Suchergebnisse

IntroductionIntensified poverty arising from economic decline and crisis may have contributed to reductions in HIV prevalence in Zimbabwe.ObjectivesTo assess the impact of the economic decline on household wealth and prevalent HIV infection using data from a population‐based open cohort.MethodsHousehold wealth was estimated using data from a prospective household census in Manicaland Province (1998 to 2011). Temporal trends in summed asset ownership indices for sellable, non‐sellable and all assets combined were compared for households in four socio‐economic strata (small towns, agricultural estates, roadside settlements and subsistence farming areas). Multivariate logistic random‐effects models were used to measure differences in individual‐level associations between prevalent HIV infection and place of residence, absolute wealth group and occupation.ResultsHousehold mean asset scores remained similar at around 0.37 (on a scale of 0 to 1) up to 2007 but decreased to below 0.35 thereafter. Sellable assets fell substantially from 2004 while non‐sellable assets continued increasing until 2008. Small‐town households had the highest wealth scores but the gap to other locations decreased over time, especially for sellable assets. Concurrently, adult HIV prevalence fell from 22.3 to 14.3%. HIV prevalence was highest in better‐off locations (small towns) but differed little by household wealth or occupation. Initially, HIV prevalence was elevated in women from poorer households and lower in men in professional occupations. However, most recently (2009 to 2011), men and women in the poorest households had lower HIV prevalence and men in professional occupations had similar prevalence to unemployed men.ConclusionsThe economic crisis drove more households into extreme poverty. However, HIV prevalence fell in all socio‐economic locations and sub‐groups, and there was limited evidence that increased poverty contributed to HIV prevalence decline.

SummaryIn the last 50 years Thailand has achieved advanced demographic and health transitions. Many infectious diseases are controlled and infant and maternal mortality rates are among the lowest in the region. Within such a low mortality setting, however, substantial variations in health persist, with education being a major driver. This paper assesses the ongoing mortality transition in Thailand, examining relationships between risk factors and mortality outcomes among a large nationwide cohort of distance-learning Open University students, as well as examining the differential mortality benefit enjoyed by this educated group when compared with the general Thai population. The cohort comprised 87,151 participants, who in 2005 completed a questionnaire collecting detailed information on socio-demographics, health behaviours and health outcomes. Participants were aged 15–87 at baseline and lived in all regions of the country. Cohort members' citizen identification numbers were matched with official death registration records to identify mortality among participants. A total of 1401 deaths were identified up to November 2016. Results show cohort study participants experiencing mortality at approximately one-third of the rate of the general population in the same age and sex groups. The gap between the mortality rates in the two groups widened with increased age. Differential risk factor prevalence among the two populations, particularly lower overweight and obesity prevalence and lower cigarette smoking rates in the cohort, can explain some of this variation. The largely unmeasurable effect of aspiration for life improvement through distance education while embedded in their communities is shown by this study to have a powerful effect on mortality risk. With overall education levels, including higher education, rising in Thailand this growing group of educated aspirational Thais may represent future trends in Thai mortality. Identifying the drivers and characteristics of this mortality variation can help inform policies to provide health services and to help reduce mortality in the whole population.

This presentation discusses Kids' Environment and Health Cohort (KEHC), a bespoke Administrative Data Research UK (ADR UK) funded linkage project. KEHC will be a comprehensive and yearly updated dataset for children born in England from 2006 onwards, integrating health, education, pregnancy, and environmental data. This integrates data from different administrative systems including the Office for National Statistics, the National Health Service, and the Department for Education as well as open environmental data.
This presentation will outline the deterministic and probabilistic linkage methods utilised and the quality assurance undertaken through clerical review and bias analysis. Additionally, we will delve into the challenges encountered in the process of data ingest, linkage, and delivery due to the diverse origins and purposes of the collected data, as well as temporal disparities. In navigating the intricacies of multiple linkages, we will discuss our unique methods, including plans to use an indexing first approach.
The first cohort of approximately 10 million children has been created to form the spine and further linkages to the 2011 and 2021 UK census data have been concluded. Linkages between address histories and open environmental data is ongoing. Linkage results have been promising, with high match rate and excellent quality.
KEHC is a powerful example of how integrated data can be used for research for the public good.
KEHC will provide a unique opportunity for academic researchers investigating the longitudinal effects of local environments on children's health and educational outcomes and will become one of ADR UK's flagship Research Ready Datasets.

The COVID-19 pandemic has brought into stark focus the economic inequities faced by precarious, criminalized and racialized workers. Sex workers have been historically excluded from structural supports due to criminalization and occupational stigma. Given emerging concerns regarding sex workers' inequitable access to COVID-19 income supports in Canada and elsewhere, our objective was to identify prevalence and correlates of accessing emergency income supports among women sex workers in Vancouver, Canada. Data were drawn from a longstanding community-based open cohort (AESHA) of cis and trans women sex workers in Metro Vancouver from April 2020–April 2021 (n = 208). We used logistic regression to model correlates of access to COVID-19 income supports. Among 208 participants, 52.9% were Indigenous, 6.3% Women of Colour (Asian, Southeast Asian, or Black), and 40.9% white. Overall, 48.6% reported accessing income supports during the pandemic. In adjusted multivariable analysis, non-injection drug use was associated with higher odds of accessing COVID-19 income supports (aOR: 2.58, 95% CI: 1.31–5.07), whereas Indigenous women faced reduced odds (aOR 0.55, 95% CI 0.30–1.01). In comparison with other service workers, access to income supports among sex workers was low overall, particularly for Indigenous sex workers, demonstrating the compounding impacts of colonization and disproportionate criminalization of Indigenous sex workers. Results highlight the need for structural supports that are low-barrier and culturally-safe to support sex workers' health, safety and dignity.

In this paper, we analyze whether work values differ between three dimensions of time (age, birth cohort, period). Using data of five waves of the World Values Survey and the European Values Study from more than forty countries and hierarchical age-period-cohort regression models, we did not find relevant gaps between birth cohorts with respect to the relative importance of work or with respect to work values. Thus, we claim that, in European and Euro-Atlantic countries, birth cohorts, on average, do not differ significantly with regard to their work values. Our results suggest, however, that the relative importance of work is significantly higher in the middle-age groups than among the younger or older groups. Regarding work values, we found that the importance of having an interesting job, good pay, and good hours decreases with age, and that job security is equally important at every age, whereas the importance of having a useful job increases with age.

There are limited data on the frequency of foregone health service use in defined populations. Here we describe Thai patterns of health service use, types of health insurance used and reports of foregone health services according to geo-demographic and socioeconomic characteristics. Data on those who considered they had needed but not received health care over the previous year were obtained from a national cohort of 87,134 students from the Sukhothai Thammathirat Open University (STOU). The cohort was enrolled in 2005 and was largely made up of young and middleage adults living throughout Thailand. Among respondents, 21.0% reported use of health services during the past year. Provincial/governmental hospitals (33.4%) were the most attended health facilities in general, followed by private clinics (24.1%) and private hospitals (20.1%). Health centers and community hospitals were sought after in rural areas. The recently available government operated Universal Coverage Scheme (UCS) was popular among the lower income groups (13.6%), especially in rural areas. When asked, 42.1% reported having foregone health service use in the past year. Professionals and office workers frequently reported 'long waiting time' (17.1%) and 'could not get time off work' (13.7%) as reasons, whereas manual workers frequently noted it was 'difficult to travel' (11.6%). This information points to non-financial opportunity cost barriers common to a wide array of Thai adults who need to use health services. This issue is relevant for health and workplace policymakers and managers concerned about equitable access to health services.

"This paper deals with the fertility transition, one of the two essential components of the demographic transition. The analysis demonstrates that by applying the cohort perspective new insights are obtained about how the fertility transition unfolded. Within the overall framework of the fertility transition there were four distinct pathways of fertility trends. Combining these findings with those of other scholars shows that the demographic transition has not yet led to an equilibrium of relatively stable low mortality and stable low fertility. The four fertility transition pathways are the following: (1) The Western fertility transition pathway characterized by major cohort total fertility rate (CTFR) fluctuations; (2) the South European fertility transition pathway characterized by an almost uninterrupted CTFR decline; (3) the Central and East European fertility transition pathway characterized by stable CTFRs in the 1920s to 1950s cohorts and a decline in the 1960s and 1970s cohorts; (4) the East and South-East Asia fertility transition pathway characterized by a late start in the mid-20th century with rapidly declining CTFRs. The exploration of societal conditions shaping fertility trends in the 19th and 20th centuries confirms Notestein's conclusions that the causes are a complex combination of 'technological, social, economic, and political developments' as well as cultural and ideational effects, and that it is 'impossible to be precise about the various causal factors'. At times the primary factors were economic, as in the Great Depression of the 1930s and the 1960s post-war prosperity in Western countries. However, these economic factors also had many political, cultural, social, policy and other important facets. In Central and Eastern Europe the primary factors during the era of state socialism were the political system and social policies. The patriarchal nature of societies was the prime factor shaping fertility trends in Southern Europe and in East and South-East Asia." (author's abstract). This article contains supplementary material in the form of an online appendix: http://dx.doi.org/10.12765/CPoS-2017-10en

There are limited data on the frequency of foregone health service use in defined populations. Here we describe Thai patterns of health service use, types of health insurance used and reports of foregone health services according to geo-demographic and socioeconomic characteristics. Data on those who considered they had needed but not received health care over the previous year were obtained from a national cohort of 87,134 students from the Sukhothai Thammathirat Open University (STOU). The cohort was enrolled in 2005 and was largely made up of young and middleage adults living throughout Thailand. Among respondents, 21.0% reported use of health services during the past year. Provincial/governmental hospitals (33.4%) were the most attended health facilities in general, followed by private clinics (24.1%) and private hospitals (20.1%). Health centers and community hospitals were sought after in rural areas. The recently available government operated Universal Coverage Scheme (UCS) was popular among the lower income groups (13.6%), especially in rural areas. When asked, 42.1% reported having foregone health service use in the past year. Professionals and office workers frequently reported 'long waiting time' (17.1%) and 'could not get time off work' (13.7%) as reasons, whereas manual workers frequently noted it was 'difficult to travel' (11.6%). This information points to non-financial opportunity cost barriers common to a wide array of Thai adults who need to use health services. This issue is relevant for health and workplace policymakers and managers concerned about equitable access to health services.

ObjectivesThe Swiss Cohort of Healthcare Professionals and Informal Caregivers (SCOHPICA) was created to study the career trajectories, retention intentions, and wellbeing of healthcare professionals (HCPs), addressing challenges such as staff turnover, low job satisfaction and burnout.MethodsSCOHPICA is a prospective open cohort. An electronic questionnaire was used to collect data from HCPs across multiple healthcare settings in Switzerland, encompassing the intention to stay in the profession, wellbeing, and various organizational, psychosocial, occupational and sociodemographic determinants.ResultsThe first (2022) baseline sample included 1707 HCPs from over 20 professions. Notably, 13% did not intend to stay in their profession, with intermediate caregivers (24%), registered nurses (17%) and pharmacists (17%) reporting the highest rates. Pharmacists scored lowest in wellbeing. Across determinants, pharmacists, physicians, and registered nurses reported worse scores for workload and work-life balance. Nursing professions had lower scores in various determinants, including influence at work, staffing and resource adequacy, and possibilities for development.ConclusionSCOHPICA will provide critical insights on HCPs' work conditions and experiences, supporting health workforce monitoring and management, and informing policy-making to ensure high-quality healthcare delivery.