The effect of heavy smoking on retirement risk: A mendelian randomisation analysis.

BACKGROUND AND AIMS: The extent to which heavy smoking and retirement risk are causally related remains to be determined. To overcome the endogeneity of heavy smoking behaviour, we employed a novel approach by exploiting the genetic predisposition to heavy smoking, as measured with a polygenic risk score (PGS), in a Mendelian Randomisation approach. METHODS: 8164 participants (mean age 68.86 years) from the English Longitudinal Study of Ageing had complete data on smoking behaviour, employment and a heavy smoking PGS. Heavy smoking was indexed as smoking at least 20 cigarettes a day. A time-to-event Mendelian Randomization (MR) analysis, using a complementary log-log (cloglog) link function, was employed to model the retirement risk. RESULTS: Our results show that being a heavy smoker significantly increases the risk of retirement (ß = 1.324, standard error = 0.622, p < 0.05). Results were robust to a battery of checks and a placebo analysis considering the never-smokers. CONCLUSIONS: Overall, our findings support a causal pathway from heavy smoking to earlier retirement.

Sick and depressed? The causal impact of a diabetes diagnosis on depression.

BACKGROUND: There is sparse evidence on the impact of health information on mental health as well as on the mechanisms governing this relationship. We estimate the causal impact of health information on mental health via the effect of a diabetes diagnosis on depression. METHODS: We employ a fuzzy regression discontinuity design (RDD) exploiting the exogenous cut-off value of a biomarker used to diagnose type-2 diabetes (glycated haemoglobin, HbA1c) and information on psycometrically validated measures of diagnosed clinical depression drawn from rich administrative longitudinal individual-level data from a large municipality in Spain. This approach allows estimating the causal impact of a type-2 diabetes diagnosis on clinica ldepression. RESULTS: We find that overall a type-2 diabetes diagnosis increases the probability of becoming depressed, however this effect appears to be driven mostly by women, and in particular those who are relatively younger and obese. Results also appear to differ by changes in lifestyle induced by the diabetes diagnosis: while women who did not lose weight are more likely to develop depression, men who did lose weight present a reduced probability of being depressed. Results are robust to alternative parametric and non-parametric specifications and placebo tests. CONCLUSIONS: The study provides novel empirical evidence on the causal impact of health information on mental health, shedding light on gender-based differences in such effects and potential mechanisms through changes in lifestyle behaviours.

Cost-effectiveness of Diagnostic Tools to Establish the Presence of Peripheral Arterial Disease in People With Diabetes.

OBJECTIVE: To evaluate the cost-effectiveness of point-of-care duplex ultrasound (PAD-scan) and other bedside tests for the diagnosis of peripheral arterial disease (PAD) in people with diabetes. BACKGROUND: PAD is a risk factor for cardiovascular disease, diabetic foot ulceration (DFU), and amputation in diabetic patients. Diagnosis enables optimization of therapies to manage these risks. PAD-scan can be performed by frontline staff and has been shown to be the most accurate bedside test. However, its cost-effectiveness has not been investigated. METHODS: A Markov model was constructed to estimate the health outcomes and costs over 5 years of different testing strategies applied to a cohort of diabetic patients. Bedside tests investigated were PAD-scan, ankle-brachial pressure index, toe-brachial pressure index, audible and visual Doppler, transcutaneous pressure of oxygen, and pulse palpation. Health outcomes were incidence of new DFU, major cardiovascular events, amputation, death, and DFU healing rates. Sensitivity analyses were performed. RESULTS: PAD-scan was the most cost-effective bedside test with an incremental cost-effectiveness ratio of £11,391/quality-adjusted life years. PADscan had the highest probability (78.7%) of having the greatest net benefit at a willingness to pay threshold of £20,000 per quality-adjusted life years. It reduced the number of amputations by 24% and the number of cardiovascular deaths by 10% over 5 years, compared to toe-brachial pressure index (next best alternative). PAD-scans superiority in incremental cost-effectiveness ratio occurred at a PAD prevalence threshold of 0.24. DISCUSSION: PAD-scan is a cost-effective test for the detection of PAD in patients with diabetes.

The Consequences of the Coronavirus Disease 2019 Pandemic on Smoking Behavior: Evidence from the English Longitudinal Study of Ageing.

INTRODUCTION: Smoking is a risk factor for the progression of COVID-19, with smokers having higher odds of COVID-19 progression than never-smokers. This study presents novel findings on the effect of the COVID-19 pandemic on smoking behavior in older adults. METHODS: Panel data were obtained from the English Longitudinal Study of Ageing (N = 60160, 12% smokers, 55% women, 62% married, mean age = 67 years, 23% employed). Fixed-effect regression models were used to estimate the extent to which the COVID-19 pandemic affected smoking behavior. A separate model was estimated for men, women, employed, and retired. RESULTS: The findings suggest a significant and positive effect of the COVID-19 pandemic on smoking behavior (ß = 0.024; P < .001). The estimated effects were stronger for men and for the sample of individuals reporting being employed. CONCLUSIONS: In this study, I provide robust evidence of the effect of the COVID-19 pandemic on smoking behavior using the English Longitudinal Study of Ageing. This large and representative dataset is uniquely suited for the analysis. I find evidence that the proportion of smokers has increased significantly as a result of the COVID-19 pandemic. IMPLICATIONS: In the United Kingdom, the proportion of smokers increased significantly as a consequence of the COVID-19 pandemic. These findings suggest that smoking behavior may have been used as a mechanism to cope with depression, stress, and anxiety due to the COVID-19 outbreak. To the extent to which smoking behavior has been used as a coping mechanism to deal with job-related issues, targeted policy action to provide financial stability to those in worse economic situations may have beneficial effects on smoking behavior.

Influence of personality traits, gender, and socio-economic factors in obesity in the English Longitudinal Study of Ageing.

Obesity is a chronic disorder associated with high mortality rates and high morbidity. The risk of obesity is associated with certain personality traits (PTs). Some studies have found correlations among some PTs and gender. Additionally, obesity implies higher costs in daily living. The aim of this paper is to overcome this problem in the literature and estimate the association between PTs and obesity by taking into account the economic situation of the individual. This study employs data from the English Longitudinal Study of Ageing (ELSA). We focus on waves 5 and 6 of the ELSA with a sample of 6562 individuals. The results suggests that the traits of agreeableness ( ß = 0.071 , se = 0.016 , p < 0.001 ) and openness ( ß = 0.028 , se : 0.014 , p < 0.001 ) are positively and significantly associated with obesity. On the other hand, consciousness has a negative and statistically significant effect on obesity ß = 0.072 , se : 0.017 , p < 0.001 . Results are robust to the inclusion/exclusion of different regressors.

Does health information affect lifestyle behaviours? The impact of a diabetes diagnosis.

Despite an increasing interest in the effect of health information on health-behaviours, evidence on the causal impact of a diagnosis on lifestyle factors is still mixed and does not often account for long-term effects. We explore the role of health information in individual health-related decisions by identifying the causal impact of a type-2 diabetes diagnosis on body mass index (BMI) and lifestyle behaviours. We employ a fuzzy regression discontinuity design (RDD) exploiting the exogenous cut-off value in the diagnosis of type-2 diabetes provided by a biomarker (glycated haemoglobin) drawn from unique administrative longitudinal data from Spain. We find that following a type-2 diabetes diagnosis individuals appear to reduce their weight in the short-term. Differently from previous studies, we also provide evidence of statistically significant long-term impacts of a type-2 diabetes diagnosis on BMI up to three years from the diagnosis. We do not find perceivable effects of a type-2 diabetes diagnosis on quitting smoking or drinking. Overall, health information appears to have a sustained causal impact on weight reduction, a key lifestyle and risk factor among individuals with type-2 diabetes.

Effect of the COVID-19 pandemic on depression in older adults: A panel data analysis.

BACKGROUND: This paper investigates the impact of the COVID-19 pandemic on depression in the older population, an especially vulnerable group for which to date there is limited empirical research. METHODS: We employ a panel data consisting of seven waves of the English Longitudinal Study of Ageing (2010-2020). The breadth and depth of the data considered enabled us to control for individual fixed effects, to adjust for pre-pandemic trends in depression levels and to perform a heterogeneity analysis, depending on the intensity of the lockdown measures implemented and relevant socioeconomic characteristics. RESULTS: We find that, following the COVID-19 pandemic, study participants reported a statistically significant increase in the depressive symptoms by around 0.7 over 8 points as measured by the Centre for Epidemiologic Studies Depression (CES-D) index. The estimated coefficients were larger in November than in July, for individuals who lost their job, retired and women. Interestingly, we observed that mental health has worsened substantially relative to the pre-pandemic period across all income groups of the older population, suggesting a limited role of income as a protective mechanism for mental health. CONCLUSIONS: Our findings provide compelling evidence that depression levels amongst older adults have worsened considerably following the COVID-19 pandemic, and that factors other than income, such as social interactions, may be highly relevant for well-being in later life.

Effect of smoking on physical function in older adults: a Mendelian randomisation analysis.

BACKGROUND: Smoking is widely known to be damaging to health. It greatly increases the risk of various cancers, cardiovascular and respiratory diseases, and remains the leading preventable cause of morbidity and mortality in the UK. The article tested the hypothesis that smoking behaviour (either smoking or non-smoking) is associated with physical function, and assessed inferred causality using genetic predisposition to smoking behaviour as an instrumental variable. METHODS AND FINDINGS: Data were drawn from the English Longitudinal Study of Ageing, waves 1-9 (mean age 65.8 years). Physical function was assessed by means of the body mobility and the activity of daily living indices. Polygenic scores for smoking behaviour were used as instrumental variables in a Mendelian randomisation framework. Instrumental variable estimators were used to examine causal effects. Among UK older adults (n=29 139), impaired physical function was significantly higher in (current) smokers compared with non-smokers. Relatively to non-smokers, smokers reported a higher level of impairment both in the body mobility index (ß=5.553; 95% CI 1.029 to 10.077) and in the activities of daily living index (ß=1.908; 95% CI 0.196 to 3.619). CONCLUSIONS: This study demonstrates smoking behaviour to be a potential causal risk factor for physical function during ageing in the UK population. Accordingly, the benefits of smoking cessations may extend to physical function.

Co-grinding with surfactants as a new approach to enhance in vitro dissolution of praziquantel.

This paper evaluates the process of co-grinding with a surfactant as a new approach to enhance physicochemical and biopharmaceutical properties of praziquantel (PZQ), a poorly soluble drug that is essential for the treatment of schistosomiasis, a neglected tropical disease. Surfactants used in this study were poloxamer F-127 and sucrose stearate (C-1816), selected based on their well-documented biocompatibility and solubilizing activity. A series of products were prepared by mechanochemical activation using vibrational ball-mill at different drug to surfactant ratio and milling times. The obtained products were characterised in terms of drug recovery, solubility and in vitro dissolution rates. The obtained results were correlated to solid-state properties of the products analysed by differential scanning calorimetry, powder X-ray diffraction and particle size analysis. Results of UPLC-MS analysis and 1H-NMR spectroscopy showed that the used surfactants and applied grinding procedures caused no chemical degradation of the PZQ. The physicochemical properties, solubility and the in vitro dissolution enhancement of the co-ground products were related to the drug to surfactant ratio and the grinding protocol applied. The highest enhancement of the in vitro dissolution rate was achieved at the drug to surfactant ratio of 10:3 and 10:2 for F-127 and C-1816, respectively with the milling time of 30 min. The MTT assay on Caco-2 cell line demonstrated the biocompatibility of both co-ground products. Furthermore, the surfactants used did not change intrinsically high intestinal permeability of PZQ (Papp ∼ 4.00 × 10-5 cm s-1). The presented results confirmed that the co-grinding with surfactant is a promising new approach in enhancing in vitro dissolution of poorly soluble drugs like PZQ.

The effect of type 2 diabetes diagnosis in the elderly.

In this paper, I use a novel approach based on biomarkers data to examine the effect of type 2 diabetes (T2D) diagnosis on both physical and mental health for a sample of individuals aged 50 and above. In order to retrieve reliable estimates, I exploit the fact that medical guidelines cause a discontinuity in the probability that General Practitioners (GP) diagnose their patients with T2D as a function of exact blood test cut-off in a regression discontinuity design (RDD) approach. Using data from the English Longitudinal Study of Ageing (ELSA), I find compelling evidence that health information, in the form of T2D diagnosis, influences the protection of health into old age. Specifically, after receiving T2D diagnosis, over time, individuals reported a 2.1 lower body mass index (BMI) as well as 5.5 cm lower waist circumference, relative to their counterparts. With respect to self-reported physical health, the results imply that those diagnosed with T2D reported a 0.19 and 0.70 higher score in increased activities of daily living (ADL) and body mobility indexes, respectively. Finally, while I find evidence that T2D-diagnosed patients reported a significant, 0.5 higher, score in the word listening test, I find no evidence that T2D diagnosis impacted self-reported depression levels. I provide a wide variety of evidence on the validity of the results.

Framing effects on bribery behaviour: experimental evidence from China and Uganda.

In this study we investigate the effect of framing on bribery behaviour. To do this, we replicate Barr and Serra (Exp Econ, 12(4):488-503, (2009) and carry out a simple one-shot bribery game that mimics corruption. In one treatment, we presented the experiment in a framed version, in which wording was embedded with social context; in the other, we removed the social context and presented the game in a neutral manner. The contribution of this paper is that it offers a comparison of framing effects in two highly corrupt countries: China and Uganda. Our results provide evidence of strong and significant framing effects for Uganda, but not for China.