Self-reported health and gender: The role of social norms

Accelerated Bacille Calmette-Guérin reactions: More than meets the eye

An accelerated local injection site reaction following Bacille Calmette-Guérin (BCG) vaccination has been associated with underlying active tuberculosis (TB) in high TB-prevalence settings. The clinical significance of this accelerated BCG reaction in individuals without TB symptoms, particularly in low TB-prevalence countries, is unclear. Using safety surveillance data and baseline interferon-gamma release assays (IGRA) within an international randomised trial of BCG vaccination in healthcare workers (the BRACE trial), we aimed to determine the incidence, and investigate for clinical implications, of an accelerated BCG reaction in asymptomatic adults in low and high TB-prevalence settings. An accelerated BCG reaction occurred in 755/1984 (38 %) of BCG-vaccinees. Although more frequently painful, tender, erythematous and/or swollen within the first fourteen days of vaccination, compared with non-accelerated reactions, the majority of injection site reactions were mild and did not meet criteria for an adverse event. Prior mycobacterial exposure, through prior BCG vaccination (OR 2.46, 95%CI 1.93-3.13, p < 0.001) or latent TB infection (OR 4.17, 95%CI 1.16-14.93, p = 0.03), and female sex (OR 1.27, 95%CI 1.03-1.57, p = 0.02), were key determinants for the occurrence of an accelerated BCG reaction. The development of an accelerated local reaction to BCG vaccination in an individual without prior history of BCG vaccination, should prompt consideration of further investigations for potential underlying TB infection.

The association between youth violence and mental health outcomes in Colombia: A cross sectional analysis

BACKGROUND

Violence against children and youth poses public health risks regarding mental health symptoms and substance use. Less studied is the relationship between violence and mental health/substance abuse in the Latin American context. This study explored sex-stratified relationships between violence and mental health/substance use among Colombian youth.

METHODS

We analyzed the 2018 Colombian Violence Against Children and Youth Survey, which collected cross-sectional data from Colombian youth (13-24 years) (n = 2705). Exposure variables were (i) binary sexual, emotional, and physical victimization and (ii) poly-victimization. The outcomes were binary suicidal thoughts, self-harm, past-month psychological distress, binge drinking, smoking, and drug use. Sex-stratified, logistic regressions were adjusted for age, primary school, parental presence, relationship status, and witnessing community violence.

RESULTS

For females, (i) emotional violence (compared to being unexposed) was associated with greater odds of suicidal thoughts, self-harm, and psychological distress and (ii) sexual violence was associated with suicidal thoughts and self-harm. For males, (i) emotional violence (compared to being unexposed) was associated with greater odds of suicidal thoughts and psychological distress, but not self-harm and (ii) sexual violence exposure was associated with suicidal thoughts and self-harm. Physical violence was generally not associated with internalized mental health outcomes for females/males, when emotional and sexual violence were held constant. Poly-victimization was consistently and positively associated with internalized mental health symptoms among females, and to a lesser degree for males. Substance use outcomes for males or females were not associated with violence.

CONCLUSIONS

Findings highlight the internalized mental health burden of emotional and sexual violence.

Differences in how women and men in a Swedish population-based sample think about sick leave: A cross-sectional vignette study

BACKGROUND

Gender differences in attitudes towards depression gives reason to believe that sociocultural gender norms play a role in other areas.

OBJECTIVE

The aim was to test (i) if the likelihood to think that sick leave with depression symptoms is not reasonable varies between women and men, and (ii) if the likelihood to think sick leave is not reasonable varies depending on the gender of the individual with depression symptoms.

METHODS

A study population of 3147 participants responded to a web-survey with a written case briefly describing a man or woman with symptoms of depression. Respondents were asked if they thought it is reasonable that the person was sick listed for two weeks. Logistic regression was used to analyse the data.

RESULTS

After controlling for age, education, self-rated health, and respondent's own experience of sickness absence the adjusted OR was 1.45 (95% CI 1.25-1.67) for men being less likely to think sick-leave was reasonable. Gender difference decreased when adjusting for negative attitudes towards depression (adjusted OR 1.24, 95% CI 1.06-1.44). No difference was found between how women and men thought about sick leave in relation to the gender of the case described in the vignette.

CONCLUSION

Men were more likely to think that sick leave was not reasonable with decreased OR after adjustment for negative attitudes towards depression. Gender norms might be part of the explanation for differences but are challenging to test. This study contributes to a bourgeoning research field on gendered attitudes and sick leave, in terms of theoretical reasoning and methodological choice.

General and COVID19-specific emotional stress: Religious practice as a potential coping strategy

Using Spanish microdata from the Survey on mental health during the COVID-19 pandemic conducted in February 2021 by the Centre for Sociological Research (CIS), this paper aims at identifying individual factors associated with an increased risk of mental or emotional distress arising from two different sources: a general pattern of depression or anxiety and distress specifically associated with the pandemic as measured by fears and worries about one's own or others' lives and job and income insecurity due to the COVID-19 health crisis. We explore gender differences in both types of mental distress as well as the role of individual religiosity, measured as religious beliefs and behaviours, as a potential coping strategy. In both general and COVID-specific mental distress, our results provide evidence of gender differences in the risk of suffering these conditions, with a higher incidence among women. We also find that religious beliefs and practice seem to have served as a coping strategy that has allowed females to narrow the gender gap, particularly for practising Catholics. The evidence is stronger for mental distress associated with anxiety or depression. However, it is still present, albeit to a lesser extent, for suffering caused by pandemic-related mental stressors. Our results suggest that religious practices and beliefs might play a key role in alleviating additional distress symptoms caused by emergency situations such as those suffered during the COVID-19 pandemic.

The contribution of risk perception and social norms to reported preventive behaviour against selected vector-borne diseases in Guyana

Preventing vector-borne diseases (VBDs) mainly relies on effective vector control tools and strategies, which in turn depend on population acceptance and adherence. Inspired by the abundant recent literature on SARS-COV-2, we investigate the relationship between risk perception and preventive behaviour for selected VBDs and the extent to which risk perception is determined by social norms. We use cross-sectional data collected from 497 individuals in four regions of Guyana in 2017. We use a conditional mixed process estimator with multilevel coefficients, estimated through a Generalized Linear Model (GLM) framework, applying a simultaneous equation structure. We find robust results on malaria: risk perception was significantly influenced by the risk perception of the reference group across different definitions of the reference group, hinting at the existence of social norms. Risk perception significantly increased the likelihood of passive behaviour by 4.48%. Less clear-cut results were found for dengue. This study applies quantitative social science methods to public health issues in the context of VBDs. Our findings point to the relevance of tailoring communications on health risks for VBDs to groups defined at the intersection of socio-economic and demographic characteristics. Such tailored strategies are expected to align risk perception among reference groups and boost preventive behaviour.

Erratum: Factors influencing scar formation following Bacille Calmette-Guérin (BCG) vaccination

[This corrects the article DOI: 10.1016/j.heliyon.2023.e15241.].

The socioeconomic inequity in healthcare utilization among individuals with cardiovascular diseases in India

We assess the effects of socioeconomic inequity on healthcare utilization among individuals with cardiovascular diseases (CVDs) in India using the indirect standardization method with Erreygers' corrected concentration index. We analyze both horizontal and vertical inequities and linearly decompose the respective inequities to identify the major factors driving both kinds of inequities. Our findings show that actual healthcare utilization is highly concentrated among rich CVD individuals. After controlling for the confounding effects of health needs, horizontal inequity is found to be significantly pro-rich, and income and urban concentration are found to be the major factors driving this inequity. However, the direction and magnitude of vertical inequity vary, depending on the selection of the target group. When we use healthcare utilization of the richest 20 percent as the target, we find no significant vertical inequity among CVD individuals. However, when we take the richest 10 percent as the target, we observe a significant pro-rich differential effect of health needs on healthcare utilization between all individuals and the target group. Decomposition reveals an inappropriate differential effect of health needs and age in driving vertical inequity. Hence, the presence of vertical inequity may trigger further pro-rich socioeconomic inequity in healthcare utilization if not supported by any targeted healthcare coverage.

Factors influencing scar formation following Bacille Calmette-Guérin (BCG) vaccination

The prevalence of scar formation following Bacille Calmette-Guérin (BCG) vaccination varies globally. The beneficial off-target effects of BCG are proposed to be stronger amongst children who develop a BCG scar. Within an international randomised trial ('BCG vaccination to reduce the impact of coronavirus disease 2019 (COVID-19) in healthcare workers'; BRACE Trial), this nested prospective cohort study assessed the prevalence of and factors influencing scar formation, as well as participant perception of BCG scarring 12 months following vaccination . Amongst 3071 BCG-recipients, 2341 (76%) developed a BCG scar. Scar prevalence was lowest in Spain and highest in UK. Absence of post-injection wheal (OR 0.4, 95%CI 0.2-0.9), BCG revaccination (OR 1.7, 95%CI 1.3-2.0), female sex (OR 2.0, 95%CI 1.7-2.4), older age (OR 0.4, 95%CI 0.4-0.5) and study country (Brazil OR 1.6, 95%CI 1.3-2.0) influenced BCG scar prevalence. Of the 2341 participants with a BCG scar, 1806 (77%) did not mind having the scar. Participants more likely to not mind were those in Brazil, males and those with a prior BCG vaccination history. The majority (96%) did not regret having the vaccine. Both vaccination-related (amenable to optimisation) and individual-related factors affected BCG scar prevalence 12 months following BCG vaccination of adults, with implications for maximising the effectiveness of BCG vaccination.

Self-reported Versus Physician-reported Severity of Chronic Hand Eczema: Concordance Analysis Based on Data from the German Chronic Hand Eczema Patient Long-Term Management Registry

Self-assessment of general health status has a significant influence on patient-related outcomes. The aims of this study were to investigate and compare the level of agreement between patients' and dermatologists' assessments of the severity of chronic hand eczema. From the German registry "German Chronic Hand Eczema Patient Long-Term Management Registry" (CARPE), 1,281 pairs of patients with chronic hand eczema and their dermatologists were included. Of these, 788 pairs served as a comparison 2 years after baseline. Concordance analyses found that complete concordance between patients' and dermatologists' assessments were 16.62% at baseline and 11.47% at follow-up. Overall, patients assessed their chronic eczema at baseline as more severe than did the dermatologists; whereas, at follow-up, patients assessed their condition as less severe than the dermatologists' assessment. Bangdiwala's B showed lower values of concordance for womens' and older patients' self-assessment with the dermatologists' assessments. In conclusion, dermatologists should consider the patient's perspective and the individual's assessment of their chronic hand eczema in order to provide effective care in clinical practice.

Gender Gap in Mental Health during the COVID-19 Pandemic in South Korea: A Decomposition Analysis

The economic and social effects of the COVID-19 pandemic have been widespread but unevenly distributed among genders. The pandemic may have also affected men's and women's mental health differently. This study examined whether the pandemic had stronger adverse effects on women's mental health than on that of men given that the decline of the labor market was greater for women than for men. Using data from South Korea (June/September/December 2020, N = 3000), we investigated the gender gap in mental health during the first year of the COVID-19 pandemic and its association with gender differences in labor market experiences. We employ the Blinder-Oaxaca decomposition method for this analysis. Although depression and anxiety increased among employed women and men during COVID-19, women showed lower levels of mental health than men. A significant portion of this gender gap is explained by women experiencing greater job loss, income reduction, and prohibition of remote work than men. We also find that women in their 30s experienced greater mental health problems than men of the same age even after controlling for other conditions. Overall, our findings show that a greater proportion of employed women than men experienced poor labor market conditions and increased family burdens during the COVID-19 pandemic, which contributed to women reporting worse mental health than men.

Toward a Better Understanding of Sex- and Gender-Related Differences in Endovascular Stroke Treatment: A Scientific Statement From the American Heart Association/American Stroke Association

There are many unknowns when it comes to the role of sex in the pathophysiology and management of acute ischemic stroke. This is particularly true for endovascular treatment (EVT). It has only recently been established as standard of care; therefore, data are even more scarce and conflicting compared with other areas of acute stroke. Assessing the role of sex and gender as isolated variables is challenging because they are closely intertwined with each other, as well as with patients' cultural, ethnic, and social backgrounds. Nevertheless, a better understanding of sex- and gender-related differences in EVT is important to develop strategies that can ultimately improve individualized outcome for both men and women. Disregarding patient sex and gender and pursuing a one-size-fits-all strategy may lead to suboptimal or even harmful treatment practices. This scientific statement is meant to outline knowledge gaps and unmet needs for future research on the role of sex and gender in EVT for acute ischemic stroke. It also provides a pragmatic road map for researchers who aim to investigate sex- and gender-related differences in EVT and for clinicians who wish to improve clinical care of their patients undergoing EVT by accounting for sex- and gender-specific factors. Although most EVT studies, including those that form the basis of this scientific statement, report patient sex rather than gender, open questions on gender-specific EVT differences are also discussed.

The Sex-Specific Impact of the FORTA (Fit-fOR-The-Aged) List on Medication Quality and Clinical Endpoints in Older Hospitalized Patients: Secondary Analysis of a Randomized Controlled Trial

Background

Little is known about the sex-specific impact of drug optimization tools such as the Fit fOR The Aged (FORTA) list on drug use and relevant clinical endpoints in older people.

Objective

We aimed to detect gender differences of interventional effects on medication quality and related clinical effects in the VALFORTA trial.

Patients and methods

A sex-specific analysis of data from 409 patients (147 men and 262 women, mean age 79.4 and 82.7 years, respectively) in acute geriatric care comparing the control and FORTA intervention groups was performed. Changes of the FORTA score (sum of over- and undertreatment errors per patient), the incidence of adverse drug events (ADEs) during hospitalization, and several clinically relevant endpoints [e.g., the Barthel index (BI)] were tested for equivalence at a 20% margin. “Success” or “failure” for the development of these clinical endpoints was defined and their frequencies compared by a risk reduction analysis.

Results

Sex differences were insignificant for the reduction of the FORTA score, the improvement of BI, or over- and undertreatment errors (p > 0.05). In women only, the FORTA intervention significantly increased the number of patients without an ADE (p = 0.010). Statistical sex equivalence was found for the improvement of the FORTA scores, BI, and the number of prevented events (e.g., falls, confusion, or renal failure) (p < 0.05), but not for the improvement of specific mistreatments or over- and undertreatment scores under altered inclusion criteria (p > 0.05).

Conclusions

Both sexes benefit equally from the FORTA intervention regarding the amelioration of the quality of drug treatment as well as several clinically relevant outcomes. In addition, the positive impact of the FORTA intervention on the number of adverse drug events appears to be greater in women.

Trial Registration Number

DRKS00000531.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40801-022-00292-9.

Associations between anxiety and the willingness to be exposed to COVID-19 risk among French young adults during the first pandemic wave

The COVID-19 outbreak has generated significant uncertainty about the future, especially for young adults. Health and economic threats, as well as more diffuse concerns about the consequences of COVID-19, can trigger feelings of anxiety, leading individuals to adopt uncertainty-reducing behaviours. We tested whether anxiety was associated with an increase in willingness to be exposed to the risk of COVID-19 infection (WiRE) using an online survey administered to 3,110 French individuals aged between 18 and 35 years old during the first pandemic wave and lockdown period (April 2020). Overall, 56.5% of the sample declared a positive WiRE. A one standard deviation increase in psychological state anxiety raised the WiRE by +3.9 pp (95% CI [+1.6, 6.2]). Unemployment was associated with a higher WiRE (+8.2 percentage points (pp); 95% CI [+0.9, 15.4]). One standard deviation increases in perceived hospitalisation risk and in income (+1160€) were associated with a -4.1 pp (95% CI [-6.2, 2.1]) decrease in the WiRE and +2.7 pp increase (95% CI [+1.1, 4.4]), respectively. Overall, our results suggest that both psychological anxiety and the prospect of economic losses can undermine young adults' adherence to physical distancing recommendations. Public policies targeting young adults must consider both their economic situation and their mental health, and they must use uncertainty-reducing communication strategies.

Revaccination with Bacille Calmette-Guérin (BCG) is associated with an increased risk of abscess and lymphadenopathy

The reported frequency and types of adverse events following initial vaccination and revaccination with Bacille Calmette-Guérin (BCG) varies worldwide. Using active surveillance in a randomised controlled trial of BCG vaccination (the BRACE trial), we determined the incidence and risk factors for the development of BCG injection site abscess and regional lymphadenopathy. Injection site abscess occurred in 3% of 1387 BCG-vaccinated participants; the majority (34/41, 83%) resolved without treatment. The rate was higher in BCG-revaccinated participants (OR 3.6, 95% CI 1.7-7.5), in whom abscess onset was also earlier (median 16 vs. 27 days, p = 0.008). No participant with an abscess had a positive interferon-gamma release assay. Regional lymphadenopathy occurred in 48/1387 (3%) of BCG-vaccinated participants, with a higher rate in revaccinated participants (OR 2.1, 95% CI 1.1-3.9). BCG-associated lymphadenopathy, but not injection site abscess, was influenced by age and sex. A previous positive tuberculin skin test was not associated with local reactions. The increased risk of injection site abscess or lymphadenopathy following BCG revaccination is relevant to BCG vaccination policy in an era when BCG is increasingly being considered for novel applications.

Gender heterogeneity in self-reported hypertension

We investigate the gender gap in hypertension misreporting using the French Constances cohort. We show that false negative reporting of hypertension is more frequent among men than among women, even after conditioning on a series of individual characteristics. As a second step, we investigate the causes of the gender gap in hypertension misreporting. We show that women go to the doctor more often than men do and that they have better knowledge of their family medical history. Once these differences are taken into account, the gender gap in false negative reporting of hypertension is reversed. This suggests that information acquisition and healthcare utilisation are crucial ingredients in fighting undiagnosed male hypertension.

Canadian French Translation and Preliminary Validation of the Conformity to Masculine Norms Inventory: A Pilot Study

Conformity to masculine norms has been linked to poor mental and physical health outcomes. Its valid assessment among subgroups of the population is therefore a crucial step in the investigation of intercultural variability in the enactment of masculinity, as well as its causes, costs, and benefits. The present pilot study aimed to adapt and conduct a preliminary validation of a French version of the Conformity to Masculine Norms Inventory (CMNI-22), a self-report questionnaire designed to assess overall conformity to male gender standards. The French adaptation of the CMNI-22 (CanFr-CMNI-22) was developed using a forward-backward translation process. The data from a sample of 57 Canadian French men (23-81 years old), collected at two time points 2 weeks apart, were then analyzed to investigate the psychometric properties and factor structure of the CanFr-CMNI-22. Findings indicated adequate internal reliability of the global scores and highly satisfactory test-retest reliability. Correlations with the Male Role Norms Inventory-Short Form (MRNI-SF) at both time points also showed strong convergent validity. Overall, the CanFr-CMNI-22 appears to be a reliable and valid instrument to assess conformity to traditional masculine gender norms in French-speaking men from the general population. This study is a key step in a research process aiming to validate the Canadian French version of the CMNI and contributes to enhance inclusive research and clinical care to foster men's health.

Factors associated with oral pain and oral health-related productivity loss in the USA, National Health and Nutrition Examination Surveys (NHANES), 2015-2018

Background

Our aim was to identify clinical and sociodemographic factors associated with oral pain and oral health-related productivity loss among US adults.

Methods

We included adults aged ≥30 years who completed the dental examination, had at least one natural tooth, and provided an answer about their oral pain experience or oral health-related productivity loss in the 2015–2018 National Health and Nutrition and Examination Survey (NHANES). We performed descriptive analyses and multivariable binary logistic regression analyses on weighted data.

Results

One out of four adults had oral pain and 4% reported oral health-related productivity loss occasionally or often within the last year of the survey. The odds of oral pain were higher among non-Hispanic black (OR = 1.35; 95%CI = 1.08–1.62) and non-Hispanic Asian individuals (OR = 1.38; 95%CI = 1.07–1.78) compared to non-Hispanic white individuals, and individuals with untreated dental caries (OR = 2.06; 95%CI = 1.72–2.47). The odds for oral health-related productivity loss were 13.85 times higher among individuals who reported oral pain (95%CI = 8.07–23.77), and 2.18 times higher among individuals with untreated dental caries (95%CI = 1.65–2.89). The odds of oral pain and reported oral health-related productivity loss decreased as family income increased.

Conclusions

Factors including non-Hispanic black race/ethnicity, lower socio-economic status, and untreated dental caries are associated with oral pain experience, which increases the odds of oral health-related productivity losses. Identifying factors associated with oral pain and productivity loss will enable clinicians, policymakers, and employers to proactively target and prioritize the higher-risk groups in early interventions and policies.

Dravet syndrome: Effects on informal caregivers' mental health and quality of life - A systematic review

BACKGROUND

Dravet syndrome (DS) is a severe developmental and epileptic encephalopathy, with predictable negative consequences for informal caregivers' mental health. This systematic review aimed to evaluate the representativeness of depression, anxiety, and burden in these caregivers and assess their quality of life.

METHODS

The PRISMA recommendations were followed, and a comprehensive search was conducted on PubMed/MEDLINE, WoS and Scopus databases, without date or language limits. Only observational quantitative studies on adult informal caregivers of patients with DS were considered.

RESULTS

Of 876 records found, 21 full-text articles were assessed and only 6 met the inclusion criteria. The latter have mostly a cross-sectional design and include samples composed by 19 to 742 caregivers, mainly mothers/females. Most of the study participants had a Bachelor's degree/higher educational level and were married. An important incidence of depression and anxiety on DS caregivers was reported, with significantly higher levels compared with population norms and with carers of other patients with epilepsy. Depression/anxiety were shown to be significantly associated with caregivers' fatigue and compromised sleep quality. Other important aspects of burden have been identified; however, comparisons between studies were not possible as different scales were used. Caregivers' health-related quality of life is also affected, with mothers reporting a worse perception on this domain.

CONCLUSIONS

Mental health and quality of life of DS caregivers are compromised, with mothers bearing an apparently greater burden. Studies using validated instruments for this population to assess the previously considered outcomes are needed, in order to inform the development of preventive strategies and problem-oriented interventions.

Health measures and long-term care use in the European frail population

This paper explores the association between health measures and long-term care (LTC) use in the 70+ old population. We examine how different measures of health-subjective versus objective-predict LTC use, provided either formally or informally. We consider an absolute measure of subjective health, the grade given by the individual to his/her health status, and additionally construct a relative measure capturing the difference between this grade and the average grade given to health by individuals sharing the same characteristics. Conceptually, this difference comes from the perception of the individual, corresponding to both the private health information and the reporting behavior affecting self-rated health. We use the baseline data from the SPRINTT study, an ongoing randomized control trial on 1519 subjects facing physical frailty and sarcopenia (PF&S) in 11 European countries. Our sample population is older than 70 (mean: 79 years) and comprises a majority (71%) of women. Results show that self-rated health indicators correlate to formal care even when objective health measures are included, while it is not the case for informal care. Formal care consumption thus appears to be more sensitive to the individual's perception of health than informal care.

Diverging ideas of health? Comparing the basis of health ratings across gender, age, and country

BACKGROUND

Self-rated health (SRH) is arguably the most widely used generic health measurement in survey research. However, SRH remains a black box for researchers. In our paper, we want to gain a better understanding of SRH by identifying its determinants, quantifying the contribution of different health domains to explain SRH, and by exploring the moderating role of gender, age groups, and the country of residence.

METHOD

Using data from 61,365 participants of the fifth wave (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE) living in fifteen European countries, we explain SRH via linear regression models. The independent variables are grouped into five health domains: functioning, diseases, pain, mental health, and behavior. Via dominance analysis, we focus on their individual contribution to explaining SRH and compare these contributions across gender, three age groups, and fifteen European countries.

RESULTS

Our model explains SRH rather well (R² = .51 for females/.48 for males) with functioning contributing most to the appraisal (.20/.18). Diseases were the second most relevant health dimension (.14/.16) followed by pain (.08/.07) and mental health (.07/.06). Health behavior (.02/.01) was less relevant for health ratings. This ranking held true for almost all countries with only little variance overall. A comparison of age groups indicated that the contribution of diseases and behavior to SRH decreased over the life-course while the contribution of functioning to R² increased.

CONCLUSION

Our paper demonstrates that SRH is largely based on diverse health information with functioning and diseases being most important. However, there is still room for idiosyncrasies or even bias.

'Measuring up': A comparison of two response expectancy assessment formats completed by men treated with radiotherapy for prostate cancer

OBJECTIVE

Response expectancies of cancer treatment toxicities are often, but not always, associated with subsequent experiences. A recent meta-analysis indicated that response expectancies, measured using different assessment formats, reveal different effect sizes, potentially explaining mixed outcomes. Utilizing a clinical sample, we compared 5-point assessments and visual analogue scales, as measures of response expectancies for the incidence and severity of subsequent toxicities.

METHODS

Four weeks pre-radiotherapy, 45 men with prostate cancer rated their response expectancies of the same 18 toxicities on 5-point assessments and visual analogue scales, presented in random order. Descriptors anchored each end of visual analogue scales and every point of 5-point assessments was labelled, including an 'unsure' midpoint. Toxicities were subsequently assessed 2-weeks into radiotherapy on 100-point visual analogue scales.

RESULTS

Across all toxicities, 17.5-62.8% of patients selected 'unsure' on 5-point assessments. No response expectancies were reported on 5-point assessments for 'blood in stools' or 'rectal urgency' yet 54.8%-64.3% of patients indicated response expectancies for these toxicities on visual analogue scales. Visual analogue scales and 5-point scales demonstrated small-to-moderate associations (r = 0.30-0.58) as measures of response expectancy incidence, but mostly large associations when visual analogue scales captured severity (r = 0.43-0.76). Response expectancies measured with visual analogue scales predicted more toxicities to a moderate degree or greater (68.8%) than 5-point assessments (37.5%).

CONCLUSION

This novel investigation demonstrated an 'unsure' midpoint is often selected, potentially reducing the sensitivity of 5-point assessments. Based on their associations, and outcomes, these assessment formats should be considered independent in response expectancy research of cancer treatment toxicities.

Fit for fight - self-reported health in military women: a cross-sectional study

Background

Substantial research has found that women assess their health as poor relative to men, but the reasons for this are not fully understood. Military women are characterised by good health and the ability to work in an archetypically male culture. Thus, studies on the gender pattern of self-reported health in military personnel could generate hypotheses for future research on the possible associations between gender and health. However, such studies are rare and limited to a few countries. The aim of this study was to examine self-reported physical and mental health in Norwegian military women.

Methods

We compared responses on self-reported health of 1068 active duty military women in Norway to those of active duty military men (n = 8100). Further, we compared the military women to civilian women working in the Norwegian Armed Forces (n = 1081). Participants were stratified into three age groups: 20–29; 30–39; and 40–60 years. We used Pearson Chi-square tests, Students t-tests and regression models to assess differences between the groups.

Results

The military women in our study reported physical illness and injuries equal to those of military men, but more military women used pain relieving and psychotropic drugs. More military women aged 20–29 and 30–39 years reported mental health issues than military men of the same age. In the age group 30–39 years, twice as many military women assessed their health as poor compared to military men. In the age group 40–60 years, more military women than men reported musculoskeletal pain. Military women used less smokeless tobacco than military men, but there were few differences in alcohol consumption and smoking. Military women appeared to be more physically healthy than civilian women, but we found few differences in mental health between these two groups.

Conclusion

Most military women reported physical symptoms equal to those of military men, but there were differences between the genders in mental health and drug use. More favourable health compared to civilian women was most evident in the youngest age group and did not apply to mental health.

Reporting biases in self-assessed physical and cognitive health status of older Europeans

This paper explores which demographic characteristics substantially bias self-reported physical and cognitive health status of older Europeans. The analysis utilises micro-data for 19 European countries from the Survey of Health, Ageing and Retirement in Europe to compare performance-tested outcomes of mobility and memory with their self-reported equivalents. Relative importance analysis based on multinomial logistic regressions shows that the bias in self-reported health is mostly due to reporting heterogeneities between countries and age groups, whereas gender contributes little to the discrepancy. Concordance of mobility and cognition measures is highly related; however, differences in reporting behaviour due to education and cultural background have a larger impact on self-assessed memory than on self-assessed mobility. Southern as well as Central and Eastern Europeans are much more likely to misreport their physical and cognitive abilities than Northern and Western Europeans. Overall, our results suggest that comparisons of self-reported health between countries and age groups are prone to significant biases, whereas comparisons between genders are credible for most European countries. These findings are crucial given that self-assessed data are often the only information available to researchers and policymakers when asking health-related questions.

Self-rated health as a valid indicator for health-equity analyses: evidence from the Italian health interview survey

BACKGROUND

Self-rated health is widely considered a good indicator of morbidity and mortality but its validity for health equity analysis and public health policies in Italy is often disregarded by policy-makers. This study had three objectives. O1: To explore response distribution across dimensions of age, chronic health conditions, functional limitations and SRH in Italy. O2: To explore associations between SRH and healthcare demand in Italy. O3: To explore the association between SRH and household income.

METHODS

Cross-sectional data were obtained from the 2015 Health Interview Survey (HIS) conducted in Italy. Italian respondents (n = 20,814) were included in logistic regression analyses. O1: associations of chronic health conditions (CHC), functional limitations (FL), and age with self-rated health (SRH) were tested. O2: associations of CHC, FL, and SRH with hospitalisation (H), medical specialist consultations (MSC), and medicine use (MU) were tested. O3: associations of SRH and CHC with household income (PEI) were tested.

RESULTS

O1: CHC, FL, and age had an independent summative effect on respondents' SRH. O2: SRH predicted H and MSC more than CHC; age and MU were more strongly correlated than SRH and MU. O3: SRH and PEI were significantly correlated, while we found no correlation between CHC and PEI.

CONCLUSIONS

Drawing from our results and the relevant literature, we suggest that policy-makers in Italy could use SRH measures to: 1) predict healthcare demand for effective allocation of resources; 2) assess subjective effectiveness of treatments; and 3) understand geosocial pockets of health inequity that require special attention.

"Take a Spoonful of Concrete and Harden the **** up!": How British Men in Hong Kong Talk About Health and Illness

The present study draws on semistructured focus group discussions conducted with British men living in Hong Kong to examine how men’s constructions of masculinity influence health behavior and attitudes. Twenty-eight men aged 21–51 years were divided into groups based on age (≤35 years and ≥36 years); length of residence ranged from 2 to 20 years. Discussions were analyzed using open-ended thematic analysis. Following intensive analysis of the transcripts, four subthemes were identified and analyzed in greater detail: (a) health talk; (b) help-seeking behavior; (c) health risk; and (d) health motivations. Findings suggest a widespread endorsement of a hegemonic view of masculinity among men in the present study. Men expressed reluctance in seeking help for illness, regardless of age, particularly when experiencing symptoms of ill-health that were deemed to be “minor.” However, help seeking was embraced when it was perceived to impact masculinity, for example, when potentially related to sexual performance or function. While men in the present study were sometimes dismissive of health advice provided by family, they were more open and responsive to seeking help upon the advice of male friends. Findings are further discussed with reference to the relationships between masculinities and health; implications for health are discussed.

Discrimination, Harassment, and Gendered Health Inequalities: Do Perceptions of Workplace Mistreatment Contribute to the Gender Gap in Self-reported Health?

This study examines the extent to which discrimination and harassment contribute to gendered health disparities. Analyzing data from the 2006, 2010, and 2014 General Social Surveys ( N = 3,724), we ask the following: (1) To what extent are perceptions of workplace gender discrimination and sexual harassment associated with self-reported mental and physical health? (2) How do multiple forms of workplace mistreatment (e.g., racism, ageism, and sexism) combine to structure workers' self-assessed health? and (3) To what extent do perceptions of mistreatment contribute to the gender gap in self-assessed health? Multivariate analyses show that among women, but not men, perceptions of workplace gender discrimination are negatively associated with poor mental health, and perceptions of sexual harassment are associated with poor physical health. Among men and women, perceptions of multiple forms of mistreatment are associated with worse mental health. Gender discrimination partially explains the gender gap in self-reported mental health.

The Influence of Masculine Norms and Occupational Factors on Mental Health: Evidence From the Baseline of the Australian Longitudinal Study on Male Health

Men employed in male-dominated occupations are at elevated risk of work-related fatalities, injuries, and suicide. Prior research has focused on associations between psychosocial and physical exposures at work and health outcomes. However, masculine norms may also contribute to mental health. We used data from the baseline survey of the Australian Longitudinal Study on Male Health to examine whether: (a) men in male-dominated jobs report greater adherence to masculine norms; (b) being in a male-dominated occupation is associated with poorer mental health; and (c) being in a male-dominated occupation modifies the association between masculine norms and mental health. Masculine norms were measured using the Conformity to Masculine Norms Inventory (CMNI-22). Mental health was assessed using the SF-12. Results of regression analysis (adjusted for covariates) suggest a linear relationship between the extent to which an occupation is male-dominated and endorsement of values on the CMNI-22. Many CMNI-22 subscales were related to poorer mental health. However, the need for self-reliance was identified as the strongest predictor of poorer mental health. The mental health scale did not appear to be patterned by occupational gender composition and we did not find an interaction between the gender ratio of an occupation and the CNMI-22 scale. These findings highlight the need to address harmful aspects of masculinity as a potential cause of mental health problems. More longitudinal research is needed on the social domains in which gender and health are experienced, such as in the workplace.

Good jobs, good pay, better health? The effects of job quality on health among older European workers

Using data from the Survey of Health, Ageing and Retirement in Europe, this study presents new evidence on the effects of job quality on the occurrence of severe acute conditions, the level of cardiovascular risk factors, musculoskeletal disorders, mental health, functional disabilities and self-assessed health among workers aged 50+. By combining intrinsic job quality with job insecurity and pay the study maps out multiple potential pathways through which work may affect health and well-being. Levering longitudinal data and external information on early retirement ages allows for accounting of unobserved heterogeneity, selection bias and reverse causality. The empirical findings suggest that inequities in health correlate with inequities in job quality, though a substantial fraction of these associations reflect time-constant unobserved heterogeneity. Still, there is evidence for genuine protective effects of better jobs on musculoskeletal disorders, mental health and general health. The effect could contribute to a substantial number of avoidable disorders among older workers, despite relatively modest effect sizes at the level of individuals. Mental health, in particular, responds to changes in job quality. Selection bias such as the healthy worker effect does not alter the results. But the influence of job quality on health may be transitional among older workers. An in-depth analysis of health dynamics reveals no evidence for persistence.

Sick leave among parents of children with cancer - a national cohort study

BACKGROUND

Due to psychological distress and an increased care burden, parents of children diagnosed with cancer may face a higher risk of sickness absence from work. The objective of this study was to examine the association of childhood cancer with parents' sick leave.

MATERIAL AND METHODS

The sample comprised 3626 parents of 1899 children diagnosed with cancer in Sweden during 2004-2009, and a matched control group of parents (n = 34 874). Sick leave was measured as number of days with sickness benefit, retrieved from national registries. Logistic and negative binomial regression models were used to compare outcomes with parents from the control cohort.

RESULTS

The risk of sick leave was statistically significantly higher up to six years following a child's cancer diagnosis. The increase in number of days with sickness benefit was most pronounced the year after diagnosis. Although mothers' sick leave prevalence was higher, the increase in risk relative to control parents was similar for mothers and fathers. Bereavement was associated with a heightened risk of sick leave, especially on the year of the child's death.

CONCLUSIONS

Findings confirm that mothers and fathers of children diagnosed with cancer are at higher risk of sickness absence from work, with particularly pronounced risk among bereaved parents. Acquisition of further knowledge is warranted regarding possibilities and constraints of parents trying to combine their work life with caring for both their child and themselves.