Self-rated health and cardiovascular disease incidence: results from a longitudinal population-based cohort in Norfolk, UK

Worry and ruminative brooding: associations with cognitive and physical health in older adults

Introduction

Mental health conditions are associated with cognition and physical function in older adults. We examined whether worry and ruminative brooding, key symptoms of certain mental health conditions, are related to subjective and/or objective measures of cognitive and physical (cardiovascular) health.

Methods

We used baseline data from 282 participants from the SCD-Well and Age-Well trials (178 female; agemean = 71.1 years). We measured worry and ruminative brooding using the Penn State Worry Questionnaire and the Ruminative Response Scale-brooding subscale. We assessed subjective physical health using the WHOQOL-Bref physical subscale, and objective physical health via blood pressure and modified versions of the Framingham Risk Score and Charlson Comorbidity Index. With subjective and objective cognition, we utilized the Cognitive Difficulties Scale and a global composite (modified Preclinical Alzheimer's Cognitive Composite, PACC5, with the Wechsler Adult Intelligence Scale-IV, category fluency, Mattis Dementia Rating Scale-2, and either the California Verbal Learning Test or the Rey Auditory Verbal Learning Test). We conducted linear regressions, adjusted for education, age, sex and cohort.

Results

Worry and ruminative brooding were negatively associated with subjective physical health (worry: β = -0.245, 95%CI -0.357 to -0.133, p < 0.001; ruminative brooding: β = -0.224, 95%CI -0.334 to -0.113, p < 0.001) and subjective cognitive difficulties (worry: β = 0.196, 95%CI 0.091 to 0.302, p < 0.001; ruminative brooding: β = 0.239, 95%CI 0.133 to 0.346, p < 0.001). We did not observe associations between worry or ruminative brooding and any measure of objective health.

Discussion

Worry and ruminative brooding may be common mechanisms associated with subjective but not objective health. Alternatively, cognitively unimpaired older adults may become aware of subtle changes not captured by objective measures used in this study. Interventions reducing worry and ruminative brooding may promote subjective physical and cognitive health; however, more research is needed to determine causality of the relationships.

Achieving goal-concordant care: Formal and informal advance care planning for White, Black, and Hispanic older adults

INTRODUCTION

Advance care planning (ACP) aims to ensure that patients receive goal-concordant care (GCC), which is especially important for racially or ethnically minoritized populations at greater risk of poor end-of-life outcomes. However, few studies have evaluated the impact of advance directives (i.e., formal ACP) or goals-of-care conversations (i.e., informal ACP) on such care. This study aimed to examine the relationship between each of formal and informal ACP and goal-concordant end-of-life care among older Americans and to determine whether their impact differed between individuals identified as White, Black, or Hispanic.

METHODS

We conducted a retrospective cohort study using 2012-2018 data from the biennial Health and Retirement Study. We examined the relationships of interest using two, separate multivariable logistic regression models. Model 1 regressed a proxy report of GCC on formal and informal ACP and sociodemographic and health-related covariates. Model 2 added interaction terms between race/ethnicity and the two types of ACP.

RESULTS

Our sample included 2048 older adults. There were differences in the proportions of White, Black, and Hispanic decedents who received GCC (83.1%, 75.3%, and 71.3%, respectively, p < 0.001) and in the use of each type of ACP by racial/ethnic group. In model 1, informal compared with no informal ACP was associated with higher odds of GCC (adjusted odds ratio = 1.38 [95% confidence interval, 1.05-1.82]). In model 2, Black decedents who had formal ACP were more likely to receive GCC than those who did not, but there were no statistically significant differences between decedents of different racial/ethnic groups who had no ACP, informal ACP only, or both types of ACP.

CONCLUSIONS

Our results build on previous work by indicating the importance of incorporating goals-of-care conversations into routine healthcare for older adults and encouraging ACP usage among racially and ethnically minoritized populations who use ACP tools at lower rates.

Gender and age variations in the association between multigenerational cohabitation and self-rated health among middle-aged and older adults in Japan

Despite encouraging multi-generational cohabitation, the population of Japanese people living alone has increased. However, little is known about the association between health and multigenerational cohabitation. This study examined the relationship between self-rated health and living arrangements among Japanese adults using data from the Japan Multi-Institutional Collaborative Cohort Study (2013-2017). The analysis employed multivariate logistic regression to examine the associations. Our results showed no association between living arrangements and self-rated health when stratified by gender. Living alone was found to be associated with poor self-rated health among women aged 65 and above. A similar association may exist among men in the same age group. Among women aged < 65 years, two-generation cohabitation was associated with a good self-rated health, similar to those living alone. Among men aged < 65 years, neither living alone nor two-generation cohabitation was significantly associated with good self-rated health. We found no association between three- or plus-generation cohabitation and self-rated health. Therefore, our findings indicate associations between multigenerational cohabitation and self-rated health, but they vary by gender and age. Invested stakeholders in the public health field should consider the potential impact of living arrangements on health based on gender and age.

Life's Essential 8 in relation to self-rated health and health-related quality of life in a large population-based sample: the SCAPIS project

PURPOSE

To monitor cardiovascular health, in 2022, the American Heart Association (AHA) updated the construct "Life's Simple 7" (LS7) to "Life's Essential 8" (LE8). This study aims to analyze the associations and capacity of discrimination of LE8 and LS7 in relation to self-rated health (SRH) and health-related quality of life (HRQoL).

METHODS

This study from the Swedish CArdioPulmonary bioImage Study (SCAPIS) included 28 731 Swedish participants, aged 50-64 years. Three different scores were derived from the SF-12 questionnaire: 1-item question SRH ("In general, would you say your health is …?"), mental-HRQoL and physical-HRQoL. Logistic regression, restricted cubic splines, and ROC analysis were used to study the associations between the AHA scores in relation to SRH and HRQoL.

RESULTS

Compared to those with a LE8 score of 80, participants with a LE8 score of 40 were 14.8 times more likely to report poor SRH (OR: 14.8, 95% CI: 13.0-17.0), after adjustments. Moreover, they were more likely to report a poor mental-HRQoL (OR: 4.9, 95% CI: 4.2-5.6) and a poor physical-HRQoL (OR: 8.0, 95% CI: 7.0-9.3). Area under curves for discriminating poor SRH were 0.696 (95% CI: 0.687-0.704), 0.666 (95% CI: 0.657-0.674), and 0.643 (95% CI: 0.634-0.651) for LE8, LS7 (0-14), and LS7 (0-7), respectively, all p values < 0.001 in the DeLong's tests.

CONCLUSION

LE8 and LS7 had strong and inverse associations with SRH, mental-HRQoL, and physical-HRQoL, though LE8 had a somewhat higher capacity of discrimination than LS7. The novel LE8, a construct initially conceived to monitor cardiovascular health, also conveys SRH and HRQoL.

Association between changed self-rated health and the risk of venous thromboembolism in Malmö Preventive Program: a cohort study

Poor self-rated health (SRH) is associated with incident arterial cardiovascular disease in both sexes. Studies on the association between SRH and incident venous thromboembolism (VTE) show divergent results in women and no association in men. This study focuses on the association between change in SRH and incident VTE in a cohort of 11,558 men and 6682 women who underwent a baseline examination and assessment of SRH between 1974 and 1992 and a re-examination in 2002-2006. To investigate if changes in SRH over time affect the risk of incident VTE in men and women. During a follow-up time from the re-examination of more than 16 years, there was a lower risk for incident VTE among women if SRH changed from poor at baseline to very good/excellent (HR 0.46, 95% CI 0.28; 0.74) at the re-examination. Stable good SRH (good to very good/excellent at the re-examination, HR 0.60, 95% CI 0.42; 0.89), or change from good SRH at baseline into poor/fair at the re-examination (HR 0.68, 95% CI 0.51; 0.90) were all significantly associated with a reduced risk for VTE. All comparisons were done with the group with stable poor SRH. This pattern was not found among men. Regardless of a decreased or increased SRH during life, having an SRH of very good/excellent at any time point seems to be associated with a decreased risk of VTE among women.

The association between self-rated health, health-related quality of life, and risk of venous thromboembolism

Poor self-rated health (SRH) is associated with various adverse health outcomes, including cardiovascular disease. Little is known about SRH and health-related quality of life (HRQoL) as predictors of first-time venous thromboembolism (VTE). Our aim was to investigate the association between SRH, HRQoL, and risk of VTE in a whole cohort, as well as in women and men separately. A total of 108,025 middle-aged inhabitants (51 % women) of Västerbotten, Sweden, participated in a health examination between 1985 and 2014. Data on SRH, HRQoL, and potential confounders were collected by questionnaire. Participants were followed as a cohort and validated first-time VTE events were registered. The mean follow-up time was 13.9 years, during which 2054 participants experienced a first-time VTE. Overall, 27 % of participants reported their health as very good, 46 % as good, 20 % as average, 5 % as somewhat bad, and 1 % as bad. In a multivariable analysis, compared with participants who self-rated as having very good SRH, hazard ratios (95 % confidence intervals) for VTE were 1.17 (1.02-1.33) with good SRH, 1.27 (1.09-1.47) with average SRH, and 1.48 (1.00-2.18) with bad SRH. The risk of VTE increased with lower SRH for both men (p for trend 0.02) and women (p for trend 0.04). In a fully adjusted model, we also found significant associations between four aspects of HRQoL (general health, bodily pain, vitality, emotional well-being) and VTE risk. In conclusion, lower perceived health is associated with an increased risk of VTE in both men and women.

The Effects of Subjective Wellbeing and Self-Rated Health on Lifetime Risk of Cardiovascular Conditions in Women

Subjective wellbeing may predict future health conditions, and lower self-rated physical health (SRH) is associated with the presence of chronic conditions, such as cardiovascular disease (CVD). This study examines whether subjective wellbeing and SRH predict long-term CVD conditions for women using the Midlife in the United States study. The study cohort includes 1716 women participants who completed waves 1 (1995-1996), 2 (2004-2006), and 3 (2013-2014). Data on demographics, chronic conditions of diabetes and CVD, subjective wellbeing (life satisfaction, positive affect, and negative affect), and SRH were collected repeatedly at each wave. Multiple logistic regressions were conducted to test whether subjective wellbeing was associated with a lifetime CVD risk. Greater life satisfaction was significantly associated with a lower risk of CVD at 10 years (odds ratio (OR): 0.83; 95% confidence interval (CI): 0.74-0.95) and 19 years (OR: 0.83; 95% CI: 0.74-0.93), while positive and negative affects were not significantly associated. Additionally, better physical SRH significantly lowered odds of having cardiovascular conditions at both 10 years (OR: 0.79; 95% CI 0.68-0.92) and 19 years (OR 0.74; 95% CI: 0.64-0.86). Measures of life satisfaction and SRH can be used as additional CVD screening tools.

Social inequalities in self-perceived health in Chile, does the urban environment matter?: a cross-sectional study

BACKGROUND

The health of a population is determined by urban factors such as the physical, social and safety environment, which can be modified by urban regeneration policies. The aim of this study was to analyze the associations of elements of the social, physical and safety environment of the neighborhood in the urban context with self-perceived health (SPH), according to axes of inequality, such as gender and educational level in Chile in 2016.

METHODS

Cross-sectional study using a nationally representative population-based survey of Chile. We used data from the 2016 National Survey of Quality of Life and Health. Poor SPH in the urban population older than 25 years was analyzed in relation to social, physical and safety environment variables. Poisson multilevel regression models were estimated to obtain prevalence ratios (PR) and their respective 95% confidence intervals (95%CI). All analyses were stratified by sex and educational level.

RESULTS

SPH was worse in women than in men, especially in those with a lower education level. Poor SPH was associated with lack of support networks (PR = 1.4; 95%CI = 1.1-1.7), non-participation in social organizations (PR = 1.3; 95%CI = 1.1-1.6) and perceived problems with the quality of public space (PR = 1.3; 95%CI = 1.2-1.5) in women with a medium-high educational level and with a feeling of not belonging to the neighborhood (PR = 1.5; 95%CI = 1.2-1.8) and the perception of pollution problems (PR = 1.2; 95%CI = 1.0-1.4) in women with a low educational level. A feeling of unsafety was associated with both educational levels (PR = 1.3; 95%CI = 1.0-1.5). Poor SPH was associated with the feeling of not belonging (PR = 1.7; 95%CI = 1.2-2.5), and unsafety (PR = 2.1; 95%CI = 1.8-2.4) in men with a medium-high educational level, while there were fewer associations in men with a lower education level.

CONCLUSIONS

Urban interventions are recommended to improve the health of the resident population and should take into account axes of inequality.

Sleep Duration, Sleep Quality, and Insomnia in Association With Self-Rated Health: A Systematic Review and Meta-Analysis

Background and Objective This study undertook a systematic review and meta-analysis of the relationship between sleep duration, sleep quality, and insomnia in association with self-rated health.Methods Studies that had examined the relationship between sleep duration, sleep quality, and insomnia with self-rated health were eligible. PubMed and Scopus were the two main databases for searching for studies related to this meta-analysis. The Google Scholar database as a source of gray literature was also searched by hand. This search was from the beginning of the formation of databases until the end of January 2022, and the search language was limited to articles published in English. The Effective Public Health Practice Project Quality Assessment Tool was used to assess the quality of studies. For this meta-analysis, odds ratio and 95% confidence interval were extracted or calculated. The pool of studies was processed by the random effects method.Results Twenty-six studies were included in this meta-analysis. Sleep duration of ≤ 8 hours per day (h/d) (odds ratio = 1.58 and 95% confidence interval = [1.41–1.77]) and sleep duration of > 8 h/d (odds ratio = 1.32 and 95% confidence interval = [1.17–1.50]) are associated with poor self-rated health. Poor sleep quality and insomnia are associated with poor self-rated health. Conclusions Sleep problems have a negative effect on self-rated health, and therefore, effective interventions can help improve sleep.

Personality Traits Predict Self-Rated Health (SRH) in Coronary Heart Disease (CHD) Patients and Healthy Controls

OBJECTIVE

The objective of the present study is to examine the association between Big Five personality traits and self-rated health (SRH) among individuals with coronary heart disease (CHD), and to compare this relationship with that of healthy control participants, which is of importance as SRH can be a determinant of outcomes.

METHODS

The current study used data from 566 participants with CHD with a mean age of 63.00 (S.D. = 15.23) years old (61.13% males) and 8608 age- and sex-matched healthy controls with a mean age of 63.87 (S.D.= 9.60) years old (61.93% males) from the UKHLS. The current study used predictive normative modelling approaches, one-sample t tests, a hierarchical regression, and two multiple regressions.

RESULTS

The current study found that CHD patients have significantly lower Conscientiousness (t(565) = -3.84, p < 0.001, 95% C.I. [-0.28, -0.09], Cohen's d = -0.16) and SRH (t(565) = -13.83, p < 0.001, 95% C.I. [-0.68, -0.51], and Cohen's d = -0.58) scores compared to age and sex-matched healthy controls. Moreover, health status (controls vs. CHD patients) moderated the links between Neuroticism, Extraversion and SRH. Specifically, Neuroticism (b = -0.03, p < 0.01, 95% C.I. [-0.04, -0.01]), Openness (b = 0.04, p < 0.001, 95% C.I. [0.02, 0.06]), and Conscientiousness (b = 0.08, p < 0.001, 95% C.I. [0.06, 0.10]) were significant predictors of SRH in healthy controls, whereas Conscientiousness (b = 0.08, p < 0.05, 95% C.I. [0.01, 0.16]) and Extraversion (b = -0.09, p < 0.01, 95% C.I. [-0.15, -0.02]) were significant predictors of SRH in CHD patients.

CONCLUSION

Based on the close associations between personality traits and SRH, and the subsequent impact on patient outcomes, the results of this study should be taken into consideration by clinicians and health professionals when developing tailored treatment and intervention programs for their patients.

Insomnia Symptoms Among Hospice Family Caregivers: Prevalence and Association with Caregiver Mental and Physical Health, Quality of Life, and Caregiver Burden

BACKGROUND

Poor sleep exacerbates mental health problems and reduces quality-of-life (QOL) but prevalence of insomnia symptoms among hospice family caregivers and associations of poor sleep with caregiver health and QOL outcomes are not known.

OBJECTIVE

To describe prevalence of insomnia symptoms among hospice family caregivers and compare anxiety, depression, self-rated health, QOL, and caregiver burden between hospice family caregivers with and without insomnia symptoms.

METHODS

Descriptive sub-study using data collected during baseline interviews of hospice family caregivers involved in a randomized clinical trial in Midwestern United States (xxxxxxxx). Caregivers were dichotomized based on Insomnia Severity Index (ISI) scores (8+ indicated insomnia symptoms).

RESULTS

Among 57 hospice family caregivers, the mean ISI score was 8.2; nearly half (49.1%) experienced insomnia symptoms. Compared to caregivers without insomnia symptoms, caregivers with insomnia symptoms reported 2.4 times greater mean anxiety scores (4.7 vs 11.4); 3.5 times greater mean depression scores (3.1 vs 10.7); 2.1 times greater caregiver burden scores (5.6 vs 11.8); and 1.3 times lower self-rated health (3.5 vs 2.8); 1.3 times lower total QOL scores (29.3 vs 22.6); including differences in emotional QOL (7.9 vs 2.2), social QOL (7.2 vs 3.0), and physical QOL (7.4 vs 5.3).

CONCLUSIONS

Hospice family caregivers experience high prevalence of insomnia symptoms; caregivers with insomnia symptoms report worse anxiety, depression, caregiver burden, QOL, self-rated health. Clinicians must screen hospice caregivers for poor sleep and mental health and offer supportive interventions that improve their sleep and health. Policy makers must expand hospice benefits to better support family caregivers.

Self-rated health and the risk of incident chronic kidney disease: a community‐based Korean study

BACKGROUND

The relationship between self-rated health (SRH) and the development of incident chronic kidney disease (CKD) has not been explored in the general population.

METHODS

We reviewed the data of 7027 participants in the Ansung-Ansan cohort study. SRH was categorized as poor, fair, or good, and the outcome was the development of CKD, defined as the first event of an estimated glomerular filtration rate < 60 mL/min/1.73 m², at least twice during the follow-up period. Hazard ratios (HRs) and confidence intervals (CIs) were calculated using Cox proportional hazards regression analysis.

RESULTS

Over a mean follow-up duration of 11.9 years, 951 participants (13.5%) developed CKD. Compared with poor self-rated health, the HR (95% CI) of fair self-rated health for incident CKD development was 0.771 (0.657-0.905; P = 0.001), whereas that of good self-rated health was 0.795 (0.676-0.935; P = 0.006). However, the renal hazard of good self-rated health did not differ from that of fair self-rated health. In the fully adjusted model, the HR (95% CI) of poor self-rated health compared to non-poor self-rated health for incident CKD was 1.278 (1.114-1.465, P < 0.001). Old age, smoking, cardiovascular disease, diabetes, hypertension, impaired sleep, and high levels of C-reactive protein and white blood cell counts were associated with increased odds of poor self-rated health, whereas male sex, college graduate level of education, and alcohol consumption were associated with decreased odds of poor self-rated health.

CONCLUSION

Poor self-rated health is independently associated with CKD development. Therefore, the early detection of potential CKD patients through a brief questionnaire assessment may help control the incidence of CKD.

Racial and Ethnic Differences in Informal and Formal Advance Care Planning Among U.S. Older Adults

OBJECTIVE

To examine advance care planning (ACP) trends among an increasingly diverse aging population, we compared informal and formal ACP use by race/ethnicity among U.S. older adults (≤65 years).

METHODS

We used Health and Retirement Study data (2012-2018) to assess relationships between race/ethnicity and ACP type (i.e., no ACP, informal ACP only, formal ACP only, or both ACP types). We reported adjusted risk ratios with 95% confidence intervals.

RESULTS

Non-Hispanic Black and Hispanic respondents were 1.77 (1.60, 1.96) and 1.76 (1.55, 1.99) times as likely, respectively, to report no ACP compared to non-Hispanic White respondents. Non-Hispanic Black and Hispanic respondents were 0.74 (0.71, 0.78) and 0.74 (0.69, 0.80) times as likely, respectively, to report using both ACP types as non-Hispanic White respondents.

DISCUSSION

Racial/ethnic differences in ACP persist after controlling for a variety of barriers to and facilitators of ACP which may contribute to disparities in end-of-life care.

Determinants of self-reported hypertension among women in South Africa: evidence from the population-based survey

Background

Hypertension (HTN), characterized by an elevation of blood pressure, is a serious public health chronic condition that significantly raises the risks of heart, brain, kidney, and other diseases. In South Africa, the prevalence of HTN (measured objectively) was reported at 46.0% in females, nonetheless little is known regarding the prevalence and risks factors of self-reported HTN among the same population. Therefore, the aim of this study was to examine determinants of self-reported HTN among women in South Africa.

Methods

The study used data obtained from the 2016 South African Demographic and Health Survey. In total, 6,027 women aged ≥ 20 years were analyzed in this study. Self-reported HTN was defined as a case in which an individual has not been clinically diagnosed with this chronic condition by a medical doctor, nurse, or health worker. Multiple logistic regression models were employed to examine the independent factors of self-reported HTN while considering the complex survey design.

Results

Overall, self-reported HTN was reported in 23.6% (95% confidence interval [CI], 23.1–24.1) of South African women. Being younger (adjusted odds ratio [aOR], 0.04; 95% CI, 0.03–0.06), never married (aOR, 0.69; 95% CI, 0.56–0.85), and not covered by health insurance (aOR, 0.74; 95% CI, 0.58–0.95) reduced the odds of self-reported HTN. On the other hand, being black/African (aOR, 1.73; 95% CI, 1.17–2.54), perception of being overweight (aOR, 1.72; 95% CI, 1.40–2.11), and perception of having poor health status (aOR, 3.53; 95% CI, 2.53–5.21) and the presence of other comorbidities (aOR, 7.92; 95% CI, 3.63–17.29) increased the odds of self-reported HTN.

Conclusions

Self-reported HTN was largely associated with multiple sociodemographic, health, and lifestyle factors and the presence of other chronic conditions. Health promotion and services aiming at reducing the burden of HTN in South Africa should consider the associated factors reported in this study to ensure healthy aging and quality of life among women.

Genome-wide association studies in non-anxiety individuals identified novel risk loci for depression

BACKGROUND

Depression is a debilitating mental disorder that often coexists with anxiety. The genetic mechanisms of depression and anxiety have considerable overlap, and studying depression in non-anxiety samples could help to discover novel gene. We assess the genetic variation of depression in non-anxiety samples, using genome-wide association studies (GWAS) and linkage disequilibrium score regression (LDSC).

METHODS

The GWAS of depression score and self-reported depression were conducted using the UK Biobank samples, comprising 99,178 non-anxiety participants with anxiety score <5 and 86,503 non-anxiety participants without self-reported anxiety, respectively. Replication analysis was then performed using two large-scale GWAS summary data of depression from Psychiatric Genomics Consortium (PGC). LDSC was finally used to evaluate genetic correlations with 855 health-related traits based on the primary GWAS.

RESULTS

Two genome-wide significant loci for non-anxiety depression were identified: rs139702470 (p = 1.54 × 10^-8, OR = 0.29) locate in PIEZO2, and rs6046722 (p = 2.52 × 10^-8, OR = 1.09) locate in CFAP61. These associated genes were replicated in two GWAS of depression from PGC, such as rs1040582 (p_{replication GWAS1} = 0.02, p_{replication GWAS2} = 2.71 × 10^-3) in CFAP61, and rs11661122 (p_{replication GWAS1} = 8.16 × 10^-3, p_{replication GWAS2} = 8.08 × 10^-3) in PIEZO2. LDSC identified 19 traits genetically associated with non-anxiety depression (p < 0.001), such as marital separation/divorce (rg = 0.45, SE = 0.15).

CONCLUSIONS

Our findings provide novel clues for understanding of the complex genetic architecture of depression.

Association between self-rated health and venous thromboembolism in Malmö Preventive Program: A cohort study

INTRODUCTION

Venous thromboembolism (VTE) and cardiovascular disease (CVD) share some risk factors such as smoking, obesity, and dietary habits. Poor self-rated health (SRH) has been shown to be a predictor of arterial CVD and mortality for both men and women. The association between SRH and VTE has only been investigated in one previous Swedish study with a cohort that just contained women. This Swedish study did not show any significant associations between poor SRH and VTE in women.

METHODS

A cohort of 22,444 men and 10,902 women in the Malmö Preventive Program was followed for a period of 44 years. All participants in the baseline screening with measurements including SRH were traced in national registers. Data on VTE events were collected from national hospital registries. Cox proportional regression analysis was used to calculate the association between SRH and time to VTE.

RESULTS

During a follow-up time of 44.31 years, a total of 2612 individuals were affected by VTE. Good SRH was associated with a lower risk for VTE in women both in the univariate model (HR = 0.75, CI = 0.65-0.85) and after adjustments for age, smoking, BMI and varicose veins (HR = 0.81, CI 0.70-0.93). SRH was not a predictor for VTE in men, neither in the unadjusted (HR = 1.05, CI 0.90-1.13) nor in the fully adjusted model (HR = 1.00, CI = 0.88-1.14).

CONCLUSION

In this cohort study, SRH was associated with VTE in women but not among men. The association was significant even when adjusting for well-known risk factors such as varicose veins, BMI and smoking.

Assessment of self-rated health: The relative importance of physiological, mental, and socioeconomic factors

BACKGROUND

The general self-rated health (SRH) question is the most common health measure employed in large population surveys. This study contributes to research on the concurrent validity of SRH using representative data with biomarkers from the Czech Republic, a population not previously used to assess the SRH measure. This work determines the relative contribution of biomedical and social characteristics to an individual's SRH assessment. Studies have already explored the associations between SRH and markers of physical health. However, according to a PubMed systematic literature search, the issue of the relative importance of physiological and psychosocial factors that affect individuals' assessments of their SRH has generally been neglected.

METHODOLOGY/PRINCIPAL FINDINGS

Using data from a specialized epidemiological survey of the Czech population (N = 1021), this study adopted ordinary least squares regression to analyze the extent to which variance in SRH is explained by biomedical measures, mental health, health behavior, and socioeconomic characteristics. This analysis showed that SRH variance can be largely attributed to biomedical and psychological measures. Socioeconomic characteristics (i.e. marital status, education, economic activity, and household income) contributed to around 5% of the total variance. After controlling for age, sex, location, and socioeconomic status, biomarkers (i.e. C-reactive protein, blood glucose, triglyceride, low-density lipoprotein, and high-density lipoprotein), number of medical conditions, and current medications explained 11% of the total SRH variance. Mental health indicators contributed to an additional 9% of the variance. Body mass index and health behaviors (i.e. smoking and alcohol consumption) explained less than 2% of the variance.

CONCLUSIONS/SIGNIFICANCE

The results suggested that SRH was a valid measure of physiological and mental health in the Czech sample, and the observed differences were likely to have reflected inequalities in bodily and mental functions between social groups.

Physical Health Complaints in Adolescents

Abstract. Background: Some of the physical health complaints adolescents have, such as headaches and stomachaches, cannot be explained on a somatic level. It is unclear which psychological factors can explain these complaints: stress and social support are often discussed, but emotions rarely are. Aims: This cross-sectional study aims to use social support, stress, the tendency toward negative emotions, and health behaviors to predict physical health complaints in adolescents. Method: The 2018 HBSC (Health Behavior in School-aged Children) data from the German state of Brandenburg was analyzed via structural equation and path modeling ( N = 3,068, age M = 13.05). Results: Results showed that the tendency toward negative emotions seems to be a better predictor for health complaints (β = .35) than stress (β = .17), and even better suited than social support (β = −.08) or health behavior (β = −.06 to β = .16). In the analysis of specific emotions (anger, sadness, and fear), correlations were low and between sadness and complaints they were highest (average β = .19). Limitations: The present cross-sectional study could not examine long-term outcomes. In addition, the results are limited to only a few physical complaints. Future long-term studies should examine multiple disease symptoms in adolescence. Conclusion: The investigated tendency toward negative emotions demonstrated promising results to better understand the relationship between psychological factors and physical health complaints. As negative emotions were particularly important in predicting physical health, prevention programs for adolescents should focus on dealing with negative emotions to improve their health.

Longitudinal validity of self-rated health: the presence and impact of response shift

Objective: This paper aimed to examine the longitudinal validity of self-rated health (SRH) and whether it would be affected by possible changes in evaluation standards (i.e., response shift) over time.Design: Data are from a longitudinal survey of a nationally representative sample in China. Analytical sample was restricted to respondents aged 45 and above (n = 15,893). Individual fixed effects models were used to analyze changes in ratings on health anchoring vignettes and self-rated health over time.Main outcome measures: SRH at two time points with a -two-year span.Results: Both SRH and anchoring vignettes ratings displayed changes over a two-year span for all the studied age groups. Compared with the self-assessed change in health ("How would you rate your health as compared to that of last year?"), changes in SRH reported over time displayed a more stable and optimistic pattern. SRH responded to doctor diagnosed chronic disease and changes in functional limitation, before and after adjusting for evaluation standards.Conclusion: SRH is responsive to the newly diagnosed chronic disease and functional limitation, regardless of whether we consider response shift within the same respondents over time.

Effectivity of a mHealth intervention for individuals with obesity: a study protocol for a controlled intervention study

BACKGROUND

Obesity is considered an epidemic problem with an increasing number of individuals affected. The physical and psychological complaints associated with obesity point to the importance of implementing effective interventions. Innovative mHealth applications appear to be promising in helping provide a continuous and flexible support during the intervention. Since research on mHealth interventions is still relatively sparse, the main goal of the current study is to assess the effectiveness of an mHealth obesity intervention in terms of weight reduction, health behaviours as well as health-related quality of life. In addition, the study aims to investigate various psychological explicit and implicit processes associated with physical activity behaviour.

METHODS

The study includes quantitative and qualitative methods. Regarding the quantitative methods, the goal is to recruit up to 450 individuals at baseline in different obesity centres across Germany with some of these centres offering an mHealth intervention. All individuals who agree to take part in the mHealth intervention will be assigned to the intervention group, while all other individuals will be assigned to the control group. The mHealth obesity intervention consists of three stays at an obesity centre, with approximately six months between stays during which patients are supported by the digital platform CASPAR. The study includes three measurements with a baseline measurement and two follow-up measurements, one after six months and one after twelve months. To assess the effectiveness of the intervention, body weight, physical activity behaviour, eating behaviour as well as health related quality of life will be assessed. In addition, motivation, intentions, self-efficacy, enjoyment, and habit will be used to assess the psychological processes related with physical activity behaviour. A multivariate analysis of variance with repeated measurement and latent growth curve models will be used to compare the development of the variables within the two groups. In relation to the qualitative methods, interviews with individuals of the intervention group will be conducted to shed light on the applicability, acceptance, and usability of the mHealth intervention.

DISCUSSION

This study may provide a valuable insight into the potential of mHealth obesity interventions and the psychological processes related to physical activity behaviour. Trial registration The trial has been registered with the German Register of Clinical Studies (DRKS) on June 30, 2021 under the registration number: DRKS00024836.

Physical Activity and Perceived Physical Fitness during the COVID-19 Epidemic: A Population of 40- to 69-Year-Olds in Japan

The COVID-19 pandemic has caused an abrupt change in lifestyle for many people with restrictions, often leading to a decrease in physical activity (PA), and thus contributing to a negative perception of health status. The purpose of this study was to examine the effects of the COVID-19 epidemic on physical activity and perceived physical fitness in Japanese adults aged 40 to 69 years. Data were collected from an online survey conducted between October 19 and 28, 2020. The analytic sample consisted of 1989 Japanese adults (mean age, 50.1 ± 6.9 years; women, 38.9%) who were aged between 40 and 69 years and completed the online survey. Overall, the PA time per week decreased by 32.4% between October 2019 and April 2020. A decrease in PA time was recorded in October 2020; however, a decline of 15.5% was observed. Compared to individuals who did not perceive a decline in physical fitness, individuals who perceived declining physical fitness during the COVID-19 state of emergency demonstrated a greater decrease in PA time in April 2020 (-50.5%), and this trend continued into October 2020 (-25.0%). These findings may indicate that Japanese adults aged 40 to 69 years who perceived declining physical fitness experienced a greater decrease in physical activity.

Effects of a web-based rehabilitation aftercare on subjective health, work ability and motivation: a partially randomized controlled trial

Background

Rehabilitation is seen as crucial in dealing with the demographic change in many European countries. In Germany, for example, after having stayed in a rehabilitation center, patients have the possibility to participate in aftercare programs aimed at promoting long-term health behaviour. Despite the relevance of follow-up support for patients’ long-term health and work ability, participation rates in aftercare programs are quite low. Here, web-based aftercare programs can be a viable alternative to the traditional face-to-face programs due to their flexibility in time and location. This research project aims to use quantitative and qualitative methods to gain more insight into the potential of web-based aftercare programs.

Methods

The goal is to recruit up to 1150 patients at baseline in five rehabilitation centers across Germany. For ethical reasons, partially randomized experimental study design is used to quantitatively assess the effectiveness of web-based aftercare programs. All patients are offered the traditional face-to-face aftercare treatment (IRENA). When patients deny to participate in traditional face-to-face aftercare, they are randomly distributed into either web-based aftercare (digIRENA) or a control group. In all three groups, the SF-12, which measures subjective health, and the WAI, which measures working ability, will be used at baseline, 13 weeks, 26 weeks and 43 weeks after the patients have left the rehabilitation center. BREQ-2, which measures motivation, is used only in the traditional aftercare group and the web-based aftercare group. A multivariate analysis of variance with repeated measurement and latent growth curve models will be used to compare the development of the variables in the three groups. For the qualitative part of the study, interviews with patients and therapists will be conducted to shed light on the applicability, acceptance, and usability of web-based aftercare programs.

Discussion

This study may provide valuable insight into the potential of web-based rehabilitation aftercare programs as a way to supplement traditional face-to-face programs. This seems particularly promising if it can manage to reach those patients who do not currently participate in traditional face-to-face rehabilitation aftercare programs due to time and location constraints.

Trial registration

The trial has been registered at the German Register of Clinical Studies (DRKS) with the registration number: DRKS00022467.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04239-z.

Mitochondria-DNA copy-number and incident venous thromboembolism among middle-aged women: a population-based cohort study

Venous thromboembolism (VTE) is the third most common cardiovascular disease. Low amount of mitochondrial DNA copy number (mtDNA-CN) has been associated with arterial cardiovascular disease (CVD) and reflects mitochondrial dysfunctions. However, whether mtDNA-CN is associated with VTE has not been determined. To examine the association between mtDNA-CN and incident VTE among middle-aged women. 6917 women aged 50-64 years, followed for 20 years in the Women's Health In the Lund Area (WHILA) study. DNA samples for mtDNA quantification were available from 2521 women. Quantification of mtDNA-CN was performed using a well-optimized droplet digital PCR method. After exclusions of women with anticoagulant treatment, women living in nursing homes, and women who were diagnosed with cancer, stroke, VTE, or coronary heart disease at baseline, a cohort of 2117 women remained for analysis. Cox regression was used to analyze the relationship between mtDNA-CN and time to VTE (hazard ratio = HR). In total, 87 women were diagnosed with VTE during follow-up, corresponding to an incidence rate of 2.8 per 1000 person-years. Neither crude nor adjusted HR for mtDNA-CN were significantly associated with incident VTE. A sensitivity analysis with inclusion of excluded women did not change the results. MtDNA-CN was not significantly associated with VTE. The present study suggests that mtDNA-CN, reflecting mitochondrial dysfunction, should not be considered a biomarker that plays a major role for developing VTE. However, due to limited study size we may not exclude minor associations.

Self-rated health and venous thromboembolism among middle-aged women: a population-based cohort study

Venous thromboembolism (VTE) is one of the most common types of cardiovascular diseases (CVDs) and is associated with increased mortality-risk. Poor-self rated health (SHR) has been associated with elevated inflammatory markers and CVDs. However, little is known about as a predictor of incident VTE. To examine the association between self-rated health, lifestyle and incident VTE among middle-aged women. 6917 women aged 50–64 years, followed for 20 years in the Women’s Health In the Lund Area (WHILA) study. After exclusion of those who medicated with anticoagulants, were living in nursing homes or suffered from cancer, stroke, VTE or CHD before baseline, a cohort of 5626 women remained. Cox regression was used to analyse the relationship between self-rated health and time to VTE, censored for any of the previous mentioned diseases during follow-up. Data were collected by questionnaires, physical examinations and Swedish registers. In total, 220 women were affected by VTE corresponding to an incidence rate of 3.9 per 1000 person-years. Adjustment for self-rated health did not significantly predict incident VTE, and neither did any of the lifestyle-related habits (e.g. physical activity and dietary habits including alcohol consumption), besides smoking. This study supports previous results with varicose veins and waist circumference as strong predictors of VTE. Poor self-rated health does not seem to be a valid predictor of VTE. Among lifestyle-related parameters, smoking was significantly associated with risk of VTE. We could also confirm the effect of the other already known risk factors.

Skin tone, life satisfaction, and psychological distress among African Americans: The mediating effect of stigma consciousness

This study examined the indirect effect of skin tone on psychological distress via (1) stigma consciousness and (2) life satisfaction among African American adults (N = 780; %Female = 57.65%; M_age = 37.68). Results show indirect effects of (1) skin tone on life satisfaction and (2) skin tone on psychological distress, each via stigma consciousness. Specifically, those with darker (vs. lighter) skin tones reported increased stigma consciousness, which then predicted (1) lower life satisfaction and (2) lower levels of psychological distress. Life satisfaction did not predict psychological distress. Implications for African American mental health are discussed.

Poor self-rated health predicts the incidence of functional disability in elderly community dwellers in Japan: a prospective cohort study

BACKGROUND

Although previous large population studies showed elderly with poor self-rated health (SRH) to be at a high risk of functional disability in Western countries, there have been few studies in which the association between SRH and functional disability was investigated in Japanese community dwellers. The association between SRH and functional disability, defined as certification of the long-term care insurance (LTCI) system, in Japanese elderly community dwellers was examined in this study.

METHODS

A total of 10,690 individuals (39.5% men, mean age of 71.4 years) who were 65 years of age or more who did not have a history of cardiovascular disease or LTCI certification were followed in this prospective study for 10.5 years. SRH was classified into four categories: good, rather good, neither good nor poor, and poor. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) for the incidence of functional disability among the SRH groups for each sex.

RESULTS

The number of individuals with functional disability was 3377. Men who rated poor for SRH scored significantly higher for functional disability (HR [95% confidence interval]: poor = 1.74 [1.42, 2.14]) while women who rated rather good, neither good nor poor, and poor scored significantly higher for functional disability (rather good =1.12 [1.00, 1.25], neither good nor poor = 1.29 [1.13, 1.48], poor = 1.92 [1.65, 2.24]: p for trend < 0.001 in both sexes).

CONCLUSION

Self-rated health, therefore, might be a useful predictor of functional disability in elderly people.

Obesity moderates the benefit of retirement on health: A 21-year prospective study in the GAZEL cohort

OBJECTIVES

Self-rated health and depressive symptoms have been shown to improve upon retirement. Participants with obesity might benefit more of retirement because of the extra work-related burden they are carrying. The present study aimed to investigate whether the association between retirement and health changes may depend upon obesity in the large French GAZEL occupational cohort during 21 years of follow-up.

METHODS

17,655 men and women were included in the analyses. Self-rated health was measured on a scale from 1 to 8 with 8 being very bad. Depressive symptoms were measured at four time points by the CES-D score. Mixed models examined the association of self-rated health or depressive symptoms with time (i.e. from -10 years before to +10 years after retirement), retirement, body mass index (BMI), and their interactions.

RESULTS

Regardless of retirement, BMI was associated with poorer health. Positive BMI by time interactions showed a less favorable time course of both health indicators in the presence versus the absence of obesity (0.024 versus 0.014 and - 0.19 versus -0.07 points per year for self-rated health and depressive symptoms, respectively). However, negative BMI by retirement interactions showed that the improvement of health observed upon retirement was stronger in with the presence versus the absence of obesity (-0.4 versus -0.3 and - 2.42 versus -1.70 points for self-rated health and depressive symptoms, respectively).

CONCLUSION

Improvement upon retirement was observed in the presence of obesity and was even higher than in the presence of normal weight and overweight.

Dieting for weight-control among older adults: The role of perceived health and perceived overweight status

BACKGROUND

Despite the ever-growing literature on weight-control diets, data about dieting among older adults are scarce.

PURPOSE

To describe the prevalence of weight-control dieting across age groups and weight statuses (from healthy-weight to overweight and obese). To identify cross-sectional associations of perceived health and perceived overweight status with dieting among older adults.

METHODS

Secondary analyses of the second and third waves of the Midlife in the US study (MIDUS). Sample included 2588 participants (40-93 years old, 54.5% females, age = 64.4 ± 11.1 years, BMI = 28.3 ± 5.9 kg/m²). Logistic regressions were used to predict dieting across age groups (independent variables: BMI, perceived health, perceived overweight status; covariates: BMI change, education, age, race).

RESULTS

As many as 15% of participants had reported dieting during the previous year. Older age was associated with less dieting among healthy weight (p = .02) and overweight (p < .001) participants, but not among participants with obesity (p = .36). Among participants younger than 75, overweight perception (vs. healthy-weight perception) was linked with higher likelihood for dieting (40-55 years: OR = 3.94[1.70-9.1]; 55-65 years: OR = 4.11[1.91-8.82]; 65-75 years: OR = 4.50[1.90-10.65]). Nevertheless, among participants older than 75, excellent (vs. good/fair/poor) perceived health was linked with higher likelihood of dieting (good vs. excellent: OR = 0.29[0.09-0.87]; fair/poor vs. excellent: OR = 0.12[0.03-0.54]).

CONCLUSIONS

Older age is associated with less weight-control dieting among people without obesity. Although overweight perception may have a stronger impact on dieting during younger age, health perception may have a stronger impact on dieting during older age, suggesting that the motivation behind weight-control diets may potentially change throughout the adult lifespan.

Gender differences in the effect of self-rated health (SRH) on all-cause mortality and specific causes of mortality among individuals aged 50 years and older

Although different gender associations between self-rated health (SRH) and mortality have been reported, the results of the respective studies have been inconsistent and little is known about the cause-specific relation of mortality with SRH by gender. Therefore, to evaluate the gender differences in all-cause or specific causes of mortality by SRH, this retrospective cohort study was conducted using the data of 19,770 Korean adults aged 50 years and over who underwent health screening at Seoul National University Hospital between March 1995 and December 2008. SRH was surveyed using a simple questionnaire, and the all-cause mortality and cause-specific mortality were followed up from baseline screening until December 31, 2016. Results showed that the relationship between SRH and all-cause mortality differed by gender, and the differences also varied depending on the cause of death. In men, the adjusted hazard ratio (aHR) of all-cause mortality was higher in the poor SRH group than the very good SRH groups even after adjustment for socio-demographic, clinical, and behavioral risk factors (aHR:1.97, 95% CI 1.51-2.56), and these results were similar to those for cancer, cardiovascular, and respiratory disease mortalities (aHR:1.52, 95% CI 0.93-2.50; aHR: 2.11, 95% CI 1.19-3.74; aHR:10.30, 95% CI 2.39-44.44, respectively). However, in women, the association between SRH and all-cause mortality was insignificant, and inverse relationships were found for cardiovascular and respiratory disease mortalities in the poor and very good SRH groups. Cancer mortality had a positive relation with SRH (aHR: 1.14, 95% CI 0.75-1.72; aHR: 2.58, 95% CI 1.03-6.48; aHR: 0.49, 95% CI 0.24-0.98; aHR: 0.15, 95% CI 0.04-0.57: all-cause, cancer, cardiovascular, and respiratory disease mortalities, respectively). Clinicians need to take these gender differences by SRH into account when evaluating the health status of over-middle aged adults.

Psychological factors and self-rated health: An observative study on cardiological patients

This study investigated the association of illness representations, awareness of bodily states and health complaints to self-rated health in N = 150 consecutive patients with heart disease (ischaemic disease, heart failure and heart valve disease) and explored differences between ‘health optimist’ and ‘health pessimist’ patients. After controlling for medical variables, health complaints accounted for 14.2 per cent of patients’ self-rated health, and illness representations contributed for another 16.2 per cent; body awareness was not associated with self-rated health. Also, ‘optimists’ tended to see less negative consequences from their illness and perceived greater control over illness treatment compared to ‘pessimists’. Targeting symptoms and illness representations may optimize rehabilitation outcomes.

Association between self-rated health and ideal cardiovascular health: The Baptist Health South Florida Employee Study

Background

There is increasing evidence of the role psychosocial factors play as determinants of cardiovascular health (CVH). We examined the association between self-rated health (SRH) and ideal CVH among employees of a large healthcare organization.

Methods

Data were collected in 2014 from employees of Baptist Health South Florida during an annual voluntary health risk assessment and wellness fair. SRH was measured using a self-administered questionnaire where responses ranged from poor, fair, good, very good to excellent. A CVH score (the proxy for CVH) that ranged from 0 to 14 was calculated, where 0-8 indicate an inadequate score, 9-10, average and 11-14, optimal. A multinomial logistic regression was used to examine the association between SRH and CVH.

Results

Of the 9056 participants, 75% were female and mean age (SD) was 43 ± 12 years. The odds of having a higher CVH score increased as SRH improved. With participants who reported their health status as poor-fair serving as reference, adjusted odds ratios for having an optimal CVH score by the categories of SRH were: excellent, 21.04 (15.08-29.36); very good 10.04 (7.25-13.9); and good 3.63 (2.61-5.05).

Conclusion

Favorable SRH was consistently associated with better CVH.

The associations of self-rated health with cardiovascular risk proteins: a proteomics approach

Background

Though subjective, poor self-rated health (SRH) has consistently been shown to predict cardiovascular disease (CVD). The underlying mechanism is unclear. This study evaluates the associations of SRH with biomarkers for CVD, aiming to explore potential pathways between poor SRH and CVD.

Methods

Based on the Malmö Diet and Cancer Cardiovascular Cohort study, a targeted proteomics approach was used to assess the associations of SRH with 88 cardiovascular risk proteins, measured in plasma from 4521 participants without CVD. The false discovery rate (FDR) was controlled using the Benjamini and Hochberg method. Covariates taken into consideration were age, sex, traditional CVD risk factors (low-density lipoprotein cholesterol, systolic blood pressure, anti-hypertensive medication, diabetes, body mass index, smoking), comorbidity, life-style and psycho-social factors (education level, living alone, alcohol consumption, low physical activity, psychiatric medication, sleep duration, and unemployment).

Results

Age and sex-adjusted associations with SRH was found for 34 plasma proteins. Nine of them remained significant after adjustments for traditional CVD risk factors. After further adjustment for comorbidity, life-style and psycho-social factors, only leptin (β = − 0.035, corrected p = 0.016) and C–C motif chemokine 20 (CCL20; β = − 0.054, corrected p = 0.016) were significantly associated with SRH.

Conclusions

Poor SRH was associated with raised concentrations of many plasma proteins. However, the relationships were largely attenuated by adjustments for CVD risk factors, comorbidity and psycho-social factors. Leptin and CCL20 were associated with poor SRH in the present study and could potentially be involved in the SRH–CVD link.

Stigma doesn't discriminate: physical and mental health and stigma in Canadian military personnel and Canadian civilians

Background

Illness-related stigma has been identified as an important public health concern. Past research suggests there is a disproportionate risk of mental-health stigma in the military, but this same finding has not yet been established for physical-health stigma. The current study aimed to assess the independent contribution of mental and physical health on both enacted stigma (discriminatory behaviour) and felt stigma (feelings of embarrassment) and to determine whether these associations were stronger for military personnel than civilians.

Methods

Data were obtained from the 2002 Canadian Community Health Survey - Mental Health and Well-being and its corresponding Canadian Forces Supplement. Logistic regressions were used to examine a potential interaction between population (military [N = 1900] versus civilian [N = 2960]), mental health, and physical health in predicting both enacted and felt stigma, with adjustments made for socio-demographic information, mental health characteristics, and disability.

Results

Mental health did not predict enacted or felt stigma as a main effect nor in an interaction. There was a strong link between physical health and enacted and felt stigma, where worse physical health was associated with an increased likelihood of experiencing both facets of stigma. The link between physical health and enacted stigma was significantly stronger for military personnel than for civilians.

Conclusions

Physical health stigma appears to be present for both civilians and military personnel, but more so for military personnel. Elements of military culture (e.g., the way care is sought, culture of toughness, strict fitness requirements) as well as the physical demands of the job could be potential predictors of group differences.

Hypertension Status and Associations with Self-Rated Health and General Practitioner Health Seeking in a Rural Australian Cohort

Hypertension is the most frequently managed condition by Australian general practitioners (GP). Knowledge of hypertension and blood pressure (BP) values may motivate individuals to seek GP management. Our study aims to determine the associations of knowledge of BP values, BP perception, GP health seeking, and self-rated health (SRH) in a rural population. Two-hundred and seventy-eight (278) residents responded to the health survey on socio-demographic profile, medical history, BP knowledge and perception, SRH, and GP visit frequency. Associations were evaluated using Chi-squared test and multivariate logistic regression. Cohort mean age was 63.6 (12.4) years with 63.3% females. Hypertension (37.8%) was the most common condition. GP visits were made at least once every month (19.1%), every 2–6 months (35.6%), >6 months (11.5%), or only when needed (29.5%). Univariate analyses showed age, education, alcohol consumption, comorbidities, hypertension status, and SRH were significantly associated with visit frequency. After adjustments, hypertension status (OR = 3.6, 95% CI [1.7, 7.9]) and poor SRH (OR = 3.1, 95% CI [1.4, 7.0]) were significantly associated with frequent monthly visits. Our cohort demonstrated that having hypertension and poor self-rated health were associated with frequent monthly GP visits. The perception of high blood pressure does not drive seeking additional GP input.

The subjective health of adults in Germany

The term 'subjective health' reflects not only existing illnesses and health complaints, but particularly emphasizes the personal well-being. Studies often collect data on subjective health by asking participants to provide self-assessments of their general state of health. This was also the case with GEDA 2014/2015-EHIS, which employed the internationally renowned Minimum European Health Module (MEHM) as part of the study. Its results demonstrate that 68.2% of adults in Germany rate their general health as very good or good, with the remaining 31.8% rating it as fair, poor or very poor. The proportion of women who rate their general health as very good or good is slightly lower than the proportion of men who do so (66.6% compared to 69.9%). With increasing age, women and men view the condition of their general health as worsening. The study also identified educational differences which showed that men and women with low levels of education tend to rate their health worse compared to self-assessments provided by women and men with higher levels of education, and in some cases also regional differences.

Molecular genetic contributions to self-rated health

Background: Poorer self-rated health (SRH) predicts worse health outcomes, even when adjusted for objective measures of disease at time of rating. Twin studies indicate SRH has a heritability of up to 60% and that its genetic architecture may overlap with that of personality and cognition.

Methods: We carried out a genome-wide association study (GWAS) of SRH on 111 749 members of the UK Biobank sample. Univariate genome-wide complex trait analysis (GCTA)-GREML analyses were used to estimate the proportion of variance explained by all common autosomal single nucleotide polymorphisms (SNPs) for SRH. Linkage disequilibrium (LD) score regression and polygenic risk scoring, two complementary methods, were used to investigate pleiotropy between SRH in the UK Biobank and up to 21 health-related and personality and cognitive traits from published GWAS consortia.

Results: The GWAS identified 13 independent signals associated with SRH, including several in regions previously associated with diseases or disease-related traits. The strongest signal was on chromosome 2 (rs2360675, P = 1.77 x 10^-10) close to KLF7. A second strong peak was identified on chromosome 6 in the major histocompatibility region (rs76380179, P = 6.15 x 10^-10). The proportion of variance in SRH that was explained by all common genetic variants was 13%. Polygenic scores for the following traits and disorders were associated with SRH: cognitive ability, education, neuroticism, body mass index (BMI), longevity, attention-deficit hyperactivity disorder (ADHD), major depressive disorder, schizophrenia, lung function, blood pressure, coronary artery disease, large vessel disease stroke and type 2 diabetes.

Conclusions: Individual differences in how people respond to a single item on SRH are partly explained by their genetic propensity to many common psychiatric and physical disorders and psychological traits.

Self-Rated Health Status and Risk of Incident Stroke in 0.5 Million Chinese Adults: The China Kadoorie Biobank Study

Background and purpose

Self-rated health (SRH) is a consistent and strong predictor of all-cause and cardiovascular mortality in various populations. However, the associations between SRH measures and risk of first-ever or recurrent stroke were rarely explored. We thus aim to prospectively investigate the associations between SRH measures and risk of total and subtypes of stroke in Chinese population.

Methods

A total of 494,113 participants from the China Kadoorie Biobank without prior heart diseases or cancer (486,541 without stroke and 7,572 with stroke) were followed from baseline (2004 to 2008) until December 31, 2013. General and age-comparative SRH were obtained from baseline questionnaires. First-ever stroke or recurrent events were ascertained through linkage to disease registry system and health insurance data.

Results

We identified 27,662 first-ever stroke and 2,909 recurrent events during an average of 7.0 years of follow-up. Compared with excellent general SRH, the hazard ratios (HRs) and 95% confidence intervals (CIs) for first-ever stroke associated with good, fair, and poor general SRH were 1.04 (1.00 to 1.08), 1.19 (1.15 to 1.23), and 1.49 (1.42 to 1.56) in the multivariate model, respectively. Compared with better age-comparative SRH, the HRs (95% CIs) of same and worse age-comparative SRH were 1.13 (1.10 to 1.17) and 1.51 (1.45 to 1.58), respectively. The relations of SRH measures with ischemic stroke, hemorrhagic stroke, and recurrent stroke were similar to that with total first-ever stroke. However, the magnitude of associations was much stronger for fatal stroke than for non-fatal stroke.

Conclusions

This large-scale prospective cohort suggests that self-perceived health status is associated with incident stroke, regardless of stroke subtype.

Is self-rated health in adolescence a predictor of prescribed medication in adulthood? Findings from the Nord Trøndelag Health Study and the Norwegian Prescription Database

Self-rated health (SRH) is a commonly used health indicator predicting morbidity and mortality in a range of populations. However, the relationship between SRH and medication is not well established. The aim of this study was to examine adolescent SRH as a predictor for prescribed medication later in young adulthood. Eighteen years' prospective data from the Nord-Trøndelag Health Study (HUNT) and the Norwegian Prescription Database (NorPD) were analyzed. Baseline data, gathered from 8982 adolescents (mean age 16.0 years) in the Young-HUNT I survey (1995-1997), were linked to individual data from NorPD, including information on all medications prescribed in 2013-2014. Gender-stratified negative binomial regression models were used to investigate the association between SRH and medication, also adjusted for age, baseline self-reported medicine use, physical and mental disability, smoking, and physical activity. Based on the Anatomical Therapeutic Chemical (ATC) Classification System, total consumption and consumption related to various ATC groups were examined. The adjusted analyses showed a dose-response relationship for females, with poorer SRH predicting higher average medication for both total consumption and for the ATC groups "Musculoskeletal system" (M), "Nervous system" (N; Analgesics (N02), Opioids (N02A)) and "Respiratiory system" (R). The predictive power of SRH, as well as the role of the adjustment factors, varies by gender and drug groups. This knowledge is important in order to identify risks for later disease and to capture pathological changes before and beyond the disease diagnosis, potentially preventing morbidity in the adult population.

Cardiovascular Disease Risk Predicts Health Perception in Prison Inmates

We hypothesized that risk factors for cardiovascular disease (CVD) would be associated with worse health perceptions in prison inmates. This study included 362 inmates recruited from four medium security prisons in Kentucky. Framingham Risk Score was used to estimate the risk of developing CVD within the next 10 years. A single item on self-rated health from the Medical Outcomes Survey–Short Form 36 was used to measure health perception. Multinomial logistic regression showed that for every 1-unit increase in Framingham Risk Score, inmates were 23% more likely to have rated their health as fair/poor and 11% more likely to rate their health as good rather than very good/excellent. These findings demonstrate that worse health perceptions may serve as a starting point for discussing cardiovascular risk factors and prevention with inmates.

Awareness of Individual Cardiovascular Risk Factors and Self-Perception of Cardiovascular Risk in Women

BACKGROUND

Cardiovascular risk factors (CVRFs) self-perception by women may be inaccurate.

MATERIALS AND METHODS

A questionnaire was completed anonymously Online by women who self-reported their personal CVRF levels including age, weight, contraceptive use, menopausal status, smoking, diet and physical activities. Self-perceived risk was matched to actual cardiovascular risk according to the Framingham score.

RESULTS

Among 5,240 young and middle-aged women with a high educational level, knowledge of personal CVRFs increased with age, from 51-90% for blood pressure (BP), 22-45% for blood glucose and 15-47% for blood cholesterol levels, between 30 and 65 years, respectively. This knowledge was lower for smoking compared with nonsmoking women: 62.5% vs. 74.5% for BP (P < 0.001), 22.7% vs. 33.8% for blood glucose (P < 0.001), 21.9% vs. 32.0% for cholesterol levels (P < 0.001). Knowledge of BP level was reduced among women using an estrogen-progestogen contraception (56.8% vs. 62.1%, P = 0.0031) and even more reduced among smokers (52.2%, P < 0.001). Conversely, women with leisure-time physical or sportive activity (60.5%), were less overweight or obese (22.4% vs. 34.2%, P < 0.001). They reported better knowledge of BP (72.4% vs. 68.3%, P < 0.001), blood cholesterol (31.1% vs. 26.4%, P < 0.001) and glucose levels (32.7% vs. 27.8%, P < 0.001). Self-perceived cardiovascular risk was rated low by 1,279 (20.4%), moderate by 3,710 (63.3%) and high by 893 (16.3%) women. Among 3,386 women tested using the Framingham score, 40.8% were at low, 25.2% at moderate and 33.8% at high risk.

CONCLUSIONS

Knowledge of CVRFs and self-perception of individual risk are inaccurate in women. Educational interventions should be emphasized.

Recommendations for cardiovascular disease research with lesbian, gay and bisexual adults

AIMS AND OBJECTIVES

The purpose of this paper is to provide recommendations to strengthen cardiovascular disease research with lesbian, gay and bisexual adults, and highlight implications for practice.

BACKGROUND

Lesbian, gay and bisexual individuals face significant discrimination that negatively impacts their health. Health disparities research in lesbian, gay and bisexual adults have focused on mental health, sexually transmitted infections and substance use. Although cardiovascular disease is the leading cause of death and many lesbian, gay and bisexual adults report increased risk factors for cardiovascular disease, there has been limited research in this area.

DESIGN

This paper is a critical review.

METHODS

A literature search was conducted that compared cardiovascular disease risk and/or prevalence between lesbian, gay and bisexual and heterosexual adults.

RESULTS

Measures to assess cardiovascular disease risk factors and diagnoses varied widely across the 31 included studies. There was a lack of standardisation in definitions used for alcohol consumption, illicit drug use, mental health and self-rated physical health. Most studies that reported body mass index relied on participant self-report. Few studies included measures of physical activity and diet and those that did lacked standardisation. Only seven studies used laboratory data to establish diagnosis of cardiovascular disease.

CONCLUSIONS

This study is the first comprehensive review on this topic. In cardiovascular disease research with lesbian, gay and bisexual adults, there is a need for: (1) inclusion of stress as a risk factor for cardiovascular disease, (2) standardised measures, (3) objective measures for determining the presence of cardiovascular disease, (4) data from electronic health records to strengthen the study of cardiovascular disease in this population.

RELEVANCE TO CLINICAL PRACTICE

Strengthening cardiovascular disease research in lesbian, gay and bisexual adults is an important step in addressing health disparities in this population. Nurses and other healthcare professionals should assess sexual orientation in routine health assessments.

Clinical characteristics of asymptomatic left ventricular diastolic dysfunction and its association with self-rated health and N-terminal B-type natriuretic peptide: a cross-sectional study

Aims

Left ventricular hypertrophy, obesity, hypertension, and N‐terminal B‐type natriuretic peptide (Nt‐proBNP) predict left ventricular diastolic dysfunction with preserved systolic function (DD‐PSF). Self‐rated health (SRH) is shown to be associated with chronic diseases, but the association of SRH with DD‐PSF is unclear. In light of the clinical implications of DD‐PSF, the following goals are of considerable importance: (1) to determine the role of SRH in patients with DD‐PSF in the general population and (2) to study the association between Nt‐proBNP and DD‐PSF.

Methods and results

The current study is a cross‐sectional study conducted on a random sampling of a rural population. Individuals 30–75 years of age were consecutively subjected to conventional echocardiography and tissue velocity imaging. Data were collected on 500 (48%) men and 538 (52%) women (n = 1038). DD‐PSF was the main outcome, and SRH and Nt‐proBNP were the primary indicators. Diabetes mellitus, hypertension, and obesity were accounted for as major confounders of the association with SRH. DD‐PSF was identified in 137 individuals, namely, 79 men (15.8%) and 58 women (10.8%). In a multivariate regression model, SRH (OR 2.95; 95% CI 1.02–8.57) and Nt‐proBNP (quartile 4 vs. quartile 1 OR 4.23; 95% CI 1.74–10.26) were both independently associated with DD‐PSF.

Conclusions

SRH, evaluated based on a descriptive question on general health, should be included in the diagnostic process of DD‐PSF. In agreement with previous studies, our study confirms that Nt‐proBNP is a major indicator of DD‐PSF.

Correlation between health-related quality of life in the physical domain and heart rate variability in asymptomatic adults

Background

Reduced health-related quality of life in the physical domain (HRQOL_physical) has been reported to increase risks for cardiovascular disease (CVD); however, the mechanism underlying this phenomenon is still unclear. The autonomic nervous system (ANS) that connects the body and mind is a biologically plausible candidate to investigate this mechanism. The aim of our study is to examine whether the HRQOL_physical independently contributes to heart rate variability (HRV), which reflects ANS activity.

Methods

We recruited 329 physically and mentally healthy adults. All participants completed Beck Anxiety Inventory, Beck Depression Inventory and World Health Organization Questionnaire on Quality of Life: Short Form-Taiwanese version (WHOQOL-BREF). They were divided into groups of individuals having high or low scores of HRQOL_physical as discriminated by the quartile value of WHOQOL-BREF. We obtained the time and frequency-domain indices of HRV, namely variance (total HRV), the low-frequency power (LF; 0.05–0.15 Hz), which may reflect baroreflex function, the high-frequency power (HF; 0.15–0.40 Hz), which reflects cardiac parasympathetic activity, and the LF/HF ratio.

Results

There was an independent contribution of HRQOL_physical to explaining the variance in HRV after excluding potential confounding factors (gender, age, physical activity, alcohol use, depression and anxiety). Compared with the participants with high levels of HRQOL_physical, those with low levels of HRQOL_physical displayed significant reductions in variance and LF.

Conclusions

This study highlights the independent role of low HRQOL_physical in contributing to the reduced HRV in healthy adults and points to a potential underlying mechanism for HRQOL_physical to confer increased risks for CVD.

Gender differences in quality of life perception and cardiovascular risk in a community sample

INTRODUCTION

Self-reported heath and quality of life is an independent predictor of overall and cardiovascular morbidity and mortality, and incident coronary heart disease. However, less is known regarding how gender differences in cardiovascular risk factors impact quality of life perception.

METHODS

Primary healthcare users (n=261, 158 women) were screened for cardiovascular risk factors and completed the Medical Outcomes Study Short Form (SF-36).

RESULTS

Women had significantly lower alcohol consumption, body mass index and exercise frequency than men, but more prevalent psychiatric history, depressive and anxiety symptoms, and negative affectivity. Prevalences of hypertension, diabetes, dyslipidemia and type D personality were similar between genders. Women reported significantly worse quality of life on most SF-36 subscales and gender differences were apparent in predictors of quality of life. Moreover, high negative affectivity was an independent predictor of worse general health for women, whereas high social inhibition and high anxiety had a comparable role for men.

CONCLUSION

Gender specifics in cardiovascular risk factors should be considered in prevention strategies. Women reported significantly worse quality of life, putting them at higher risk for cardiovascular morbidity and mortality. Therefore, gender differences in predictors of quality of life warrant further investigation.

The Cost of Color: Skin Color, Discrimination, and Health among African-Americans

In this study, the author uses a nationally representative survey to examine the relationship(s) between skin tone, discrimination, and health among African-Americans. He finds that skin tone is a significant predictor of multiple forms of perceived discrimination (including perceived skin color discrimination from whites and blacks) and, in turn, these forms of perceived discrimination are significant predictors of key health outcomes, such as depression and self-rated mental and physical health. Intraracial health differences related to skin tone (and discrimination) often rival or even exceed disparities between blacks and whites as a whole. The author also finds that self-reported skin tone, conceptualized as a form of embodied social status, is a stronger predictor of perceived discrimination than interviewer-rated skin tone. He discusses the implications of these findings for the study of ethnoracial health disparities and highlights the utility of cognitive and multidimensional approaches to ethnoracial and social inequality.

Self-perceived health versus actual cardiovascular disease risks

AIM

Self-perceived poor health is related to cardiovascular disease (CVD) risk perception, cardiovascular event, hospital readmission, and death from CVD. This study evaluated the associations between self-perceived health and actual CVD risk in South Koreans as well as the influence of sociodemographic and cardiovascular risk factors on self-perceived poor health.

METHODS

This is a secondary data analysis of the 2010 Korea National Health and Nutrition Examination Survey. The sample was 4535 South Koreans aged 30-74 years without CVD. Self-perceived health status was compared with actual cardiovascular risk separately by sex using χ(2) -tests. Logistic regressions were used to identify potential sociodemographic and cardiovascular risk factors of self-perceived poor health.

RESULTS

Self-perceived poor health was related to higher CVD risk but there were substantial gaps between them. Among cardiovascular risk factors, dyslipidemia, obesity, smoking, and a family history of CVD did not affect self-perceived health.

CONCLUSION

Gaps between perceived health and actual CVD risk should be closed to optimize cardiovascular health of South Koreans. Koreans need to increase risk perception to a level commensurate with their actual risk. Healthcare providers should try to provide individuals at increased CVD risk with better information more frequently, especially those who have favorable perceptions of their health but smoke or have elevated cholesterol levels and bodyweight.

Associations of a Short Sleep Duration, Insufficient Sleep, and Insomnia with Self-Rated Health among Nurses

Epidemiological evidence suggests that sleep duration and poor sleep are associated with mortality, as well as with a wide range of negative health outcomes. However, few studies have examined the association between sleep and self-rated health, particularly through the combination of sleep complaints. The objective of this study was to examine whether self-rated health is associated with sleep complaints, considering the combination of sleep duration, insomnia, and sleep sufficiency. This cross-sectional study was performed in the 18 largest public hospitals in the city of Rio de Janeiro, Brazil. A total of 2518 female nurses answered a self-filled multidimensional questionnaire. The adjusted odds ratios and 95% confidence intervals (CIs) estimated the chance of poor self-rated health in the presence of different combinations of sleep duration and quality. Compared with women who reported adequate sleep duration with no sleep quality complaints (reference group), the odds ratios (95% CI) for poor self-rated health were 1.79 (1.27–2.24) for those who reported only insufficient sleep, 1.85 (0.94–3.66) for only a short sleep duration, and 3.12 (1.94–5.01) for only insomnia. Compared with those who expressed all three complaints (short sleep duration, insomnia, and insufficient sleep), the odds ratio for poor self-rated health was 4.49 (3.25–6.22). Differences in the magnitude of the associations were observed, depending on the combination of sleep complaints. Because self-rated health is a consistent predictor of morbidity, these results reinforce the increasing awareness of the role of sleep in health and disease. Our findings contribute to the recognition of sleep as a public health matter that deserves to be better understood and addressed by policymakers.

The impact of health behaviours on incident cardiovascular disease in Europeans and South Asians--a prospective analysis in the UK SABRE study

Background

There is consistent evidence on the impact of health behaviours on risk of cardiovascular disease (CVD) in European populations. As South Asians in the UK have an excess risk of CVD and coronary heart disease (CHD) compared to Europeans, we investigated whether a similar association between combined health behaviours and risk of CVD and CHD among this high-risk group exists, and estimated the population impact.

Methods and Findings

In a prospective cohort of 1090 Europeans and 1006 South Asians (40–69 y) without prevalent CVD at baseline (1988–1990), followed up for 21 years to 2011, there were 601 incident CVD events [Europeans n = 255; South Asians n = 346] of which 520 were CHD events [n = 207 and 313 respectively]. Participants scored between 0 to 4 points for a composite score including four baseline healthy behaviours (non-smoker, moderate alcohol intake, physically active, frequent fruit/vegetable intake). Adjusted hazard ratios (95% confidence intervals) for incident CHD in Europeans who had three, two, one, and zero compared to four health behaviours were 1.33 (0.78–2.29), 1.96 (1.15–3.33), 1.36 (0.74–2.48) and 2.45 (1.18–5.10), respectively, p-trend = 0.025. In South Asians, corresponding HRs were 2.88 (1.33–6.24), 2.28 (1.06–4.91), 3.36 (1.53–7.39) and 3.48 (1.38–8.81), p-trend = 0.022. The results were similar for incident CVD; Europeans HR 2.12 (1.14–3.94), p–trend = 0.014; South Asians HR 2.73 (1.20–6.21), p-trend = 0.018. The population attributable fraction in Europeans was 43% for CHD and 28% for CVD. In South Asians it was 63% and 51% respectively.

Conclusions

Lack of adherence to four combined health behaviours was associated with 2 to 3-fold increased risk of incident CVD in Europeans and South Asians. A substantial population impact in the South Asian group indicates important potential for disease prevention in this high-risk group by adherence to healthy behaviours.