Search Results (39)

This article examines two-state proportional hazard rate models with unobserved heterogeneity specific to each state, a framework that is especially relevant for labor market transitions. To make estimation feasible in large longitudinal datasets, we implement hshaz2s, a Stata routine that uses analytical expressions for the gradient vector and Hessian matrix of the log-likelihood function through the dual second-order moment (d2 ml) method. The empirical application estimates a discrete-time duration model for transitions between employment and unemployment using Spanish labor market microdata for young low-skilled workers over 2000–2019. The results show that apprenticeship contracts are associated with lower exit rates from employment than other temporary contracts, but not with faster transitions from unemployment back into employment. The estimates also reveal substantial state-specific unobserved heterogeneity, with a large latent group characterized by persistent spells in both states. Analytical second-order information also markedly reduces convergence time under richer heterogeneity structures. Overall, the article makes this class of two-state hazard models operational for applied research and provides new evidence on apprenticeship and temporary contracts in Spain. Full article

Desmoid-type fibromatosis (DT) is a rare, locally aggressive soft tissue tumor with a frequently chronic course and substantial impact on health-related quality of life (HRQoL). While international studies have demonstrated considerable symptom burden and psychosocial impairment, data from Germany are lacking. This study aimed to assess HRQoL in German patients and to identify factors associated with HRQoL. In this cross-sectional analysis, adult patients with histologically confirmed DT completed the EORTC QLQ-C30 and the disease-specific Desmoid-Type Fibromatosis Quality of Life Questionnaire (DTF-QoL). HRQoL scores were compared with reference data from the German general population, German sarcoma patients, and international DT cohorts. Sociodemographic, disease-, tumor-, and treatment-related factors associated with HRQoL were examined using multivariate linear regression analyses. A total of 155 patients were included (69.7% female; mean age 45.0 years). Compared with the German general population, DT patients reported clinically relevant impairments in role, social, and emotional functioning and higher symptom burden, particularly pain, fatigue, and insomnia. Compared with sarcoma patients, DT patients showed better physical, role, and social functioning, while emotional functioning and symptom burden were largely comparable. German DT patients reported consistently worse HRQoL than Dutch/UK cohorts and moderately worse outcomes than Indian cohorts. Female gender, unemployment or disability pension, intensive multimodal treatment, multiple lines of systemic therapy, and tumor location in the lower extremities were independently associated with poorer HRQoL. DT is associated with sustained and clinically meaningful HRQoL impairment. HRQoL is driven primarily by psychosocial and treatment-related factors rather than disease duration, supporting the concept of DT as a chronic condition requiring long-term, multidisciplinary supportive care. Full article

Background: Research on psychological abuse among patients with breast cancer and survivors of breast cancer in Saudi Arabia is scarce. This study aimed to identify psychological abuse and its associated factors among these individuals. Methods: This cross-sectional study included 146 patients with breast cancer and survivors of breast cancer. Data were collected from December 2024 to April 2025 using a modified survey instrument based on the United Nations Economic Commission for Europe violence against women module. An online questionnaire comprised two parts: the first collected demographic characteristics, including age, education, employment, breast cancer diagnosis, and mastectomy duration, and the second assessed psychological abuse via four items: insults, belittlement/humiliation, intimidation, and undermining of relationship stability. The association between psychological abuse and sociodemographic factors was assessed using the chi-square test. Significant associations in bivariate analyses were subsequently analyzed using exploratory logistic regression. Results: Approximately 20.5% of participants reported experiencing at least one form of psychological abuse. The most commonly reported behaviors were insults and undermining of relationship stability (both 20.5%), followed by belittlement/humiliation (17.8%) and intimidation (15.1%). Bivariate analyses indicated a greater incidence of humiliation among women whose spouses were unemployed or retired, as well as among those with more than six children. Logistic analysis indicated that spouse unemployment or retirement (OR = 5.36, 95% CI 1.62–17.74, p = 0.006) and having more than six children (OR = 5.84, 95% CI 1.33–25.55, p = 0.019) were associated with belittlement/humiliation, even after FDR correction. No significant correlations were identified regarding patient age, education, mastectomy status, or duration since diagnosis. Model diagnostics demonstrated a satisfactory fit (Nagelkerke R² = 0.22; accuracy = 82.2%) and a lack of multicollinearity (VIF = 1.00–1.03). Conclusions: Psychological abuse affects around 20% of women diagnosed with breast cancer, especially those with unemployed spouses and larger families. These results highlight the need for psychological screening and couple-based therapies in cancer care to mitigate marital stresses and enhance survivors’ well-being. Full article

This article introduces new counterfactual standardization techniques for comparing duration distributions subject to random censoring through counterfactual decompositions. The counterfactual distribution of one population relative to another is computed after estimating the conditional distribution, using either a semiparametric or a nonparametric specification. We consider both the semiparametric proportional hazard model and a fully nonparametric partition-based estimator. The finite-sample performance of the proposed methods is evaluated through Monte Carlo experiments. We also illustrate the methodology with an application to unemployment duration in Spain during the period between 2004 and 2007, focusing on gender differences. The results indicate that observable characteristics account for only a small portion of the observed gap. Full article

In Poland—especially in the less developed eastern regions—the level of health-enhancing physical activity (HEPA) remains below the WHO recommendations, and its determinants are not yet fully understood. The study was conducted as part of the international EUPASMOS PLUS project on a sample of 173 adult individuals living in eastern Poland. Physical activity was measured using accelerometers worn continuously for seven days (24/7). The duration of moderate and vigorous physical activity as well as episodes of physical activity lasting at least 10 min were analyzed. The median daily MVPA time was 50 min, and the median VPA time only 10 s, both below WHO recommendations of 150 min/week of MVPA or 75 min/week of VPA. Overall, more than 70% of participants did not meet the recommended levels. The level of HEPA was found to be below WHO recommendations, especially among men, individuals over 50 years old, and those who were professionally inactive. Higher physical activity levels were recorded among women and younger participants. Significant correlations were found between HEPA level and self-rated health status (ρ = 0.28–0.38, p < 0.001), as well as body mass index and waist circumference (ρ ≈ −0.20 to −0.30, p < 0.01). Although statistically significant, the effect sizes were small to moderate, indicating limited explanatory power. Unemployment negatively affected MVPA and VPA levels, while household size positively correlated with physical activity. Interventions promoting HEPA should consider demographic and regional diversity, with particular focus on less active groups such as older adults and the unemployed. It is also necessary to develop new screening tools aimed at easy and quick diagnosis of social groups that should be targeted by HEPA promotion strategies. Full article

Introduction: This study aimed to explore the clinical and psychosocial characteristics associated with functional non-remission in young adults involuntarily hospitalized for a first episode of psychosis (FEP), focusing on the role of duration of untreated psychosis (DUP) and contextual vulnerabilities. Material and method: We conducted a retrospective monocentric study including 123 patients aged 18–30 who were involuntarily admitted between 2013 and 2023 for a first psychotic episode. Sociodemographic, clinical, and care-related data were extracted from medical records. Functional remission was defined as a Global Assessment of Functioning (GAF) score ≥70 at discharge. Univariate and multivariate logistic regressions were used to identify predictors of functional non-remission. Results: Only 48.8% of patients achieved functional remission at discharge. Social isolation, low socioeconomic status, unemployment, lack of structured activities, and a DUP ≥ 4 weeks were significantly associated with functional non-remission. After multivariate logistic regressions, DUP ≥ 4 weeks remained an independent predictor of functional non-remission. Conclusions: Involuntary admission per se was not a direct predictor of poor outcome. Our findings highlight the critical role of prolonged DUP and psychosocial vulnerability in the trajectory of early psychosis. Early detection strategies, psychosocial support integration, and individualized care planning are essential to improve outcomes among young people experiencing FEP under compulsory admission. Full article

Since Shannon’s pioneering work, the concept of entropy has been used in many major scientific fields. It is therefore a universal concept but also defined in different ways. Entropy is used in studies of system complexity and to investigate the information content of probability distributions. One of the areas of its applications is human lifespan, i.e., the link between entropy and the methods of survival analysis. These methods are also used in assessing the duration of any socio-economic phenomenon. The aim of this article is to assess the market situation on the basis of the entropy of duration in unemployment. This study determines the Shannon entropy, residual entropy, past entropy, and cumulative residual entropy under the assumption of an exponential distribution of duration. Ward’s hierarchical clustering and the Dynamic Time Warping measure were used to analyse entropy and its relationship with the unemployment rate. It was shown that not all of the analysed models determine the entropy of duration in unemployment well for an exponential distribution. It was substantiated that there is a similarity between the formation of the entropy of duration in unemployment and the registered unemployment rate. It is shown that high unemployment rates in the labour market are a destabilising element of the labour market, more so than crises. Full article

Background: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition characterized by persistent bladder-related pain and urinary symptoms, often refractory to conventional treatments. Sacral neuromodulation (SNM) has emerged as a promising therapeutic option for managing refractory IC/BPS. Methods: This retrospective study included 24 patients with IC/BPS treated with SNM between 2017 and 2022. Baseline and follow-up data were collected on pain, opioid use, urinary symptoms, and quality of life. Patients underwent a trial of tonic stimulation before permanent implantation. Continuous variables were reported as median (IQR) and categorical data as counts and percentages. Pre- and post-SNM differences were analyzed using the Wilcoxon rank-sum test. Kaplan–Meier analysis evaluated lead survival, and a Sankey diagram illustrated employment status transitions. Results: Patients had a median age of 54.5 years (IQR: 47–61), with 92% female. Subtypes included Type 1 IC/BPS (8.3%), Type 2 (45.8%), Type 3 (37.6%), and unknown type (8.3%). Median pain duration was 4.5 years (IQR: 3–7.3). SNM resulted in significant improvements in pain (NRS: baseline 8 [IQR: 8–9], last follow-up 3 [IQR: 2–4], p < 0.0001), opioid use (MME: baseline 20 [IQR: 10–40], last follow-up 0 [IQR: 0–10], p < 0.0001), urinary function (24-h voids: baseline 19 [IQR: 14.5–25.8], last follow-up 8 [IQR: 6–12], p < 0.0001), and quality of life (QOL) (EQ-5D-5L: baseline 0.50 [IQR: 0.36–0.56], last follow-up 0.83 [IQR: 0.76–0.89], p < 0.0001). Employment rates increased from 43.5% to 50%, and unemployment decreased from 8.7% to 4.2%. The median follow-up was 35 months (IQR: 28–53). Conclusions: SNM significantly improved pain, urinary symptoms, quality of life, and employment outcomes in patients with refractory IC/BPS. These findings highlight its efficacy as a minimally invasive and reversible option for managing this challenging condition. Full article

(1) Background: Home health care (HHC) services guarantee good patient care and family support. Understanding how we can better help our informal caregivers (ICs) by understanding their needs and the burden they experience is crucial. (2) Methods: A cross-sectional study was conducted from June to September 2024 at an HHC facility in Riyadh, Saudi Arabia. The 22-item Zarit Burden Interview (ZBI-22) was used to assess the caregiver burden (CB). ICs of patients with specific diseases (palliative, cancer, chronic, and dementia patients) and other factors were studied to identify any association with informal caregiver burden (ICB). (3) Results: Significant CB was defined as ZBI ≥ 21. The IC (384) participants comprised 119 caregivers of dementia patients, 104 caregivers of chronic patients, 83 caregivers of palliative patients, and 78 caregivers of cancer patients. The total mean of the ZBI-22 score among ICs was 31.66, representing a significant CB. The means by groups were as follows: chronic patients, 38.28; dementia patients, 34.97; cancer patients, 25.21; and palliative patients, 22.94. Other variables, such as the duration of care, education level, relationship with the patient, and unemployment, were associated with CB (p-value < 0.05). (4) Conclusions: The caregivers’ characteristics and the patients’ disease were associated with significant CB. More interventions from healthcare workers to support ICs are essential to release their burden. Full article

Therapeutic education (TE) plays a central role in the management of chronic inflammatory rheumatic diseases and inflammatory bowel disease. The BIOSECURE questionnaire was developed and validated in 2012 to assess self-management and patient safety, initially in rheumatology. Objectives: The aim of our study was to assess the knowledge of patients followed in both rheumatology and gastroenterology regarding their treatment through the BIOSECURE questionnaire. The secondary objective was to identify factors associated with a low level of knowledge according to the BIOSECURE questionnaire. Methods: This was a descriptive observational study, conducted in a single center at the Reims University Hospital between January 2023 and April 2024. The population was divided into quartiles. Participation in therapeutic education (TE) included receiving brochures about their disease or treatment and/or participation in group or individual TE sessions. We compared the patients with the lowest scores to those with the highest scores. Results: The study population consisted of 312 patients, including 32.05% with rheumatoid arthritis (RA) and 29.81% with Crohn’s disease. In our population, 82.03% had participated in therapeutic education, which included a TE session and/or the distribution of brochures about their disease and/or treatment. The median [IQR] BIOSECURE score was 71.04/100 [IQR 61.77–81.9]. When comparing patients with a low BIOSECURE score (<61.77) to those with a high score (>81.9), univariate factors associated with a low score were older age (p = 0.02), less participation in therapeutic education (p = 0.01), shorter duration of targeted therapy (p = 0.01), and lower level of education (p < 0.05). Conversely, patients who had received therapeutic education had a higher BIOSECURE score (p = 0.01). There was no difference in BIOSECURE scores based on place of residence, location of patient follow-up, route of administration, or type of inflammatory disease. In a multivariate analysis with a model including age, TE participation, and duration of targeted therapy, the results remained significant (p < 0.05). Discussion: We were able to compare the results of our study with two other French studies previously conducted on the same population of 677 patients undergoing biotherapy for chronic inflammatory rheumatism. The median BIOSECURE score in those studies was 73/100. In the study by Rat AC, published in 2017, the population was divided based on their BIOSECURE questionnaire results into three groups; they compared high and low response levels. Similarly to our study, a lower educational level and unemployment were associated with a lower rate of correct responses. The same was true for the absence of therapeutic education (TE) or distribution of brochures. Conclusions: The analysis of the BIOSECURE questionnaire in our population provides a practical message: factors associated with a low BIOSECURE score include older age, lower educational level, recent initiation of targeted therapy, and lack of participation in therapeutic education. This population could be a priority target for TE in order to ensure treatment safety for these patients. Full article

Labor market surveys usually measure unemployment duration in time intervals. In these cases, traditional duration models such as Cox regression and parametric survival models are not suitable for studying the duration of unemployment spells. In order to deal with this above issue, we use Han and Hausman’s ordered logit model for grouped durations, which has more flexibility than standard specifications. In particular, its flexibility arises from the fact that we do not need to specify any functional form for the baseline hazard function—it also circumvents problems associated with heterogeneity. The focus of interest is on the first unemployment duration of higher education graduates. The analysis is accomplished by using a large dataset from a graduate survey of Spanish university graduates. The results show that the university-to-work transition of higher education graduates is significantly associated with the graduate’s age, participation in internship programs, field of study, type of university, and gender. Specifically, graduates who participated in internship programs, engineering graduates, and graduates from private universities experience a smooth transition. Full article

The article aims to identify the firm-level effects of public support within the Polish Investment Zone (PIZ) on firms’ employment located in lagging regions of Poland, signalling insights into sustainable employment creation. Utilising a difference-in-differences framework and accounting for controls, including the firms’ size, age, leverage, other public aid programmes, subsidies, and firm-level fixed effects, our objective is to ascertain the average treatment effects (ATEs) of the programme, particularly concerning the creation of additional workplaces. To ensure the reliability of our findings, we conducted robustness checks utilising alternative econometric approaches and scrutinise changes in the duration of both the pre- and post-treatment periods. No significant ATEs were observed in the year of the treatment or in one to three years following treatment. This outcome remains robust to variations in the econometric approach, the set of variables considered, and alterations in the length of both pre- and post-treatment periods. This article contributes to an ongoing discussion marked by a lack of consensus regarding the effectiveness of special economic zones in fostering sustainable employment and reducing unemployment rates by presenting the effects of the PIZ and directing policy attention towards more qualitative aspects of created workplaces, fostering sustainable employment. Full article

Background: Although mood disorders are prevalent among systemic lupus erythematosus (SLE) patients, they are usually underrecognized. This study aimed to estimate the prevalence of anxiety and depression among Saudi SLE patients. Methods: This cross-sectional study was conducted among SLE patients from July 2022 to June 2023 in the Eastern Province of Saudi Arabia. A self-reported questionnaire was used to collect the data through validated tools including the Hamilton Anxiety Rating Scale-A and the Beck Depression Inventory score. Results: There were 133 females (91.7%) and 12 males (8.3%) included in this study. Based on the HAM-A score, 45.5% of participants had an anxiety disorder, and according to the BDI score, 46.2% had a depression disorder. Anxiety and depression were significantly associated with a longer duration of SLE, unemployment status, smoking, and the presence of comorbidities. Moreover, the present study found a significant association between depression and male gender. Conclusion: This study found that Saudi SLE patients have a high prevalence of both anxiety and depression. Therefore, SLE patients should be screened for neuropsychiatric disorders during routine follow-ups and managed as early as possible. Full article

Background: For a subgroup of people with rheumatoid arthritis (RA) and severe disability, insight into their limitations is crucial for adequate treatment. Aim: To describe the extent and nature of functional limitations in people with RA and severe disability and to explore the associations of the extent of the functional limitations with patient characteristics, disease characteristics, and outcome measures. Methods: Baseline data of 215 participants in an RCT on the (cost-)effectiveness of longstanding physiotherapy were used. Functional limitations were assessed with the Health Assessment Questionnaire Disability Index (HAQ-DI). The total HAQ-DI including eight domain scores were calculated. Associations between high HAQ-DI scores (≥2, yes/no) and other variables were examined using the Student’s t-test or Chi-squared test where appropriate. Results: The participants (90% women, age 58.8 ± 12.8 years) had a mean HAQ-DI score of 1.7 ± 0.5. The majority (56%) showed a moderate-to-severe disability in all domains. Higher HAQ-DI scores seemed to be associated with advanced age, longer disease duration, unemployment, joint replacements, and outcomes for daily functioning and physical quality of life, but not with measures of disease activity. Conclusions: Our findings indicate that a comprehensive assessment of all areas of daily activities in this subgroup is necessary in order to provide appropriate (non-)pharmacological care. Full article

Background: The worldwide increase in the prevalence and incidence of sleep disturbances represents a major public health issue. Among multiple determinants affecting sleep health, an individual’s socioeconomic status (SES) is the most ignored and underestimated throughout the literature. No systematic review on the relation between SES and sleep health has been previously conducted in Latin America. Methods: PRISMA guidelines were used. Results: Twenty articles were included in the final sample (all cross-sectional studies), and twelve among them were rated as fair or poor quality. Among these studies, 80.0% (n = 16) were performed in Brazil, 10.0% (n = 2) were performed in Peru, 5.0% (n = 1) were performed in Chile, and 5.0% (n = 1) were multicentric (11 countries). The combined total number of participants was N = 128.455, comprising 3.7% (n = 4693) children, 16.0% (n = 20,586) adolescents, and 80.3% (n = 103,176) adults. The results show the following: (1) The sleep outcomes analyzed were sleep duration, sleep quality/sleep disturbance, insomnia, excessive daytime sleepiness (EDS), obstructive sleep apnea (OSA)/sleep-disordered breathing (SDB) symptoms, and bruxism. (2) The most used determinants were income, education level, employment status/occupation, wealth/assets, and composite indices. (3) Higher SES was associated with shorter sleep duration. (4) Lower SES was associated with a decrease in sleep quality, less frequent snoring, more prevalent EDS, and sleep bruxism. (5) Lower education was associated with insomnia. (6) Higher education was associated with more sleep bruxism. (7) The pooled prevalence using a meta-analysis of the random effects model was 24.73% (95%CI, 19.98–30.19), with high heterogeneity (I² = 100%). (8) The prevalence of sleep disturbances decreased with high education (OR, 0.83; 95%CI, [0.69–0.99]; I² = 79%), while it increased with low income (OR, 1.26; 95%CI, [1.12–1.42]; I² = 59%), unemployment (OR, 2.84; 95%CI, [2.14–3.76]; I² = 0%), and being a housewife (OR, 1.72; 95%CI, [1.19–2.48]; I² = 55%). Discussion: This meta-analysis shows that lower SES (education, income, and work) was associated with sleep disturbances in Latin America. Therefore, sleep disturbance management should be addressed with a multidimensional approach, and a significant investment in targeted public health programs to reduce sleep disparities and support research should be made by the government before the situation becomes uncontrollable. Full article