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Work Schedules And The Sleep Quality Of Nurses In Hungary
A190
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
therapy: pharmacotherapy only and combination therapy. The dependent variables were: adherence (measured as proportion of days covered); persistence (duration of therapy without a gap of > 30 days); augmentation (initiation of a new ADHD medication with a continuous overlap of ≥ 30 days with the index medication); and switching (prescription claim for an alternative ADHD medication received on or after the index date), before or within 30 days of discontinuation of the index medication. Multivariate analyses were used to assess the treatment patterns among treatment groups. Results: Of the 8,833 preschoolers identified in the study, pharmacotherapy group patients had 11.1% lower odds of adherence (Odds Ratio [OR] = 0.889; 95% Confidence Interval (CI) = 0.799–0.988; p = 0.03), 26.2% lower odds of augmentation (OR = 0.738; CI = 0.642–0.850; p < 0.0001), and 20.2% lower odds of switching (OR = 0.798; CI = 0.725–0.878; p < 0.0001) compared to combination therapy group patients, while controlling for covariates. Discontinuation of medication therapy did not differ significantly between the treatment groups. Conclusions: Comparison of treatments revealed that the combination therapy group had higher adherence, persistence, and augmentation compared to the pharmacotherapy group. PMH46 The Connection Between The Cristian Faith And The Tackle Of Elder Patients Fusz K1, Rabné Récsei P1, Pusztai D1, Boncz I1, Máté O2, Stromájer-Rácz T1, Pakai A3, Oláh A1 of Pécs, Pécs, Hungary, 2University of Pécs, Pécs, Hungary, 3University of Pécs, Zalaegerszeg, Hungary 1University
Objectives: The aim of this research was to measure the connection between the Christian Faith and welfare, tackle, and health behaviour among elders. Methods: The research was quantitative and cross-sectional. We used non-random, convenience sampling among the religious elders living in Kozarmisleny and the habitants of Dorothea Institute and the Malomvolgy Social Institute of Pecs (N= 114). According to the including criterias, the participants had to be older then 60 years with undamaged state of mind. We applied own- structured questions besides the welfare questionnaire of the WHO and the BSCI-Cohenerce subscale. To statistical analysis we used SPSS 22., with descriptive statistics, Chi2-probe, T-probe and correlations, (p< 0.05). Results: Those who does not have any kids and grandchildren reached less points on the WHO’s welfare scale (p= 0.012) than those who has. According to the martial status the welfare of those who are devorced are on the lowest level (p= 0.014) and those who live in relationship the highest (p= 0.002). The believers tackle mechanism is higher, because there is moderate positive connection between the rate of religiousness and tackle (r= 0.303, p= 0.001). The religious people significantly have less harmful addiction (p= 0.021), pay attention to healthier diet more (p= 0.014) and go to screening tests more frequently (p< 0.001). Furthermore, those who go to masses do more physical activites (p= 0.006), take part in screening tests more frequently (p< 0.001), pay attention to healthier diet (p< 0.001), and have less harmful addictions. Conclusions: Several studies prove that the religious faith gives power against the usual problems, the tackle og deseases, and has benefit on the health. Our results confirm that it is really important to support the religious practice among the elders. PMH47 Work Schedules And The Sleep Quality Of Nurses In Hungary Fusz K1, Pakai A2, Horváthné Kívés Z3, Fullér N1, Boncz I1, Szunomár S1, Varga B1, Oláh A1 1University of Pécs, Pécs, Hungary, 2University of Pécs, Zalaegerszeg, Hungary, 3University of Pécs, Pécs, Hungary
Objectives: The shift work is burdensome and it can lead to sleep disturbances due to the disturbed circadian rhythm. The aims of the study were to measure the typical nursing shift systems in hungarian hospitals, and to compare the sleep quality of nurses in different work schedules. Methods: 325 nurses working in shifts filled out the Hungarian version of Bergen Shift Work Sleep Questionnaire, and 236 head nurses filled out the national online survey about about 8697 nurses’s schedules. Results: Most of nurses (51.89%) work in flexible shift system. Only 22,35% of nurses work in regular shift system, most of them in the following order: a 12-hour day shift, after a 12-hour night shift, followed by one or two rest days. Where there is no system of shifts, the most frequent causes are the nurse shortage and the needs of nurses. The frequency of discrete sleep symptoms significantly differed with the shifts, nurses experienced the worst sleep quality and daytime fatigue after the night shift (p< 0,001). Nurses working in irregular shift system had worse sleep quality than nurses working in regular and flexible shift system (p< 0,001). Conclusions: The sleep disorder of nurses should be assessed with the Hungarian version of Bergen Shift Work Sleep Questionnaire on a representative nationally sample, and the least burdensome shift system could be established. PMH48 Constructing Classification System For A New Qaly Measure In Mental Health: Recovering Quality Of Life (Reqol) Brazier J, Keetharuth A, Connell J, Barkham M, Carlton J, Ricketts T, Taylor-Buck L University of Sheffield, Sheffield, UK
Objectives: It has been recognised that EQ-5D, the most widely used generic measure used in the UK, is not appropriate in many areas of mental health. We report the development of a classification amenable to valuation for use in mental health. Methods: The themes were identified through a review of the qualitative literature on the quality of life of people (QoL) with mental health difficulties complemented with in-depth interviews with service users. Framework analysis was used to identify the relevant themes. Items were selected under each theme from interview transcripts, revised versions of those from existing measures and items were newly coined by the team. Items shortlisted using a list of set criteria were presented to service users to assess their content validity. Service users from the primary, secondary and tertiary sectors were asked to complete a pool of items at baseline and follow-up. Factor analysis was used to determine the dimensional structure of the ReQoL. Item Response theory was used to select items through
item information functions. Results: Thirteen relevant papers from the 200 set retrieved and 19 in-depth interviews yielded seven themes - 6 mental health and one physical health. Out of 1600 potential items 100 items were tested for content validity with 76 service users -59 adults and 17 aged 16-18. Over 3600 service users completed a pool of 40 items. Factor analyses and Classical psychometric analyses have informed the selection of items for a six-dimension classification for ReQoL each item containing five levels. Conclusions: ReQoL provides an important basis for a new QALY measure that better reflects the way different mental health problems impact on the lives of people who use services. The next stage is to obtain preference weights so that the measure can be used in the economic evaluation of interventions in mental health. PMH49 Preferences For Pediatric Attention-Deficit/Hyperactivity Disorder Management And Medication Changes And Caregiver-Reported Improvement Over A 6-Month Follow-Up dosReis S1, Ng X1, Ross MM1, Frosch EJ2, Reeves GM3, Bridges JF4 1University of Maryland School of Pharmacy, Baltimore, MD, USA, 2Johns Hopkins Hopital, Baltimore, MD, USA, 3University of Maryland School of Medicine, Baltimore, MD, USA, 4John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Objectives: Little is known about how caregiver preferences may be related to pediatric medication treatment over time. This study examined caregivers’ preferences for their child’s attention-deficit/hyperactivity disorder (ADHD) treatment and ADHD medication changes and parent-reported outcomes over a six-month followup. Methods: Caregivers of children aged 4-14 years-old in care for ADHD (n= 182) were recruited from clinic settings and caregiver support groups across Maryland to complete a computer-based survey. Current treatment was obtained at study entry and six-month follow-up. ADHD care management preferences were assessed in a case 2 Best-Worst Scaling (BWS) experiment with seven attributes and three levels. An orthogonal main-effects design was used to construct 18 choice tasks, each displaying seven attributes, and caregivers selected one best and one worst attribute. Two mutually-exclusive preference groups, identified in a previous scaleadjusted latent class analysis of the choice experiment, included those who preferred medication (medication-oriented) and those who preferred behavioral approaches (behavior-oriented) for their child’s ADHD. The present analysis compares medication changes and caregiver-reported improvement in ADHD between preference groups. Changes were measured as a switch, addition, or discontinuation of a medication in the ADHD treatment regimen between study entry and six-months. Caregiverreported improvement was measured as: improved, less symptoms, good/bad days, no change. Results: Follow-up data for 156/182 participants (86%) included 99 medication-oriented and 57 behavior-oriented. Most were Caucasian (69%) and the biological mother of a male child (75%). Most (83%) were using medication at sixmonths, with no difference by behavior-oriented or medication-oriented groups. Relative to the behavior-oriented group, more caregivers in the medication-oriented group reported medication changes (51% vs 27%) from study entry to six-months and more reported no improvement in ADHD (16% vs 6%). Conclusions: Preferences may not impact decisions to initiate medication. However, preferences may influence expectations and perceptions of treatment effectiveness and outcomes. PMH50 The Association Between Alcohol Consumption And Cognitive Function In The Middle-Aged And Older Population: A Study Using The Health And Retirement Study (Hrs) Data Chen C, Raisch DW University of New Mexico College of Pharmacy, Albuquerque, NM, USA
Objectives: To examine the relationship between alcohol consumption and cognitive function in the middle-aged and older population through the HRS data. Methods: A cross-sectional study was conducted using 2012 HRS telephone survey data. Survey respondents who finished all relevant questions in the cognition section and provided information on alcohol consumption were included in our analysis. Cognition scores (0-35) were summed for each individual, indicating overall cognitive performance. A multivariate regression model, including age, years of education, and general health status was used to estimate the effects of drinking status (abstainer/drinker), drinking days/week, and binge drinking (> 4 drinks per occasion) on cognitive performance. The model was stratified by gender. Curvilinear relationships were also examined because previous studies demonstrated nonlinear relationships between drinking and cognition. Results: There were 7625 participants included (male, 42.8%; female, 57.2%). Overall, females scored 0.97 higher than males (SE= 0.09, p< 0.001). For males, we identified 1303 (39.3%) abstainers and the mean drinking days/week was 1.5 days for drinkers; for females, we identified 2405 (55.1%) abstainers and the mean drinking days/week was 2.0 days for drinkers. No significant curvilinear relationship was observed for cognitive function and drinking days/week among either males or females. Among males, abstainers scored 0.91 (SE= 0.18, p< 0.001) lower compared with non-binge drinkers. Among male drinkers, one more drinking day/week was associated with a significant increase of 0.15 (SE= 0.05, p< 0.01) points. Among females, abstainers scored 0.95 (SE= 0.17, p< 0.001) lower than non-binge drinkers, but among drinkers, drinking days/week was not associated with cognition. Binge drinking (4.1% of males, 0.5% of females) was not significantly related to cognition. Conclusions: Our findings suggest a positive effect of drinking on cognition, however this effect is very small and varied by gender. Longitudinal studies are needed to investigate the cumulative effect of alcohol consumption on cognition and to specify the causal relationship. PMH51 Initiating Medication To Treat Pediatric Attention-Deficit/ Hyperactivity Disorder: A Best-Worst Scaling To Compare Caregivers’ And Clinicians’ Preferences Ross MM1, Kim H2, Bridges JF3, Ng X1, Frosch EJ4, Reeves GM5, dosReis S1 1University of Maryland School of Pharmacy, Baltimore, MD, USA, 2University of Maryland,
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
therapy: pharmacotherapy only and combination therapy. The dependent variables were: adherence (measured as proportion of days covered); persistence (duration of therapy without a gap of > 30 days); augmentation (initiation of a new ADHD medication with a continuous overlap of ≥ 30 days with the index medication); and switching (prescription claim for an alternative ADHD medication received on or after the index date), before or within 30 days of discontinuation of the index medication. Multivariate analyses were used to assess the treatment patterns among treatment groups. Results: Of the 8,833 preschoolers identified in the study, pharmacotherapy group patients had 11.1% lower odds of adherence (Odds Ratio [OR] = 0.889; 95% Confidence Interval (CI) = 0.799–0.988; p = 0.03), 26.2% lower odds of augmentation (OR = 0.738; CI = 0.642–0.850; p < 0.0001), and 20.2% lower odds of switching (OR = 0.798; CI = 0.725–0.878; p < 0.0001) compared to combination therapy group patients, while controlling for covariates. Discontinuation of medication therapy did not differ significantly between the treatment groups. Conclusions: Comparison of treatments revealed that the combination therapy group had higher adherence, persistence, and augmentation compared to the pharmacotherapy group. PMH46 The Connection Between The Cristian Faith And The Tackle Of Elder Patients Fusz K1, Rabné Récsei P1, Pusztai D1, Boncz I1, Máté O2, Stromájer-Rácz T1, Pakai A3, Oláh A1 of Pécs, Pécs, Hungary, 2University of Pécs, Pécs, Hungary, 3University of Pécs, Zalaegerszeg, Hungary 1University
Objectives: The aim of this research was to measure the connection between the Christian Faith and welfare, tackle, and health behaviour among elders. Methods: The research was quantitative and cross-sectional. We used non-random, convenience sampling among the religious elders living in Kozarmisleny and the habitants of Dorothea Institute and the Malomvolgy Social Institute of Pecs (N= 114). According to the including criterias, the participants had to be older then 60 years with undamaged state of mind. We applied own- structured questions besides the welfare questionnaire of the WHO and the BSCI-Cohenerce subscale. To statistical analysis we used SPSS 22., with descriptive statistics, Chi2-probe, T-probe and correlations, (p< 0.05). Results: Those who does not have any kids and grandchildren reached less points on the WHO’s welfare scale (p= 0.012) than those who has. According to the martial status the welfare of those who are devorced are on the lowest level (p= 0.014) and those who live in relationship the highest (p= 0.002). The believers tackle mechanism is higher, because there is moderate positive connection between the rate of religiousness and tackle (r= 0.303, p= 0.001). The religious people significantly have less harmful addiction (p= 0.021), pay attention to healthier diet more (p= 0.014) and go to screening tests more frequently (p< 0.001). Furthermore, those who go to masses do more physical activites (p= 0.006), take part in screening tests more frequently (p< 0.001), pay attention to healthier diet (p< 0.001), and have less harmful addictions. Conclusions: Several studies prove that the religious faith gives power against the usual problems, the tackle og deseases, and has benefit on the health. Our results confirm that it is really important to support the religious practice among the elders. PMH47 Work Schedules And The Sleep Quality Of Nurses In Hungary Fusz K1, Pakai A2, Horváthné Kívés Z3, Fullér N1, Boncz I1, Szunomár S1, Varga B1, Oláh A1 1University of Pécs, Pécs, Hungary, 2University of Pécs, Zalaegerszeg, Hungary, 3University of Pécs, Pécs, Hungary
Objectives: The shift work is burdensome and it can lead to sleep disturbances due to the disturbed circadian rhythm. The aims of the study were to measure the typical nursing shift systems in hungarian hospitals, and to compare the sleep quality of nurses in different work schedules. Methods: 325 nurses working in shifts filled out the Hungarian version of Bergen Shift Work Sleep Questionnaire, and 236 head nurses filled out the national online survey about about 8697 nurses’s schedules. Results: Most of nurses (51.89%) work in flexible shift system. Only 22,35% of nurses work in regular shift system, most of them in the following order: a 12-hour day shift, after a 12-hour night shift, followed by one or two rest days. Where there is no system of shifts, the most frequent causes are the nurse shortage and the needs of nurses. The frequency of discrete sleep symptoms significantly differed with the shifts, nurses experienced the worst sleep quality and daytime fatigue after the night shift (p< 0,001). Nurses working in irregular shift system had worse sleep quality than nurses working in regular and flexible shift system (p< 0,001). Conclusions: The sleep disorder of nurses should be assessed with the Hungarian version of Bergen Shift Work Sleep Questionnaire on a representative nationally sample, and the least burdensome shift system could be established. PMH48 Constructing Classification System For A New Qaly Measure In Mental Health: Recovering Quality Of Life (Reqol) Brazier J, Keetharuth A, Connell J, Barkham M, Carlton J, Ricketts T, Taylor-Buck L University of Sheffield, Sheffield, UK
Objectives: It has been recognised that EQ-5D, the most widely used generic measure used in the UK, is not appropriate in many areas of mental health. We report the development of a classification amenable to valuation for use in mental health. Methods: The themes were identified through a review of the qualitative literature on the quality of life of people (QoL) with mental health difficulties complemented with in-depth interviews with service users. Framework analysis was used to identify the relevant themes. Items were selected under each theme from interview transcripts, revised versions of those from existing measures and items were newly coined by the team. Items shortlisted using a list of set criteria were presented to service users to assess their content validity. Service users from the primary, secondary and tertiary sectors were asked to complete a pool of items at baseline and follow-up. Factor analysis was used to determine the dimensional structure of the ReQoL. Item Response theory was used to select items through
item information functions. Results: Thirteen relevant papers from the 200 set retrieved and 19 in-depth interviews yielded seven themes - 6 mental health and one physical health. Out of 1600 potential items 100 items were tested for content validity with 76 service users -59 adults and 17 aged 16-18. Over 3600 service users completed a pool of 40 items. Factor analyses and Classical psychometric analyses have informed the selection of items for a six-dimension classification for ReQoL each item containing five levels. Conclusions: ReQoL provides an important basis for a new QALY measure that better reflects the way different mental health problems impact on the lives of people who use services. The next stage is to obtain preference weights so that the measure can be used in the economic evaluation of interventions in mental health. PMH49 Preferences For Pediatric Attention-Deficit/Hyperactivity Disorder Management And Medication Changes And Caregiver-Reported Improvement Over A 6-Month Follow-Up dosReis S1, Ng X1, Ross MM1, Frosch EJ2, Reeves GM3, Bridges JF4 1University of Maryland School of Pharmacy, Baltimore, MD, USA, 2Johns Hopkins Hopital, Baltimore, MD, USA, 3University of Maryland School of Medicine, Baltimore, MD, USA, 4John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Objectives: Little is known about how caregiver preferences may be related to pediatric medication treatment over time. This study examined caregivers’ preferences for their child’s attention-deficit/hyperactivity disorder (ADHD) treatment and ADHD medication changes and parent-reported outcomes over a six-month followup. Methods: Caregivers of children aged 4-14 years-old in care for ADHD (n= 182) were recruited from clinic settings and caregiver support groups across Maryland to complete a computer-based survey. Current treatment was obtained at study entry and six-month follow-up. ADHD care management preferences were assessed in a case 2 Best-Worst Scaling (BWS) experiment with seven attributes and three levels. An orthogonal main-effects design was used to construct 18 choice tasks, each displaying seven attributes, and caregivers selected one best and one worst attribute. Two mutually-exclusive preference groups, identified in a previous scaleadjusted latent class analysis of the choice experiment, included those who preferred medication (medication-oriented) and those who preferred behavioral approaches (behavior-oriented) for their child’s ADHD. The present analysis compares medication changes and caregiver-reported improvement in ADHD between preference groups. Changes were measured as a switch, addition, or discontinuation of a medication in the ADHD treatment regimen between study entry and six-months. Caregiverreported improvement was measured as: improved, less symptoms, good/bad days, no change. Results: Follow-up data for 156/182 participants (86%) included 99 medication-oriented and 57 behavior-oriented. Most were Caucasian (69%) and the biological mother of a male child (75%). Most (83%) were using medication at sixmonths, with no difference by behavior-oriented or medication-oriented groups. Relative to the behavior-oriented group, more caregivers in the medication-oriented group reported medication changes (51% vs 27%) from study entry to six-months and more reported no improvement in ADHD (16% vs 6%). Conclusions: Preferences may not impact decisions to initiate medication. However, preferences may influence expectations and perceptions of treatment effectiveness and outcomes. PMH50 The Association Between Alcohol Consumption And Cognitive Function In The Middle-Aged And Older Population: A Study Using The Health And Retirement Study (Hrs) Data Chen C, Raisch DW University of New Mexico College of Pharmacy, Albuquerque, NM, USA
Objectives: To examine the relationship between alcohol consumption and cognitive function in the middle-aged and older population through the HRS data. Methods: A cross-sectional study was conducted using 2012 HRS telephone survey data. Survey respondents who finished all relevant questions in the cognition section and provided information on alcohol consumption were included in our analysis. Cognition scores (0-35) were summed for each individual, indicating overall cognitive performance. A multivariate regression model, including age, years of education, and general health status was used to estimate the effects of drinking status (abstainer/drinker), drinking days/week, and binge drinking (> 4 drinks per occasion) on cognitive performance. The model was stratified by gender. Curvilinear relationships were also examined because previous studies demonstrated nonlinear relationships between drinking and cognition. Results: There were 7625 participants included (male, 42.8%; female, 57.2%). Overall, females scored 0.97 higher than males (SE= 0.09, p< 0.001). For males, we identified 1303 (39.3%) abstainers and the mean drinking days/week was 1.5 days for drinkers; for females, we identified 2405 (55.1%) abstainers and the mean drinking days/week was 2.0 days for drinkers. No significant curvilinear relationship was observed for cognitive function and drinking days/week among either males or females. Among males, abstainers scored 0.91 (SE= 0.18, p< 0.001) lower compared with non-binge drinkers. Among male drinkers, one more drinking day/week was associated with a significant increase of 0.15 (SE= 0.05, p< 0.01) points. Among females, abstainers scored 0.95 (SE= 0.17, p< 0.001) lower than non-binge drinkers, but among drinkers, drinking days/week was not associated with cognition. Binge drinking (4.1% of males, 0.5% of females) was not significantly related to cognition. Conclusions: Our findings suggest a positive effect of drinking on cognition, however this effect is very small and varied by gender. Longitudinal studies are needed to investigate the cumulative effect of alcohol consumption on cognition and to specify the causal relationship. PMH51 Initiating Medication To Treat Pediatric Attention-Deficit/ Hyperactivity Disorder: A Best-Worst Scaling To Compare Caregivers’ And Clinicians’ Preferences Ross MM1, Kim H2, Bridges JF3, Ng X1, Frosch EJ4, Reeves GM5, dosReis S1 1University of Maryland School of Pharmacy, Baltimore, MD, USA, 2University of Maryland,