Life satisfaction and age: Dealing with underidentification in age-period-cohort models

Recent literature typically finds a U shaped relationship between life satisfaction and age. Age profiles, however, are not identified without forcing arbitrary restrictions on the cohort and/or time profiles. In this paper we report what can be identified about the relationship between life satisfaction and age without applying such restrictions. Also, we identify the restrictions needed to conclude that life satisfaction is U shaped in age. For the case of Germany, we find that the relationship between life satisfaction and age is indeed U shaped, but only under the untestable condition that the linear time trend is negative and that the linear trend across birth cohorts is practically flat.     

大学生主观幸福感和生活事件的关系

目的研究大学生主观幸福感和生活事件的关系,为高校大学生心理健康教育提供依据。方法运用主观幸福感问卷和青少年生活事件量表,对769名大学生进行测试。结果大学生主观幸福感处于中等偏上水平。主观幸福感和生活事件均存在性别差异、年级差异、城乡差异;生活事件分别可以解释总体主观幸福感、生活满意度、正性情感及负性情感变异的5.4%,3.7%,1.3%和17.3%。不喜欢上学、学习负担重、受人歧视冷遇、亲友死亡、与教师关系紧张、考试失败或不理想、受批评或处分、长期远离家人不能团聚、被盗或丢失东西、家庭经济困难、与人打架、家庭施加学习压力等是影响大学生主观幸福感的主要生活事件,可以不同程度地解释总体主观幸福感、生活满意度、正性情感及负性情感变异的14.8%,13.9%,8.4%和30.0%。结论生活事件对大学生主观幸福感有显著影响。     

Well-being and menopause: An investigation of purpose in life,self-acceptance and social role in premenopausal,perimenopausal and postmenopausal women

OBJECTIVES: Many studies have investigated anxiety and depression during the menopausal transition. However, there is little understanding of positive aspects of well-being among menopausal women. This paper reports on two studies which investigated how menopausal stage and age accounted for how women felt about their purpose in life, self-acceptance and social role. METHOD: In Study One, 304 women from a community sample completed structured questionnaires which included questions relating to demographic background and two subscales of the Psychological Well-being Inventory: purpose in life and self-acceptance. In Study Two, 203 participants from Study One returned a follow-up structured questionnaire related to purpose in life and social role. RESULTS: Study One found that the effects of age group and menopausal group could not be separated: All women felt they would be more positive about these well-being measures in the future than they had been in the past and at present. Study Two found that women who were perimenopausal and postmenopausal did not feel as positive about their role/s in life as premenopausal women, regardless of their age. CONCLUSIONS: The results suggest that the menopause may indicate to women that their role/purpose in life is changing. It is important that any understanding of the menopause incorporate psychosocial aspects of women's lives. Further longitudinal studies are needed to explore well-being factors and the menopause.     

我国2006-2030年乙肝免疫预防经济学效果的评价和预测

目的 对我国2006-2030年乙型病毒性肝炎（乙肝）免疫预防经济学效果做出评价和预测,为消除乙肝策略制订提供依据。方法 采用决策分析马尔科夫模型,以新生儿数为队列人群,从医疗卫生和全社会角度计算成本、效益和效果,包括避免的乙肝病毒（hepatitis B virus,HBV）感染数和乙肝相关疾病数,获得的质量调整期望寿命（quality adjusted life years,QALYs）。以多获得一个QALYs所需成本、净效益和效益成本比（benefit cost ratio,BCR）为分析指标。结果 2006-2015年间,从医疗卫生和全社会角度,我国乙肝免疫预防投入分别为6 256.64亿元和8 125.03亿元,净收益为43 571.85亿元和53 703.80亿元,BCR为7.96和7.61;多获得一个QALYs需要的投入分别为6 471.53元和10 023.55元;累积获得0.96亿个QALYs。2016-2030年间,从医疗卫生和全社会角度,所需投入分别为7 500.15亿元和10 290.86亿元,将获净效益72 729.35亿元和89 818.08亿元,BCR分别为9.45和8.79;多获得一个QALYs所需投入分别为5 398.36元和8 389.38元;累积将获得1.37亿个QALYs。结论 我国近10年实施乙肝免疫预防策略,具有较高的成本效益和成本效果价值。未来15年,需要持续高水平实施乙肝免疫预防策略,将会获得更高效益和效果。     

Economic analysis of the global polio eradication initiative

The global polio eradication initiative (GPEI), which started in 1988, represents the single largest, internationally coordinated public health project to date. Completion remains within reach, with type 2 wild polioviruses apparently eradicated since 1999 and fewer than 2000 annual paralytic poliomyelitis cases of wild types 1 and 3 reported since then. This economic analysis of the GPEI reflects the status of the program as of February 2010, including full consideration of post-eradication policies. For the GPEI intervention, we consider the actual pre-eradication experience to date followed by two distinct potential future post-eradication vaccination policies. We estimate GPEI costs based on actual and projected expenditures and poliomyelitis incidence using reported numbers corrected for underreporting and model projections. For the comparator, which assumes only routine vaccination for polio historically and into the future (i.e., no GPEI), we estimate poliomyelitis incidence using a dynamic infection transmission model and costs based on numbers of vaccinated children. Cost-effectiveness ratios for the GPEI vs. only routine vaccination qualify as highly cost-effective based on standard criteria. We estimate incremental net benefits of the GPEI between 1988 and 2035 of approximately 40-50 billion dollars (2008 US dollars; 1988 net present values). Despite the high costs of achieving eradication in low-income countries, low-income countries account for approximately 85% of the total net benefits generated by the GPEI in the base case analysis. The total economic costs saved per prevented paralytic poliomyelitis case drive the incremental net benefits, which become positive even if we estimate the loss in productivity as a result of disability as below the recommended value of one year in average per-capita gross national income per disability-adjusted life year saved. Sensitivity analysis suggests that the finding of positive net benefits of the GPEI remains robust over a wide range of assumptions, and that consideration of the additional net benefits of externalities that occurred during polio campaigns to date, such as the mortality reduction associated with delivery of Vitamin A supplements, significantly increases the net benefits. This study finds a strong economic justification for the GPEI despite the rising costs of the initiative.     

Systematic review of health economic evaluation studies of dengue vaccines

Objectives

To review the literature on economic evaluation of dengue vaccination to produce evidence to support a local cost-effectiveness study and to subsidize the decision to introduce a dengue vaccine in the Brazilian National Immunization Program. Methods: We systematically searched multiple databases (MEDLINE (via PubMed), EMBASE, SCOPUS, NHS Economic Evaluation Database (NHS EED), HTA Database (via Centre for Reviews and Dissemination – CRD) and LILACS), selecting full HEEs of dengue vaccine. Two independent reviewers screened articles for relevance and extracted the data. The methodology for the quality reporting was assessed using CHEERS checklist. We performed a qualitative narrative synthesis. Results: Thirteen studies conducted in Asian and Latin America countries were reviewed. All studies were favorable to the incorporation of the vaccine. However, the assumptions and values assumed for vaccine efficacy, safety and duration of protection, as well as the choice of the study population and the type of model used in the analyses, associated to an insufficient reporting of the methodological steps, affect the validity of the studies’ results. The quality reporting appraisal showed that the majority (8/13) of the studies reported less than 55% of the CHEERS checklists’ items. Conclusions: This systematic review shows that the economic evaluation of dengue vaccination did not adhere to key recommended general methods for economic evaluation. The presented cost-effectiveness results should not be transferred to other countries. It is recommended to conduct studies with local epidemiological and cost data, as well as assumptions about vaccination that reflect the results observed in clinical trials.     

Well-being in the nursing home – a methodological approach towards the quality of life

Which dimensions have a decisive influence on the quality of life in nursing homes and which objective conditions could and should be changed to improve the situation of the residents of nursing homes? Can such questions be answered within the framework of an approach based on a daily life experience when life in nursing homes is so different from the every day life outside? Although there is a pressing need for answers to these questions, very little research has been conducted in this area to date. The furthering of empirically based knowledge, the development of concepts and the refinement and adaptation of research instruments are all crucial tasks currently facing researchers in this field. There are no one-dimensional causal relationships between objective conditions and subjectively experienced life quality. The latter is multidimensional and multidirectional, it changes over time and it varies according to cognitive-psychic and physical conditions. The objective of the project reported here was to study the quality of life in nursing homes from a radical subjective perspective that is reflected in the theoretical concepts and the methodological approaches adopted. Life quality in nursing homes can be enhanced and it can be hindered – and in both cases there are objective and subjective factors to be observed. In order to fulfil two tasks simultaneously – obtaining basic empirical insights and developing concepts and methods – we established a multi-method approach within the framework of an interdisciplinary perspective. Persons in nursing homes with slight or moderate cognitive impairments can be interviewed by standardised instruments, a fact which is mainly mirrored in the orientation capacity. For random sampling purposes, a systematically developed gradation of responsiveness is a useful guiding criterion. Additionally, life quality research in the setting of nursing homes requires a methodological approach on different levels with adaptable methods and instruments. The results from this study show that the degree of responsiveness and capacity of orientation are part of the life quality dimension and influence the results in terms of well-being which, in turn, is only one dimension among others. Therefore, life quality in the nursing home can be framed on three levels: individual resources, structural resources, well-being. The explanatory power of resources for subjectively felt well-being is shown in such relevant action-contexts as, for example, home admittance.     

甲型H1N1流感暴发疫情处置的卫生经济学评价

目的 从卫生经济学角度评价南宁市2009～2011年学校甲型H1N1流感暴发疫情处置的效果和效益,探索传染病暴发疫情处置的卫生经济学评价方法.方法 采用成本-效果和成本-效益分析方法对南宁市2009～2011年学校甲型H1N1流感暴发疫情处置过程中的投人情况及相关资料进行分析.结果 通过采取疫情防控措施减少了41 899人发病,减少了35 882 303.60元的损失,效果-成本比为18.91,效益-成本比为161.93.按照疫情发生时间划分为3个阶段,不同阶段疫情处置措施的经济学效果不同,效果-成本比和效益-成本比均以第三阶段为最高,其次是第二阶段,第一阶段最低.结论 疫情处置措施的实施取得了显著的社会效益和经济效益,但是防控措施的应用应强调以科学为依据.     

幼儿园教师心理幸福感及其相关因素分析

目的探讨幼儿教师心理幸福感状况,为维护幼儿教师的心理健康提供参考。方法采用Ryff心理幸福感量表,通过分层整群抽样,对河北省11所幼儿园437名教师进行调查分析。结果已婚教师的总体幸福感、自主幸福感、掌握环境、生活目标、自我接纳幸福感显著高于未婚教师;有子女幼儿教师的自主性和掌握环境幸福感水平高于无子女幼儿教师;幼儿园管理及辅助人员的自主幸福感水平显著高于保育员和教养员;不带班教师的自主幸福感高于带班教师。在自主性因子上,城乡来源与学历之间存在交互作用(P=0.030):农村教师学历越高自主幸福感越低;中专及以下与大专学历教师间的差异无统计学意义,但本科及以上学历城市教师显著高于农村教师。结论婚姻、子女、岗位、带班情况影响幼儿教师心理幸福感。     

河池地区农村留守儿童主观幸福感研究

目的了解农村留守儿童主观幸福感及其影响因素,为提高农村留守儿童主观幸福感提供相关依据。方法采用青少年主观幸福感量表和自编量表,对农村留守儿童442名和非留守儿童434名进行问卷调查。结果农村留守儿童与非留守儿童在生活满意度和积极情感体验上差异有统计学意义,在消极情感体验上差异无统计学意义。多元回归分析显示,农村留守儿童留守时间、与外出父母交流频次、家庭经济状况、学习成绩、兄弟姐妹个数、朋友个数等因素影响其主观幸福感。结论与非留守儿童相比,农村留守儿童生活满意度较低,但农村留守儿童体验到更多的积极情感。     

小学教师的主观幸福感及其影响因素分析

目的探讨小学教师主观幸福感及其影响因素,为提高教师生活质量提供参考。方法采用总体幸福感量表、艾森克个性问卷(EPQ)和社会支持量表对小学教师328名进行调查。结果已婚教师在情感和行为控制因子分与未婚教师差异有显著性。主观幸福感水平在不同性别、教师类型(骨干教师和普通教师)、已婚和未婚教师间差异无显著性。总体幸福感评分与主观支持评分、EPQ-N分、经济状况呈显著相关。结论主观支持、神经质与经济状况是影响小学教师主观幸福感的重要因素。     

The U-shape without controls: A response to Glenn

This paper is a continuation of results reported in our article “Is well-being U-shaped over the life cycle?” (Blanchflower & Oswald, 2008). It provides new evidence that well-being follows a curve through life. We use data on half a million randomly sampled individuals across eight major European nations. Importantly, we show that in this set of countries there is a U-shape even in unadjusted data, that is, without the inclusion of control variables. But we also advise against a focus on elementary bivariate associations.     

应用Reed-Frost模型探讨风疹爆发应急性预防接种近期卫生经济学效果

为探讨风疹应急性预防接种的近期卫生经济学效果,通过对马鞍山市12所小学风疹爆发进行流行病学调查,并按卫生经济学研究方法收集风疹爆发的成本资料.首先利用1所小学自然爆发至终止的数据建立本次风疹爆发的Reed-Frost模型,以此模型预测其它11所小学经应急性预防接种的理论风疹发病人数,进而推算应急性预防接种的成本-效果与成本-效益.结果显示:11所小学风疹的理论显性发病例数为1 157例,应急性预防接种减少了风疹发病1 050例;应急性预防接种预防1例风疹的成本34.23元(人民币).应急性预防接种的成本效益比(CBR)为1/3.02,增量成本效益比(ICBR)为1/4.80.提示风疹爆发应尽早进行风疹疫苗的应急性预防接种,且应急性预防接种是控制风疹爆发经济有效的措施.     

Well-being losses by providing informal care to elderly people: Evidence from 310 caregivers in Shanghai,China

A series of policies aimed toward rational resource allocation of long-term care have being actively discussed since the launch of the social long-term care insurance in Shanghai, and it is important to take a societal perspective for informed decision-making. This study aims to explore factors that are associated with well-being of informal caregivers in Shanghai, and to provide empirical evidence of application of an established well-being valuation method to monetise informal caregivers' well-being losses in a developing country. 310 informal caregivers of applicants for social long-term care insurance in Shanghai were interviewed. Univariate and multivariate analyses were conducted to explore the associated factors with life satisfaction of the caregivers. The monetary values of an additional hour of caregiving with and without specification of care tasks were estimated by the well-being valuation method. Life satisfaction was consistently associated with monthly income, health status, and caring hours of the caregivers. The money needed to compensate one additional hour of caring per week was 12.58 CNY (0.3% of the monthly income), and 96.95 CNY (2.0% of the monthly income) for activities of daily living (ADL) tasks. Income, health status, and caregiving are significantly associated with well-being of informal caregivers. Caregivers in relatively poor health condition and/or involved in more ADL tasks should be particularly considered in supporting policies in Shanghai.     

Associations between neighborhood perceptions and mental well-being among older adults

This study examined whether perceived neighborhood factors were associated with positive well-being in older adults using data from the English Longitudinal Study of Ageing. Neighborhood perceptions were assessed at baseline (2006/2007) and three measures of well-being – hedonic, eudaimonic and evaluative – were assessed at baseline and follow-up (2010/2011) for 6134 participants. In cross-sectional and longitudinal analyses, negative neighborhood perceptions were associated with poorer well-being on all three measures. These associations remained significant after adjusting for a range of sociodemographic and health status variables and depressive symptoms.     

北京市高中生主观幸福感及其影响因素分析

目的了解北京市高中生主观幸福感状况及其影响因素，为高中生心理健康教育提供依据。方法采用幸福感量表、自尊量表、中学生心理健康诊断测验对北京市1118名高中生进行测查。结果高中生总体平均主观幸福感处于中等水平。主观幸福感与自尊量表总分呈中度负相关，主观幸福感与中学生心理健康诊断测验总分及其8个分量表呈负相关。多元逐步回归分析显示，学习压力、同学关系、学习成绩、健康状况和父母关系是高中生主观幸福感的影响因素。结论学生的主观幸福感水平是学校、家庭、社会共同作用的结果。学习成绩与素质教育并不矛盾，应把素质教育的切入点放在找出二者的关联上，从而整合资源，使之相互促进、协调发展。     

Determinants of primary and non-primary informal care-giving to home-based palliative care cancer care-recipients in Ontario,Canada

Informal care plays an important role in the care of care-recipients. Most of the previous studies focused on the primary caregivers and ignored the importance of non-primary caregivers. Moreover, little is known about the provision of informal care in the context of home-based palliative care. The purpose of this study was to examine the provision of primary and non-primary informal care-giving and their respective determinants. Primary caregivers assume the main responsibility for care, while non-primary caregivers are those other than the primary caregiver who provide care-giving. A longitudinal, prospective cohort design was conducted and data were drawn from two palliative care programs in Canada between November 2013 and August 2017. A total of 273 caregivers of home-based palliative care cancer care-recipients were interviewed biweekly until the care recipient died. The outcomes were the propensity and intensity of informal care-giving. Regression analysis with instrumental variables was used. About 90% of primary caregivers were spouses and children, while 53% of non-primary caregivers were others rather than spouses and children. The average number of hours of primary and non-primary informal care-giving reported for each 2-week interview period was 83 hr and 23 hr, respectively. Hours of home-based personal support workers decreased the intensity of primary care-giving and the likelihood of non-primary care-giving. Home-based nursing visits increased the propensity of non-primary care-giving. The primary care-giving and non-primary care-giving complement each other. Care recipients living alone received less primary informal care-giving. Employed primary caregivers decreased their provision of primary care-giving, but promoted the involvement of non-primary care-giving. Our study has clinical practices and policy implications. Suitable and targeted interventions are encouraged to make sure the provision of primary and non-primary care-giving, to balance the work of the primary caregivers and their care-giving responsibility, and to effectively arrange the formal home-based palliative care services.     

Life satisfaction in patients with chest pain subsequently diagnosed as coronary heart disease – connection through depressive symptoms?

The aim of this study was to investigate factors associated with life dissatisfaction in symptomatic patients (n = 144) with chest pain subsequently diagnosed as coronary heart disease (CHD) by coronary angiography. Life dissatisfaction was assessed with a four-item life satisfaction scale (LS), depression with the 21-item Beck Depression Inventory (BDI) and other psychiatric symptoms with the symptom check list (SCL). DSM-III-R Axis I and Axis II psychiatric diagnoses were performed by means of the Structured Clinical Interview. All assessments took place one day before angiography. Twenty-four per cent of CHD patients were dissatisfied with their lives. Life dissatisfaction was associated with being unmarried. Dissatisfied patients had Axis I mental disorders and Axis II personality disorders more frequently than others. Psychiatric and depressive symptoms according to the SCL and BDI, respectively, were also higher among dissatisfied patients. In multiple logistic regression analyses, mental disorders were related to life dissatisfaction when age, sex, employment status, New York Heart Association class, duration of chest pain symptoms and work load were controlled in the model. Married subjects had a lower probability of being dissatisfied with their lives than other subjects (Odds Ratio, OR: 0.23). When BDI scores were included in the model, the only factor independently associated with life dissatisfaction was the severity of depressive symptoms (OR: 1.81). To conclude, life dissatisfaction is not primarily determined by the severity of CHD but by the existence of depressive symptoms.     

Validating a Self-report Measure of Global Subjective Well-being to Predict Adverse Clinical Outcomes

Objectives: To examine the relationship between a single-item indicator of subjective well-being (SWB) and (1) medical conditions frequently associated with adverse clinical outcomes, (2) health-related quality of life and depressive symptoms, (3) global self-rated health (SRH), and (4) increased risk of adverse clinical outcomes. Methods: Self-reports of depressive symptoms and HRQoL were obtained by mail surveys from 2317 men and women with hypertension and coronary artery disease. Subjects rated their overall SWB at clinic visits. Mean scores of subjects reporting excellent SWB were compared to scores of subjects rating SWB for HRQoL domains and depressive symptom scores using ANOVA. The association between SWB and individual endpoints was assessed using the χ² test. The adjusted association between SWB and the composite endpoint of mortality, nonfatal stroke or nonfatal myocardial infarction was estimated using binary logistic regression. Results: Excellent SWB was associated with fewer depressive symptoms and more favorable HRQoL scores. The proportion of subjects suffering one of the adverse health outcomes within 1 year increased (p < 0.002) with poorer reported SWB. One-year mortality was higher in subjects with poor/fair SWB (5.7%) than in subjects with good or excellent SWB (3.4 and 4.5%, respectively; p = 0.05). Subjects rating their SWB as poor/fair were more likely to suffer a nonfatal stroke (unadjusted RR = 2.67, 95% CI = 1.24, 5.74). SWB added to the prediction of adverse outcomes after adjusting for demographics, baseline medical conditions, and SRH (OR = 2.49, 95% CI = 1.51, 4.11). Conclusion: A global indicator of SWB may be a useful addition to a screening instrument for identifying persons at increased risk for adverse health outcomes.