Self-rated health in different social classes of Slovenian adult population: nationwide cross-sectional study

Risk factors associated with surveillance loss after endoscopic submucosal dissection in patients with gastric neoplasm

Background

After endoscopic submucosal dissection of gastric neoplasms, surveillance endoscopy is required for patients with synchronous or metachronous neoplasms. We aimed to evaluate the risk factors associated with surveillance loss in patients who underwent endoscopic submucosal dissection.

Methods

Ninety-five patients treated with endoscopic submucosal dissection for gastric neoplasms between May 2015 and June 2016 were retrospectively reviewed. Clinicopathologic factors, sociodemographic factors, psychiatric measures, and associated risk factors for surveillance loss were evaluated. The chi-square or Fisher exact test, t-test, and logistic regression analysis were used in data analysis.

Results

Twenty-five (26.3%) patients were identified as having surveillance loss. Compared to the surveillance group, the surveillance loss group was old and had dysplasia, and a healthy American Society of Anesthesiologists physical status. Similarly, surveillance loss was related to low symptom perception, low incidence of alexithymia, mindful awareness, and high trait forgiveness. Logistic regression analysis showed that dysplasia (odds ratio, 15.23; 95% CI, 1.56-149.09, P=0.019), old age (odds ratio, 7.14; 95% CI, 1.90-26.88, P=0.004), and American Society of Anesthesiologists physical status 1 (odds ratio, 3.99; 95% CI, 1.09-14.60, P=0.037) were associated with surveillance loss.

Conclusions

Dysplasia, old age, and the American Society of Anesthesiologists physical status 1 were associated with surveillance loss in patients who underwent gastric endoscopic submucosal dissection. It could be helpful to proactively monitor patients with such conditions after gastric endoscopic submucosal dissection.

Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): socio-occupational class as an effect modifier for the relationship between adiposity measures and self-rated health

BACKGROUND

Little is known about the role of social class in the association between adiposity measures and self-rated health, and several studies have evaluated its influence as a confounder. The aim of the study is to investigate whether social class is an effect modifier in the association between adiposity measures and self-rated health in participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

METHOD

Cross-sectional design, including 6453 men and 7686 women. Body mass index (kg/m2) and waist circumference (cms) were assessed. Self-rated health was categorized as good, fair and poor. Socio-occupational class was based on the participants' occupation, education and per capita income. Multicovariate ordinal logistic model was used to evaluate the association between adiposity measures and self-rated health.

RESULTS

For women, the low and medium socio-occupational class effects were higher for those with waist circumference between 80 and 88 cm or overweight. For men, the low and medium socio-occupational class effects were higher for those with adequate waist circumference or normal body mass index.

CONCLUSIONS

Social class is an effect modifier in the association between body mass index or waist circumference and self-rated health.

Assessment of the association between dentate status and self-rated general health

OBJECTIVE

Aiming at preparing the basis for evidence-based dental public health policy making in Slovenia, the objective of the study was to assess the strength of association between oral health status measured by the number of missing teeth and self-rated health (SRH).

METHODS

The study was designed as a pooled individual-level data study from four national cross-sectional studies carried out in the period 2001-2012, based on CINDI Health Monitor methodology. Altogether, 34,412 participants were included. A logistic regression model with poor SRH as observed outcome and the number of teeth as explanatory factor (adjusted for selected biologic, socio-economic and health factors) was proposed.

RESULTS

In the sample, women represented 55.7% and men 44.3%, median age was 45 years. Persons with more missing teeth more likely rated their health as poor. The association was persistent even when different confounding variables were included in the model. In the group with 1-5 missing teeth, in comparison to the group with none missing teeth, OR was 1.23 (p=0.049), whereas for the group with 6-10 missing teeth, OR was 1.32 (p=0.019); for the group with >10 missing teeth, but not all, OR was 1.77 (p<0.001), and for the group with all missing teeth, OR was 2.19 (p<0.001).

CONCLUSIONS

Study results showed clear association of SRH with dentate status, which confirms the oral-general health connection. This indicates the need for the development of proper dental public health policies for better oral health, and presents a new view on the importance of preserving teeth.

Health-related Quality of Life Assessed by the EORTC QLQ-C30 Questionnaire in the General Slovenian Population

Background

The aim of our study was to obtain reference data of the EORTC QLQ-C30 quality of life dimensions for the general Slovenian population. We intend to provide the researchers and clinicians in our country with the expected mean health-related quality of life (HRQL) scores for distinctive socio-demographic population groups.

Methods

The EORTC QLQ-C30 questionnaire supplemented by a socio-demographic inquiry was mailed or distributed to 1,685 randomly selected individuals in the Slovenian population aged 18 – 90. Answers from 1,231 subjects representing socio-demographic diversity of the Slovenian population were collected and transformed into EORTC dimensions and symptoms. The impact of socio-demographic features on HRQL scores was assessed by multiple linear regression models.

Results

Gender, age and self-rated social class are the important confounders in the quality of life scores in our population. Men reported better quality of life on the majority of the specific scales and, at the same time, reported fewer symptoms. There was no gender-specific difference in cognitive functioning. The mean scores were consistently lower with age in both sexes.

Conclusions

This is the first study to report the normative EORTC QLQ-C30 scores for one of the south-eastern European populations. The reported expected mean scores allow Slovenian oncologists to estimate what the quality of life in cancer patients would be, had they not been ill. As they are derived by common methodology, our results can easily be included in any further international comparisons or in the calculation of European summarized HRQL scores.

Do Factors Associated Self-rated Good Health and Their Influences Differ between Males and Females across Different Age Groups in Korean and Australia?

OBJECTIVES

This was a comparative study between Australia and Korea that investigated whether and to what extent factors related to self-rated good health (SRGH) differ by gender among age groups.

METHODS

This study was a secondary analysis of data that were collected in nationally representative, cross-sectional, and population-based surveys. We analyzed Australian and Korean participants > 20 years of age using 2011 data from the Australian National Nutritional Physical Activity Survey (n = 9,276) and the Korean National Health and Nutritional Examination Survey (n = 5,915). Analyses were based on multiple logistic regression after controlling for covariates.

RESULTS

Factors associated with SRGH and the extent of their influence differed by gender among age groups within each nation. Australian SRGH was associated with more factors than Korean SRGH, except in participants > 65 years old. Many differences among adults aged 20-44 years were observed, particularly with regard to the influence of socioeconomic factors. Living with a spouse only influenced SRGH in men 20-44 years old in both countries, negatively for Korean men and positively for Australian men. In this same age group, SRGH was positively influenced by employment and attainment of a higher education level in Australian men but not among Korean men; among women, income, but not education, affected SRGH in Korea, whereas in Australia, women were more influenced by education than by income. Lack of chronic disease had a strong influence on SRGH in both countries and was influential in all Australians and Koreans except those ≥ 65 years old.

CONCLUSION

Broad features of society should be considered when discussing health and differences in associated factors and their influences. For focused public health interventions of population groups, it is also necessary to consider gender and age groups within social environments.

Did past economic prosperity affect the health related quality of life predictors? A longitudinal study on a representative sample of Slovenian family medicine patients

Background

Health related quality of life (HRQOL) as an important measure of medical outcomes has been shown to be associated with demographic factors and the most common mental and chronic somatic diseases. This study’s aim was to identify factors predicting changes in HRQOL over a follow-up period in a representative sample of Slovenian family medicine patients.

Methods

In a longitudinal multi-centred study between 2003 and 2005, data were collected from 1118 consecutive attendees from 60 family medicine practices in Slovenia on quality of life, socio-demographic factors and the presence of mental disorders, with follow-up after 6 and 24 months. Retrospective information on chronic diseases was obtained from patients` health records. In three time-sequential multiple linear regression models, data on 601 patients (53.8%) was analysed to determine factors associated with each component score of quality of life.

Results

At baseline the patients were 48.58 (SE = 0.58) years of age, over half were women (386 (64.2%)) and most were Slovenian (548 (91.2%)). Quality of life was seen to improve over the two-year period. Factors significantly and consistently associated with a better mental component score of quality of life were social support, satisfactory circumstances in patients` household and absence of anxiety. Major life events in the past year and depression were shown to be risk factors for mental and physical components, while level of education, absence of long-term disability and chronic pain were identified as predictors of the physical component.

Conclusions

Detection and successful treatment of depression and anxiety has a potential to lead to improved quality of life in family medicine attendees; family physicians should be alert for the early onset of these conditions, knowing that symptoms of chronic pain, depression and anxiety often overlap in patients. Poorly educated patients and those lacking social support and/or satisfactory household circumstances should be recognised and empowered, and appropriate coping mechanisms should be introduced.

Thirty years of gender differences in self-assessed health: the case of Slovenia / Trideset let razlik v samoocenah zdravja med spoloma: primer Slovenije

Background: This article explores gender trends in self-rated health in Slovenia over the period of thirty years. The main research goals are to examine the associations between gender, social class and health, establish the extent that the patterns of subjective health converge with those in other countries and identify the most vulnerable health groups.

Methods: The study is based on six waves of the Slovenian Public Opinion survey carried out between 1981 and 2012 on representative samples of the adult Slovenian population. The main dependent variables are the respondent’s self-assessed health and three indicators of psychosomatic health - experiences of insomnia, irregular heartbeat and anxiety. The main independent variables are gender and socio-economic status. The relationship between them was examined using Chi-square tests.

Results: The 30 year trend is consistent with prior studies, which found that women report poorer self-assessed health than men. In Slovenia, this gender gap was observed in both social classes, but was more pronounced for women in the lower educated category. The higher prevalence of stress symptoms among women supports the theory of chronic exhaustion resulting from the dual-role strain.

Conclusions: In Slovenia the welfare state was able to buffer the adverse effects of increased economic stresses to a significant extent after 1991, resulting in favourable health outcomes for both genders. Dismantling these arrangements may result in short-term financial gains but is likely to trigger long-lasting negative consequences for public health, especially in the case of vulnerable groups such as women.

Reliability of the MacArthur scale of subjective social status - Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Background

The MacArthur Scale of Subjective Social Status intend to measure the subjective social status using a numbered stepladder image. This study investigated the reliability of the MacArthur scale in a subsample of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Method

Three scales were employed using different references: 1) the overall socioeconomic position; 2) the socioeconomic situation of the participant’s closer community; 3) the workplace as a whole. A total of 245 of the ELSA participants from six states were involved. They were interviewed twice by the same person within an interval of seven to fourteen days. The reliability of the scale was assessed with weighted Kappa statistics and intraclass correlation coefficient (ICC), with their respective 95% confidence interval (CI).

Results

Kappa values were 0.62(0.58 to 0.64) for the society ladder; 0.58(0.56 to 0.61) for the community-related ladder; and 0.67(0.66 to 0.72) for the work-related ladder. The ICC ranged from 0.75 for the work ladder to 0.64 for the community ladder. These values differed slightly according to the participants’ age, sex and education category.

Conclusion

The three ladders showed good stability in the test-retest, except the community ladder that showed moderate stability. Because the social structure in Brazil is rapidly changing, future qualitative and longitudinal studies are needed to confirm and understand the construct underlying the MacArthur Scale in the country.

Socioeconomic inequalities, health damaging behavior, and self-perceived health in Serbia: a cross-sectional study

Aim

To analyze the association of socioeconomic factors with self-perceived health in Serbia and examine whether this association can be partly explained by health behavior variables.

Methods

We used data from the 2007 Living Standards Measurement Study for Serbia. A representative sample of 13 831 persons aged ≥20 years was interviewed. The associations between demographic factors (age, sex, marital status, and type of settlement), socioeconomic factors (education, employment status, and household consumption tertiles), and health behavior variables (smoking, alcohol consumption) and self-perceived health were examined using logistic regression analyses.

Results

A stepwise gradient was found between education and self-perceived health for the total sample, men, and women. Compared to people with high education, people with low education had a 4.5 times higher chance of assessing their health as poor. Unemployed (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.29-2.10), inactive (OR, 2.82; 95% CI, 2.49-3.19), and the most deprived respondents (OR, 1.17; 95% CI, 1.02-1.34) were more likely to report poor self-perceived health than employed persons and the most affluent group. After adjustment for demographic and health behavior variables, the magnitudes of all associations decreased but remained clearly and significantly graded.

Conclusions

This study revealed inequalities in self-perceived health by socioeconomic position, in particular educational and employment status. The reduction of such inequalities through wisely tailored interventions that benefit people’s health should be a target of a national health policy in Serbia.