Mark Avery

Suicide, recession, and unemployment

www.thelancet.com Vol 381 March 2, 2013 721 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ Aaron Reeves and colleagues suggest that the suicide rate in the USA has increased since 2007 in direct correlation to the increase in unemployment caused by economic recession. However, although this correlation seems strong, the cause and eff ect interpretation remains problematic. In the data Reeves and colleagues provide in their appendix, there is a temporal advance of the rise in suicides in relation to the rise in unemployment. Thus if a causative correlation really exists between the two, and since the cause should appear fi rst and the eff ect should follow, then the inevitable conclusion should be that suicides cause un employment and not vice versa. Of course such an assumption is irrational, but it points to the simple fact that, despite the widely believed theory that unemployment increases suicide, the data are inconclusive. Argentina experienced a severe crisis during 1999–2002, and, according to WHO data, suicide rates increased during 2000–08 (from 6·4–6·6 per 100 000 in 1985–95 to 7·5–7·7 per 100 000 in 2000–08); however, this increase was still lower than the rates reported for the years before 1980 (9·4–9·9 per 100 000). Con cerning eastern European countries, the data are confl icting. For example, Hungary saw an increase in suicide rates in the mid-1980s, before the fall of the Berlin wall, and a relative decrease a decade later, whereas Ukraine experienced a sharp increase only after the Berlin wall had fallen. Some data suggest an increase in suicides in east Asia because of the fi nancial crisis of the late 1990s. Premature overinterpretations are not only unwise but can also be harmful. Indeed, discussion of suicidality in the media is itself an independent risk factor for suicide.

How best practices are copied, transferred, or translated between health care facilities: a conceptual framework

Introduction: In spite of significant investment in quality programs and activities, there is a persistent struggle to achieve quality outcomes and performance improvements within the constraints and support of sociopolitical parsimonies. Equally, such constraints have intensified the need to better understand the best practice methods for achieving quality improvements in health care organizations over time. This study proposes a conceptual framework to assist with strategies for the copying, transferring, and/or translation of best practice between different health care facilities. Purpose: Applying a deductive logic, the conceptual framework was developed by blending selected theoretical lenses drawn from the knowledge management and organizational learning literatures. Findings: The proposed framework highlighted that (a) major constraints need to be addressed to turn best practices into everyday practices and (b) double-loop learning is an adequate learning mode to copy and to transfer best practices and deuteron learning mode is a more suitable learning mode for translating best practice. We also found that, in complex organizations, copying, transferring, and translating new knowledge is more difficult than in smaller, less complex organizations. We also posit that knowledge translation cannot happen without transfer and copy, and transfer cannot happen without copy of best practices. Hence, an integration of all three learning processes is required for knowledge translation (copy best practice–transfer knowledge about best practice–translation of best practice into new context). In addition, the higher the level of complexity of the organization, the more best practice is tacit oriented and, in this case, the higher the level of K&L capabilities are required to successfully copy, transfer, and/or translate best practices between organizations. Practice Implications: The approach provides a framework for assessing organizational context and capabilities to guide copy/transfer/translation of best practices. A roadmap is provided to assist managers and practitioners to select appropriate learning modes for building success and positive systemic change.

Somatic complaints and refrain from buying prescribed medications. Results from a cross-sectional study on people 60 years and older living in Kaunas (Lithuania)

BackgroundThe use of medicines by elderly people is a growing area of concern in social pharmacy. A significant proportion of older people do not follow the recommendations from physicians and refrain from buying prescribed medications. The aim of this study is to evaluate associations between self-rated health, somatic complaints and refraining from buying prescribed medications by elderly people.FindingsData was collected in a cross-sectional study in 2009. We received 624 completed questionnaires (response rate – 48.9%) from persons aged 60–84 years living in Kaunas (Lithuania). Somatic complaints were measured with the 24 item version of the Giessen Complaint List (GBB-24). Logistic regression (Enter model) was used for evaluation of the associations between refraining from buying medications and somatic complaints. These associations were measured using odds ratio (OR) and calculating the 95% confidence interval (CI).The mean scores in total for the GBB scale and sub-scales (exhaustion, gastrointestinal and cardiovascular) were lowest among respondents who did not refrain from buying prescribed medications (means for GBB-24 scale: 21.04 vs. 24.82; p=0.001). Logistic regression suggests that somatic complaints were associated with a increased risk of refraining from buying prescribed medications (OR=1.35, 95% CI=1.15-1.60).ConclusionsSomatic complaints were significantly associated with the decision to refrain from buying prescribed medications.

Clinical leadership to improve health outcomes

www.thelancet.com Vol 382 November 2, 2013 1483 Evidence suggests that the health profession falls short of providing leaders with the full complement of competencies so urgently needed for finding sustainable solutions to the wicked problems endemic in our health systems. Clinical leaders must be trained to recognise ailments in the organisational systems they rely on to deliver effective preventive and therapeutic services. We have been doing this in medicine and public health for years, adopting and adapting quality improvement approaches—such as the managerial concept Lean Six Sigma borrowed from manufacturing and engineering specialties. We need to do a better job of diagnosing healthcare system failures and applying eff ective strategies for rapid process improvement. We suggest an eleventh principle: a culture of leadership that embraces a commitment to building problem solving and implementation capacity, and focuses on organisational outcomes. We will build communities of practice that share and apply problem solving approaches, results achieved, and lessons learned. It is the only way our health systems, and the people they serve, will all enjoy sustainable positive outcomes.

Accessibility to Health Services Among Elderly People in the European Union: Do Health Care Finance and Organizational Models Matter?

Accessibility to Health Services Among Elderly People in the European Union: Do Health Care Finance and Organizational Models Matter?

Factors associated with refraining from buying prescribed medications among older people in Europe

To evaluate the associations between refraining from buying prescribed medications and selected factors among older persons.

Use of medications amongst older persons in Kaunas, Lithuania

AimTo evaluate the associations between socio-economical factors and the use of medications in the elderly.MethodsThe data was collected in a cross-sectional study in 2009. We received 624 completed questionnaires (response rate — 48.9%) from elderly people aged 60–84 years living in Kaunas (Lithuania). For an evaluation of the impact of explanatory variables on the analyzed events (binary dependent variable), an Enter model of logistic regression was used.ResultsOur findings suggest that 50.8% (n=317) of respondents used at least one drug daily. 18.3% (n=114) of respondents indicated that they use medications regularly, but not on a day-by-day basis. One quarter (25.6%; n=160) used medication only on an “at need” basis. Only 5.3% (n=33) of older persons did not use any medications at all. Logistic regression showed that being male (OR=0.67; 95%CI:0.45–0.98) was associated with using medications “regularly + daily.” For the use of “daily” medications, older age (OR=1.33; 95%CI:1.15–1.53) was associated with using medications daily. An opposite association was observed for respondents having no paid work (OR=0.48; 95%CI:0.26–0.82).ConclusionsOur study suggests that more than half of older persons in Lithuania use medications every day. Use was associated with socioeconomic factors (gender, age, and employment status).

Health Care Access and Quality Index and Financing of Health Care Systems

The GBD 2016 Healthcare Access and quality collaborators group has introduced the Healthcare Access and Quality (HAQ) index and ranked 195 countries and territories based on this index methodology.1 We have measured the link between health care system performance and financing. The Pearson correlation (r) was calculated between the HAQ index and current health expenditure per capita in purchasing power parity international dollars. Data for the latter were obtained from the Global Health Observatory.2 We observed a strong and statistically significant correlation (r = 0.775, P < 0.001) between financing of health care systems and their performance (data are available from the authors upon request).

Abuse in the Elderly—Cost Driver in a Health Care System?

The abuse of older persons within the community is a source of major concern in Europe and beyond. Although elder abuse has historically been considered primarily a social welfare issue and a problem of aging, a more contemporary viewpoint is that it is a population health issue.1 Findings from the cross-national abuse survey, ABUEL (Abuse of the Elderly in Europe), conducted in 2009 demonstrate that 26.0% of people aged 60–84 years living in 7 European urban communities (Stuttgart, Germany; Athens, Greece; Ancona, Italy; Kaunas, Lithuania; Porto, Portugal; Granada, Spain; Stockholm, Sweden) experienced some form of abuse during the 12 months prior to the survey. The survey provides an estimation of 433,256 people in this age group who experience any type of abuse every year.2Regardless of the nature or type of abuse, it may lead to physical and mental health problems and decreased quality of life for older persons. This may lead to more intensive use of health care services and additional expenditures for health systems. However, this association is investigated only occasionally and needs more attention from researchers and decision makers.

The Evaluation of Peculiarities in Staff Organization in General Hospitals in Lithuania

The aim of this study was to evaluate peculiarities of staff organizational systems in general hospitals in Lithuania. A cross sectional survey was carried out in 2009. Questionnaires were sent to all general hospitals in Lithuania with requests to chief executive officers or other senior managers in charge of personnel and human resource departments, to complete these surveys. Data was received from 58 hospitals (response rate 90.6%). Results revealed that only 14% of hospitals are using a full range of work or system practices relating to staff organization. The most common practices were: organization of staff development (96.5%), human resource or workforce planning (82.5%), and staff recruitment programs (82.5%). Individual career planning and employment probation was not widely practiced (36.8% and 40.4%). In most of hospitals (83.5%) the annual turnover of employees was low (≤5 %). Our study evaluated the difficulties hospitals had in finding new candidates for vacant staff positions. Results showed that physician recruitment was the most challenging task for hospitals. Participants of this study evaluated positively their competency in management of human resources. Nevertheless hospital managers expressed the desire for competency improvement in this area, particularly in relation to management for probation, personnel development and workplace analysis. doi:10.5200/sm-hs.2012.058