Cross-border mobility in European countries: associations between cross-border worker status and health outcomes

in BMC Public Health (2021), 21

Mobility of workers living in one country and working in a different country has increased in the European Union. Exposed to commuting factors, cross-border workers (CBWs) constitute a potential high-risk ... [more ▼]

Mobility of workers living in one country and working in a different country has increased in the European Union. Exposed to commuting factors, cross-border workers (CBWs) constitute a potential high-risk population. But the relationships between health and commuting abroad are under-documented. Our aims were to: (1) measure the prevalence of the perceived health status and the physical health outcomes (activity limitation, chronic diseases, disability and no leisure activities), (2) analyse their associations with commuting status as well as (3) with income and health index among CBWs. Based on the ‘Enquête Emploi’, the French cross-sectional survey segment of the European Labour Force Survey (EU LFS), the population was composed of 2,546,802 workers. Inclusion criteria for the samples were aged between 20 and 60 years and living in the French cross-border departments of Germany, Belgium, Switzerland and Luxembourg. The Health Index is an additional measure obtained with five health variables. A logistic model was used to estimate the odds ratios of each group of CBWs, taking non-cross border workers (NCBWs) as the reference group, controlling by demographic background and labour status variables. A sample of 22,828 observations (2456 CBWs vs. 20,372 NCBWs) was retained. The CBW status is negatively associated with chronic diseases and disability. A marginal improvement of the health index is correlated with a wage premium for both NCBWs and CBWs. Commuters to Luxembourg have the best health outcomes, whereas commuters to Germany the worst. CBWs are healthier and have more income. Interpretations suggest (1) a healthy cross-border phenomenon steming from a social selection and a positive association between income and the health index is confirmed; (2) the existence of major health disparities among CBWs; and (3) the rejection of the spillover phenomenon assumption for CBWs. The newly founded European Labour Authority (ELA) should take into account health policies as a promising way to support the cross-border mobility within the European Union. [less ▲]

Orienter les soins vers le patient partenaire. Un livre blanc pour la Grande Région

Book published by INTERREG APPS (2020)

Les différents chapitres de ce livre proposent une approche holistique pour faire évoluer le système de santé vers le partenariat de soins. Résultat de trois années de recherche et de concertation, le ... [more ▼]

Les différents chapitres de ce livre proposent une approche holistique pour faire évoluer le système de santé vers le partenariat de soins. Résultat de trois années de recherche et de concertation, le Livre Blanc s’appuie sur des recherches documentaires (analyse de la littérature scientifique et de la législation spécifique de chaque pays), des entretiens et des enquêtes auprès de nombreux acteurs, le repérage et l’analyse d’initiatives en GR et la discussion orientée vers le consensus. Par ailleurs, les propositions de recommandations ont été élaborées et discutées lors d’un séminaire interrégional réalisé en décembre 2019. Le Livre Blanc est structuré en 5 parties qui s’adressent chacune à un public ciblé. La première partie situe le contexte dans lequel s’est réalisé le projet et décrit la méthodologie du programme. La seconde partie est consacrée aux aspects réglementaires de l’approche patient partenaire et à leurs conséquences sur les pratiques et les initiatives analysées sur le terrain. Elle est destinée de manière privilégiée aux mandataires politiques. La troisième partie propose une réflexion sur le développement de stratégies de partenariat au niveau des institutions de santé. Elle concerne les gestionnaires des établissements de santé. La quatrième partie vise à amener les professionnels à s’interroger sur ce que le partenariat de soins peut leur apporter dans leurs pratiques de soins. Elle s’adresse, en particulier, aux acteurs en contact direct avec les patients. La cinquième et dernière partie suggère différentes voies possibles de développement de l’APPS dans les domaines de l’enseignement et de la recherche. Toutes ces parties s’adressent bien évidemment au patient, qui est au coeur de l’APPS. Les prises de position proposées par ce Livre Blanc s’appuient sur les données collectées par le consortium de recherche de 2017 à 2020. Dès lors, ce document ne peut être exhaustif et est appelé à évoluer, basé davantage sur une fonction vectrice de normes que de règles. Pour davantage d’information et pour connaitre nos activités et nos publications, rendezvous sur le site web du projet APPS (https://www.patientpartner.org/). [less ▲]

Adolescent Body Dissatisfaction in ContrastingSocioeconomic Milieus, Coming from a French andLuxembourgish Context

in International Journal of Environmental Research and Public Health (2020), 17(61),

: To analyze the relationships between body mass index (BMI), ideal body,current declared body shape, and gap between ideal and declared body shape, and the associationsthat these have with social and ... [more ▼]

: To analyze the relationships between body mass index (BMI), ideal body,current declared body shape, and gap between ideal and declared body shape, and the associationsthat these have with social and cultural factors among 329 adolescents (11 to 15 years i.e., at two stagesof adolescence, the early and late adolescence), attending an international school in Luxembourg,and 281 from Paris.Methods:A cross-sectional survey was conducted using an online questionnaire.Missing data were addressed using the data augmentation method in a Bayesian framework.Results: For both sets, higher the BMI and bigger their current body shape (CBS), the slimmertheir ideal body shape, especially for those who perceive a link between body shape and beauty.For girls, slimness is a shared ideal; for boys, older they are, more they want a muscular body shape.Most students want slimmer bodies, but in affluent or intermediate social milieu students in relationsto identification to personalities such as celebrities, while students from modest milieus, this isexpressed in relation to success in love. In addition, they declared that their “talk diet with friends”were associated with large gap between ideal and declared body shape.Conclusions:A social controlnorm was revealed involving a displacement of values affecting body weight and health in the latestage of adolescence to early adolescence, especially for boys. [less ▲]

Hospital practices for the implementation of patient partnership in a multi-national European region

in European Journal of Public Health (2020)

The extent to which patients are involved in their care can be influenced by hospital policies and interventions. Nevertheless, the implementation of patient participation and involvement (PPI) at the ... [more ▼]

The extent to which patients are involved in their care can be influenced by hospital policies and interventions. Nevertheless, the implementation of patient participation and involvement (PPI) at the organisational (meso) level has rarely been assessed systematically. The aim of this study was to assess the occurrence of PPI practises in hospitals in Belgium, France, Germany and Luxembourg and to analyze if, and to what extent, the hospital vision and the presence of a patient committee influence the implementation of PPI practises. Methods: A cross-sectional study was carried out using an online questionnaire in hospitals in the border regions of the four countries. The data were analyzed for differences between regions and the maturity of PPI development. Results: Full responses were obtained from 64 hospitals. A wide range of practices were observed, the degree of maturity was mixed. A majority of hospitals promoted patient partnership in the hospital's philosophy of care statement. However, the implementation of specific interventions for PPI was not found uniformly and differences could be observed between the countries. Conclusions: Hospitals in the region seem to be motivated to include patients more fully, however, implementation of PPI interventions seems incomplete and only partially integrated into the general functioning of the hospitals. The implementation of the concept seems to be more mature in the francophone part of the region perhaps due, in part, to a more favourable political context. [less ▲]

Quality of doctor-patient communication in cardiovascular diseases and secondary preventive adherence. The role of gender

in Innovative ideas in Health Psychology (2017)

The doctor-patient communication intervenes on the preventive behaviours of chronic patients by reducing their risk factors – in cardiovascular diseases: hypertension, overweight, obesity ... [more ▼]

The doctor-patient communication intervenes on the preventive behaviours of chronic patients by reducing their risk factors – in cardiovascular diseases: hypertension, overweight, obesity, hypercholesterolemia, diabetes. What are the associations between the quality of communication and the improvement of secondary preventive behaviours? How does gender influence these relationships? Methods: 1,289 patients who underwent a coronary angiography in 2008/09 in Luxembourg completed a self-administered questionnaire at the time of the visit, and at a five-year follow-up. The probability of improving each preventive eating behaviour (decrease of salt, sugar, fat consumption and increase of fruits/vegetables), and the quality of doctor-patient communication (5-item scale) were evaluated using logistic regression models. Sex was introduced in interaction with the communication score. Findings: Among hypertensive respondents, a higher quality of communication was associated with a higher probability of decreasing the salt intake in women (OR [95% CI]: 1.139 [1.060; 1.223]) whereas in men, the OR was only 1.086 [1.017; 1.159]. ORs were also higher in women among patients with hypertension, overweight and hypercholesterolemia regarding the increase of fruits/vegetables consumption; among patients with diabetes and hypercholesterolemia regarding sugar decrease or cessation; and among patients with overweight and hypercholesterolemia regarding fat reduction or stop. ORs were slightly higher among men only among diabetic and obese patients, regarding the increase of fruits/vegetables consumption. Discussion: The quality of the communication showed an effect on the adoption of secondary preventive eating behaviours, especially in women patients. Motivational interviews could encourage, especially men patients, to adhere to the recommendations about lifestyle change. [less ▲]

Impact of Patients’ Communication with the Medical Practitioners, on Their Adherence Declared to Preventive Behaviours, Five Years after a Coronary Angiography, in Luxembourg

in PLoS ONE (2016), 11(6), 0157321

Patients of the National Institute of Cardiac Surgery and Interventional Cardiology in Luxembourg who underwent coronary angiography were surveyed for hypertension, hypercholesterolemia, diabetes and ... [more ▼]

Patients of the National Institute of Cardiac Surgery and Interventional Cardiology in Luxembourg who underwent coronary angiography were surveyed for hypertension, hypercholesterolemia, diabetes and overweight/obesity between 2008/9 and 2013/4. For each cardiovascular risk factor (CVRFs), we analysed the associations between the quality of the patients' communication with the medical practitioner and their adherence declared to preventive behaviours. Methods 1,289 completed a self-administered questionnaire on communication with the medical practitioner (P’Com-5 items scale; Cronbach 0.87). 61.8%stopped smoking, 57.9% reduced or stopped their consumption of salt, 71.9% of fat, and 62.8%of sugar, and whereas 65% increased their consumption of fruit and vegetables and 19.8% increased their physical activity. Around 37% reported having made changes following their doctor's advice. 90% were followed by a cardiologist and 95.9% by an attending physician. Results No link was observed between declaration of physical activity, smoking, fats, and quality of communication. Significant associations: for increased consumption of fruit and vegetables was linked with the quality of doctor-patient communication when patients were overweight (OR = 1.081), obese (OR = 1.130), hypercholesterolemic (OR = 1.102), hypertensive (OR = 1.084) or diabetic (OR = 1.103). Reduction in salt intake was linked only to patients with hypertension (OR = 1.102), whereas reduction or cessation of sugar consumption was linked to overweight (OR = 1.093), and more so obese, (OR = 1.106), hypercholesterolemics (OR = 1.103) and diabetics (OR = 1.173). Conclusions Good doctor-patient communication was related to nutrition, particularly increased consumption of fresh fruits and vegetables. Accurate perception of CVRFs by both patients and medical practitioners is essential for CV protection. The aim of instructing patients is to encourage them to make informed decisions about how to change their lifestyle. In routinely, P’Com-5 scale can collect data to assess the improvement of the professional skills. It can be used in medical training to enhance the quality of the therapeutic communication, especially for nutritional coaching, and to evaluate its efficacy in reducing CVRFs. [less ▲]

A social gradient in fatal opioids and cocaine related overdoses?

in PLoS ONE (2015), 4(10(5)),

To determine the existence of a social gradient in fatal overdose cases related to non-prescribed opioids and cocaine use, recorded in Luxembourg between 1994 and 2011. METHODS: Overdose cases were ... [more ▼]

To determine the existence of a social gradient in fatal overdose cases related to non-prescribed opioids and cocaine use, recorded in Luxembourg between 1994 and 2011. METHODS: Overdose cases were individually matched with four controls in a nested case-control study design, according to sex, year of birth, drug administration route and duration of drug use. The study sample, composed of 272 cases and 1,056 controls, was stratified according to a Social Inequality Accumulation Score (SIAS), based on educational attainment, employment, income, financial situation of subjects and the professional status of their father or legal guardian. Least squares linear regression analysis on overdose mortality rates and ridit scores were applied to determine the Relative Index of Inequality (RII) of the study sample. RESULTS: A negative linear relationship between the overdose mortality rate and the relative socioeconomic position was observed. We found a difference in mortality of 29.22 overdose deaths per 100 drug users in the lowest socioeconomic group compared to the most advantaged group. In terms of the Relative Inequality Index, the overdose mortality rate of opioid and cocaine users with lowest socioeconomic profiles was 9.88 times as high as that of their peers from the highest socioeconomic group (95% CI 6.49-13.26). CONCLUSIONS: Our findings suggest the existence of a marked social gradient in opioids and cocaine related overdose fatalities. Harm reduction services should integrate socially supportive offers, not only because of their general aim of social (re)integration but crucially in order to meet their most important objective, that is to reduce drug-related mortality [less ▲]

Life satisfaction, cardiovascular risk factors, unhealthy behaviours and socioeconomic inequality, 5 years after coronary angiography.

in BMC Public Health (2015), (15), 668-678

Five years after coronary angiography, life satisfaction (LS) among patients may be related to incidents of cardiovascular diseases, risk factors and unhealthy behaviours and socioeconomic conditions, but ... [more ▼]

Five years after coronary angiography, life satisfaction (LS) among patients may be related to incidents of cardiovascular diseases, risk factors and unhealthy behaviours and socioeconomic conditions, but their respective influence remains unclear. Our aim is to analyze LS and its relationships with those factors. Methods. Among the 4,391 patients initially contacted, 547 deaths were reported and 209 had an invalid address. In 2013-2014, 3,635 patients who underwent coronary angiography in 2008-2009 at the National Institute of Cardiac Surgery and Cardiological Intervention in Luxembourg were asked to complete a self-administered questionnaire assessing LS [1-10] and other variables. Data were analysed via multiple regression models adjusted initially on age, sex and income, and for a second time with the addition of all CVRF. Results. LS of 1,289 volunteers (69.2 years) was 7.3/10. Most were men, Luxembourgish, employees and manual workers, had secondary education and an income of 36,000 euros or more per year. LS was lowest in female patients, and those with a low to middle income. Patients who lived in a couple had the best LS. Patients with a history in the previous 5 years of physical inactivity (regression coefficient: -0.903), angina pectoris (rc -0.843), obesity (rc -0.512), diabetes, or hypercholesterolemia, were more likely to have lower LS. The previous associations were mostly maintained on the second analysis, with the exceptions of diabetes and obesity. In addition, patients who stopped smoking because of peer pressure (rc -0.011) had a lower LS. Conclusions. The finding that LS was lowest among female patients calls for further research on symptoms, and potential risk factors. Also, certain patient profiles are linked with low LS: ‘inclined abstainers’ who intended to modify their behaviours, but could not do so, and ‘disinclined abstainers’ who had no intention of changing and were insufficiently concerned to do so. Patients who stopped smoking and perceived it as unpleasant also had low LS. ‘Disinclined actors’ were those patients who had to adjust their lifestyles, but were ambivalent about their intentions and the behaviour, which they continued. Health promotion programs would benefit from targeting factors that moderate the unfavourable intention-behaviour relationship and can help enhance LS. [less ▲]

The Luxembourg Teacher Databank 1845-1939. Academic Research into the Social History of the Luxembourg Primary School Teaching Staff

in Lausen, Berthold; Krolak-Schwerdt, Sabine; Böhmer, Matthias (Eds.) Data Science, Learning by Latent Structures, and Knowledge Discovery (2015)

From 1845 to 1939 the pedagogical journal Der Luxemburger Schulbote published a comprehensive annual directory of the primary school teaching staff of the Grand Duchy. On the basis of this directory, we ... [more ▼]

From 1845 to 1939 the pedagogical journal Der Luxemburger Schulbote published a comprehensive annual directory of the primary school teaching staff of the Grand Duchy. On the basis of this directory, we have established a databank encompassing 75,000 entries relating to a total of approx. 4,700 primary school teachers, both male and female, who taught in the Grand Duchy during this period. With the assistance of IBM SPSS Statistics, we have been able to process the data and compile a collective biography or prosopography that provides a profound insight into the development of an occupational group over a period of nearly 100 years at a local, regional and national level. This paper presents an analysis of initial research findings relating to the number of teaching staff, length of service and the level of qualification and mobility among teaching staff for the first half of this period from 1845 to 1895. [less ▲]

Associations between quality of life and socioeconomic factors, functional impairments and dissatisfaction with received information and home-care services among survivors living at home two years after stroke onset

in BMC Neurology (2014), 14

Quality of life (QoL) assessment is important when monitoring over time the recovery of stroke-survivors living at home. This study explores the associations between QoL and socioeconomic factors ... [more ▼]

Quality of life (QoL) assessment is important when monitoring over time the recovery of stroke-survivors living at home. This study explores the associations between QoL and socioeconomic factors, functional impairments and self-reported dissatisfaction with received information and home-care services among survivors two years after stroke onset. This problem remains partially addressed though optimal information and services may improve survivors' QoL. Methods Stroke-survivors admitted to all hospitals in Luxembourg 18 months or more previously were identified using the only care-expenditure-reimbursement national system database. The clinical diagnosis was confirmed. Ninety four patients aged 65 years and living at home were interviewed to gather socioeconomic characteristics, functional impairments, dissatisfaction with information and home-care services, and QoL (using the Newcastle Stroke-Specific QoL, newsqol) assessing 11 domains. Data were analyzed using multiple linear regression models. Results About 50% of survivors had low education and lower income. Functional impairments were common: sensory (45%), motor (35%), memory (32%), language (31%), and vision (20%). Survivors with education (<12th grade) or lower income had low values for most newsqol domains (sex-age-adjusted regression coefficient saRC, i.e. mean difference, between -23 and -8). Patients who were working had better values for pain, mental feelings and sleep domains than did retired people (saRC between -3.9 and 4.2). Various functional impairments were associated with markedly low values of nearly all domains (saRC between -33.5 and -7.5) and motor, language, memory and sensory impairments had the highest impact. The survivors' perceived QoL was markedly low, especially for the domains of interpersonal relationship, sleep, cognition, mental feelings, and pain. Various QoL domains were strongly related to dissatisfaction with information about stroke and its consequences/changes over time, accuracy of information obtained, help received, coordination between services, and the possibility of receiving help when necessary (saRC reaching -30). Conclusions Stroke-survivors had major alterations in QoL that reflected depressive symptoms, which should be appropriately treated. These findings may help with the development of public policies aiming at improving QoL among stroke survivors. The newsqol could be used routinely to measure the recovery of survivors over time and their needs in terms of information, help and care services [less ▲]