The added value of applying a disinvestment approach to the process of health technology assessment in Italy.

OBJECTIVES: The objective of the present policy analysis was to understand how a disinvestment approach to the process of health technology assessment (HTA), applied to the field of medical devices, might help Italian policymakers to properly spend the resources in healthcare. METHODS: Previous international and national experiences in disinvestment for medical devices were reviewed. Precious insights for the rational expenditure of the resources were derived by assessing the evidence available. RESULTS: The disinvestment of ineffective or inappropriate technologies or interventions with an inadequate value-for-money ratio has become a growing priority for National Health Systems. Different international disinvestment experiences of medical devices were identified and described through a rapid review. Although most of them have a strong theoretical framework, their practical application remains difficult. In Italy, there are no examples of large and complex HTA-based disinvestment practices, but their importance is becoming increasingly acknowledged, especially given the need to prioritize the funds provided by Recovery and Resilience Plan. CONCLUSIONS: Anchoring decisions on health technologies without reassessing the current technological landscape through a robust HTA model might expose to the risk of not ensuring the best employment of the resources available. Thus, it is necessary to develop a strong HTA ecosystem in Italy through adequate consultation with stakeholders to enable a data-driven and evidence-based prioritization of resources toward choices characterized by high value for both patients and society as a whole.

Nuevas oportunidades para la carrera profesional de las personas con discapacidadEl impacto de la metodología de itinerarios en su acceso al empleo. El modelo de Castilla y León / New Opportunities for the Professional Career of People with Intellectual Disabilities: The Impact of the Itinerary Methodology on their Access to Employment. The Castilla y León Model

El acceso al empleo de las personas con discapacidad intelectual y del desarrollo requiere de procesos individualizados de acompañamiento, especialmente en el tránsito de la escuela al empleo. Las iniciativas de colaboración público/privada se perfilan como estrategias de éxito. Este estudio analiza la implantación del Proyecto de Itinerarios Individualizados en Castilla y León, analizando su impacto en la carrera profesional de las personas con discapacidad intelectual y su incursión en las políticas públicas. Del análisis realizado podemos concluir que estos programas favorecen la empleabilidad del colectivo, bajo un modelo integral de intervención que trasciende a la intermediación, abarcando acciones planificadas desde la formación para el empleo hasta el acceso a la vivienda. Se observa, además, su consolidación dentro de la estrategia de atención a la discapacidad en este territorio y su orientación hacia el logro de un nuevo modelo de centros de día, orientados a la capacitación profesional de las personas con discapacidad intelectual, con el objetivo de lograr un nuevo rol social que contribuya a su proyecto de vida. (AU)

Access to employment for people with intellectual and developmental disabilities requires individualized support processes, especially in the transition from school to employment. Public/private collaboration initiatives are emerging as successful strategies. This paper analyzes the implementation of the Individualized Itineraries Project in Castilla y León, analyzing its impact on the professional career of people with intellectual disabilities and its incursion into public policies. From the analysis we can conclude that these programs promote the employability of the group, under a comprehensive model of intervention that transcends the intermediation, covering planned actions from training for employment to access to housing. It is also observed its consolidation within the strategy of attention to disability in this territory and its orientation towards the achievement of a new model of day centers, oriented to the professional training of people with intellectual disabilities, with the aim of achieving a new social role that contributes to their life project. (AU)

Sickness absence among employees of healthcare organizations in the public sector in Mongolia: A cross-sectional study.

OBJECTIVES: This study aimed to understand the rate of sickness absence (SA) among employees of public healthcare organizations in Mongolia, to identify factors associated with long-term SA, and to estimate costs due to SA. METHODS: This cross-sectional study included employees of public healthcare organizations who had certified SA from 2016 to 2018. Sociodemographic and occupational characteristics of absentees and the data on absences were collected. A logistic regression analysis was performed to identify factors associated with long-term SA (≥15 days) among employees who had SA. Absence parameters and the average costs due to SA were calculated and the total cost due to SA at all public healthcare organizations was estimated. RESULTS: From 2016 to 2018, there were 13 653 absentees and 21 043 SA, and the absence rate was 0.9%. The average absence length per absence and absentee were 9.63 days and 14.85 days, respectively. Factors associated with long-term SA were age ≥40 years, 10-19 years in employment, working at the second and tertiary levels, and night shift. The average cost per absentee was 295.5 USD, and the estimated total cost for all health organizations was 1 796 993 USD per year. CONCLUSIONS: The absence rate was 0.9% and older age, longer work experience, higher organizational level, and night shift were associated with taking a long-term SA. To reduce the costs of absenteeism and promote the health of employees in healthcare organizations, policymakers should review the policies related to SA and develop national guidelines on SA for employers, healthcare managers, and employees.

Factors associated with children and young people's mental health in the English-speaking Caribbean region: Systematic review and narrative synthesis.

BACKGROUND: Studies conducted in regions consisting of low and middle income and developing countries often report high prevalence of mental health problems among children and young people (CYP). To identify some of the contributing factors we examined the available evidence from research in one such setting. METHODS: Multiple academic databases and grey literature sources were searched until January 2022. We then identified primary research focusing on CYP's mental health in the English-speaking Caribbean region. Data was extracted and summarized to form a narrative synthesis of the factors associated with CYP's mental health. The synthesis was then organised according to the social-ecological model. The Joanna Briggs Institute's critical appraisal tools were used to examine the quality of the reviewed evidence. The study protocol was registered with PROSPERO, CRD42021283161. RESULTS: From 9684 records, 83 publications representing CYP ages 3 to 24 years from 13 countries met our inclusion criteria. The evidence was varied in quality, quantity and consistency for 21 factors associated with CYP's mental health. Adverse events and negative peer to peer and sibling relationships were consistently associated with mental health problems, while helpful coping strategies were associated with better mental health. There were mixed findings for age, sex/gender, race/ethnicity, academic level, comorbidity, positive affect, health risks behaviours, religion/prayer, parent history, parent to parent and parent to child relationships, school/employment, geography and social status. There was also some limited evidence for associations between sexuality, screen time and policies/procedures and CYP's mental health. At least 40% of the evidence contributing to each of the factors was judged as high quality. CONCLUSION: Individual, relationship, community and societal factors may influence CYP's mental health outcomes in the English-speaking Caribbean. Knowledge of these factors is useful to inform early identification and early interventions. More research is needed to explore inconsistent findings and understudied areas.

Low-Frequency Noise: Experiences from a Low-Frequency Noise Perceiving Population.

Although low-frequency noise (LFN) is associated with various complaints, there is still much unknown about this phenomenon. This research aims to provide an extensive description of (1) LFN perceptions, (2) LFN-related complaints, and (3) the characteristics of LFN complainants. In an explorative observational cross-sectional survey study, a sample of Dutch adults reporting to experience LFN (n = 190) and a group not experiencing LFN (n = 371) completed a comprehensive questionnaire. Descriptions of LFN perceptions varied individually and were dependent on different circumstances, although some common patterns were observed. Complaints were wide-ranging and individual, with a reported high impact on daily living. Common complaints included sleeping difficulties, fatigue, or annoyance. Societal consequences were described regarding housing, work, and relationships. Attempts to stop or escape the perception were manifold but often unsuccessful. The LFN sample differed regarding sex, education level, and age from the Dutch adult population, indicating more frequent inability to work, less full-time work, and less years lived in their homes. No further differences in occupational or marital status or living circumstances were found. Although this research supports some previous findings and identifies common patterns, it also highlights the individual nature of LFN-related experiences and the heterogeneity of this group. It is advised to pay attention to the complaints of affected individuals, to inform concerned authorities, and to conduct more systematic and multidisciplinary research using standardized and validated measuring instruments.

Effects of External Employment Opportunities, Nursing Professionalism, and Nursing Work Environments on Korean Hospital Nurses' Intent to Stay or Leave.

This study aims to explore Korean Hospital nurses' intent to stay or leave their working environment, and to identify the difference between the intent to stay and the intent to leave by identifying the relationship between external employment opportunities, professionalism, and work environment. Data were collected via an online survey and analyzed using stepwise multiple regression analysis. As a result of the analysis, the intent to stay among Korean hospital nurses was influenced by the work environment, external employment opportunities, education level, and marital status, whereas the intent to leave was influenced by the nursing work environment, marital status, and total clinical experience. As a result, the reflected variables differed. Thus, it can be concluded that hospital nurses' intent to either stay or leave are not concepts that simply contradict each other in the same context but are, in fact, influenced differently by various factors. Nevertheless, it can also be concluded that nursing managers should make efforts to improve the nursing work environment to lower nurses' intent to leave and increase their intent to stay by improving only the nursing work environment.

Differences in humble leadership and team performance in nursing: an online cross-sectional study.

OBJECTIVES: The current study measures the differences in humble leadership and team performance in nursing based on the sample's characteristics. DESIGN: A cross-sectional study. SETTING: In 2022, the current study sample was recruited from governmental and private universities and hospitals using an online survey. PARTICIPANTS: A convenience snowball sample of 251 nursing educators, nurses and students was recruited. RESULTS: A leader's humble leadership, a team's humble leadership and overall humble leadership were at moderate levels. The overall mean team performance was 'working well'. The single male humble leaders, aged more than 35 years and working full-time in an organisation with quality initiatives, have a higher leader's humble leadership. Members of the team aged more than 35 years working full-time in organisations with quality initiatives have a higher team's humble leadership. Team performance in organisations with quality initiatives was higher in resolving many conflicts by compromising between team members, with each one giving in a little. There was a moderate correlation (r=0.644) between the total scores of the overall humble leadership and team performance. Humble leadership correlated significantly but negatively and weakly with quality initiatives (r=-0.169) and the participant's role (r=-0.163). There was no significant correlation between team performance and the sample's characteristics. CONCLUSIONS: Humble leadership has positive outcomes, such as team performance. The shared sample characteristic that sets the differences between a leader's and a team's humble leadership and team performance was the presence of quality initiatives in the organisation. The shared sample characteristics that set the differences in a leader's and a team's humble leadership were working full-time and the presence of quality initiatives in the organisation. Humble leaders are contagious; they will produce creative team members by 'social contagion', 'behavioural similarity', 'team potency' and 'collective focus'. Thus, leadership protocols and interventions are mandated to fuel humble leadership and team performance.

Optimizing the Agricultural Supply Chain through E-Commerce: A Case Study of Tudouec in Inner Mongolia, China.

E-commerce has the potential to address problems in the agricultural supply chain and support the implementation of rural revitalization strategies. Previous research has largely focused on the business models of rural e-commerce platforms, but has not examined the mechanisms by which they can optimize and reconfigure the agricultural supply chain. This study aims to fill this gap through a case study of Tudouec, a potato e-commerce platform in Inner Mongolia, China. The study employs a single-case study method and utilizes data from interviews, fieldwork, and secondary sources. The findings show that Tudouec is a multi-functional platform offering technical support, warehousing, logistics, supply chain finance, and insurance, among other services. It not only serves as a multi-channel information management platform, but also enhances supply chain capabilities through the interaction of information flow with capital and material flows. This rural e-commerce model addresses the limitations of traditional agricultural models and promotes poverty reduction and rural revitalization. The study's main contribution is in demonstrating the potential for the Tudouec model to be applied to other agricultural products and in other developing countries.

From Housewives to Employees, the Mental Benefits of Employment across Women with Different Gender Role Attitudes and Parenthood Status.

Previous studies suggest that paid employment can improve workers' mental health status by offering a series of manifest and latent benefits (i.e., income, self-achievement and social engagement), which motivates policymakers' ongoing promotion of labour force participation as an approach to protect women's mental health status. This study extends the literature by investigating the mental health consequences of housewives' transition into paid employment across different gender role attitude groups. In addition, the study also tests the potential moderating role of the presence of children in relationships. This study yields two major findings by using nationally representative data (N = 1222) from the United Kingdom Longitudinal Household Study (2010-2014) and OLS regressions. First, from the first wave to the next, housewives who transitioned into paid employment reported better mental health status than those who remained housewives. Second, the presence of children can moderate such associations, but only among housewives with more traditional gender role attitudes. Specifically, among the traditional group, the mental benefits of transition into paid employment are more pronounced among those without children. Therefore, policymakers should develop more innovative approaches to promote housewives' mental health by considering a more gender-role-attitudes-sensitive design of future labour market policies.

My Family Accounts Much for Me: How Does Work-to-Family Conflict Lead to Unethical Pro-Family Behavior.

Although unethical behaviors are prevalent in the workplace, little is known about the unethical behavior aiming at benefiting one's family (unethical pro-family behavior, UPFB). In this paper, we leverage self-determination theory to explore the association between work-to-family conflict and UPFB. Specifically, we hypothesize and corroborate a positive relationship between work-to-family conflict and UPFB, and such relationship is mediated by family motivation. Moreover, we identify two conditional factors, guilt proneness (at first stage) and ethical leadership (at second stage), in moderating the proposed relationship. In study 1 (scenario-based experiment, N = 118), we tested the causality of work-to-family conflict and intention to perform UPFB. In study 2 (field study, N = 255), we tested our hypotheses by employing a three-wave time-lagged survey design. As expected, results from two studies fully supported our predictions. Overall, we explain whether, how, and when work-to-family conflict will lead to UPFB. Implications of theory and practice are then discussed.

Inferring incompetence from employment status: An audit-like experiment.

Audit studies demonstrate that unemployed people are less likely to receive a callback when they apply for a job than employed candidates, the reason for this is unclear. Across two experiments (N = 461), we examine whether the perceived competence of unemployed candidates accounts for this disparity. In both studies, participants assessed one of two equivalent curriculum vitae's, differing only on the current employment status. We find that unemployed applicants are less likely to be offered an interview or hired. The relationship between the employment status of the applicant and these employment-related outcomes is mediated by the perceived competence of the applicant. We conducted a mini meta-analysis, finding that the effect size for the difference in employment outcomes was d = .274 and d = .307 respectively, while the estimated indirect effect was -.151[-.241, -.062]. These results offer a mechanism for the differential outcomes of job candidates by employment status.

The effect of a preconception and antenatal nutritional supplement on children's BMI and weight gain over the first 2 years of life: findings from the NiPPeR randomised controlled trial.

BACKGROUND: Nutritional intervention before and throughout pregnancy might promote healthy infant weight gain; however, clinical evidence is scarce. Therefore, we examined whether preconception and antenatal supplementation would affect the body size and growth of children in the first 2 years of life. METHODS: Women were recruited from the community before conception in the UK, Singapore, and New Zealand, and randomly allocated to either the intervention (myo-inositol, probiotics, and additional micronutrients) or control group (standard micronutrient supplement) with stratification by site and ethnicity. Measurements of weight and length were obtained from 576 children at multiple timepoints in the first 2 years of life. Differences in age and sex standardised BMI at age 2 years (WHO standards) and the change in weight from birth were examined. Written informed consent was obtained from the mothers, and ethics approval was granted by local committees. The NiPPeR trial was registered with ClinicalTrials.gov (NCT02509988) on July 16, 2015 (Universal Trial Number U1111-1171-8056). FINDINGS: 1729 women were recruited between Aug 3, 2015, and May 31, 2017. Of the women randomised, 586 had births at 24 weeks or more of gestation between April, 2016, and January, 2019. At age 2 years, adjusting for study site, infant sex, parity, maternal smoking, maternal prepregnancy BMI, and gestational age, fewer children of mothers who received the intervention had a BMI of more than the 95th percentile (22 [9%] of 239 vs 44 [18%] of 245, adjusted risk ratio 0·51, 95% CI 0·31-0·82, p=0·006). Longitudinal data revealed that the children of mothers who received the intervention had a 24% reduced risk of experiencing rapid weight gain of more than 0·67 SD in the first year of life (58 [21·9%] of 265 vs 80 [31·1%] of 257, adjusted risk ratio 0·76, 95% CI 0·58-1·00, p=0·047). Risk was likewise decreased for sustained weight gain of more than 1·34 SD in the first 2 years (19 [7·7%] of 246 vs 43 [17·1%] of 251, adjusted risk ratio 0·55, 95% CI 0·34-0·88, p=0·014). INTERPRETATION: Rapid weight gain in infancy is associated with future adverse metabolic health. The intervention supplement taken before and throughout pregnancy was associated with lower risk of rapid weight gain and high BMI at age 2 years among children. Long-term follow-up is required to assess the longevity of these benefits. FUNDING: National Institute for Health Research; New Zealand Ministry of Business, Innovation and Employment; Société Des Produits Nestlé; UK Medical Research Council; Singapore National Research Foundation; National University of Singapore and the Agency of Science, Technology and Research; and Gravida.

Rural job preferences of graduate class medical students in Ethiopia-a discrete choice experiment (DCE).

BACKGROUND: Human resource is one of the health system's building blocks, which ultimately leads to improved health status, equity, and efficiency. However, human resources in the health sector are characterized by high attrition, distributional imbalance, and geographic inequalities in urban and rural settings. METHODS: An discrete choice experiment (DCE) with 16 choice tasks with two blocks containing five attributes (salary, housing, drug and medical equipment, year of experience before study leave, management support, and workload) were conducted. A latent class and mixed logit model were fitted to estimate the rural job preferences and heterogeneity. Furthermore, the relative importance, willingness to accept and marginal choice probabilities were calculated. Finally, the interaction of preference with age and sex was tested. RESULTS: A total of 352 (5632 observations) final-year medical students completed the choice tasks. On average, respondents prefer to work with a higher salary with a superior housing allowance In addition, respondents prefer a health facility with a stock of drug and medical equipment which provide education opportunities after one year of service with supportive management with a normal workload. Young medical students prefer lower service years more than older students. Besides age and service year, we do not find an interaction between age/sex and rural job preference attributes. A three-class latent class model best fits the data. The salary was the most important attribute in classes 1 and 3. Contrary to the other classes, respondents in class 2 do not have a significant preference for salary. Respondents were willing to accept an additional 4271 ETB (104.2 USD), 1998 ETB (48.7 USD), 1896 ETB (46.2 USD), 1869 (45.6 USD), and 1175 ETB (28.7 USD) per month for the inadequate drug and medical supply, mandatory two years of service, heavy workload, unsupportive management, and basic housing, respectively. CONCLUSION: Rural job uptake by medical students was influenced by all the attributes, and there was individual and group-level heterogeneity in preference. Policymakers should account for the job preferences and heterogeneity to incentivize medical graduates to work in rural settings and minimize attrition.

Maternal precarious employment and child overweight/obesity in the United States.

Precarious employment has increased in the United States and is now recognized as an important social determinant of health. Women are disproportionately employed in precarious jobs and are largely responsible for caretaking, which could deleteriously affect child weight. We utilized data from the National Longitudinal Survey of Youth adult and child cohorts (1996-2016; N = 4453) and identified 13 survey indicators to operationalize 7 dimensions of precarious employment (score range: 0-7, 7 indicating the most precarious): material rewards, working-time arrangements, stability, workers' rights, collective organization, interpersonal relations, and training. We estimated the association between maternal precarious employment and incident child overweight/obesity (BMI ≥85th percentile) using adjusted Poisson models. Between 1996 and 2016, the average age-adjusted precarious employment score among mothers was 3.7 (Standard Error [SE] = 0.02) and the average prevalence of children with overweight/obesity was 26.2% (SE = 0.5%). Higher maternal precarious employment was associated with a 10% higher incidence of children having overweight/obesity (Confidence Interval: 1.05, 1.14). A higher incidence of childhood overweight/obesity may have important implications at the population-level, due to the long-term health consequences of child obesity into adulthood. Policies to reduce employment precariousness should be considered and monitored for impacts on childhood obesity.

Employment Insurance may mitigate impact of unemployment on food security: Analysis on a propensity-score matched sample from the Canadian Income Survey.

Food insecurity, the inadequate access to food due to financial constraints, affects one-sixth of Canadian households, with substantial health implications. We examine the impact of unemployment and the mitigating effect of Employment Insurance (EI) on household food insecurity in Canada. Using the Canadian Income Survey 2018-2019, we sampled 28,650 households with adult workers 18-64 years old. We used propensity score matching to pair the 4085 households with unemployed workers with 3390 households with only continuously employed workers on their propensity towards unemployment. Among unemployed households, we also matched 2195 EI recipients with 950 nonrecipients. We applied adjusted logistic regression to the two matched samples. Food insecurity affected 15.1% of the households without unemployed workers and 24.6% of their unemployed counterparts, including 22.2% of EI recipients and 27.5% of nonrecipients. Unemployment was associated with 48% (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.32-1.66; 5.67 percentage points) higher likelihood of food insecurity. This association was significant and similar across income levels, full-time and part-time workers, and household compositions. EI receipt was associated with 23% (aOR 0.77, 95% CI 0.66-0.90; 4.02 percentage points) lower likelihood of food insecurity, but this association was only significant among households with lower income, full-time workers, and children under 18. The findings suggest a broad impact of unemployment on working adults' food insecurity and a substantial mitigating effect by EI on select unemployed workers. Making EI more generous and accessible for part-time workers may help alleviate food insecurity.

The short-term economic consequences of COVID-19: Exposure to disease, remote work and government response.

We examine the determinants of the consequences of COVID-19 on employment and wages in the United States. Guided by a pre-analysis plan, we investigate whether the economic consequences of COVID-19 were larger for certain occupations, using four indexes: workers relatively more exposed to disease, workers that work with proximity to coworkers, essential/critical workers and workers who can easily work remotely. We find that individuals that work in proximity to others are more affected while individuals able to work remotely and essential workers are less affected by the pandemic. We also present suggestive evidence that our indexes are likely explanations why certain demographic groups such as younger and minority workers have worse labor market outcomes during the pandemic.

Exploration on the optimization of occupational injury and employment protection of takeout workers in the context of public health.

With the acceleration of the pace of urban life and the development of information technology, the takeout industry has emerged as the times require, which obtains intermediate costs by distributing goods to consumers. People pay more and more attention to public health, which requires takeout workers to drive as fast as possible to ensure the quality and safety of goods, but it also makes takeout workers suffer from various occupational injuries, such as car accidents, stomach diseases caused by eating disorders and long-term psychological pressure. This paper optimized the employment protection of takeout workers in combination with their professional characteristics. This paper used the analytic hierarchy process (AHP) to analyze the indicators that can evaluate the optimization effect of employment protection for takeout workers, and compared the occupation of takeout workers before and after employment protection. The experimental results showed that in Meituan takeout, the rationality of the average delivery management system before and after the optimization of employment protection was 47.2 and 64.4%, respectively; in ELEME takeout, the rationality of the average takeout distribution management system before and after the optimization of employment protection was 55.0% and 69.8%, respectively. Therefore, in the context of public health, the implementation of social security, employment relationship and optimization of service evaluation mechanism for outbound sales personnel can effectively improve the rationality of the delivery management system.