Physician-evaluated and self-reported morbidity for predicting disability

Experts' Perceived Patient Burden and Outcomes of Knee-ankle-foot-orthoses (Kafos) Vs. Microprocessor-stance-and-swing-phase-controlled-knee-ankle-foot Orthoses (Mp-sscos)

BACKGROUND

Patients with neuromuscular knee-instability assisted with orthotic devices experience problems including pain, falls, mobility issues and limited engagement in daily activities.

OBJECTIVES

The aim of this study was to analyse current real-life burden, needs and orthotic device outcomes in patients in need for advanced orthotic knee-ankle-foot-orthoses (KAFOs).

METHODOLOGY

An observer-based semi-structured telephone interview with orthotic care experts in Germany was applied. Interviews were transcribed and content-analysed. Quantitative questions were analysed descriptively.

FINDINGS

Clinical experts from eight centres which delivered an average of 49.9 KAFOs per year and 13.3 microprocessor-stance-and-swing-phase-controlled-knee-ankle-foot orthoses (MP-SSCOs) since product availability participated. Reported underlying conditions comprised incomplete paraplegia (18%), peripheral nerve lesions (20%), poliomyelitis (41%), post-traumatic lesions (8%) and other disorders (13%). The leading observed patient burdens were "restriction of mobility" (n=6), followed by "emotional strain" (n=5) and "impaired gait pattern" (n=4). Corresponding results for potential patient benefits were seen in "improved quality-of-life" (n=8) as well as "improved gait pattern" (n=8) followed by "high reliability of the orthosis" (n=7). In total, experts reported falls occurring in 71.5% of patients at a combined annual frequency of 7.0 fall events per year when using KAFOs or stance control orthoses (SCOs). In contrast, falls were observed in only 7.2 % of MPSSCO users.

CONCLUSION

Advanced orthotic technology might contribute to better quality of life of patients, improved gait pattern and perceived reliability of orthosis. In terms of safety a substantial decrease in frequency of falls was observed when comparing KAFO and MP-SSCO users.

Factors affecting subjective health of child-rearing-aged Japanese adults, considering the effect of healthy life expectancy: A cross-sectional study

Objectives:

The extension of healthy life expectancy is an important policy issue in Japan. This study aimed to clarify the association between subjective health and healthy life expectancy and identify the factors that improve subjective health of child-rearing-aged adults in Japan.

Methods:

A cross-sectional study was conducted. We used data from 2718 participants of the Japanese General Social Survey 2009 Life Course Study. The mean age was 35.5 ± 4.10 years, and 56% were female. Multivariate logistic regression analysis was performed on subjective health, which was treated as a binary variable when calculating healthy life expectancy as an objective variable. The predictors were gender, age, marital status, number of family members living in the home, household income, mental health score, age of youngest child, and the person from whom one seeks help. The prefecture where the participants resided was treated as a control variable.

Results:

There was no association between individual subjective health and healthy life expectancy. Mental health score (measured by the Mental Health Inventory-5, MHI-5) was significantly associated with subjective health. With a MHI-5 score of ⩽ 10 points as the reference criterion, as the score increased, the odds ratio of subjective health increased, and for MHI-5 scores ⩾ 16 points, odds ratio was 14.14 (confidence interval: 7.57–26.38).

Conclusion:

Among the child-rearing-aged adults, prefectural healthy life expectancy was not associated with individual subjective health. Mental health was significantly associated with subjective health and may be underestimated in calculating healthy life expectancy.

Personality variable differences between disease clusters

Previous studies of personality and health have focused mainly on the influence of psychological factors on single diseases such as cancer and coronary heart disease (CHD), thereby neglecting the problem of comorbidity (i.e. the combination of different diseases). The main focus of the present study was the discrimination between single‐ and multiple‐disease conditions on the basis of personality traits. An extensive battery of personality scales implicated in health was administered to a sample of n=5133 individuals of both genders between the ages of 40 and 65. Subjects also reported their health or illness status. A factor analysis of the personality scales yielded five dimensions clearly interpretable as “Emotional Lability”, “Type A Behaviour”, “Behavioural Control”, “Locus of Control over Diseases”, and “Psychoticism”. Hierarchical cluster analyses of the subsample of participants who reported suffering from more than one disease led to eight clusters representing individuals with different combinations of diseases. Generally, there were very few significant differences between healthy and single‐disease participants with regard to personality. However, mean factor scores calculated for “Emotional Lability” were higher across the multiple‐disease groups than in the healthy and single‐disease groups. No other personality factor showed this trend. In general the results reported here show the important role negative affectivity (e.g. Emotional Lability, Neuroticism, Depression) plays in differentiating between single and multiple diseases. Copyright © 2003 John Wiley & Sons, Ltd.

Disparities in illicit drug use and disability status among a nationally representative sample of U.S. college students

BACKGROUND

The number of students with disabilities attending postsecondary institutions is increasing. However, research on substance use among this population is limited.

OBJECTIVE

This study examined disparities in the prevalence of illicit drug use and drug use disorders among college students with disabilities and their counterparts without disabilities.

METHODS

Data from the 2017 National Survey on Drug Use and Health were analyzed. We estimated prevalence and odds of disability, illicit drug use, and illicit drug dependence or abuse in a subsample of college students (n = 6,189).

RESULTS

A majority of college students reporting a disability had a cognitive limitation. Students with any disability had a higher prevalence of illicit drug use and significantly higher odds of ever use of illicit drugs (AOR = 1.47; 95% CI 1.20-1.79). Compared to their peers with no disabilities, they were more likely to have misused any psychotherapeutic in the past year (AOR = 1.38; 95% CI 1.08-1.76), and had nearly twice the odds of misusing prescription pain relievers in the past month (AOR = 1.97; 95% CI 1.11-3.49). Additionally, students with disabilities had three times the odds of meeting criteria for past-year dependence or abuse of any illicit drug (AOR = 3.01; 95% CI 2.06-4.40).

CONCLUSION

This study documented a higher prevalence of drug use and drug use disorders among college students with disabilities compared to their nondisabled peers. Understanding the risk factors for substance use in this population is critical for developing effective prevention and treatment strategies.

Disabling stroke in persons already with a disability: Ethical dimensions and directives

Stroke is the second leading cause of death worldwide and a leading cause of adult disability worldwide. More than a third of individuals presenting with strokes are estimated to have a preexisting disability. Despite unprecedented advances in stroke research and clinical practice over the past decade, approaches to acute stroke care for persons with preexisting disability have received scant attention. Current standards of research and clinical practice are influenced by an underexplored range of biases that may hinder acute stroke care for persons with disability. These trends may exacerbate unequal health outcomes by rendering novel stroke therapies inaccessible to many persons with disabilities. Here, we explore the underpinnings and implications of biases involving persons with disability in stroke research and practice. Recent insights from bioethics, disability rights, and health law are explained and critically evaluated in the context of prevailing research and clinical practices. Allowing disability to drive decisions to withhold acute stroke interventions may perpetuate disparate health outcomes and undermine ethically resilient stroke care. Advocacy for inclusion of persons with disability in future stroke trials can improve equity in stroke care delivery.

Impact of self-reported bank fraud on self-rated health, comorbidity and pain

OBJECTIVES

As reported in other high-income countries, around the 2008 Great Recession the Spanish banking sector engaged abusive practices that satisfy the definition of fraud. Our objective is to examine the association between self-reported bank fraud and physical health, using a gender perspective.

METHODS

With data from the 2017 Madrid Health Survey, we examined the association between the economic impact of fraud and poor self-rated health (SRH), comorbidity and pain (N = 4425). Interactions of time since fraud and sex with economic impact were tested by Poisson regression models with robust variance.

RESULTS

In total, 11% of adults in Madrid reported bank fraud since 2006. Among men, those who experienced frauds with severe economic impact were more likely to report adverse health than those who did not experience fraud (PR comorbidity: 1.46; PR pain conditions: 2.17). Among men time elapsed since fraud strengthened the association between severe economic impact and poor SRH (p = 0.022; p = 0.006, respectively). Among women, associations did not reach statistical significance.

CONCLUSIONS

Bank frauds are an emerging phenomenon which is likely to damage public health. Stricter regulation to protect people from fraudulent bank practices is needed.

A meta-analysis of the possible behavioural and biological variables linking trait emotional intelligence to health

Trait Emotional Intelligence (trait EI) is a constellation of correlated emotion-related traits that capture an individual's typical way of processing emotion-related information and reacting in emotional situations. Numerous studies have shown that trait EI is a significant predictor of both subjective and objective health. This correlational meta-analysis (k = 106, N = 45,262) aims to explore the behavioural and biological variables that could account for these effects. It also aims to provide a roadmap for future research by identifying what should be studied (pinpointing dead-end roads and promising paths) and how (methodological improvements needed to draw stronger conclusions). The results revealed large associations of trait EI with social support, sleep quality, and hypothalamic-pituitary-adrenal axis activity in challenging situations as well as medium associations with dietary habits, physical activity, and substance use. Other candidate pathways have given rise to much less research. Based on both theoretical predictions and preliminary findings, the paper categorises these pathways as promising or not promising. Future research would benefit from using more diverse samples, measuring behavioural variables more objectively, controlling for personality, and systematically examining to what extent changes in EI (e.g., following training) lead to changes in behaviours and/or biological parameters.

The current and projected burden of multimorbidity: a cross-sectional study in a Southern Europe population

In a context of increasing ageing of the population, it is crucial to better understand multimorbidity and its consequences. This study measured the prevalence of multimorbidity in a Southern Europe population and projected its evolution based on expected demographic changes. It also analysed its associated consequences on self-reported health status, functional capacity, and healthcare use. Our sample included all people aged 25-79 years (6679 men and 8517 women) who participated in the fifth Portuguese National Health Interview Survey, conducted in 2014. Multimorbidity was measured by the presence of at least two self-reported chronic conditions. Multivariable regressions were used to assess the association of multimorbidity with health status, functional capacity, and healthcare use. The projected evolution of multimorbidity was based on official demographic projections. 43.9% of the Portuguese population self-reported the multimorbidity, which was more frequent among older people, women, and low-educated people. We found an association of multimorbidity with poorer health status (OR 3.32, 95%CI 2.60-4.24) and with limited functional capacity (OR 4.44, 95%CI 3.85-5.11). Multimorbidity was also associated with higher healthcare resource use, namely a 26% increased likelihood of hospitalization in the previous 12 months per additional comorbidity. We projected a 13.1% growth in the prevalence of multimorbidity until the year 2050. Multimorbidity affects a substantial share of the population and is expected to grow in the near future related to population ageing. The co-occurrence of chronic health conditions increases sharply with age and is associated with worse health status, reduced functional capacity, and increased healthcare use.

Prevalence and associated factors of diabetes in the elderly population in Viçosa, Minas Gerais, Brazil

OBJECTIVES

To assess the prevalence and factors associated with diabetes in the elderly population and verify the correlation between the use of medications for diabetes and information about the disease.

METHODS

This epidemiological cross-sectional study was conducted in Viçosa, Minas Gerais, Brazil, with 621 elderly people aged 60 years or older selected by simple random sampling. A semi-structured questionnaire was used as a research tool and included questions about socioeconomic conditions, lifestyle, health conditions, and nutritional status. The weight, height, and waist circumference were measured. The dependent variable was the self-reported diabetes. In the association analysis between explanatory variables and self-reported diabetes, the Poisson regression analysis with robust variance was used. In the bivariate analysis, a p value < 0.25 was used to include the variables for the multivariate modeling, and in the final model, the variables with p value < 0.10 association were included.

RESULTS

The prevalence of diabetes was 22.4%. The multivariate hierarchical analysis showed the following factors independently and positively associated with diabetes: gender, self-reported health, history of hypertension/dyslipidemia, polypharmacy, and waist circumference. The elderly schooling was negatively associated with diabetes.

CONCLUSION

The results showed the need for implementation of educational public policies to promote behavior changes of the population to prevent and control diabetes and its complications.

Assistance provided by physical therapists from primary health care to patients after stroke

Abstract Introduction: Motor impairments, which are prevalent in stroke subjects, require physical therapy (PT) rehabilitation. In primary care in the Brazilian Public Health System, PT are part of the Núcleo de Apoio à Saúde da Família (NASF). Objective: To describe the PT assistance provided to stroke patients in a primary healthcare center. Methods: The records of all stroke patients (n = 44; 69.23 ± 13.12 years) identified by the health professionals were analyzed. Using keyword recognition, frequency analysis of the services offered by the PT was performed. Subjects were classified according to the Modified Rankin Scale. Results: In the 44 records, 45.5% had a description of the assistance provided by any professional of the NASF and 36.4% of the PT care. PT care was provided at the subject’s home (94.2%) and at the healthcare center (5.8%). The PT practices were identified as: orientation (93.8%), evaluation (87.5%), exercises (50%), follow-up (37.5%), referral to another service or to undergrad PT students (18.8%), and referral to other NASF professionals (12.5%). Most of the subjects were classified as having mild/moderate disability. Conclusion: The minority of records had registration of attendance by the NASF PT. The majority of the sessions occurred at the subject’s home, which reveals a practice focused on individual care. The orientation was common, which illustrates that in primary care there is a focus on empowerment for health self-improvement. Follow-up was not common, despite clinical guidelines state that stroke subjects should be monitored at least once a year by the rehabilitation team.

Determinants of Health-Related Quality of Life Among Older American Indians and Alaska Natives

During the past decade, health-related quality of life (HRQoL) has been recognized in both clinical and community health research as an important health outcome and a needed supplement to conventional health outcomes. The authors provide a profile of HRQoL and examine its determinants among American Indians and Alaska Natives aged 50 or older. Multivariate analyses of cross-sectional survey data from the 1996-1998 Centers for Disease Control Behavioral Risk Factor Surveillance System were conducted. Thirty-four percent of the sample reported fair or poor self-rated health. The mean number of poor health days in the past month ranged from 4 to 6 on different measures. Age, sex, education, annual household income, employment status, hypertension, and obesity were associated with aspects of HRQoL. Further research aimed at eliminating health disparities among this population should focus on identifying additional indicators of poor HRQoL and on understanding variables that mediate the relationship between disease and HRQoL.

Cholesterol testing among men and women with disability: the role of morbidity

PURPOSE

Despite more frequent use of health services by people living with disability, the quality of preventive care received may be suboptimal. In this retrospective cohort study, we used administrative data to examine the relationship between cholesterol testing and levels of disability and morbidity among women and men in Ontario, Canada.

METHODS

We linked multiple provincial-level databases in this study. In stratified analyses for women and men, we used multivariable logistic regression to examine differences in cholesterol testing, and we tested for an interaction effect between disability and morbidity. In a secondary analysis, we tested for a three-way interaction between sex, disability, and morbidity on the entire cohort.

RESULTS

There was an interaction between morbidity and disability for both women and men. Women and men with no chronic conditions appeared to be least likely to be up-to-date on cholesterol testing, and among this group, those with moderate disability were more likely to be up-to-date on cholesterol testing than those with no disability (adjusted odds ratio [AOR] =1.51; 95% confidence interval [CI] 1.20-1.90 for women; AOR =1.16; 95% CI 1.00-1.34 for men). Among women and men who had one chronic condition, having severe disability put them at significant disadvantage versus those with no disability. Only 58.5% of men with no disability and no chronic conditions were up-to-date on cholesterol testing.

CONCLUSION

An intermediate level of health care need (reflected in this study as level of disability and level of morbidity) may provide a benefit for cholesterol testing, and conversely, health care needs that are too few or too great may negatively affect testing. Public health and practice-based interventions need to be explored to address these findings.

Personality and Disease: Correlations of Multiple Trait Scores with Various Illnesses

Correlations between personality measures and self-reported data on health status were examined in a sample of 5133 men and women, aged between 40 and 65. A wider range of diseases was studied than is typical. Small but theoretically meaningful correlations with personality were found for some diseases. Personality syndromes of Emotional Lability, Type A Behaviour, Behavioural Control, Locus of Control over Diseases and Psychoticism were distinguished factorially. Emotional Lability appeared to be the most robust predictor of general disease vulnerability. Some small but significant associations between specific illnesses and Type A and Behavioural Control were also found.

Changing circumstances drive changing attendance: A longitudinal cohort study of time varying predictors of frequent attendance in primary health care

OBJECTIVE

To investigate risk factors for frequent attendance in primary care over time, contrasting models based on baseline and time-varying characteristics.

METHODS

Analysis of data from the Personality and Total Health (PATH) Through Life Project: a representative community cohort study from the Canberra region of Australia. A balanced sample of 1734 respondents, initially aged in their early 40s, were assessed on three occasions over 8 years. The survey assessed respondents' experience of chronic physical conditions, self-reported health, depression symptoms, personality, life events, socio-demographic characteristics and self-reported medication use. Survey data were linked to respondent's own administrative health service use data, and used to generate an objective measure of general practitioner (GP) consultations over a 12-month period. For each gender, respondents in the (approximate) highest decile of GP consultations at each time point were defined as frequent attenders (FAs).

RESULTS

Analysis showed chronic health conditions, self- reported health, mental health and medication use measured at baseline was associated with FA status, with some gender differences evident. However taking into account of changing circumstances improved the model fit and the prediction over FA status over time.

CONCLUSIONS

The study showed that there is considerable variability in frequent attender status over the study period. While baseline characteristics can predict current and future frequent attender status, it is clear that frequent attender in primary care does reflect changing circumstances over time.

Associations of chronic conditions, APOE4 allele, stress factors, and health behaviors with self-rated health

Background

Self-rated health (SRH) has been widely used to measure the overall health status of older adults. Research has shown that SRH is determined by a large array of factors, such as chronic disease conditions, genetic markers (e.g., Apolipoprotein E, APOE, NM_000041), stress factors, and health behaviors. However, few studies have incorporated these factors simultaneously in the analytic framework of SRH. The aim of this study is to examine the associations of these four sets of factors with SRH.

Methods

Using a dataset from a population-based, random-cluster survey of 1,005 elderly respondents aged 54–91 conducted in Taiwan in 2000, we use logistic regressions to examine associations of chronic health conditions, the APOE4 allele stress factors, and health behaviors with SRH. The four disease conditions include diabetes, heart diseases, gastric ulcers, and chronic obstructive pulmonary disease. Stress factors are measured by traumatic events (having an earthquake-damaged house) and chronic life stress (financial difficulty). Health behaviors include smoking, drinking alcohol, vegetable and fruit intake, daily milk intake, and physical exercise.

Results

Diabetes, heart diseases, gastric ulcers, and chronic obstructive pulmonary disease are found to be associated with 2.63 (95 % CI: 1.75–3.95), 1.72 (95 % CI: 1.15–2.58), 1.94 (95 % CI: 1.35–2.80), and 2.54 (95 % CI: 1.66–3.92) odds ratios of poor SRH. The APOE4 allele is found to be significantly associated with poor SRH with odd ratio of 1.58 (95 % CI: 1.02–2.41). Financial difficulty is associated with increased likelihood of poor SRH, with odds ratios of 1.76 (95 % CI: 1.22–2.54) Doing exercise more than 5 times per week are associated with reduced likelihood of poor SRH by 44 % (odds ratio is 0.56, 95 % CI: 0.39–1.82). The interaction term between gender and gastric ulcer showed that the impact of gastric ulcer on SRH is more pronounced in women than in men, with an odds ratio of 2.63 (95 % CI: 1.24–5.58).

Conclusions

Chronic conditions and the APOE4 allele are significantly associated with increased likelihood of reporting poor health, and the associations appear differently among women and men. To better understand the mechanism of how people self-assess their overall health, chronic conditions and genetic components should be considered together with conventional factors such as life stress and health behaviors.

Longitudinal cohort study describing persistent frequent attenders in Australian primary healthcare

OBJECTIVES

To describe patterns of frequent attendance in Australian primary care, and identify the prospective risk factors for persistent frequent attendance.

DESIGN, SETTING AND PARTICIPANTS

This study draws on data from the Personality and Total Health (PATH) Through Life Project, a representative community cohort study of residents from the Canberra region of Australia. Participants were assessed on 3 occasions over 8 years. The survey assessed respondents' experience of chronic physical conditions, self-reported health, symptoms of common mental disorders, personality, life events, sociodemographic characteristics and self-reported medication use. A balanced sample was used in analysis, comprising 1734 respondents with 3 waves of data. The survey data for each respondent were individually linked to their administrative health service use data which were used to generate an objective measure of general practitioner (GP) consultations in the 12 months surrounding their interview date.

MAIN OUTCOME MEASURES

Respondents in the (approximate) highest decile of attenders on number of GP consultations over a 12-month period at each time point were defined as frequent attenders (FAs).

RESULTS

Baseline FAs (8.4%) were responsible for 33.4% of baseline consultations, while persistent FAs (3.6%) for 15.5% of all consultations over the 3 occasions. While there was considerable movement between FA status over time, consistency was greater than expected by chance alone. While there were many factors that differentiated non-FAs from FAs in general, persistent frequent attendance was specifically associated with gender, baseline reports of depression, self-reported physical conditions and disability, and medication use.

CONCLUSIONS

The degree of persistence in GP consultations was limited. The findings of this study contribute to our understanding of the risk factors that predict subsequent persistent frequent attendance in primary care. However, further detailed investigation of longitudinal patterns of frequent attendance and consideration of time-varying determinants of frequent attendance is required.

The relationship between changes in employment status and mortality risk based on the Korea Labor and Income Panel Study (2003-2008)

The aim of this study was to analyze the relationship between the mortality rate and changes in employment status. This study used mortality data from the Korean Labor and Income Panel Study. To analyze the relationship between the mortality rate and changes in employment status, the population was classified into employed, unemployed, or economically inactive. Demographic and socioeconomic variables such as gender, age, educational level, annual household income, marital status, and self-rated health status were controlled. In this study, the generalized estimating equations were used to analyze the relationship between the morality rate and the changes in employment status. The mortality rate was higher (odds ratio = 4.31) among the population that experienced a change in economic status from employed to unemployed than those who maintained employment. The mortality rate for the population who became unemployed or economically inactive was higher (odds ratio = 5.05) in cases of death by disease.

Are chronic diseases related to height? Results from the Portuguese National Health Interview Survey

This paper analyze the association between height and chronic diseases in Portugal and the extent to which this relationship is mediated by education. The sample upon which the analysis is based comprised those participants in the 2005/2006 Portuguese National Health Interview Survey (n=28,433) aged 25-79. Logistic regressions measured the association of height with ten chronic diseases, adjusting for age, lifestyle, education, and other socioeconomic factors. Among women, an additional centimeter in stature significantly decreased the prevalence of asthma, chronic pain, and acute cardiac disease, by 0.057, 0.221, and 0.033 percentage points, respectively. Also, mental disorders were significantly less prevalent in the last quartile of height. Among men, an additional centimeter in height was associated with a 0.074 lower prevalence of asthma, and men in the last quartile of height were significantly less at risk of acute cardiovascular disease. There was no significant association between height and the risk of diabetes, high blood pressure, cancer, and pulmonary diseases. As for the impact of education, women with a tertiary level were on average 5.3cm taller than those with no schooling; among men, the difference was almost 9cm. Adjusting for education reduced the height-related excess risk of ill health by 36% on average among men, and by 7% among women. The analysis indicates that there is a significant association of height with several chronic conditions, and that education plays a mediating role in the height-health connection. By emphasizing the role of height and education as determinants of chronic conditions, this paper also highlights the role of conditions related to childhood health and socioeconomic background.

Health Disparities among Wage Workers Driven by Employment Instability in the Republic of Korea

Even though labor market flexibility continues to be a source of grave concern in terms of employment instability, as evidenced by temporary employment, only a few longitudinal studies have examined the effects of employment instability on the health status of wage workers. Against this backdrop, this study assesses the manner in which changes in employment type affect the health status of wage workers. The data originate from the Korean Labor and Income Panel Study's health-related surveys for the first through fourth years (n = 1,789; 1998 to 2001). This study estimates potential damage to self-rated health through the application of a generalized estimating equation, according to specific levels of employment instability. While controlling for age, socioeconomic position, marital status, health behavior, and access to health care, the study analysis confirms that changes in employment type exert significant and adverse effects on health status for a given year (OR = 1.47; 95% CI 1.10–1.96), to an extent comparable to the marked effects of smoking on human health (OR = 1.47; 95% CI 1.05–2.04). Given the global prevalence of labor flexibility, policy interventions must be implemented if employment instability triggers broad discrepancies not only in social standing, wage, and welfare benefits, but also in health status.

Health behaviors and all-cause mortality in African American men

Because of the excess burden of preventable chronic diseases and premature death among African American men, identifying health behaviors to enhance longevity is needed. We used data from the Third National Health and Nutrition Examination Survey 1988-1994 (NHANES III) and the NHANES III Linked Mortality Public-use File to determine the association between health behaviors and all-cause mortality and if these behaviors varied by age in 2029 African American men. Health behaviors included smoking, drinking, physical inactivity, obesity, and a healthy eating index score. Age was categorized as 25-44 years (n = 1,045), 45-64 years (n = 544), and 65 years and older (n = 440). Cox regression analyses were used to estimate the relationship between health behaviors and mortality within each age-group. All models were adjusted for marital status, education, poverty-to-income ratio, insurance status, and number of health conditions. Being a current smoker was associated with an increased risk of mortality in the 25- to 44-year age-group, whereas being physically inactive was associated with an increased risk of mortality in the 45- to 64-year age-group. For the 65 years and older age-group, being overweight or obese was associated with decreased mortality risk. Efforts to improve longevity should focus on developing age-tailored health promoting strategies and interventions aimed at smoking cessation and increasing physical activity in young and middle-aged African American men.

The influence of childhood physical abuse on adult health status in sexual minority women: the mediating role of smoking

BACKGROUND

Among women in the general population, childhood physical abuse (CPA) is associated with poor adult health status and engagement in health risk behaviors. Sexual minority women (SMW) are at elevated risk of CPA, have higher rates of smoking, and may be at higher risk for poorer general health. In this study, we examined the influences of CPA on health status in a diverse sample of SMW. We hypothesized that SMW with a history of CPA would report poorer health than those without such histories and that early onset of smoking-an important health risk behavior-would mediate the relationship between CPA and current health status.

METHODS

Structural equation modeling was used to evaluate the influence of CPA on early health risk behavior (i.e., age of smoking onset) and current perceived health status in a community based sample of 368 SMW.

RESULTS

More than one fifth of the sample (21.5%) reported a history of CPA. One fourth of the sample was current smokers; the average age of smoking onset was 19 to 20 years old. The mean level of self-rated health status was between "fair" and "good." When relationships were simultaneously estimated, the effect of CPA on health status was mediated by two sequential smoking factors: CPA was associated with earlier age of smoking onset, and age of smoking onset was associated with current smoker status. Being a current smoker had a negative effect on perceived health status.

IMPLICATIONS FOR PRACTICE AND/OR POLICY

These results suggest that tobacco use is an important pathway by which CPA influences current health status. Prevention and early intervention initiatives should focus on the reduction of CPA among SMW to eliminate the long-term health consequences of adverse childhood events among SMW.

Trends in disability and related chronic conditions among people ages fifty to sixty-four

Although still below 2 percent, the proportion of people ages 50-64 who reported needing help with personal care activities increased significantly from 1997 to 2007. The proportions needing help with routine household chores and indicating difficulty with physical functions were stable. These patterns contrast with reported declines in disability among the population age sixty-five and older. Particularly concerning among those ages 50-64 are significant increases in limitations in specific mobility-related activities, such as getting into and out of bed. Musculoskeletal conditions remained the most commonly cited causes of disability at these ages. There were also substantial increases in the attribution of disability to depression, diabetes, and nervous system conditions for this age group.

Residential Context, Social Relationships, and Subjective Well-Being in Assisted Living

Adaptive reframing and cumulative inequality theory provide the conceptual framework for investigating associations between four measures of subjective well-being (general, temporal, comparative, and experiential), residential context, and social relationships. Data from 344 cognitively intact assisted living (AL) residents aged 60 years and older interviewed for the Florida Study of Assisted Living were analyzed using logistic regression. Having control over the AL transition, often associated with socioeconomic status, was positively associated with all four dimensions of subjective well-being, consistent with a cumulative inequality framework. Other residential context characteristics (living arrangements prior to AL, private pay, size, licensure status) were less consistently associated with well-being. High-quality staff relationships were associated with temporal well-being, while positive coresident relationships were associated with all four well-being indicators. Compared with preexisting external relationships with family and friends, and consistent with adaptive reframing, social relationships unique to AL were independently and more consistently associated with residents’ perceptions of subjective well-being.

Morbidades referidas por trabalhadoras que produzem joias folheadas em Limeira, SP

RESUMO INTRODUÇÃO: a cidade de Limeira (SP) se caracteriza por ser um polo de empresas do ramo de joias folheadas e bijuterias, sendo a maior parte da mão de obra composta por mulheres. OBJETIVO: verificar as morbidades referidas por mulheres expostas ao cianeto no setor de bijuterias e joias folheadas na cidade de Limeira em 2007. METEDOLOGIA: estudo transversal realizado com 383 trabalhadoras, comparando-se um grupo de 191 mulheres trabalhadoras em galvanoplastias consideradas qualitativamente expostas ao cianeto com um grupo de 192 mulheres não expostas ao cianeto. Foi aplicado o Índice de Capacidade para o Trabalho, o Questionário de Tolerância de Fagerström e um questionário sociodemográfico e ocupacional. RESULTADOS: O grupo considerado exposto ao cianeto apresentou: menor média de tempo de trabalho no cargo (p = 0,008), maior proporção que trabalha com produtos químicos (p < 0,001), que usa Equipamento de Proteção Individual (p < 0,001), que recebe equipamento das empresas em que trabalham (p < 0,001), menor quantidade de morbidades referidas (p = 0,042), mas maior prevalência de bronquite crônica (p = 0,027), sinusite crônica (p = 0,022) e disfunções da tireoide (p = 0,022). CONCLUSÕES: os resultados apontam para a necessidade de pesquisas de coorte que analisem a associação entre os agravos apresentados e a exposição ao cianeto.

Adverse childhood experiences and smoking persistence in adults with smoking-related symptoms and illness

OBJECTIVES

Little is known about why people continue to smoke after learning that they have diseases and conditions that contraindicate smoking. Using data from the Adverse Childhood Experiences (ACE) Study, we examined the relation between ACEs and smoking behavior when smoking-related illnesses or conditions are present, both with and without depression as a mediator.

METHODS

Participants were more than 17,000 adult HMO members who retrospectively reported on eight categories of ACEs (emotional, physical, and sexual abuse; witnessing interparental violence; parental divorce; and growing up with a substance-abusing, mentally ill, or incarcerated household member). The number of maltreatment categories was summed to form an ordinal variable called the ACE Score. We measured current smoking, conditions that contraindicate smoking (heart disease, chronic lung disease, and diabetes), and symptoms of these illnesses (chronic bronchitis, chronic cough, and shortness of breath). Logistic regression models compared the ACE Score of smokers with smoking-related illnesses to participants who reported these illnesses but were not current smokers (n = 7483).

RESULTS

Significant dose-response relations between the ACE Score and smoking persistence were found (odds ratio = 1.69; confidence interval = 1.34-2.13 for participants with ≥4 ACEs). Depression was a significant independent predictor of smoking persistence as well as a mediator. Depression only slightly attenuated the relation between the ACE Score and persistent smoking, however.

CONCLUSION

Medical practitioners should consider the maltreatment history and depression status of their patients when a smoking-related diagnosis fails to elicit smoking cessation. Programs should be developed that better address the underlying motivations for continuing to smoke in the face of health problems that contraindicate smoking.

Social grants, welfare, and the incentive to trade-off health for income among individuals on HAART in South Africa

South Africa's government disability grants are considered important in providing income support to low-income AIDS patients. Indeed, anecdotal evidence suggests that some individuals may opt to compromise their health by foregoing Highly Active Antiretroviral Treatment (HAART) to remain eligible for the grant. In this study, we examined the disability grant's importance to individual and household welfare, and the impact of its loss using a unique longitudinal dataset of HAART patients in Khayelitsha, Cape Town. We found that grant loss was associated with sizeable declines in income and changes in household composition. However, we found no evidence of individuals choosing poor health over grant loss. Our analysis also suggested that though the grants officially target those too sick to work, some people were able to keep grants longer than expected, and others received grants while employed. This has helped cushion people on HAART, but other welfare measures need consideration.

Measuring health status: self-, interviewer, and physician reports of overall health

OBJECTIVE

This study examines and compares respondent, interviewer, and physician ratings of overall health.

METHOD

Data are from the 2006 Social Environment and Biomarkers of Aging Study, a nationally representative survey of older adults in Taiwan. Ordered probit models are used to examine factors associated with self- and external assessments of health and discordant health ratings.

RESULTS

Our results suggest similarities and differences in factors influencing health ratings across evaluators but a high level of interevaluator disagreement in ratings. Discrepancies in ratings between physicians and both respondents and interviewers are associated with the greater weight given to functional limitations and psychological well-being in interviewer and respondent ratings and to the importance of clinical measures or risk factors of illness and mortality in physician assessments.

DISCUSSION

Interviewer and physician assessments may be complementary to self-assessed health measures. The importance and implications of these findings for future research are discussed.

[Prevalence of respiratory symptoms and associated factors: a population-based study in adults from Lages, Santa Catarina State, Brazil]

A cross-sectional population-based study was conducted in Lages, Santa Catarina State, Brazil, in order to estimate the prevalence of symptoms of chronic bronchitis, breathlessness, and wheezing and associated factors in a sample of adults 20 to 59 years of age (n = 2,051). The study employed a cluster sample design and Poisson regression analyses. Prevalence rates for chronic bronchitis, breathlessness, and wheezing were 5%, 35.7%, and 20.2%, respectively. The adjusted analysis showed chronic bronchitis associated with low schooling, smoking, and hospital admissions due to respiratory illness during childhood. Breathlessness was associated with female gender, low schooling and family income, non-white race, hospital admissions due to respiratory illness during childhood, smoking, and occupational exposure to dust. Wheezing was associated with female gender, low schooling and family income, non-white race, hospital admissions due to respiratory illness during childhood, smoking, and occupational exposure to dust. Public health planners should consider climatic factors and work activities when developing activities to prevent respiratory diseases.

Risks associated with tendinitis: effects from demographic, socioeconomic, and psychological status among Brazilian workers

BACKGROUND

Self-reported tendinitis/tenosynovitis was evaluated by gender, age group, skin color, family income, and educational and psychological status.

METHODS

!The study was carried out in a representative sample of formally contracted Brazilian workers from a household survey. A total of 54,660 participants were included. Occupations were stratified according to estimated prevalences of self-reported injuries. Non-conditional logistic regression was performed, and all variables were analyzed in two occupational groups.

RESULTS

The overall prevalence rate of tendinitis/tenosynovitis was 3.1%: 5.5% in high-prevalence occupations (n = 10,726); and 2.5% in low-prevalence occupations (n = 43,934). White female workers between the ages of 45 and 64 years and at a higher socioeconomic level were more likely to report tendinitis/tenosynovitis regardless of their occupational category. An adjusted OR = 3.59 [95% CI: 3.15--4.09] was found between tendinitis/tenosynovitis and psychological status.

CONCLUSION

Among formally contracted Brazilian workers, higher income can imply greater physical and psychological demands that, regardless of occupational stratum, increase the risk of tendinitis/tenosynovitis.

Socio-demographic and clinical features of Irish iatrogenic hepatitis C patients: a cross-sectional survey

BACKGROUND

A discrete sub-group of iatrogenically-acquired hepatitis C virus (HCV)-infected individuals exists in the Irish population on whom limited current research data is available. The aim of this study was to establish a current profile of the socio-demographic and clinical characteristics of the Irish iatrogenic hepatitis C population and to determine factors predicting symptoms experienced.

METHODS

An anonymous, national, cross-sectional survey was conducted to explore this populations' self-reported health and social attributes. Data were collected on 290 respondents.

RESULTS

Mean time since infection was 26 years. Eighty-four percent (n = 237) of respondents were female (mean age = 55.9 +/- 9.6 years). Hepatic and extra-hepatic symptoms were common (62% and 99% respectively). Fatigue and pain were frequent complaints while 89% reported diagnosed co-morbid disease. On logistic regression, female gender, age and co-morbid disease emerged as independent predictors of self-reported symptoms.

CONCLUSION

This study describes the current status of the iatrogenically infected patient cohort in Ireland, adding to existing knowledge regarding the clinical course and consequences of HCV infection. Changing healthcare needs were shown by comparison with earlier surveys in this same population, in terms of disease progression, development of co-morbid disease and ageing.

Explaining health differences between men and women in later life: a cross-city comparison in Latin America and the Caribbean

This paper describes differences in health and functional status among older men and women and attempts to anchor the explanations for these differences within a lifecourse perspective. Seven health outcomes for men and women 60 years and older from seven Latin American and Caribbean cities are examined, using data from the 2000 SABE survey (Salud, Bienestar y Envejecimiento-n=10,587). Age-adjusted as well as city- and sex-specific prevalence was estimated for poor self-rated health, comorbidity, mobility limitations, cognitive impairment, depressive symptoms and disability in basic and instrumental activities of daily living. Logistic regressions were fitted to determine if the differences between men and women in each outcome could be explained by differential exposures in childhood (hunger, poverty), adulthood (education, occupation) and old age (income) and/or by differential vulnerability of men and women to these exposures. Sao Paulo, Santiago and Mexico, cities in countries with a high level of income inequalities, presented the highest prevalence of disability, functional limitations and poor physical health for both women and men. Women showed poorer health outcomes as compared with men for all health indicators and in all cities. Controlling for lifecourse exposures in childhood, adulthood and old age did not attenuate these differences. Women's unadjusted and adjusted odds of reporting poor self-rated health, cognitive impairment and basic activities of daily living disability were approximately 50% higher than for men, twice as high for number of comorbidities, depressive symptoms and instrumental activities of daily living disability, and almost three times as high for mobility limitations. Higher vulnerability to lifecourse exposures in women as compared with men was not found, meaning that lifecourse exposures have similar odds of poor health outcomes for men and women. A more integrated understanding of how sex and gender act together to influence health and function in old age needs consideration of additional biological and social factors.

[Measurements of reported morbidity and interrelationships with health dimensions]

OBJECTIVE

To assess the interrelationships between self-rated health, perceptions of long-term illness and diagnoses of chronic diseases.

METHODS

In the World Health Survey, carried out in Brazil in 2003, 5,000 individuals aged 18 years and over who had been selected from a three-stage stratified sample were interviewed. The original questionnaire was adapted for the Brazilian context. It covered the presence of long-term illness or disability, self-rating of health (general and in several domains) and diagnoses of six chronic diseases (arthritis, angina, asthma, depression, schizophrenia and diabetes mellitus). To compare the relationships between self-rated health, perceptions of long-term illness and the chronic diseases evaluated, the statistical test of homogeneity of proportions and multiple logistic regression models were used.

RESULTS

Self-rating of health as "not good" and perceptions of having long-term illnesses were significantly more frequent among women, individuals aged 50 years and over and individuals with one or more of the diseases investigated. The interviewees with a diagnosis of diabetes mellitus presented the worst self-rated health: 70.9% reported having a long-term illness and 79.3% considered that their health was "not good". Worse health ratings were found when two or more diseases were present together. The effect of self-rating of health on the perceptions of long-term illness was stronger than was the number of diseases.

CONCLUSIONS

The three ways of measuring morbidity presented significant interrelationships. Self-rating of health as "not good" had a more important effect on the perceptions of long-term illness, thus suggesting that subjective measurements of health status may be more sensitive for establishing and monitoring individuals' wellbeing.

Chronic conditions and the decline in late-life disability

Using data from the 1997-2004 National Health Interview Survey (NHIS), we examine the role of chronic conditions in recent declines in late-life disability prevalence. Building upon prior studies, we decompose disability declines into changes in the prevalence of chronic conditions and in the risk of disability given a condition. In doing so, we extend Kitigawa's (1955) classical decomposition technique to take advantage of the annual data points in the NHIS. Then we use respondents' reports of conditions causing their disability to repartition these traditional decomposition components. We find a general pattern of increasing prevalence of chronic conditions accompanied by declines in the percentage reporting disability among those with a given condition. We also find declines in heart and circulatory conditions, vision impairments, and possibly arthritis and increases in obesity as reported causes of disability. Based on decomposition analyses, we conclude that heart and circulatory conditions as well as vision limitations played a major role in recent declines in late-life disability prevalence and that arthritis may also be a contributing factor. We discuss these findings in light of improvements in treatments and changes in the environments of older adults.

Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003

Os inquéritos de saúde de base populacional constituem o principal instrumento utilizado para conhecer a prevalência de doenças crônicas, de restrições de atividades e de uso de serviços de saúde. Com base nos dados da PNAD-2003, foram estimadas as prevalências das 12 doenças crônicas pesquisadas, segundo sexo, idade, cor, escolaridade, macrorregião de residência e situação urbana ou rural do domicílio. Foram analisados a presença de limitações e o uso de serviços de saúde segundo a presença de doença crônica. Utilizando regressão de Poisson, foram estimadas as razões de prevalências ajustadas por idade, sexo, macrorregião de residência e tipo de respondente. A prevalência de pelo menos uma doença crônica aumentou com a idade, foi maior entre mulheres, indígenas, pessoas com menor escolaridade, cidadãos detentores de plano de saúde, migrantes de outros estados, residentes em áreas urbanas e moradores da região Sul. A presença de doença crônica provocou aumento de limitação de atividades e da demanda por serviços de saúde. As condições mais prevalentes foram: doença de coluna, hipertensão, artrite e depressão. Foi detectada significativa desigualdade social no padrão das doenças crônicas, segundo gênero, cor/raça, nível de escolaridade, região de residência e situação do domicílio.

Interviews or medical records, which type of data yields the best information on elderly people's health status?

BACKGROUND AND AIMS

Self-reported data and/or medical records are often used to assess the prevalence of illness and impairment in epidemiological studies. However, these two data sources do not always provide the same information. The aim was to compare data from interviews and medical records regarding illness, symptoms and impairment in the elderly, and to analyze the agreement between a consensus from both data sources and data from interviews and medical records, respectively.

METHODS

We interviewed 130 persons (age range 67-99) regarding socio-demographic background data and physical and mental health. Medical records were reviewed. Illness burden was rated according to the Cumulative Illness Rating Scale for Geriatrics, and was rated in three ways based on: (1) interview data; (2) medical records; (3) information from both interviews and medical records considered to be consensus. Agreement was measured by the Kappa coefficient and the Svensson Paired Rank Measurement. A permutation test tested whether the ratings from interviews and medical records had the same agreement when compared with consensus.

RESULTS

Statistically significant differences in agreement were found between interview versus consensus and medical records versus consensus for the vascular system (medical records best), eyes/ears/nose/throat/larynx and musculoskeletal/integument (interview best). Medical records gave better in formation concerning specific diseases and diagnoses, whereas interview data provided a better measure of illness, functional impairment and health in a broader sense.

CONCLUSIONS

Both medical records and interviews yield good information of elderly people's health status, but they focus on different aspects of health.

Socio-demographic characteristics, treatment coverage, and self-rated health of individuals who reported six chronic diseases in Brazil, 2003

The Brazilian World Health Survey, carried out in 2003, included questions about diagnosis of six chronic diseases: arthritis, angina, asthma, depression, schizophrenia and diabetes mellitus. The probabilistic sample of 5,000 adults was selected in 250 census tracts. We analyzed the socio-demographic profile, the coverage of treatment, and self-rated health of the individuals that reported diagnosis of one of these diseases. To control for age and sex, logistic regression models were used. Among the 5,000 participants, 39.1% reported medical diagnosis of at least one of the six diseases. Depression was the most prevalent (19.2%), followed by asthma (12.0%), arthritis (10.5%), angina (6.7%), diabetes (6.2%) and schizophrenia (1.7%). Significant differences by age were found for all diseases, except for asthma. All diseases were more prevalent among women, except angina. Analysis by educational level showed that the diabetes prevalence rate was significantly larger among those with incomplete schooling. Although the six diseases presented different treatment coverage rates, for individuals with diagnosis of any one of the six diseases, the self-rated health was always worst, even after controlling for age and sex.

Perceived health status and perceived diabetes control: psychological indicators and accuracy

OBJECTIVE

The aim of this study is to assess the association of psychological, as well as physical and sociodemographic, indicators with patients' ratings of personal health status and diabetes control and to investigate the association of mental health and depression with errors in the perception of diabetes control.

METHOD

A sociodemographically diverse sample of 623 diabetes patients was recruited from the general medicine clinics of a county health care system and a Veterans Affairs health care system. We examined three types of determinants of patients' health perceptions: physical health indicators (symptoms, comorbid diagnoses, and glycosylated hemoglobin or HbA1c levels), psychological health indicators (general mental health and diabetes-related worry), and sociodemographic factors (age, race, gender, income, and education).

RESULTS

After controlling for patient' sociodemographic characteristics, perceived general health was associated with patients' symptom burden and emotional distress (but not with patients' HbA1c levels). Perceived diabetes control additionally was associated with HbA1c and diabetes-related worries. Further analyses showed that both mental health and diagnosed depression were associated with errors in personal appraisals of diabetes control, with depressed patients more often inaccurately assessing their glycemic control as poor (false-positive error) and nondepressed patients more often missing poor HbA1c levels (false-negative error).

CONCLUSIONS

Findings indicate that patients use a comprehensive model for assessing their general health and that depression may lead to more accurate assessments of poor glucose control.

Changing health inequalities in east and west Germany since unification

The unification of Germany in 1990 brought about substantial social and economic changes in its eastern part, with new uncertainties and, despite increasing overall income, rising inequality. This paper explores the potential impact on health of these changes during the 1990s, looking specifically at income-related health inequalities in east and west Germany and its modulation by psychosocial factors. We used data from the German Socio-Economic Panel (GSOEP) for the years 1992 and 1997, including individuals aged 25+. We investigated changes in self-perceived health in the two parts of Germany and its socio-economic and psychosocial determinants. Analyses estimated odds ratios of less than good health using logistic regression. In 1992, 47% of east Germans rated their health worse than good compared with 54% in the west. By 1997, the east-west gap in self-rated health had disappeared, with the prevalence of poor health increasing to 56% in both parts. Income and education were important determinants of health in east and west, with, in the age-sex-adjusted model, those having available less than 60% of median equivalent income being at increased risk of poor health in 1992 (OR(east) 2.39, 1.45-3.94; OR(west) 2.04, 1.65-2.52). Addition of education reduced the strength of this relationship only slightly. In the west, income-related health inequalities widened between 1992 and 1997 yet the initially stronger gradient declined in the east, despite an overall increase in income inequality (OR(east) 1.63, 1.04-2.56; OR(west) 2.65, 2.19-3.21). The impact of education remained stable. Psychosocial variables were important determinants, mediating the effects of income, with leisure-cultural social involvement exerting the strongest effect in both east and west.The results show that, unlike in the west, the overall increase in income inequality in east Germany between 1992 and 1997 was not accompanied by a simultaneous increase in income-related health inequalities. This suggests that mechanisms involved in the association of socio-economic factors and health possibly behave differently in east and west.

The association between multiple domains of discrimination and self-assessed health: a multilevel analysis of Latinos and blacks in four low-income New York City neighborhoods

OBJECTIVE

This study examines the association between discrimination due to race and other attributes (e.g., sex, age) and self-assessed mental and physical health among Latinos and blacks.

DATA SOURCE

Latino and black adult participants (n = 873) identified by random digit dialing were interviewed by telephone in four low-income neighborhoods in New York City: the South Bronx, East Harlem, Central Harlem, and Bedford-Stuyvesant.

STUDY DESIGN

In this cross-sectional study, generalized estimating equations were used to fit multilevel multivariable models to test the association between discrimination and poor mental and physical health while controlling for socioeconomic status, access to health care, social support, smoking, and the racial and ethnic composition of each neighborhood.

PRINCIPAL FINDINGS

Discrimination due to race and discrimination due to other attributes were associated with poor self-assessed mental but not physical health in separate multivariable models. Persons who experienced multiple domains of discrimination had a greater probability of reporting poor mental health than persons who experienced no discrimination.

CONCLUSIONS

Discrimination due to race and other attributes was a significant correlate of mental health among Latinos and blacks independent of other accepted determinants of health.

Morbidade declarada e condições de trabalho: o caso dos motoristas de São Paulo e Belo Horizonte

Neste artigo se apresentam os principais resultados de levantamentos feitos em São Paulo e Belo Horizonte sobre as condições de trabalho e de saúde dos motoristas do transporte de passageiros. Constataram-se condições de trabalho bastante desfavoráveis e estabeleceram-se associações estatísticas entre essas condições e sérios sintomas de morbidade declarados pelos motoristas. Sugere-se a necessidade de políticas públicas para o setor.

Contemporary work characteristics, stress, and ill health

This study investigates the relationship between work and ill health resulting from stressors originating in the work environment. The association between work and health has been well-documented. Factors in the work environment leading to ill health have included generalized psychological stress and/or specific physical environmental characteristics. Data for this study come from a 1998 telephone survey, the Indiana Survey of Work in a Polarized Economy, under the auspices of the Center for Survey Research at Indiana University. The dependent variable is an index that measures ill health among workers; control variables include sociodemographic and lifestyle characteristics of these workers as well as their job characteristics; and the four key independent variables are occupational status, organizational disruption, layoff experience, and educational discordance of the workers. Multiple regression analysis on the entire sample (n = 919) demonstrates that occupational status is negatively associated with ill health, while organizational disruption, layoff experience, and educational discordance are positively associated with it. Separate analyses for male (n = 474) and female (n = 445) respondents find significant sex differences in the effects of the key variables: for males, organizational disruption is positively related to ill health while for women occupational status is negatively related and layoff experience and educational discordance are positively related to ill health. The findings from the present research provide insight into the interrelationship of occupational environment and health within the framework of evolutionary medicine.

Determinants of and inequalities in self-perceived health in Ukraine

Ukraine is the second most populous of the former Soviet Republics and since transition its economy has fared even more poorly than Russia. Although the impact of the collapse of the former Soviet Union on health in Russia has been investigated, little is known of its impact in other post-Soviet republics. We report a cross-sectional study undertaken in Ukraine in March 2000. A multi-stage random sampling technique was used and 1600 interviews completed (72% response rate) with a representative national sample of Ukrainian adults. We investigated socioeconomic and psychosocial determinants of self-perceived health, which has been shown to be a valid and reliable measure of overall health and predictive of mortality. Odds ratios for less than good physical health were calculated using logistic regression. The self-rated health of Ukrainians was poor, 25% of men and 43% of women rated their health as poor or very poor. This is worse than levels recorded in Russia and considerably worse than levels seen in western Europe. Marked gender, geographical and socioeconomic inequalities in health were recorded. Women are at increased risk of poor self-rated health compared with men (OR 3.58, 2.50-5.14) as are women living in villages compared with those in cities (OR 3.24, 1.30-8.07). Socioeconomic factors including poor material situation (OR 1.64, 1.01-2.67), and psychosocial factors including low control over life (OR 1.89, 1.15-3.11) were identified as independent health determinants. Control over life was found to account for the negative impact of low social position on health. Good family relations protected against poor health. The findings suggest that a decrease in control, arising from an increasingly uncertain political and economic environment, a reduction in material wealth and the stress of change may all have contributed to the decline in life expectancy seen with transition.