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Pasanen TP, White MP, Wheeler BW, Garrett JK, Elliott LR. Neighbourhood blue space, health and wellbeing: The mediating role of different types of physical activity. ENVIRONMENT INTERNATIONAL 2019; 131:105016. [PMID: 31352260 DOI: 10.1016/j.envint.2019.105016] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/17/2019] [Accepted: 07/13/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Evidence suggests that living near blue spaces such as the coast, lakes and rivers may be good for health and wellbeing. Although greater levels of physical activity (PA) may be a potential mechanism, we know little about the types of PA that might account for this. OBJECTIVES To explore the mediating role of: a) 'watersports' (e.g. sailing/canoeing); b) 'on-land outdoor PA' in natural/mixed settings (e.g. walking/running/cycling); and, c) 'indoor/other PA' (e.g. gym/squash) in the relationships between residential blue space availability and health outcomes. METHODS Using data from the Health Survey for England (n = 21,097), we constructed a path model to explore whether weekly volumes of each PA type mediate any of the relationships between residential blue space availability (coastal proximity and presence of freshwater) and self-reported general and mental health, controlling for green space density and a range of socio-economic factors at the individual- and area-level. RESULTS Supporting predictions, living nearer the coast was associated with better self-reported general and mental health and this was partially mediated by on-land outdoor PA (primarily walking). Watersports were more common among those living within 5kms of the coast, but did not mediate associations between coastal proximity and health. Presence of freshwater in the neighbourhood was associated with better mental health, but this effect was not mediated by PA. CONCLUSIONS Although nearby blue spaces offer potentially easier access to watersports, relatively few individuals in England engage in them and thus they do not account for positive population health associations. Rather, the benefits to health from coastal living seem, at least in part, due to participation in land-based outdoor activities (especially walking). Further research is needed to explore the mechanisms behind the relationship between freshwater presence and mental health.
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Affiliation(s)
- Tytti P Pasanen
- Faculty of Social Sciences/Psychology, Tampere University, Kalevantie 5, 33014, Finland.
| | - Mathew P White
- European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, United Kingdom
| | - Benedict W Wheeler
- European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, United Kingdom
| | - Joanne K Garrett
- European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, United Kingdom
| | - Lewis R Elliott
- European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, United Kingdom
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Sandvik J, Hole T, Klöckner CA, Kulseng BE, Wibe A. Assessment of self-rated health 5 years after Roux-en-Y gastric bypass for severe obesity. BJS Open 2019; 3:777-784. [PMID: 31832584 PMCID: PMC6887919 DOI: 10.1002/bjs5.50223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/14/2019] [Indexed: 12/20/2022] Open
Abstract
Background Patients' perceptions of health change after bariatric surgery are complex. The aim of this study was to explore whether self‐rated health (SRH), a widely used tool in public health research, might be relevant as an outcome measure after Roux‐en‐Y gastric bypass (RYGB) for severe obesity. Methods This was a single‐centre retrospective study of a local quality registry. SRH score was registered at baseline and 5 years after RYGB. SRH, one of the 36 items in the quality‐of‐life Short Form 36 (SF‐36®) questionnaire, is the answer to this single question: ‘In general, would you say your health is excellent (1), very good (2), good (3), fair (4) or poor (5)?’ Change in SRH was analysed in relation to change in weight, co‐morbidities and quality of life after 5 years. Results Of a total of 359 patients who underwent RYGB between September 2006 and February 2011, 233 (64·9 per cent) reported on SRH before and 5 years after surgery. Of these, 180 (77·3 per cent) were women, and the mean(s.d.) age was 40(9) years. Some 154 patients (66·1 per cent) reported an improvement in SRH, 60 (25·8 per cent) had no change, and SRH decreased in 19 patients (8·2 per cent). SRH in improvers was related to better scores in all SF‐36® domains, whereas SRH in non‐improvers was related to unchanged or worsened scores in all SF‐36® domains except physical function. Conclusion Two‐thirds of patients reported improved SRH 5 years after RYGB for severe obesity. In view of its simplicity, SRH may be an easy‐to‐use outcome measure in bariatric surgery.
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Affiliation(s)
- J Sandvik
- Clinic of Medicine and Rehabilitation Møre and Romsdal Hospital Trust Aalesund Norway.,Centre for Obesity, Department of Surgery St Olav Hospital, Trondheim University Hospital Trondheim Norway.,Obesity Research Group, Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
| | - T Hole
- Clinic of Medicine and Rehabilitation Møre and Romsdal Hospital Trust Aalesund Norway.,Faculty of Medicine and Health Sciences Norwegian University of Science and Technology Trondheim Norway
| | - C A Klöckner
- Centre for Obesity, Department of Surgery St Olav Hospital, Trondheim University Hospital Trondheim Norway.,Department of Psychology Norwegian University of Science and Technology Trondheim Norway
| | - B E Kulseng
- Centre for Obesity, Department of Surgery St Olav Hospital, Trondheim University Hospital Trondheim Norway.,Obesity Research Group, Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
| | - A Wibe
- Department of Surgery St Olav Hospital, Trondheim University Hospital Trondheim Norway.,Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
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Abdollahpour I, Mooijaart S, Aguilar-Palacio I, Salimi Y, Nedjat S, Mansournia MA, de Courten M. Socioeconomic status as the strongest predictor of self-rated health in Iranian population; a population-based cross-sectional study. J Psychosom Res 2019; 124:109775. [PMID: 31443805 DOI: 10.1016/j.jpsychores.2019.109775] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is little evidence comparing the role of subjective versus objective indicators of socioeconomic status (SES) on individuals' self-rated health (SRH) in Iran. OBJECTIVES We aimed to investigate underlying predictors of SRH including subjective and objective SES in Tehran, a multi-ethnic city. METHOD This is an analysis of cross-sectional survey data on subjective and objective SES from a population-based case-control study conducted in Tehran, Iran (2015). We used random digit dialing for study sample recruitment. Linear regression models were used for estimating crude and adjusted coefficients (95% confidence intervals). Age, gender, SES as well as cigarette smoking were included as confounders. RESULTS 15-50 years old residents of Tehran were recruited in the study (n = 1057). High reported objective and subjective SES was consistently associated with a better SRH. Subjective current SES (p < .001), subjective adolescence SES (p = .018), change in subjective SES (current vs. adolescent) (p = .034) and participants' education years (p < .001). Improvements over time in current SES in comparison to SES rated during adolescence increased the participants' SRH after adjustment for potential confounders (coefficient = 0.170, 95% CI: (0.015, 0.325)). Female participants (coefficient = -0.305, 95% CI: (-0.418, -0.192)) and smokers (high category vs. never smokers) (coefficient = -0.456, 95% CI: (-0.714, -0.197)) reported significantly worse SRH. Increasing age - 0.008 (95% CI: -0.014, -0.002) was associated with decreased SRH. CONCLUSION High subjective and objective SES consistently was the most important predictor of high SRH.
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Affiliation(s)
- Ibrahim Abdollahpour
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Simon Mooijaart
- Department of Medicine, Division of Gerontology and Geriatrics (C7-Q-44), Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Yahya Salimi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Epidemiology, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Knowledge Utilization Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maximilian de Courten
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
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Zijlema WL, Christian H, Triguero-Mas M, Cirach M, van den Berg M, Maas J, Gidlow CJ, Kruize H, Wendel-Vos W, Andrušaitytė S, Grazuleviciene R, Litt J, Nieuwenhuijsen MJ. Dog ownership, the natural outdoor environment and health: a cross-sectional study. BMJ Open 2019; 9:e023000. [PMID: 31138578 PMCID: PMC6549751 DOI: 10.1136/bmjopen-2018-023000] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Dog owners walking their dog in natural outdoor environments (NOE) may benefit from the physical activity facilitated by dog walking and from time spent in nature. However, it is unclear whether dog owners receive additional health benefits associated with having access to NOE above the physical activity benefit of walking with their dog. We investigated associations between dog ownership, walking, time spent in NOE and health and whether these associations differed among those with good and poor access to NOE and those living in green and less green areas. DESIGN Cross-sectional study. SETTING The Positive Health Effects of the Natural Outdoor Environment in Typical Populations in Different Regions in Europe project. PARTICIPANTS n=3586 adults from Barcelona (Spain), Doetinchem (the Netherlands), Kaunas (Lithuania) and Stoke-on-Trent (UK). DATA COLLECTION AND ANALYSIS We calculated access to NOE with land maps and residential surrounding greenness with satellite data. Leisure time walking, time spent in NOE and general and mental health status were measured using validated questionnaires. Associations were estimated using multilevel analysis with a random intercept defined at the neighbourhood level. RESULTS Dog ownership was associated with higher rates of leisure time walking and time spending in NOE (OR 2.17, 95% CI 1.86 to 2.54 and 2.37, 95% CI 2.02 to 2.79, respectively). These associations were stronger in those living within 300 m of a NOE and in greener areas. No consistent associations were found between dog ownership and perceived general or mental health status. CONCLUSIONS Compared with non-dog owners, dog owners walked more and spent more time in NOE, especially those living within 300 m of a NOE and in greener areas. The health implications of these relationships should be further investigated. In a largely physically inactive society, dog walking in NOE may be a simple way of promoting physical activity and health.
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Affiliation(s)
- Wilma L Zijlema
- Instituto de Salud Global Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Hayley Christian
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Margarita Triguero-Mas
- Instituto de Salud Global Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marta Cirach
- Instituto de Salud Global Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Magdalena van den Berg
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jolanda Maas
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Christopher J Gidlow
- Centre for Sport, Health and Exercise Research, Staffordshire University, Stoke-on-Trent, UK
| | - Hanneke Kruize
- Centre of Environmental Health Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Wanda Wendel-Vos
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Sandra Andrušaitytė
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania
| | | | - Jill Litt
- Instituto de Salud Global Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Environmental Studies Program, University of Colorado Boulder, Boulder, Colorado, USA
| | - Mark J Nieuwenhuijsen
- Instituto de Salud Global Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Gorabi AM, Heshmat R, Farid M, Motamed-Gorji N, Motlagh ME, Zavareh NHT, Djalalinia S, Sheidaei A, Asayesh H, Madadi Z, Qorbani M, Kelishadi R. Economic Inequality in Life Satisfaction and Self-perceived Health in Iranian Children and Adolescents: The CASPIAN IV Study. Int J Prev Med 2019; 10:70. [PMID: 31198505 PMCID: PMC6547786 DOI: 10.4103/ijpvm.ijpvm_508_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/18/2017] [Indexed: 11/15/2022] Open
Abstract
Background: The purpose of this study was to assess socioeconomic status (SES) inequality in life satisfaction (LS) and good self-perceived health (SPH) in Iranian children and adolescents. Methods: This nationwide study was conducted as part of a fourth national school-based surveillance program performed on 14880 students aged 6–18 years who were living in urban and rural areas of 30 provinces of Iran between 2011 and 2012. Using principle component analysis, the SES of participants was constructed as single variable. SES inequality in LS and good SPH across the SES quintiles was assessed using the concentration index (C) and slope index of inequality (SII). The determinants of this inequality are investigated by the Oaxaca Blinder decomposition method. Results: Frequency of LS along with the SES quintiles shifted significantly from 73.28% (95% CI: 71.49, 75.08) in the lowest quintile to 86.57% (95% CI:85.20, 87.93) in the highest SES quintile. Frequency of favorable SPH linearly increased from lowest SES quintile (76.18% (95% CI: 74.45, 77.92)) to highest SES quintile (83.39% (95% CI: 81.89, 84.89)). C index for LS and good SPH was negative, which suggests inequality was in favor of high SES group. SII for LS and SPH was 15.73 (95% CI: 12.10, 19.35) and 8.21 (95% CI: 5.46, 10.96)]. Living area and passive smoking were the most contributed factors in SES inequality of LS. Also passive smoking and physical activity were the most contributed factors in SES inequality of SPH. Conclusions: SES inequality in LS and good SPH was in favor of high SES group. These findings are useful for health policies, better programming and future complementary analyses.
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Affiliation(s)
- Armita Mahdavi Gorabi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Malihe Farid
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Nazgol Motamed-Gorji
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Neda Hani-Tabaei Zavareh
- Department of Public Health, Master Candidate in Public Health, Massachusetts College of Pharmacy and Health Sciences, Boston, USA
| | - Shirin Djalalinia
- Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Asayesh
- Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran
| | - Zahra Madadi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Department of Epidemiology, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
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Assari S, Smith J, Bazargan M. Depression Fully Mediates the Effect of Multimorbidity on Self-Rated Health for Economically Disadvantaged African American Men but Not Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1670. [PMID: 31091652 PMCID: PMC6572520 DOI: 10.3390/ijerph16101670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/17/2019] [Accepted: 05/10/2019] [Indexed: 12/14/2022]
Abstract
Background. Although chronic medical conditions (CMCs), depression, and self-rated health (SRH) are associated, their associations may depend on race, ethnicity, gender, and their intersections. In predominantly White samples, SRH is shown to better reflect the risk of mortality and multimorbidity for men than it is for women, which suggests that poor SRH among women may be caused not only by CMCs, but also by conditions like depression and social relations-a phenomenon known as "the sponge hypothesis." However, little is known about gender differences in the links between multimorbidity, depression, and SRH among African Americans (AAs). Objective. To study whether depression differently mediates the association between multimorbidity and SRH for economically disadvantaged AA men and women. Methods. This survey was conducted in South Los Angeles between 2015 to 2018. A total number of 740 AA older adults (age ≥ 55 years) were enrolled in this study, of which 266 were AA men and 474 were AA women. The independent variable was the number of CMCs. The dependent variable was SRH. Age and socioeconomic status (educational attainment and marital status) were covariates. Depression was the mediator. Gender was the moderator. Structural Equation Modeling (SEM) was used to analyze the data. Results. In the pooled sample that included both genders, depression partially mediated the effect of multimorbidity on SRH. In gender specific models, depression fully mediated the effects of multimorbidity on SRH for AA men but not AA women. For AA women but not AA men, social isolation was associated with depression. Conclusion. Gender differences exist in the role of depression as an underlying mechanism behind the effect of multimorbidity on the SRH of economically disadvantaged AA older adults. For AA men, depression may be the reason people with multimorbidity report worse SRH. For AA women, depression is only one of the many reasons individuals with multiple CMCs report poor SRH. Prevention of depression may differently influence the SRH of low-income AA men and women with multimorbidity.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - James Smith
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA.
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Hulman A, Ibsen DB, Laursen ASD, Dahm CC. Body mass index trajectories preceding first report of poor self-rated health: A longitudinal case-control analysis of the English Longitudinal Study of Ageing. PLoS One 2019; 14:e0212862. [PMID: 30794702 PMCID: PMC6386346 DOI: 10.1371/journal.pone.0212862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/12/2019] [Indexed: 01/24/2023] Open
Abstract
Background Studies have consistently found that obesity is associated with poor self-rated health, but how body mass index (BMI) developed in the lead up to poor self-rated health is unknown. Methods We nested a longitudinal case-control study in the English Longitudinal Study of Ageing (1998–2015) to investigate BMI trajectories in the years preceding a first self-report of poor health. Participants rated their health at each data collection; every other collection included a BMI assessment by a nurse. Case status was defined as a first report of poor health during follow-up. Three age- and sex-matched controls were identified per case using density sampling. BMI trajectories were fitted to time backwards prior to first report of poor health using mixed-effects models. Age and sex were potential modifiers. We conducted subgroup analyses of those not reporting certain chronic diseases or smoking. Results We identified 732 cases and 2195 controls. Age, but not sex, modified the association between BMI and self-rated health. Participants reporting poor health at age 60 had a 1.5 kg/m2 (95%CI: 0.8 to 2.1) higher BMI at the time of reporting than controls, and their BMI had previously increased markedly (1.3 kg/m2 95%CI: 0.9 to 1.8 over ten years). After age 75, cases no longer had higher BMI than controls, and their BMI had decreased sharply prior to reporting poor health (e.g. -2.0 kg/m2 95%CI: -2.6 to -1.5 per decade on average for those reporting poor health at age 90). Age was also an effect modifier among those without diabetes, however BMI trajectories were more similar among the middle-aged. The subgroup analysis of those without cardiovascular disease, cancer and chronic lung disease showed similar results to the main findings. Conclusion Development of BMI was associated with poor self-rated health; however, the nature of the association depended markedly on age.
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Affiliation(s)
- Adam Hulman
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Daniel B. Ibsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Rao N, Esber A, Turner A, Mopiwa G, Banda J, Norris A. Infertility and self-rated health among Malawian women. Women Health 2018; 58:1081-1093. [PMID: 29240537 DOI: 10.1080/03630242.2017.1414098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 10/29/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
Infertility is prevalent and stigmatized in sub-Saharan Africa. Self-rated health, a subjective indicator that has been consistently related to objectively measured health, may be useful in evaluating the relationship between women's infertility and health. Data were from surveys conducted from July 2014 to January 2015 with women aged 15-39 years (n = 915) as part of the initial assessment in a cohort study in Lilongwe district, Malawi. We first assessed correlates of self-reported infertility among women in rural Malawi. We then used multiple logistic regression to examine associations between infertility and self-rated health. Of women surveyed, 20 percent had a history of infertility. Compared to women who had not experienced infertility, women with a history of infertility were older (p = 0.05), less educated (p = 0.01), and more likely to report depressive symptoms (p = 0.02) and forced first intercourse (p = 0.02) and to have been previously diagnosed with a sexually transmitted infection (p = 0.05). However, women with a history of infertility were not significantly more likely to report poor self-rated health (adjusted odds ratio: 1.69; 95 percent confidence interval: 0.70-4.07). Infertility was prevalent in our sample of Malawian women but was not significantly related to self-rated health, an instrument widely used in public-health research.
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Affiliation(s)
- Nisha Rao
- a The Ohio State University College of Medicine , Columbus , Ohio , USA
- b Department of Medicine , Columbia University Medical Center , New York , New York , USA
| | - Allahna Esber
- c The Ohio State University College of Public Health , Columbus , Ohio, USA
| | - Abigail Turner
- a The Ohio State University College of Medicine , Columbus , Ohio , USA
- c The Ohio State University College of Public Health , Columbus , Ohio, USA
| | | | - Joana Banda
- d Child Legacy International , Lilongwe , Malawi
| | - Alison Norris
- a The Ohio State University College of Medicine , Columbus , Ohio , USA
- c The Ohio State University College of Public Health , Columbus , Ohio, USA
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Coats H, Downey L, Sharma RK, Curtis JR, Engelberg RA. Quality of Communication and Trust in Patients With Serious Illness: An Exploratory Study of the Relationships of Race/Ethnicity, Socioeconomic Status, and Religiosity. J Pain Symptom Manage 2018; 56:530-540.e6. [PMID: 30025937 PMCID: PMC6242783 DOI: 10.1016/j.jpainsymman.2018.07.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/29/2018] [Accepted: 07/06/2018] [Indexed: 12/01/2022]
Abstract
CONTEXT Better understanding of clinicians' skill communicating with their patients and of patients' trust in clinicians is necessary to develop culturally sensitive palliative care interventions. Race/ethnicity, socioeconomic status, and religiosity have been documented as factors influencing quality of communication and trust. OBJECTIVES The objective of this study was to explore associations of seriously ill patients' race/ethnicity, socioeconomic status, and religiosity with patients' ratings of the quality of clinicians' communication and trust in clinicians. METHODS An observational analysis was performed using baseline data from a multicenter cluster-randomized trial of a communication intervention. We enrolled consecutive patients with chronic, life-limiting illnesses (n = 537) cared for by primary and specialty care clinicians (n = 128) between 2014 and 2016 in outpatient clinics in Seattle, Washington. We assessed patient demographics (age, gender, race/ethnicity, education, income, and self-rated health status), Duke University Religion Index, Quality of Communication Scale, and Wake Forest Physician Trust Scale. We used probit and linear regression and path analyses to examine associations. RESULTS Patients providing higher ratings of clinician communication included those belonging to racial/ethnic minority groups (P = 0.001), those with lower income (P = 0.008), and those with high religiosity/spirituality (P = 0.004). Higher trust in clinicians was associated with minority status (P = 0.018), lower education (P = 0.019), and clinician skill in communication (P < 0.001). CONCLUSION Contrary to prior studies, racial/ethnic minorities and patients with lower income rated communication higher and reported higher trust in their clinicians than white and higher income patients. More research is needed to identify and understand factors associated with quality communication and trust between seriously ill patients and clinicians to guide development of patient-centered palliative care communication interventions.
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Affiliation(s)
- Heather Coats
- College of Nursing, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA.
| | - Lois Downey
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care & Sleep Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Rashmi K Sharma
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care & Sleep Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care & Sleep Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
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60
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Brindley P, Jorgensen A, Maheswaran R. Domestic gardens and self-reported health: a national population study. Int J Health Geogr 2018; 17:31. [PMID: 30064435 PMCID: PMC6069855 DOI: 10.1186/s12942-018-0148-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a growing recognition of the health benefits of the natural environment. Whilst domestic gardens account for a significant proportion of greenspace in urban areas, few studies, and no population level studies, have investigated their potential health benefits. With gardens offering immediate interaction with nature on our doorsteps, we hypothesise that garden size will affect general health-with smaller domestic gardens associated with poorer health. METHODS A small area ecological design was undertaken using two separate analyses based on data from the 2001 and 2011 UK census. The urban population of England was classified into 'quintiles' based on deprivation (Index of Multiple Deprivation) and average garden size (Generalised Land Use Database). Self-reported general health was obtained from the UK population census. We controlled for greenspace exposure, population density, air pollution, house prices, smoking, and geographic location. Models were stratified to explore the associations. RESULTS Smaller domestic gardens were associated with a higher prevalence of self-reported poor health. The adjusted prevalence ratio of poor self-reported general health for the quintile with smallest average garden size was 1.13 (95% CI 1.12-1.14) relative to the quintile with the largest gardens. Additionally, the analysis suggested that income-related inequalities in health were greater in areas with smaller gardens. The adjusted prevalence ratio for poor self-reported general health for the most income deprived quintile compared against the least deprived was 1.72 (95% CI 1.64-1.79) in the areas with the smallest gardens, compared to 1.31 (95% CI 1.21-1.42) in areas with the largest gardens. CONCLUSIONS Residents of areas with small domestic gardens have the highest levels of poor health/health inequality related to income deprivation. Although causality needs to be confirmed, the implications for new housing are that adequate garden sizes may be an important means of reducing socioeconomic health inequalities. These findings suggest that the trend for continued urban densification and new housing with minimal gardens could have adverse impacts on health.
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Affiliation(s)
- Paul Brindley
- Department of Landscape, University of Sheffield, The Arts Tower, Western Bank, Sheffield, S10 2TN, UK.
| | - Anna Jorgensen
- Department of Landscape, University of Sheffield, The Arts Tower, Western Bank, Sheffield, S10 2TN, UK
| | - Ravi Maheswaran
- Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
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Maharlouei N, Kazemeini F, Shahraki HR, Lankarani KB. Associated Factors of Self-Rated Mental Health Status in Southwestern Iran: Using SCAD Regression Model in a Population-Based Study. Community Ment Health J 2018; 54:616-624. [PMID: 29119361 DOI: 10.1007/s10597-017-0176-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 10/24/2017] [Indexed: 02/08/2023]
Abstract
This study aimed to investigate the association between self-rated mental health (SRMH) and current health status of an Iranian population. A cross-sectional study was conducted on 3400 individuals selected through random sampling in Shiraz, Iran between January 2014 and March 2015. Data were gathered through face-to-face interviews. Statistical analyses were performed using the SPSS 19.0, and R.3.1.2 software was used for SCAD penalized logistic regression. The mean age of the participants was 38.5 (± 14.1 years). There were significant relationships between better SRMH and younger ages (p < 0.001), and between better SRMH and better self-rated physical health (p < 0.001). Individuals with poor SRMH were more likely to have signs and symptoms of medical diseases. SRMH, a component of self-rated health, was related to a variety of health problems in our study population. Therefore, paying attention to SRMH and mental well-being could be useful in making decision about implementation of preventive measures.
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Affiliation(s)
- Najmeh Maharlouei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh Kazemeini
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Motahhari Hospital, Marvdasht, Iran
| | - Hadi Raeisi Shahraki
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Kamran B Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Chylińska J, Łazarewicz M, Rzadkiewicz M, Adamus M, Jaworski M, Haugan G, Lillefjel M, Espnes GA, Włodarczyk D. The role of gender in the active attitude toward treatment and health among older patients in primary health care-self-assessed health status and sociodemographic factors as moderators. BMC Geriatr 2017; 17:284. [PMID: 29216837 PMCID: PMC5721697 DOI: 10.1186/s12877-017-0677-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/27/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Active attitude toward treatment and health (ATH) leads to improved cooperation and better health outcomes in patients. Supporting it in the population of older adults is a growing need in primary care. Recognising the role of gender, health and other sociodemographic factors can help to distinguish patients who need the most assistance in activation from general practitioners (GPs). The objective of the study was to investigate gender differences in ATH as well as the moderating role of self-assessed health (SAH) and selected sociodemographic factors (age, education, financial status, marital status). METHODS A cross-sectional, multicentre study among 4936 primary care older patients (aged 50+) was conducted. The PRACTA-Attitude toward Treatment and Health questionnaire (PRACTA-ATH) was used to measure the cognitive, emotional (positive and negative affect), and motivational dimensions of ATH. Patients were approached before and after their visits in the primary health-care facilities randomly selected in Central Poland. RESULTS Generalised linear models (GENLIN) revealed the main effects of gender, SAH, and sociodemographic characteristics, such as financial status, marital status and education. Interaction effects of gender and age (Wald's χ2 = 24.767, p < 0.001 for ATH Global), as well as gender and SAH (Wald's χ2 = 16.712, p < 0.002 for ATH Global) on ATH were found. The most assistance in regard to ATH was required by men aged 50-74 and men declaring good self-assessed health. Generally, women declared a more active attitude than men, showing more knowledge (M = 5.40, SD = 0.07 and M = 5.21, SD = 0.07, for women and men, respectively, p = 0.046), positive emotion (M = 5.55, SD = 0.06 and M = 5.33, SD =0.06, for women and men, respectively, p = 0.015) and motivation to be involved in their health issues (M = 5.71, SD = 0.07 and M = 5.39, SD = 0.07, for women and men, respectively, p = 0.001). The level of negative emotions related to health was not significantly different between genders (p = 0.971). CONCLUSIONS The need to create health promoting programmes taking account of particular gender differences in older adults emerges. In regard to clinical practice, building a sense of efficacy and individual responsibility for health, providing information about the means of health promotion and prevention, and recognising health-related cognitions, is recommended especially for men who feel well and are less advanced in age (50-74).
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Affiliation(s)
- Joanna Chylińska
- Department of Medical Psychology, Medical University of Warsaw, Ul. Żwirki i Wigury 81, 02-091, Warsaw, Poland.
| | - Magdalena Łazarewicz
- Department of Medical Psychology, Medical University of Warsaw, Ul. Żwirki i Wigury 81, 02-091, Warsaw, Poland
| | - Marta Rzadkiewicz
- Department of Medical Psychology, Medical University of Warsaw, Ul. Żwirki i Wigury 81, 02-091, Warsaw, Poland
| | - Mirosława Adamus
- Department of Medical Psychology, Medical University of Warsaw, Ul. Żwirki i Wigury 81, 02-091, Warsaw, Poland
| | - Mariusz Jaworski
- Department of Medical Psychology, Medical University of Warsaw, Ul. Żwirki i Wigury 81, 02-091, Warsaw, Poland
| | - Gørill Haugan
- NTNU Center for Health Promotion Research, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Monica Lillefjel
- NTNU Center for Health Promotion Research, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir A Espnes
- NTNU Center for Health Promotion Research, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dorota Włodarczyk
- Department of Medical Psychology, Medical University of Warsaw, Ul. Żwirki i Wigury 81, 02-091, Warsaw, Poland
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Lahiri S, Van Ommeren M, Roberts B. The influence of humanitarian crises on social functioning among civilians in low- and middle-income countries: A systematic review. Glob Public Health 2017; 12:1461-1478. [PMID: 26963867 PMCID: PMC5638016 DOI: 10.1080/17441692.2016.1154585] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Our aim was to systematically review how social functioning is measured, conceptualised, impacted, and associated with mental disorders in populations affected by humanitarian crises. Quantitative studies conducted with civilian populations affected by humanitarian crises in low- and middle-income countries with outcomes of social functioning were examined up to 2014. Data sources included Medline, Embase, PsycInfo, and Global Health, and 8 grey literature sources, yielding 14,350 records, of which 20 studies met inclusion criteria. A descriptive synthesis analysis was used, and the final selected studies assessed for quality using a modified Newcastle-Ottawa Scale. In the 20 studies, social functioning was conceptualised in 6 categories: family functioning, friendship quality, functional impairment, overall social functioning, social adaptation, and social relations. Seventeen studies were cross-sectional, two were cohort, and one a controlled trial. The quality of the studies was generally moderate. The limited evidence suggests that social functioning is a relevant variable. Greater crisis exposure is associated with more severe depression and lower social functioning. The protective role of familial and social resources for social functioning is highlighted in different crisis settings. However, greater research on social functioning and mental health is required.
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Affiliation(s)
- Shaon Lahiri
- Department of Global Health, Imperial College London, United Kingdom
| | - Mark Van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Bayard Roberts
- Bayard Roberts, ECOHOST - Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Archer G, Pinto Pereira S, Power C. Child maltreatment as a predictor of adult physical functioning in a prospective British birth cohort. BMJ Open 2017; 7:e017900. [PMID: 29079607 PMCID: PMC5665268 DOI: 10.1136/bmjopen-2017-017900] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/05/2017] [Accepted: 09/28/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Child maltreatment (abuse and neglect) has established associations with mental health; however, little is known about its relationship with physical functioning. Physical functioning (ie, the ability to perform the physical tasks of daily living) in adulthood is an important outcome to consider, as it is strongly associated with an individual's ability to work, and future disability and dependency. We aimed to establish whether maltreatment was associated with physical functioning, independent of other early-life factors. SETTING 1958 British birth cohort. PARTICIPANTS 8150 males and females with data on abuse and who participated at age 50 years. OUTCOME MEASURES The primary outcome was poor physical functioning at 50 years (<65 on the Short-Form 36 survey physical functioning subscale). Secondary outcomes included mental health and self-reported health at 50 years. RESULTS 23% of participants reported at least one type of maltreatment; 12% were identified with poor physical functioning. Neglect (ORadj 1.55, 95% CI 1.24 to 1.93), psychological abuse (ORadj 1.49, 1.17-1.88) and sexual abuse (ORadj 2.56, 1.66-3.96) were associated with poor physical functioning independent of other maltreatments and covariates, including childhood social class, birth weight and childhood illness. Odds of poor physical functioning increased with multiple types of maltreatment (ptrend <0.001); ORadj ranged from 1.49 (1.23-1.82) for a single type to 2.09 (1.53-2.87) for those reporting > 3 types of maltreatment, compared with those with none. Associations of similar magnitude were observed for mental and self-reported health outcomes. CONCLUSIONS Child neglect, psychological and sexual abuse were associated with poor physical functioning at 50 years, with accumulating risk for those with multiple types of maltreatment. Associations were independent of numerous early-life factors and were comparable in magnitude to those observed for mental health and self-rated health. Prevention or alleviation of the ill effects of maltreatment could be an effective policy intervention to promote healthy ageing.
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Affiliation(s)
- Gemma Archer
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Snehal Pinto Pereira
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Christine Power
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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Lorem GF, Schirmer H, Emaus N. What is the impact of underweight on self-reported health trajectories and mortality rates: a cohort study. Health Qual Life Outcomes 2017; 15:191. [PMID: 28969649 PMCID: PMC5625617 DOI: 10.1186/s12955-017-0766-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/25/2017] [Indexed: 12/15/2022] Open
Abstract
Background Utilizing a cohort study design combining a survey approach with repeated physical examinations, we examined the independent effects of BMI on mortality and self-reported health (SRH) and whether these independent effects change as people grow older. Methods The Tromsø Study consists of six surveys conducted in the municipality of Tromsø, Norway, with large representative samples of a general population. In total, 31,985 subjects participated in at least one of the four surveys administered between 1986 and 2008. Outcomes of interest were SRH and all-cause mortality. Results Overweight and underweight subjects reported significantly lower levels of SRH, but age affected the thinnest subjects more than all others. The SRH trajectory of underweight subjects at age 25 was slightly above the other categories (0.08), but it fell to −.30 below the reference category at age 90. For obese subjects, the difference was −0.15 below the reference category at age 25 and −0.18 below at age 90. This implies that even though a low BMI was slightly beneficial at a young age, it represented an increasing risk with age that crossed the reference curve at age 38 and even crossed the obese trajectory at age 67 in the full fitted model. The proportional hazard ratio for those who were underweight was 1.69 (95% CI: 1.38-2.06) for all-cause death as compared to 1.12 (95% CI: 1.02-1.23) for obese subjects. Conclusion BMI affected SRH and all-cause mortality independently from comorbidity, mental health, health-related behaviors and other biological risk factors. Being underweight was associated with excess mortality as compared to all others, and age affected the thinnest subjects more than all others. Weight increase was beneficial for mortality but not for SRH among the underweight. The rapid decline of SRH with increasing age suggests that particular attention should be paid to underweight after 38 years of age. Electronic supplementary material The online version of this article (10.1186/s12955-017-0766-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Geir Fagerjord Lorem
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Henrik Schirmer
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Nina Emaus
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Malard L, Chastang JF, Niedhammer I. Évolution des comportements et indicateurs de santé mentale entre 2006 et 2010 dans la population au travail en France. Rev Epidemiol Sante Publique 2017. [DOI: '10.1016/j.respe.2017.04.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Song Q. Aging and separation from children: The health implications of adult migration for elderly parents in rural China. DEMOGRAPHIC RESEARCH 2017; 37:1761-1792. [PMID: 30581322 PMCID: PMC6301042 DOI: 10.4054/demres.2017.37.55] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Massive rural-to-urban migration in China has profoundly altered the family life of rural older adults, as adult children remain the primary caretakers of their elderly parents. And yet little is known about the health and well-being of the parents of adult migrants in rural China whose main source of support has been displaced. OBJECTIVE This study takes a comprehensive view and compares the trajectories of self-rated health among the rural elderly and examines how these health trajectories are associated with adult children's migration. METHODS We analyze older adults aged 55 years and over in rural China, using four waves of data from the China Health and Nutrition Survey (1997, 2000, 2004, 2006) and multilevel growth curve models. RESULTS The results show that parents of migrants persistently scored worse self-rated health across ages than their counterparts whose children had not migrated. Long-term migration of adults takes a heavier toll on the health of their elderly parents than short-term migration. However, these associations with children's migration are driven by the migration of sons. The migration of daughters and of children of both genders may have disparate effects on the health trajectories of elderly men and women. CONCLUSIONS The findings suggest that the interplay of gendered family dynamics and migration processes affects the health outcomes of older adults. CONTRIBUTION The findings contribute to current debates on the health and well-being of family members left behind by migrants and call for further study of the relationship between migration and family processes in the well-being of migrant families.
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Affiliation(s)
- Qian Song
- RAND Corporation, Santa Monica, USA.
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68
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Malard L, Chastang JF, Niedhammer I. [Changes in behaviors and indicators of mental health between 2006 and 2010 in the French working population]. Rev Epidemiol Sante Publique 2017; 65:309-320. [PMID: 28601504 DOI: 10.1016/j.respe.2017.04.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 12/02/2016] [Accepted: 04/03/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The 2008 economic crisis may have had an impact on mental health but the studies on this topic are sparse, in particular among the working population. However, mental health at work is a crucial issue involving substantial costs and consequences. The aim of the study was to assess changes in behaviors and indicators of mental health in the French working population between 2006 and 2010, and to explore the differential changes according to age, origin, occupation, activity sector, public/private sector, self-employed/employee status and work contract. METHODS The data came from the prospective national representative Santé et itinéraire professionnel (SIP) survey, including a sample of 5600 French workers interviewed in 2006 and 2010. The behaviors and indicators of mental health studied were excessive alcohol consumption, smoking, sleep problems (sleep disorders and/or insufficient sleep duration), psychotropic drug use (antidepressants, anxiolytics and/or hypnotics), and poor self-reported health. Generalized estimating equations were used to analyze changes in behaviors and indicators of mental health, and the analyses were adjusted for age. Covariates (age, origin, occupation, activity sector, public/private sector, self-employed/employee status and type of contract) were added separately to assess differential changes. RESULTS Increases in excessive alcohol consumption among women, sleep problems among men, and smoking, insufficient sleep duration and poor self-reported health for both genders were observed in the French working population between 2006 and 2010. Some differential changes were observed, negative changes being more likely to affect young workers and workers with a permanent contract. CONCLUSION Prevention policies should consider that behavior and indicators of mental health may deteriorate in times of economic crisis, especially among some sub-groups of the working population, such as young workers and workers with a permanent contract. These changes might foreshadow a forthcoming increase in mental disorders.
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Affiliation(s)
- L Malard
- Inserm, UMR_S 1136, Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, 75013 Paris, France; Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, Sorbonne universités, UPMC université Paris 06, UMR S 1136, 75013 Paris, France; Université de Versailles-Saint-Quentin, 78000 Versailles, France
| | - J-F Chastang
- Inserm, UMR_S 1136, Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, 75013 Paris, France; Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, Sorbonne universités, UPMC université Paris 06, UMR S 1136, 75013 Paris, France
| | - I Niedhammer
- Inserm, UMR_S 1136, Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, 75013 Paris, France; Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, Sorbonne universités, UPMC université Paris 06, UMR S 1136, 75013 Paris, France.
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Kumparatana P, Cournos F, Terlikbayeva A, Rozental Y, Gilbert L. Factors associated with self-rated health among migrant workers: results from a population-based cross-sectional study in Almaty, Kazakhstan. Int J Public Health 2017; 62:541-550. [PMID: 28233019 PMCID: PMC5429909 DOI: 10.1007/s00038-017-0944-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/22/2016] [Accepted: 01/04/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To determine factors associated with SRH among migrant workers in Almaty, Kazakhstan. METHODS In 2007, 805 vendors were screened. Approximately half were eligible (n =450), defined as at least 18 years old, a worker/owner in a randomly selected stall, having traveled 2 + hours outside of Almaty within the past year, and being an internal/external migrant. 28 non-migrants were excluded, leaving 422 participants. Logistic regression was used to examine the relationship between SRH, mental health, and psychosocial problems. RESULTS Approximately 46% reported having poor or fair SRH. Clinical depression (OR 0.859, 95% CI 0.342-2.154), alcohol problems (OR 1.169, 95% CI 0.527-2.593), and legal status (OR 0.995, 95% CI 0.806-1.229) were not significantly associated with SRH, nor was exposure to interpersonal violence among women (OR 1.554, 95% CI 0.703-3.435). After adjusting for key variables, only ethnicity and social support were found to be significantly protective against poor or fair SRH. CONCLUSIONS SRH was not a comprehensive health measure for these Central Asian migrant workers. More specific questions are needed to identify mental illness and interpersonal violence.
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Affiliation(s)
- Pam Kumparatana
- Mailman School of Public Health, Columbia University, New York, NY, USA.
- School of Social Work, Columbia University, New York, NY, USA.
| | - Francine Cournos
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Assel Terlikbayeva
- Global Health Research Center of Central Asia (GHRCCA), Almaty, Kazakhstan
| | - Yelena Rozental
- Global Health Research Center of Central Asia (GHRCCA), Almaty, Kazakhstan
| | - Louisa Gilbert
- School of Social Work, Columbia University, New York, NY, USA
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Jagsi R, Griffith KA, Sabolch A, Jones R, Spence R, De Vries R, Grande D, Bradbury AR. Perspectives of Patients With Cancer on the Ethics of Rapid-Learning Health Systems. J Clin Oncol 2017; 35:2315-2323. [PMID: 28537812 DOI: 10.1200/jco.2016.72.0284] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To inform the evolving implementation of CancerLinQ and other rapid-learning systems for oncology care, we sought to evaluate perspectives of patients with cancer regarding ethical issues. Methods Using the GfK Group online research panel, representative of the US population, we surveyed 875 patients with cancer; 621 (71%) responded. We evaluated perceptions of appropriateness (scored from 1 to 10; 10, very appropriate) using scenarios and compared responses by age, race, and education. We constructed a scaled measure of comfort with secondary use of deidentified medical information and evaluated its correlates in a multivariable model. Results Of the sample, 9% were black and 9% Hispanic; 38% had completed high school or less, and 59% were age ≥ 65 years. Perceptions of appropriateness were highest when consent was obtained and university researchers used data to publish a research study (weighted mean appropriateness, 8.47) and lowest when consent was not obtained and a pharmaceutical company used data for marketing (weighted mean appropriateness, 2.7). Most respondents (72%) thought secondary use of data for research was very important, although those with lower education were less likely to endorse this (62% v 78%; P < .001). Overall, 35% believed it was necessary to obtain consent each time such research was to be performed; this proportion was higher among blacks/Hispanics than others (48% v 33%; P = .02). Comfort with the use of deidentified information from medical records varied by scenario and overall was associated with distrust in the health care system. Conclusion Perceptions of patients with cancer regarding secondary data use depend on the user and the specific use of the data, while also frequently differing by patient sociodemographic factors. Such information is critical to inform ongoing efforts to implement oncology learning systems.
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Affiliation(s)
- Reshma Jagsi
- Reshma Jagsi, Aaron Sabolch, Rochelle Jones, and Raymond De Vries, University of Michigan; Kent A. Griffith, University of Michigan School of Public Health, Ann Arbor, MI; Rebecca Spence, American Society of Clinical Oncology, Alexandria, VA; and David Grande and Angela R. Bradbury, University of Pennsylvania, Philadelphia, PA
| | - Kent A Griffith
- Reshma Jagsi, Aaron Sabolch, Rochelle Jones, and Raymond De Vries, University of Michigan; Kent A. Griffith, University of Michigan School of Public Health, Ann Arbor, MI; Rebecca Spence, American Society of Clinical Oncology, Alexandria, VA; and David Grande and Angela R. Bradbury, University of Pennsylvania, Philadelphia, PA
| | - Aaron Sabolch
- Reshma Jagsi, Aaron Sabolch, Rochelle Jones, and Raymond De Vries, University of Michigan; Kent A. Griffith, University of Michigan School of Public Health, Ann Arbor, MI; Rebecca Spence, American Society of Clinical Oncology, Alexandria, VA; and David Grande and Angela R. Bradbury, University of Pennsylvania, Philadelphia, PA
| | - Rochelle Jones
- Reshma Jagsi, Aaron Sabolch, Rochelle Jones, and Raymond De Vries, University of Michigan; Kent A. Griffith, University of Michigan School of Public Health, Ann Arbor, MI; Rebecca Spence, American Society of Clinical Oncology, Alexandria, VA; and David Grande and Angela R. Bradbury, University of Pennsylvania, Philadelphia, PA
| | - Rebecca Spence
- Reshma Jagsi, Aaron Sabolch, Rochelle Jones, and Raymond De Vries, University of Michigan; Kent A. Griffith, University of Michigan School of Public Health, Ann Arbor, MI; Rebecca Spence, American Society of Clinical Oncology, Alexandria, VA; and David Grande and Angela R. Bradbury, University of Pennsylvania, Philadelphia, PA
| | - Raymond De Vries
- Reshma Jagsi, Aaron Sabolch, Rochelle Jones, and Raymond De Vries, University of Michigan; Kent A. Griffith, University of Michigan School of Public Health, Ann Arbor, MI; Rebecca Spence, American Society of Clinical Oncology, Alexandria, VA; and David Grande and Angela R. Bradbury, University of Pennsylvania, Philadelphia, PA
| | - David Grande
- Reshma Jagsi, Aaron Sabolch, Rochelle Jones, and Raymond De Vries, University of Michigan; Kent A. Griffith, University of Michigan School of Public Health, Ann Arbor, MI; Rebecca Spence, American Society of Clinical Oncology, Alexandria, VA; and David Grande and Angela R. Bradbury, University of Pennsylvania, Philadelphia, PA
| | - Angela R Bradbury
- Reshma Jagsi, Aaron Sabolch, Rochelle Jones, and Raymond De Vries, University of Michigan; Kent A. Griffith, University of Michigan School of Public Health, Ann Arbor, MI; Rebecca Spence, American Society of Clinical Oncology, Alexandria, VA; and David Grande and Angela R. Bradbury, University of Pennsylvania, Philadelphia, PA
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Remes O, Wainwright N, Surtees P, Lafortune L, Khaw KT, Brayne C. Sex differences in the association between area deprivation and generalised anxiety disorder: British population study. BMJ Open 2017; 7:e013590. [PMID: 28473351 PMCID: PMC5777465 DOI: 10.1136/bmjopen-2016-013590] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Studies have shown that area-level deprivation measured by factors, such as non-home ownership, non-car ownership and household overcrowding, can increase the risk for mental disorders over and above individual-level circumstances, such as education and social class. Whether area-level deprivation is associated with generalised anxiety disorder (GAD) independent of personal circumstances, and whether this association is different between British women and men is unknown. DESIGN Large, population study. SETTING UK population-based cohort. PARTICIPANTS 30 445 people from the general population aged 40 years and older and living in England consented to participate at study baseline, and of these, 21 921 participants completed a structured health and lifestyle questionnaire used to capture GAD. Area deprivation was measured in 1991 using Census data, and GAD was assessed in 1996-2000. 10 275 women and 8219 men had complete data on all covariates. MAIN OUTCOME MEASURE Past-year GAD defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). RESULTS In this study, 2.5% (261/10 275) of women and 1.8% (145/8219) of men had GAD. Women living in the most deprived areas were over 60% more likely to develop anxiety than those living in areas that were not deprived (OR=1.63, 95% CI 1.21 to 2.21; p=0.001), but this association between deprivation and GAD was not apparent in men (OR=1.13, 95% CI 0.72 to 1.77; p=0.598). CONCLUSIONS The absolute numbers of people living in deprived conditions are large worldwide. This, combined with a growing mental health burden, means that the findings obtained in this study remain highly relevant. The WHO has emphasised the need to reduce social and health inequalities. Our findings provide a strong evidence base to this call, showing that the environment needs to be taken into account when developing mental health policy; gender is important when it comes to assessing the influence of the environment on our mental health.
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Affiliation(s)
- Olivia Remes
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nick Wainwright
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Paul Surtees
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Louise Lafortune
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Strandberg T, Levälahti E, Ngandu T, Solomon A, Kivipelto M, Kivipelto M, Ngandu T, Lehtisalo J, Laatikainen T, Soininen H, Strandberg T, Antikainen R, Jula A, Tuomilehto J, Peltonen M, Levälahti E, Lindström J, Rauramaa R, Pajala S, Hänninen T, Solomon A, Paajanen T, Mangialasche F. Health-related quality of life in a multidomain intervention trial to prevent cognitive decline (FINGER). Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2016.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Tomioka K, Kurumatani N, Hosoi H. Self-rated health predicts decline in instrumental activities of daily living among high-functioning community-dwelling older people. Age Ageing 2017; 46:265-270. [PMID: 27614076 DOI: 10.1093/ageing/afw164] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/08/2016] [Indexed: 11/12/2022] Open
Abstract
Background self-rated health (SRH) is a strong predictor of mortality, but it is unclear if SRH independently predicts a decline in instrumental activities of daily living (IADL). Objective to verify whether SRH is an independent predictor of IADL decline. Design a population-based longitudinal cohort study. Setting two local municipalities in Nara, Japan. Subjects community-dwelling older adults 65 years or older (2,638 males and 3,346 females) with independent IADL at baseline. Methods SRH was assessed using a single-item measure. IADL was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Multiple logistic regressions were used to examine the association of SRH with IADL decline. Results during the 3-year follow-up, 13.2% of males and 8.2% of females developed IADL decline. After adjusting for age, family, body mass index, economic situations, chronic diseases, alcohol, smoking, depression, cognitive functioning and ADL, poorer SHR was significantly associated with IADL decline in both genders. Compared with very good SRH, the odds ratios of good, poor and very poor were 1.69 (95% confidence interval: 1.14-2.51), 2.10 (1.25-3.55) and 3.11 (1.50-6.45) for males, and 0.88 (0.54-1.42), 2.08 (1.16-3.75) and 3.42 (1.57-7.42) for females, respectively. Significant associations were not affected by chronic diseases, cognitive functioning or ADL but observed only among subjects aged 65-74 or those without depression. Conclusions this study confirms that SRH is an independent predictor of IADL decline among non-disabled community-dwelling older adults. Our findings suggest that SRH is an effective tool for identifying older people with future risk for IADL decline, particularly among the young-old or those without depression.
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Affiliation(s)
- Kimiko Tomioka
- Nara Prefectural Health Research Center, Nara Medical University, Kashihara, Nara, Japan
| | - Norio Kurumatani
- Nara Prefectural Health Research Center, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroshi Hosoi
- Nara Prefectural Health Research Center, Nara Medical University, Kashihara, Nara, Japan
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General health status in army personnel: relations with health behaviors and psychosocial variables. Qual Life Res 2017; 26:1839-1851. [DOI: 10.1007/s11136-017-1523-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2017] [Indexed: 10/20/2022]
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Prentice C, McKillop D, French D. How financial strain affects health: Evidence from the Dutch National Bank Household Survey. Soc Sci Med 2017; 178:127-135. [PMID: 28214723 DOI: 10.1016/j.socscimed.2017.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/19/2016] [Accepted: 02/03/2017] [Indexed: 01/25/2023]
Abstract
The mechanisms by which financial strain affects health are not well understood. In this paper, we conduct a longitudinal mediation analysis of the Dutch National Bank Household Survey. To quantify the relative importance of biological and nonbiological pathways from financial strain to health, we consider smoking, heavy drinking and being overweight as plausible behavioural responses to financial strain but find that only 4.9% of the response of self-reported health to financial strain is mediated by these behaviours. Further analysis indicates that although financial strain increases impulsivity this has little effect on unhealthy behaviours. Economic stresses therefore appear to be distinct from other forms of stress in the relatively minor influence of nonbiological pathways to ill-health.
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Affiliation(s)
- Carla Prentice
- Queen's Management School, Queen's University Belfast, Northern Ireland, UK
| | - Donal McKillop
- Queen's Management School, Queen's University Belfast, Northern Ireland, UK
| | - Declan French
- Queen's Management School, Queen's University Belfast, Northern Ireland, UK.
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76
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Roelen C, Thorsen S, Heymans M, Twisk J, Bültmann U, Bjørner J. Development and validation of a prediction model for long-term sickness absence based on occupational health survey variables. Disabil Rehabil 2016; 40:168-175. [PMID: 27830962 DOI: 10.1080/09638288.2016.1247471] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to develop and validate a prediction model for identifying employees at increased risk of long-term sickness absence (LTSA), by using variables commonly measured in occupational health surveys. MATERIALS AND METHODS Based on the literature, 15 predictor variables were retrieved from the DAnish National working Environment Survey (DANES) and included in a model predicting incident LTSA (≥4 consecutive weeks) during 1-year follow-up in a sample of 4000 DANES participants. The 15-predictor model was reduced by backward stepwise statistical techniques and then validated in a sample of 2524 DANES participants, not included in the development sample. Identification of employees at increased LTSA risk was investigated by receiver operating characteristic (ROC) analysis; the area-under-the-ROC-curve (AUC) reflected discrimination between employees with and without LTSA during follow-up. RESULTS The 15-predictor model was reduced to a 9-predictor model including age, gender, education, self-rated health, mental health, prior LTSA, work ability, emotional job demands, and recognition by the management. Discrimination by the 9-predictor model was significant (AUC = 0.68; 95% CI 0.61-0.76), but not practically useful. CONCLUSIONS A prediction model based on occupational health survey variables identified employees with an increased LTSA risk, but should be further developed into a practically useful tool to predict the risk of LTSA in the general working population. Implications for rehabilitation Long-term sickness absence risk predictions would enable healthcare providers to refer high-risk employees to rehabilitation programs aimed at preventing or reducing work disability. A prediction model based on health survey variables discriminates between employees at high and low risk of long-term sickness absence, but discrimination was not practically useful. Health survey variables provide insufficient information to determine long-term sickness absence risk profiles. There is a need for new variables, based on the knowledge and experience of rehabilitation professionals, to improve long-term sickness absence risk profiles.
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Affiliation(s)
- Corné Roelen
- a Department of Health Sciences, Community and Occupational Medicine , University Medical Center Groningen, University of Groningen, Groningen , Groningen , The Netherlands.,b Department of Epidemiology and Biostatistics , VU University Medical Center, VU University , Amsterdam , The Netherlands
| | - Sannie Thorsen
- c National Research Center for the Working Environment , Copenhagen , Demark
| | - Martijn Heymans
- b Department of Epidemiology and Biostatistics , VU University Medical Center, VU University , Amsterdam , The Netherlands
| | - Jos Twisk
- b Department of Epidemiology and Biostatistics , VU University Medical Center, VU University , Amsterdam , The Netherlands
| | - Ute Bültmann
- a Department of Health Sciences, Community and Occupational Medicine , University Medical Center Groningen, University of Groningen, Groningen , Groningen , The Netherlands.,c National Research Center for the Working Environment , Copenhagen , Demark
| | - Jakob Bjørner
- c National Research Center for the Working Environment , Copenhagen , Demark.,d Department of Public Health , University of Copenhagen , Copenhagen , Denmark
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Kato K, Zweig R, Schechter CB, Barzilai N, Atzmon G. Positive attitude toward life, emotional expression, self-rated health, and depressive symptoms among centenarians and near-centenarians. Aging Ment Health 2016; 20:930-9. [PMID: 26114814 PMCID: PMC5048681 DOI: 10.1080/13607863.2015.1056770] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Favorable attitudes, emotions, personality characteristics, and self-rated health have been associated with successful aging in late life. However, less is known regarding these constructs and their relationships to mental health outcomes in the oldest old persons. This study examined cross-sectional relationships of these psychological factors to depressive symptoms in centenarians and near-centenarians. METHODS A selected sample of Ashkenazi Jewish older adults aged 98-107 (n = 54, 78% female) without significant cognitive impairment participated. Cognitive function was assessed by Mini-Mental Status Examination, positive attitude toward life and emotional expression by the Personality Outlook Profile Scale (POPS), self-rated health by participants' subjective rating of their present health, and depressive symptoms by the Geriatric Depression Scale. RESULTS Results demonstrated inverse associations of the positive attitude toward life domain of the POPS and self-rated health with participants' levels of depressive symptoms even after adjusting for the effects of history of medical illnesses, cognitive function, and demographic variables. Additionally, participants with high levels of care showed higher levels of depressive symptoms. Path analysis supported the partially mediating role of positive attitude toward life in the relationship between self-rated health and depressive symptoms. CONCLUSION These findings emphasized the important roles of positive attitudes and emotions as well as self-rated health in mental health outcomes in the oldest old. Although, limited by its cross-sectional design, findings suggest these psychological factors may exert protective effects on mental health outcomes in advanced age.
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Affiliation(s)
- Kaori Kato
- Woodhull Medical and Mental Health Center / NYU Langone Medical School, Department of Psychiatry, 760 Broadway, Brooklyn, NY 11206, USA
| | - Richard Zweig
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Bronx, NY 10461, USA. (718)430-3958.
| | - Clyde B. Schechter
- Department of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, 1300 Morris Park Avenue, Bronx, NY 10461, USA. (718)430-2754.
| | - Nir Barzilai
- Departments of Medicine and Genetics, Albert Einstein College of Medicine, Yeshiva University, 1300 Morris Park Avenue, Bronx, NY 10461, USA. (718)430-3144.
| | - Gil Atzmon
- Departments of Medicine and Genetics, Albert Einstein College of Medicine, Yeshiva University, 1300 Morris Park Avenue, Bronx, NY 10461, USA. (718)430-3628.
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Fakhri S, Engelberg RA, Downey L, Nielsen EL, Paul S, Lahdya AZ, Treece PD, Curtis JR. Factors Affecting Patients' Preferences for and Actual Discussions About End-of-Life Care. J Pain Symptom Manage 2016; 52:386-94. [PMID: 27265813 PMCID: PMC5023466 DOI: 10.1016/j.jpainsymman.2016.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/28/2016] [Accepted: 04/27/2016] [Indexed: 11/20/2022]
Abstract
CONTEXT Discussions about end-of-life care are often difficult for patients and clinicians, and inadequate communication poses a barrier to patients receiving the care they desire. OBJECTIVES To understand factors that facilitate end-of-life care discussions that guide interventions to improve care. METHODS We examined baseline data from an ongoing randomized trial to evaluate associations between patients' self-reported desire for, and occurrence of, discussions about end-of-life care and factors influencing these discussions. Factors included emotional symptoms and barriers and facilitators to discussions. The sample included patients with serious illness (n = 473) and their primary or specialty care clinicians (n = 128). Regression analyses were adjusted for confounders and clustered patients under clinicians. RESULTS Patients who endorsed each of three barriers to discussions were less likely to have had a discussion with their clinician (P-values ranging from <0.001 to 0.046). One facilitator (having had family/friends who died) was associated with past discussions (P = 0.037), and two facilitators were associated with wanting future discussion (P < 0.001): 1) concerns about future quality of life, 2) worries about being a burden on friends/family. Depression and anxiety were not associated with past discussions. However, patients with more anxiety were more likely to want future discussions (P = 0.001), as were patients with more depressive symptoms who had had discussions in the past (P < 0.001). CONCLUSION The occurrence of, and desire for, patient-clinician communication about end-of-life care is associated with patient factors including communication barriers and facilitators and symptoms of depression and anxiety. Understanding these factors may facilitate design of effective communication interventions.
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Affiliation(s)
- Shoaib Fakhri
- Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington, USA
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington, USA
| | - Lois Downey
- Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington, USA
| | - Elizabeth L Nielsen
- Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington, USA
| | - Sudiptho Paul
- Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington, USA
| | - Alexandria Z Lahdya
- Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington, USA
| | - Patsy D Treece
- Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington, USA
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington, USA.
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Choi NG, DiNitto DM, Marti CN. Relationship Between the Types of Insurance Coverage and Outpatient Mental Health Treatment Use Among Older Adults. J Appl Gerontol 2016; 35:1343-1362. [DOI: 10.1177/0733464815577143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/13/2015] [Indexed: 11/17/2022] Open
Abstract
Using the public use data files of the 2008 to 2012 National Survey on Drug Use and Health, this study examined (a) the payment sources for mental health treatment among those aged 50 to 64 years and those aged 65+ years and (b) the relationship between outpatient mental health treatment use and different types of insurance coverage among members of these two age groups. The results show that 16% of the 50 to 64 age group and 10% of the 65+ age group used inpatient or outpatient mental health treatment in the preceding year. Logistic regression analyses showed that mental health problem severity and public insurance programs (Medicare, Medicaid, and Department of Veterans Affairs [VA]/military insurance) significantly increased the odds of receiving outpatient treatment. Private insurance was not a significant factor for either age group. Older adults with mental health problems must be encouraged to seek treatment and need to be informed about mental health coverage included in their insurance(s).
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80
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Feng Q, Zhu H, Zhen Z, Gu D. Self-Rated Health, Interviewer-Rated Health, and Their Predictive Powers on Mortality in Old Age. J Gerontol B Psychol Sci Soc Sci 2016; 71:538-50. [PMID: 25617400 PMCID: PMC6366535 DOI: 10.1093/geronb/gbu186] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 12/08/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study examines the potential use of interviewer-rated health (IRH) as a complementary measure of self-rated health (SRH) through a systematic comparison of their components and mortality-predictive powers in the Chinese elderly population. METHODS This study used a nationwide dataset with more than 12,000 adults aged 65 or older drawn from the 2005 and 2008 waves of the Chinese Longitudinal Health Longevity Survey (CLHLS). RESULTS Disability, cognitive function, chronic disease conditions, psychological well-being, and health behaviors influenced both the SRH and IRH of Chinese older adults; these factors, especially disabilities, explained a large portion of the association between SRH and mortality. However, the impact of these factors on the association between IRH and mortality was limited. Furthermore, when both SRH and IRH were included in the analytical models, the association between SRH and mortality disappeared, while the association between IRH and mortality still persisted. DISCUSSION Although there is some difference between IRH and SRH, IRH captures similar health information as SRH and is strongly predictive of mortality independent of SRH; thus, IRH could be a good supplementary measurement for well-adopted SRH.
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Affiliation(s)
- Qiushi Feng
- Department of Sociology, National University of Singapore, Singapore
| | - Haiyan Zhu
- Department of Sociology, Virginia Polytechnic Institute and State University, Blacksburg
| | - Zhihong Zhen
- Department of Sociology, Shanghai University, Shanghai, China
| | - Danan Gu
- United Nations Population Division, New York, New York. :
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Abstract
OBJECTIVES Excessive gestational weight gain (GWG) is associated with higher body mass index (BMI) later in life. Increased BMI is associated with health problems, but there is limited evidence linking GWG directly to later health in black women. We examined the association between GWG and health conditions 18 years after a first birth. METHODS This study was a secondary data analysis of 467 urban black women, enrolled during pregnancy (1990-1991). GWG was the difference between self-reported pre-pregnancy weight and measured weight at delivery. Hypertension, diabetes, obesity, and self-reported health were assessed with self-report and measurements of blood pressure, height, and weight, approximately 18 years after first childbirth. RESULTS Higher pre-pregnancy BMI was associated with increased probability of each health condition. Higher GWG was associated with hypertension for women with a pre-pregnancy BMI under 21.3 kg/m(2) (P < .05) and obesity for women with a pre-pregnancy BMI under 25.9 kg/m(2) (P < .05). Diabetes and poor health were not associated with GWG. CONCLUSIONS GWG may impact a mother's hypertension and obesity status 18 years after childbirth for underweight and normal weight women.
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Vásquez-Vera H, Rodríguez-Sanz M, Palència L, Borrell C. Foreclosure and Health in Southern Europe: Results from the Platform for People Affected by Mortgages. J Urban Health 2016; 93:312-30. [PMID: 26940706 PMCID: PMC4835360 DOI: 10.1007/s11524-016-0030-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Housing instability has been shown to be related to poorer health outcomes in various studies, mainly in the USA and UK. Affected individuals are more prone to psychiatric (e.g., major depression, anxiety) and physical disorders (e.g., hypertension). This situation has deteriorated with the onset of the economic crisis. One of the most affected countries is Spain, which has high rates of foreclosure and eviction that continue to rise. In response, a civil movement, The Platform for People Affected by Mortgages (PAH), works to provide solutions to its members affected by foreclosure and advocates for the right to decent housing. The aims of this study ware to describe and compare the health status of PAH members from Catalonia to a sample of the general population and to analyze the association between health status and mortgage status, foreclosure stage, and other socioeconomic variables, among members of the PAH. We conducted a cross-sectional study using a self-administered online questionnaire (2014) administered to 905 PAH members in Catalonia (>18 years; 559 women and 346 men). Results were compared with health indicators from The Health Survey of Catalonia 2013 (n = 4830). The dependent variables were poor mental health (GHQ 12 ≥ 3), and poor self-reported health (fair or poor). All analyses were stratified by sex. We computed age-standardized prevalence and prevalence ratios of poor mental and self-reported health in both samples. We also analyzed health outcomes among PAH members according to mortgage status (mortgage holders or guarantors), stage of foreclosure, and other socioeconomic variables by computing prevalence ratios from robust Poisson regression models. The prevalence of poor mental health among PAH members was 90.6 % in women and 84.4 % in men, and 15.5 and 10.2 % in the general population, respectively. The prevalence of poor self-reported health was 55.6 % in women and 39.4 % in men from the PAH, and 19.2 and 16.1 % in the general population, respectively. These health inequalities were independent of socioeconomic status. The prevalence of poor mental health was higher among individuals in the non-payment stage of foreclosure than among those who were up to date with their payments (e.g., PRc = 1.16 [95 % CI 1.04-1.28]). In contrast, self-reported poor health was more prominent in later stages of foreclosure, such as in post-eviction without dation in payment stage in men (PRc = 2.24 [95 %CI = 1.35-3.72]). We observed a considerably higher prevalence of poor mental and self-reported health among male and female PAH members than in the general population. Public policies that tackle housing instability and its consequences are urgently needed in Spain.
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Affiliation(s)
- Hugo Vásquez-Vera
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Centro de Estudios para la Equidad en Salud, Universidad de La Frontera, Temuco, Chile
| | - Maica Rodríguez-Sanz
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain
- Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain
| | - Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain
| | - Carme Borrell
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
- Agència de Salut Pública de Barcelona, Barcelona, Spain.
- CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain.
- Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain.
- Agència de Salut Pública de Barcelona, Avinguda Lesseps 1, ES-08023, Barcelona, Spain.
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Mavaddat N, van der Linde R, Parker R, Savva G, Kinmonth AL, Brayne C, Mant J. Relationship of Self-Rated Health to Stroke Incidence and Mortality in Older Individuals with and without a History of Stroke: A Longitudinal Study of the MRC Cognitive Function and Ageing (CFAS) Population. PLoS One 2016; 11:e0150178. [PMID: 26928666 PMCID: PMC4771829 DOI: 10.1371/journal.pone.0150178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 02/10/2016] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Poor self-rated health (SRH) has been associated with increased risk of death and poor health outcomes even after adjusting for confounders. However its' relationship with disease-specific mortality and morbidity has been less studied. SRH may also be particularly predictive of health outcomes in those with pre-existing conditions. We studied whether SRH predicts new stroke in older people who have never had a stroke, or a recurrence in those with a prior history of stroke. METHODS MRC CFAS I is a multicentre cohort study of a population representative sample of people in their 65th year and older. A comprehensive interview at baseline included questions about presence of stroke, self-rated health and functional disability. Follow-up at 2 years included self-report of stroke and stroke death obtained from death certificates. Multiple logistical regression determined odds of stroke at 2 years adjusting for confounders including disability and health behaviours. Survival analysis was performed until June 2014 with follow-up for up to 13 years. RESULTS 11,957 participants were included, of whom 11,181 (93.8%) had no history of stroke and 776 (6.2%) one or more previous strokes. Fewer with no history of stroke reported poor SRH than those with stroke (5 versus 21%). In those with no history of stroke, poor self-rated health predicted stroke incidence (OR 1.5 (1.1-1.9)), but not stroke mortality (OR 1.2 (0.8-1.9)) at 2 years nor for up to 13 years (OR 1.2(0.9-1.7)). In those with a history of stroke, self-rated health did not predict stroke incidence (OR 0.9(0.6-1.4)), stroke mortality (OR 1.1(0.5-2.5)), or survival (OR 1.1(0.6-2.1)). CONCLUSIONS Poor self-rated health predicts risk of stroke at 2 years but not stroke mortality among the older population without a previous history of stroke. SRH may be helpful in predicting who may be at risk of developing a stroke in the near future.
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Affiliation(s)
- Nahal Mavaddat
- Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, Worts Causeway, Cambridge, United Kingdom, CB1 8RN
- * E-mail:
| | - Rianne van der Linde
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, University Forvie Site, Robinson Way, Cambridge, United Kingdom, CB2 0SR
| | - Richard Parker
- Health Services Research Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - George Savva
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom, NR4 7TJ
| | - Ann Louise Kinmonth
- Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, Worts Causeway, Cambridge, United Kingdom, CB1 8RN
| | - Carol Brayne
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, University Forvie Site, Robinson Way, Cambridge, United Kingdom, CB2 0SR
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, Worts Causeway, Cambridge, United Kingdom, CB1 8RN
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Lorem GF, Schirmer H, Emaus N. Health Impact Index. Development and Validation of a Method for Classifying Comorbid Disease Measured against Self-Reported Health. PLoS One 2016; 11:e0148830. [PMID: 26849044 PMCID: PMC4746071 DOI: 10.1371/journal.pone.0148830] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/21/2016] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to develop a method of classifying comorbid conditions that accounts for both the severity and joint effects of the diseases. The Tromsø Study is a cohort study with a longitudinal design utilizing a survey approach with physical examinations in the Tromsø municipality from 1974 to 2008, where in total 40051 subjects participated. We used Tromsø 4 as reference population and the Norwegian Institute of Public Health (FHI) panel as validation population. Ordinal regression was used to assess the effect of comorbid disease on Self-Reported Health (SRH). The model is controlled for interaction between diseases, mental health, age, and gender. The health impact index estimated levels of SRH. The comparison of predicted and observed SRH showed no significant differences. Spearman’s correlation showed that increasing levels of comorbidity were related to lower levels of SRH (RS = -0.36, p <.001). The Charlson Comorbidity Index(CCI) was also associated with SRH (r = -.25, p <.001). When focusing on only individuals with a comorbid disease, the relation between SRH and the Health Impact Index (HII) was strengthened (r = -.42, p <.001), while the association between SRH and CCI was attenuated (r = -.14, p <.001). CCI was designed to control for comorbid conditions when survival/mortality is the outcome of interest but is inaccurate when the outcome is SRH. We conclude that HII should be used when SRH is not available, and well-being or quality of survival/life is the outcome of interest.
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Affiliation(s)
- Geir Fagerjord Lorem
- Department of caring and health science, Faculty of health sciences, The Arctic University of Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of clinical medicine, Faculty of health sciences, The Arctic University of Norway, Tromsø, Norway.,Division of Cardiothoracic and Respiratory Medicine, University Hospital of Northern Norway, Tromsø, Norway
| | - Nina Emaus
- Department of caring and health science, Faculty of health sciences, The Arctic University of Norway, Tromsø, Norway
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Huohvanainen E, Strandberg AY, Stenholm S, Pitkälä KH, Tilvis RS, Strandberg TE. Association of Self-Rated Health in Midlife With Mortality and Old Age Frailty: A 26-Year Follow-Up of Initially Healthy Men. J Gerontol A Biol Sci Med Sci 2016; 71:923-8. [PMID: 26774116 DOI: 10.1093/gerona/glv311] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 12/18/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim was to investigate the relationship between self-rated health (SRH) in healthy midlife, mortality, and frailty in old age. METHODS In 1974, male volunteers for a primary prevention trial in the Helsinki Businessmen Study (mean age 47 years, n = 1,753) reported SRH using a five-step scale (1 = "very good," n = 124; 2 = "fairly good," n = 862; 3 = "average," n = 706; 4 = "fairly poor," or 5 = "very poor"; in the analyses, 4 and 5 were combined as "poor", n = 61). In 2000 (mean age 73 years), the survivors were assessed using a questionnaire including the RAND-36/SF-36 health-related quality of life instrument. Simplified self-reported criteria were used to define phenotypic prefrailty and frailty. Mortality was retrieved from national registers. RESULTS During the 26-year follow-up, 410 men had died. Frailty status was assessed in 81.0% (n = 1,088) of survivors: 434 (39.9%), 552 (50.7%), and 102 (9.4%) were classified as not frail, prefrail, and frail, respectively. With fairly good SRH as reference, and adjusted for cardiovascular risk in midlife and comorbidity in old age, midlife SRH was related to mortality in a J-shaped fashion: significant increase with both very good and poor SRH. In similar analyses, average SRH in midlife (n = 425) was related to prefrailty (odds ratio: 1.52, 95% confidence interval: 1.14-2.04) and poor SRH (n = 31) both to prefrailty (odds ratio: 3.56, 95% confidence interval: 1.16-10.9) and frailty (odds ratio: 8.38, 95% confidence interval: 2.32-30.3) in old age. CONCLUSIONS SRH in clinically healthy midlife among volunteers of a primary prevention trial was related to the development of both prefrailty and frailty in old age, independent of baseline cardiovascular risk and later comorbidity.
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Affiliation(s)
| | - Arto Y Strandberg
- Geriatrics, Helsinki University Central Hospital, University of Helsinki, Finland
| | - Sari Stenholm
- School of Health Sciences, University of Tampere, Finland. Gerontology Research Center, University of Tampere and University of Jyväskylä, Finland. Department of Public Health, University of Turku, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, Unit of Primary Health Care, Helsinki University Central Hospital, University of Helsinki, Finland
| | - Reijo S Tilvis
- Geriatrics, Helsinki University Central Hospital, University of Helsinki, Finland
| | - Timo E Strandberg
- Center for Life Course Health Research, University of Oulu, Finland. Geriatrics, Helsinki University Central Hospital, University of Helsinki, Finland.
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86
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Waller G, Janlert U, Hamberg K, Forssén A. What does age-comparative self-rated health measure? A cross-sectional study from the Northern Sweden MONICA Project. Scand J Public Health 2015; 44:233-9. [PMID: 26644159 DOI: 10.1177/1403494815618554] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/15/2022]
Abstract
AIMS Self-rated health comprehensively accounts for many health domains. Using self-ratings and a knowledge of associations with health domains might help personnel in the health care sector to understand reports of ill health. The aim of this paper was to investigate associations between age-comparative self-rated health and disease, risk factors, emotions and psychosocial factors in a general population. METHODS We based our study on population-based cross-sectional surveys performed in 1999, 2004 and 2009 in northern Sweden. Participants were 25-74 years of age and 5314 of the 7500 people invited completed the survey. Comparative self-rated health was measured on a three-grade ordinal scale by the question 'How would you assess your general health condition compared to persons of your own age?' with the alternatives 'better', 'worse' or 'similar'. The independent variables were sex, age, blood pressure, cholesterol, body mass index, self-reported myocardial infarction, stroke, diabetes, physical activity, smoking, risk of unemployment, satisfaction with economic situation, anxiety and depressive emotions, education and Karasek scale of working conditions. Odds ratios using ordinal regression were calculated. RESULTS Age, sex, stroke, myocardial infarction, diabetes, body mass index, physical activity, economic satisfaction, anxiety and depressive emotions were associated with comparative self-rated health. The risk of unemployment, a tense work situation and educational level were also associated with comparative self-rated health, although they were considerably weaker when adjusted for the the other variables. Anxiety, depressive emotions, low economic satisfaction and a tense work situation were common in the population. CONCLUSIONS Emotions and economic satisfaction were associated with comparative self-rated health as well as some medical variables. Utilization of the knowledge of these associations in health care should be further investigated.
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Affiliation(s)
- Göran Waller
- Department of Public Health and Clinical Medicine, Division of Family Medicine, Umeå University, Umeå, Sweden
| | - Urban Janlert
- Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Katarina Hamberg
- Department of Public Health and Clinical Medicine, Division of Family Medicine, Umeå University, Umeå, Sweden
| | - Annika Forssén
- Department of Public Health and Clinical Medicine, Division of Family Medicine, Umeå University, Umeå, Sweden
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van der Hoeven NV, Niessen MAJ, Stroes ESG, Burdorf L, Kraaijenhagen RA, van den Born BJH. A six question screen to facilitate primary cardiovascular disease prevention. BMC Cardiovasc Disord 2015; 15:140. [PMID: 26518623 PMCID: PMC4628315 DOI: 10.1186/s12872-015-0131-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/20/2015] [Indexed: 01/20/2023] Open
Abstract
Background European guidelines on primary prevention of cardiovascular disease (CVD) recommend the SCORE risk charts for determining CVD risk, which include blood pressure and serum cholesterol as risk parameters. To facilitate cost-effective large-scale screening, we aimed to construct a risk score with ‘non-invasive’ parameters as a first screening step to identify persons at increased CVD risk requiring further risk assessment. Methods We used data of Dutch employees from 25 organisations participating in a health risk assessment between August 2007 and January 2013. Backward multivariate logistic regression analysis was employed to select non-invasive, independent predictors of high CVD risk, defined as the 10-year risk of fatal CVD of ≥5 % based on the SCORE formula. The total CVD risk score was calculated as the summed coefficients of the retained variables. Results Data of 6189 male participants was used for the development and validation of the risk score. Age, tobacco use, history of hypertension, alcohol consumption, BMI, and waist circumference were independent predictors of high CVD risk. Ten-fold cross-validation resulted in an area under the curve of 0.95 (SE 0.01, 95 % confidence interval 0.94–0.96). A cut-off score ≥45 on the CVD risk score yielded a sensitivity of 0.93, and a specificity of 0.85. Conclusions We developed a simple, non-invasive risk score that accurately identifies persons at increased CVD risk according to the SCORE formula in a population of working men. The risk score enables a stepwise approach in large screening programmes, strongly reducing the number of persons that require full risk estimation including blood pressure and cholesterol measures. Electronic supplementary material The online version of this article (doi:10.1186/s12872-015-0131-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Niels V van der Hoeven
- Departments of Internal and Vascular Medicine, Academic Medical Center of the University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands. .,NIPED Research Foundation, Amsterdam, The Netherlands.
| | | | - Erik S G Stroes
- Departments of Internal and Vascular Medicine, Academic Medical Center of the University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Lex Burdorf
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | - Bert-Jan H van den Born
- Departments of Internal and Vascular Medicine, Academic Medical Center of the University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
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Abstract
The research performance of the single-item self-rating In general, would you say your health is: excellent, very good, good, fair, or poor? was evaluated relative to the SF-36 General Health Scale that contains this item, using data for a sample of psychiatric outpatients who had co-occurring chronic physical conditions (N = 177). The scale was more robust than the single-item in cross-sectional validity tests and for predicting 2-year outcomes, but the single-item had stronger discriminant validity as a measure of physical health, especially in post-baseline analyses. Single-item and scale were both sensitive enough to detect change in perceived health over 2 years and a conditional experimental effect on health self-perceptions in a randomized trial. These findings demonstrate that a global single-item can be as valid, reliable, and sensitive as a multi-item scale for longitudinal research purposes, even if the scale performs better in cross-sectional surveys or as a screening measure.
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89
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Macias C, Gold PB, Öngür D, Cohen BM, Panch T. Are Single-Item Global Ratings Useful for Assessing Health Status? J Clin Psychol Med Settings 2015; 22:10.1007/s10880-015-9436-5. [PMID: 26492891 DOI: 10.1007/s10880-015-9436-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The research performance of the single-item self-rating In general, would you say your health is: excellent, very good, good, fair, or poor? was evaluated relative to the SF-36 General Health Scale that contains this item, using data for a sample of psychiatric outpatients who had co-occurring chronic physical conditions (N = 177). The scale was more robust than the single-item in cross-sectional validity tests and for predicting 2-year outcomes, but the single-item had stronger discriminant validity as a measure of physical health, especially in post-baseline analyses. Single-item and scale were both sensitive enough to detect change in perceived health over 2 years and a conditional experimental effect on health self-perceptions in a randomized trial. These findings demonstrate that a global single-item can be as valid, reliable, and sensitive as a multi-item scale for longitudinal research purposes, even if the scale performs better in cross-sectional surveys or as a screening measure.
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Affiliation(s)
- Cathaleene Macias
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
- McLean Hospital, Belmont, MA, USA.
| | - Paul B Gold
- Counseling, Higher Education, and Special Education, University of Maryland at College Park, College Park, USA
| | - Dost Öngür
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA
| | - Bruce M Cohen
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Program for Neuropsychiatric Research, McLean Hospital, Belmont, MA, USA
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90
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Gu D, Zhu H, Brown T, Hoenig H, Zeng Y. Tourism Experiences and Self-Rated Health Among Older Adults in China. J Aging Health 2015; 28:675-703. [PMID: 26486781 DOI: 10.1177/0898264315609906] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate factors associated with tourism experiences, and the association between tourism experiences and subsequent self-rated health. METHOD Multilevel logistic regression models and four waves of panel data from a large nationally representative survey of older adults in China were employed. RESULTS Those who had a tourism experience tended to be younger, men, urban residents, have a higher socioeconomic status (SES), and frequently participate in leisure activities and exercise. However, controlling for SES, women were more likely than men to have a tourism experience. Notably, tourism was negatively associated with poor self-rated health and the association was robust to adjustments for a wide range of confounders. DISCUSSION The net beneficial impact of tourism on self-rated health may operate through several mechanisms such as improvements in tourists' cognitive functioning, healthy lifestyles, self-esteen, family and social relations, and psychological and spirtual well-being. Tourism participation is an effective way to promote healthy aging.
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Affiliation(s)
- Danan Gu
- United Nations Population Division, New York, NY, USA
| | - Haiyan Zhu
- Virginia Polytechnic Institute and State University, Blacksburg, USA
| | | | - Helen Hoenig
- Division of Geriatrics, Department of Medicine, Duke University Medicial Center, Durham, NC, USA Physical Medicine & Rehabilitation Service, Durham Veteran Affairs Medical Center, Durham, NC, USA
| | - Yi Zeng
- Center for the Study of Aging and Human Development and Geriatrics Division, Duke University, Durham, NC, USA National School of Development, Peking University, Beijing, China
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91
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Gotsens M, Malmusi D, Villarroel N, Vives-Cases C, Garcia-Subirats I, Hernando C, Borrell C. Health inequality between immigrants and natives in Spain: the loss of the healthy immigrant effect in times of economic crisis. Eur J Public Health 2015; 25:923-9. [PMID: 26136466 DOI: 10.1093/eurpub/ckv126] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The immigrant population living in Spain grew exponentially in the early 2000s but has been particularly affected by the economic crisis. This study aims to analyse health inequalities between immigrants born in middle- or low-income countries and natives in Spain, in 2006 and 2012, taking into account gender, year of arrival and socioeconomic exposures. METHODS Study of trends using two cross-sections, the 2006 and 2012 editions of the Spanish National Health Survey, including residents in Spain aged 15-64 years (20 810 natives and 2950 immigrants in 2006, 14 291 natives and 2448 immigrants in 2012). Fair/poor self-rated health, poor mental health (GHQ-12 > 2), chronic activity limitation and use of psychotropic drugs were compared between natives and immigrants who arrived in Spain before 2006, adjusting robust Poisson regression models for age and socioeconomic variables to obtain prevalence ratios (PR) and 95% confidence interval (CI). RESULTS Inequalities in poor self-rated health between immigrants and natives tend to increase among women (age-adjusted PR2006 = 1.39; 95% CI: 1.24-1.56, PR2012 = 1.56; 95% CI: 1.33-1.82). Among men, there is a new onset of inequalities in poor mental health (PR2006 = 1.10; 95% CI: 0.86-1.40, PR2012 = 1.34; 95% CI: 1.06-1.69) and an equalization of the previously lower use of psychotropic drugs (PR2006 = 0.22; 95% CI: 0.11-0.43, PR2012 = 1.20; 95% CI: 0.73-2.01). CONCLUSIONS Between 2006 and 2012, immigrants who arrived in Spain before 2006 appeared to worsen their health status when compared with natives. The loss of the healthy immigrant effect in the context of a worse impact of the economic crisis on immigrants appears as potential explanation. Employment, social protection and re-universalization of healthcare would prevent further deterioration of immigrants' health status.
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Affiliation(s)
- Mercè Gotsens
- 1 CIBER Epidemiología y Salud Pública, Spain 2 Agència de Salut Pública de Barcelona, Health Information Systems Unit, Barcelona, Spain 3 Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Davide Malmusi
- 1 CIBER Epidemiología y Salud Pública, Spain 2 Agència de Salut Pública de Barcelona, Health Information Systems Unit, Barcelona, Spain 3 Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | | | - Carmen Vives-Cases
- 1 CIBER Epidemiología y Salud Pública, Spain 4 Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
| | - Irene Garcia-Subirats
- 5 Health Policy and Health Services Research Group, Health Policy Research Unit, Consorci de Salut i Social de Catalunya, Barcelona, Spain
| | - Cristina Hernando
- 1 CIBER Epidemiología y Salud Pública, Spain 6 Centre d'Estudis Epidemiologics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain 7 Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Carme Borrell
- 1 CIBER Epidemiología y Salud Pública, Spain 2 Agència de Salut Pública de Barcelona, Health Information Systems Unit, Barcelona, Spain 3 Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain 8 Universitat Pompeu Fabra, Barcelona, Spain
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Wheeler BW, Lovell R, Higgins SL, White MP, Alcock I, Osborne NJ, Husk K, Sabel CE, Depledge MH. Beyond greenspace: an ecological study of population general health and indicators of natural environment type and quality. Int J Health Geogr 2015; 14:17. [PMID: 25924685 PMCID: PMC4455695 DOI: 10.1186/s12942-015-0009-5] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/30/2015] [Indexed: 11/16/2022] Open
Abstract
Background Many studies suggest that exposure to natural environments (‘greenspace’) enhances human health and wellbeing. Benefits potentially arise via several mechanisms including stress reduction, opportunity and motivation for physical activity, and reduced air pollution exposure. However, the evidence is mixed and sometimes inconclusive. One explanation may be that “greenspace” is typically treated as a homogenous environment type. However, recent research has revealed that different types and qualities of natural environments may influence health and wellbeing to different extents. Methods This ecological study explores this issue further using data on land cover type, bird species richness, water quality and protected or designated status to create small-area environmental indicators across Great Britain. Associations between these indicators and age/sex standardised prevalence of both good and bad health from the 2011 Census were assessed using linear regression models. Models were adjusted for indicators of socio-economic deprivation and rurality, and also investigated effect modification by these contextual characteristics. Results Positive associations were observed between good health prevalence and the density of the greenspace types, “broadleaf woodland”, “arable and horticulture”, “improved grassland”, “saltwater” and “coastal”, after adjusting for potential confounders. Inverse associations with bad health prevalence were observed for the same greenspace types, with the exception of “saltwater”. Land cover diversity and density of protected/designated areas were also associated with good and bad health in the predicted manner. Bird species richness (an indicator of local biodiversity) was only associated with good health prevalence. Surface water quality, an indicator of general local environmental condition, was associated with good and bad health prevalence contrary to the manner expected, with poorer water quality associated with better population health. Effect modification by income deprivation and urban/rural status was observed for several of the indicators. Conclusions The findings indicate that the type, quality and context of ‘greenspace’ should be considered in the assessment of relationships between greenspace and human health and wellbeing. Opportunities exist to further integrate approaches from ecosystem services and public health perspectives to maximise opportunities to inform policies for health and environmental improvement and protection.
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Affiliation(s)
- Benedict W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK.
| | - Rebecca Lovell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK.
| | - Sahran L Higgins
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK.
| | - Mathew P White
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK.
| | - Ian Alcock
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK.
| | - Nicholas J Osborne
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK. .,Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Melbourne, Australia.
| | - Kerryn Husk
- NIHR CLAHRC South West Peninsula (PenCLAHRC), Plymouth University Peninsula Schools of Medicine and Dentistry, N32, ITTC Building, Tamar Science Park, Plymouth, PL6 8BX, UK.
| | - Clive E Sabel
- School of Geographical Sciences, University of Bristol, University Road, Bristol, BS8 1SS, UK.
| | - Michael H Depledge
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD, UK.
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Barry Hultquist T, Laux Kaiser K, Rajaram S. Factors related to self-reported health status in low income midlife women. Women Health 2015; 55:378-99. [PMID: 25758548 DOI: 10.1080/03630242.2015.1022684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Transition throughout midlife can affect women's perception of their health status. Multiple factors are potentially related to self-reported health status (SRHS), but it was not clear what factors are related to SRHS for midlife women, especially those with low income. This study examined factors related to SRHS in low income midlife women over time. A multi-step linear regression of longitudinal Medicaid Managed Care (MMC) data (n = 310) from July 2000 through November 2006 was used. Participants completed SRHS at initial (baseline) enrollment into MMC (T1), with a second assessment completed 11 to 23 months later for those retaining MMC eligibility (T2). Results indicated that disability and number of medical conditions were the factors most related to SRHS. SRHS scores differed significantly between non-disabled and disabled women. For disabled women, SRHS improved significantly between T1 and T2 (p < .001), but not for non-disabled women. Those with lower SRHS scores used community agencies more often. Further studies of SRHS and health-related factors are needed as SRHS is frequently an indicator of population health. Greater evidenced-based knowledge of SRHS in midlife women will inform preventive interventions for this population.
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Affiliation(s)
- Teresa Barry Hultquist
- a Omaha Division, College of Nursing , University of Nebraska Medical Center , Omaha , Nebraska , USA
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94
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Gjesdal S. Helse og dødelighet – to sider av samme sak? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:412. [DOI: 10.4045/tidsskr.15.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Abstract
In search of a better understanding of inequalities in citizen political engagement, scholars have begun addressing the relationship between personal health and patterns of political behavior. This study focuses on the impact of personal health on various forms of political participation. The analysis contributes to existing knowledge by examining a number of different participation forms beyond just voting. Using European Social Survey data from 2012/2013 for Denmark, Finland, Iceland, Norway and Sweden (N = 8,060), self-reported turnout and six alternative modes of political engagement were modeled as dependent variables. Contrary to expectations, poor health did not depress participation across all forms. As assumed by the increased activism hypothesis, all else equal, people with poor health were more active than their healthy counterparts in direct contacts with power holders and demonstrations. The results reveal a "reversed health gap" by showing that people with health problems are in fact more politically active than what previous research, which has focused on voting, has suggested. Although the magnitude of the gap should not be overdramatized, our results stress the importance of distinguishing between different forms of participation when analyzing the impact of health on political engagement. Nevertheless, the findings show that poor health can stimulate people into political engagement rather than depressing activity. This finding holds when the effects of several sociodemographic and motivational factors are controlled for.
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96
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Levinson D, Kaplan G. What does Self Rated Mental Health Represent. J Public Health Res 2014; 3:287. [PMID: 25553310 PMCID: PMC4274494 DOI: 10.4081/jphr.2014.287] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 11/21/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Unlike the widely used self rated health, the self rated mental health was found unsuitable as a proxy for mental illness. This paper analyses the relationships between the self ratings of physical health, mental health and overall health, and their association of with the objective indicators for physical and mental health. DESIGN AND METHODS The study is a secondary analysis of data from a nationwide representative sample of the non-institutionalized adult residents of Israel in 2003 that was collected via computer-assisted personal interview methods [n=4859]. RESULTS The self rated physical health and the self rated mental health were strongly related to each other yet the self rated mental health was not related to chronic physical conditions and the self rated physical health was not related to mental disorders. In a multiple logistic regression analysis, those with positive self rated mental health had 93 times the odds of reporting positive overall health whereas those with positive self rated physical health had 40 times the odds of reporting positive overall health. CONCLUSIONS The self rating of mental health presents a qualitatively different dimension from mental illness. The self rated mental health is two times more important than the self rated physical health in predicting the self rated overall health Significance for public healthThe present study is an original study on the self rated physical, mental and overall health measures. Because of the wide range of associations with other health indicators, and the simplicity with which they are collected, self-rated health measures are widely used in large population surveys.The present study questions the automatic assumption that the self rated mental health functions as a proxy measure of psychiatric morbidity, and suggests that the self rated mental health is more closely related to subjective well-being. The results show that self rated mental health predicts self rated general health better than self rated physical health.
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Affiliation(s)
| | - Giora Kaplan
- Certner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Israel
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Abraham CM, Obremskey WT, Song Y, Jackson JC, Ely EW, Archer KR. Hospital Delirium and Psychological Distress at 1 Year and Health-Related Quality of Life After Moderate-to-Severe Traumatic Injury Without Intracranial Hemorrhage. Arch Phys Med Rehabil 2014; 95:2382-9. [DOI: 10.1016/j.apmr.2014.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/02/2014] [Accepted: 08/02/2014] [Indexed: 11/27/2022]
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Mavaddat N, Valderas JM, van der Linde R, Khaw KT, Kinmonth AL. Association of self-rated health with multimorbidity, chronic disease and psychosocial factors in a large middle-aged and older cohort from general practice: a cross-sectional study. BMC FAMILY PRACTICE 2014; 15:185. [PMID: 25421440 PMCID: PMC4245775 DOI: 10.1186/s12875-014-0185-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 10/28/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND The prevalence of coexisting chronic conditions (multimorbidity) is rising. Disease labels, however, give little information about impact on subjective health and personal illness experience. We aim to examine the strength of association of single and multimorbid physical chronic diseases with self-rated health in a middle-aged and older population in England, and to determine whether any association is mediated by depression and other psychosocial factors. METHODS 25 268 individuals aged 39 to 79 years recruited from general practice registers in the European Prospective Investigation of Cancer (EPIC-Norfolk) study, completed a survey including self-rated health, psychosocial function and presence of common physical chronic conditions (cancer, stroke, heart attack, diabetes, asthma/bronchitis and arthritis). Logistic regression models determined odds of "moderate/poor" compared to "good/excellent" health by condition and number of conditions adjusting for psychosocial measures. RESULTS One-third (8252) reported one, around 7.5% (1899) two, and around 1% (194) three or more conditions. Odds of "moderate/poor" self-rated health worsened with increasing number of conditions (one (OR = 1.3(1.2-1.4)) versus three or more (OR = 3.4(2.3-5.1)), and were highest where there was comorbidity with stroke (OR = 8.7(4.6-16.7)) or heart attack (OR = 8.5(5.3-13.6)). Psychosocial measures did not explain the association between chronic diseases and multimorbidity with self-rated health.The relationship of multimorbidity with self-rated health was particularly strong in men compared to women (three or more conditions: men (OR = 5.2(3.0-8.9)), women OR = 2.1(1.1-3.9)). CONCLUSIONS Self-rated health provides a simple, integrative patient-centred assessment for evaluation of illness in the context of multiple chronic disease diagnoses. Those registering in general practice in particular men with three or more diseases or those with cardiovascular comorbidities and with poorer self-rated health may warrant further assessment and intervention to improve their physical and subjective health.
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Affiliation(s)
- Nahal Mavaddat
- Primary Care Unit, Department of Public Health and Primary Care, Strangeways Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK.
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Individualized and institutionalized residential place-based discrimination and self-rated health: a cross-sectional study of the working-age general population in Osaka city, Japan. BMC Public Health 2014; 14:449. [PMID: 24885239 PMCID: PMC4046154 DOI: 10.1186/1471-2458-14-449] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 05/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies have reported that individualized residential place-based discrimination (PBD) affects residents' health. However, studies exploring the association between institutionalized PBD and health are scarce, especially in Asian countries including Japan. METHODS A cross-sectional study was conducted with random two-stage sampling of 6191 adults aged 25-64 years in 100 census tracts across Osaka city in 2011. Of 3244 respondents (response rate 52.4%), 2963 were analyzed using multilevel logistic regression to examine the association of both individualized and institutionalized PBD with self-rated health (SRH) after adjustment for individual-level factors such as socioeconomic status (SES). An area-level PBD indicator was created by aggregating individual-level PBD responses in each tract, representing a proxy for institutionalized PBD, i.e., the concept that living in a stigmatized neighborhood affects neighborhood health. 100 tracts were divided into quartiles in order. The health impact of area-level PBD was compared with that of area-level SES indicators (quartile) such as deprivation. RESULTS After adjustment for individual-level PBD, the highest and third area-level PBD quartiles showed odds ratio (OR) 1.57 (95% credible interval: 1.13-2.18) and 1.38 (0.99-1.92), respectively, for poor SRH compared with the lowest area-level PBD quartile. In a further SES-adjusted model, ORs of area-level PBD (highest and third quartile) were attenuated to 1.32 and 1.31, respectively, but remained marginally significant, although those of the highest area-level not-home-owner (census-based indicator) and deprivation index quartiles were attenuated to 1.26 and 1.21, respectively, and not significant. Individual-level PBD showed significant OR 1.89 (1.33-2.81) for poor SRH in an age, sex, PBD and SES-adjusted model. CONCLUSION Institutionalized PBD may be a more important environmental determinant of SRH than other area-level SES indicators such as deprivation. Although it may have a smaller health impact than individualized PBD, attention should be paid to invisible and unconscious aspects of institutionalized PBD to improve residents' health.
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Chandwani KD, Heckler CE, Mohile SG, Mustian KM, Janelsins M, Peppone LJ, Bushunow P, Flynn PJ, Morrow GR. Hot flashes severity, complementary and alternative medicine use, and self-rated health in women with breast cancer. Explore (NY) 2014; 10:241-7. [PMID: 25037667 DOI: 10.1016/j.explore.2014.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Indexed: 11/12/2022]
Abstract
CONTEXT Hot flashes (HF) are a common distressing symptom in women with breast cancer (BC). Current pharmacologic options are moderately effective and are associated with bothersome side effects. Complementary and alternative medicine is commonly used by cancer patients. However, information on the association of hot flashes severity with such use and self-rated health is lacking. OBJECTIVE To examine the hot flashes severity in women with breast cancer and its association with complementary and alternative medicine use and self-rated health (SRH). DESIGN Longitudinal multicenter study to assess information needs of cancer outpatients. PARTICIPANTS Patients with a diagnosis of breast cancer who were scheduled to undergo chemotherapy and/or radiotherapy. OUTCOME MEASURES Hot flashes severity (0 = not present and 10 = as bad as you can imagine), use of complementary and alternative medicine (yes/no), and self-rating of health (SRH) status post-treatment and six-months thereafter (1-5, higher score = better SRH). RESULTS The majority of women with HF (mean age = 54.4 years) were Caucasian and married, with higher education, and 93% had received surgical treatment for BC. At the end of treatment, 79% women reported experiencing HF [mean severity = 5.87, standard deviation (SD) = 2.9]; significantly more severe HF were reported by younger women with poor SRH, poor performance status, and those reporting doing spiritual practices. At follow-up, 73% had HF (mean severity = 4.86, SD = 3.0), and more severe HF were reported by younger women with poor self-rated health who had undergone chemotherapy plus radiotherapy, used vitamins, and did not exercise. CONCLUSIONS A high percentage of women experienced hot flashes at the end of treatment and at six-month follow-up. A significant association of hot flashes severity with spiritual practice, increased vitamin use, and reduced exercise emphasize the need for future studies to confirm the results. This can facilitate safe use of complementary and alternative medicine and favorable outcomes while managing cancer-related hot flashes.
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Affiliation(s)
- Kavita D Chandwani
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY.
| | - Charles E Heckler
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | - Supriya G Mohile
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | - Karen M Mustian
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | - Michelle Janelsins
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | - Luke J Peppone
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | | | | | - Gary R Morrow
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
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