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Nilsson E, Johanson S, Behm L, Bejerholm U. Public health nurses experience of mental health encounters in the context of primary health care: a constructivist grounded theory study. BMC Nurs 2023; 22:181. [PMID: 37231400 PMCID: PMC10209567 DOI: 10.1186/s12912-023-01340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND In primary health care people with mental health needs are often overlooked or masked with physical complaints. It has been suggested that public health nurses lack sufficient knowledge when encountering people with mental health problems. Low levels of mental health literacy among professionals are associated with negative patient outcome. There is a need to understand public health nurses process and strategies used when encountering a person with mental health problems in order to promote mental health. This study aimed to construct a theory that explains the process of public health nurses experience when encountering people with mental health problems based on their knowledge, attitudes, and beliefs about mental health. METHODS A constructivist grounded theory design was used to meet the aim of the study. Interviews were conducted with 13 public health nurses working in primary health care between October 2019 and June 2021, and the data analysis was performed according to the principles of Charmaz. RESULTS The core category, "Public health nurses as a relationship builder - to initiate the dialogue" reflected the process while the main categories "Being on your own", "Being on top of things- knowing your limits", and "Professional comfort zone" reflected conditions that were decisive for initiating a dialogue. CONCLUSION Managing mental health encounters in primary health care was a personal and complex decision-making process that depends on the public health nurses' professional comfort zone and acquired mental health literacy. Narratives of the public health nurses helped to construct a theory and understand the conditions for recognizing, managing and promoting mental health in primary health care.
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Affiliation(s)
- Emmy Nilsson
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden.
| | - Suzanne Johanson
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden
| | - Lina Behm
- Department of Nursing and Integrated Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Ulrika Bejerholm
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden
- Department of Research and development, Region Skåne, Mental Health Services, County Council of Skåne, Malmö, Sweden
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Aplicação do IVCF-20 adaptado para o telefone como estratégia de avaliação em tempos de Covid-19. CONSCIENTIAE SAÚDE 2022. [DOI: 10.5585/21.2022.21473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ResumoIntrodução: o risco de fragilidade em idosos é algo que deve ser monitorizado, sendo importante seu acompanhamento pelo sistema de saúde, especialmente durante uma pandemia. Objetivo: estimar o risco de fragilidade em idosos comunitários adscritos de uma Unidade Básica de Saúde (UBS) durante a pandemia de COVID-19 com a aplicação do questionário de Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20) adaptado para telefone. Métodos: estudo transversal com 152 idosos (≥ 60 anos) de ambos os sexos, cadastrados na Estratégia em Saúde da Família referente a uma UBS na região urbana de Londrina-PR. A coleta de dados foi realizada em etapa única, durante contato telefônico, utilizando para o registro de informações o IVCF-20, sendo realizadas três tentativas de contato telefônico. Resultados: 68,4% dos idosos eram hipertensos e 24,3% diabéticos. Com relação à moradia, 94,7% dos idosos “não” moram sozinhos e 70,4% possuem uma “boa percepção de saúde”. Para classificação do IVCF-20, 73,0% dos homens são classificados como “robustos”, quando comparados às mulheres (51,7%). Conclusão: a aplicação do IVCF-20 por telefone apresenta capacidade de uso em momentos de risco para a saúde pública, como a pandemia de COVID-19.
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van de Ven D, Robroek SJ, Oude Hengel KM, van Zon SK, Brouwer S, Ots P, Burdorf A, Schuring M. Associations of within-individual changes in working conditions, health behaviour and BMI with work ability and self-rated health: a fixed effects analysis among Dutch workers. BMJ Open 2022; 12:e058574. [PMID: 35487715 PMCID: PMC9058761 DOI: 10.1136/bmjopen-2021-058574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study assessed the associations of (1) within-individual improvements and (2) within-individual deteriorations in working conditions, health behaviour and body mass index (BMI) with changes in work ability and self-rated health among workers. DESIGN Prospective cohort study. SETTING The Netherlands. PARTICIPANTS Persons in paid employment, aged 45-64 years, who participated in the Dutch Study on Transitions in Employment, Ability and Motivation (STREAM) between 2010 and 2017, and improved or deteriorated at least once with respect to working conditions (psychological and emotional job demands, autonomy, social support, physical workload), health behaviour (moderate and vigorous physical activity, smoking status), or BMI between any of two consecutive measurements during the 7-year follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES Changes in self-reported work ability on a scale from 0 to 10 (1st item of the work ability index) and self-rated health on a scale from 1 to 5 (SF-12). RESULTS Of the 21 856 STREAM participants, ultimately 14 159 workers were included in the fixed effects analyses on improvements (N=14 045) and deteriorations (N=14 066). Workers with deteriorated working conditions decreased in work ability (β's: -0.21 (95% CI: -0.25 to -0.18) to -0.28 (95% CI: -0.33 to -0.24)) and health (β's: -0.07 (95% CI: -0.09 to -0.06) to -0.10 (95% CI: -0.12 to -0.08)), whereas improvements were to a lesser extent associated with increased work ability (β's: 0.06 (95% CI: 0.02 to 0.09) to 0.11 (95% CI: 0.06 to 0.16)) and health (β's: 0.02 (95% CI: 0.00 to 0.03) to 0.04 (95% CI: 0.02 to 0.06)). Workers with increased BMI or decreased physical activity reduced in work ability and health. Likewise, decreased BMI or increased vigorous physical activity was associated with improved health. An increase in moderate or vigorous physical activity was modestly associated with a reduced work ability. Quitting smoking was associated with reduced work ability and health. CONCLUSIONS Compared with improvements, preventing deteriorations in working conditions, health behaviour and BMI, might be more beneficial for work ability and workers' health.
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Affiliation(s)
- David van de Ven
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Suzan Jw Robroek
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Karen M Oude Hengel
- Department of Work Health Technology, Netherlands Organisation for Applied Scientific Research (TNO), Leiden, The Netherlands
| | - Sander Kr van Zon
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Patricia Ots
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Merel Schuring
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Hwang JH, Park SW. The relationship between poor sleep quality measured by Pittsburgh Sleep Quality Index and cigarette smoking according to sex and age. Epidemiol Health 2022; 44:e2022022. [PMID: 35167741 PMCID: PMC9117098 DOI: 10.4178/epih.e2022022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/14/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Multiple studies have found that cigarette smokers are more likely to experience sleep disturbances than non-smokers. This study aimed to examine various associations between smoking and sleep quality according to sex and age, which have yet to be sufficiently examined in prior studies. METHODS Data analysis was conducted using a nationally representative sample of 224,986 Korean adults who participated in the 2018 Korea Community Health Survey. Sleep quality, as the dependent variable, was measured using the Pittsburgh Sleep Quality Index (PSQI), with PSQI scores indicating either good (≤4 points) or poor (>5 points) sleep quality. Multiple logistic regression analysis was performed considering socio-demographic factors, health behaviors, comorbidities, and psychological factors as covariates. RESULTS The overall weighted prevalence of poor sleep quality was 39.4% (95% confidence interval, 39.1 to 39.7). In the multivariate model that excluded psychological factors, poor sleep quality positively correlated to smoking for both sexes and all age groups except for male aged ≥65 years. However, in the full model that included psychological factors, statistically significant odds ratios (approximately 1.5) for poor sleep quality according to smoking status were only observed for female under 65 years of age. CONCLUSIONS The relationship between poor sleep quality and smoking status differed according to sex and age. In order to improve the quality of sleep, it is necessary to intervene smoking cessation along with solving psychological problems, especially female in middle age and younger.
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Affiliation(s)
- Jun Hyun Hwang
- Department of Preventive Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Soon-Woo Park
- Department of Preventive Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
- Correspondence: Soon-Woo Park Department of Preventive Medicine, Daegu Catholic University School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea E-mail:
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Hrezova E, Bobak M, Capkova N, Stefler D, Pikhart H. Low fruit and vegetable intake is associated with poor self-rated health in the Czech part of the HAPIEE study. Nutr Health 2021; 29:269-276. [PMID: 34931934 DOI: 10.1177/02601060211069209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Although fruits and vegetables are considered a pillar of healthy eating, previous evidence suggests that their consumption in Eastern European countries is low, and their association with health outcomes has rarely been researched in this region. Aim: To examine the effect of fruit and vegetable intake on self-rated health (SRH) in the Czech arm of the Health, Alcohol and Psychosocial factors in Eastern Europe prospective cohort study. Methods: Dietary data on fruit and vegetable intake was measured at baseline using food frequency questionnaires, and SRH from the second wave was chosen as the main outcome. The relationship between fruit and vegetable intake and SRH was analysed using multivariable ordinal regression. Results: A total of 4255 persons aged 45-69, in good and very good SRH at baseline were included in the longitudinal analysis, with a median follow-up time of 3.7 years. In the second wave, 218 (5.1%) individuals reported poor or very poor SRH. In the fully adjusted model, individuals in the lowest fruit and vegetable intake quartile had higher odds of poor SRH compared to those in the highest quartile (OR = 1.24, 95% CI: 1.01-1.52). When examined separately, the results were similar: for vegetables (OR = 1.25, 95% CI: 1.03-1.51) and fruit (OR = 1.18, 95% CI: 0.97-1.44). Conclusion: The observed longitudinal association suggests that low fruit and vegetable intake is associated with poor SRH in the Czech Republic. Considering almost half of our sample reported less than the daily recommended intake of 400 grams of fruits and vegetables, higher consumption should be supported.
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Affiliation(s)
- Eliska Hrezova
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, 37748Masaryk University, Kamenice 753/5, D29, 625 00 Brno, Czech Republic
| | - Martin Bobak
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, 37748Masaryk University, Kamenice 753/5, D29, 625 00 Brno, Czech Republic.,Research Department of Epidemiology and Public Health, 4919University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Nadezda Capkova
- 37739The National Institute of Public Health, Šrobárova 49/48, 100 00 Praha, Czech Republic
| | - Denes Stefler
- Research Department of Epidemiology and Public Health, 4919University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Hynek Pikhart
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, 37748Masaryk University, Kamenice 753/5, D29, 625 00 Brno, Czech Republic.,Research Department of Epidemiology and Public Health, 4919University College London, 1-19 Torrington Place, London WC1E 7HB, UK
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Ma T, Gao B. The Association of Social Capital and Self-Rated Health Between Urban Residents and Urbanized Rural Residents in Southwest China. Front Public Health 2021; 9:718793. [PMID: 34513788 PMCID: PMC8425509 DOI: 10.3389/fpubh.2021.718793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/04/2021] [Indexed: 02/05/2023] Open
Abstract
China has seen an accelerated process of urbanization in the past 30 years. The influence of urbanization on health is complex and primarily influenced by changes in social capital. The purpose of this research was to compare the social capital between urban residents and urbanized rural residents of southwest China and its relationship with self-rated health. It is of great significance to study the difference of social capital between urban and urbanized rural residents to help urbanized rural residents improve their social adaptability and health. Data was collected from 1,646 residents between November and December of 2017 in Chengdu. Three logistic regressions were used to investigate the association between social capital and self-rated health by controlling for demographic variables, lifestyles factors, and health status factors. We observed that urban residents' self-rated health had a higher proportion of “good” than that of urbanized rural residents (P = 0.017). After controlling for factors such as health status and demographic characteristics, participants with higher social capital had better self-rated health. Urbanized rural residents with higher community trust and belonging had better self-rated health (OR = 0.701, 95% CI = 0.503~0.978), however urban residents with higher personal social networks and family relationships had better self-rated health (OR = 0.676, 95% CI = 0.490~0.933 and OR = 0.666, 95% CI = 0.450~0.987, respectively). Different types of communities should focus on the types of social capital from different sources, so as to take more targeted measures to improve the social support of residents and improve their health. Improving residents' social trust and sense of belonging may help urbanized rural residents better adapt to the new living environment and help them complete the identity transformation.
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Affiliation(s)
- Tianpei Ma
- Laboratory for Aging and Cancer Research, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Bo Gao
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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van der Haar S, Hoevenaars FPM, van den Brink WJ, van den Broek T, Timmer M, Boorsma A, Doets EL. Exploring the Potential of Personalized Dietary Advice for Health Improvement in Motivated Individuals With Premetabolic Syndrome: Pretest-Posttest Study. JMIR Form Res 2021; 5:e25043. [PMID: 34185002 PMCID: PMC8277310 DOI: 10.2196/25043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/11/2021] [Accepted: 05/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background Dietary quality plays an essential role in the prevention and management of metabolic syndrome (MetS). Objective The aim of this pilot study is to organize personalized dietary advice in a real-life setting and to explore the effects on dietary intake, metabolic health, and perceived health. Methods We followed a one-group pretest-posttest design and included 37 individuals at risk of MetS, who indicated motivation to change dietary behavior. For a period of 16 weeks, participants received personalized advice (t=0 and t=8) and feedback (t=0, t=4, t=8, t=12 and t=16) on dietary quality and metabolic health (ie, waist circumference, BMI, blood pressure, lipid profile, fasting glucose levels, and C-peptide). Personalized advice was generated in a two-stage process. In stage 1, an automated algorithm generated advice per food group, integrating data on individual dietary quality (Dutch Healthy Diet Index; total score 8-80) and metabolic health parameters. Stage 2 included a telephone consultation with a trained dietitian to define a personal dietary behavior change strategy and to discuss individual preferences. Dietary quality and metabolic health markers were assessed at t=0, t=8, and t=16. Self-perceived health was evaluated on 7-point Likert scales at t=0 and t=16. Results At the end of the study period, dietary quality was significantly improved compared with the baseline (Dutch Healthy Diet Index +4.3; P<.001). In addition, lipid profile (triglycerides, P=.02; total cholesterol, P=.01; high-density lipoprotein, P<.001; and low-density lipoprotein, P<.001), BMI (P<.001), waist circumference (P=.01), and C-peptide (P=.01) were all significantly improved, whereas plasma glucose increased by 0.23 nmol/L (P=.04). In line with these results, self-perceived health scores were higher at t=16 weeks than at baseline (+0.67; P=.005). Conclusions This exploratory study showed that personalized dietary advice resulted in positive effects on dietary behavior, metabolic health, and self-perceived health in motivated pre-MetS adults. The study was performed in a do-it-yourself setting, highlighting the potential of at-home health improvement through dietary changes. Trial Registration ClinicalTrials.gov NCT04595669; https://clinicaltrials.gov/ct2/show/NCT04595669
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Affiliation(s)
- Sandra van der Haar
- Wageningen Food & Biobased Research, Wageningen University & Research, Wageningen, Netherlands
| | - Femke P M Hoevenaars
- Microbiology & Systems Biology Department, TNO, Netherlands Organization for Applied Scientific Research, Zeist, Netherlands
| | - Willem J van den Brink
- Microbiology & Systems Biology Department, TNO, Netherlands Organization for Applied Scientific Research, Zeist, Netherlands
| | - Tim van den Broek
- Microbiology & Systems Biology Department, TNO, Netherlands Organization for Applied Scientific Research, Zeist, Netherlands
| | - Mariëlle Timmer
- Wageningen Food & Biobased Research, Wageningen University & Research, Wageningen, Netherlands
| | - André Boorsma
- Microbiology & Systems Biology Department, TNO, Netherlands Organization for Applied Scientific Research, Zeist, Netherlands
| | - Esmée L Doets
- Wageningen Food & Biobased Research, Wageningen University & Research, Wageningen, Netherlands
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Asplund S, Åhlin J, Åström S, Hedlund M, Lindgren BM, Ericson-Lidman E. Self-rated exhaustion disorder and associated health-related factors among municipal employees in rural areas of northern Sweden. Int Arch Occup Environ Health 2020; 94:659-668. [PMID: 33296011 PMCID: PMC8068702 DOI: 10.1007/s00420-020-01617-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aims of this study among municipal employees in rural areas of northern Sweden were to assess the prevalence of self-rated exhaustion disorder (s-ED), describe plausible between-group differences in self-reported health-related factors among employees with or without s-ED, and identify health-related factors associated with s-ED. METHODS In a cross-sectional study, data were collected from 1093 municipal employees (76.1% women) in two rural areas using an instrument measuring s-ED and health variables drawn from the Modern Worklife Questionnaire (MWQ), the Perceived Stress Scale (PSS), and the National Board of Health and Welfare's questions about physical activity. Comparisons were made between an s-ED and a non-s-ED group. Health-related factors associated with s-ED were identified through a logistic regression. RESULTS Self-rated exhaustion disorder was reported by 21.5% of the participants. Health-related factors associated with s-ED were cognitive problems, sleep problems, depressive symptoms, high stress, poor self-rated health, and stomach problems. There was no statistically significant difference in the prevalence of participants who met the criteria of physical activity among s-ED and non-s-ED group. CONCLUSION Findings from this study suggest that s-ED is more common among municipal employees in rural areas than in other working populations in Sweden. Several health-related factors were associated with s-ED. Regular use of a self-rated instrument in evaluating the organizational and social work environment can identify people at risk of developing exhaustion disorder and requiring long-term sick leave.
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Affiliation(s)
- Sofia Asplund
- Department of Nursing, Umeå University, 90187, Umeå, Sweden.
| | - Johan Åhlin
- Department of Nursing, Umeå University, 90187, Umeå, Sweden
| | - Sture Åström
- Department of Nursing, Umeå University, 90187, Umeå, Sweden
| | - Mattias Hedlund
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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Tanaka S, Muraki S, Inoue Y, Miura K, Imai E. The association between subjective health perception and lifestyle factors in Shiga prefecture, Japan: a cross-sectional study. BMC Public Health 2020; 20:1786. [PMID: 33238945 PMCID: PMC7690120 DOI: 10.1186/s12889-020-09911-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 11/17/2020] [Indexed: 11/11/2022] Open
Abstract
Background The Ministry of Health has reported that in Japan, the Shiga prefecture has the highest life expectancy. Subjective health perception is a predictive indicator of mortality. For this study, we examined the association between subjective health perception and multiple lifestyle factors. Methods Data were obtained from the 2015 Health and Nutrition Survey in Shiga prefecture. The analytic sample comprised 6057 adults aged 20 or older. Information on subjective health perception and lifestyle behaviors was obtained from a self-administered questionnaire. As for subjective health perception, participants were divided into 2 groups: (1) Excellent or Good and (2) Average, Poor, or Very Poor. A 1-day dietary survey was also administered. The health behaviors score (HBS) was calculated based on 5 factors: consuming a healthy diet, never smoking, low-risk alcohol drinking, regular exercise, and moderate sleep duration. HBS scores ranged from 0 to 5. Multiple logistic regression was used to calculate the sex-, age- BMI- and energy intake-adjusted odds ratios (ORs) of poor subjective health across HBS, with 0 points as the reference. Results Among all participants, 2397 (39.6%) individuals were classified into the good subjective health group. Participants with an HBS of 3 (OR 0.59, 95% CI 0.37–0.96), 4 (OR 0.40, 95% CI 0.24–0.65) or 5 (OR 0.33, 95% CI 0.19–0.59) had a lower OR of rating themselves as being average/poor health compared with those having zero. The association with a higher HBS was remarkable (p for trend: < 0.001). Additional analyses revealed that the combinations including regular exercise were particularly associated with a lower risk of subjective average/poor health. Conclusions This study showed that the higher the number of healthy lifestyle factors, the lower risk of subjective average/poor health. Combinations of healthy lifestyle factors, especially those involving exercise, suggest good subjective health for individuals living in the Shiga prefecture.
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Al-Rubaye AKQ, Johansson K, Alrubaiy L. The association of health behavioral risk factors with quality of life in northern Sweden-A cross-sectional survey. J Gen Fam Med 2020; 21:167-177. [PMID: 33014667 PMCID: PMC7521790 DOI: 10.1002/jgf2.333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It is well known that behavioral risk factors such as obesity, smoking, physical activity, diet, and excessive alcohol are linked to general health in northern Sweden. This study aimed to explore the joint relationship between these risk factors and the quality of life (QoL). METHODS Data were collected from Sweden's national public health survey between February and May 2014 in the four northern counties in Sweden. QoL was assessed using the EuroQol (EQ-5D). Multivariable regression analysis was used to examine the relationship between five risk factors: BMI, physical activity, smoking status, fruit and vegetable intake, and alcohol consumption and QoL. RESULTS Data from 17 138 complete questionnaires showed that individuals who were not obese, did at least 30 minutes of physical activity daily, consumed at least 3 portions of vegetable or fruits, were not smoking daily, and who did not report being drunk at least once every week were found to have better QoL (P < .005). The mean EQ-5D score ranged from 0.85 to 0.79. Approximately, two thirds of the studied population reported being physically active for at least 30 minutes every day and two fifths of them had a normal BMI. Only around 7% of the sample reported that they were eating the recommended daily level of fruits and vegetables. CONCLUSIONS The results of the study suggest that QoL has a significant relationship with lifestyle behaviors. This finding would emphasize the role of interventions to improve population health.
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Affiliation(s)
| | - Klara Johansson
- Department of Epidemiology and Global Health Umeå University Umeå Sweden
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Lindemann IL, Reis NR, Mintem GC, Mendoza-Sassi RA. Self-perceived health among adult and elderly users of Primary Health Care. CIENCIA & SAUDE COLETIVA 2019; 24:45-52. [PMID: 30698239 DOI: 10.1590/1413-81232018241.34932016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/08/2017] [Indexed: 11/22/2022] Open
Abstract
A cross-sectional study was conducted with 1,246 adults and senior men and women in Pelotas (RS), Brasil to evaluate the negative self-perception of health among Primary Health Care users. The prevalence of negative self-perception of health was reported by 41.6% of respondents. Women, those who were unemployed, who reported a diagnosis of three or more chronic noncommunicable diseases, who were food insecure and did not engage in physical activity reported a higher proportion of negative self-perceived health. Users with at least higher education level and those whose households had four or more residents were less predisposed to the outcome. The high prevalence of negative self-perceived health in this population, as well as the associations found, indicate the need for a better understanding of the influence of these factors on the search for care and, consequently, on adherence to treatment.
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Affiliation(s)
- Ivana Loraine Lindemann
- Coordenação Acadêmica, Universidade Federal da Fronteira Sul. R. Capitão Araújo 20, Centro. 99010-200 Passo Fundo RS Brasil.
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Kim N, Nam HJ, Noh J, Park EC. The effect of multimorbidity on the gap between global and age-comparative self-rated health scores among the Korean elderly. Arch Gerontol Geriatr 2018; 76:19-25. [PMID: 29448237 DOI: 10.1016/j.archger.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 11/14/2017] [Accepted: 01/02/2018] [Indexed: 11/30/2022]
Abstract
Most of the behavior change models regard perceived health status as a motivation for healthy behaviors or chronic disease self-management. The aim of this study was to examine the association between the number of chronic diseases and the difference between global and age-comparative self-rated health scores (GSRH and ASRH). We used national representative survey data pertaining to the elderly in 2011 from the Korea Institute for Health and Social Affairs. In total, 10,003 participants (≥60 years old) were selected from those who had completed the survey in 2008. Multinomial logistic regression was used to estimate relative risk ratios (RRR) with 95% confidence intervals. Demographic factors, socioeconomic status, social connection, and healthy life style were adjusted. Individuals with many chronic diseases were more likely to have a positive gap, resulting in a better ASRH score relative to GSRH (p for trend <0.001): 1-2 diseases (RRR = 1.30, 95% CI = 1.07-1.57), 3-4 diseases (RRR = 1.90, 95% CI = 1.55-2.32), and ≥5 diseases (RRR = 1.75, 95% CI = 1.39-2.20). In addition, the association between the number of chronic diseases and a positive gap varied by sex and living area. Our results suggest that a positive gap between GSRH and ASRH that indicates an overestimated age-comparative health, was associated with the number of chronic diseases. Female or urban-living people had stronger associations. Further research is needed to understand how the gap between GSRH and ASRH could be an alternative measure of SRH and a predictor of major health outcomes.
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Affiliation(s)
- Namsoo Kim
- Medical Courses, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jun Nam
- Medical Courses, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Juhwan Noh
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
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Veromaa V, Kautiainen H, Juonala M, Rantanen A, Korhonen PE. Self-rated health as an indicator of ideal cardiovascular health among working-aged women. Scand J Prim Health Care 2017; 35:322-328. [PMID: 29096579 PMCID: PMC5730029 DOI: 10.1080/02813432.2017.1397299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the relationship between self-rated health (SRH) and the American Heart Association's (AHA) concept of ideal cardiovascular health (CVH) among female municipal employees. Studies about the association are scarce, even though AHA recommends to use SRH status surveys in clinical practice and research settings of CVH. DESIGN Cross-sectional study conducted in 2014. SETTING SRH was assessed with a one-item question and the data of seven ideal CVH measurements (nonsmoking, body mass index <25.0 kg/m2, healthy diet, physical activity at goal, blood pressure <120/80 mmHg, cholesterol <5.18 mmol/l and glucose (HbA1c < 6.0%)) was gathered with a physical examination, laboratory tests, medical history and self-administrated questionnaires. SUBJECTS A total of 725 female subjects from 10 work units of the city of Pori, Finland. MAIN OUTCOME MEASURES SRH and ideal CVH. RESULTS Of the study subjects, 28.8% reported ill-health (poor/fair SRH). The sum of ideal CVH metrics was positively associated with good SRH driven by favorable health behaviors (nonsmoking, normal body mass index, healthy diet and physical activity). A linear decrease in the prevalence of 0-2 ideal CVH metrics, and a linear increase in 5-7 metrics was associated with better SRH. Nonsmoking and normal weight were the most potent indicators of good SRH in multivariate analysis. CONCLUSIONS Most of the subjects with 0-3 of the seven CVH metrics at ideal level were dissatisfied with their health. Since unhealthy lifestyle factors accumulate mainly to people feeling ill-health, the value of SRH is worth recognizing especially in primary health care.
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Affiliation(s)
- Veera Veromaa
- Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital, Turku, Finland
- Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
- CONTACT Veera Veromaa ICT-City, General Practice, Joukahaisenkatu 3-5, 20520 Turku, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Markus Juonala
- Department of Internal Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland
| | - Ansa Rantanen
- Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital, Turku, Finland
- Health Centre of Salo, Salo, Finland
| | - Päivi E. Korhonen
- Institute of Clinical Medicine, Family Medicine, University of Turku and Turku University Hospital, Turku, Finland
- Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
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Dong W, Pan X, Yu C, Lv J, Guo Y, Bian Z, Yang L, Chen Y, Wu T, Chen Z, Pan A, Li L. Self-Rated Health Status and Risk of Ischemic Heart Disease in the China Kadoorie Biobank Study: A Population-Based Cohort Study. J Am Heart Assoc 2017; 6:e006595. [PMID: 28939702 PMCID: PMC5634301 DOI: 10.1161/jaha.117.006595] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/09/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Self-rated health (SRH) is a strong predictor of mortality in different populations. However, the associations between SRH measures and risk of ischemic heart disease (IHD) have not been extensively explored, especially in a Chinese population. METHODS AND RESULTS More than 500 000 adults from 10 cities in China were followed from baseline (2004-2008) through December 31, 2013. Global and age-comparative SRH were reported from baseline questionnaires. Incident IHD cases were identified through links to well-established disease registry systems and the national health insurance system. During 3 423 542 person-years of follow-up, we identified 24 705 incident cases of IHD. In multivariable-adjusted models, both global and age-comparative SRH was significantly associated with incident IHD. Compared with excellent SRH, the hazard ratios for good, fair, and poor SRH were 1.02 (95% confidence interval [CI], 0.98-1.07), 1.32 (95% CI, 1.27-1.37), and 1.76 (95% CI, 1.68-1.85), respectively. Compared with better age-comparative SRH, the hazard ratios for same and worse age-comparative SRH were 1.23 (95% CI, 1.19-1.27) and 1.78 (95% CI, 1.70-1.86), respectively. The associations persisted in all subgroup analyses, although they were slightly modified by study location, education, and income levels. CONCLUSIONS A simple questionnaire for self-assessment of health status was significantly associated with incident IHD in Chinese adults. Individuals and healthcare providers can use SRH measures as a convenient tool for assessing future IHD risk.
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Affiliation(s)
- Wenhong Dong
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating)School of Public HealthTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xiong‐Fei Pan
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating)School of Public HealthTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Canqing Yu
- Department of Epidemiology and BiostatisticsSchool of Public HealthBeijing UniversityBeijingChina
| | - Jun Lv
- Department of Epidemiology and BiostatisticsSchool of Public HealthBeijing UniversityBeijingChina
| | - Yu Guo
- Chinese Academy of Medical SciencesBeijingChina
| | - Zheng Bian
- Chinese Academy of Medical SciencesBeijingChina
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Tangchun Wu
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating)School of Public HealthTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - An Pan
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating)School of Public HealthTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Liming Li
- Department of Epidemiology and BiostatisticsSchool of Public HealthBeijing UniversityBeijingChina
- Chinese Academy of Medical SciencesBeijingChina
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Szwarcwald CL, Damacena GN, de Souza Júnior PRB, de Almeida WDS, de Lima LTM, Malta DC, Stopa SR, Vieira MLFP, Pereira CA. Determinants of self-rated health and the influence of healthy behaviors: results from the National Health Survey, 2013. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 18 Suppl 2:33-44. [PMID: 27008601 DOI: 10.1590/1980-5497201500060004] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/13/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate the determinants of self-rated health in Brazil and the influence of healthy lifestyles. METHODS We used data from the National Health Survey (PNS), 2013. The self-rated health was categorized as very good/good, fair, and poor/very poor. Differences in the distribution of self-rated health according to the age group and sex were tested. Logistic regression models were used to test the effects of educational level, race/skin color, and the presence of at least one noncommunicable chronic disease on poor/very poor health perception. In addition, the influence of healthy behaviors was tested controlling for the effects of sociodemographic factors and the presence of at least one chronic disease. RESULTS We analyzed 60,202 individuals; about 66.1% rated their health as very good/good and 5.9% as poor/very poor; about 47.1% reported the diagnosis of at least one noncommunicable chronic disease; and only 9.3% reported a "healthy lifestyle" (do not use tobacco products, consume fruits and vegetables properly, and do physical activity during leisure time). Among the sociodemographic factors, age, sex, educational level, and race were significantly associated with self-rated health and the presence of at least one chronic disease. The effects of all healthy behaviors were statistically significant even after controlling for the other determinants. CONCLUSION Although the adoption of healthy lifestyles in Brazil is still insufficient, the association of healthy practices with self-perception of health found in this study is an indication that the Brazilian population is beginning to relate healthy behaviors to their well-being and better health evaluation.
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Affiliation(s)
- Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Giseli Nogueira Damacena
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Deborah Carvalho Malta
- Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brazil
| | - Sheila Rizzato Stopa
- Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brazil
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16
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Health Behaviours Among Users of Drugs: in a Brazilian Sample. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-017-9773-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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17
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Blázquez Abellán G, López-Torres Hidalgo JD, Rabanales Sotos J, López-Torres López J, Val Jiménez CL. [Healthy eating and self-perception of health]. Aten Primaria 2016; 48:535-542. [PMID: 26920449 PMCID: PMC6877839 DOI: 10.1016/j.aprim.2015.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/06/2015] [Accepted: 12/07/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim is to determine whether there is an association between perceived health status, healthy eating and other lifestyles in people over 50 years old. DESIGN Cross-sectional study. SETTING 8 Basic Health Zones from the Health Area of Albacete. PARTICIPANTS A total of 781 subjects, randomly selected by simple random sampling. MAIN MEASUREMENTS variables: self-rated quality of life (EuroQol 5D), dietary habits (questionnaire on frequency of food consumption), physical activity (IPAQ questionnaire), toxic habits, health problems (International Classification of Primary Care) and sociodemographic characteristics. RESULTS The mean age was 61.4 years (SD: 6.6) and the proportion of women was 60.1%. On a scale of 0-100 the mean score in the perceived health status was 74.0 (SD: 15.2). This score had a weak correlation with the number of healthy eating criteria (r=0.078; P=.03). A linear trend (P=.001) was observed between exercise intensity and better self-rated health. The score was lower in smokers (70.9±15.6 vs 74.9±15.1 SD; P=.004). In the multiple regression, the number of healthy eating criteria remained an association with the score on perceived health status (P=.04), after adjusting the model for sociodemographic characteristics, number of health problems, and toxic habits. CONCLUSIONS In people over 50years of age the level of self-rated health is associated with the fulfilment of the criteria of a healthy diet, which is independent of other health habits and main sociodemographic variables.
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Affiliation(s)
| | | | - Joseba Rabanales Sotos
- Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Universidad de Castilla-La Mancha, Cuenca, España
| | | | - Carmen Ll Val Jiménez
- Complejo Hospitalario Universitario de Albacete, Servicio de Salud de Castilla-La Mancha, Albacete, España
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Li X, Miao X, Wang H, Wang Y, Li F, Yang Q, Cui R, Li B. Association of Serum Uric Acid Levels in Psoriasis: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2016; 95:e3676. [PMID: 27175702 PMCID: PMC4902544 DOI: 10.1097/md.0000000000003676] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
High levels of serum uric acid (SUAC) are frequently detected in patients with psoriasis. However, the relationship between psoriasis and hyperuricemia remains unknown. Here we conducted a meta-analysis to identify the SUAC levels in subjects with psoriasis and to determine whether there is an associated risk between psoriasis and hyperuricemia.A comprehensive search of the literature from January 1980 to November 2014 across 7 databases (MEDLINE, Embase, Cochrane Central Register, and 4 Chinese databases) was conducted to determine whether there is an associated risk between psoriasis and hyperuricemia.Among the 170 identified reports, 14 observational studies were included in this meta-analysis. We found a significant higher SUAC level (MD 0.68, 95% CI 0.26-1.09; P = 0.002) in patients with psoriasis in Western Europe, but no significant differences were found between the East Asia and India subgroup (MD 1.22, 95% CI -0.13-2.56; P = 0.08) or the Middle East subgroup (MD 0.48, 95% CI -0.49-1.44; P = 0.33). Similar results were obtained from the meta-analysis of SUAC levels in subjects with severe psoriasis.Our meta-analysis showed that the correlation between psoriasis and hyperuricemia was either ethnicity- or region-dependent and that patients with psoriasis in Western Europe were more likely to have hyperuricemia.
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Affiliation(s)
- Xin Li
- From the Department of Dermatology (XL, XM, YW, FL, BL), Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Pharmacology and Experimental Therapeutics (XL, HW, RC), Boston University School of Medicine; and Department of Statistics (QY), Boston University School of Public Health, Boston, MA
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Petarli GB, Salaroli LB, Bissoli NS, Zandonade E. Autoavaliação do estado de saúde e fatores associados: um estudo em trabalhadores bancários. CAD SAUDE PUBLICA 2015; 31:787-99. [DOI: 10.1590/0102-311x00083114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/17/2014] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste trabalho foi verificar como trabalhadores bancários avaliam seu estado de saúde e os principais fatores associados a esse indicador nessa população. Trata-se de um estudo transversal com 525 funcionários de uma rede bancária do Estado do Espírito Santo, Brasil. A magnitude das associações foi avaliada através de regressão logística hierarquizada em níveis. Verificou-se que 17% (n = 87) dos bancários autoavaliaram seu estado de saúde como regular ou ruim. Estiveram associados à pior autoavaliação de saúde o reduzido nível socioeconômico (OR = 1,80; IC95%: 1,06-3,05), o estilo de vida sedentário (OR = 2,64; IC95%: 1,42-4,89), o excesso de peso (OR = 3,18; IC95%: 1,79-5,65), o baixo apoio social (OR = 3,71; IC95%: 2,10-6,58) e a presença de doenças crônicas (OR = 5,49; IC95%: 2,46-12,27). Concluiu-se que, comparado com outras localidades, houve um expressivo número de bancários que autoavaliaram seu estado de saúde como regular ou ruim, e que a presença de doenças crônicas apresentou-se como o fator de maior impacto sobre a forma como o indivíduo avalia sua própria saúde.
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Association of Mediterranean diet and other health behaviours with barriers to healthy eating and perceived health among British adults of retirement age. Maturitas 2014; 79:292-8. [PMID: 25096829 DOI: 10.1016/j.maturitas.2014.07.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 06/24/2014] [Accepted: 07/01/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Health behaviours including diet, smoking, alcohol consumption, and physical activity, predict health risks at the population level. We explored health behaviours, barriers to healthy eating and self-rated health among individuals of retirement age. Study design 82 men and 124 women participated in an observational, cross-sectional online survey. Main outcome measures A 14-item Mediterranean diet score (MDPS), perceived barriers to healthy eating (PBHE), self-reported smoking, physical activity habits, and current and prior perceived health status (PHS) were assessed. A health behaviours score (HBS) including smoking, physical activity, body mass index (BMI) and MDPS was created to evaluate associations with PHS. Two-step cluster analysis identified natural groups based on PBHE. Analysis of variance was used to evaluate between group comparisons. RESULTS PBHE number was associated with BMI (r=0.28, P<0.001), age (r=-0.19; P=0.006), and MDPS (r=-0.31; P<0.001). PHBE cluster analysis produced three clusters. Cluster-1 members (busy lifestyle) were significantly younger (57 years), more overweight (28kg/m(2)), scored lower on MDPS (4.7) and reported more PBHE (7). Cluster-3 members (no characteristic PBHE) were leaner (25kg/m(2)), reported the lowest number of PBHE (2), and scored higher on HBS (2.7) and MDPS (6.2). Those in PHS categories, bad/fair, good, and very good, reported mean HBS of 2.0, 2.4 and 3.0, respectively (P<0.001). Compared with the previous year, no significant associations between PHS and HBS were observed. CONCLUSIONS PBHE clusters were associated with BMI, MDPS and PHS and could be a useful tool to tailor interventions for those of peri-retirement age.
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