Trajectories of physical activity from mid to older age in women: 21 years of data from the Australian Longitudinal Study on Women's Health

BACKGROUND

Women's physical activity varies across the adult lifespan. However, changes in physical activity among mid-aged women are not well understood. We analysed 21 years of data from women born in 1946-51 to identify: (1) trajectories of physical activity in the transition from mid- to old-age and (2) determinants of different physical activity trajectories.

METHODS

Data were from the 1946-51 cohort of the Australian Longitudinal Study on Women's Health (N = 10,371). Surveys were mailed at three-year intervals from 1998 (age 47-52) to 2019 (age 68-73) to collect data on physical activity, sociodemographic factors (country of birth, area of residence, educational attainment, marital status, income management, paid work hours, living with children age < 18, providing care), health indicators (menopause status, BMI, physical and mental health, chronic conditions), and health behaviours (smoking, alcohol status). Group-based trajectory modelling was used to identify trajectories of physical activity. Multinomial logistic regression models were used to examine the determinants of physical activity trajectories.

RESULTS

Five trajectories were identified: Low-stable (13.3% of participants), Moderate-stable (50.4%), Moderate-increasing (22.2%), High-declining (7.7%), and High-stable (6.6%). Sociodemographic characteristics (area of residence, education, income management, living with children, and providing care) were determinants of physical activity trajectories, but the strongest factors were BMI, physical and mental health. Women who were overweight/obese and had poor physical and mental health were less likely to be in the High-stable group than in any other group. Changes in these variables (increasing BMI, and declining physical and mental health) and in marital status (getting married) were positively associated with being in trajectories other than the High-stable group.

CONCLUSIONS

Although most women maintained physical activity at or above current guidelines, very low physical activity levels in the Low-stable group, and declining levels in the High-declining group are concerning. The data suggest that physical activity promotion strategies could be targeted to these groups, which are characterised by socioeconomic disadvantage, high (and increasing) BMI, and poor (and worsening) physical and mental health. Removing barriers to physical activity in these women, and increasing opportunities for activity, may reduce chronic disease risk in older age.

Multiple mediation effect of coping styles and self-esteem in the relationship between spousal support and pregnancy stress of married immigrant pregnant women

Background

The purpose of this study was to identify the total, direct, and indirect influence of spousal support on pregnancy stress among married immigrant pregnant women. The study aimed to determine the relative magnitudes of specific mediating effects of coping styles and self-esteem.

Method

A cross-sectional correlational survey was conducted in Jeonnam with 206 married immigrant pregnant women. Data were collected from September 7 to November 7 in 2019. A self-report questionnaire was used to measure spousal support, pregnancy stress, coping styles, and self-esteem. The study employed a linear multiple regression analysis to examine the potential multi-mediating effects. The effect size was set at 0.15, the significance level at 0.05, and the power at 0.95. Through the analysis, the researchers explored the mediating mechanisms among the variables and identified the presence of multi-mediating effects.

Results

The effect sizes (b) and statistical significance (p) for the predictors were as follows: problem-focused coping (b = 0.13, p = 0.001), emotion-focused coping (b = 0.11, p = 0.004), and self-esteem (b = 0.10, p < 0.001). Emotion-focused coping (b = 0.26, p = 0.001) and self-esteem (b = -0.20, p = 0.035) had a significant impact on pregnancy stress. The total effect of spousal support on pregnancy stress was significant at -0.25 (p < 0.001), and the direct effect was also significant at -0.26 (p < 0.001). We observed significant mediating effects for emotion-focused coping and self-esteem.

Conclusions

As a result of this study, the self-esteem of married immigrant pregnant women can have a protective effect by preventing the aggravation of pregnancy stress in the relationship between spousal support and pregnancy stress. Meanwhile, the emotion-focused coping style can balance out the effect of self-esteem. Therefore, in order to alleviate the stress of pregnancy for women, it is necessary to provide intervention to help improve self-esteem with spousal support. In addition, nursing professionals should help them use appropriate coping styles.

Factors affecting ability of TB patients to follow treatment guidelines - applying a capability approach

BACKGROUND

Negotiating anti-Tuberculosis treatment is a complicated process comprising daily consumption of multiple medications at stipulated times and dosages, as well as periodic follow-ups and investigations, may not be uniform for all Tuberculosis (TB) patients and some may perform better than others. In this context, we conducted a study in Thiruvananthapuram district, Kerala to ascertain the ability of those suffering from TB to follow treatment guidelines.

METHODS

This study used an embedded mixed methods design. We collected cross-sectional data from 135 drug sensitive pulmonary TB patients aged 18 years or above in Thiruvananthapuram, Kerala using a structured questionnaire to get the proportion of patients following all treatment guidelines. We also did eight in-depth interviews (four men and four women) from within the survey sample. The in-depth interviews were inductively analysed for getting deeper insights about reasons for the choices people made regarding the treatment guidelines. Written informed consent was taken from all participants and the study was implemented after the necessary programmatic and ethical clearances.

RESULTS

Of the 105 men and 30 women studied, uninterrupted daily drug consumption was reported by 80 persons (59.3%, 95% Confidence Intervals (CI) 50.8-67.2%). Overall, 38 (28.2%, 95% CI 21.3%-36.3%) persons were able to follow all seven aspects of advised guidelines. Living in an extended/ joint family (Adjusted Odds ratio (AOR) 2.6, 95% CI 1.1-6.0), approximate monthly household expenditure of over rupees 13,500 (AOR 2.9, 95% CI 1.3-6.7) and no perceived delay in seeking initial care (AOR 3.2, 95% CI 1.2-8.7) were significantly associated with following all aspects of treatment guidelines. In-depth interviews revealed reflective treatment related behaviours were influenced by bodily experiences, moral perceptions, social construct of TB, programmatic factors and substance use. Sometimes behaviours were non-reflective also. Programmatic stress was on individual agency for changing behaviour but capability and opportunity for these were influenced social aspects like stigma, gender roles and poverty.

CONCLUSION

TB patients live amidst a syndemic of biomedical and social problems. These problems influence the capabilities and opportunities of such TB patients to follow treatment guidelines. Interventions should balance focus on individual agency and social abd economic factors.

Gender equality in science, medicine, and global health: where are we at and why does it matter?

The purpose of this Review is to provide evidence for why gender equality in science, medicine, and global health matters for health and health-related outcomes. We present a high-level synthesis of global gender data, summarise progress towards gender equality in science, medicine, and global health, review the evidence for why gender equality in these fields matters in terms of health and social outcomes, and reflect on strategies to promote change. Notwithstanding the evolving landscape of global gender data, the overall pattern of gender equality for women in science, medicine, and global health is one of mixed gains and persistent challenges. Gender equality in science, medicine, and global health has the potential to lead to substantial health, social, and economic gains. Positioned within an evolving landscape of gender activism and evidence, our Review highlights missed and future opportunities, as well as the need to draw upon contemporary social movements to advance the field.

Interrupção e Retomada da Vida Sexual após o Câncer de Mama

RESUMO Investigou-se a interrupção/retomada da vida sexual após o tratamento do câncer de mama e sua relação com a satisfação e outros aspectos valorizados em um relacionamento. Foram empregados métodos mistos de pesquisa com a análise dos dados de uma survey realizada com 139 mulheres e dados provenientes de entrevistas com roteiro semiestruturado realizadas com 24 participantes. Um percentual expressivo de mulheres (66%) sexualmente ativas interrompeu as atividades sexuais durante o tratamento. Observou-se que a interrupção e retomada da vida sexual relacionou-se às concepções pessoais de sexualidade, influenciadas pelas relações de gênero e pela qualidade do relacionamento amoroso. A identificação de necessidades relacionadas à intimidade sexual pelo profissional de saúde pode contribuir para a assistência apropriada no processo de reabilitação psicossocial da mulher.

Comparing adult users of public and private dental services in the state of Minas Gerais, Brazil

BACKGROUND

Studying the factors associated with the use of dental services can provide the necessary knowledge to understand the reasons why individuals seek out public healthcare services and the formulation of more appropriate public policies for the present-day reality.

METHODS

This work was a cross-sectional epidemiological study consisting of a sample of adults found in a research databank concerning the conditions of the oral health of the population of the state of Minas Gerais, Brazil. This study examined both main oral health disorders and relevant socioeconomic aspects. The dependent variable was defined as the type of service used, categorized under public and private use. The independent variables were selected and grouped to be inserted in the analysis model according to an adaptation of the behavioral model described by Andersen and Davidson. A hierarchical model was used to analyze the data. The description of variables and bivariate analyses were performed in an attempt to verify possible associations. For each group of variables at each hierarchical level, the gross and adjusted odds ratios (OR) and the respective 95% confidence intervals (CI) were estimated by means of logistic regression. The Complex Samples model from the SPSS statistics program, version 19.0, was used to analyze the sample framework.

RESULTS

In the final model, the factors associated with the use of public healthcare services by adults were directly related to the socioeconomic and demographic conditions of the individuals, including: being of a dark-skinned black race/color, belonging to families with more than four household residents and with a lower income level, residing in small towns, having more teeth that need treatment.

CONCLUSIONS

According to the findings from this study, socioeconomic and demographic factors, as well as normative treatment needs, are associated with the use of public dental services.

Dehomed: the impacts of house demolitions on the well-being of women from the unrecognized Bedouin-Arab villages in the Negev/Israel

Thirty-five Bedouin-Arab villages in South Israel are regarded illegal settlements by the state. Consequently, the residents׳ homes are subject to demolition. Based on 12 semi-structured multiple-participant interviews, this paper examines the house demolitions׳ impacts on women, in the context of gendered constructions of social roles and space. It highlights that the marginalized position of Arab-Bedouin women - as women in a patriarchal community, as members of a minority within Israeli society, and as residents of an "invisible" settlement - contributes to the devastating effects of the house demolitions. In particular, the study׳s results show that the house demolitions inflict severe personal and collective trauma, amplified by women׳s primary role as mothers. Paradoxically, the very same role also becomes a source of resilience and political resistance, as women act to defend a sense of home and restore family life in the face of state violence.

Subjective Income Security of (Middle) Aging and Elderly Canadians

Nous avons examiné la sécurité du revenu subjective chez les Canadiens de 45 ans et plus à l'aide de données quantitatives. Nous avons étudié la relation entre les variables démographiques, socio-économiques et socio-psychologiques et la sécurité du revenu par le biais d'analyses multidimensionnelles, notamment la possibilité d'une insatisfaction à l'égard du revenu actuel ou prévu. Notre examen porte sur plusieurs résultats imprévus reliés aux effets de l'âge, de la situation maritale et du sexe sur la sécurité du revenu subjective. Cinq théories socio-psychologiques pourraient contribuer à l'explication de ces résultats: la théorie de l'aspiration, la théorie du groupe de référence, la théorie de l'équité, l'examen de la vie et la théorie de la socialisation et de l'identité. Bien que ces théories ne puissent être vérifiées en partant des données utilisées, elles fournissent une orientation de recherche éventuelle. Nous concluons que l'évaluation subjective du revenu adéquat ne doit pas constituer le fondement de l'établissement des politiques sociales de la redistribution du revenu.

Gender, depression and physical impairment: an epidemiologic perspective from Aleppo, Syria

OBJECTIVE

Examine the association of physical impairment with gender, depression, and socio-demographics in the community in Aleppo, Syria.

METHOD

We conducted a cross-sectional, population-based study in Aleppo on adults aged 18-65 (N = 2,038). We used a computerized interviewer-administered structured questionnaire. Physical impairment was measured via an adapted 12-item World Health Organization, Health State Description Individual Questionnaire which includes both physical and emotional items. We used physical impairment items score to classify individuals into low, middle, and high physical impairment category. Self-report of physician-diagnosed depression and chronic diseases active in the past year and their current treatment status were obtained.

RESULTS

Sample mean age (SD) was 35.3 (12.1) years, 55% were female, and 4.5% had depression. Female gender, low socioeconomic status (SES), and depression were associated with high physical impairment. Women had more impairment (OR = 3.35, 95% CI: 2.15-5.21) with little change after controlling for depression and chronic diseases, but significantly decreased after controlling for socio-demographics (OR = 1.51, 95% CI: 0.84-2.73). The association with low (vs. high) SES was prominent (OR = 2.48, 95% CI: 1.32-4.67) after controlling for all variables. Depression's association (OR = 4.85, 95% CI: 1.93-12.15) lost significance after controlling for chronic diseases (OR = 2.81, 95% CI: 0.96-8.25), but further adjustment for socio-demographics had little effect.

CONCLUSION

Women and individuals of low SES appear more vulnerable to physical impairment in the community in Aleppo. Depression's association with physical impairment may be mediated through co-existing chronic diseases. Public health planning regarding physical impairment in Syria should encompass these as putative risk factors.

Predictors of loneliness in U.S. adults over age sixty-five

The purpose of this study was to examine sociodemographic and health-related risks for loneliness among older adults using Health and Retirement Study Data. Overall prevalence of loneliness was 19.3%. Marital status, self-report of health, number of chronic illnesses, gross motor impairment, fine motor impairment, and living alone were predictors of loneliness. Age, female gender, use of home care, and frequency of healthcare visits were not predictive. Loneliness is a prevalent problem for older adults in the United States with its own health-related risks. Future research of interventions targeting identified risks would enhance the evidence base for nursing and the problem of loneliness.

“Far as I Get Is the Clothesline”: The Impact of Leisure on Women's Health and Unpaid Caregiving Experiences in Nova Scotia, Canada

This qualitative study explored the unique ways in which caregiving and leisure are conceptualized and mediated among diverse groups of female caregivers (n = 98) in the province of Nova Scotia, Canada. Data were obtained through 17 focus group discussions between March and June of 2002. Findings reveal that the contexts within which caregivers experience the health effects of caregiving create meanings, opportunities, and challenges for leisure. This study of diverse caregiving experiences fills a significant gap in the existing literature by integrating considerations of subjectivity and the ways in which caregiving influences women's perceptions and engagement in leisure pursuits. Constructivism guides the interpretive framework upon which the data were analyzed; results inform recommendations relative to policy and program audiences associated with unpaid caregiving.

Engendering health disparities

How is gender implicated in our exploration of health disparities in Canada? Set against the backdrop of federal government policy, this review paper examines the ways in which gender intersects with other health determinants to produce disparate health outcomes. An overview of salient issues including the impact of gender roles, environmental exposures, gender violence, workplace hazards, economic disparities, the costs of poverty, social marginalization and racism, aging, health conditions, interactions with health services, and health behaviours are considered. This review suggests health is detrimentally affected by gender roles and statuses as they intersect with economic disparities, cultural, sexual, physical and historical marginalization as well as the strains of domestic and paid labour. These conditions result in an unfair health burden borne in particular by women whose access to health determinants is--in various degrees--limited. While progress has certainly been made on some fronts, the persistence of health disparities among diverse populations of women and men suggests a postponement of the vision of a just society with health for all that was articulated in the Federal Plan on Gender Equality. Commitment, creativity and collaboration from stakeholders ranging from various levels of government, communities, academics, non-governmental agencies and health professionals will be required to reduce and eliminate health disparities between and among all members of our society.

Women's rights and health: the case of Oromo women in Ethiopia

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), for which we have no cure or vaccination, is the major health problem in Ethiopia. This epidemic generally has affected poor communities and women. To contain this epidemic, the empowerment of women is essential. In fact, the current working definition of health by the World Health Organization (WHO) makes social well-being a part of everyday living, which is an essential dimension of the quality of life. The concept of quality of life means an opportunity to make choices and even change the situation one is in. Here, the concepts of health and human rights intersect, because of the quality of life requires freedom of choice, dignity and respect. Dignity, the right to access basic education and information, as well as the right to life are the major elements of human rights. It is for that purpose that health promotion is intended to enable people to increase their control over determinants of health and thereby improve their health. Women's involvement in outlining the agendas of health promotion is vital to achieve the desired goals. In this article I examine human rights violations in Ethiopia and the lost opportunities for Oromo women to make choices in life within the framework of the Universal Declarations of Human Rights (UDHR).

Relating health policy to women's health outcomes

Individuals' social and economic circumstances, including socioeconomic status and medical care availability, are central to health outcomes, particularly for women. These factors are often mediated by governmental policies. This exploratory study found associations between women's health outcomes and state-level policies related to women's health. Outcomes were mortality rates for four leading causes of death for women in the US (heart disease, stroke, lung cancer, and breast cancer), infant mortality, and a mental health outcome variable. State policies on key women's health issues were evaluated on the degree to which they adequately protected women's health. Our regression models accounted for significant variance in mortality rates and substantial variance in the mental health outcome. Policies affecting access to care (Medicaid eligibility and efforts to expand Medicaid) and community (environmental health tracking and violence against women) were significantly associated with mortality outcomes. State health policies should be examined further for their relationship to health outcomes.

Untreated cervical cancer in the United States

OBJECTIVE

To evaluate treatment patterns, including lack of treatment, among women diagnosed with cervical cancer in the United States.

METHODS

Using the National Cancer Institute's (NCI's) Surveillance, Epidemiology, and End Results (SEER) program, we identified 13,715 women diagnosed with invasive cervical cancer between 1992 and 1999 and eligible for inclusion in the study.

RESULTS

Nearly 9% of women diagnosed with invasive cervical cancer received no therapy for their disease. Lack of therapy was associated with a later stage of disease at diagnosis, older age, and unmarried status. More than 16% of women aged 65 and older with stage IIB/IV cervical cancer received no therapy for their disease.

CONCLUSION

We must educate women diagnosed with cervical cancer and their families about the importance of treatment for potential cure and control of symptoms. We must identify and overcome obstacles that may prevent adherence to treatment recommendations. These may include comorbidity, access to cancer treatment, inability to pay for treatment, and inadequate social support.

Gender and use of health care among older adults in Egypt and Tunisia

In Western industrialized countries, women report using health services more often than do men. We explore the applicability of existing theory to explain gender differences in use of health care among older adults in Egypt and Tunisia, where females have received less health care than males in early life. Findings show that women report visiting providers and using medications more often than do men; however, adjusted odds of visiting doctors are comparable for women and men in Tunisia and lower for women than men in Egypt. Odds of using health care are higher for women than men among those reporting no morbidity or functional impairment, but these relative odds diminish or reverse among those reporting multiple morbidities or severe impairments. The contributions of subjective and objective illness, quality of social support, and availability of services on gender differences in care in later life should be assessed in these and other settings where girls' excess mortality persists.

Hip fractures among older people: do marital status and type of residence matter?

This study analysed the extent to which civil status and type of residence affect the risk of elderly people sustaining a hip fracture. The study population consisted of all residents, aged 65 years or older, living in Stockholm County in Sweden between the years 1993 and 1995 (about 250,000 in total). Cases of hip fractures in the County's outpatient register (1993-1995) were linked to national registers, enabling injured people to be attributed a marital status (during year of injury), and also a size of dwelling and form of residential entitlement (in 1990). Gender-specific injury rates for three age groups were computed, as were age-standardized odds ratios (ORs) by gender for each variable of interest. As expected, hip fractures were found to rise with age among both men and women, and the risk of women sustaining such injuries was higher than that of men for all age groups. The proportion of injured men and women was higher among the unmarried than the married, and the majority of the injured were in rented accommodation (in all three age groups). The age-standardized ORs showed that the risk of hip fracture was substantially affected by civil (marital) status, but form of residential entitlement and size of dwelling did not affect the risk to any remarkable extent. The study demonstrates that being unmarried increases the risk of hip fracture among older men and women. This suggests that elderly unpartnered people may have a different daily-life pattern and may be in poorer health, both of which may be associated with a diminished social network.

Suicide differentials in Australian males and females by various measures of socio-economic status, 1994-98

OBJECTIVES

To investigate Australian suicide differentials in males and females by three area-based measures of socio-economic status (SES).

METHODS

Suicide data for 1994-98 were used to investigate area-based gradients of SES for the Index of Relative Socio-Economic Disadvantage (IRSED) (an overall measure of SES), the Index of Economic Resources (IER), and the Index of Education and Occupation (IEO), using Poisson regression models adjusting for age, country-of-birth and urban-rural residence.

RESULTS

After adjusting for age, country-of-birth and urban-rural residence, significant increasing linear trends in suicide risk from high to low quintiles of SES were evident in males for the IRSED (an average multiplicative increase in suicide risk of 8% per quintile), IER (9% increase) and IEO (5% increase). For females, there was no evident SES gradient for the IRSED after adjusting for age, country-of-birth and urban-rural residence, but a significant positive linear trend from high to low quintiles of SES was found for the IER (6% increase per quintile). A significant decreasing linear trend (increasing suicide risk with increasing SES) was evident for the IEO (30% per quintle).

CONCLUSION

Male suicide is positively associated with all three measures of SES examined. Female suicide is significantly associated with the IER (positive association) and IEO (negative), and because of this is not associated with the overall measure of SES. These findings partly explain why female suicide has been found to be poorly correlated with area-based measures of SES.

IMPLICATIONS

Specific components of area-based socio-economic status provide a clearer picture of socio-economic suicide differentials in Australian females, with implications for population-based preventive strategies.

Socio-economic status and serum lipids: a cross-sectional study in a Chinese urban population

Socio-economic status and serum lipids are important factors in the progression of cardiovascular disease. We studied the association between socio-economic status and serum lipids in a Chinese urban population. In all, 4,541 respondents (2,231 men and 2,310 women) between 25-64 years of age participated in a cross-sectional population survey carried out in Tianjin, China, and provided blood samples. Three socio-economic indicators (education, occupation, and income), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were determined. People in higher socio-economic groups had a more unfavorable serum lipid profile compared with those in lower socio-economic groups. This significant association was especially apparent in men. Education seemed to be the most important predictor of serum lipids in the three socio-economic indicators. The direction of the association between high socio-economic status and poor serum lipid profiles appears to be opposite to those observed in the developed countries.