Health status of university football athletes through multidimensional screening

OBJECTIVE

Adequate conditioning results from various physical, environmental, and psychological factors in sports activities. In this study, we aimed to clarify the concurrence and relevance of injuries, psychological problems, and sleep disturbance in university football (soccer) players. Biomechanical characteristics and risk factors for those injuries were also investigated.

METHODS

Overall, 1,084 university football players participated in this cross-sectional study using a web-based health history questionnaire. Assessments were made via the presence of injuries for physical problems, the Athlete Psychological Strain Questionnaire (APSQ) for psychological problems, and the Athlete Sleep Screening Questionnaire (ASSQ) for sleep difficulties.

RESULTS

There were 200 (19%) athletes with injuries; 413 (38%) of these were APSQ-positive, 246 (23%) were ASSQ-positive, and 468 (43%) athletes had no physical, psychological, or sleep problems. APSQ-positive respondents were significantly more likely to have a current injury than those who were APSQ-negative. No significant difference was observed between the number of ASSQ-positive and -negative respondents and current injuries. Those with sleep problems were significantly more likely to have psychological problems.

CONCLUSION

More than 60% of university football players had one or more physical, psychological, or sleep problems. Players may have co-occurring problems, and it is important to address them for these athletes to reach peak performance.

Health-related quality of life measured using the EQ-5D-3L: iranian population norms

BACKGROUND

Normative values are valuable for comparing a specific population with the general population, making them particularly useful in disease burden studies and cost-effectiveness analysis. The objective of this study was to estimate HRQoL normative values for the EQ-5D measure in Iran.

METHODS

The analysis was performed using a sample (n = 27,704) of the Iranian adult population, which was extracted from a nationwide survey conducted in 2021. Participants assessed their health-related quality of life using the EQ-5D-3 L instrument and a visual analogue scale (EQ VAS). Multivariable regression analyses were performed to examine the relationships between utility scores, EQ VAS scores, and various socio-demographic factors.

RESULTS

The mean utility and EQ VAS scores of the total sample were 0.87 (95% CI: 0.86, 0.88) and 72.9 (95% CI: 72.7, 73.1), respectively. Almost half of the respondents (46.8%) reported a health state without any problems. The most prevalent problems were pain/discomfort (38.3%) and anxiety/depression (35.2%). Furthermore, EQ-5D values and EQ VAS scores were associated with gender, age, employment status, education level, marital status, and chronic illness.

CONCLUSIONS

This study provided normative values for the general population in Iran. Policymakers and researchers can use these values as a reference for population norms in economic assessments and studies focusing on the population's health.

Social isolation, social media use, and poor mental health among older adults, California Health Interview Survey 2019-2020

BACKGROUND

Older adults' engagement on social media may be a resource to reduce loneliness and improve mental health.

PURPOSE

This study aimed to examine loneliness and social media use and its association with severe psychological distress among older adults and whether social media use moderated the association of loneliness on severe psychological distress among older adults.

METHODS

This study is a secondary analysis of the 2019-2020 California Health Interview Survey. The Kessler 6-item Psychological Distress Scale (K6) assessed symptoms of psychological distress, with a K6 score ≥ 13 associated with severe mental illness. Loneliness was measured using a revised Three Item Loneliness Scale (TILS) score. Multiple regression analyses were conducted to examine associations between loneliness and severe psychological distress.

RESULTS

Loneliness, health status, and identification as Asian, remained strong predictors of severe psychological distress among older adults when adjusting for other factors. In bivariate analysis, high-frequent social media users, but did not remain significant when accounting for covariates. Social media use did not moderate the association between loneliness and severe psychological distress.

CONCLUSION

This study underscores the significant impact of loneliness on poor mental health among older adults, emphasizing that while frequent social media use correlates with severe psychological distress, it may not alleviate the association of loneliness on poor mental health, thus highlighting the urgent need to address social isolation and promote genuine social connectedness, particularly among Asian older adults.

Effects of a Physical Exercise Program on Quality of Life and Physical Fitness of Breast Cancer Survivors: the MAMA_MOVE Gaia After Treatment Trial

To assess the effects of a group class physical exercise program on health-related quality of life (HRQOL), physical fitness and activity, and safety in early breast cancer women after treatment, a double-phase trial [16-week control phase (CP) followed by a 16-week intervention phase (IP)] was designed. Outcomes were evaluated at baseline (T1), 8 (T2) and 16 (T3) weeks (CP), and 24 (T4) and 32 (T5) weeks (IP). The primary endpoint was global health status. Out of 82 enrolled patients, 37 completed the IP. Global health status decreased (-10,1; 95% CI -19.8 to -0.4; p = 0.040) during the CP and stabilized during the IP. Physical and sexual functioning increased during the IP (p = 0.008; p = 0.017), while cardiorespiratory fitness increased in the CP (p = 0.004). Upper limb strength and lower limb functionality increased during both phases [CP: p < 0.0001, p = 0.001 (surgical and nonsurgical arm), p = 0.028; IP: p < 0.0001, p = 0.002, p = 0.009]. Body mass index decreased in the IP (p = 0.026). Waist circumference increased in the CP (p = 0.001) and decreased in the IP (p = 0.010); sedentary behaviours and moderate and vigorous physical activity did not change. Adherence to 70% of the sessions was reported in 54% of patients. No serious adverse events related to the intervention were reported. In conclusion, the physical exercise program was able to prevent the decline in global health status and to improve other domains of HRQOL and physical fitness. As physical exercise is not the standard of care in many countries, the implementation of group class programs might be an option.

Well-being in healthy Icelandic women varies with extreme seasonality in ambient light

Seasonal variation in photoperiod may affect psychosocial and physical well-being in healthy persons. We tested this hypothesis in healthy pre-menopausal women, without a history of mood disorders, living year-round in Reykjavik, Iceland (64.1°N). Participants reported daily self-assessments of well-being throughout a complete ovulatory menstrual cycle in summer and/or winter (70% participated in both seasons). Scores for mood, cognitive acuity, social support, physical health and a composite of these four indicators were each significantly higher in summer than in winter (linear mixed effects models: p < .001 for each model); tiredness did not differ by season. The effect of season was not significantly changed by inclusion of body mass index and/or age as covariates. Some prior studies have been hampered by sparse time sampling, inattention to covariates and/or relying on recalled data. This is to our knowledge the first investigation to test the study hypothesis with daily real-time data spanning complete ovulatory menstrual cycles in each of two seasons. This dense sampling has revealed modest seasonal variation in well-being in healthy women. Daylength (sunlight exposure) is likely a major, but not necessarily sole, factor in these seasonal differences in well-being; temperature is likely less important given Iceland's relatively moderate (for its high latitude) seasonal temperature swings.

Cancer population norms using a new value set for the SF-6Dv2 based on the preferences of patients with breast or colorectal cancer in Quebec

BACKGROUND

Because health resources are limited, health programs should be compared to allow the most efficient ones to emerge. To that aim, health utility instruments have been developed to allow the calculation of quality-adjusted life-year (QALY). However, generic instruments, which can be used by any individual regardless of their health profile, typically consider the preferences of the general population when developing their value set. Consequently, they are often criticized for lacking sensitivity in certain domains, such as cancer. In response, the latest version of the Short Form 6-Dimension (SF-6Dv2) has been adapted to suit the preferences of patients with breast or colorectal cancer in the Canadian province of Quebec. By extension, our study's aim was to determine cancer population norms of utility among patients with breast or colorectal cancer in Quebec using the SF-6Dv2.

METHOD

To determine the cancer population norms, we exploited the data that were used in the development of a new value set for the SF-6Dv2. This value set was developed considering the preferences of patients with breast or colorectal cancer. Stratification by time of data collection (i.e., T1 and T2), sociodemographic variables (i.e., age, sex, body mass index, and self-reported health problems affecting quality of life), and clinical aspects (i.e., cancer site, histopathological classification, cancer stage at diagnosis, modality, and treatment characteristics) was performed.

RESULTS

In 353 observations, patients were more likely to have negative utility scores at T1 than at T2. Males had higher mean utility scores than females considering type of cancer and comorbidities. Considering the SF-6Dv2's dimensions, more females than males reported having health issues, most which concerned physical functioning. Significant differences by sex surfaced for all dimensions except "Role Limitation" and "Mental health." Patients with multifocal cancer had the highest mean and median utility values in all cancer sites considered.

CONCLUSION

Cancer population norms can serve as a baseline for interpreting the scores obtained by a given population in comparison to the situation of another group. In this way, our results can assist in comparing utility scores among cancer patients with different sociodemographic groups to other patients/populations groups. To our knowledge, our identified utility norms are the first for patients with breast or colorectal cancer from Quebec.

Relationship between dietary knowledge, food preference, and long-short term health status among Chinese adults

BACKGROUND AND OBJECTIVES

In recent years, with the improvement of people's living standards and changes in dietary patterns, dietary knowledge and food preference have been playing an increasingly crucial role in health. The aim of our study was to examine the relationship between dietary knowledge, food preference, and long-short term health status among Chinese adults aged 18-70.

METHODS AND STUDY DESIGN

This study employed cross-sectional data from the 2015 China Health and Nutrition Survey obtained from 4822 adults. We utilized self-assessed health status as an indicator of long-term health status and utilized sickness in the last four weeks as a measure of short-term health status. Taking advantage of ordered probit regression, long-term health status was regressed on all predictors, while the binary logistic regression was used to analyze the factors influencing short-term health status. The propensity score matching is employed to account for potential selection bias in analysis, thereby increasing the robustness and credibility of results.

RESULTS

The analysis revealed that dietary knowledge and food preference can improve an individual's long-term health status significantly. However, there is no evidence to show that short-term health status is affected by food preference. Furthermore, dietary knowledge is negatively associated with short-term health status.

CONCLUSIONS

These findings highlight the importance of dietary education and healthy eating habits in improving the long-term health status of Chinese adults. The study suggests implications for public health strategies aimed at enhancing the health and well-being of Chinese adults.

Health and Demographic Factors for Chronic Obstructive Pulmonary Disease Among Hispanic Adults in the United States: Analysis of Behavioral Risk Factor Surveillance System Survey Data

Introduction: Appropriate diagnosis and regular primary care appointments are markers of quality chronic obstructive pulmonary disease (COPD) care. Underdiagnosis of COPD has been associated with an absence of health insurance, lower socioeconomic status, and race and ethnicity. Methods: This study examined predictors of COPD using data from the Behavioral Risk Factor Surveillance System (BRFSS, 2021) to provide information for prevention messaging and interventions. Participants included Hispanic adults (n = 17,782) aged 45 years and older. Chi-square tests and a multinomial logistic regression analysis (adjusted with the BRFSS weighting variable) were used to understand how sex, income, health status, smoking behaviors, asthma morbidity, and health insurance coverage were related to having COPD. Results: Patients with poor health, lower income level, current smokers, former smokers, or asthma were more likely to report COPD. Females were more likely to report COPD than males. Patients with COPD were more likely to be without health insurance when compared to those who did not have COPD, indicating unmet medical needs. Conclusion: Studies such as this one, aiming to evaluate the relationship between COPD prevalence and predictors of health and outcomes among Hispanic patients in the United States will remain important for developing health messaging to attenuate disease progression.

Health literacy in older adults receiving hemodialysis in Turkey: A cross-sectional study

INTRODUCTION

This study aimed to determine the health literacy level and related factors of older adults receiving hemodialysis treatment.

METHODS

A cross-sectional study was conducted at the five dialysis centers, using the information form and Turkish Health Literacy Survey-32 (THLS-32). A total of 336 older adults receiving hemodialysis treatment participated.

RESULTS

The general health literacy score was found to be 25.69 ± 14.47. Based on the health literacy assessment scores, 62.5% of the participants were in the category of inadequate and limited level of health literacy. The lower level of education, perceived health status, income, and getting help in reading and writing were statistically significant predictors of the health literacy score.

CONCLUSION

The health literacy of older adults receiving hemodialysis treatment was inadequate and limited. Findings of this study emphasize the importance of integrating health literacy assessment in clinical care settings and supporting the health literacy of older adults receiving hemodialysis treatment.

Self-reported oral health status, edentulism and all-cause mortality risk in 12 809 Australian older adults: a prospective cohort study

OBJECTIVE

To investigate the association between oral health status and all-cause mortality in older adults using prospective cohort study design.

SETTING AND PARTICIPANTS

In total, 12 809 adults aged ≥70 years (54.3% females) were participants of the ASPREE Longitudinal Study of Older Persons (ALSOP).

METHODS

Participants self-reported the presence of natural teeth and oral health status. The association of self-reported oral health, edentulism and the integrative measure of the two with all-cause mortality were explored using the Cox-regression models adjusted for age, gender, socio-economic status, health-related behaviours, weight status, aspirin and polypharmacy. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported.

RESULTS

In total, 22.2% of participants reported edentulism and 13.8% had fair/poor oral health. After adjustment for confounders, risk of all-cause mortality was higher among those with edentulism (vs. no edentulism) HR (95% CI) 1.43 (1.18, 1.73); and those with edentulism and reporting poor/fair oral health HR (95% CI) 1.69 (1.02, 2.82), or with no edentulism but reporting poor/fair oral health HR (95% CI) 1.46 (1.19-1.80) vs. no edentulism and reporting good/very good/excellent oral health. No association was observed between self-reported oral health alone and all-cause mortality.

CONCLUSIONS

The risk of all-cause mortality was 69% higher among older adults reporting both edentulism and poor/fair oral health compared with those with teeth and more favourable self-reported oral health. © 2023 Australian Dental Association.

The impact of social determinants on health outcomes in a region in the North of England: a structural equation modelling analysis

OBJECTIVES

The aim of this study was to identify the impact of social determinants of health on physical and mental health outcomes in a UK population.

STUDY DESIGN

Structural equation modelling was used to hypothesise a model of relationships between health determinants and outcomes within a region in the North of England using large-scale population survey data (6208 responses).

METHODS

We analysed responses from a population survey to assess the influence of a deprivation-based index at the environmental level, education and income on a behaviour index (smoking, alcohol consumption, physical activity, and dietary habits) and the influence of all these factors on self-reported physical health and the influence of the behaviour index and income on mental wellbeing.

RESULTS

The proposed model was well supported by the data. Goodness-of-fit statistics, most notably a low value of the root mean square error of approximation (RMSEA), supported the validity of the proposed relationships (RMSEA = 0.054). The model revealed all examined paths to be statistically significant. Income and education were influential in determining an individual's behaviour index score, which, with income was the most important predictor of both the correlated outcomes of physical health and mental wellbeing (P < 0.001 in all cases).

CONCLUSIONS

Findings challenge the traditional view of singular causal pathways, emphasising that interventions should consider the underlying influencing socio-economic conditions, which would influence behaviour and therefore physical and mental wellbeing. The extent to which the model is supported by the data, and the statistical significance of individual relationships accentuates the imperative for comprehensive public health strategies that integrate multiple socio-economic factors.

Using Standardised International Oral Health-Related Datasets in 6 Countries

INTRODUCTION

Oral diseases affect a significant proportion of the world's population, yet international comparisons involving oral health outcomes have often been limited due to differences in the way country-level primary data are collected. In response to this, the World Dental Federation (FDI) Oral Health Observatory project was launched with the goal of collecting and producing standardised international data on oral health across countries. The aim of this descriptive cross-sectional study was to examine associations between self-reported general health and a range of factors (sociodemographics, oral health-related behaviours, oral impacts, clinical variables) using these standardised international datasets.

METHODS

Dentists within FDI member National Dental Associations who chose to take part in the project were selected using a multistage sampling method. The number of dentists in each cluster was set according to the proportion of the national population living in the area, and 50 patients per dentist were systematically approached to take part. Patients and dentists completed 2 separate questionnaires on a mobile app. Ordinal logistic regression (conducted in December 2022) was used to analyse the linked patient and dentist data from 6 countries: China (n = 2242); Colombia (n = 1029); India (n = 999); Italy (n = 711); Japan (n = 1271); and Lebanon (n = 798). Self-reported general health was the dependent variable, with age, sex, education, self-reported oral health-related behaviours, self-reported oral impacts, and clinical variables acting as the independent variables.

RESULTS

The results demonstrated a different pattern of associations in the different countries. Better self-reported general health was associated with degree-level education in all 6 countries and with reporting no oral impact and no sensitive teeth in 4 countries. Several country-specific patterns were also found, including the importance of tooth brushing in Colombia, periodontal health in Italy, and differing associations with sugary drinks consumption in India and Japan.

CONCLUSIONS

These descriptive findings provide a basis for further research and, importantly, for advocacy in identifying patient oral health care needs according to both person-reported and clinical aspects. This can facilitate optimisation of service provision and potentially influence policy and investments.

Age and Sex Differences in the Genetic Architecture of Measures of Subjective Health: Relationships With Physical Health, Depressive Symptoms, and Episodic Memory

OBJECTIVES

Subjective health (SH) is not just an indicator of physical health, but also reflects active cognitive processing of information about one's own health and has been associated with emotional health measures, such as neuroticism and depression. Behavior genetic approaches investigate the genetic architecture of SH, that is, genetic and environmental influences on individual differences in SH and associations with potential components such as physical, cognitive, and emotional health. Previous twin analyses have been limited by sex, sample size, age range, and focus on single covariates.

METHODS

The current analysis used data from 24,173 adults ranging in age from 40 to 90 years from the international Interplay of Genes and Environment across Multiple Studies consortium to investigate the genetic architecture of 3 measures of SH: self-rated health, health compared to others, and impact of health on activities. Independent pathways model of SH included physical health, depressive symptoms, and episodic memory, with age, sex, and country included as covariates.

RESULTS

Most or all of the genetic variance for SH measures were shared with physical health, depressive symptoms, and episodic memory. Genetic architecture of SH differed across measures, age groups (40-65, 66-90), and sexes. Age comparisons indicated stronger correlations with all 3 covariates in older adults, often resulting from greater shared genetic variance.

DISCUSSION

The predictive value of SH has been amply demonstrated. The higher genetic contributions to associations between SH and its components in older adults support the increasing conceptualization with age of SH as an intuitive summation of one's vital reserve.

Work-, lifestyle-, and health-related factors among women and men working in the emergency medical services

Objectives. This study aimed to describe work-, lifestyle-, and health-related factors among ambulance personnel, and to analyse differences between women and men. Methods. The cross-sectional study (N = 106) included self-reported and objective measures of work, lifestyle, and health in 10 Swedish ambulance stations. The data collection comprised clinical health examination, blood samples, tests of physical capacity, and questionnaires. Results. A high proportion of the ambulance personnel reported heavy lifting, risk of accidents, threats and violence at work. A low level of smoking and alcohol use, and a high level of leisure-time physical activity were reported. The ambulance personnel had, on average, good self-rated health, high work ability and high physical capacity. However, the results also showed high proportions with risk factors for cardiovascular disease (CVD), e.g., high blood pressure, and high levels of blood lipids. More women than men reported high work demands. Furthermore, women performed better in tests of physical capacity and had a lower level of CVD risk factors. Conclusions. Exposure to work-related factors that might affect health was common among ambulance personnel. Lifestyle- and health-related factors were somewhat contradictory, with a low proportion reporting lifestyle-related risk factors, but a high proportion having risk factors for CVD.

Unrelenting Growth and Diversification: Using the Health and Retirement Study to Illuminate Cannabis Use Among Aging Americans

BACKGROUND AND OBJECTIVES

Cannabis use among aging Americans continues to increase. We examine correlates of cannabis use including attitudes, state of residence, health status, and service use.

RESEARCH DESIGN AND METHODS

Using the 2018 Health and Retirement Study Cannabis module completed by 1,372 respondents aged 50 and older, we distinguished current cannabis users from those who have never used or have some prior use. We linked 2018 and 2016 core HRS data and used multinomial regressions to identify associations among current use, attitudes, place of residence, as well as current (2018) and past (2016) medical conditions, pain, and sleep issues. We also examined associations among cannabis use, hospital stays, and outpatient medical visits.

RESULTS

Past-year cannabis use reached 10.3% among aging Americans. Attitudes toward cannabis have changed over time with 4 of 5 survey respondents currently holding a favorable attitude. Attitude and state of residence were associated with current use. Cannabis users reported higher levels of pain, were more likely to use prescription opioids, and report activity limitations in both 2016 and 2018. Associations between cannabis use and sleep issues or concurrent healthcare use were not observed.

DISCUSSION AND IMPLICATIONS

Changing attitudes and state legalization appear important for late middle-aged and older persons, and as many as 1 of every 5 persons over 50 may be using cannabis by 2030. Cannabis use among aging Americans warrants increased attention from care providers, program administrators, and policymakers, especially as a prevention or harm reduction strategy relative to prescription opioids.

The Mediating Role of Proxy Respondents on the Relationship Between Cognitive Function and Self-Rated Health

BACKGROUND AND OBJECTIVES

Proxy respondents are an important tool in survey research, especially among people with cognitive impairment. However, proxy respondents may be unable to accurately answer subjective survey instruments for cognitively impaired persons. This study investigates the mediating effect of proxy status on the relationship between cognitive impairment and subjectively rated health.

RESEARCH DESIGN AND METHODS

Respondents from the 2018 wave of the Health and Retirement Study (N = 17,146) were included, and the Baron and Kenny method assessed the potential mediating role of having a proxy on subjectively rated health. Subjectively rated health and proxy status were dichotomously coded, and relationships between cognitive impairment, proxy status, and subjectively rated health were assessed using logistic regression.

RESULTS

Findings indicate that cognitive impairment is inversely associated with subjectively rated health, and it is directly associated with having a proxy. They also indicate that having a proxy is inversely related to subjectively rated health. When including proxy status and cognitive impairment in the same model, cognitive impairment no longer predicted subjectively rated health. This indicates that proxy status perfectly mediated the relationship between cognitive impairment and subjectively rated health.

DISCUSSION AND IMPLICATIONS

Measuring the experiences of people with cognitive impairment is challenging in survey research due to the limiting features of cognitive impairment. Although having a proxy respondent helps address attrition-related measurement challenges in survey research, findings indicate that proxies report worse subjectively rated health for people with cognitive impairment compared to individuals with comparable levels of cognitive impairment without a proxy. Future research may benefit from exploring optimal proxy-respondent characteristics.

Early-Life Exposure to War and Later-Life Physical Functional Health

OBJECTIVES

A growing body of research shows that early-life exposure to war has adverse effects on later-life health. Research has emphasized the importance of exposure timing implicating domain-specific developmental processes and associated critical/sensitive periods. This study looks at the impacts of early childhood war exposure and the repercussions for later-life physical and functional health, with a focus on time of exposure as a source of variability.

METHODS

We use residential histories from the Survey of Health Ageing, and Retirement in Europe linked to external data on the location and timing of hostilities to examine the impact of early-life exposure to World War II on later-life physical and functional health.

RESULTS

Exposure to war increases the risk of objective (grip strength, chair rise, and peak expiratory flow) and self-reported (mobility limitations and activities of daily living) measures of functional health. Effects are especially pronounced for those born during the war and for those with more prolonged exposures. There is little evidence that the impact of war is mediated by war-related hardships, socioeconomic conditions, health behaviors, or adult chronic disease.

DISCUSSION

Our results suggest early-life exposure to war has a lasting impact on physical functional health. Exposure appears to largely operate via direct effects, indicative of altered initial development of physical capacity in early life. Because exposure was so pervasive among some cohorts of older individuals, understanding the health of present older European populations requires wrestling with the residual consequences of wartime exposure at the start of their lives.

Intrarelationships between suboptimal health status and anxiety symptoms: A network analysis

BACKGROUND

Suboptimal health status is a global public health concern of worldwide academic interest, which is an intermediate health status between health and illness. The purpose of the survey is to investigate the relationship between anxiety statuses and suboptimal health status and to identify the central symptoms and bridge symptoms.

METHODS

This study recruited 26,010 participants aged <60 from a cross-sectional study in China in 2022. General Anxiety Disorder-7 (GAD-7) and suboptimal health status short form (SHSQ-9) were used to quantify the levels of anxiety and suboptimal health symptoms, respectively. The network analysis method by the R program was used to judge the central and bridge symptoms. The Network Comparison Test (NCT) was used to investigate the network differences by gender, place of residence, and age in the population.

RESULTS

In this survey, the prevalence of anxiety symptoms, SHS, and comorbidities was 50.7 %, 54.8 %, and 38.5 %, respectively. "Decreased responsiveness", "Shortness of breath", "Uncontrollable worry" were the nodes with the highest expected influence. "Irritable", "Exhausted" were the two symptom nodes with the highest expected bridge influence in the network. There were significant differences in network structure among different subgroup networks.

LIMITATIONS

Unable to study the causal relationship and dynamic changes among variables. Anxiety and sub-health were self-rated and may be limited by memory bias.

CONCLUSIONS

Interventions targeting central symptoms and bridge nodes may be expected to improve suboptimal health status and anxiety in Chinese residents. Researchers can build symptom networks for different populations to capture symptom relationships.

A comparison of chronic conditions and health characteristics between cancer survivors and non-cancer survivors

OBJECTIVE

Cancer survivors have unique healthcare needs. An important consideration for survivorship is chronic diseases and health risk factors. The purpose of this study is to describe demographics, risk factors, and comorbid health conditions in adult cancer survivors.

METHOD

We analyzed 2019 Arizona Behavioral Risk Factor Surveillance System data to compare cancer survivors to non-cancer survivors (aged 18 or older) to assess differences between the two populations. Adjusted and unadjusted population-based estimates and 95% confidence intervals were calculated, and multivariable logistic regression models were performed.

RESULTS

Eight thousand nine-hundred and twenty (8920) respondents (1007 survivors; 7913 non-cancer survivors) were included. Compared to non-cancer survivors, cancer survivors were more likely to be female, 65 years and older, non-Hispanic white, veterans, and less likely to be employed. Survivors had higher rates of coronary heart disease, stroke, chronic obstructive pulmonary disease, kidney disease, hypertension, arthritis, multiple chronic conditions, being overweight, and being a former smoker. Survivors were more likely to report fair/poor health than non-cancer survivors.

DISCUSSION

These findings can be used by healthcare and public health practitioners to evaluate the programmatic efforts and resources, implement targeted interventions toward cancer survivors, and improve health and quality of life.

Generativity as a Traditional Way of Life: Successful aging among Unangan Elders in the Aleutian Pribilof Islands

Predominantly Western-based biomedical models of successful aging have been used to research, understand, and explain successful aging among diverse populations. With an increasingly heterogeneous older adult population nationwide, scholars have been exploring Indigenous understandings of successful aging. To add to the accumulation of knowledge of diverse Alaska Native populations, this study involved semi-structured qualitative interviews with 20 Unangan Elders from the Aleutian and Pribilof Islands. This community-based participatory research study explores the aging experiences and conceptualization of successful aging of these Elders from this remote and culturally distinct region of Alaska. Thematic analysis was employed to identify themes related to successful aging within this specific region, which supported our previous four themes, or characteristics, of Alaska Native successful aging: physical health, social support and emotional well-being, generativity as a traditional way of life, and community engagement and Inidgenous cultural generativity. Each of these themes or characteristics of Eldership is intertwined and together support successful aging within two remote communities in the Bering Sea. The findings of this study illuminate how Alaska Native Elders can live in geographically diverse regions of the State, yet the values and teachings they possess on successful aging possess the same cultural values and teachings. This study highlighted two new emerging constructs that influence Alaska Native Elders' successful aging based on geographical location. Findings contribute to the thematic saturation of the four main successful aging domains while outlining the importance of future research to conduct deeper investigations into the role of environment and history on Elders' perceptions and understanding of aging.

Tumor necrosis factor-α is transferred to equine neonates via colostrum but is not associated with their health status

We followed the hypothesis that equine neonates with reduced transfer of tumor necrosis factor-α (TNFα) are at increased risk of neonatal infection. We investigated TNFα concentrations in colostrum of healthy mares and blood of their neonates in a non-hospitalized population of Warmblood mares where delivery, neonatal adaptation and health was closely monitored by veterinarians. Concentration of TNFα and IgG was determined in colostrum respective milk and in neonatal blood collected immediately after delivery and 18 h thereafter in 97 foals that were assigned to groups failure of passive transfer (FPT; n = 31) and control (CON; n = 66) based on serum IgG concentration at 18 h of age. Foal health was assessed repeatedly during the first 24 h of life. Statistical analysis was done with p < 0.05 indicating significance. There were no significant differences between foal groups FPT and CON regarding age and parity of dams, gestation length (FPT 343 ± 10, CON 340 ± 8 days) and foal sex. Concentrations of TNFα in colostrum at birth and in foals at 18 h varied but did not differ between groups (colostrum FPT 6.1 ± 9.1, CON 9.9 ± 31.5 ng/ml; foal FPT 2.3 ± 5.9, CON 2.4 ± 5.3 ng/ml; n.s.). There was an increase in the mean serum TNFα concentration until 18 h in foals (n.s. between groups). Results of the present study confirm previous findings of TNFα transfer from the mare to the neonate via colostrum but do not suggest that transfer of TNFα via colostrum is important for protection of the neonate against infectious diseases.

The silent epidemic of loneliness: identifying the antecedents of loneliness using a lagged exposure-wide approach

BACKGROUND

A large and accumulating body of evidence shows that loneliness is detrimental for various health and well-being outcomes. However, less is known about potentially modifiable factors that lead to decreased loneliness.

METHODS

We used data from the Health and Retirement Study to prospectively evaluate a wide array of candidate predictors of subsequent loneliness. Importantly, we examined if changes in 69 physical-, behavioral-, and psychosocial-health factors (from t0;2006/2008 to t1;2010/2012) were associated with subsequent loneliness 4 years later (t2;2014/2016).

RESULTS

Adjusting for a large range of covariates, changes in certain health behaviors (e.g. increased physical activity), physical health factors (e.g. fewer functioning limitations), psychological factors (e.g. increased purpose in life, decreased depression), and social factors (e.g. greater number of close friends) were associated with less subsequent loneliness.

CONCLUSIONS

Our findings suggest that subjective ratings of physical and psychological health and perceived social environment (e.g. chronic pain, self-rated health, purpose in life, anxiety, neighborhood cohesion) are more strongly associated with subsequent loneliness. Yet, objective ratings (e.g. specific chronic health conditions, living status) show less evidence of associations with subsequent loneliness. The current study identified potentially modifiable predictors of subsequent loneliness that may be important targets for interventions aimed at reducing loneliness.

Clinical Impact of Routine Assessment of Patient-Reported Health Status in Heart Failure Clinic: The PRO-HF Trial

BACKGROUND

The impact of routine clinic use of patient-reported outcome (PRO) measures on clinical outcomes in patients with heart failure (HF) has not been well-characterized. We tested if clinic-based use of a disease-specific PRO improves patient-reported quality of life at 1 year.

METHODS

The PRO-HF trial (Patient-Reported Outcome Measurement in Heart Failure Clinic) was an open-label, parallel, patient-level randomized clinical trial of routine PRO assessment or usual care at an academic HF clinic between August 30, 2021, and June 30, 2022, with 1 year of follow-up. In the PRO assessment arm, participants completed the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) at each HF clinic visit, and results were shared with their treating clinician. The usual care arm completed the KCCQ-12 at randomization and 1 year later, which was not shared with the treating clinician. The primary outcome was the KCCQ-12 overall summary score (OSS) between 12 and 15 months after randomization. Secondary outcomes included domains of the KCCQ-12, hospitalization and emergency department visit rates, HF medication therapy, clinic visit frequency, and testing rates.

RESULTS

Across 17 clinicians, 1248 participants were enrolled and randomized to PRO assessment (n=624) or usual care (n=624). The median age was 63.9 years (interquartile range [IQR], 51.8-72.8), 38.9% were women, and the median baseline KCCQ-12 OSS was 82.3 (IQR, 58.3-94.8). Final KCCQ-12 (available in 87.9% of the PRO arm and 85.1% in usual care; P=0.16) median OSS were 87.5 (IQR, 68.8-96.9) in the PRO arm and 87.6 (IQR, 69.7-96.9) in the usual care arm with a baseline-adjusted mean difference of 0.2 ([95% CI, -1.7 to 2.0]; P=0.85). The results were consistent across prespecified subgroups. A post hoc analysis demonstrated a significant interaction with greater benefit among participants with a baseline KCCQ-12 OSS of 60 to 80 but not in less or more symptomatic participants. No significant differences were found in 1-year mortality, hospitalizations, emergency department visits, medication therapy, clinic follow-up, or testing rates between arms.

CONCLUSIONS

Routine PRO assessment in HF clinic visits did not impact patient-reported quality of life or other clinical outcomes. Alternate strategies and settings for embedding PROs into routine clinical care should be tested.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT04164004.

Interfaces of 'being healthy and being Ill': how is health being perceived by individuals with non-communicable chronic conditions?

BACKGROUND

Accommodating chronic care into the everyday lives of individuals diagnosed with non-communicable chronic conditions often poses significant challenges. Several studies in public health literature that addressed the question of non-adherence to treatment by turning their gaze towards individual's perception of their own health restricted the use of perception exploration to visceral states and corporeality without adequately acknowledging the mutual permeance of socio-biological worlds. This study explored the socio-economic genealogies of individuals, to understand the role of structural and intermediate factors that determine health perceptions, by attempting to answer the question 'how do individuals with non-communicable chronic conditions perceive their health as healthy or ill'?.

METHODS

This study was conducted in a low-income neighbourhood called Kadugondanahalli in India using qualitative research methods. A total of 20 in-depth interviews were conducted with individuals diagnosed with non-communicable chronic conditions. Individuals were recruited through purposive and snowball sampling.

RESULTS

The participants predominantly perceived their health as being healthy and ill in an episodic manner while adhering to their treatment and medications for chronic conditions. This was strongly determined by the factors such as presence of family support and caregiving, changes in work and occupation, changes in lifestyle, psychological stress from being diagnosed, and care-seeking practices. This episodic perception of illness led to the non-adherence of prescribed chronic care.

CONCLUSIONS

Due to the episodic manner in which the participants experienced their illness, the paper recommends considering health and illness as two different entities while researching chronic conditions. It is important for the health system to understand and fix the healthy and ill episodes, which often lead to switching between controlled and uncontrolled states of diabetes and hypertension. To do so, it is important to consider the social, economic, behavioural and psychological factors in an individual's health outcome. The interplay between these factors has socialized health perception and various related practices from the individual to the community level. Therefore, the health system needs to re-strategize its focus from individual to community level interventions to address the determinants of health and NCD risk factors by strengthening the NCD prevention approach.

Influence of exercise prescription intervention based on WeChat on glycolipid metabolism and fitness of suboptimal-health teachers

Exercise is an effective means to promote health, but adherence is low. Due to the advantages of immediacy, economy and effectiveness, the use of WeChat social software has permeated into every aspect in daily life in China. To explore the influence of WeChat-based exercise prescription intervention mode on glycolipid metabolism and fitness of suboptimal-health teachers. 293 suboptimal-health teachers with senior professional titles were randomized to a control group (CG) or an experimental group (e.g.). The CG exercised on its own, while the e.g. adopted the exercise prescription intervention based on WeChat. The intervention period was 6 months. Finally, 264 cases were adhered to and completed, including 132 cases in the CG and 132 cases in the e.g.. The Suboptimal-Health Status Questionnaires-25 scores (SHSQ-25 scores), exercise adherence, subjective feelings, physical fitness, blood glucose and blood lipids were detected before and after intervention and compared between 2 groups. After the intervention, the SHSQ-25 scores in the e.g. was significantly decreased than those in the CG (P < .01). The complete exercise adherence in the e.g. was significantly higher than those in the CG (P < .01). After intervention, the subjective feelings of e.g. were significantly improved compared to CG (P < .05). The body shape, body function and physical quality in the e.g. was higher than those in the CG (P < .05). Total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) decreased significantly in the e.g. but not in the CG (P < .05). Fasting blood glucose (FBG) decreased significantly in the e.g. but not in the CG, with a significant difference between groups (P < .05). The subjects in the e.g. were very satisfied with WeChat management. WeChat-based exercise prescription intervention could improve SHS, exercise adherence, subjective feelings, physical fitness and glycolipid metabolism.

Variations in health-related quality of life (EQ-5D) associated with cardiovascular health: a cross-sectional study of adults with diabetes in the Korean general population

OBJECTIVES

Previous studies on the differences in the mechanism and complications of diabetes between men and women have indicated potential sex differences in cardiovascular health, which affect health-related quality of life (HRQoL).

DESIGN

A cross-sectional cohort study.

SETTING

To determine how sex differences can be noticed, acknowledged and applied in clinical practice, we aimed to determine the cardiovascular (CV) health status of men and women with diabetes and its effects on HRQoL.

PARTICIPANTS

In total, 2829 individuals with diabetes (1518 men and 1311 women) aged ≥40 years who participated in the Korean National Health and Nutrition Examination Survey from 2013 to 2018 were enrolled.

OUTCOME MEASURES

Individuals with diabetes were categorised into poor, intermediate and ideal groups based on CV health indicators recommended by the American Heart Association. We used EQ-5D-3L to compare HRQoL scores between the sexes. Multivariable ordinal logistic regression and analysis of covariance were used to analyse the outcome variables.

RESULTS

In the poor CV health score group, female sex was associated with mobility problems (OR 1.93, 95% CI 1.46 to 2.54), problems with usual activities (OR1.71, 95% CI 1.24 to 2.35), pain/discomfort (OR 1.69, 95% CI 1.32 to 2.16) and anxiety/depression (OR 1.66 95% CI 1.16 to 2.38). In the intermediate and ideal CV health score groups, female sex was associated with pain/discomfort (OR 1.57, 95% CI 1.15 to 2.15). Men had higher EQ-5D index scores in the poor and intermediate CV health score groups than did women.

CONCLUSIONS

Although women tended to have high health-related CV health scores, HRQoL was lower in women than in men, especially in the poor CV health score group and in the pain/discomfort domain.

Factors associated with the enrollment of commercial medical insurance in China: Results from China General Social Survey

BACKGROUND

The Chinese government has been promoting commercial medical insurance (CMI) in recent decades as it plays an increasingly important role in addressing disease burden, health inequities, and other healthcare challenges. However, compared with developed countries, the CMI is still less fledged with low coverage.

OBJECTIVE

This study aims to explore the factors associated with enrollment in CMI, with regards to explicit characteristics (including sociodemographic characteristics and family economic status), latent characteristics (including social security status), and the global incentive compatibility index (including health status), to inform the design of CMI to improve its coverage in China.

METHODS

Based on the principal-agent model, we summarized and classified the factors associated with the enrollment in CMI, and then analyzed the data generated from the Chinese General Social Survey in 2015,2018 and 2021 respectively. A comparison of factors regarding sociodemographic characteristics, family economic status, social security status, and health status was conducted between individuals enrolled and unenrolled in CMI using Mann-Whitney U test and Chi-square test. Binary logistic regression analysis was used to explore factors influencing the enrollment status of CMI.

RESULTS

Of all individuals, the proportion of enrolled individuals shows an increasing trend year by year, with 8.7%,11.8% and 14.1% enrolled in CMI in 2015,2018 and 2021, respectively. The binary regression analysis further suggested that the factors associated with the enrollment in CMI were consistent in 2015,2018 and 2021.We found that individuals divorced, obese, who had a higher level of education, had non-agricultural household registration, perceived themselves as the upper social status, conducted daily exercise, had more family houses, had a car, had investment activities, or did not have basic health insurance were more likely to be enrolled in CMI.

CONCLUSIONS

We identified multidimensional factors associated with the enrollment of CMI, which help inform the government and insurance industry to improve the coverage of CMI.

Methodological considerations in the study of perceived discrimination at work and its association with workers health and occupational outcomes: A scoping review

Introduction

Perceived workplace discrimination is a complex phenomenon involving unfair treatment in the workplace based on personal characteristics such as age, ethnicity, gender, or disability. The objective of this study is to explore the association of perceived workplace discrimination with health and occupational outcomes.

Methods

Following the PRISMA-ScR guidelines and the Joanna Briggs Institute methodology, a scoping review of articles published between 2000 and 2022 was conducted in databases such as Pubmed, Scopus, and PsyInfo. Inclusion criteria focused on studies exploring perceived workplace discrimination among workers, excluding those on patients, students, or the general population, and articles not written in English or Spanish.

Results

Of the 9,871 articles identified, 102 met the criteria and were analyzed. Research showed a progressive increase in the study of perceived workplace discrimination, with a majority of studies in North America and Europe and a predominance of cross-sectional designs. Most studies did not clearly define the concept of perceived workplace discrimination nor report the psychometric characteristics of the measurement instruments. A significant association was found between perceived discrimination and negative outcomes in workers' mental and physical health, as well as a negative impact on job satisfaction and an increase in absenteeism. Additionally, sociodemographic characteristics such as race/ethnicity, gender, and age influenced the perception of discrimination.

Conclusions

This review confirms that perceived workplace discrimination significantly impacts the health and job satisfaction of workers, with particular detriment in minorities and women. Despite an increase in research over the last two decades, there remains a lack of consistency in the definition and measurement of the phenomenon. Most studies have used cross-sectional designs, and there is a notable absence of research in the Latin American context.

The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019

BACKGROUND

The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010.

METHODS

We used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE).

RESULTS

In 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for "HIV/AIDS and sexually transmitted diseases" and "transport injuries" (each -19%). "Diabetes and kidney diseases" showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, "mental disorders" showed an increasing age-standardised YLL rate (14.5%).

CONCLUSIONS

There was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.

Five-Year Cumulative Cardiovascular Health and Clinical Events in Patients With Chronic Kidney Disease: The CRIC Study

BACKGROUND

Higher cardiovascular health (CVH) score is associated with lower risks of cardiovascular disease (CVD) and mortality in the general population. However, it is unclear whether cumulative CVH is associated with CVD, end-stage kidney disease (ESKD), and death in patients with chronic kidney disease.

METHODS AND RESULTS

Among individuals from the prospective CRIC (Chronic Renal Insufficiency Cohort) Study, we used the percentage of the maximum possible CVH score attained from baseline to the year 5 visit to calculate cumulative CVH score. Multivariable-adjusted Cox proportional hazards regression was used to investigate the associations of cumulative CVH with risks of adjudicated CVD (myocardial infarction, stroke, and heart failure), ESKD, and all-cause mortality. A total of 3939 participants (mean age, 57.7 years; 54.9% men) were included. The mean (SD) cumulative CVH score attained during 5 years was 55.5% (12.3%). Over a subsequent median 10.2-year follow-up, 597 participants developed CVD, 656 had ESKD, and 1324 died. A higher cumulative CVH score was significantly associated with lower risks of CVD, ESKD, and mortality, independent of the CVH score at year 5. Multivariable-adjusted hazard ratios and 95% CIs per 10% higher cumulative CVH score during 5 years were 0.81 (0.69-0.95) for CVD, 0.82 (0.70-0.97) for ESKD, and 0.80 (0.72-0.89) for mortality.

CONCLUSIONS

Among patients with chronic kidney disease stages 2 to 4, a better CVH status maintained throughout 5 years is associated with lower risks of CVD, ESKD, and all-cause mortality. The findings support the need for interventions to maintain ideal CVH status for prevention of adverse outcomes in the population with chronic kidney disease.

Evaluating the association between effort-reward imbalance and suboptimal health status among hospital nurses: a cross-sectional study

OBJECTIVES

Occupational stress is a common complaint in nurses, who perceived more sense of effort-reward imbalance (ERI). Suboptimal health status (SHS) is a state between health and disease. However, the correlation between ERI and SHS is unclear. Therefore, the aim of this study was to examine the prevalence of SHS and ERI and evaluate the relationship between ERI and SHS in clinical nurses by a cross-sectional study.

MATERIAL AND METHODS

The current cross-sectional study was conducted through an online survey at Dongping People's Hospital in China. A total of 633 completed surveys were received. Effort-reward imbalance was measured by subscales of the ERI questionnaire. SHS was measured by the Suboptimal Health Status Questionnaire - 25 (SHSQ-25). The relationship between ERI and SHS in nurses was subsequently assessed by Spearman's correlation coefficient and logistic regression model.

RESULTS

The mean age of the optimal health status (OHS) group (M±SD 26.3±7.3 years) was younger than the SHS group (M±SD 30.3±6.9 years). The prevalence of SHS was 54.5% (345/633). Female nurses aged ≥30 years, a junior college or university graduate educational level, smokers, and nurses without regular exercise were at a higher risk of SHS. In Spearman's correlation analysis, ERI reflected by the effort-reward ratio was correlated with SHSQ-25 score (r = 0.662, p < 0.001). In logistic regression, ERI was strongly associated with SHS after potential confounding factors adjusting (OR 27.924, 95% CI 22.845-34.132).

CONCLUSIONS

The prevalence of SHS was significantly high in clinical nurses. Administrators should pay more attention to health status of female nurses aged ≥30 years, with a junior college or bachelor's degree, smoking, and without regular exercise to reduce the SHS and ERI. Int J Occup Med Environ Health. 2024;37(2):166-75.

Geographical accessibility of medical resources, health status, and demand of integrated care for older people: a cross-sectional survey from Western China

BACKGROUND

The World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to help healthcare providers cope with the population aging crisis. However, the relevant evidence on the demands of older people and the compensatory capacity of the environment is limited. This study reports for the first time the level of the ICOPE demand in Western China that includes the impact of geographic accessibility of medical resources (GAMR) on ICOPE demand and the potential mechanism of health status.

METHODS

A cross-sectional questionnaire survey was conducted among 1200 adults aged 60 years and older selected through multi-stage stratified cluster sampling to obtain relevant data, including ICOPE demand, health status, and GAMR. Propensity score matching (PSM) was used to analyze the impact of GAMR on ICOPE demand among older people and those with different health statuses.

RESULTS

Among the prospective research participants, 1043 were eligible for the study. The mean score of ICOPE demand among all participants was 3.68 (standard deviation [SD] = 0.78). After adjusting for covariates between high and low GAMR groups (1:1 match), ICOPE demand was significantly higher in the low GAMR group than in the high GAMR group (average treatment effect on the treated [ATT] = 0.270, p < 0.05). For both good and poor self-rated health status, the ICOPE demand of the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.345, p < 0.05; ATT = 0.190, p < 0.05). For chronic diseases, the ICOPE demand of older people with multimorbidity in the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.318, p < 0.01).

CONCLUSIONS

The older population in Western China has a relatively high demand for ICOPE. Low GAMR is a key factor in ICOPE demand growth in this region. It accelerates demand release for both older people with multimorbidity and self-perceptions of health.

The Impact of Income Inequality on Health Levels: Empirical Evidence from China:2002-2016

Income inequality had been one of the important manifestations of social inequality, which can affect the health level by affecting savings, health care and living standards. Existing researches about the relationship between income inequality and health ignored the comprehensive characteristic of health concept, and did not consider the intrinsic relationship between health and income inequality. This paper attempts to re-shed light on the relationship. Firstly, this paper constructs a new health level evaluation system from three aspects: health basis, health environment and behavior, and health security. By means of the combination evaluation method, the health levels can be obtained. Then, considering the interaction between health and income inequality, a simultaneous equation group model is constructed to empirically test the relationship between income inequality and health levels in China. The results reveal that health level is negatively correlated with income inequality. Reducing income inequality plays an important role in improving health levels in China.

Feasibility and acceptability of a home-based virtual group exercise program in global Asian adult population: Baseline characteristics of a cohort study

BACKGROUND

To determine the potential influence of a home-based virtual group exercise on people's long-term overall health consequences in global Asian population.

METHODS

We recruited 1021 participants from more than 7 regions across the globe including Taiwan, Malaysia, Singapore, Hong Kong, United States, Canada, Europe, and other regions. All the participants attended the virtual group Qigong exercise 60-minute bi-weekly with instructors for 6 months from June 2022 to December 2022. The physical, mental, and social well-being and other variables were measured via online questionnaires.

RESULTS

The majority were 51 to 65 (50.6%) years old, female (90.2%), married (68.5%), and came from Taiwan (48.9%). Older adults had higher scores on measures of overall health and exercise adherence, and lower scores on measures of sleep quality and depressive symptoms compared with younger counterparts (P < .05). Most of them (95.3%) acknowledged that the improvement of health status was their motivating factor for exercise. Eighty nine percent of the participants believed that social media played an important role in this exercise program.

CONCLUSION

This study will suggest such approach has great potential to reduce health disparities and can be implemented to underserved population who has limited recourses to join in-person exercise program.

Cultural and co-designed principles for developing a Māori kaumātua housing village to address health and social wellbeing

BACKGROUND

The current study is a case study of a Māori (Indigenous people of New Zealand) organisation and their developmental processes in creating a kaumātua (older people) housing village for health and social wellbeing. This study identifies how a set of established co-design and culturally-centred principles were enacted when creating and developing the village.

METHOD

A mixed-method concurrent design was used in creating the case with interviews (n = 4), focus groups (N = 4 with 16 total participants) and survey questionnaires (n = 56) involving kaumātua and organisation members.

RESULTS

Survey results illustrate that suitable and affordable housing are associated with self-rated health, loneliness, and life satisfaction. The primary purpose of the housing village was to enable kaumātua to be connected to the marae (community meeting house) as part of a larger vision of developing intergenerational housing around the marae to enhance wellbeing. Further, key themes around visioning, collaborative team and funding, leadership, fit-for-purpose design, and tenancy management were grounded in cultural elements using te ao Māori (Māori worldview).

CONCLUSION

This case study illustrates several co-design and culturally-centred principles from a previously developed toolkit that supported the project. This case study demonstrates how one community enacted these principles to provide the ground for developing a housing project that meets the health and social wellbeing of kaumātua.

The shifts in intergenerational relations in Cameroon and their potential impact on the health of older adults

INTRODUCTION

Africa is experiencing a gradual demographic shift due to rising life expectancy and increasing urbanisation. In sub-Saharan Africa, elderly individuals typically reside with their children. The rise in life expectancy by almost a decade and the prevalence of precarious living conditions raise concerns about the sustainability of the healthcare system, which has traditionally relied on intergenerational solidarity.

METHODS

The research aims to analyse the evolving role of older adults in Cameroonian society and to examine the potential impact of this change on intergenerational relationships and the health of older adults. A qualitative methodology was employed, using intergenerational focus groups in Cameroon.

RESULTS

Traditionally, older adults held a central role in knowledge transmission through discourse. However, the modernisation of society is challenging this position.The emergence of new technologies, particularly communication tools, is leading to a questioning of older adults' experiential knowledge. Societal changes are contributing to a decline in respect for older adults in discourse. Older adults deplore these societal changes and fear for their place in society while young people are questioning the central role of older people in society.

DISCUSSION

These changes could reduce the sense of usefulness of older people, with negative consequences for their health. Several studies have highlighted the impacts of ageism on the health of older adults in industrialised countries. However, there are little data on the impact of the marginalisation of older adults on their health in industrialising societies. Further research is needed to study the impact on the health of older adults.

Variables associated with owner perceptions of the health of their dog: Further analysis of data from a large international survey

In a recent study (doi: 10.1371/journal.pone.0265662), associations were identified between owner-reported dog health status and diet, whereby those fed a vegan diet were perceived to be healthier. However, the study was limited because it did not consider possible confounding from variables not included in the analysis. The aim of the current study was to extend these earlier findings, using different modelling techniques and including multiple variables, to identify the most important predictors of owner perceptions of dog health. From the original dataset, two binary outcome variables were created: the 'any health problem' distinguished dogs that owners perceived to be healthy ("no") from those perceived to have illness of any severity; the 'significant illness' variable distinguished dogs that owners perceived to be either healthy or having mild illness ("no") from those perceived to have significant or serious illness ("yes"). Associations between these health outcomes and both owner-animal metadata and healthcare variables were assessed using logistic regression and machine learning predictive modelling using XGBoost. For the any health problem outcome, best-fit models for both logistic regression (area under curve [AUC] 0.842) and XGBoost (AUC 0.836) contained the variables dog age, veterinary visits and received medication, whilst owner age and breed size category also featured. For the significant illness outcome, received medication, veterinary visits, dog age and were again the most important predictors for both logistic regression (AUC 0.903) and XGBoost (AUC 0.887), whilst breed size category, education and owner age also featured in the latter. Any contribution from the dog vegan diet variable was negligible. The results of the current study extend the previous research using the same dataset and suggest that diet has limited impact on owner-perceived dog health status; instead, dog age, frequency of veterinary visits and receiving medication are most important.

A Workplace Health Promotion Program for a Predominantly Military Population: Associations with General Health, Mental Well-Being and Sustainable Employability

Due to the globally increasing life expectancies, many countries are raising their official retirement age to prevent labor shortages and sustain retirement systems. This trend emphasizes the need for sustainable employability. Unhealthy lifestyles pose a risk to sustainable employability as they contribute to chronic diseases and decreased productivity. Workplace Health Promotion (WHP) programs have gained attention as a strategy to enhance employee health and well-being. The Netherlands Armed Forces, a unique employer with demanding psychological and physical requirements, was used as a case study to investigate the associations of a WHP Program with workers health and sustainable employability. The program offered tailor-made guidance to participants (N = 341) through individual coaching trajectories. The program's impact was evaluated by measuring self-reported health, mental well-being, and sustainable employability over a 6-month period. Results indicated significant improvements across all these dimensions after participation in the program. This study provides valuable insights into the benefits of tailor-made WHP programs. While this was an observational study without a control group, this study supports the importance of incorporating individualized approaches in WHP initiatives to foster positive outcomes in health and sustainable employability.

Association between cardiovascular health and abdominal aortic calcification: Analyses of NHANES 2013-2014

BACKGROUND

Abdominal aortic calcification (AAC) is closely connected to cardiovascular disease. We aimed to measure the association between cardiovascular health (CVH) levels, assessed by the Life's Essential 8 (LE8) score, and AAC within a nationally representative sample of the US.

METHODS

The National Health and Nutrition Examination Survey 2013-2014 participants were chosen for this cross-sectional investigation. LE8 scores, ranging from 0 to 100, were calculated according to the criteria outlined by the American Heart Association. AAC was evaluated using a semi-quantitative scoring system known as AAC-24. Weighted linear regression, multivariate logistic regression, and restricted cubic spline models were used to investigate the correlations. Subgroup analysis and interaction tests were conducted to assess this association's robustness across different population groups.

RESULTS

Increased CVH levels were associated with diminished AAC scores and a reduced prevalence of severe AAC. In the partially adjusted model, each unit increase in LE8 score was associated with a 2% decrease in severe AAC prevalence [OR 0.98; 95% CI 0.96, 0.99]. Participants in the high CVH level group experienced a 72% reduced prevalence of severe AAC compared to those in the low CVH level group in model 2 [OR 0.28; 95% CI 0.12, 0.63]. This inverse association was notably more prominent in adults aged 60 years and above.

CONCLUSIONS

CVH exhibited a robust negative correlation with AAC. Promoting optimal CVH levels may favor averting AAC within the general population.

Determinants of Weight Status and Body, Health and Life Satisfaction in Young Adults

Health behaviors include behavioral patterns and habits that relate to health maintenance, restoration and improvement. They do not only affect the physical condition; they are also associated with life satisfaction. In our study, we focused on young adulthood, a specific lifespan period for establishing long-term health behavior patterns. The aim of the present study was to investigate depressive symptoms, lifestyle and eating behaviors and delineate their associations with overweight/obesity and body, health and life satisfaction in young adults in Poland. We enrolled 800 students (81.4% females and 18.6% males). Diet, physical activity, depressive symptoms, eating behaviors and body, health and life satisfaction were assessed. Multivariate logistic regression models were employed. Almost half of the participants in our study had at least mild symptoms of depression. Symptoms of depression significantly reduced the odds of satisfaction with body, health and life, whereas physical activity increased them. Overweight/obesity significantly reduced the odds of body and health satisfaction. In women, a history of depression and emotional eating increased the odds of being overweight/obese. The results of our study may contribute to the development of educational programs and intervention strategies for young adults.

Disease Burden and Health-Related Quality of Life (HRQoL) of Chronic Obstructive Pulmonary Disease (COPD) in the US - Evidence from the Medical Expenditure Panel Survey (MEPS) from 2016-2019

Purpose

Chronic obstructive pulmonary disease (COPD) is a progressive disease associated with reduced life expectancy, increased morbidity, mortality, and cost. This study characterized the US COPD burden, including socioeconomic and health-related quality of life (HRQoL) outcomes.

Study Design and Methods

In this retrospective, cross-sectional study using nationally representative estimates from Medical Expenditures Survey (MEPS) data (2016-2019), adults (≥18 years) living with and without COPD were identified. Adults living without COPD (control cohort) and with COPD were matched 5:1 on age, sex, geographic region, and entry year. Demographics, clinical characteristics, socioeconomic, and generic HRQoL measures were examined to include a race-stratified analysis of people living with COPD.

Results

A total of 4,135 people living with COPD were identified; the matched dataset represented a weighted non-institutionalized population of 11.3 million with and 54.2 million people without COPD. Among people living with COPD, 66.3% had ≥1 COPD-related condition; 62.7% had ≥1 cardiovascular condition, compared to 33.5% and 50.5% without COPD. More people living with COPD were unemployed (56.2% vs 45.3%), unable to work due to illness/disability (30.1% vs 12.1%), had problems paying bills (16.1% vs 8.8%), reported poorer perceived health (fair/poor: 36.2% vs 14.4%), missed more working days due to illness/injury per year (median, 2.5 days vs 0.0 days), and had limitations in physical functioning (40.1% vs 19.4%) (all P<0.0001). In race-stratified analyses for people living with COPD, people self-reporting as Black had higher prevalence of cardiovascular-risk conditions, poorer socioeconomic and HRQoL outcomes, and higher healthcare expenses than White or Other races.

Conclusion

Adults living with COPD had higher clinical disease burden, lower socioeconomic status, and reduced HRQoL than those without, with greater disparities among Black people living with COPD compared to White and other races. Understanding the characteristics of patients helps address care disparities and access challenges.

Unravelling the acute respiratory infection landscape: virus type, viral load, health status and coinfection do matter

Introduction

Acute respiratory infections (ARI) are the most common infections in the general population and are mainly caused by respiratory viruses. Detecting several viruses in a respiratory sample is common. To better understand these viral codetections and potential interferences, we tested for the presence of viruses and developed quantitative PCR (Polymerase Chain Reaction) for the viruses most prevalent in coinfections: human rhinovirus (HRV) and respiratory syncytial virus (RSV), and quantified their viral loads according to coinfections and health status, age, cellular abundance and other variables.

Materials and methods

Samples from two different cohorts were analyzed: one included hospitalized infants under 12 months of age with acute bronchiolitis (n=719) and the other primary care patients of all ages with symptoms of ARI (n=685). We performed Multiplex PCR on nasopharyngeal swabs, and quantitative PCR on samples positive for HRV or/and RSV to determine viral loads (VL). Cellular abundance (CA) was also estimated by qPCR targeting the GAPDH gene. Genotyping was performed either directly from first-line molecular panel or by PCR and sequencing for HRV.

Results

The risks of viral codetection were 4.1 (IC95[1.8; 10.0]) and 93.9 1 (IC95[48.7; 190.7]) higher in infants hospitalized for bronchiolitis than in infants in primary care for RSV and HRV respectively (p<0.001). CA was higher in samples positive for multiple viruses than in mono-infected or negative samples (p<0.001), and higher in samples positive for RSV (p<0.001) and HRV (p<0.001) than in negative samples. We found a positive correlation between CA and VL for both RSV and HRV. HRV VL was higher in children than in the elderly (p<0.05), but not RSV VL. HRV VL was higher when detected alone than in samples coinfected with RSV-A and with RSV-B. There was a significant increase of RSV-A VL when codetecting with HRV (p=0.001) and when co-detecting with RSV-B+HRV versus RSV-A+ RSV-B (p=0.02).

Conclusions

Many parameters influence the natural history of respiratory viral infections, and quantifying respiratory viral loads can help disentangle their contributions to viral outcome.

A Bayesian nonparametric meta-analysis model for estimating the reference interval

A reference interval represents the normative range for measurements from a healthy population. It plays an important role in laboratory testing, as well as in differentiating healthy from diseased patients. The reference interval based on a single study might not be applicable to a broader population. Meta-analysis can provide a more generalizable reference interval based on the combined population by synthesizing results from multiple studies. However, the assumptions of normally distributed underlying study-specific means and equal within-study variances, which are commonly used in existing methods, are strong and may not hold in practice. We propose a Bayesian nonparametric model with more flexible assumptions to extend random effects meta-analysis for estimating reference intervals. We illustrate through simulation studies and two real data examples the performance of our proposed approach when the assumptions of normally distributed study means and equal within-study variances do not hold.

Factors associated with the quality of life of living kidney donors in Korea: A cross-sectional study

This study investigated the relationship between self-determination, physical health status, and Health related Quality of Life (=HRQoL) among living kidney donors. A descriptive survey was conducted between 2019 and 2020 and included 111 kidney donors. Data were collected using a self-report questionnaire on general and donation-related characteristics, self-determination, and HRQoL. The data also included medical records reflecting the physical health status at the time of the survey. Data were analyzed using a multiple regression model. Factors associated with HRQoL were perceived health recovery after donation (β = 0.42, P < .001), up to 1 year since donation (β = 0.33, P = .008), more than 1 up to 5 years since donation (β = 0.52, P < .001), more than 5 up to 10 years since donation (β = 0.53, P < .001), and competence of self-determination (β = 0.23, P = .033). The explanatory power of these variables was 43.3%. HRQoL of living kidney donors can be affected by subjective and psychological factors. Therefore, health care providers should help living kidney donors have high self-determination during pre and post donation and concentrate on the subjective and psychological factors as well as objective health status.

Depression and associated factors among older people in Vietnam: Findings from a National Aging Survey

BACKGROUND

Depression is one of the most common mental health disorders among older people. Depressive symptoms are often overlooked and untreated in primary care settings. This study aims to assess the prevalence of depressive symptoms and associated factors among older people in Vietnam.

METHOD

The study analyzed data from the Vietnam National Aging Survey (VNAS) conducted in 2022 with a nationally representative sample of 3,006 older people aged 60 and over in 12 provinces. The 15-item Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms. Bivariate and multiple logistic regression analyses were used to explore the association between depressive symptoms and other related factors such as sociodemographic and economic characteristics, social support, health status, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) limitations, chronic diseases, cigarette smoking status, alcoholic drinking, and domestic violence.

RESULTS

The prevalence of depressive symptoms among older people was 20.2%. The associated factors that increase the odds of having depression among older people were female gender (OR = 2.21, 95% CI 1.34-3.62), living in rural areas (OR = 1.83, 95% CI 1.15-2.89), the poorest quintile (OR = 2.26, 95% CI 1.39-3.66), self-rated poor health (OR = 11.68, 95% CI 4.96-27.49), ADL limitations (OR = 2.12, 95% CI 1.51-2.99), IADL limitation (OR = 1.61 95% CI 1.16-2.25), and experiencing domestic violence in the last 12 months (OR = 6.66, 95% CI 4.00-11.05).

CONCLUSION

Depression symptoms were prevalent among older people in Vietnam. Depression screening for older people should be included in primary care settings for early identification and treatment of depression.

Cohort profile: the Adverse Childhood Experiences cohort of the Malawi Longitudinal Study of Families and Health

PURPOSE

The Adverse Childhood Experiences (ACE) cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-ACE) is a study of adolescents surveyed during 2017-2021. It provides an important opportunity to examine the longitudinal impact of ACEs on health and development across the early life course. The MLSFH-ACE cohort provides rich data on adolescents, their children and adult caregivers in a low-income, high-HIV-prevalence context in sub-Saharan Africa (SSA).

PARTICIPANTS

The MLSFH-ACE cohort is a population-based study of adolescents living in three districts in rural Malawi. Wave 1 enrolment took place in 2017-2018 and included 2061 adolescents aged 10-16 years and 1438 caregivers. Wave 2 took place in 2021 and included data on 1878 adolescents and 208 offspring. Survey instruments captured ACEs during childhood and adolescence, HIV-related behavioural risk, mental and physical health, cognitive development and education, intimate partner violence (IPV), marriage and aspirations, early transitions to adulthood and protective factors. Biological indicators included HIV, herpes simplex virus and anthropometric measurements.

FINDINGS TO DATE

Key findings include a high prevalence of ACEs among adolescents in Malawi, a low incidence of HIV and positive associations between ACE scores and composite HIV risk scores. There were also strong associations between ACEs and both IPV victimisation and perpetration.

FUTURE PLANS

MLSFH-ACE data will be publicly released and will provide a wealth of information on ACEs and adolescent outcomes in low-income, HIV-endemic SSA contexts. Future expansions of the cohort are planned to capture data during early adulthood.