Preventive health services use, lifestyle health behavior risks, and self-reported health status of women in Ohio by ethnicity and completed education status

Causal effect of education on bone mineral density: A Mendelian randomization study

Education level may have some association with the incidence of osteoporosis, but it is elusive if this association is causal. This two-sample Mendelian randomization analysis focused on the causal effect of education level on femoral neck bone mineral density (FN-BMD), forearm BMD, lumbar spine BMD, and heel BMD. Twelve single nucleotide polymorphisms were used as instrumental variables. The results suggested that high education level was associated with improved FN-BMD (beta-estimate: 0.406, 95% confidence interval: 0.061 to 0.751, standard error: 0.176, P-value = .021). There were null association between education and other sites of bone mineral density. Our results found the causal effect of high education level on improved FN-BMD, and improved educational attainment may be beneficial to prevent osteoporosis.

Patterns of black and white hysterectomy incidence among reproductive aged women

OBJECTIVE

To investigate the intersection of race and economic context in treatment with hysterectomy among reproductive aged women with noncancerous gynecologic conditions.

DATA SOURCES

We combined administrative billing records of inpatient and outpatient hysterectomy procedures (N = 28 301) occurring in North Carolina between 2011 and 2014 with census data to calculate county-level hysterectomy rates.

STUDY DESIGN

Spatial analysis techniques examined the distribution of black and white hysterectomy rates across counties, and county-level black and white rate differences were compared across economic contexts.

DATA COLLECTION/EXTRACTION

We restricted to those of premenopausal age identifying as non-Hispanic black or white, undergoing hysterectomy for nonemergent causes (N = 28 301 procedures).

PRINCIPAL FINDINGS

County-level hysterectomy rates were spatially patterned (Moran's I, P < .05) and similarly so for black and white women (LISA, P < .005). The black-white difference in hysterectomy rates was the largest in the high economic tier counties (22/10 000 person-years [PY], P < .05) and smallest in the mid and low economic tier counties (11/10 000 PY, P > .05 and 10/10 000 PY, P > .05, respectively).

CONCLUSION

Socioeconomic context is important to understand, particularly for black-white disparities in hysterectomy. Efforts should be made to understand the causes of higher rates of hysterectomy among blacks than whites, especially in counties in the highest economic tier.

A study on people's concepts associating community health exam interventions with their participation in future health examinations

This study primarily employed the health belief model (HBM) to identify the effect between health examination services and intentions to continue receiving health examinations. The research participants (n = 905) were people who received a health examination in a hospital in Central Taiwan in 2012. The study conducted an anonymous questionnaire survey to collect data and implemented cross-sectional research to examine the factors. The results for the threat construct the participants who showed concern regarding potential physical conditions, and the causes of diseases were more likely to anticipate in health examinations. The participants who indicated their intentions to modify dietary and exercise regimen according to their health examination reports were more likely to anticipate examinations. The results for the cues to action construct showed that the participants who considered advice from others were more inclined to undergo examinations. The results for the barriers construct found that factors, including anxiety, concern for personal-information disclosure. Providing community health examinations helps health care facilities understand people's concepts regarding health examinations and ensures that hospitals enhance the delivery of health examinations to satisfy people's demands and achieve community health.

The correlation of osteoporosis to clinical features: a study of 4382 female cases of a hospital cohort with musculoskeletal symptoms in southwest China

BACKGROUND

By analyzing the clinical features and risk factors in female patients with musculoskeletal symptoms of Southwest China, this report presents the initial analysis of characteristics in this region and compared with international evaluative criteria.

METHODS

Diagnosis of osteoporosis (OP) was made in female hospital patients age > or = 18 years admitted from January 1998 to December 2008 according to WHO definition. Case data were analyzed by symptoms, age, disease course and risk factors to reveal correlation with diagnosis of OP. Logistic regression was used to identify the risks of osteoporosis.

RESULTS

A total of 4382 patients were included in the analysis of the baseline characteristics, among which 1455 in the OP group and 2927 in the non-OP group. The morbidity of OP is significantly increased in females' > or = 50 years. Both groups had symptoms related to pain and numbness; no significant difference was found in reported upper and lower back pain, or leg pain between two groups (p > 0.05). Neck, shoulder and arm pain, leg and arm numbness were more common in the non-osteoporosis group (p < 0.05, OR < 1, and upper limit of 95% CI of OR < 1). Hypertension, diabetes, hyperostosis were major risk factors for the patients with OP. The most common lifestyle-related risk factors for osteoporosis were smoking, body mass index, lack of physical activity and menopause.

CONCLUSIONS

The present study offers the first reference data of the relationship between epidemiologic distribution of osteoporosis and associated factors in adults Chinese women. These findings provide a theoretical basis for its prevention and treatment in developing country.

Educational level and osteoporosis risk in postmenopausal Moroccan women: a classification tree analysis

The objectives of this study are (1) to evaluate whether the prevalence of osteoporosis and peripheral fractures might be influenced by the educational level and (2) to develop a simple algorithm using a tree-based approach with education level and other easily collected clinical data that allow clinicians to classify women into varying levels of osteoporosis risk. A total number of 356 women with a mean age of 58.9±7.7 years were included in this study. Patients were separated into four groups according to school educational level; group 1, no education (n=98 patients); group 2, elementary level (n=57 patients); group 3, secondary level (n=138 patients) and group 4, university level (n=66 patients). We observed dose-response linear relations between educational level and mean bone mineral density (BMD). The mean BMDs of education group 1 (10.39% (lumbar spine), 10.8% (trochanter), 16.8% (wrist), and 8.8% (femoral neck)) were lower compared with those of group IV (p<0.05). Twelve percent of patient had peripheral fractures. The prevalence of peripheral fractures increased with lowered educational levels. Logistic regression analysis revealed a significant independent increase in the risk of peripheral fracture in patients with no formal education (odds ratio, 5.68; 95% , 1.16-27.64) after adjustment for age, BMI and spine BMD. Using the classification tree, four predictors were identified as the most important determinant for osteoporosis risk: the level of education, physical activity, age>62 years and BMI<30 kg/m2. This algorithm correctly classified 74% of the women with osteoporosis. Based on the area under the receiver-operator characteristic curves, the accuracy of the Classification and Regression Tree (CART) model was 0.79. Our findings suggested that a lower level of education was associated with significantly lower BMDs at the lumbar spine and the hip sites, and with higher prevalence of osteoporosis at these sites in a dose-response manner, even after controlling for the strong confounders. On the other hand, our CART algorithm based on four clinical variables may help to estimate the risk of osteoporosis in a health care system with limited resources.

Role of the social milieu in health and wellness

Can "we" be modified? The impact of the social milieu on health and wellness is not a new concept. Before the invention of an effective pharmacopoeia, manipulation of the social environment was one of the few tools available to physicians. Modern medicine continues to focus on individual rather than community efforts at risk reduction. To understand health and wellness, we must look not only at bodies and illnesses but also at communities and social structure. This article discusses the impact of spirituality and religion, education, economics, and politics on health and wellness. The impact of these issues on health will drive system-level change in global health.

A sociobehavioral model of acupuncture use, patterns, and satisfaction among women in the United States, 2002

OBJECTIVES

To examine the correlates of recent acupuncture use among American women, applying a sociobehavioral model of utilization of conventional health care. Patterns of use, satisfaction, and reasons for acupuncture use are also examined.

METHODS

The 2002 National Health Interview Survey (NHIS) is used, which included the Alternative Health/Complementary Alternative Medicine Supplement. All analyses and estimates used the NHIS individual-level sampling weights; variance estimates were adjusted to account for complex sample design. Bivariate statistics and logistic regression were used. We included data from 17,112 women.

RESULTS

Prevalence of recent acupuncture use was low (1.1%), but translates to >1.2 million American women. Multivariate results showed the effects of race and ethnicity on acupuncture use were contingent on educational level. Women living in the West were more likely to use acupuncture, as were women with fair health status, former smokers, current moderate/heavy alcohol users, and women with a higher body mass index. Women tended to use acupuncture for conditions not commonly well treated by conventional medicine (e.g., chronic pain) and the majority reported using acupuncture in conjunction with conventional medicine.

CONCLUSIONS

Predisposing and enabling factors, as well as medical need and personal health practices, are associated with women's recent use of acupuncture services, including several that are also associated with conventional health care services.

Factors affecting change over time in self-reported health

BACKGROUND

Self-reported health status has become a conventional measure of health status at the population level. Further, the literature supports its use as a valid indicator of morbidity and mortality. However, relatively little attention has been paid to how self-reported health status changes over time or the factors affecting change. This paper explores the factors affecting health status change over time using data from a neighbourhood health survey.

METHODS

Two rounds (2001; 2003) of health survey data (n=671) were collected across 4 distinct neighbourhoods in Hamilton, Ontario. Logistic regression analysis is used to predict change in self-reported health status between the two time periods as well as determinants of change using a range of compositional, contextual and collective characteristics of individuals as potential explanatory variables.

RESULTS

Results reveal that approximately one third of participants experienced a change in health status between the two survey years. Interestingly, the key factors affecting change in health status are compositional characteristics of individuals (e.g., smoking, health care use) as opposed to contextual (e.g., neighbourhood of residence) or collective (e.g., marital status). Contrary to published literature, the current study does not reveal any significant links between a change in health status and either gender or age.

CONCLUSION

These results inform our understanding of both the stability of health ratings over time and the determinants of health status change. Further research should be undertaken to enhance this understanding; in particular, studies with larger sample sizes, longer time frames and more sensitive indicators of composition, context and collective are needed.

Multivariate models of self-reported health often neglected essential candidate determinants and methodological issues

BACKGROUND AND OBJECTIVE

Self-reported health is an important indicator of overall well-being that may be influenced by diverse parameters. We intended to evaluate the variety of candidate determinants used in models of self-reported health (SRH) and to examine the methodological problems encountered in multivariate models used in recent studies in this field.

STUDY DESIGN AND SETTING

Medline searches identified articles published in 2002 in which SRH was included as an outcome, at least one other variable was used as a determinant of SRH, and the study population was not defined by the presence of specific diseases.

RESULTS

Of 1,991 initially identified reports, 56 were eligible. In 91% of the eligible articles, multivariate models were used. In total, 133 different determinants of SRH were considered (median 7 determinants considered per study with multivariate models). The proportions of studies with problems in multivariate modeling were: overfitting, 10%; nonconformity to a linear gradient, 29%; no report of tests for interactions, 63%; unspecified coding of variables, 49%; and unspecified selection of variables, 29%.

CONCLUSION

Models that try to identify what influences SRH should consider appropriate lists of candidate determinants, with proper attention to methodological aspects of multivariate modeling.

Elderly health disparities on the U.S.-México border

The Ageless Health Needs Assessment is a multi-phase project designed to assess the health and quality of life of the 60 and older population along the U.S.-México border. The present study used a health survey, which was administered to 1,450 participants by telephone and through face-to-face interviews in Western Texas and Southern New Mexico. Several demographic differences were found between the samples: 52% of the Texas sample was Hispanic compared to 23% of the New Mexico sample; 63% of the Texas sample was born in the U.S. compared to 92% of the New Mexico sample; and Texans reported less education and lower incomes than New Mexicans. Exploratory factor analysis revealed four health-related factors, which were labeled Physical Health, Emotional Health, General Health, and Activity Potential. A MANCOVA showed significant differences between groups after controlling for socioeconomic status and age.