an approach is not unfamiliar in the Hungarian health policy, judicial practice, and even private obstetric care. Moreover, there is a government-supported obstetric model program in the public system in Hungary, where an explicit goal is to replace informal payments with formal fees to be paid by the patients for the free choice of the obstetrician who attends the delivery. All of these seem to be realistic starting points to introduce a technically and politically feasible pilot project, but the detailed regulations should be designed so that the involved health workers have no financial interest to discriminate against non-paying patients. To achieve this, we recommend that the attending physicians are also paid a fee even if they care for a patient, who did not choose them and pay them out of pocket, but live in the catchment area of the health service delivery organization, which is obliged to care for the local residents. Obviously, the source of this fee, which is eventually a performance-based component of the income of physicians, in this case, has to be the social health insurance scheme.

Exploring the relationship between self-employment and women's cardiovascular health.

BACKGROUND: Compared with wage and salary work, self-employment has been linked to more favorable cardiovascular health outcomes within the general population. Women comprise a significant proportion of the self-employed workforce and are disproportionately affected by cardiovascular disease. Self-employed women represent a unique population in that their cardiovascular health outcomes may be related to gender-specific advantages of non-traditional employment. To date, no studies have comprehensively explored the association between self-employment and risk factors for cardiovascular disease among women. METHODS: We conducted a weighted cross-sectional analysis using data from the University of Michigan Health and Retirement Study (HRS). Our study sample consisted of 4624 working women (employed for wages and self-employed) enrolled in the 2016 HRS cohort. Multivariable linear and logistic regression were used to examine the relationship between self-employment and several self-reported physical and mental health risk factors for cardiovascular disease, controlling for healthcare access. RESULTS: Among working women, self-employment was associated with a 34% decrease in the odds of reporting obesity, a 43% decrease in the odds of reporting hypertension, a 30% decrease in the odds of reporting diabetes, and a 68% increase in the odds of reporting participation in at least twice-weekly physical activity (p < 0.05). BMI for self-employed women was on average 1.79 units lower than it was for women working for wages (p < 0.01). CONCLUSIONS: Employment structure may have important implications for cardiovascular health among women, and future studies should explore the causal relationship between self-employment and cardiovascular health outcomes in this population. TRIAL REGISTRATION: Not applicable.

Post-basic education training, age and gender of healthcare workers for elderly patients in Germany and Canada: A comparison.

BACKGROUND: This study compares Canadian and German healthcare workers employment status and wages based on age, gender, and educational training. The German and Canadian healthcare systems are rarely compared, that if such a comparison between the two countries is available, can provide an insight of health workers employment status and how that might affect the wellbeing of elderly. OBJECTIVES: The study investigates the relation of age, gender and post-basic training with annual employment and income of health care workers in Canada and Germany. METHODS: Secondary data on age, gender, post-basic education training, employment status and average monthly wages/salary was obtained from the German Socioeconomic Panel and the Canadian Survey of Labor and Income Dynamics data. The German dataset comprised 571 healthcare workers, including 219 nurses, 231 elder carers and 121 care assistants. The Canadian dataset comprised 2,580 healthcare workers, including 947 nurses, 493 elder carers and 1,140 care assistants. RESULTS: Primarily, there was a strong relationship between post-basic training and wages for both the Canadian and German samples among elder carers and care assistants. Older healthcare workers (46 years old and above) were generally employed, and age had no predictive power on annual labor earnings. This difference in age was significant among the Canadian than the German nurses. Post-basic training had a significant relation with annual earnings and monthly wages in both the Canadian and German samples. CONCLUSIONS: This study suggests that the socio-demographics of healthcare workers as age, gender and advanced training are associated with their employment opportunities, financial rewards, and better career opportunities. The relationship between demographic variables helps understand the relation of healthcare workers employment dispositions and how it might improve the quality of life of older people in nursing homes, hospitals and elderly private homes in Canada and Germany.

[Associations between labor-related and socioeconomic factors and unmet healthcare needs among working women stratified by employment status].

Objectives　Using a nationally representative dataset, this study aimed to analyze associations between labor-related and socioeconomic factors and unmet healthcare needs among working women, stratified by employment status.Methods　Secondary data analyses were conducted on the data extracted for 639 working women, aged 20 to 65 years, from the 2,496-person dataset of the Japanese General Social Survey 2010 (JGSS-2010). First, unmet healthcare needs, labor-related factors (occupation, years of employment, working hours, and company size), and socioeconomic factors (age, marital status, number of children under 15 years age, education, and equivalent disposable income) were cross-tabulated by employment status. Second, logistic regression analyses were conducted, stratified by employment status, with experience of an unmet healthcare need as the objective variable and labor-related and socioeconomic factors as explanatory variables.Results　Of the total sample, 227 (35.5%) experienced an unmet healthcare need in the past year. There was no significant association between unmet healthcare needs and employment status. Labor-related and socioeconomic factors were strongly associated with employment status. Restricting women in regular employment and managerial positions, odds ratios (ORs) of having experienced an unmet healthcare need for those with 2-5 years of employment, 5-10 years and over 10 years, compared to under 2 years, were 3.91 (95% confidence interval (CI): 1.31-11.7), 2.86 (95%CI: 0.97-8.44), 1.99 (95%CI: 070-5.66), respectively. Among women in non-regular employment and others, adjusted ORs (aORs) of having experienced an unmet healthcare need in their 50s, 40s, 30s, and 20s compared to those in their 60s were 2.26 (95%CI: 0.99-5.16), 4.09 (95%CI: 1.70-9.82), 5.03 (95%CI: 1.90-13.30), and 5.32(95%CI: 1.87-15.10) respectively with younger age groups showing higher aORs. No significant association between other labor-related and socioeconomic factors and unmet healthcare needs was found.Conclusion　More than 30% of participants had experienced unmet healthcare needs in the past year. Although no association between employment status and unmet healthcare needs was found, aORs of having experienced an unmet healthcare need were significantly higher among regularly employed women at mid-career level and among non-regularly employed women of reproductive and child-rearing age. This implies differences in women's health issues due to employment status. It is considered necessary to provide health support, taking into account the individual's work situation and environment, along with their life stage and family relationships.

Assessment of cognitive function in long-term Hodgkin lymphoma survivors, results based on data from a major treatment center in Hungary.

INTRODUCTION: Nowadays, more than 80% of newly diagnosed classical Hodgkin lymphoma (HL) patients can be cured and become long-term survivors due to risk and response-adapted treatment strategies. A well-known side effect is cognitive dysfunction that appears in HL patients after chemotherapy. In the present study, we aimed to measure cognitive dysfunction in our HL patients in this study and to find potential correlations between patient-related factors, the signs and symptoms of their diseases, or therapeutic factors. METHODS: We carried out a computer-assisted assessment (CANTAB) of cognitive dysfunction in 118 patients. We examined the domains of visual memory, attention, working memory, and planning. RESULTS: The median age of 64 females and 54 males at diagnosis was 29 (13-74) and 41 (21-81) years at the completion of CANTAB. Fifty-two percent of all patients showed cognitive impairment. Attention was impaired in 35% of patients, the working memory and planning were impaired in 25%, while visual memory was affected in 22%. All the three functions showed a significant association with inactive employments status. A close correlation was found between visual memory/working memory and planning, higher age at HL diagnosis or the completion of CANTAB test, and disability pensioner status. DISCUSSION: Our investigation suggests that patients with inactive employment status and older age require enhanced attention. Their cognitive function and quality of life can be improved if they return to work or, if it is not possible, they receive a cognitive training.

Employment, Economic, and Sociodemographic Factors Associated with Changes in Smoking and Drinking Behaviors during the COVID-19 Pandemic in South Korea.

The societal disruptions resulting from the coronavirus disease 2019 (COVID-19) pandemic may have caused changes in smoking and alcohol consumption. Using data from the Koreans' Happiness Survey, a nationally representative survey in South Korea, we (1) described population-level smoking and drinking behaviors; (2) assessed changes in smoking and drinking behaviors during the COVID-19 pandemic; and (3) identified employment, economic, and sociodemographic factors associated with these changes using multinomial logistic regression. The overall amount of smoking and drinking decreased during the pandemic, but the changes were heterogeneous across subgroups. Male gender, receipt of the basic living allowance, self-employment, unemployment, and chronic disease status were associated with increased smoking, while higher household income, temporary worker status, living with someone (versus alone), and having fewer offline friends were associated with decreased smoking. Male gender, self-employment, living alone, having more offline friends, and chronic disease status were associated with increased drinking, while younger age, male gender, low and high household income (i.e., a U-shaped relationship), long-term rent with a deposit, temporary worker status, and chronic disease status were associated with decreased drinking. Our findings provide evidence on changes in smoking and drinking during the COVID-19 pandemic in South Korea and differential changes across subgroups.

Employment status, unemployment duration, and health-related metrics among US adults of prime working age: Behavioral Risk Factor Surveillance System, 2018-2019.

BACKGROUND: While unemployment has been associated with poor health, few recent studies in the United States have comprehensively assessed associations between employment status (including duration unemployed) and healthcare access, health-related behaviors, and specific health outcomes. METHODS: We assessed health-related metrics by employment status in 2018-2019 Behavioral Risk Factor Surveillance System respondents ages 25-54. We calculated the unadjusted prevalence and adjusted prevalence ratios to compare employed workers to respondents who were self-employed, short-term (<12 months) unemployed, long-term unemployed, and unable to work. RESULTS: Adverse health outcomes increased with unemployment duration and were highest for those unable to work. Non-Hispanic Blacks were most likely to be unemployed or unable to work. Short-term unemployment and self-employment were associated with poor healthcare access. Health behaviors and outcomes declined with increasing duration of unemployment and were worst for those unable to work. CONCLUSIONS: In the United States, access to affordable healthcare is problematic for both the self-employed and the short-term unemployed. Short-term unemployment is a particularly important locus for intervention and provision of resources to prevent health declines that may hinder re-employment.