We aimed to test the hypothesis that serum 25-hydroxyvitamin D3 (25(OH)D) concentration is associated with mental health and life stress measures in young adults and investigate gender and racial disparities in these associations. This study comprised 327 black and white participants. Depression, trait anxiety, perceived stress, and hostility were measured by the following validated instruments: Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), and Cook–Medley Hostility Scale (CMHS). Linear regression was used to estimate correlations between serum 25(OH)D concentration and mental health measurements in the total population and in subgroups stratified by gender and race. In this sample (28.2 ± 3.1 years, 52% female, 53% black), serum 25(OH)D concentration was negatively related to BDI, STAI, PSS, total CMHS score, and the majority of CMHS subscale scores (p-values < 0.05). Stratified by gender, most of these associations remained significant only in women (p-values < 0.05). Stratified by race, higher 25(OH)D concentrations in white participants were significantly related to lower BDI, STAI, PSS, and CMHS-cynicism subscales (p-values < 0.05); 25(OH)D concentrations in the black participants were only inversely associated with CMHS and most CMHS subscales (p-values < 0.05) but not with BDI, STAI, and PSS. We present novel findings of consistent inverse relationships between serum 25(OH)D concentration and various measures of mental health and life stress. Long-term interventional studies are warranted in order to investigate the roles of vitamin D supplementation in the prevention and mitigation of depression, anxiety, and psychological stress in young adults.

https://www.mdpi.com/2072-6643/12/7/1938/pdf

Serum 25-Hydroxyvitamin D Concentrations Are Associated with Mental Health and Psychosocial Stress in Young Adults.

Payment mechanisms have attracted substantial research interest because of their consequent effect on care outcomes, including treatment costs, admission and readmission rates and patient satisfaction. Those mechanisms create the incentive environment within which health workers operate and can influence provider behaviour in ways that can facilitate achievement of national health policy goals. This systematic review aims to understand the effects of changes in hospital payment mechanisms introduced in low- and middle-income countries (LMICs) on hospital- and patient-level outcomes. A standardised search of seven databases and a manual search of the grey literature and reference lists of existing reviews were performed to identify relevant articles published between January 2000 and July 2019. We included original studies focused on hospital payment reforms and their effect on hospital and patient outcomes in LMICs. Narrative descriptions or studies focusing only on provider payments or primary care settings were excluded. The authors used the Risk of Bias in Non-Randomized Studies of Interventions tool to assess the risk of bias and quality. Results were synthesized in a narrative description due to methodological heterogeneity. A total of 24 articles from seven middle-income countries were included, the majority of which are from Asia. In most cases, hospital payment reforms included shifts from passive (fee-for-service) to active payment models-the most common being diagnosis-related group payments, capitation and global budget. In general, hospital payment reforms were associated with decreases in hospital expenditures, out-of-pocket payments, length of hospital stay and readmission rates. The majority of the articles scored low on quality due to weak study design. A shift from passive to active hospital payment methods in LMICs has been associated with lower hospital and patient costs as well as increased efficiency without any apparent compromise on quality. However, there is an important need for high-quality studies in this area.

Effectiveness of hospital payment reforms in low- and middle-income countries: a systematic review

Many assert the need for home hospice care. However, limited research has shown its effectiveness. The authors of this study thus evaluated the effectiveness of a home hospice care pilot project regarding (1) early enrollment in hospice care, (2) efficient use of inpatient hospice resources, and (3) enabling terminally ill patients to stay at their preferred place of care. The authors conducted a nationwide prospective observational study. Patients were divided into home hospice care users (ever-users, n = 902) and inpatient-only hospice care users (never-users, n = 8210). Information about hospice service utilization was collected from a web-based registry system. Patients were registered if they started to receive the hospice service after providing written informed consent during the pilot project from March 2016–July 2017. Most ever-users preferred to stay at home (84.0%), while never-users preferred hospital admission (66.9%). Most ever-users were enrolled in hospice by home care (78.9%) and used both home and inpatient care (72.4%). The overall duration of hospice care was significantly longer among ever-users than never-users (median 39 vs. 15 days, respectively; mean ± SD 59.6 ± 62.8 vs. 24.8 ± 32.1, respectively; p < .001). Participation in the pilot program improved bed utilization (p = .025) and turnover rate (p < .001) of inpatient hospice service. Home hospice care enabled early enrollment in hospice services and provided a valid option to patients who wished to stay at home. Policy efforts to facilitate home hospice care are needed.

Effectiveness of home hospice care: a nationwide prospective observational study.

Mood disorders such as anxiety, depression, stresses, and low sleep quality are common among overweight/obese women. The relation of vitamin D and its blood carrier, vitamin D binding protein (VDBP), to mental health is still unknown. This study aimed to examine the relation of serum 25(OH)D and VDBP to mental health measures including depression, anxiety, stress and sleep quality of overweight/obese women.This cross-sectional study included a total of 265 overweight/obese women in Tehran, Iran, from 2016 to 2017. The 21-question version of the Depression Anxiety Stress Scales (DASS-21) and the Pittsburgh Sleep Quality Index (PSQI) were used to evaluate mental health and sleep quality of participants, respectively. Serum 25(OH)D was assessed using the radioimmunoassay method and VDBP was evaluated with the use of ELISA. Associations were tested by logistic regression analysis.In the crud analysis, higher serum 25(OH)D was marginally related to decreased odds of stress, but, women with higher VDBP levels had a marginal increased risk for depression. After adjustment for age, educational level, physical activity, body mass index and dietary energy intake, higher serum 25(OH)D was significantly related to a 42% decreased odds of stress (OR = 0.58, 95%CI: 0.28-0.99, p = 0.04), while, women with higher VDBP levels had an increased risk for depression (OR = 1.74, 95%CI: 1.002-3.42, p = 0.04). Serum vitamin D and VDBP were not significantly related to other indices of mental health.Higher serum vitamin D was related to decreased odds of stress but higher VDBP was related to increased odds of depression. 

Association of serum levels of vitamin D and vitamin D binding protein with mental health of overweight/obese women: A cross sectional study

BACKGROUND Adequate levels of vitamin D are important for women of childbearing age as vitamin D helps maintain the pregnancy and ensures proper maternal and fetal bone metabolism and fetal skeletal development. However, vitamin D deficiency is a health problem prevalent in women of all ages, worldwide. This study aimed to determine the current status of serum vitamin D levels and the risk factors for vitamin D deficiency among South Korean nurses of childbearing age. METHODS Serum levels of 25-hydroxyvitamin D (25[OH]D) were measured in 1594 registered nurses aged 20 to 45 years who are participants in an ongoing prospective cohort study of the Korean Nurses' Health Study initiated in 2013. The participants completed surveys about demographic and occupational characteristics and physical and psychological health. We examined associations with vitamin D deficiency through multivariable logistic regression analysis. RESULTS The average blood 25(OH) D concentration of the participants was 12.92 ng/mL (4.0-63.4 ng/mL), while the prevalence of vitamin D deficiency (< 20 ng/mL) was 89% (1419/1594). Multivariable logistic regression showed that significant risk factors for vitamin D deficiency included month of sampling (there was a lower level of vitamin D deficiency in winter than in spring, summer, or fall), age (women in their 20s had a lower vitamin D level than those in their 30s and 40s), and stress symptoms. Vitamin D levels were not associated with body mass index, physical activity, and depressive symptoms. CONCLUSIONS This study showed a high prevalence of vitamin D deficiency in Korean female nurses. Serum levels of vitamin D were associated with age and season. Vitamin D deficiency should be recognized as one of the primary health concerns among young women. More proactive actions, such as vitamin D supplements and food fortification, are needed to improve vitamin D deficiency in high-risk groups.

Vitamin D deficiency and associated factors in south Korean childbearing women: a cross-sectional study.

Hypovitaminosis D and stress are common problems among the elderly. The aim of this cross-sectional nationally representative study was to evaluate the association between hypovitaminosis D and stress perception using large-scale nationally representative data from the Korea National Health and Nutrition Examination Survey (2012–2013). In our study, a total of 1393 elders (≥65 years old) were included to evaluate the association between hypovitaminosis D and stress perception. Serum 25-hydroxyvitamin D levels were determined using radioimmunoassay, and perceived stress status was assessed by a self-reporting questionnaire. The association between hypovitaminosis D and stress perception according to sex was examined using logistic regression analysis. After multivariate adjustment for sociodemographic and lifestyle factors and comorbidities, hypovitaminosis D was significantly associated with perceived stress (odds ratio, 2.73; 95% confidence interval, 1.10–6.77; p = 0.029) among women; however, this association was not significant among men. Hypovitaminosis D was a risk factor for higher stress perception in older Korean women. Even though the role of vitamin D in stress perception is still unclear, we suggest screening for hypovitaminosis D among the elderly.

https://www.mdpi.com/2072-6643/8/10/647/pdf

Is Hypovitaminosis D Associated with Stress Perception in the Elderly? A Nationwide Representative Study in Korea

This study investigates the effects of a new medical insurance payment system for hospice patients in palliative care programs and analyzes length of survival (LoS) determinants. At the Pusan National University Hospital hospice center, between January 2015 and April 2016, 276 patients were hospitalized with several diagnosed types of terminal stage cancer. This study separated patients into two groups, “old” and “new,” by admission date, considering the new system has been applied from July 15, 2015. The study subsequently compared LoS, total cost, and out-of-pocket expenses for the two groups. Overall, 142 patients applied to the new medical insurance payment system group, while the old medical insurance payment system included 134 patients. The results do not show a significantly negative difference in LoS for the new system group (p = 0.054). Total cost is higher within the new group (p <  0.001); however, the new system registers lower patient out-of-pocket expenses (p <  0.001). The novelty of this study is proving that the new medical insurance payment system is not inferior to the classic one in terms of LoS. The total cost of the new system increased due to a multidisciplinary approach toward palliative care. However, out-of-pocket expenses for patients overall decreased, easing their financial burden.

/pdf/effects-of-a-new-medical-insurance-payment-system-for-2p5kpt9f16.pdf

Effects of a new medical insurance payment system for hospice patients in palliative care programs in Korea

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Is Hypovitaminosis D Associated with Stress Perception in the Elderly? A Nationwide Representative Study in Korea

Effects of a new medical insurance payment system for hospice patients in palliative care programs in Korea