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Westrick AC, Esiaka DK, Meier HCS, Rooks RN, Manning M, Tarraf W. Cognition and Wealth Changes in Mid-to-later Life: A Latent Class Trajectories Approach Using the Health and Retirement Study. J Aging Health 2024; 36:510-522. [PMID: 38356174 DOI: 10.1177/08982643241232003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
ObjectivesTo assess how cognitive trajectories from mid-to-later life relate to wealth change, overall and by mid-life income. Methods: Data were from participants (51-64 years) in the 2000-2018 U.S. Health and Retirement Study who were cognitively healthy at baseline (year 2000; unweighted n = 3821). Longitudinal latent class analyses generated cognitive and wealth trajectories, independently, and multinomial logistic regressions estimated the association between cognitive trajectories and wealth profiles, overall and by median income. Results: We identified three cognitive: cognitively healthy (CH), increasing cognitive impairment (ICI), and increasing dementia (ID) and four wealth profiles: stable wealth loss (SWL), delayed gradual wealth loss (DGWL), stable wealth gain (SWG), and gradual wealth gain (GWG). The ID group had higher probability of being in the SWL group and lower probability of SWG, which was more pronounced in respondents with greater median income. Discussion: Individuals with ID may be vulnerable to wealth loss, particularly for middle-class households.
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Affiliation(s)
- Ashly C Westrick
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Darlingtina K Esiaka
- Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Helen C S Meier
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Ronica N Rooks
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA
| | - Mark Manning
- Department of Psychology, Oakland University, Rochester, MI, USA
| | - Wassim Tarraf
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
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Mira R, Newton JT, Sabbah W. The Longitudinal Relationship between Edentulism and the Progress of Multimorbidity. Nutrients 2024; 16:2234. [PMID: 39064677 PMCID: PMC11279822 DOI: 10.3390/nu16142234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/03/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVES To examine the longitudinal relationship between edentulism, nutritional intake, and the progress of multimorbidity among older Americans. METHODS We used data from the Health and Retirement Study (2006-2018), a longitudinal survey of older Americans that has collected data biennially since 1992. Edentulism was assessed in 2006 while nutritional intake was assessed in 2013. Multimorbidity was indicated by five self-reported chronic conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Individuals with two or more conditions at baseline were excluded from the analysis. Nutritional intake was calculated by summing 10 nutrients (protein, vitamins C, D, B12 and E, calcium, zinc, polyunsaturated fatty acids, folate, and ß-carotene). Structural equation modelling (SEM) was used to examine the nutritional pathway between edentulism (2006) and the increase in multimorbidity from 2006 to 2018. RESULTS The number of individuals included in the analysis was 3463. The incidence of multimorbidity between 2006 and 2018 was 24.07%, while the percentage of edentate participants in 2006 was 16.42%. The mean total nutrition in 2013 was 4.50 (4.43, 4.55). The SEM analysis showed that edentulism was negatively associated with nutritional intake {estimate -0.15 (95%CI: -0.30, -0.01)}. A negative association was found between total nutrition and multimorbidity {estimate -0.008 (95%CI: -0.01, -0.002)}. Age, wealth, and smoking were included in the analysis and had statistically significant associations with multimorbidity. CONCLUSION The analysis demonstrated a longitudinal association between edentulism, nutritional intake, and the progress of multimorbidity.
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Affiliation(s)
| | | | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London SE1 9RT, UK; (R.M.); (J.T.N.)
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Takale G, Handore A, Jeyakumar A, Godbharle S. Prevalence and determinants of multiple chronic conditions (MCC) among young adults in Indian households: an analysis of NFHS-5. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:77. [PMID: 38835054 DOI: 10.1186/s41043-024-00560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 05/03/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Multiple chronic conditions (MCC) are defined as the presence of two or more chronic conditions, that significantly impact health status, functional capacity, quality of life, and overall healthcare management. Despite the significant evidence on chronic disease burden, the co-existence of MCC within a household in low- and middle-income countries (LMICs) is less studied. This study therefore estimates the prevalence of MCC and its determinants among adults in the Indian households. METHODS Data used in this study were drawn from the fifth round of the National Family Health Survey (NFHS) conducted in 2019-21. Data sets of men (15-54 years) and women (15-49 years) were used for the study. The total sample size of adults for this analysis was N = 239,848. The outcome variable of this study was multiple chronic conditions (MCC) in adults which included a total of nine chronic conditions (hypertension, diabetes, chronic respiratory diseases, chronic kidney disorders, cancer, thyroid disorders, obesity, and heart diseases, consuming alcohol, chewing tobacco, and smoking) documented in NFHS-5. Descriptive statistics and binary logistic regression analysis were used to quantify the results. RESULTS A prevalence of 5.5% of MCC in adults emerged from our study. Logistic regression analysis identified that younger age, males (AOR 0.36 (0.33-0.39)), urban areas (AOR 1.11 (1.02-1.17)) as the place of residence, and participants representing SC (AOR 0.89 (0.81-0.97)), and ST (AOR 1.30 (1.17-1.45)), had a higher risk of MCC irrespective of level of education, type of occupation, marital status, or wealth index, and states from any category of social progress. CONCLUSION A 5% prevalence of MCC specifically obesity, substance use, and hypertension calls for integrated efforts aiming at behavior change, and regulatory efforts to prevent further increase of MCC among young adults in India.
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Affiliation(s)
- Geetanjali Takale
- Department of Health Sciences, Savitribai Phule Pune University, Ganeshkhind Road, Pune, Maharashtra, India
| | - Avantika Handore
- Department of Health Sciences, Savitribai Phule Pune University, Ganeshkhind Road, Pune, Maharashtra, India
| | - Angeline Jeyakumar
- Food Evolution Research Laboratory (FERL), School of Tourism and Hospitality Management, College of Business and Economics, University of Johannesburg, Johannesburg, South Africa
- Department of Nutrition, University of Nevada, Reno, NV, USA
| | - Swapnil Godbharle
- Department of Health Sciences, Savitribai Phule Pune University, Ganeshkhind Road, Pune, Maharashtra, India.
- Food Evolution Research Laboratory (FERL), School of Tourism and Hospitality Management, College of Business and Economics, University of Johannesburg, Johannesburg, South Africa.
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García-Ovejero E, Pisano-González M, Salcedo-Diego I, Serrano-Gallardo P. Impact of Chronic Disease Self-Management Program on the Self-Perceived Health of People in Areas of Social Vulnerability in Asturias, Spain. Healthcare (Basel) 2024; 12:811. [PMID: 38667573 PMCID: PMC11049834 DOI: 10.3390/healthcare12080811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
The Chronic Disease Self-Management Program (CDSMP) focuses on a health promotion perspective with a salutogenic approach, reinforcing the pillars of self-efficacy. The aim of this study was to assess the impact of the CDSMP on Self-perceived Health (SPH) in disadvantaged areas of Asturias, España. The study included vulnerable adults with experience of chronic diseases for over six months, along with their caregivers. The intervention consisted of a six-session workshop led by two trained peers. SPH was evaluated by administering the initial item of the SF-12 questionnaire at both baseline and six months post-intervention. To evaluate the variable "Change in SPH" [improvement; remained well; worsening/no improvement (reference category)], global and disaggregated by sex multivariate multinomial logistic regression models were applied. There were 332 participants (mean = 60.5 years; 33.6% were at risk of social vulnerability; 66.8% had low incomes). Among the participants, 22.9% reported an improvement in their SPH, without statistically significant sex-based differences, while 38.9% remained in good health. The global model showed age was linked to decreased "improvement" probability (RRRa = 0.96), and the "remaining well" likelihood drops with social risk (RRRa = 0.42). In men, the probability of "remaining well" decreased by having secondary/higher education (RRRa = 0.25) and increased by cohabitation (RRRa = 5.11). Women at social risk were less likely to report "remaining well" (RRRa = 0.36). In conclusion, six months after the intervention, 22.9% of the participants had improved SPH. Age consistently decreased the improvement in the different models.
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Affiliation(s)
- Ester García-Ovejero
- Nursing Department, Faculty of Medicine, Autonomous University of Madrid, 28029 Madrid, Spain;
- National Centre for Epidemiology, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marta Pisano-González
- General Directorate of Social and Health Care and Coordination, Ministry of Health of the Principality of Asturias, 33005 Asturias, Spain
- Research Group “Person-Centered Care” of the Research Institute of Asturias (ISPA), 33005 Asturias, Spain
| | - Isabel Salcedo-Diego
- Puerta de Hierro Majadahonda University Hospital, 28222 Majadahonda, Spain
- Puerta de Hierro-Segovia de Arana Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
| | - Pilar Serrano-Gallardo
- Nursing Department, Faculty of Medicine, Autonomous University of Madrid, 28029 Madrid, Spain;
- Puerta de Hierro-Segovia de Arana Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
- Interuniversity Institute “Advanced Research on Evaluation of Science and the University” (INAECU), 28029 Madrid, Spain
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Lalande FD. The Effects of Reverse-Role Simulation on Nursing Students' Ethnocultural Empathy: A Quantitative Study. Nurs Educ Perspect 2024:00024776-990000000-00210. [PMID: 38315749 DOI: 10.1097/01.nep.0000000000001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
AIM The aim of this study was to examine the impact of reverse-role simulation on nursing students' empathy levels toward ethnoculturally diverse patients. BACKGROUND Empathy is an essential component of culturally competent care; however, it is often left out of cultural competence education. Enhancing nursing students' cultural empathy may benefit students and patients. METHOD The study used a quasi-experimental one-group pretest-posttest design in a private nursing school in the Northeast. The sample consisted of 37 undergraduate nursing students. RESULTS Pretest and posttest scores were statistically different, indicating a significant increase in the students' ethnocultural empathy, t (36) = -3.20, p = .003. CONCLUSION This study supports using reverse-role simulation as an effective teaching strategy to enhance nursing students' empathy toward ethnocultural diverse patients. Placing students in the "shoes" of an ethnoculturally diverse patient can increase their empathy levels and enhance cultural competence education.
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Affiliation(s)
- Fabiola D Lalande
- About the Author Fabiola D. Lalande, DNP, RN, is an associate professor, Richard and Sheila Young School of Nursing Regis College, Regis College, Weston, Massachusetts. For more information, contact her at or
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Bensken WP, Navale SM, McGrath BM, Cook N, Nishiike Y, Mertes G, Goueth R, Jones M, Templeton A, Zyzanski SJ, Koroukian SM, Stange KC. Variation in multimorbidity by sociodemographics and social drivers of health among patients seen at community-based health centers. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2024; 14:26335565241236410. [PMID: 38419819 PMCID: PMC10901061 DOI: 10.1177/26335565241236410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024]
Abstract
Purpose Understanding variation in multimorbidity across sociodemographics and social drivers of health is critical to reducing health inequities. Methods From the multi-state OCHIN network of community-based health centers (CBHCs), we identified a cross-sectional cohort of adult (> 25 years old) patients who had a visit between 2019-2021. We used generalized linear models to examine the relationship between the Multimorbidity Weighted Index (MWI) and sociodemographics and social drivers of health (Area Deprivation Index [ADI] and social risks [e.g., food insecurity]). Each model included an interaction term between the primary predictor and age to examine if certain groups had a higher MWI at younger ages. Results Among 642,730 patients, 28.2% were Hispanic/Latino, 42.8% were male, and the median age was 48. The median MWI was 2.05 (IQR: 0.34, 4.87) and was higher for adults over the age of 40 and American Indians and Alaska Natives. The regression model revealed a higher MWI at younger ages for patients living in areas of higher deprivation. Additionally, patients with social risks had a higher MWI (3.16; IQR: 1.33, 6.65) than those without (2.13; IQR: 0.34, 4.89) and the interaction between age and social risk suggested a higher MWI at younger ages. Conclusions Greater multimorbidity at younger ages and among those with social risks and living in areas of deprivation shows possible mechanisms for the premature aging and disability often seen in community-based health centers and highlights the need for comprehensive approaches to improving the health of vulnerable populations.
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Affiliation(s)
- Wyatt P Bensken
- OCHIN, Portland, OR, USA
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | | | | | | | | | | | | | | | - Stephen J Zyzanski
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Kurt C Stange
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Kivimäki M, Frank P. Tackling socioeconomic disparities in multimorbidity. THE LANCET REGIONAL HEALTH. EUROPE 2023; 32:100689. [PMID: 37520146 PMCID: PMC10372891 DOI: 10.1016/j.lanepe.2023.100689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Mika Kivimäki
- UCL Brain Sciences, University College London, London, UK
- Clinicum, University of Helsinki, Helsinki, Finland
| | - Philipp Frank
- UCL Brain Sciences, University College London, London, UK
- Clinicum, University of Helsinki, Helsinki, Finland
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Hag Mohamed S, Sabbah W. Is tooth loss associated with multiple chronic conditions? Acta Odontol Scand 2023; 81:443-448. [PMID: 36634031 DOI: 10.1080/00016357.2023.2166986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 09/07/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine the relationship between tooth loss and co-occurrence of multiple chronic conditions (MCC) among American adults at working age. MATERIALS AND METHODS Data was from the Behavioural Risk Factor Surveillance System 2018, a cross-sectional telephone-based, nationally representative survey of American adults. We included participants aged 25-64 years. The survey included sociodemographic data, reported diagnosis of chronic conditions, the number of missing teeth and health behaviours. An aggregate variable of chronic conditions was created which included heart attack, angina, stroke, cancer, chronic pulmonary disease, diabetes, asthma, arthritis, depression, and kidney diseases. The association between the number of missing teeth and the aggregate of chronic conditions was assessed adjusting for confounders. RESULTS The analysis included 202,809 participants. The mean number of MCC was 0.86 (95% Confidence Interval 'CI':0.85,0.87). Tooth loss was significantly associated with MCC with rate ratio 1.18 (95% CI:1.15,1.21), 1.53 (95% CI:1.48,1.59) and 1.62 (95% CI:1.55,1.69) for those reporting losing 1-5 teeth, 6 or more but not all, and all teeth, respectively after adjusting for demographic, socioeconomic, and behavioural factors. CONCLUSION Tooth loss could be an early marker for the co-occurrence of multiple chronic conditions among adults of working age. The association could be attributed to common risk factors for oral and general health.
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Levinsen AKG, Kjaer TK, Maltesen T, Jakobsen E, Gögenur I, Borre M, Christiansen P, Zachariae R, Laurberg S, Christensen P, Kroman N, Larsen SB, Degett TH, Hölmich LR, Brown PDN, Johansen C, Kjær SK, Thygesen LC, Dalton SO. Educational differences in healthcare use among survivors after breast, prostate, lung, and colon cancer - a SEQUEL cohort study. BMC Health Serv Res 2023; 23:674. [PMID: 37349718 DOI: 10.1186/s12913-023-09683-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/10/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Many cancer survivors experience late effects after cancer. Comorbidity, health literacy, late effects, and help-seeking behavior may affect healthcare use and may differ among socioeconomic groups. We examined healthcare use among cancer survivors, compared with cancer-free individuals, and investigated educational differences in healthcare use among cancer survivors. METHODS A Danish cohort of 127,472 breast, prostate, lung, and colon cancer survivors from the national cancer databases, and 637,258 age- and sex-matched cancer-free individuals was established. Date of entry was 12 months after diagnosis/index date (for cancer-free individuals). Follow-up ended at death, emigration, new primary cancer, December 31st, 2018, or up to 10 years. Information about education and healthcare use, defined as the number of consultations with general practitioner (GP), private practicing specialists (PPS), hospital, and acute healthcare contacts 1-9 years after diagnosis/index date, was extracted from national registers. We used Poisson regression models to compare healthcare use between cancer survivors and cancer-free individuals, and to investigate the association between education and healthcare use among cancer survivors. RESULTS Cancer survivors had more GP, hospital, and acute healthcare contacts than cancer-free individuals, while the use of PPS were alike. One-to-four-year survivors with short compared to long education had more GP consultations (breast, rate ratios (RR) = 1.28, 95% CI = 1.25-1.30; prostate, RR = 1.14, 95% CI = 1.10-1.18; lung, RR = 1.18, 95% CI = 1.13-1.23; and colon cancer, RR = 1.17, 95% CI = 1.13-1.22) and acute contacts (breast, RR = 1.35, 95% CI = 1.26-1.45; prostate, RR = 1.26, 95% CI = 1.15-1.38; lung, RR = 1.24, 95% CI = 1.16-1.33; and colon cancer, RR = 1.35, 95% CI = 1.14-1.60), even after adjusting for comorbidity. One-to-four-year survivors with short compared to long education had less consultations with PPS, while no association was observed for hospital contacts. CONCLUSION Cancer survivors used more healthcare than cancer-free individuals. Cancer survivors with short education had more GP and acute healthcare contacts than survivors with long education. To optimize healthcare use after cancer, we need to better understand survivors' healthcare-seeking behaviors and their specific needs, especially among survivors with short education.
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Affiliation(s)
| | - Trille Kristina Kjaer
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
| | - Thomas Maltesen
- Statistics and Data Analysis, Danish Cancer Institute, Copenhagen, Denmark
| | - Erik Jakobsen
- Department of Thoracic surgery, Odense University hospital, Odense, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark
- Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Peer Christiansen
- Danish Breast Cancer Group Center and Clinic for Late Effects, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Danish Breast Cancer Group Center and Clinic for Late Effects, Aarhus, Denmark
| | - Søren Laurberg
- Department of Surgery, Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Christensen
- Department of Surgery, Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Danish Cancer Society, Copenhagen, Denmark
| | - Signe Benzon Larsen
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
- Urological Research Unit, Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thea Helene Degett
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
| | | | - Peter de Nully Brown
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer late effects, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Psychological Aspects of Cancer, Danish Cancer Institute, Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
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Yun JY, Yun YH. Health-promoting behavior to enhance perceived meaning and control of life in chronic disease patients with role limitations and depressive symptoms: a network approach. Sci Rep 2023; 13:4848. [PMID: 36964273 PMCID: PMC10039031 DOI: 10.1038/s41598-023-31867-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/20/2023] [Indexed: 03/26/2023] Open
Abstract
The association between health-related role limitations in the mental and physical subdomains and clinical status (i.e., chronic disease and comorbid depressive symptoms) is mediated by health-promoting behaviors. To enhance health-promoting behaviors in adults with chronic disease, it is necessary to identify item-level associations among targets of health-related monitoring and management. Therefore, the current study used a network approach to examine associations among health-related role limitations, depressive symptoms, existential well-being, socioeconomic position, and health-promoting behavior in adults with chronic disease. A total of 535 adults (mean ± SD age = 62.9 ± 11.9 years; males, n = 231, females, n = 304) who were regularly visiting an outpatient clinic for chronic disease treatment participated in this cross-sectional study. Data on participant demographics, chronic disease diagnoses, socioeconomic status, health-related role limitations (12-item short form survey scores), depressive symptoms (patient health questionnaire-9 scores), existential well-being (scores for four items of the McGill quality of life questionnaire-Revised), and health-promoting behavior (Healthy Habits Questionnaire scores) were acquired. "Undirected regularized partial correlations" and "directional joint probability distributions" among these variables were calculated using a mixed graphical model (MGM) and directed acyclic graph (DAG). In the MGM, the most influential nodes were emotional well-being, feelings of failure, and health-related limitations affecting usual role and physical activities. According to both the MGM and DAG, the relationship between emotional well-being and feelings of failure mediated the relationships of health-related role limitations with concentration difficulty and suicidal ideation. A positive mindset was dependent on the probability distributions of suicidal ideation, controllability of life, and positive self-image. Both the meaning of life and a positive mindset had direct associations with proactive living. Specifically, proactive living was associated with a balanced diet, regular exercise, volunteering in the community, and nurturing intimacy in social interactions. The meaning and controllability of life in individuals with chronic diseases could mediate the relationships of health-promoting behavior with health-related limitations related to usual role activities, physical activities, and depressive symptoms. Thus, interventions targeting health-promoting behaviors should aim to enhance the meaning and controllability of life (as it pertains to limitations in usual role and physical activities), as well as promote proactive screening and timely psychiatric treatment of depressive symptoms including feelings of failure, concentration difficulties, and suicidal ideation.
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Affiliation(s)
- Je-Yeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea
- Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Yun
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Family Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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Mira R, Newton T, Sabbah W. Socioeconomic and Ethnic Inequalities in the Progress of Multimorbidity and the Role of Health Behaviors. J Am Med Dir Assoc 2023:S1525-8610(23)00048-8. [PMID: 36822233 DOI: 10.1016/j.jamda.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVES To assess socioeconomic and ethnic inequalities in the progress of multimorbidity and whether behavioral factors explain these inequalities among older Americans. DESIGN Health and Retirement Study, a longitudinal survey of older American adults. SETTING AND PARTICIPANTS Data pooled from 2006 to 2018 (waves 8-14), which include 38,061 participants. METHODS We used 7 waves of the survey from 2006 to 2018. Socioeconomic factors were indicated by education, total wealth, poverty-income ratio (income), and race/ethnicity. Multimorbidity was indicated by self-reported diagnoses of 5 chronic conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Behavioral factors were smoking, excessive alcohol consumption, physical activity, and body mass index (BMI). Multilevel mixed effects generalized linear models were constructed to assess socioeconomic and ethnic inequalities in the progress of multimorbidity and the role of behavior. All variables included in the analysis were time-varying except gender, race/ethnicity, and education. RESULTS African American individuals had higher rates of multimorbidity than White individuals; however, after adjusting for income and education, the association was reversed. There were clear income, wealth, and education gradients in the progress of multimorbidity. After adjusting for behavioral factors, the relationships were attenuated. The rate ratio (RR) of multimorbidity attenuated by 9% among participants with the lowest level of education after accounting for behavior (RR 1.21; 95% CI 1.18-1.23 and 1.11; 95% CI 1.17-1.14) in the models unadjusted and adjusted for behaviors, respectively. Similarly, RR for multimorbidity among those in the lowest wealth quartile attenuated from 1.47 (95% CI 1.44-1.51) and 1.31 (95% CI 1.26-1.36) after accounting for behaviors. CONCLUSION AND IMPLICATIONS Ethnic inequalities in the progress of multimorbidity were explained by wealth, income, and education. Behavioral factors partially attenuated socioeconomic inequalities in multimorbidity. The findings are useful in identifying the behaviors that should be included in health promotion programs aiming at tackling inequalities in multimorbidity.
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Affiliation(s)
- Rolla Mira
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK.
| | - Tim Newton
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Wael Sabbah
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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The effect of family-centered empowerment model on the quality of life of adults with chronic diseases: An updated systematic review and meta-analysis. J Affect Disord 2022; 316:140-147. [PMID: 35964767 DOI: 10.1016/j.jad.2022.07.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 07/27/2022] [Accepted: 07/30/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Family-centered empowerment model (FCEM) is a concept that strengthens the family to help a chronic patient to obtain a better quality of life (QoL). The effects of FCEM on QoL of chronic patients are still inconclusive. Therefore, this meta-analysis was conducted to evaluate the effect of FCEM on QoL of adult patients with chronic diseases. METHODS Following an online search PubMed/MEDLINE, Scopus, Web of Science, ProQuest, OVID, EMBASE, EBSCO, PsycINFO and Persian databases (Irandoc, IranMedex, SID and MagIran), all studies that tested the impact of FCEM on QoL of patients with chronic diseases were included. Cochrane Risk of Bias Tool was used to assessment the quality of included randomized clinical trials (RCTs) and before/after studies. Analyses were conducted by STATA16. RESULTS Six hundred and ninety-seven studies were identified for screening. After screening process, 11 eligible studies were included in this meta-analysis. There were significant intervention effects in all QoL dimensions, physical and mental subscales and QoL total score (All P < 0.05). The minimum lower bound for SMD was 0.61 (95%CI: 0.96 to 1.66), indicating an increasing effect of the intervention on all QOL dimensions. The results showed substantial heterogeneity between the studies for all QoL dimensions, physical and mental subscales and QoL total scores (P < 0.001). CONCLUSION FCEM is an appropriate model with a simple and effective application for families with a patient suffering from a chronic illness. Nursing education planners and healthcare providers could benefit from this model for improving the nursing education curriculum and accrediting programs.
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