1
|
Zhao Q, Deng Y. Education and income are associated with long-term outcome in the metabolic dysfunction-associated steatotic liver disease population. Geriatr Gerontol Int 2023; 23:975-976. [PMID: 37905692 DOI: 10.1111/ggi.14719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/07/2023] [Accepted: 10/13/2023] [Indexed: 11/02/2023]
Affiliation(s)
- Qianwen Zhao
- Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Yunlei Deng
- Department of Nephrology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| |
Collapse
|
2
|
Purbey A, Nambiar A, Roy Choudhury D, Vennam T, Balani K, Agnihotri SB. Stillbirth rates and its spatial patterns in India: an exploration of HMIS data. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 9:100116. [PMID: 37383033 PMCID: PMC10306056 DOI: 10.1016/j.lansea.2022.100116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/01/2022] [Accepted: 11/04/2022] [Indexed: 06/30/2023]
Abstract
Background High prevalence of stillbirths is a significant concern for the health system of India. This necessitates a closer scrutiny of the prevalence, spatial pattern and the risk factors of stillbirth at both national and local level. Methods We analysed stillbirth data of three financial years (April 2017-March 2020) from Health Management Information System (HMIS) of India which provides majorly public facility level data for stillbirths up to the district level on a monthly basis. National and state level prevalence of stillbirth rate (SBR) were estimated. Spatial patterns of SBR at district level was identified using local indicator of spatial association (LISA). Risk factors of stillbirths were studied by triangulation of HMIS and National Family Health Survey (NFHS-4) data using bivariate LISA. Findings National average of SBR in 2017-18, 2018-2019 and 2019-2020 are 13.4 [4.2-24.2], 13.1 [4.2-22.2] and 12.4 [3.7-22.5] respectively. Districts of Odisha, Madhya Pradesh, Rajasthan and Chhattisgarh (OMRC) form a contiguous east-west belt of high SBR. Body mass index (BMI) of the mother, antenatal care (ANC), maternal anemia, iron-folic acid (IFA) supplementation and institutional delivery show significant spatial autocorrelation with SBR. Interpretation Maternal and child health programme delivery should prioritise targeted intervention in the hotspot clusters of high SBR, considering the locally significant determinants. The findings show inter alia, the need to focus on ANC to reduce stillbirth in India. Funding The study is not funded.
Collapse
Affiliation(s)
| | - Apoorva Nambiar
- CTARA, IIT-B Monash Research Academy, Mumbai, Maharashtra, India
| | | | | | - Khushboo Balani
- Ashank Desai Centre for Policy Studies, IIT-B, Mumbai, Maharashtra, India
| | | |
Collapse
|
3
|
Aliyas Z. Physical, mental, and physiological health benefits of green and blue outdoor spaces among elderly people. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2021; 31:703-714. [PMID: 31625761 DOI: 10.1080/09603123.2019.1681379] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/13/2019] [Indexed: 06/10/2023]
Abstract
This study investigated the influence of designed natural outdoor spaces and space type on the physical, mental, and physiological health status of elderlies. A total of 978 questionnaires were distributed among a population-based randomized sample of elderlies residing in Bandar Abbas city, Iran. Blue space users reported better health status. Park access was associated with physical and physiological health. Those participants who had cardiovascular diseases were more likely to visit the parks more often, while the people with hypertension visited the parks less often. Length of park stay positively was associated with all aspects of health status. In addition, the level of physical activity positively was associated with physical and mental health. The park organizations should work on establishing parks in shorter distances and consider the opportunity for elderlies to participate in social programs to encourage them to frequently visit the parks and increase their length of park stay.
Collapse
Affiliation(s)
- Zeinab Aliyas
- Department of Architecture, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, Iran
- Young Researchers and Elite Club, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, Iran
| |
Collapse
|
4
|
Zou M, Guo D, Chen A, Young CA, Li Y, Zheng D, Jin G. Prevalence of visual impairment among older Chinese population: A systematic review and meta-analysis. J Glob Health 2021; 11:08004. [PMID: 33981412 PMCID: PMC8088771 DOI: 10.7189/jogh.11.08004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background To evaluate the prevalence of visual impairment (VI) among elderly Chinese population. Methods All population-based studies on VI prevalence among elderly Chinese populations were searched and only studies with clear definitions of diagnosis were selected. Meta-analysis methods were used to estimate the pooled prevalence and its 95% confidence interval (95%CI) of moderate and severe visual impairment (MSVI) and blindness both by presenting visual acuity (PVA) and best corrected visual acuity (BCVA). Subgroup analysis of gender, district, geographical location, age, education level and examined year were also conducted. Results 72 studies with 465 039 individuals were included and analyzed. Using PVA, the pooled prevalence of MSVI is 10.9% (95% CI = 9.4%-12.6%) and blindness is 2.2% (95% CI = 1.8%-2.8%), while prevalence of MSVI and blindness by BCVA was 5.4% (95% CI = 4.6%-6.2%) and 2.2% (95% CI = 1.9%-2.5%), respectively. Females, rural residents, older age and lower educational level were risk factors for MSVI and blindness. Conclusions VI causes a great health burden among Chinese populations, particularly affecting female subjects, subjects dwelling in rural area, older subjects and subjects with lower educational level.
Collapse
Affiliation(s)
- Minjie Zou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Dongwei Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Aiming Chen
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Charlotte Aimee Young
- Department of Ophthalmology, Third Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China
| | - Yi Li
- Department of Applied Biology and Chemical Technology, Hong Kong Polytechnic University, Hongkong, China
| | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
5
|
Borg M, Løkke A, Hilberg O. Geographical and socioeconomic differences in compliance with and access to allergen immunotherapy in Denmark: A nationwide registry-based study - 1998-2016. Respir Med 2021; 178:106332. [PMID: 33588210 DOI: 10.1016/j.rmed.2021.106332] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Allergen immunotherapy (AIT) is a cost-effective treatment option in moderate-severe allergic rhino-conjunctivitis. Inequality in access to AIT and variation in compliance related to socioeconomic status or geographical location have not been described previously. OBJECTIVE The aim of the study was to evaluate access to grass pollen AIT at various educational attainment levels in the five regions of Denmark. Furthermore, grass pollen AIT treatment compliance was evaluated with respect to age, educational attainment and geographical area. METHODS The unique civil registration number of every citizen in Denmark was combined with the nationwide Danish National Health Service Prescription Database and Statistics Denmark Database to extract age, gender, residence and educational attainment of every citizen who collected prescribed AIT medication from 1998 to 2016. Then, compliance and use of AIT were calculated with respect to age, geographical location and educational attainment. RESULTS The use of subcutaneous AIT (SCIT) was significantly higher in the Capital Region; this difference was less predominant for sublingual AIT (SLIT). People who were educated only to primary school or vocational training levels were less frequent users of AIT. Compliance was especially low in the Capital Region and among people educated only to primary school level. In the age groups, compliance was similar, apart from SLIT users aged 0-9, for whom compliance was higher. CONCLUSION This nationwide study finds that SLIT has the potential to reduce inequality in access to AIT. A focus intervention is needed to facilitate access to and compliance with AIT in groups with lower socioeconomic status.
Collapse
Affiliation(s)
- Morten Borg
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - Anders Løkke
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
| |
Collapse
|
6
|
Yang T. Association between perceived environmental pollution and health among urban and rural residents-a Chinese national study. BMC Public Health 2020; 20:194. [PMID: 32028903 PMCID: PMC7006119 DOI: 10.1186/s12889-020-8204-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/13/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND China's economic boom has led to severe environmental pollution, which has created significant health risks for residents. Although current studies have found urban residents can sense the harmful effects of environmental pollution in China, few studies have talked about their rural counterparts' attitudes towards the health impacts of environmental pollution. Similarly, little research has talked about the inequality of environmental awareness between urban and rural residents. METHODS Descriptive and analytical statistics were used for the data analyses based on a national survey, namely, The 3rd Survey on the Status of Chinese Women in 2010, which was jointly conducted by the All China Women's Federation and the China Statistical Bureau in 2010. A total of 24741observations were selected. RESULTS Among urban residents, 67.21% reported that their total health was good, which was 1.35% lower than the reported rate of their rural counterparts; 25.88% of urban residents reported that their total health was general, which was nearly 3% higher than the reported rate of their rural counterparts; 6.91% of urban residents reported that their total health was poor, which was 1.63% lower than the reported rate of their rural counterparts. The study also found that the rates of urban residents who perceived air pollution (35.67%), water pollution (17.96%), garbage pollution (25.05%), and noise pollution (32.05%) were higher than those of their rural counterparts. Perceived air pollution, and perceived noise pollution both had a negative effect on urban residents' good health (B = - 0.14, p < 0.05; B = -0.23, p < 0.001). Perceived garbage pollution had a positive effect on urban residents' poor health (B = 0.33, p < 0.01). Perceived water pollution had no significant effect on urban residents' health. The four types of perceived environmental pollution all had insignificant effects on rural residents' health. CONCLUSIONS Rural residents lack awareness of the impacts of environmental pollution on health, which may create risks and vulnerability within the rural environment and the livelihood of these residents. Great attention should be paid to the impacts of environmental pollution on the health of not only urban residents but also rural residents, which will highly improve the support of green development among the public in China.
Collapse
Affiliation(s)
- Ting Yang
- School of Sociology, Huazhong University of Science & Technology, 1037 Luoyu Road, Wuchang, Wuhan, 430074, China.
| |
Collapse
|
7
|
Gumà J, Spijker J. Are partner's features important to understand health at older ages? The Spanish case. GACETA SANITARIA 2019; 35:193-198. [PMID: 31530484 DOI: 10.1016/j.gaceta.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyse health differences among partnered individuals in Spain aged 65-81 considering their combined (education of both partners and age gap) and household (economic capacity of the household) characteristics. METHOD A cross-sectional study of the 2015 Spanish sample of the European Union Statistics on Income and Living Conditions survey (EU-SILC) on partnered individuals aged 65-81 years (N=1787). Using logistic regression models separately for women and men we obtained odds and predicted probabilities of having less than good health (95% confidence intervals) according to combined information from both partners on education and age, the household's economic capacity and partner's health status. RESULTS Probabilities of not having good health are significantly less among lower educated women whose partners are more highly educated (compared to both partners being lower educated) and among women whose partner is younger or has good health status. The latter also applies to men. Living in a household without economic difficulties also favours health (both sexes). CONCLUSIONS For both sexes a partner's health status is the variable that shows the largest effect on elderly partnered Spanish people's health but women's health appears to be more sensitive to their partner's educational attainment and the household's economic situation.
Collapse
Affiliation(s)
- Jordi Gumà
- Department of Political and Social Sciences and Expertise Centre for Survey Methodology, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Jeroen Spijker
- Centre d'Estudis Demogràfics, Bellaterra (Barcelona), Spain
| |
Collapse
|
8
|
Permanyer I, Spijker J, Blanes A, Renteria E. Longevity and Lifespan Variation by Educational Attainment in Spain: 1960-2015. Demography 2019; 55:2045-2070. [PMID: 30324395 DOI: 10.1007/s13524-018-0718-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
For a long time, studies of socioeconomic gradients in health have limited their attention to between-group comparisons. Yet, ignoring the differences that might exist within groups and focusing on group-specific life expectancy levels and trends alone, one might arrive at overly simplistic conclusions. Using data from the Spanish Encuesta Sociodemográfica and recently released mortality files by the Spanish Statistical Office (INE), this is the first study to simultaneously document (1) the gradient in life expectancy by educational attainment groups, and (2) the inequality in age-at-death distributions within and across those groups for the period between 1960 and 2015 in Spain. Our findings suggest that life expectancy has been increasing for all education groups but particularly among the highly educated. We observe diverging trends in life expectancy, with the differences between the low- and highly educated becoming increasingly large, particularly among men. Concomitantly with increasing disparities across groups, length-of-life inequality has decreased for the population as a whole and for most education groups, and the contribution of the between-group component of inequality to overall inequality has been extremely small. Even if between-group inequality has increased over time, its contribution has been too small to have sizable effects on overall inequality. In addition, our results suggest that education expansion and declining within-group variability might have been the main drivers of overall lifespan inequality reductions. Nevertheless, the diverging trends in longevity and lifespan inequality across education groups represent an important phenomenon whose underlying causes and potential implications should be investigated in detail.
Collapse
Affiliation(s)
- Iñaki Permanyer
- Centre d'Estudis Demogràfics, Carrer de Ca n'Altayó, Edifici E-2, Campus de la UAB, 08193, Cerdanyola del Vallès, Spain.
| | - Jeroen Spijker
- Centre d'Estudis Demogràfics, Carrer de Ca n'Altayó, Edifici E-2, Campus de la UAB, 08193, Cerdanyola del Vallès, Spain
| | - Amand Blanes
- Centre d'Estudis Demogràfics, Carrer de Ca n'Altayó, Edifici E-2, Campus de la UAB, 08193, Cerdanyola del Vallès, Spain
| | - Elisenda Renteria
- Centre d'Estudis Demogràfics, Carrer de Ca n'Altayó, Edifici E-2, Campus de la UAB, 08193, Cerdanyola del Vallès, Spain
| |
Collapse
|
9
|
Permanyer I, Scholl N. Global trends in lifespan inequality: 1950-2015. PLoS One 2019; 14:e0215742. [PMID: 31048892 PMCID: PMC6497240 DOI: 10.1371/journal.pone.0215742] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/08/2019] [Indexed: 11/23/2022] Open
Abstract
Using data from the UN World Population Prospects, we document global trends in lifespan inequality from 1950 until 2015. Our findings indicate that (i) there has been a sustained decline in overall lifespan inequality, (ii) adult lifespan variability has also declined, but some plateaus and trend reversals have been identified, (iii) lifespan inequality among the elderly has increased virtually everywhere, and (iv) most of the world variability in age-at-death can be attributed to within-country variability. Such changes have occurred against a backdrop of generalized longevity increases. Our analyses suggest that the world is facing a new challenge: the emergence of diverging trends in longevity and age-at-death inequality among the elderly around the globe-particularly in high-income areas. As larger fractions of the world population survive to more advanced ages, it will be necessary for national and international health planners to recognize the growing heterogeneity that characterizes older populations.
Collapse
Affiliation(s)
- Iñaki Permanyer
- Centre d’Estudis Demogràfics (a member of the CERCA Programme / Generalitat de Catalunya), Cerdanyola del Vallès, Barcelona, Spain
| | - Nathalie Scholl
- Centre d’Estudis Demogràfics (a member of the CERCA Programme / Generalitat de Catalunya), Cerdanyola del Vallès, Barcelona, Spain
| |
Collapse
|
10
|
The effect of the economic crisis on health in Spain according to educational level and employment status: Does the duration of the crisis also matter? Salud Colect 2019; 14:655-670. [PMID: 30726440 DOI: 10.18294/sc.2018.1297] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 07/27/2017] [Indexed: 11/24/2022] Open
Abstract
The objective of this study is to explore the possible impact of the economic crisis on the health of the Spanish-born population not of retirement age (between 30 and 59 years). Specifically, using data from the European Union Statistics on Income and Living Conditions (EU-SILC) for the years 2006, 2010 and 2014, we analyze differences in self-perceived health by socioeconomic profile and position occupied in the household. According to our results, the health of men and women show similar levels of association with certain factors (such as education) and different levels with others (women's health is more sensitive to household income level while men's is more sensitive to employment status). Finally, while substantial improvements in self-perceived health were observed during the first period in almost all socioeconomic groups, during the second period there was almost no change, and for the most disadvantaged men (inactive in the labor market and with low educational levels), health worsened.
Collapse
|
11
|
Frith E, Ramulu PY, Ashar B, Loprinzi PD. Association of Single and Multiple Medical Conditions with Work Status among Adults in the United States. J Lifestyle Med 2019; 9:15-26. [PMID: 30918830 PMCID: PMC6425902 DOI: 10.15280/jlm.2019.9.1.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/10/2018] [Indexed: 11/22/2022] Open
Abstract
Background The purpose of this study was to comprehensively examine the association of a multitude of individual medical conditions, as well as multimorbidity, on work status among a national sample of U.S. adults. Methods The present study included 7 cycles (1999–2012) from the National Health and Nutrition Examination Survey (N = 28,119). Results In total, 26 medical conditions increased the odds of not working. Multimorbidity as well as having prevalent medical condition(s) within each of the Cumulative Index Rating Scale Morbidity Classes were associated with increased odds of not working. Few medical conditions were associated with higher odds of working part-time (vs. full-time) or unemployment (vs. working). Conclusion These findings underscore the importance of instating comprehensive worksite wellness health promotion policies, as well as providing individuals with resources to preserve and enhance personal health.
Collapse
Affiliation(s)
- Emily Frith
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, University, MS, USA
| | | | - Bimal Ashar
- Division of General Internal Medicine, Johns Hopkins Hospital, School of Medicine, Baltimore, MD, USA
| | - Paul D Loprinzi
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, University, MS, USA
| |
Collapse
|
12
|
Altijani N, Carson C, Choudhury SS, Rani A, Sarma UC, Knight M, Nair M. Stillbirth among women in nine states in India: rate and risk factors in study of 886,505 women from the annual health survey. BMJ Open 2018; 8:e022583. [PMID: 30413502 PMCID: PMC6231551 DOI: 10.1136/bmjopen-2018-022583] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To assess the rate of stillbirth and associated risk factors across nine states in India. DESIGN Secondary analysis of cross-sectional data from the Indian Annual Health Survey (2010-2013). SETTING Nine states in India: Madhya Pradesh, Chhattisgarh, Rajasthan, Uttarakhand, Jharkhand, Odisha, Bihar, Assam and Uttar Pradesh. PARTICIPANTS 886 505 women, aged 15-49 years. MAIN OUTCOME MEASURES Stillbirth rate with 95% CI. Adjusted OR to examine the associations between stillbirth and (1) socioeconomic, behavioural and biodemographic risk factors and (2) complications in pregnancy (anaemia, eclampsia, other hypertensive disorders, antepartum and intrapartum haemorrhage, obstructed labour, breech presentation, abnormal fetal position). RESULTS The overall rate of stillbirth was 10 per 1000 total births (95% CI 9.8 to 10.3). Indicators of socioeconomic deprivation were strongly associated with an increase in stillbirth: rural residence (adjusted OR (aOR) 1.27, 95% CI 1.16 to 1.39), female illiteracy (aOR 1.43, 95% CI 1.17 to 1.74), low socioeconomic status (aOR 2.42, 95% CI 1.82 to 3.21), schedule caste background (aOR 1.11, 95% CI 1.04 to 1.19) and woman not in paid employment (aOR 1.15, 95% CI 1.07 to 1.24). Women from minority religious groups were at higher risk than the Hindu majority (Muslim (aOR 1.33, 95% CI 1.25 to 1.43); Christian (aOR 1.42, 95% CI 1.19 to 1.70)). While a few women smoked (<1%), around 9% reported chewing tobacco, which was associated with an increased odds of stillbirth (aOR 1.11, 95% CI 1.02 to 1.21). Adverse pregnancy and birth characteristics were also associated with stillbirth: antenatal care visits <4 (aOR 1.08, 95% CI 1.01 to 1.15), maternal age <25 years (aOR 1.29, 95% CI 1.21 to 1.37) and ≥35 years (aOR 1.16, 95% CI 1.04 to 1.29), multigravida (aOR 3.06, 95% CI 2.42 to 3.86), multiple pregnancy (aOR 1.77, 95% CI 1.47 to 2.15), assisted delivery (aOR 3.45, 95% CI 3.02 to 3.93), caesarean section (aOR 1.73, 95% CI 1.58 to 1.89), as were pregnancy complications (aOR 1.42, 95% CI 1.33 to 1.51). CONCLUSION India is an emerging market economy experiencing a rapid health transition, yet these findings demonstrate the marked disparity in risk of stillbirth by women's socioeconomic status. Tobacco chewing and maternal and fetal complications were each found to be important modifiable risk factors. Targeting the 'at-risk' population identified here, improved recording of stillbirths and the introduction of local reviews would be important steps to reduce the high burden of stillbirths in India.
Collapse
Affiliation(s)
- Noon Altijani
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Saswati Sanyal Choudhury
- Department of Obstetrics and Gynaecology, FAA Medical College and Hospital, Barpeta, Assam, India
| | - Anjali Rani
- Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Ajagara, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Umesh C Sarma
- Srimanta Sankaradeva University of Health Sciences, Assam, Narkashur Hilltop, Christian Basti Bhangagarh, Guwahati, Assam, India
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
13
|
Bączyk G, Kozłowska K. The role of demographic and clinical variables in assessing the quality of life of outpatients with rheumatoid arthritis. Arch Med Sci 2018; 14:1070-1079. [PMID: 30154890 PMCID: PMC6111345 DOI: 10.5114/aoms.2018.77254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 04/06/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The aim of this study was to assess quality of life among patients with rheumatoid arthritis (RA) treated as outpatients. The specific question was: does the quality of life of RA patients depend on demographic variables and clinical variables? MATERIAL AND METHODS The study included 240 patients with RA recruited from outpatients. To assess quality of life, the Arthritis Impact Measurement Scales 2 was applied. Clinical tests: VAS, Morning Stiffness, Grip Strength, Richie Articular Index. RESULTS The analysis of life quality for the total group was carried out in the particular AIMS2 of the mean scores for arthritis pain - 7.37; walking and bending - 6.62; social activity - 5.52; level of tension - 5.17; satisfaction - 5.17; hand and finger function - 4.28; mood - 4.03; physical activity - 3.27; arm function - 3.16; household tasks - 2.67; self-care - 2.18; and support from family and friends - 1.75. The arthritis impact score was 6.01. The analysis of the correlation between clinical variables and individual AIMS2 subscales showed a statistically significant relationship between the VAS Pain, Grip Strength Measurement, Morning Stiffness and quality of life subscales (p < 0.01). VAS Pain, Morning Stiffness, and Grip Strength Measurement were the most important predictors among clinical variables of physical component, affect and symptoms (p < 0.001). Among demographic variables: age over 60 years and low education were the most important predictors of physical component (p < 0.01). CONCLUSIONS The study results may be helpful for further health-related studies on quality of life among RA studies and in making therapeutic decisions concerning quality of life improvement.
Collapse
Affiliation(s)
- Grażyna Bączyk
- Department of Nursing Practice, Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Kozłowska
- Department of Nursing Practice, Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
14
|
Arntzen A, Nybo Andersen AM. Social determinants for infant mortality in the Nordic countries, 1980 - 2001. Scand J Public Health 2016; 32:381-9. [PMID: 15513672 DOI: 10.1080/14034940410029450] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: Social equity in health is an important goal of public health policies in the Nordic countries. Infant mortality is often used as an indicator of the health of societies, and has decreased substantially in the Nordic welfare states over the past 20 years. To identify social patterns in infant mortality in this context the authors set out to review the existing epidemiological literature on associations between social indicators and infant mortality in Denmark, Finland, Norway, and Sweden during the period 1980 - 2000. Methods: Nordic epidemiological studies in the databases ISI Web of Science, PubMed, and OVID, published between 1980 and 2000 focusing on social indicators of infant, neonatal, and postneonatal mortality, were identified. The selected keywords on social indicators were: education, income, occupation, social factors, socioeconomic status, social position, and social class. Results: Social inequality in infant mortality was reported from Denmark, Finland, Norway, and Sweden, and it was found that these increased during the study period. Post-neonatal mortality showed a stronger association with social indicators than neonatal mortality. Some studies showed that neonatal mortality was associated with social indicators in a non-linear fashion, with high rates of mortality in both the lowest and highest social strata. The pattern differed, however, between countries with Finland and Sweden showing consistently less social inequalities than Denmark and Norway. While the increased inequality shown in most studies was an increase in relative risk, a single study from Denmark demonstrated an absolute increase in infant mortality among children born to less educated women. Conclusions: Social inequalities in infant mortality are observed in all four countries, irrespective of social indicators used in the studies. It is, however, difficult to draw inferences from the comparisons between countries, since different measures of social position and different inclusion criteria are used in the studies. Nordic collaborative analyses of social gradients in infant death are needed, taking advantage of the population-covering registers in longitudinal designs, to explore the mechanisms behind the social patterns in infant mortality.
Collapse
Affiliation(s)
- Annett Arntzen
- Faculty of Social Science, Vestfold University College, Tønsberg, Norway.
| | | |
Collapse
|
15
|
Malta DC, Bernal RTI. Comparison of risk and protective factors for chronic diseases in the population with and without health insurance in the Brazilian capitals, 2011. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2016; 17 Suppl 1:241-55. [PMID: 25054267 DOI: 10.1590/1809-4503201400050019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 02/17/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The article compares the risk and protective factors for Non-communicable Diseases (NCD), referred morbidity and access to preventive examinations in the population with and without health insurance in all Brazilian State capitals. METHODS The study population consists of adults (≥ 18 years old) living in households with landlines in 26 Brazilian State capitals and the Federal District. Estimates of selected variables are presented according to possession of health plans ("Yes" or "No") and sex. A post-stratification was performed according to age, gender and education in both populations, and prevalence ratios were calculated, adjusted for age and sex between people with and without health insurance for the risk and protective factors for NCDs. RESULTS A total of 54,099 people at the age of 18 or older were evaluated, 47.4% of them were beneficiaries of health plans. The coverage of health insurance tends to increase with age and level of education. Compared to non-beneficiaries of health plans, beneficiaries were more likely to have protective factors, such as healthy eating, physical activity, coverage tests, such as mammography and Pap test, and lower prevalence of risk factors such as smoking, physical inactivity, poor health assessment and hypertension. Alcohol abuse, consumption of excessively fat meats, overweight, obesity and diabetes were not associated with the variable possession of health insurance. When controlled by education, individuals who have health insurance generally have better indicators. CONCLUSION This information is important to establish measures for reducing differences among people with and without health insurance.
Collapse
Affiliation(s)
- Deborah Carvalho Malta
- Department of Non-Communicable Diseases Surveillance and Health Promotion, Ministry of Health, Brasília, DF, Brazil
| | - Regina Tomie Ivata Bernal
- Center for Epidemiological Research in Nutrition and Health, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
16
|
Critical review of the evidence for the connection between education and health: A guide for exploration of the causal pathways. ACTA ACUST UNITED AC 2015. [DOI: 10.1108/s0275-4959(2009)0000027009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
|
17
|
Kim HS, Jung UH, Lee H, Kim SK, Lee H, Choe JY, Kwak SG, Pincus T, Park SH. Effect of Formal Education Level on Measurement of Rheumatoid Arthritis Disease Activity. JOURNAL OF RHEUMATIC DISEASES 2015. [DOI: 10.4078/jrd.2015.22.4.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Hyeon Su Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ui Hong Jung
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hyesun Lee
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Seong-Kyu Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hwajeong Lee
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jung-Yoon Choe
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Theodore Pincus
- Division of Rheumatology, Rush University School of Medicine, Chicago, IL, USA
| | - Sung-Hoon Park
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| |
Collapse
|
18
|
Schwartz CE, Quaranto BR, Healy BC, Benedict RH, Vollmer TL. Altruism and health outcomes in multiple sclerosis: The effect of cognitive reserve. JOURNAL OF POSITIVE PSYCHOLOGY 2013. [DOI: 10.1080/17439760.2013.776621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
19
|
Johansson E, Leijon O, Falkstedt D, Farah A, Hemmingsson T. Educational differences in disability pension among Swedish middle-aged men: role of factors in late adolescence and work characteristics in adulthood. J Epidemiol Community Health 2011; 66:901-7. [DOI: 10.1136/jech-2011-200317] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
20
|
Malta DC, Moura EC, Oliveira M, dos Santos FP. [Health insurance users: self-reported morbidity and access to preventive tests according to a telephone survey, Brazil, 2008]. CAD SAUDE PUBLICA 2011; 27:57-66. [PMID: 21340104 DOI: 10.1590/s0102-311x2011000100006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 08/11/2010] [Indexed: 11/22/2022] Open
Abstract
This article describes a telephone survey in 2008 to monitor non-communicable diseases. The study population consisted of adults (> 18 years of age) living in households with landline telephones in the 27 Brazilian State Capitals. The selected variables are presented according to health insurance coverage (yes/no), gender, and adjusted prevalence ratios between populations with and without health insurance. The results represent 54,353 persons 18 years or older, 41.8% of whom with health insurance. Health insurance coverage tended to increase with age and schooling. Compared to those without health insurance, men with health coverage were more likely to have a diagnosis of dyslipidemia, and women with coverage were more likely to have had a mammogram, Pap smear, and diagnosis of dyslipidemia and/or osteoporosis, besides showing less arterial hypertension and infrequent poor health status. This information is essential to support health promotion and prevention with appropriate programs.
Collapse
|
21
|
Callahan LF, Martin KR, Shreffler J, Kumar D, Schoster B, Kaufman JS, Schwartz TA. Independent and combined influence of homeownership, occupation, education, income, and community poverty on physical health in persons with arthritis. Arthritis Care Res (Hoboken) 2011; 63:643-53. [PMID: 21225675 DOI: 10.1002/acr.20428] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the independent and combined influence of individual- and community-level socioeconomic status (SES) measures on physical health status outcomes in people with self-reported arthritis. METHODS From 2004-2005, 968 participants completed a telephone survey assessing health status, chronic conditions, community characteristics, and sociodemographic variables. Individual-level SES measures used included homeownership, occupation (professional or not), educational attainment (less than high school, high school degree, and more than high school), and income (<$15,000, $15,000-$45,000, and >$45,000). Community poverty (2000 US Census block group percentage of individuals living below the poverty line [low, medium, and high]) was used as a community-level SES measure. Outcomes were physical functioning (Medical Outcomes Study Short Form 12 version 2 physical component summary [PCS]), functional disability (Health Assessment Questionnaire [HAQ]), and the Centers for Disease Control and Prevention (CDC) Health-Related Quality of Life (HRQOL) Healthy Days physical and limited activity days, and were analyzed via multivariable regressions. RESULTS When entered separately, all individual-level SES variables were significantly (P < 0.01) associated with poorer PCS, HAQ, and CDC HRQOL scores. A higher magnitude of effect was seen for household income, specifically <$15,000 per year in final models with all 4 individual SES measures and community poverty. The magnitude of effect for education is reduced and marginally significant for the PCS and number of physically unhealthy days. No effects were seen for occupation, homeownership, and community poverty. CONCLUSION Findings confirm that after adjusting for important covariates, lower individual- and community-level SES measures are associated with poorer physical health outcomes, while household income is the strongest predictor (as measured by both significance and effect) of poorer health status in final models. Studies not having participant-reported income available should make use of other SES measures, as they do independently predict physical health.
Collapse
|
22
|
Luy M, Di Giulio P, Caselli G. Differences in life expectancy by education and occupation in Italy, 1980–94: Indirect estimates from maternal and paternal orphanhood. Population Studies 2011; 65:137-55. [DOI: 10.1080/00324728.2011.568192] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
23
|
Falkstedt D, Hemmingsson T. Educational Level and Coronary Heart Disease: A Study of Potential Confounding from Factors in Childhood and Adolescence Based on the Swedish 1969 Conscription Cohort. Ann Epidemiol 2011; 21:336-42. [DOI: 10.1016/j.annepidem.2010.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/16/2010] [Accepted: 12/30/2010] [Indexed: 12/19/2022]
|
24
|
Rivera AV, Blaney S, Crawford ND, White K, Stern RJ, Amesty S, Fuller C. Individual- and neighborhood-level factors associated with nonprescription counseling in pharmacies participating in the New York State Expanded Syringe Access Program. J Am Pharm Assoc (2003) 2011; 50:580-7. [PMID: 20833615 DOI: 10.1331/japha.2010.09202] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the individual- and neighborhood-level predictors of frequent nonprescription in-pharmacy counseling. DESIGN Descriptive, nonexperimental, cross-sectional study. SETTING New York City (NYC) during January 2008 to March 2009. INTERVENTION 130 pharmacies registered in the Expanded Syringe Access Program (ESAP) completed a survey. PARTICIPANTS 477 pharmacists, nonpharmacist owners/managers, and technicians/clerks. MAIN OUTCOME MEASURES Frequent counseling on medical conditions, health insurance, and other products. RESULTS Technicians were less likely than pharmacists to provide frequent counseling on medical conditions or health insurance. Regarding neighborhood-level characteristics, pharmacies in areas of high employment disability were less likely to provide frequent health insurance counseling and pharmacies in areas with higher deprivation were more likely to provide counseling on other products. CONCLUSION ESAP pharmacy staff members are a frequent source of nonprescription counseling for their patients in disadvantaged neighborhoods of NYC. These findings suggest that ESAP pharmacy staff may be amenable to providing relevant counseling services to injection drug users and warrant further investigation.
Collapse
Affiliation(s)
- Alexis V Rivera
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York 10029, USA.
| | | | | | | | | | | | | |
Collapse
|
25
|
Screening for low literacy in a rheumatology setting: more than 10% of patients cannot read "cartilage," "diagnosis," "rheumatologist," or "symptom". J Clin Rheumatol 2011; 16:359-64. [PMID: 21085021 DOI: 10.1097/rhu.0b013e3181fe8ab1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives of the study were to analyze literacy in 194 consecutive patients at an academic rheumatology setting with the Rapid Estimate of Adult Literacy in Medicine (REALM) and an "Arthritis-Adapted" REALM (A-REALM), and to compare responses to one another and to demographic and clinical measures. METHODS The REALM and A-REALM are two 66-item word recognition tests. Both were administered to 194 consecutive patients in usual rheumatology care. Multidimensional Health Assessment Questionnaire (MDHAQ) scores for physical function, pain, fatigue, and global estimate, and laboratory assessments also were available. Descriptive statistics and analyses of agreement were computed. RESULTS REALM and A-REALM administration involved 2 to 3 minutes each. Scores below 61, indicating a reading level at eighth grade or less, were seen in 35 (18%) of 194 patients on the REALM and 46 patients (24%) on the A-REALM. No patient was classified as having severely low literacy at or below a third-grade level. However, words not read correctly by 10% or more of the patients on the REALM included diagnosis (14%), osteoporosis (17%), and inflammatory (10%), and on the A-REALM, rheumatologist (11%), cartilage (14%), and symptom (14%). REALM and A-REALM scores were correlated significantly (Pearson r = 0.94, P < 0.001). Almost all patients (33/35) with REALM scores of less than 61 also had A-REALM scores of less than 61, less formal education, and poorer clinical status on all measures, most not statistically significant. CONCLUSION Low literacy is an important underrecognized problem in medical care, which may be assessed easily in standard care using the REALM or A-REALM. Further attention to literacy-associated barriers may reduce socioeconomic disparities in health.
Collapse
|
26
|
Callahan LF, Shreffler J, Siaton BC, Helmick CG, Schoster B, Schwartz TA, Chen JC, Renner JB, Jordan JM. Limited educational attainment and radiographic and symptomatic knee osteoarthritis: a cross-sectional analysis using data from the Johnston County (North Carolina) Osteoarthritis Project. Arthritis Res Ther 2010; 12:R46. [PMID: 20298606 PMCID: PMC2888194 DOI: 10.1186/ar2956] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 03/08/2010] [Accepted: 03/18/2010] [Indexed: 11/25/2022] Open
Abstract
Introduction Applying a cross-sectional analysis to a sample of 2,627 African-American and Caucasian adults aged ≥ 45 years from the Johnston County Osteoarthritis Project, we studied the association between educational attainment and prevalence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis. Methods Age- and race-adjusted associations between education and osteoarthritis outcomes were assessed by gender-stratified logistic regression models, with additional models adjusting for body mass index, knee injury, smoking, alcohol use, and occupational factors. Results In an analysis of all participants, low educational attainment (<12 years) was associated with higher prevalence of four knee osteoarthritis outcomes (unilateral and bilateral radiographic and symptomatic osteoarthritis). Women with low educational attainment had 50% higher odds of having radiographic knee osteoarthritis and 65% higher odds of symptomatic knee osteoarthritis compared with those with higher educational attainment (≥ 12 years), by using fully adjusted models. In the subset of postmenopausal women, these associations tended to be weaker but little affected by adjustment for hormone replacement therapy. Men with low educational attainment had 85% higher odds of having symptomatic knee osteoarthritis by using fully adjusted models, but the association with radiographic knee osteoarthritis was explained by age. Conclusions After adjustment for known risk factors, educational attainment, as an indicator of socioeconomic status, is associated with symptomatic knee osteoarthritis in both men and women and with radiographic knee osteoarthritis in women.
Collapse
Affiliation(s)
- Leigh F Callahan
- Thurston Arthritis Research Center, Department of Medicine, 3300 Thurston Building, CB # 7280, University of North Carolina, Chapel Hill, NC 27599-7330, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Kim MY, Park JK, Koh SB, Kim CB. Factors Influencing Utilization of Medical Care Among Osteoarthritis Patients in Korea: Using 2005 Korean National Health and Nutrition Survey Data. J Prev Med Public Health 2010; 43:513-22. [DOI: 10.3961/jpmph.2010.43.6.513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Min Young Kim
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Korea
| | - Jong Ku Park
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Korea
| | - Sang Baek Koh
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Korea
| | - Chun-Bae Kim
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Korea
| |
Collapse
|
28
|
Chung C, Escalante A, Pincus T. How many versions and translations of the HAQ and its variants are needed? It doesn't matter-just use one. J Clin Rheumatol 2009; 10:101-4. [PMID: 17043479 DOI: 10.1097/01.rhu.0000128220.27054.6e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
29
|
McCollum L, Pincus T. A Biopsychosocial Model to Complement a Biomedical Model: Patient Questionnaire Data and Socioeconomic Status Usually Are More Significant than Laboratory Tests and Imaging Studies in Prognosis of Rheumatoid Arthritis. Rheum Dis Clin North Am 2009; 35:699-712, v. [DOI: 10.1016/j.rdc.2009.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
30
|
Maciel SC, Jennings F, Jones A, Natour J. The development and validation of a Low Back Pain Knowledge Questionnaire - LKQ. Clinics (Sao Paulo) 2009; 64:1167-75. [PMID: 20037704 PMCID: PMC2797585 DOI: 10.1590/s1807-59322009001200006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 09/08/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to develop and validate a questionnaire on specific knowledge about low back pain entitled "The Low Back Pain Knowledge Questionnaire". INTRODUCTION There is a need for instruments to assess patient knowledge regarding chronic illness. Such methods can contribute to the education of patients. METHODS The Low Back Pain Knowledge Questionnaire was developed through five focus groups. The questionnaire was distributed to 50 patients to assess their comprehension of the terms. To assess the reproducibility, 20 patients were surveyed by two different interviewers on the same day and twice by a single interviewer with a one-to-two week interval. For the construct validation, the Low Back Pain Knowledge Questionnaire was given to 20 healthcare professionals with knowledge on low back pain and 20 patients to determine whether the questionnaire would discriminate between the two different populations. To assess the sensitivity of the questionnaire to changes in the knowledge level of the patients, it was given to 60 patients who were randomly assigned to the Intervention Group and the Control Group. The Intervention Group answered the questionnaire both before and after attending a chronic back pain educational program (back school), whereas the Control Group answered the questionnaire twice with an interval of one month and no educational intervention. RESULTS The focus groups generated a questionnaire with 16 items. The Spearman's correlation coefficient and the intra-class correlation coefficients ranged from 0.61 to 0.95 in the assessments of the intra-observer and inter-observer reproducibility (p< 0.01). In the construct validation, the healthcare professionals and patients showed statistically different scores (p< 0.001). In the phase regarding the sensitivity to change, the Intervention Group exhibited a significant increase in their specific knowledge over the Control Group (p< 0.001). CONCLUSION The Low Back Pain Knowledge Questionnaire was validated and proved to be reproducible, valid and sensitive to changes in patient knowledge.
Collapse
Affiliation(s)
| | - Fabio Jennings
- Division of Rheumatology, Federal University of São Paulo - São Paulo Paulo/SP, Brazil
| | - Anamaria Jones
- Division of Rheumatology, Federal University of São Paulo - São Paulo Paulo/SP, Brazil
| | - Jamil Natour
- Division of Rheumatology, Federal University of São Paulo - São Paulo Paulo/SP, Brazil
| |
Collapse
|
31
|
Steinvil A, Shirom A, Melamed S, Toker S, Justo D, Saar N, Shapira I, Berliner S, Rogowski O. Relation of educational level to inflammation-sensitive biomarker level. Am J Cardiol 2008; 102:1034-9. [PMID: 18929705 DOI: 10.1016/j.amjcard.2008.05.055] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Revised: 05/30/2008] [Accepted: 05/30/2008] [Indexed: 02/05/2023]
Abstract
It is a well-established finding that cardiovascular morbidity varies among groups of different socioeconomic status. Inflammatory processes have been proposed as a possible mediator of this variance. Level of education is an important indicator of socioeconomic status, inversely related to levels of inflammatory biomarkers. Whether this association was significant in a subpopulation of highly educated individuals was questioned. This cross-sectional study enrolled attendees of an executive health screening program intended specifically for executive and high-wage personnel from September 2002 to November 2007. A detailed questionnaire, anthropometric measurements, and laboratory data were used to determine self-reported years of education and cardiovascular risk factors. Linear regression models included high-sensitivity C-reactive protein, fibrinogen, erythrocyte sedimentation rate, and white blood cell count as dependent variables and were adjusted for multiple potential confounders. Data for 8,998 subjects (5,757 men, 3,241 women) with a mean age of 44 years (range 18 to 84) were analyzed. More than two-thirds reported >or=14 years of schooling, and >2,900 reported >or=17 years of schooling. We found a statistically significant inverse association between number of school years and high-sensitivity C-reactive protein, fibrinogen, and erythrocyte sedimentation rate. Higher levels of education were associated with lower prevalences of diabetes and current smoking in both genders and lower prevalences of hypertension and dyslipidemia in women. In conclusion, level of education was inversely associated with inflammatory biomarkers and prevalence of cardiovascular risk factors, even within highly educated populations.
Collapse
Affiliation(s)
- Arie Steinvil
- Department of Internal Medicine D, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Merkin SS. Exploring the pathways between socioeconomic status and ESRD. Am J Kidney Dis 2008; 51:539-41. [PMID: 18371527 DOI: 10.1053/j.ajkd.2008.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 01/18/2008] [Indexed: 11/11/2022]
|
33
|
Arntzen A, Mortensen L, Schnor O, Cnattingius S, Gissler M, Andersen AMN. Neonatal and postneonatal mortality by maternal education—a population-based study of trends in the Nordic countries, 1981–2000. Eur J Public Health 2007; 18:245-51. [DOI: 10.1093/eurpub/ckm125] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
34
|
Nolte S, Elsworth GR, Sinclair AJ, Osborne RH. The extent and breadth of benefits from participating in chronic disease self-management courses: a national patient-reported outcomes survey. PATIENT EDUCATION AND COUNSELING 2007; 65:351-60. [PMID: 17027221 DOI: 10.1016/j.pec.2006.08.016] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Revised: 08/30/2006] [Accepted: 08/30/2006] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To quantify the benefits that people receive from participating in self-management courses and identify subgroups that benefit most. METHODS People with a wide range of chronic conditions attending self-management courses (N = 1341 individuals) were administered the Health Education Impact Questionnaire (heiQ). Baseline and follow-up data were collected resulting in 842 complete responses. Outcomes were categorized as substantial improvement (effect size, ES > or = 0.5), minimal/no change (ES -0.49 to 0.49) and substantial decline (ES < or = -0.5). RESULTS On average, one third of participants reported substantial benefits at the end of a course and this ranged from 49% in the heiQ subscale Skill and technique acquisition to 27% in the heiQ subscale Health service navigation. Stratification by gender, age and education showed that younger participants were more likely to benefit, particularly young women. No further subgroup differences were observed. CONCLUSION While the well-being of people with chronic diseases tends to decline, about one third of participants from a wide range of backgrounds show substantial improvements in a range of skills that enable them to self-manage. PRACTICE IMPLICATIONS These data support the application of self-management courses indicating that they are a useful adjunct to usual care for a modest proportion of attendees.
Collapse
Affiliation(s)
- Sandra Nolte
- AFV Centre for Rheumatic Diseases, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Vic. 3050, Australia
| | | | | | | |
Collapse
|
35
|
Fillenbaum GG, Burchett BM, Dan JD, Blazer G. Health service use and outcome: comparison of low charge, integrated, comprehensive services with usual health care. Aging Ment Health 2007; 11:226-35. [PMID: 17453556 DOI: 10.1080/13607860600844556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We examined the effects of use of low charge, integrated and comprehensive health care services (Veterans Administration (VA) health care system) on health care service use and health-related outcomes. Data came from the 10-year (1986/87-1996/97) Duke Established Populations for Epidemiologic Studies of the Elderly, with 159 men aged 65-85 who primarily used VA health services compared with 1,100 men aged 65-85 who did not. In controlled analyses, no differences were found between the two groups on number of OTC medications used, or in speed or likelihood of entering a nursing home. However, veterans who primarily used the VA health care system reported more outpatient visits and prescription drugs, and increased likelihood of using an adjunct health care provider; entry into a hospital was quicker, and number of hospitalizations was greater. Although health status was controlled, because of eligibility requirements it remains possible that veterans were sicker. Nevertheless, no differences were found in health outcome (functional status or mortality). Readier access to better integrated health services appears to result in increased use of health services controlled by the health care provider, but not of services requiring the recipient's relocation, while functional status and mortality attained equivalence.
Collapse
Affiliation(s)
- Gerda G Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | |
Collapse
|
36
|
Russell MA, Phipps MG, Olson CL, Welch HG, Carpenter MW. Rates of Postpartum Glucose Testing After Gestational Diabetes Mellitus. Obstet Gynecol 2006; 108:1456-62. [PMID: 17138780 DOI: 10.1097/01.aog.0000245446.85868.73] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate rates of postpartum glucose tolerance testing in women diagnosed with gestational diabetes mellitus (GDM) and to assess factors associated with testing. METHODS This was a retrospective cohort study of 344 women with GDM who received prenatal care in a maternal diabetes clinic during 2001-2004. Rates of postpartum glucose testing were estimated from hospital, clinic, and laboratory records. Demographic, clinical (obstetric history, antenatal, and delivery), and health care information was obtained from chart review. RESULTS Less than one half (45%) of women with GDM in our cohort underwent postpartum glucose testing-more than one third (36%) of whom had persistent abnormal glucose tolerance. After adjusting for clinical and health care characteristics, there was no independent relationship between most demographic characteristics and postpartum testing. Nor was there an association between clinical characteristics and the likelihood of being tested. Postpartum testing was strongly associated only with attendance of the postpartum visit: 54% of women who attended the visit were tested compared with 17% of women who did not attend (adjusted relative risk 3.04, 95% confidence interval 1.75-5.34, P<.001). CONCLUSION Although persistent abnormal glucose tolerance was common in our cohort, less than half of the women were tested for it. Our data suggest that to increase rates of postpartum glucose testing, improved attendance at the postpartum visit with greater attention to testing and better continuity between antenatal and postpartum care are required. LEVEL OF EVIDENCE II-2.
Collapse
Affiliation(s)
- Michelle A Russell
- Brown Medical School, Women and Infants' Hospital, Providence, Rhode Island, USA.
| | | | | | | | | |
Collapse
|
37
|
Kalediene R, Petrauskiene J. Inequalities in mortality by education and socio-economic transition in Lithuania: equal opportunities? Public Health 2006; 119:808-15. [PMID: 15913676 DOI: 10.1016/j.puhe.2004.11.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Revised: 09/07/2004] [Accepted: 11/13/2004] [Indexed: 10/25/2022]
Abstract
AIM The aim of this study was to examine the changes in mortality differentials by level of education during the period of socio-economic transition in Lithuania. METHODS This analysis was based on routine mortality statistics and census data for 1989 and 2001 for the entire country. RESULTS Despite a general improvement in the level of education in the Lithuanian population, some negative educational patterns were observed amongst its young members. Increasing inequalities in mortality by education have occurred due to a declining mortality rate in people with higher educational achievements and, conversely, an increasing mortality rate in people with a low level of education. Mortality inequalities by education amongst females exceeded those amongst males in 2001, particularly in middle-aged groups and due to external causes. The results of this survey predict an unfavourable forecast of increasing health inequalities in Lithuania in the near future. CONCLUSIONS General policies for health promotion and disease prevention should be based on the realities faced by lower educated groups, rather than on experiences that are general for the total population or the class of society that has at least achieved an average education. Inequalities in health by the level of education should plateau as the society-at-large enters into a more stable stage of social and economic development.
Collapse
Affiliation(s)
- R Kalediene
- Department of Social Medicine, Faculty of Public Health, Kaunas University of Medicine, Mickevicius St 9, 3000 Kaunas, Lithuania.
| | | |
Collapse
|
38
|
Bautista D, Alfonso JL, Corella D, Saiz C. Influence of social factors on avoidable mortality: a hospital-based case-control study. Public Health Rep 2005; 120:55-62. [PMID: 15736332 PMCID: PMC1497679 DOI: 10.1177/003335490512000110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The effect of socioeconomic factors on avoidable mortality at an individual level is not well known, since most studies showing this association are based on aggregate data. The purpose of this study was to determine socioeconomic differences between those patients who die of avoidable causes and those who do not die. METHODS A matched case-control study was carried out regarding in-hospital avoidable mortality (Holland's medical care indicators) that occurred in a university hospital serving a Spanish-Mediterranean population during a 30-month period. RESULTS We studied 82 cases of death from avoidable causes and 300 controls matched on medical care indicators and age. The variables that showed a statistically significant association with in-hospital avoidable mortality were number of diagnoses (the greater the number, the higher the risk), length of stay (patients staying seven or more days presented a lower risk), and education. Those patients with low and middle educational levels showed a greater risk of avoidable mortality (adjusted odds ratio=3.57 and 2.82, respectively) than those patients with higher levels of education. CONCLUSIONS Consistent with the findings of studies based on aggregate data, our case-control analyses indicated that among several socioeconomic variables studied, educational level was significantly associated with the risk of in-hospital avoidable mortality, regardless of age and medical care indicators. Patients with low levels of education (<6 years of schooling) were at highest risk for in-hospital avoidable mortality, followed by those with middle levels of education (7-10 years of schooling).
Collapse
Affiliation(s)
- Daniel Bautista
- Department of Preventive Medicine, Dr. Peset University Hospital, Valencia, Spain.
| | | | | | | |
Collapse
|
39
|
Brekke M, Hjortdahl P, Kvien TK. Changes in self-efficacy and health status over 5 years: a longitudinal observational study of 306 patients with rheumatoid arthritis. ARTHRITIS AND RHEUMATISM 2003; 49:342-8. [PMID: 12794789 DOI: 10.1002/art.11112] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate changes in self-efficacy and health status over 5 years in patients with rheumatoid arthritis (RA), the relationships between these changes, and the influence of baseline values on subsequent changes. METHODS 306 adult patients with RA, born in 1926 or later, were examined by questionnaire in 1994 and again in 1999. We analyzed data regarding pain (visual analogue scale [VAS], Arthritis Impact Measurement Scale [AIMS2] symptom scale, Short Form-36 [SF-36] pain scale), fatigue (VAS, SF-36 vitality scale), mental distress (AIMS2 affect scale, SF-36 mental health scale) and self-efficacy (Arthritis Self-Efficacy Scales for pain and for other symptoms). RESULTS On group level, all health status measures were numerically somewhat improved, and self-efficacy slightly reduced. Changes in self-efficacy and in corresponding health status measures were significantly correlated. For patients with above average educational level self-efficacy for pain at baseline was positively correlated to improvement in pain measures. Good mental health at baseline was correlated to improvement in self-efficacy for other symptoms, but only for patients with below average educational level. CONCLUSION Baseline self-efficacy seems to influence future level of perceived pain and baseline mental health status seems to influence future self-efficacy. These associations seem to be affected by level of education.
Collapse
Affiliation(s)
- Mette Brekke
- Oslo City Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
| | | | | |
Collapse
|
40
|
Hart CL, Deary IJ, Taylor MD, MacKinnon PL, Smith GD, Whalley LJ, Wilson V, Hole DJ, Starr JM. The Scottish mental survey 1932 linked to the Midspan studies: a prospective investigation of childhood intelligence and future health. Public Health 2003; 117:187-95. [PMID: 12825469 DOI: 10.1016/s0033-3506(02)00028-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Scottish mental survey of 1932 (SMS1932) recorded mental ability test scores for nearly all children born in 1921 and at school in Scotland on 1 June 1932. The Collaborative and Renfrew/Paisley studies, two of the Midspan studies, obtained health and social data by questionnaire and a physical examination in the 1970s. Some Midspan participants were born in 1921 and may also have taken part in the SMS1932, so there was a possibility that their mental ability data from childhood would be available. The 1921 born Midspan participants were matched with the computerized SMS1932 database, and in total, 1032 of 1251 people (82.5%) were matched successfully. Of those matched, 938 (90.9%) had a mental ability test score recorded. The mean score of the matched sample was 37.2 (standard deviation (SD) 13.9) out of a possible score of 76. The mean (SD) for the boys and girls was 38.3 (14.2) and 35.7 (13.9), respectively. This compared with 38.6 (15.7) and 37.2 (14.3) for boys and girls in all of Scotland. Graded relationships were found between mental ability in childhood, and social class and deprivation category of residence in adulthood. Being in a higher social class or in a more affluent deprivation category was associated with higher childhood mental ability scores, and the scores reduced with increasing deprivation. Future plans for the matched data include examining associations between childhood mental ability and other childhood and adult risk factors for disease in adulthood, and modelling childhood mental ability, alongside other factors available in the Midspan database, as a risk factor for specific illnesses, admission to hospital and mortality.
Collapse
Affiliation(s)
- C L Hart
- Department of Public Health, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
Social epidemiology, a subdiscipline of epidemiology, aims to identify socioenvironmental exposures that may be related to a broad range of health status outcomes. The strong association throughout the developed world between lower levels of individual socioeconomic status and poorer health outcomes from many diseases, including arthritis, is well established. Although not yet well studied in arthritis, recent data suggest that community social determinants, the socioeconomic environment of an individual's neighborhood, may be operant in this regard as well. It is of considerable interest that the association of community social determinants with health outcomes appears to be independent of an individual's socioeconomic status, at least in some clinical situations. Both Healthy People 2010 and the National Arthritis Action Plan place high priority on reducing disparities in health outcomes in the United States. Development of effective prevention strategies will require (1) precise recognition of individual and community variables that are associated with health outcomes and (2) evaluation of the putative mediating mechanisms.
Collapse
Affiliation(s)
- Leigh F Callahan
- Orthopaedics, Medicine and Social Medicine, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill 27599, USA.
| |
Collapse
|
42
|
Roth RS, Geisser ME. Educational achievement and chronic pain disability: mediating role of pain-related cognitions. Clin J Pain 2002; 18:286-96. [PMID: 12218499 DOI: 10.1097/00002508-200209000-00003] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined the relation between level of educational achievement (LOE) and the clinical morbidity associated with chronic pain. SETTING a multidisciplinary pain rehabilitation program located within a university hospital. PATIENTS Two hundred ninety-nine consecutive patients with chronic spinal pain, average age 39.6 years (SD = 10.7) and with an average duration of pain of 41.9 months (SD = 51.6). OUTCOME MEASURES Age, duration of pain, sex, and compensation and litigation status were controlled for in the statistical analysis because each was found to be significantly associated with LOE. Pain intensity was assessed by the McGill Pain Questionnaire. Affective distress was assessed by the Global Severity Index from the Brief Symptom Inventory. Severity of depressive symptoms was derived from scores from the Center for Epidemiological Studies-Depression Scale. Pain beliefs and pain coping strategies were assessed by the Survey of Pain Attitudes and the Coping Strategies Questionnaire, respectively. Finally, self-report of pain-related disability was assessed by the Pain Disability Index. RESULTS AND CONCLUSIONS After controlling for relevant covariates, LOE was unrelated to pain intensity, severity of depressive symptoms, or affective distress, but was inversely related to self-reported disability. Persons with lower LOEs possessed a greater belief that pain is a "signal of harm," unrelated to emotional experience, disabling and uncontrollable. They also endorsed more passive and maladaptive coping strategies, including a tendency to catastrophize about their pain. Path analysis indicated that, after controlling for the influence of both the belief that pain is a "signal of harm" and catastrophizing on the association between LOE and disability, this relation loses statistical significance. These results suggest that pain-related cognitions mediate the relation between LOE and pain disability and that persons with lower LOEs are more likely to develop maladaptive pain beliefs and coping strategies.
Collapse
Affiliation(s)
- Randy S Roth
- Anesthesiology and Psychology, Department of Physical Medicine and Rehabilitation, University of Michigan Health System, University of Michigan, Ann Arbor, Michigan 48109, USA.
| | | |
Collapse
|
43
|
Abstract
Osteoarthritis (OA) is not a simple consequence of "wear and tear" or aging--the presence of cytokines suggests a role for inflammation. OA is polyarticular in most patients, with metabolic and differential risk factors for prevalence and severity. Odds ratios for the prevalence of OA according to formal education levels are similar to those seen for dysregulatory diseases such as hypertension, diabetes, and rheumatoid arthritis. Clinical survey data indicate significant patient preference for nonsteroidal anti-inflammatory drugs (NSAIDs) compared with acetaminophen. A recent crossover clinical trial indicated significantly greater efficacy of the NSAID, diclofenac/misoprostol, versus acetaminophen for most patients with OA.
Collapse
Affiliation(s)
- T Pincus
- Division of Rheumatology, Vanderbilt University Medical Center, 203 Oxford House, Box 5, Nashville, TN 37232-4500, USA
| |
Collapse
|
44
|
Abstract
OBJECTIVE This study examined the relationship of level of educational (LOE) achievement to pain experience, affective disturbance, and perceived disability among women with chronic pelvic pain presenting for pain treatment. METHODS 187 patients completed a battery of self-report inventories assessing pain, psychological status, and functional ability. Educational attainment was stratified across five levels from "less than high school" to "graduate/professional school." RESULTS Significant inverse associations were found between lower educational achievement and more severe pain, somatic preoccupation, emotional suffering and guardedness, and functional impairment. No differences were obtained across the groups for age, duration of pain, or symptoms of depression. CONCLUSIONS These data provide support for the importance of socioeconomic factors, particularly LOE, in furthering our understanding of the morbidity observed among women suffering chronic pelvic pain.
Collapse
Affiliation(s)
- R S Roth
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI 48109, USA.
| | | | | |
Collapse
|
45
|
Freidl W, Stronegger WJ, Rásky E, Neuhold C. Associations of income with self-reported ill-health and health resources in a rural community sample of Austria. SOZIAL- UND PRAVENTIVMEDIZIN 2001; 46:106-14. [PMID: 11446305 DOI: 10.1007/bf01299727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Three levels of health indicators (1) self-reported ill-health, (2) internal health resources, and (3) external health resources were analysed in relation to a four-category house-hold income distribution in order to describe possible social gradients. The particular aim of this study was to obtain information on the association of income data with self-reported ill-health. METHODS This cross-sectional study was based on a health survey. The sample represents around 10% of the rural population of some communities in Styria, randomly selected from the population registry. Interview data was collected from 3781 participants aged 15 years and older, 1559 males and 2222 females. RESULTS The results show that individuals from lower house-hold income classes are disadvantaged with regard to indicators of ill-health, internal and external health resources. Overall, the link between low income and poor health is highly consistent within our data. CONCLUSIONS Considering our results we conclude that internal and external health resources are as unequally distributed over income levels as health outcome indicators.
Collapse
Affiliation(s)
- W Freidl
- Institute of Social Medicine and Epidemiology, University of Graz.
| | | | | | | |
Collapse
|
46
|
Dionne CE, Von Korff M, Koepsell TD, Deyo RA, Barlow WE, Checkoway H. Formal education and back pain: a review. J Epidemiol Community Health 2001; 55:455-68. [PMID: 11413174 PMCID: PMC1731944 DOI: 10.1136/jech.55.7.455] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To summarise the scientific evidence on the relation between educational status and measures of the frequency and the consequences of back pain and of the outcomes of interventions among back pain patients, and to outline possible mechanisms that could explain such an association if found. DESIGN Sixty four articles published between 1966 and 2000 that documented the association of formal education with back pain were reviewed. MAIN RESULTS Overall, the current available evidence points indirectly to a stronger association of low education with longer duration and/or higher recurrence of back pain than to an association with onset. The many reports of an association of low education with adverse consequences of back pain also suggest that the course of a back pain episode is less favourable among persons with low educational attainment. Mechanisms that could explain these associations include variations in behavioural and environmental risk factors by educational status, differences in occupational factors, compromised "health stock" among people with low education, differences in access to and utilisation of health services, and adaptation to stress. Although lower education was not associated with the outcomes of interventions in major studies, it is difficult, in light of the current limited available evidence, to draw firm conclusions on this association. CONCLUSION Scientific evidence supports the hypothesis that less well educated people are more likely to be affected by disabling back pain. Further study of this association may help advance our understanding of back pain as well as understanding of the relation between socioeconomic status and disease as a general phenomenon.
Collapse
Affiliation(s)
- C E Dionne
- Department of Epidemiology, University of Washington, Seattle, USA.
| | | | | | | | | | | |
Collapse
|
47
|
Axelrod DA, Proctor MC, Geisser ME, Roth RS, Greenfield LJ. Outcomes after surgery for thoracic outlet syndrome. J Vasc Surg 2001; 33:1220-5. [PMID: 11389421 DOI: 10.1067/mva.2001.113484] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE This study determined whether there is an association between psychological and socioeconomic characteristics and the long-term outcome of operative treatment for patients with sensory neurogenic thoracic outlet syndrome (N-TOS). METHODS Clinical records, preoperative psychological testing results, and long-term follow-up questionnaire data were reviewed for consecutive patients who underwent surgery for N-TOS from 1990 to 1999. Multivariate logistic regression models were developed as a means of identifying independent risk factors for postoperative disability. RESULTS Operative decompression of the brachial plexus via a supraclavicular approach was performed for upper extremity pain and paresthesia with no mortality and minimal morbidity in 170 patients. After an average follow-up period of 47 months, 65% of patients reported improved symptoms, and 64% of patients were satisfied with their operative outcome. However, 35% of patients remained on medication, and 18% of patients were disabled. Preoperative factors associated with persistent disability include major depression (odds ratio [OR], 15.7; P =.02), not being married (OR, 7.9; P =.04), and having less than a high school education (OR, 8.1; P =.09). CONCLUSION Operative decompression was beneficial for most patients. Psychological and social factors, including depression, marital status, and education, are associated with self-reported disability. The impact of the preoperative treatment of depression on the outcome of TOS decompression should be studied prospectively.
Collapse
Affiliation(s)
- D A Axelrod
- Department of Surgery, University of Michigan Hospitals, Ann Arbor, USA
| | | | | | | | | |
Collapse
|
48
|
Fillenbaum GG, Hanlon JT, Landerman LR, Schmader KE. Impact of estrogen use on decline in cognitive function in a representative sample of older community-resident women. Am J Epidemiol 2001; 153:137-44. [PMID: 11159158 DOI: 10.1093/aje/153.2.137] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The authors investigated whether postmenopausal estrogen use helps to maintain cognitive function; a brief screen, the Short Portable Mental Status Questionnaire (SPMSQ), was used. Information was gathered from a stratified, random sample of 1,907 African-American and White women (aged 65-100 years) participating in the longitudinal Duke Established Populations for Epidemiologic Studies of the Elderly project carried out in five urban and rural counties of North Carolina. All women were cognitively unimpaired in 1986-1987 and were evaluated 3 and 6 years later. Decline in cognitive function was measured as an increase of two or more errors on the SPMSQ and crossing of an SPMSQ threshold indicative of cognitive impairment. Recency and continuity of estrogen use were measured. Univariate analyses indicated that recent (crude odds ratio = 0.42, 95% confidence interval: 0.21, 0.86) and continuous (crude odds ratio = 0.32, 95% confidence interval: 0.13, 0.81) estrogen use reduced the risk of cognitive decline but not of cognitive impairment. After adjustment for demographic and health characteristics, protective effects became nonsignificant. While postmenopausal use of estrogen may be protective for Alzheimer's disease, current findings based on a brief cognitive screen suggest that it is not protective for cognitive decline related to aging.
Collapse
Affiliation(s)
- G G Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | |
Collapse
|
49
|
Kalediene R, Petrauskiene J. Inequalities in life expectancy in Lithuania by level of education. Scand J Public Health 2000; 28:4-9. [PMID: 10817308 DOI: 10.1177/140349480002800103] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to examine educational inequalities in life expectancy of the Lithuanian population. The life-tables by level of education were calculated on the basis of the individual records of the 1989 census, which were linked to the death records of males and females, aged 25-70 years. In comparison with the group with university education, the life expectancy of males with primary or lower education was 11.7 years shorter, and of females 4.3 years shorter. The greatest impact of educational differentials on life expectancy was the inequality found in the mortality of the population, aged 25-44 years. Sex differences in life expectancy were greatest among those with primary or lower education. External causes of death contributed most to educational differences in life expectancy of males, whereas cardiovascular diseases had a major impact to educational differences in females.
Collapse
|
50
|
Davis TC, Byrd RS, Arnold CL, Auinger P, Bocchini JA. Low literacy and violence among adolescents in a summer sports program. J Adolesc Health 1999; 24:403-11. [PMID: 10401968 DOI: 10.1016/s1054-139x(98)00148-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To investigate the relationship between inadequate literacy and violent behavior among adolescents. METHODS This descriptive study involved a convenience sample of 386 adolescents who participated in a summer track and field and literacy program serving youths in low-income neighborhoods in Shreveport, Louisiana, during 1994-1996. Self-reported violence was measured using the Youth Risk Behavior Survey (YRBS) and reading grade levels were measured by the Slosson Oral Reading Test-Revised (SORT-R). RESULTS Youths ranged in age from 11 to 18 years; 66% were male, and 86% were African-American. Forty-three percent of adolescents tested had below-grade reading levels (> or = 2 grades). Participants with below-grade reading skills had higher rates of self-reported violent behaviors compared with those reading at grade level. When gender, race, and age were controlled for, adolescents reading below grade level were significantly more likely to report carrying weapons [odds ratio (OR) = 1.9; 95% confidence interval (CI) 1.1-3.5], carrying guns (OR = 2.6; CI 1.1- 6.2), to have been in a physical fight at school (OR = 1.7; CI 1.1-2.6), and to have been in a physical fight resulting in injuries requiring treatment (OR = 3.1; CI 1.6-6.1). In addition, youths reading below grade level were significantly more likely to be threatened at school with a weapon (OR = 2.1; CI 1.2-3.7) and to report missing days of school in the previous 30 days because they felt unsafe at school (OR = 2.3; CI 1.3-4.3). In characterizing the violence related behaviors, we found that low reading-level adolescents were more likely to be both aggressor/perpetrator and victim (44% vs. 32%; p = .02) and less likely to be only a victim (6% vs. 12%; p = .04) compared to adolescents with grade-appropriate reading skills. CONCLUSIONS Below-grade-level reading was significantly related to violence behaviors among adolescents who volunteered for a summer track and field program. Longitudinal studies are needed to further investigate the relationship of below-grade-level reading and aggressive/perpetrator and victim behaviors.
Collapse
Affiliation(s)
- T C Davis
- Department of General Medicine and Pediatrics, Louisiana State University Medical Center in Shreveport, 71130-3932, USA
| | | | | | | | | |
Collapse
|