Socioeconomic Position and Risk of Disease Progression and Death in Patients with Myelodysplastic Syndromes: A Danish Nation-Wide Population-Based Cohort Study

Background: Five-year overall survival for patients with myelodysplastic syndromes (MDS) is around 30%. Adverse prognostic factors include advancing age, higher blast cell percentage, poor risk cytogenetics, two or more cytopenias, high burden of comorbidity, and transfusion-dependency. The impact of socioeconomic position on clinical outcomes in MDS patients is however unclear. In this nationwide population-based cohort-study, we therefore examined the associations between the individual-level socioeconomic markers education level, cohabitation status, and income, and the risk of progression to acute myeloid leukemia (AML), and all-cause mortality among MDS patients. Methods: Using the Danish Myelodysplastic Syndromes Database, we identified all patients with incident MDS diagnosed between January 1st 2010 and December 31th 2018. The database holds valid and detailed patient- and disease-characteristics on all Danish MDS patients diagnosed since 2010. We linked the study-population with individual-level information on education, cohabitation status, income, comorbidity, progression to AML, and vital status retrieved from high-quality Danish population-based registries. We computed absolute risks of progression to AML and all-cause mortality using the cumulative incidence (risk) function accounting for death as competing risk when AML was the outcome. Also, 1-year, 3-year, and 5-year relative risks (RRs) of progression to AML and death were computed using the pseudovalue approach. All results were given crude and adjusted for age, sex, socioeconomic position (SEP), comorbidity and subtype of MDS according to the "International Prognostic Scoring System" (IPSS) and with 95% confidence intervals (CIs). Results: The final cohort comprised 2233 MDS patients (median age 75 years, 63% males). Median follow-up time was 1.7 years. The 1-year risks of progression to AML was similar across education levels (long education (>13 years): 5%, medium education (9-12 years): 6%, short education (<9 years): 6%. In adjusted models, there were no associations between education, income or cohabitation status and risk of progression to AML (Table 1). Still, patients with a short education had higher 1-year all-cause mortality (33%) compared to those with medium (22%) and longer education (21%) (Figure 1). In adjusted models the risk of death one year from diagnosis was higher in patients with short vs. longer education [RR=1.26 (95% CI: 1.03-1.55)], in patients with lower vs. higher income [RR=1.43 (95% CI: 1.17-1.75)], and among patients who were living alone compared to those who lived with someone [RR=1.19 (1.02-1.39)]. The increased risk of death among patients with short education, low income, and those who lived alone persisted after 3-year and 5-years of follow-up (Table 1). Conclusion: In a real world setting, shorter education, living alone, and lower income were not associated with increased risk of progression to AML but with inferior survival in Danish MDS patients. These results suggest that in spite of "free and equal access" to healthcare and cancer treatment in Denmark, short education, living alone, and low income are adverse prognostic factors for patients with MDS. Further analyses are ongoing to get insight into the mechanisms driving these socioeconomic disparities in MDS patients. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Socioeconomic Position and Late-Onset Dementia: A Nationwide Register-Based Study

Objectives Previous research on the association between socioeconomic position (SEP) and dementia has not sufficiently accounted for the complex relationship between education and occupation. We investigated the independent and joint effects of educational attainment and occupation-based SEP on dementia. Methods We used register-based information about educational attainment, occupation-based SEP, and dementia from 1,210,720 individuals. Information about cognitive ability at conscription was available for a subsample of men. Results When mutually adjusted, lower educational attainment and occupation-based SEP were associated with higher dementia risk in a dose–response manner. Higher occupation-based SEP partly mitigated the higher dementia risk associated with lower educational attainment. After adjusting for cognitive ability in a subgroup of men, only unskilled work was associated with higher dementia risk. Discussion Occupation-based SEP is independently associated with dementia and may mitigate the higher dementia risk associated with short education. Future research should elucidate the mechanisms underlying social inequality in dementia.

INVESTIGATING THE USE ACTION LEARNING APPROACHES IN CIVIL ENGINEERING AND CONSTRUCTION STUDIES: A CASE OF SKILLS CENTRE

Civil Engineering and Construction studies are the study fields that embraces practical and theory. While action learning approaches is encompassed with a myriad of teaching and learning methods to closed the deficits. The research aims to investigate the use of action learning approaches in Civil engineering and Construction studies. while the objective of the research is to assess the extent to which action learning approaches is employed in teaching practical and content knowledge in Civil Engineering and Construction studies. The research used a mixed-method approach comprising quantitative and qualitative methodology to collect data. Questionnaire and face to face semi-structured interview were used as the tools to gather data. Participants were all 10 lecturers and assistance lecturers, males and females from different culture, age and race. Findings of the research revealed that lecturers are using action learning approaches unaware. The research, suggests that all lecturer at the skills centres should be afforded opportunities to attend facilitations and assessor courses or Universities of Technology should develop a short education methodology for them of which it will equip their teaching and learning skills.

IMPORTANCE OF YOUTH EDUCATION

The article discusses the important role of education in human life. It talks about the values and directions of education in the lives of young people. It notes that the education generally provides the people with knowledge and skills. It plays a major role in shaping the personality of young people. Education is essential for every individual to succeed in life. In short, education is a guide from darkness to the light. It emphasizes that education is vital to the healthy growth and development of one’s personality. Key words: education, youth, society, knowledge, communication, generation

A health inequality impact assessment from reduction in overweight and obesity

Background In recent years, social differences in overweight and obesity (OWOB) have become more pronounced. Health impact assessments provide population-level scenario evaluations of changes in disease prevalence and risk factors. The objective of this study was to simulate the health effects of reducing the prevalence of overweight and obesity in populations with short and medium education. Methods The DYNAMO-HIA tool was used to conduct a health inequality impact assessment of the future reduced disease prevalence (ischemic heart disease (IHD), diabetes, stroke, and multi-morbidity) and changes in life expectancy for the 2040-population of Copenhagen, Denmark (n = 742,130). We simulated an equalized weight scenario where the prevalence of OWOB in the population with short and medium education was reduced to the levels of the population with long education. Results A higher proportion of the population with short and medium education were OWOB relative to the population with long education. They also had a higher prevalence of cardiometabolic diseases. In the equalized weight scenario, the prevalence of diabetes in the population with short education was reduced by 8–10% for men and 12–13% for women. Life expectancy increased by one year among women with short education. Only small changes in prevalence and life expectancy related to stroke and IHD were observed. Conclusion Reducing the prevalence of OWOB in populations with short and medium education will reduce the future prevalence of cardiometabolic diseases, increase life expectancy, and reduce the social inequality in health. These simulations serve as reference points for public health debates.

A health inequality impact assessment of leveling down overweight and obesity

Background Social differences in the proportion of overweight and obesity have increased in recent decades. Health impact assessments provide population-level valuations of changes in disease prevalence related to scenarios with different risk factors levels. These scenarios can be focused on reducing overweight and obesity among people with low socioeconomic position. Methods This study included the projected population of Copenhagen, Denmark in year 2040 (n = 742,130). Using the DYNAMO-HIA tool we conducted a health inequality impact assessment. Future prevented disease prevalence (IHD, diabetes, stroke, and multi-morbidity) and change in life expectancy related to an equalized scenario were estimated in a scenario where the prevalence of overweight/obesity (OWOB) in the group of people with short and medium educational attainment was reduced to the levels of people with long education. Results A higher proportion of people with short and medium education were OWOB than among people with long education and they had higher prevalence of cardiometabolic diseases. The diabetes prevalence among people with short education was reduced by 8-10% for men and 12-13% for women and life expectancy with diabetes decreased by one year in the group of women with short education. No notable effect of the equalized OWOB was seen regarding life expectancy with and prevalence of stroke and IHD. Conclusions Reaching the low prevalence of OWOB observed among people with high educational level, will reduce future cardiometabolic disease, increase life expectancy and meanwhile reduce the social inequality in health. These findings can serve as relevant references points for public health planners. Key messages This study is the first to combine advanced mathematical modelling and population data to assess changes in health from reducing socioeconomic inequality in obesity and overweight. These results propose valuable reference values for outcome assessments of interventions on inequalities in health.

The number of years lost in 30-year work life spans of people with type 1 and type 2 diabetes

Background Although diabetes is among the most common causes of lifelong disability, no studies have yet outlined work disability from a life course perspective. This study estimated the number of years people with type 1 and type 2 diabetes lost in a work life span compared to people without diabetes Methods Individuals aged 18-65 years, diagnosed with type 1 (n = 33,188) or type 2 diabetes (n = 81,930) were identified from national registers from the entire Danish population and age and gender matched with controls without diabetes (n = 663,656), for period 2000-2017. WLE in years were estimated as time in employment from age 35 to 65. We used a life table approach with multi-state Cox proportional hazard modelling (95% Confidence Intervals: CI). Age was the underlying time-axis. Inverse probability weights accounted for differences between populations. Analyses were performed separately for sex, educational status, and types of diabetes in 5-year age intervals. Results Individuals with type 1 diabetes and type 2 diabetes had significantly shorter WLE compared to people without diabetes in the 30-year span. Type 1 diabetes: WLE ranged from 8 years shorter among women with short education [-8.0; CI:-11/-5.0] to 4 years shorter [-4.4; CI:-6.6/-2.3] with high education; WLE in men ranged from -6.4 [CI:-8.7/-4.0] with short education to -3.0 [CI:-4.5/-1.5] with high education. Type 2 diabetes: WLE ranged from -6.5 [CI: -8.9/-4.0] in women with short education to -2.9 [CI: -4.5/-1.3] with high education. WLE in men ranged from -7.0 [CI: -9.4/-4.5] with short education to -3.7 [CI: -5.4/-2.0] with high education. Conclusions The substantial number of years lost in a work life span for individuals with type 1 or type 2 diabetes, highlight need for new strategies that prevent work disability, particularly for individuals with short education. Key messages Individuals with type 1 diabetes and type 2 diabetes had between 9 and 3 years shorter work life expectancies compared to people without diabetes in a 30-year span. The work life spans are substantial shorter for individuals with type 1 or type 2 diabetes with short educations.

Resuscitation status conversations: a short education session improves junior doctors’ confidence

AimJunior doctors are frequently required to discuss resuscitation status with patients. They generally lack experience, confidence and skill in having these conversations. However, there is currently no formal postgraduate education requirement to improve or develop in this area. The aim of this educational intervention was to improve junior doctors’ level of confidence and skill in having resuscitation status conversations with patients.MethodAn educational intervention for 27 prevocational postgraduate second and third-year house officers at a tertiary hospital in Hamilton, New Zealand was conducted. A self-administered survey was completed preintervention and postintervention.ResultsFour factors were assessed in the survey (level of confidence having conversations regarding resuscitation status, ability to prognosticate, content of conversations and perceived barriers to having conversations), with a statistically significant difference found with respect to level of confidence having conversations regarding resuscitation status (p=0.001).ConclusionThis study demonstrated that a short education session improves confidence in discussing resuscitation status. It has also identified the need for further postgraduate training in complex communication skills.