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More people are working into older age, raising questions about how many hours they can work before their health becomes compromised. This paper models work-hour tipping points for mental health and vitality among older Australian workers aged 50–70 years. We use longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey, 2005–2016 (about 44,900 observations), and bootstrapping Three Stage Least Squares (3SLS) estimation techniques to adjust for reverse and reciprocal relationships between wages, work hours and health. Our approach corrects for heteroscedasticity in the system equation error terms, and we estimate models on the relatively healthy older adults who have remained employed into older age. Among these older workers we observe weekly thresholds of 39–40 hours beyond which mental health and vitality decline. This average, however, hides variability in work-hour limits linked to overall health and occupation. Thus, weekly tipping points for blue- and pink-collar jobs are 7–9 hours lower compared to white-collar jobs, and even wider gaps (11 hours) are apparent for workers with poorer physical functioning, which becomes common as people age. Our modelling reveals that age is not the biggest limiting factor for how many hours older adults can work, rather their health and the types of jobs are critical, and likely widen the gap in who ages successfully or not.
A combination of olanzapine and samidorphan (OLZ/SAM) that provides the efficacy of olanzapine while mitigating weight gain was recently approved by the FDA for the treatment of schizophrenia and bipolar I disorder. To improve communication of the OLZ/SAM benefit-risk profile, a structured framework was utilized.
The Benefit-Risk Action Team framework was used to evaluate OLZ/SAM, with analyses completed for each pivotal study. ENLIGHTEN-1 evaluated antipsychotic efficacy and safety. ENLIGHTEN-2 evaluated the weight profile of OLZ/SAM vs olanzapine. Benefit-risk outcomes were selected based on study outcome parameters, known risks of olanzapine and samidorphan, and public health importance. A subset of opioid antagonist risks was not assessed due to clinical trial exclusions; however, they were factored into the overall evaluation. Risk differences and confidence intervals were analyzed.
In ENLIGHTEN-1, OLZ/SAM had a lower risk of psychiatric discontinuation and nonresponse to treatment compared with placebo; higher risks of hyperprolactinemia, weight gain (≥7%), sedation, and worsening of fasting triglycerides and glucose, and no difference for fasting total and LDL cholesterol, neutropenia, orthostatic hypotension, and movement disorders. In ENLIGHTEN-2, OLZ/SAM had reduced risks of weight gain and waist circumference increase compared to olanzapine along with similar risks of relapse and psychiatric discontinuation and no difference in metabolic worsening, neutropenia, hyperprolactinemia, orthostatic hypotension, sedation, and movement disorders.
Based on this assessment, OLZ/SAM has comparable efficacy and a safety profile consistent with olanzapine, with reduced weight gain. A structured approach to assessing the benefit-risk profile of a product facilitates transparent evaluation and communication.
Patients with single ventricle heart disease are living into adulthood due to medical and surgical advancements but have significant physical comorbidities and an increased risk for psychological comorbidities compared to healthy subjects or those with other CHD diagnoses. This study aimed to systematically review psychological functioning in paediatric single ventricle heart disease.
Literature was searched using PubMed, Embase, PsycInfo, CINAHL Complete and Scopus. Peer-reviewed articles that included patients ages 0–25 years with single ventricle heart disease, and quantitative measures of psychological outcomes were included. Meta-analysis using a fixed-effect model was conducted for internalising and externalising t-scores, utilised by the Achenbach Child Behavior Checklist.
Twenty-nine records met the criteria for inclusion. 13/24 studies demonstrated increased risk for internalising disorders, such as anxiety/depression; 16/22 studies demonstrated risk for externalising disorders, such as attention or behavioural problems. Meta-analysis of four studies revealed that paediatric single ventricle heart disease patients had no significant difference in internalising and externalising t-scores compared to normative values.
The current review demonstrates the need for further studies to better understand psychological functioning in patients with single ventricle heart disease, with a majority of studies showing increased risk for psychological problems despite no difference seen in a small meta-analysis. This summary of the literature underscores the need for regular psychological screening, earlier intervention and integrated mental health therapies in paediatric single ventricle heart disease.
The current scientifically informed view of suicide is that, while complex, suicide is a health-related outcome. Driven by a convergence of health factors along with other psychosocial and environmental factors, suicide risk is multifactorial. Like most health outcomes, a set of genetic, environmental, and psychological/behavioral factors are relevant. It is critically important that health professionals develop a current understanding of suicide as older views have permeated and clouded societal understanding leading to assumptions and judgment that have silenced generations of people suffering suicidal struggles or loss of a loved one to suicide.
For which patients does this guidance apply? These principles should be applied in clinical decision making for a broader group of patients than just those with expressed suicidal ideation. Suicide risk includes any patients with elevated risk, many of whom do not present with a chief complaint of suicidal ideation. Their risk may be identified by a recent suicide attempt, or by a family history of suicide along with current psychosocial stressors, or the patient facing a life transition or loss along with deterioration in clinical status. (See Suicide Risk Assessment in Chapter 6). At the broadest level, current clinical standards (including those of The Joint Commission which is based in the USA but accredits health systems in the USA and internationally) consider all patients being treated in behavioral healthcare settings (psychiatric inpatient and outpatient care, psychological therapy, substances use disorder treatment, etc.) as having potentially elevated suicide risk.
The science of suicide risk and prevention is growing, making one thing very clear. While suicide risk involves a complex set of risk factors, the end common pathway is a life-threatening health crisis. As is the case with all health-related causes of death, a robust public health strategy can reduce mortality. This chapter provides a framework for understanding the public health approach to preventing suicide. Examples of effective public health suicide prevention strategies at national and regional levels are provided.
When engaging with persons at risk for suicide, healthcare professionals have an opportunity to make a real difference in the life of the patient. However, the situation can place a great deal of pressure on those trying to help. When dealing with a person struggling with suicidal thoughts, a variety of concerns might arise
The proportion of time a person spends in direct contact with a health professional is minute. We can make the most of our direct encounters by following best practices for connection, assessment and respond described in Chapters 5, 6, and 7. But ultimately, we must also consider how to extend the impact of our interventions beyond our healthcare environment into the lives and networks of the people we serve.
Cultural factors including conscious and unconscious beliefs and attitudes have an influence on suicide risk for individuals, families, and populations. Science shows clearly that suicide risk draws on multiple risk and protective factors at the individual and environmental levels. By understanding how particular beliefs and stigma may impact suicide risk, healthcare professionals can communicate more effectively with patients from different cultural backgrounds for the purpose of both risk assessment and patient care. For example, eliciting the patient’s perspectives about particular life challenges, about mental healthcare, and even about suicide itself, can be useful in engaging the patient in both self-care and treatment planning.