Annual health checks for people with intellectual disabilities: An exploration of experiences, follow-up and self-management of health conditions

BACKGROUND

Little is known about how health issues identified at the annual health check (AHC) are followed up and addressed, how participants self-manage their health in between AHCs, and what support they receive. This research aimed to explore this.

METHODS

People with intellectual disabilities (n = 12), and/or their supporters residing in Wales, were interviewed following their AHC and again at 6 and 11 months. A recurrent cross-sectional thematic analysis was undertaken.

RESULTS

Five main themes emerged from interview one: going for a health check, issues identified, and actions taken, supporting the self-management of health, the personal context, and addressing health inequities. Four main themes emerged from follow-up interviews: follow-up, supporting the self-management of health, the need for reasonably adjusted health services, and going for another health check.

CONCLUSION

A broader system of support around the AHC is required if people are to achieve or maintain the best possible health.

Measuring the Economic Burden of Health Conditions among White-Collar Employees: A Cross-Sectional Study from Delhi-NCR

Background

In the past few decades, there has been a significant increase in healthcare expenditure due to the prevalence of health issues across the globe. This is primarily seen among white-collar employees due to the sedentary nature of their jobs, which affects their current earnings (Purchasing Power) directly due to the reallocation of their real income towards healthcare expenditure (Economic Burden) and indirectly by impacting work productivity through sick leaves.

Aim

To measure the economic burden of disease(s) among white-collar employees, and to study the same across different socio-demographic variables.

Methods

A cross-sectional study has been conducted in the region of Delhi-NCR among 357 white-collar employees. A random sampling method was adopted using a structured questionnaire. The questionnaire collected information regarding the direct and indirect costs of health conditions with a recall period of one month. The cumulative score of these monthly costs was converted to annual data to estimate the economic burden of the health conditions among the employees over a year.

Results

As compared to Communicable diseases (16.24%), Non-communicable diseases (27.17%) were more prevalent among the respondents. Compared to other diseases, the employees suffering from Heart diseases (INR 7,62,237.50), Spinal health issues (INR 1,73,625.00), and Diabetes (INR 1,64,535.71) incurred more economic burden. At a 5% significance level, no significant difference was observed in economic burden for Gender and BMI. However, the economic burden was significantly different across the categories of Age and Monthly income. A positive association can be observed in economic burden with the increasing categories of age and monthly income.

Conclusion

With the nature of sedentary work (desk jobs), white-collar employees are at a greater risk of exposure to various NCDs than CDs and incur a significant amount of out-of-pocket expenditure to manage their health status.

Health Conditions in Older Adults Suspected of Being Maltreated: A 20-Year Real-World Study

Older adult maltreatment (OAM) is a global problem that has attracted increasing attention due to the ageing population and its severe impact on victim health. Thus, this study aims to analyse the prevalence of certain health conditions in people ≥ 60 years old whom physicians from a local healthcare unit suspected to be victims of maltreatment. The specific objectives are to determine the prevalence rates of health-related risk factors, traumatic injuries and intoxications, mental disorders, and physical disorders. We conducted a real-world, retrospective, observational, and cross-sectional study based on secondary data analyses of electronic health records and healthcare registers of patients at the Local Healthcare Unit of Matosinhos (2001-2021). Information was obtained based on codes from the International Classification of Diseases, codes from the International Classification of Primary Care, and clinical notes (according to previously defined keywords). We identified 3092 suspected victims of OAM, representing 4.5% of the total population analysed. This prevalence is lower than the known rates. We also found that some health risk factors, traumatic injuries and intoxications, mental health disorders, and physical disorders presented higher rates in the suspected victims than among the total population. In this age group, we cannot assume that these health problems are only related to a possible current victimisation process; they could also be associated with adverse childhood experiences or intimate partner violence, among other forms of violence, all of which can lead to cumulative effects on the victim's health. This evidence increases healthcare providers' responsibility in detecting and reporting all cases of suspected maltreatment.

Health conditions in autism: Defining the trajectory from adolescence to early adulthood

Autistic adults, as compared to non-autistic adults, have increased rates of nearly all medical and psychiatric conditions. Many of these conditions begin in childhood, although few longitudinal studies have been conducted to examine prevalence rates of these conditions from adolescence into early adulthood. In this study, we analyze the longitudinal trajectory of health conditions in autistic youth, compared to age and sex-matched non-autistic youth, transitioning from adolescence into early adulthood in a large integrated health care delivery system. The percent and modeled prevalence of common medical and psychiatric conditions increased from age 14 to 22 years, with autistic youth having a higher prevalence of most conditions than non-autistic youth. The most prevalent conditions in autistic youth at all ages were obesity, neurological disorders, anxiety, and ADHD. The prevalence of obesity and dyslipidemia rose at a faster rate in autistic youth compared to non-autistic youth. By age 22, autistic females showed a higher prevalence of all medical and psychiatric conditions compared to autistic males. Our findings emphasize the importance of screening for medical and psychiatric conditions in autistic youth, coupled with health education targeted at this population, to mitigate the development of adverse health outcomes in autistic adults.

Determinants of Nutritional Risk among Community-Dwelling Older Adults with Social Support

BACKGROUND

It is well established that older adults are at risk for malnutrition due to several social and non-social determinants, namely physiological, psychosocial, dietary and environmental determinants. The progression to malnutrition is often insidious and undetected. Thus, nutritional assessment should consider a complex web of factors that can impact nutritional status (NS). The primary objective of this study was to assess the NS of older adults attending senior centres (SCs) and to identify its predictors.

METHODS

This cross-sectional study enrolled a sample of community-dwelling older adults in Lisbon. NS was assessed using Mini Nutritional Assessment (MNA^®). Malnutrition or malnutrition risk (recategorised into a single group) was predicted using binary logistic regression models, considering those participants classified as having a normal NS as the reference group. Data were collected through face-to-face interviews and anthropometric indices were measured according to Isak procedures.

RESULTS

A sample of 337 older adults, with an average age of 78.4 years old (range 66-99), mostly women (n = 210; 62.3%), were enrolled. Older adults at risk of malnutrition accounted for 40.7% of the sample. Being older (OR = 1.045, CI 95% [1.003-1.089], p = 0.037), having a worse perception of health status (OR = 3.395, CI 95% [1.182-9.746], p = 0.023), having or having had depression (OR = 5.138, CI 95% [2.869-9.201], p < 0.001), and not having or having had respiratory tract problems (OR = 0.477, CI 95% [0.246-0.925], p = 0.028) were independent predictors of malnutrition or malnutrition risk. An intermediate time of SC attendance was associated with a lower probability of malnutrition or risk (OR = 0.367, CI 95% [0.191-0.705], p = 0.003).

CONCLUSIONS

NS among older adults has a multifactorial aetiology, with a strongly social component and is related to health circumstances. Further research is needed to timely identify and understand nutritional risk among this population.

Associations between Knowledge of Health Risks and Sugar-Sweetened Beverage Intake among US Adolescents

BACKGROUND

Sugar-sweetened beverage (SSB) intake is associated with adverse health outcomes.

OBJECTIVE

We examined associations between the knowledge of health risks related to SSB and SSB intake among adolescents.

DESIGN

A cross-sectional study using 2021 YouthStyles survey data.

PARTICIPANTS/SETTINGS

831 US adolescents (12-17 years old).

MAIN OUTCOME MEASURES

The outcome variable was SSB intake (none, 1-6 times/week, and ≥1 time/day). Exposure variables were knowledge of seven SSB-related health risks.

STATISTICAL ANALYSES PERFORMED

Seven multinomial regressions were used to estimate adjusted odds ratios (AOR) for drinking SSB, according to knowledge of SSB-related health risks and after controlling for sociodemographics.

RESULTS

Overall, 29% of adolescents consumed SSB ≥1 time/day. Although most adolescents identified cavities (75.4%), weight gain (74.6%), and diabetes (69.7%) as being related to drinking SSB, fewer adolescents identified related conditions such as high blood pressure (31.7%), high cholesterol (25.8%), heart disease (24.6%), and some cancers (18.0%). Compared to non-SSB consumers, drinking SSB ≥1 time/day was significantly higher among adolescents who lacked knowledge of associations between SSB intake and weight gain (AOR = 2.0), heart disease (AOR = 1.9), or some cancers (AOR = 2.3) after controlling for covariates.

CONCLUSIONS

Among US adolescents, knowledge of SSB-related health risks varied by condition, ranging from 18% (some cancers) to 75% (cavities and weight gain). There were increased odds of drinking SSB among those unaware that weight gain, heart disease, and some cancers are associated with SSB intake. Intervention could evaluate whether increasing certain types of knowledge may influence youth SSB intake.

The Role of Environmental Factors on Health Conditions, General Health and Quality of Life in Persons with Spinal Cord Injuries in South Africa

OBJECTIVE

The objective was to describe the individual items of the environmental factors and to investigate the relationship between the environmental factors to health conditions, general health and quality of life in people with SCI in South Africa.

METHODS

Two hundred persons with SCI participated in a cross-sectional survey design. This study formed part of the International Spinal Cord Injury (InSCI) Community Survey. Four major domains, environmental factors, health conditions, general health and quality of life of the survey questionnaire responses, were used for the analysis. Regression models were used to determine the association between the independent variable, which consisted of the specific environmental factors items, and the dependent variables comprising health conditions, general health and quality of life.

RESULTS

The commonly reported environmental barriers were public access, lack of short- and long-distance transport and finances. Environmental factors such as public access (p < 0.001), short- (p < 0.001) and long-distance transport (p = 0.001), and friends' (p = 0.003) and colleagues' (p < 0.001) attitudes and communication (p = 0.042) were significantly associated with the presence of secondary health conditions. Finances (p = 0.026), family attitudes (p = 0.037) and communication (p = 0.039) had a significant association with worsened mental health. Services (p = 0.022) and communication (p = 0.042) were also significantly associated with decreased general health.

CONCLUSION

The results provide insight into modifiable environmental factors policymakers need to consider or adapt to improve the lives of people with SCI in South Africa with respect to health (secondary health conditions), as well as general and mental health.

Examining Disparities in Current E-Cigarette Use among U.S. Adults before and after the WHO Declaration of the COVID-19 Pandemic in March 2020

This paper aims to estimate the prevalence of e-cigarette use before and after the COVID-19 pandemic declaration and to delineate disparities in use across subpopulations. Data were derived from the 2020 Health Information National Trends Survey (N = 3865) to conduct weighted multivariable logistic regression and marginal analyses. The overall prevalence of current e-cigarette use increased from 4.79% to 8.63% after the COVID-19 pandemic declaration. Furthermore, non-Hispanic Black people and Hispanic people had lower odds of current e-cigarette use than non-Hispanic White people, but no significant differences were observed between groups before the pandemic. Compared to heterosexual participants, sexual minority (SM) participants had higher odds of current e-cigarette use after the declaration, with insignificant differences before. People who had cardiovascular disease conditions, relative to those without, had higher odds of current e-cigarette use after the declaration, but no group differences were found before the declaration. The marginal analyses showed that before and after the pandemic declaration, SM individuals had a significantly higher probability of using e-cigarettes compared to heterosexual individuals. These findings suggest the importance of adopting a subpopulation approach to understand and develop initiatives to address substance use, such as e-cigarettes, during pandemics and other public health emergencies.

Benefits of animal-Assisted interventions in preschool children: A systematic review

Animal-assisted interventions are frequently used to stimulate and improve different skills in children with and without disabilities. However, the heterogeneity of AAI studies in preschool children is large, including different health conditions, duration, outcomes, study design or therapy animals. Therefore, the current study aims to summarize all intervention procedures and provide an updated analysis of the effectiveness of AAI intervention in the early childhood. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), a systematic search was conducted in two databases: Pubmed (MedLine) and Web of Science. The risk of bias was assessed using the Evidence Project risk of bias tool. A total of 319 articles were identified and 17 were finally included in the qualitative synthesis. Due to the large heterogeneity in terms of study design, intervention, and sample characteristics, it was not possible to conduct a meta-analysis. Animal-assisted interventions might lead to a positive impact on physical, physiological, psychosocial, and language skills in preschool children. These enhancements may be observed both in healthy children and in those with different health conditions, such as intellectual disabilities, cerebral palsy, autism disorder, or Down syndrome. Results must be interpreted with caution due to the large heterogeneity and risk of bias in the included articles.

Lifestyle, vulnerability to stress and prevailing health conditions of ambulatory older patients in a care facility

Background

Lifestyle and vulnerability to stress are major determinants of age-related health outcomes.

Objectives

To assess the lifestyle and health states of older adults, and evaluate their personality-related vulnerability to stress, to enable improved and targeted health promotional activities.

Methods

A hospital record review and a purposive cross-sectional study was conducted among 200 respondents who were ≥ 50 years old, and visited the General Hospital Oyo, South-western Nigeria. Descriptive statistics was performed using SPSS version 21. Analysis of vulnerability to stress was performed by the addition of scores from Marshal's personality stress prone test. Lifestyle were measured by frequencies and Chi-Square tests, while presence of chronic diseases was measured by respondents' past prescriptions, from the hospital case notes. P < 0.05 was considered statistically significant.

Results

A total of 200 respondents participated in the study. Majority, 156 (78.0%) were 50-59 years old and self-employed 96 (46.0%). Ninety-three (46.5%) smoked, 65 (32.3%) consumed alcohol, 128 (64.0%) had periodic exercise and 67 (33.3%) experienced insomnia. Majority (60.5%) were vulnerable to stress, and this was significantly associated with age (P=0.001), marital status (P=0.021), body weight (P=0.05), occupation (P=0.002) and income (P=0.002). From the retrospective study, most frequently prescribed drugs were anti-hypertensives 225 (69.7%), vitamins/minerals (49.5%), sedatives 158 (48.9%) and analgesics 158 (48.9%) respectively.

Conclusion

Periodic exercise, alcohol use, and smoking were reported at varying degrees. High prevalence of vulnerability to stress and use of anti-hypertensives were also observed, and vulnerability to stress was associated with selected socio-demographics. These findings reinforce the need for routine education of this category of populace on healthy lifestyle for improved health.

Social Stressors and Health Among Older Transgender and Gender Diverse Veterans

Purpose: Health disparities in transgender and gender diverse (TGD) veterans compared with cisgender veterans have been documented. However, there is a paucity of literature focused on older TGD veterans. We assessed health conditions and social stressors in older TGD veterans compared with matched cisgender veterans. Methods: Using gender identity disorder diagnosis codes, we identified 1244 TGD veterans (65+ years of age) receiving care in the Veterans Health Administration (VHA) from 2006 to 2018. These TGD veterans were then matched to 3732 cisgender veterans based on age, VHA site, and date of care in VHA. Results: In adjusted models, TGD veterans compared with cisgender veterans were less likely to have alcohol use disorder (adjusted odds ratio [AOR; 95% confidence interval]: [0.70; 0.58-0.85]), drug use disorder (0.59; 0.47-0.74), tobacco use (0.75; 0.65-0.86), and anxiety (0.74; 0.62-0.90). However, compared with cisgender veterans, TGD veterans were more likely to experience depression (1.63; 1.39-1.93), Alzheimer's disease (8.95; 4.25-18.83), cancer (1.83; 1.56-2.14), violence (1.82; 1.14-2.91), social/familial problems (2.45; 1.99-3.02), lack of access to care/transportation (2.23; 1.48-3.37), and military sexual trauma (2.59; 1.93-3.46). Furthermore, compared with cisgender veterans, TGD veterans were more likely to have documentation of a higher count of social stressors: 1 or more stressors (1.64; 1.38-1.95) and 2 or more stressors (1.22; 1.01-1.49). Conclusion: Despite significant disparities in social stressors and health conditions compared with cisgender veterans, TGD veterans had a lower likelihood of substance use and anxiety. Interventions are needed to mitigate social stressors and improve health among the older TGD veteran population.

Characterizing the physical and mental health profile of children, adolescents and adults with autism spectrum disorder in Spain

Introduction

Autistic men and women are more likely to experience health issues than the general population, although the available epidemiological studies addressing co-occurrence conditions are limited. This is the first Spanish epidemiologic study addressing the health profile and poor-health exacerbating factors in individuals of all ages with autism spectrum disorder (ASD).

Methods

We analyzed 2,629 registries extracted from Autism Spain's sociodemographic registry (November 2017-May 2020). A descriptive health data analysis was conducted to assess the prevalence of other conditions associated to ASD in the Spanish population. Nervous system disorders (12.9%), mental health diagnoses (17.8%), and other comorbidities (25.4%) were reported. Men-to-women ratio was 4:1.

Results

Women, elder individuals and those with intellectual disability (ID) were at an increased risk of health comorbidities and psychopharmacological exposure. Women were also more prone to severe intellectual and functional impairment. Nearly all individuals had difficulties in their adaptative functioning, especially those with ID (50% of the population). Almost half of the sample received psychopharmacological treatments starting from infancy and early childhood, mostly antipsychotics and anticonvulsants.

Discussion

This study represents an important first approach to the health status of autistic people in Spain and can contribute to the development of public policies and innovative health strategies.

The association between lifestyles and health conditions and the choice of traditional Chinese medical treatment in China: A latent class analysis

Traditional Chinese medicine (TCM) plays a major role in preventing and treating the disease, however, it is also facing a slice of challenges as fewer choices of TCM treatment. Although lifestyles and health conditions might be paramount influencing factors for the choice of TCM treatment, the relative evidence is scarce. The current observational study was designed to evaluate this association. A total of 24,173 Chinese individuals with a mean age of 47.3 years from the Chinese Family Panel Studies 2014 were selected. The choice of TCM treatment was acquired by the self-report questionnaire. Latent class analysis was employed to identify clusters of lifestyles and health conditions. The binary logistic regression model was employed to examine the association between lifestyles, health conditions and the choice of TCM treatment. Lifestyles and health conditions were classified into 3 classes with latent class analysis, healthy group, unhealthy behavior group, and physical inactivity group. After controlling for potential confounding factors, the results showed individuals in unhealthy behavior group (odds ratio = 1.51, 95% confidence interval: 1.35-1.68, P < .001) or physical inactivity group (odds ratio = 1.11, 95% confidence interval: 1.02-1.22, P = .019) were more likely to visit TCM doctors than healthy group. Sex-specific difference was observed, the relationship still existed among the males. The current study revealed the relationship between lifestyles, health conditions and the choice of TCM treatment. This will provide evidence for the TCM development and provide support for further research.

Results from the International Spinal Cord Injury Community Survey: The Lived Experience of People with Spinal Cord Injury in South-Eastern Brazil

OBJECTIVE

The incidence of spinal cord injury in Brazil is increasing. It is important to understand more about how individuals are living with spinal cord injury.

DESIGN

Cross-sectional, observational study of individuals with spinal cord injury in south-eastern Brazil.

SUBJECTS

A questionnaire with 125 questions was applied to individuals diagnosed with spinal cord injury. Participants were recruited by survey team from 2 rehabilitation centres (both in south-eastern Brazil) that treat persons diagnosed with SCI. Personal characteristics, associated health conditions, quality of life, work status, environmental factors, and other functioning-related aspects were evaluated.

RESULTS

A total of 201 individuals participated in the survey. Of these, 79% were male, mean age 44 years, 60% were considered paraplegic, and the major causes of impairment were firearm injuries and road traffic accidents. Spasticity was the most frequently reported health condition, followed by neuropathic pain. 50% of subjects did not report any difficulty with participation in activities of daily living. However, only approximately 10% of subjects returned to work after spinal trauma. Their quality of life is reported 44% as good.

CONCLUSION

Most people with spinal cord injury in south-eastern Brazil are male and paraplegic, health problems and spasticity is considered their most problematic health condition. Although they report having a good quality of life, they still encounter disabling environmental barriers that make their life more difficult, such as poor accessibility of public spaces, and only a small proportion (10%) returned to work after their injury. This study provides an initial overview of the lived experience of people with spinal cord injury in south-eastern Brazil and should serve as a starting point for future research on this population.

Workplace Mistreatment and Health Conditions Prior and during the COVID-19 in South Korea: A Cross-Sectional Study

BACKGROUND

This study examined the relationship between workplace mistreatment, including discrimination, abuse, and overworking, and health problems among full-time workers prior to and during the coronavirus disease (COVID-19) outbreak in South Korea.

METHODS

We analyzed data from the 2017 and 2020-2021 Korean Working Conditions Surveys, including the final sample of 44,425 participants. Multiple logistic regression was used to examine the relationship between workplace mistreatment and health problems among workers by gender. Interaction analysis was conducted to establish the association between the COVID-19 pandemic and health problems related to mistreatment. The occupational, demographic, and socioeconomic backgrounds were adjusted.

RESULTS

We found a significant association between workplace mistreatment and health problems, including headaches, eyestrain, and anxiety. The association increased after the COVID-19 pandemic: "discrimination" (men (OR 2.26, 95% CI 1.93-2.65), women (OR 2.73, 95% CI 2.36-3.17)); abuse (men (OR 5.42, 95% CI 2.87-10.23), women (OR 4.70, 95% CI 3.12-7.08)); and overworking: men (OR 2.36, 95% CI 2.01-2.77), women (OR 3.52, 95% CI 2.68-4.61). The interaction indicates an increased incidence of people having health problems due to workplace mistreatment (OR 1.03, 95% CI 1.00-1.06) during the COVID-19 pandemic.

CONCLUSION

Statistically, employees who experience workplace mistreatment have worse health conditions. The COVID-19 pandemic has affected the job environment and increased the association between workplace mistreatment and health problems. To eliminate the health problems related to workplace mistreatment, it is necessary to address the impact of the COVID-19 pandemic on work and employee health conditions.

Social Frailty among Community-Dwelling Older Adults during the COVID-19 Pandemic in Korea: A Cross-Sectional Study

Social frailty among older adults has become a growing concern from a public health perspective in the context of the coronavirus disease 2019 (COVID-19) pandemic. This study's aim was to investigate the influence of various aspects of social frailty in community-dwelling older adults during the COVID-19 pandemic. This study carried out a secondary analysis of data collected from the 2020 National Survey of Older Koreans and performed multinomial logistic regression analysis to identify the predictive factors of social frailty. The affected factors for the social frailty group were health conditions (depression), behavioral and metabolic risk factors (exercise, nutritional status, current smoking status, drinking frequency), intrinsic capacity (cognitive functions, activities of daily living), and digital literacy (use of smartphone or tablet PCs). Since multidimensional factors could affect older adults' social frailty, comprehensive strategies are urgently needed to reduce their rate of social frailty.

Research progress of health care in Yemeni children during the war: review

BACKGROUND

Yemen crisis, which has been going on for more than six years, represents one of the most gruesome human plights in the modern history, especially children.

OBJECTIVES

This research aimed to present a comprehensive view of Yemeni children's studies during the ongoing war period, to come up with a comprehensive base that concerns humanitarians, researchers, decision-makers, and general public at large about the reality of the predicament of Yemeni child.

METHOD

We searched databases and identified 373 articles, of which 68 were included in this review. Review of literature between 2014 and 2020 is taken from academic sources, multilateral organizations, donors, and governmental and non-governmental organizations. The data are analyzed by date and governorates.

RESULTS

We chose 68 articles and divided them according to the diseases and health conditions as follows: infectious diseases (15 studies), non-infectious diseases (10 studies), blood-related diseases (7 studies), oral and dental problems (12 studies), accidents and injuries (2 studies), health system (16 studies), family and community (6 studies). Moreover, the studies were divided geographically as follows: 7 studies that were almost comprehensive for all governorates; additional studies were conducted for Amanat Al Asimah (21 studies), Taiz (12 studies), Aden and Al Hudaydah (7 studies for each), Dhamar and Ibb (6 studies for each), Abyan and Lahij (2 study for each). As for Al Bayda, Marib, Sana'a, and Socotra, each of them had one study.

CONCLUSION

Our assessment revealed that the ongoing Yemen crisis is underrated and largely neglected. The studies conducted so far do match the ground reality both in terms of inclusiveness and numbers.

Preexisting Condition Protections Under the Affordable Care Act: Changes in Insurance Coverage, Premium Contributions, and Out-of-Pocket Spending

OBJECTIVES

In January 2014, the Affordable Care Act (ACA) preexisting condition protections prohibited coverage denials, premium increases, and claim denials on the basis of preexisting conditions. This study aimed to examine changes in coverage and premiums and out-of-pocket spending after the implementation of the preexisting condition protections under the ACA.

METHODS

We identified adults aged 18 to 64 years with (n = 59 041) and without preexisting conditions (n = 61 970) from the 2011-2013 and 2015-2017 Medical Expenditure Panel Survey. We used a difference-in-differences and a difference-in-difference-in-differences approach to assess the associations of preexisting condition protections and changes in insurance coverage, premium contributions, and out-of-pocket spending after the ACA. Simple and multivariable logistic or multivariable 2-part models were fitted for the full sample and stratified by family income (low ≤138% federal poverty level [FPL]; middle 139%-400% FPL; and high > 400 FPL).

RESULTS

The ACA increased nongroup insurance coverage to a similar extent for individuals with or without preexisting conditions at all income levels. Decreases in premium contributions were observed to a similar extent among families with nongroup private coverage regardless of declinable preexisting condition status, whereas no significant changes were observed among families with group coverage. We found greater decreases in out-of-pocket spending for individuals with preexisting conditions than those without conditions among both individuals covered by nongroup and group insurance, and a greater difference was observed among those covered by nongroup insurance (difference-in-difference-in-differences -$279; 95% confidence interval -$528 to -$29).

CONCLUSIONS

The ACA protections were associated with decreases in out-of-pocket spending among adults with preexisting conditions.

Gender Differences in Prescription Medications Among Transitioning Justice-Involved Individuals

Little is known-especially with regard to gender differences-about the prescription trends among justice-involved individuals with health conditions after release from correctional facilities. This article presents initial findings from a large outreach program designed to provide prescription support during the turbulent prison-to-community transition period. We analyzed data derived from a prescription outreach program during the years 2018-2019. Multivariate logistic regression was employed to examine the association between gender and therapeutic areas, controlling for age and race. Compared with men, women were at higher odds of receiving prescriptions for psychiatric conditions followed by neurological conditions, but lower odds of receiving prescriptions for cardiovascular conditions. Further research is necessary to unpack the causal pathways that underlie the associational trends observed in our current analysis.

Working conditions, lifestyle and mental health of Brazilian public-school teachers during the COVID-19 pandemic

This study aimed to describe the working conditions, lifestyle and mental health of Brazilian public-school teachers during the COVID-19 pandemic. This is an epidemiological websurvey, carried out from August to September 2020. Teachers from public schools in rural and urban areas in the state of Minas Gerais, Brazil, participated in the study. A digital questionnaire was used and the study addressed variables related to four major thematic topics: sociodemographic and economic profile, working conditions, lifestyle and health conditions, and mental health problems during the pandemic. The sample consisted of 15,641 teachers, of which 13.3% worked in rural areas, 81.9% were women, 56.2% were aged 41-60 years, 66.8% were married, 99.2% were working remotely and 79.8% adhered to social distancing. During the pandemic, 40.6% showed a decrease in family income, 33.7% were dissatisfied with their work, 58% reported increased body weight, 47.9% did not exercise, 35.8% were part of at least one risk group for COVID-19, 40.5% had some flu-like symptoms during the pandemic and 1.2% tested positive for COVID-19. Regarding mental health problems, 25.9% of teachers self-reported formal diagnosis of anxiety and/or depression during the pandemic. In addition, 7.1% of teachers were drinking more alcohol than usual, 33.4% started having sleep problems, 30.4% were using relax/sleep/anxiety/depression medications, 67.1% reported that their quality of life worsened and 43.7% reported having severe fear of COVID-19. It was also found that 82.3% of teachers had at least one mental health problem during the pandemic, such as increased alcohol consumption, sleep problems, use of psychotropic medication, decreased quality of life, and fear of COVID-19. The results of this study reveal the numerous challenges and the extent of the impact of the pandemic on working conditions, lifestyle, and especially on the mental health of teachers.

CHU9D Normative Data in Peruvian Adolescents

BACKGROUND

Due to the vulnerability to protective and risk factors during adolescence, there is a growing interest in the study of health-related quality of life (HRQoL) at this stage. The CHU9D is a generic and practical HRQoL instrument that provides values on all dimensions of self-perceived health, in addition to providing utilities and a cost-utility assessment fee, unlike other instruments. This study was conducted with an adolescent population in Peru. The main objective of this article is to report the normative values of the CHU9D questionnaire in Peruvian adolescents.

METHODS

The CHU9D questionnaire was administered to Peruvian adolescent students. A total of 1229 young people participated in the survey. The CHU9D score was reflected as a function of gender, age, weight, height, and educational level.

RESULTS

The mean CHU9D utility index for the total sample was 0.890; this rating was significantly better for boys with 0.887 and girls with 0.867. The ceiling effect was higher for male adolescents with 32.6 than for female adolescents.

CONCLUSIONS

The results of the present study show that adolescents in school show a positive perception of HRQoL. It is also concluded that the CHU9D instrument can be effectively applied to economic evaluations for interventions to improve the quality of life of adolescents.

Health Conditions in Adults With Cerebral Palsy: The Association With CP Subtype and Severity of Impairments

Aim: To determine the prevalence of common health conditions in adults with cerebral palsy (CP) and to identify associations with the CP subtype or the severity of impairments.

Methods: A population-based, cross-sectional study of 153 adults with CP born from 1959 to 1978 (87 males, 66 females; median age 48 years 3 months, range 37–58 years; 41% with unilateral spastic, 36% bilateral spastic, 19% dyskinetic, and 4% with ataxic CP). Data was gathered through interviews, physical assessments, and medical record reviews.

Results: The most common health conditions in adults with CP were pain 65%, upper gastrointestinal disorders 33%, dysphagia 29%, epilepsy 29%, and depression 27%. Cerebral palsy subtype was significantly associated with the presence of pain (p = 0.029), gastrointestinal (p < 0.001), and respiratory disorders (p = 0.006). A more severe physical impairment was associated with a higher prevalence of gastrointestinal disorders (p < 0.001), respiratory disorders (p < 0.001), and pressure ulcers (p < 0.001). Intellectual disability was associated with a higher prevalence of gastrointestinal disorders (p < 0.001), pneumonia (p = 0.001) epilepsy (p = 0.001), and pressure ulcers (p < 0.001), but with a lower prevalence of pain (p < 0.004) and hypertension (p = 0.043).

Conclusion: The prevalence of several common health conditions is related to the CP subtype and severity of impairments, indicating that CP plays a role in the development of these health conditions. Follow-up of adults with CP needs to include not only impairments, but general health as well. Increased attention directed toward signs of gastrointestinal and respiratory disorders in individuals with either dyskinetic CP, gross motor function classification system (GMFCS) levels IV–V, or intellectual disability, is recommended.

Is the Mediterranean Diet Pattern Associated with Weight Related Health Complications in Adults? A Cross-Sectional Study of Australian Health Survey

We hypothesized that unhealthy dietary pattern would be associated with weight related complications among overweight. We analysed data from the Australian Health Survey conducted from 2011 to 2013. A total of 5055 adults with at least overweight (body mass index ≥25 kg/m²) were analysed. We used logistic regression to assess the association between unhealthy dietary pattern, defined by low adherence to Mediterranean Diet Score (MDS), and weight related complications, defined by the Edmonton Obesity Staging System (EOSS). We repeated the logistic regression models by age and socio-economic disadvantage strata in sensitivity analyses. We also repeated the main analysis on a propensity score matched dataset (n = 3364). Complications by EOSS ≥2 was present in 3036 (60.1%) participants. There was no statistically significant association between unhealthy dietary pattern and weight related complication (odds ratio 0.98 (95%confidence interval: 0.85, 1.12)). The null association remained the same after repeating the analysis on three age and five socio-economic indexes for areas strata. The finding persisted after the analysis was repeated on a propensity score matched dataset. We found no evidence to support the hypothesis that unhealthy dietary pattern was associated with weight related complications in this cross-sectional study of the Australian population with overweight or obesity.

Tracking Self-reported Symptoms and Medical Conditions on Social Media During the COVID-19 Pandemic: Infodemiological Study

BACKGROUND

Harnessing health-related data posted on social media in real time can offer insights into how the pandemic impacts the mental health and general well-being of individuals and populations over time.

OBJECTIVE

This study aimed to obtain information on symptoms and medical conditions self-reported by non-Twitter social media users during the COVID-19 pandemic, to determine how discussion of these symptoms and medical conditions changed over time, and to identify correlations between frequency of the top 5 commonly mentioned symptoms post and daily COVID-19 statistics (new cases, new deaths, new active cases, and new recovered cases) in the United States.

METHODS

We used natural language processing (NLP) algorithms to identify symptom- and medical condition-related topics being discussed on social media between June 14 and December 13, 2020. The sample posts were geotagged by NetBase, a third-party data provider. We calculated the positive predictive value and sensitivity to validate the classification of posts. We also assessed the frequency of health-related discussions on social media over time during the study period, and used Pearson correlation coefficients to identify statistically significant correlations between the frequency of the 5 most commonly mentioned symptoms and fluctuation of daily US COVID-19 statistics.

RESULTS

Within a total of 9,807,813 posts (nearly 70% were sourced from the United States), we identified a discussion of 120 symptom-related topics and 1542 medical condition-related topics. Our classification of the health-related posts had a positive predictive value of over 80% and an average classification rate of 92% sensitivity. The 5 most commonly mentioned symptoms on social media during the study period were anxiety (in 201,303 posts or 12.2% of the total posts mentioning symptoms), generalized pain (189,673, 11.5%), weight loss (95,793, 5.8%), fatigue (91,252, 5.5%), and coughing (86,235, 5.2%). The 5 most discussed medical conditions were COVID-19 (in 5,420,276 posts or 66.4% of the total posts mentioning medical conditions), unspecified infectious disease (469,356, 5.8%), influenza (270,166, 3.3%), unspecified disorders of the central nervous system (253,407, 3.1%), and depression (151,752, 1.9%). Changes in posts in the frequency of anxiety, generalized pain, and weight loss were significant but negatively correlated with daily new COVID-19 cases in the United States (r=-0.49, r=-0.46, and r=-0.39, respectively; P<.05). Posts on the frequency of anxiety, generalized pain, weight loss, fatigue, and the changes in fatigue positively and significantly correlated with daily changes in both new deaths and new active cases in the United States (r ranged=0.39-0.48; P<.05).

CONCLUSIONS

COVID-19 and symptoms of anxiety were the 2 most commonly discussed health-related topics on social media from June 14 to December 13, 2020. Real-time monitoring of social media posts on symptoms and medical conditions may help assess the population's mental health status and enhance public health surveillance for infectious disease.

Health-Related Quality of Life Norm Data of the Peruvian Adolescents: Results Using the EQ-5D-Y

(1) Introduction: There is a growing interest in health-related quality of life (HRQOL) in adolescent population. The EQ-5D-Y is a generic HRQOL instrument that allows adolescents to understand the health status of different levels of physical, mental, and social health. This study was carried out with an adolescent population in Peru. The main objective of this article is to report the normative values of the EQ-5D-Y questionnaire in Peruvian adolescents. (2) Methods: The EQ-5D-Y questionnaire was administered to Peruvian adolescent students. A total of 1229 young people participated in the survey. The EQ-5D-Y score was reflected as a function of sex and age. (3) Results: The mean utility index of the EQ-5D-Y for the total sample was 0.890; this rating was significantly better for males at (0.899) and females at (0.881). The ceiling effect was higher for adolescent males with (47.3) females (40.7). (4) Conclusions: The results of the present study provide evidence that schooled adolescents show a positive perception of HRQOL.

[Personalization of Nordic walking programs in a sanatorium-type medical center]

Nordic walking is a wellness technology available to people of all ages with varying fitness levels and health conditions. The greatest health strengthening effect when using it is achieved in those cases when the program is personified depending on a specific disease taking into account the current functional state of the body and system-forming parameters of activity including the initial vegetative tone.

OBJECTIVE

To assess the effectiveness of Nordic walking in adolescent 15-17 years old depending on type of initial vegetative tone and the time of the lessons.

MATERIAL AND METHODS

It was examined 60 adolescents aged 15-17 years of the II health group including 30 persons with vagotonic and 30 persons with sympathicotonic type of initial vegetative tone. In each groups the subgroups were identified who were engaged in Nordic walking from 8:00 to 9:00 (morning subgroups, 15 teenagers) and from 18:00 to 19:00 (evening subgroups, 15 teenagers). The course included 21 sessions of 45 minutes daily. Heart rate variability, the level of self-esteem according to D. Keirsey, well-being, activity and mood according to the SAN method, subjective load tolerance according to the Borg scale and general physical endurance according to the results of a test with a 6-minute run were assessed.

RESULTS

A significant positive effect was observed with the differentiated use of Nordic walking taking into account the type of the initial vegetative tone and the daily rhythm of physical activity. In adolescent vagotonics training in the evening according to the analysis of heart rate variability, the functional reserve and activity of regulatory systems increased with a tendency to normalize the sympathetic-parasympathetic balance, the indicators of the psychological sphere improved, physical endurance increased, as well as the motivation for training and their subjective tolerance. In sympathicotonic adolescents, a similar positive effect of Nordic walking took place when exercising in the morning. A different distribution of training time (morning hours for vagotonics and evening hours for sympathicotonics) was accompanied by tension in the work of the autonomic nervous system apparatus caused disharmony in the emotional state, did not lead to an increase in physical endurance and worsened subjective load tolerance.

CONCLUSION

When planning a course of Nordic walking in adolescents it is necessary to take into account the type of initial vegetative tone and choose the right time for classes: with vagotonia they should be carried out in the evening, with sympathicotonia - in the morning.

Health-Related Productivity Loss According to Health Conditions among Workers in South Korea

This study aimed to investigate the degree of health-related productivity loss (HRPL) for common health conditions. A total of 4197 workers participated in a web-based questionnaire survey from January to February 2020. HRPL was measured using the Work Productivity and Activity Impairment questionnaire, and a difference in HRPL was calculated for each common health condition. The burden of productivity loss due to each health condition was calculated by the product of the difference in HRPL scores and the percentage of participants who complained. The health conditions most strongly associated with increased HRPL were infertility treatment (30.6%), osteoporosis (25.9%), cancer (25.3%), gastric ulcer or duodenal ulcer (25.0%) and anaemia (23.9%). The most important health conditions in order of their magnitude of induced burden of productivity loss were fatigue, neck or shoulder pain, insufficient sleep, back pain, headache, common cold and flu, insomnia, anxiety and diarrhoea or constipation. HRPL is more strongly and importantly associated with the aforementioned health conditions. Occupational health managers should prioritise addressing health conditions strongly and importantly associated with HRPL when implementing health promotion programmes.

Treatment Of Opioid Use Disorder Among Commercially Insured US Adults, 2008-17

There is abundant literature on efforts to reduce opioid prescriptions and misuse, but comparatively little on the treatment provided to people with opioid use disorder (OUD). Using claims data representing 12-15 million nonelderly adults covered through commercial group insurance during the period 2008-17, we explored rates of OUD diagnoses, treatment patterns, and spending. We found three key patterns: The rate of diagnosed OUD nearly doubled during 2008-17, and the distribution has shifted toward older age groups; the likelihood that diagnosed patients will receive any treatment has declined, particularly among those ages forty-five and older, because of a reduction in the use of medication-assisted treatment (MAT) and despite clinical evidence demonstrating its efficacy; and treatment spending is lower for patients who choose MAT. These patterns suggest that policies supporting the use of MAT are critical to addressing the undertreatment of OUD among the commercially insured and that further research to assess the cost-effectiveness of treatment with versus without medication is needed.

Structural determinants of stigma across health and social conditions: a rapid review and conceptual framework to guide future research and intervention

INTRODUCTION

Stigma has been identified as a key determinant of health and health inequities because of its effects on access to health-enabling resources and stress exposure. Though existing reports offer in-depth summaries of the mechanisms through which stigma influences health, a review of evidence on the upstream drivers of stigma across health and social conditions has been missing. The objective of this review is to summarize known structural determinants of stigma experienced across health and social conditions in developed country settings.

METHODS

We conducted a rapid review of the literature. English- and French-language peer-reviewed and grey literature works published after 2008 were identified using MEDLINE, Embase, PsycINFO, Google and Google Scholar. Titles and abstracts were independently screened by two reviewers. Information from relevant publications was extracted, and a thematic analysis of identified determinants was conducted to identify broad domains of structural determinants. A narrative synthesis of study characteristics and identified determinants was conducted.

RESULTS

Of 657 publications identified, 53 were included. Ten domains of structural determinants of stigma were identified: legal frameworks, welfare policies, economic policies, social and built environments, media and marketing, pedagogical factors, health care policies and practices, biomedical technology, diagnostic frameworks and public health interventions. Each domain is defined and summarized, and a conceptual framework for how the identified domains relate to the stigma process is proposed.

CONCLUSION

At least 10 domains of structural factors influence the occurrence of stigma across health and social conditions. These domains can be used to structure policy discussions centred on ways to reduce stigma at the population level.

Health Conditions, Lifestyle Factors and Depression in Adults in Qingdao, China: A Cross-Sectional Study

Background: Depression is a common mental illness. Previous studies suggested that health conditions and lifestyle factors were associated with depression. However, only few studies have explored the risk factors of depression in a large representative sample of the general population in the world. Methods: A population-based cross-sectional survey was conducted in the 2006 survey and 2009 survey in Qingdao, China. The participants with insufficient information were excluded: Zung score, body mass index (BMI), diabetes items, physical activity, smoking, or drinking. Finally, a total of 3,300 participants were included in this analysis. The category of depression was used in the Zung self-rating depression scale (ZSDS). The associations between different indicators of health conditions (diabetic status, BMI), lifestyle factors (physical activity, smoking, and alcohol consumption), and depression were assessed by the logistic regression model. Results: The mean Zung scores for all participants, male participants, and female participants were 29.73 ± 7.57, 28.89 ± 7.30, 30.30 ± 7.70, respectively. In all participants, those who were pre-diabetes status (OR: 1.53, 95% CI: 1.04-2.27), and irregular physical activity (OR: 0.39, 95% CI: 0.17-0.89) had an increased risk of depression. In man, the analysis showed an increased risk of depression those with pre-diabetes (OR: 2.49, 95% CI: 1.25-4.97), previously diagnosed diabetes (OR: 4.44, 95% CI: 1.58, 12.48), and in those irregular activities (OR: 0.07, 95% CI: 0.01-0.61). In women, those who were underweight (OR: 5.66, 95% CI: 1.04-30.71) had a greater risk of depression. Conclusions: These results suggested that health conditions and lifestyle factors were the potential risk factors for depression. Men with pre-diabetes, previously diagnosed diabetes, and irregular activity had an increased risk for depression; women with underweight status had a higher risk for depression.

Analysis of epidemiological trends in chronic diseases of Chinese residents

Following the population aging in China, dramatic changes have been observed in the spectrum of diseases among Chinese residents. E.g., the incidence and prevalence of chronic diseases, such as cardiovascular, cerebrovascular, metabolic, and respiratory diseases, are constantly growing. Additionally, osteoporosis, sarcopenia, and chronic renal disease have gradually become common chronic diseases among the elderly. Chronic diseases in the elderly have ranked first in the spectrum of diseases among Chinese residents. Therefore, understanding the trends of main chronic diseases among Chinese residents and developing proactive countermeasures have become a major public health issue for China.

Occupational Health Conditions and Associated Factors Among Municipal Solid Waste Collectors in Addis Ababa, Ethiopia

Background

Municipal solid waste collection is one of the most dangerous jobs in the world. It exposes the workers to physical, biological, and chemical hazards, and occupation-related morbidities. In developing countries, municipal solid waste management-related occupational morbidities are not properly addressed. Therefore, the aim of this study was to investigate occupational health conditions and associated factors among municipal solid waste collectors in Addis Ababa, Ethiopia.

Materials and Methods

An institution-based cross-sectional study was conducted among 576 municipal solid waste collectors in Addis Ababa from August 2019 to September 2019. To select the study participants, a multistage sampling technique was used. The data were collected by using a structured interviewer administered questionnaire. The association between the dependent and independent variables was analyzed using binary logistic regression analysis at 95% confidence interval and variables with P-value<0.05 were considered as statistically significant to the dependent variable.

Results

A total of 576 municipal solid waste collectors participated in the study, which makes the response rate 96.9%. Among the total municipal solid waste collectors, 295 (51.2%) of them had occupational health symptoms. Work experience (AOR=1.86, 95% CI=1.01–2.18), family size (AOR=1.76, 95% CI=1.15–2.71), personal protective equipment (AOR=2.31, 95% CI=1.32–4.04), and working hours per day (AOR=1.76, 95% CI=1.22–2.68) were significantly associated with occupational health conditions.

Conclusion

The magnitude of occupational health symptoms among municipal solid waste collectors in Addis Ababa was high. Work experience, working hours per day, type of PPE, and family size were significantly associated with occupational health conditions. Therefore, providing appropriate and full body cover personal protective equipment, giving training, monitoring working hours, and conducting studies including medical evaluation is crucial.

Are health conditions and concerns about health effects of smoking predictive of quitting? Findings from the ITC 4CV Survey ( 2016-2018 )

INTRODUCTION

Limited research has investigated the relationship between multiple health conditions and subsequent quitting activities at the population level. This study examines whether nine health conditions and concerns related to smoking are predictive of quit attempts and success among those who tried.

METHODS

Data came from the International Tobacco Control Four Country Smoking and Vaping Survey conducted in Australia, Canada, England and the US. A total of 3998 daily smokers were surveyed in 2016 and recontacted in 2018. Respondents were asked in 2016 whether they had a medical diagnosis for depression, anxiety, alcohol problems, obesity, chronic pain, diabetes, heart disease, cancer, and chronic lung disease, and whether they had concerns about past/future health effects of smoking. Outcomes were quit attempts and success (having been abstinent for at least one month between surveys).

RESULTS

Across all four countries, 44.4% of smokers tried to quit between the two survey years, and of these 36.8% were successful. Concerns about past (adjusted odds ratio, AOR=1.66, 95% CI: 1.32–2.08, p<0.001) and future effects of smoking (AOR=2.17, 95% CI: 1.62–2.91, p<0.001) and most health conditions predicted quit attempts, but were mostly unrelated to quit success, with concerns about future effects (AOR=0.59, 95% CI: 0.35–0.99, p<0.05), chronic lung conditions (AOR=0.56, 95% CI: 0.37–0.86, p<0.01) and chronic pain (with a trend) being associated with lower success.

CONCLUSIONS

Having a major chronic health condition does, generally, motivate making quit attempts, but in some cases it is associated with failure among those who try. More effective cessation support is required for these high priority groups.

Impacts of major health conditions affecting the Australian sheepmeat value chain: a review

Major health conditions in sheep contribute to substantial economic losses throughout the sheepmeat supply chain in Australia. A systematic review was undertaken to explore the measurable impact of six conditions: arthritis, sheep measles, pleurisy, pneumonia, grass seeds and rib fractures, on the production of lamb and mutton across the meat value chain. Peer-reviewed scientific literature from three databases and non-peer-reviewed articles and reports from Australian government and non-government websites were searched between 11 and 17 November 2019. Original articles, including studies conducted in Australia and New Zealand, that had measurable impacts on conditions of interest were included. The search yielded 16 articles and reports and were classified as producer impact and/or processor impact studies. Mortalities were quantified for pneumonia and arthritis, with pneumonia having the highest impact for producers. Grass seed infestation resulted in the highest impact on carcase and liveweight losses compared to arthritis and pneumonia. Arthritis had the highest trim weight losses for both lamb and mutton and the highest rate of carcase condemnation. Grass seed was the only condition where other impacts on the processor (chain speed and staff relocation to the boning room) were quantified. Although quantifiable production and processing losses were available for some conditions, this review has highlighted that limited quantifiable data based on scientifically sound research were not available for other conditions. The evidence for some conditions found in this review can be used to target future research activities and to further assist producers in making informed management decisions on prevention and control.

The causal effects of health conditions and risk factors on social and socioeconomic outcomes: Mendelian randomization in UK Biobank

BACKGROUND

We aimed to estimate the causal effect of health conditions and risk factors on social and socioeconomic outcomes in UK Biobank. Evidence on socioeconomic impacts is important to understand because it can help governments, policy makers and decision makers allocate resources efficiently and effectively.

METHODS

We used Mendelian randomization to estimate the causal effects of eight health conditions (asthma, breast cancer, coronary heart disease, depression, eczema, migraine, osteoarthritis, type 2 diabetes) and five health risk factors [alcohol intake, body mass index (BMI), cholesterol, systolic blood pressure, smoking] on 19 social and socioeconomic outcomes in 336 997 men and women of White British ancestry in UK Biobank, aged between 39 and 72 years. Outcomes included annual household income, employment, deprivation [measured by the Townsend deprivation index (TDI)], degree-level education, happiness, loneliness and 13 other social and socioeconomic outcomes.

RESULTS

Results suggested that BMI, smoking and alcohol intake affect many socioeconomic outcomes. For example, smoking was estimated to reduce household income [mean difference = -£22 838, 95% confidence interval (CI): -£31 354 to -£14 321] and the chance of owning accommodation [absolute percentage change (APC) = -20.8%, 95% CI: -28.2% to -13.4%], of being satisfied with health (APC = -35.4%, 95% CI: -51.2% to -19.5%) and of obtaining a university degree (APC = -65.9%, 95% CI: -81.4% to -50.4%), while also increasing deprivation (mean difference in TDI = 1.73, 95% CI: 1.02 to 2.44, approximately 216% of a decile of TDI). There was evidence that asthma decreased household income, the chance of obtaining a university degree and the chance of cohabiting, and migraine reduced the chance of having a weekly leisure or social activity, especially in men. For other associations, estimates were null.

CONCLUSIONS

Higher BMI, alcohol intake and smoking were all estimated to adversely affect multiple social and socioeconomic outcomes. Effects were not detected between health conditions and socioeconomic outcomes using Mendelian randomization, with the exceptions of depression, asthma and migraines. This may reflect true null associations, selection bias given the relative health and age of participants in UK Biobank, and/or lack of power to detect effects.

Effects of Toxic Metal Contamination in the Tri-State Mining District on the Ecological Community and Human Health: A Systematic Review

Although extensive research exists on toxic environments in the Tri-State Mining District (TSMD), there has been a lack of research on how harmful effects in TSMD could affect residents living in those areas. However, quite recently, such research regarding relationships between the health conditions of residents and toxic elements in the TSMD began to grow. The increase of empirical studies means greater complexity of the findings that require a more intricate understanding. To meet the goals of this study, an extensive, systematic review of the literature using PRISMA was conducted. This method resulted in 19 articles that define the harmful effects of the TSMD on the ecology and the physical health of residents. This research found that toxic metals not only negatively impact natural processes in the TSMD environments (fish species reduction, kidney and liver problems, and toxic diet) but also continuously affect the health of residents (high blood Pb and mortality).This study makes a vital contribution building upon the existing outcomes of the correlations between toxic elements in the TSMD areas and the health of residents. Furthermore, conclusions of this study provide updated information to policymakers and health-related professionals by providing adequate and innovative remediations and health-related services in the TSMD.

Occupational hazards, health conditions and personal protective equipment used among healthcare workers in hospitals, Thailand

This cross-sectional study aimed to evaluate occupational hazards, health conditions and personal protective equipment used among healthcare workers. Information from the sample size of 1,128 healthcare workers were collected using questionnaires. The healthcare workers participated in this study were from five departments including inpatient, outpatient, surgery and anesthesia, nutrition service and hospital support services departments in five hospitals in Thailand. The results indicated that the majority of healthcare workers were female; these healthcare workers work 9.0 to 11.1 hours/day on average and were exposed to several chemical, biological and physical hazards. The healthcare workers in the nutrition service department reported the highest percentage of musculoskeletal disorder and respiratory problems. The highest percentage of skin problems were reported by healthcare workers in surgery and anesthesia department. The results showed musculoskeletal disorder, respiratory and skin problem significantly differed among healthcare workers in the five departments including the wrists/hands (p = 0.024), upper back (p = 0.009), chest pain symptoms (p = 0.004), and dry/wound symptoms (p = 0.013). Healthcare workers did not have adequate protection from work-related hazards in their workplace. Health education programs, control measures and organizational policies should be implemented to mitigate the hazards for healthcare workers in hospitals.

Fewer Than Half Of US Mental Health Treatment Facilities Provide Services For Children With Autism Spectrum Disorder

Despite estimates of rising prevalence of children with autism spectrum disorder (ASD) in the US, there is little research on the availability of behavioral health care services for this vulnerable population. To fill the gap, we surveyed 8,184 mental health treatment facilities in the contiguous US. As of August 2019, 43.0 percent of facilities reported providing behavioral health care for children with ASD, and 36.6 percent were accepting such children as new patients. Only 12.7 percent reported having a clinician with specialized training, and 4.3 percent reported having a specialized treatment program. Multivariable regression results indicated that there was poorer access to specialized ASD care in rural and lower-income communities. New policies are needed to increase the availability of behavioral health care for children with ASD.

Racial differences in future care planning in late life

Objectives: Although many older adults fear frailty and loss of independence in late life, relatively few make plans for their future care. Such planning is particularly limited among racial minorities. Given the benefits of future care planning (FCP), it is important to understand factors that facilitate or hamper FCP in late life. Our study explored racial, demographic, and dispositional influences on thinking about and engagement in FCP among community-dwelling older adults.Design: This study utilized data from the Elderly Care Research Center's longitudinal study of successful aging based on interviews with 409 older adults. Along with race, education and other demographic factors, we explored dispositional influences of optimism and religiosity on FCP using logistic regression.Results: African American older adults had significantly lower odds of executing FCP (β = 0.36, p < .05) when compared to White older adults. However, this estimate was no longer statistically significant after controlling for education, disability status, optimism, and religiosity. Older adults with higher education had significantly higher odds of thinking about and executing FCP. Higher level of optimism was associated with lower odds of FCP.Conclusions: Limited educational resources and the greater prevalence of dispositions of religiosity and optimism among African American older adults may contribute to their reluctance to engage in FCP in comparison to their white counterparts. Our findings offer practice implications indicating a need for interventions to encourage older adults, particularly racial minorities, to recognize and actively plan for their future care needs.

Depression and activity-limiting fall worry among older adults: longitudinal reciprocal relationships

OBJECTIVES

Late-life depression, falls, and fall worry are public health problems. While previous research confirms the cross-sectional relationship between depression and fall worry, few longitudinal studies have examined whether changes in fall worry are associated with changes in depressive illness and vice versa. This study examined longitudinal relationships between probable major depression (PMD) and activity-limiting fall worry (ALW).

DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS

This longitudinal panel observational study used data from the National Health and Aging Trends Study (NHATS) waves 5 (referred to as T1 in this study) and 6 (T2), conducted in 2015 and 2016, respectively (N = 6,299, aged 65 and older). We examined associations of new and continued ALW between T1 and T2 with T2 PMD, controlling for T1 PMD; and associations of new and continued PMD between T1 and T2 with T2 ALW, controlling for T1 ALW. We used χ2 and t tests for descriptive statistics and logistic regression for multivariable analysis.

RESULTS

Those with new ALW at T2 had significantly greater odds of T2 PMD compared to those without ALW at both time points (AOR = 2.64, 95% CI = 1.98-3.51), and those with new PMD at T2 had significantly greater odds of T2 ALW (AOR = 2.42, 95% CI = 1.66-3.52). Those with continued PMD also had greater odds of T2 ALW compared to those without PMD at either time point (AOR = 2.31, 95% CI = 1.62-3.29).

CONCLUSIONS

The findings add to knowledge about bidirectional (mutually reinforcing) relationships between depression and activity-limiting fall worry. Innovative interventions are needed to reduce both late-life depression and activity-limiting fall worry.

Correlates of Poor Self-Assessed Health Status among Socially Disadvantaged Populations in Poland

Self-assessment of health is recommended as valuable source of information about subjective health status. The present study was performed to evaluate the correlates of self-rated health status among beneficiaries of social care in Poland. This assessment could be crucial for the implementation of targeted preventive measures among this valuable population. The study population consisted of 1710 beneficiaries of social care from the Piotrkowski District. The relationship between self-rated health status and its correlates (sociodemographic, lifestyle factors, and health conditions) was examined using logistic regression, with a poor health rating as the outcome. Overall, 11% of respondents declared poor self-assessed health status. Men more often rated health status as poor (15%) as compared to women (8.5%) (p < 0.001). The odds of a poor assessment of health increased with age, being unemployed or disabled/retired (OR = 2.34 95%CI (1.34–4.19) or OR = 9.07 95%CI (3.68–22.37), respectively), and additionally with poor life satisfaction (OR = 5.14 95% CI (1.94–13.64)). Regarding lifestyle characteristics, only binge drinking was associated with poor health status assessment (OR = 12.62 95%CI (3.71–42.87)). In addition, having any illness or health problems decreased health status (OR = 4.26 95%CI (1.36–13.31)). Socially-disadvantaged populations, especially men who poorly rated their health status, still constituted a large percentage of the population, which is an important public health problem. Increasing knowledge about the correlates of health status will allow greater prevention strategies to be developed for the population.

The association between smokers' self-reported health problems and quitting: Findings from the ITC Four Country Smoking and Vaping Wave 1 Survey

INTRODUCTION

This study aimed to systematically examine whether having health conditions or concerns related to smoking are associated with quitting activities among smokers across four western countries.

METHODS

Data came from the 2016 International Tobacco Control Four Country Smoking and Vaping Survey conducted in Australia, Canada, England and US. We asked smokers and recent quitters (n=11838) whether they had a medical diagnosis for heart disease, cancer, chronic lung disease, depression, anxiety, alcohol problems, diabetes, severe obesity and chronic pain (nine conditions), and whether they believed smoking had harmed/would harm their health, along with questions on quitting activities.

RESULTS

General concerns about smoking harming health and all specific health conditions, except for alcohol problems, were positively associated with quit attempts, but the relationships between health conditions and other quitting measures (being abstinent, planning to quit, use of quitting medications) were less consistent. Positive associations between conditions and use of quitting medications were only significant for depression, anxiety and chronic pain (adjusted odds ratios ranged from 1.4 to 1.5). There was a general tendency to report lower self-efficacy for quitting among those with the health conditions.

CONCLUSIONS

While those with smoking related conditions are somewhat more aware of the links to their smoking, and are largely taking more action, the extent of this is lower than one might reasonably expect. Enhanced awareness campaigns are needed and health professionals need to do more to use health conditions to motivate quit attempts and to ensure they are made with the most effective forms of help.

How Are Self-Reported Physical and Mental Health Conditions Related to Vaping Activities among Smokers and Quitters: Findings from the ITC Four Country Smoking and Vaping Wave 1 Survey

This study examines whether having health conditions or concerns related to smoking is associated with use of vaping products. Data came from the 2016 wave of the International Tobacco Control Four Country Smoking and Vaping Survey. Smokers and recent quitters (n = 11,344) were asked whether they had a medical diagnosis for nine health conditions (i.e., depression, anxiety, alcohol problems, severe obesity, chronic pain, diabetes, heart disease, cancer, and chronic lung disease) and concerns about past and future health effects of smoking, and their vaping activities. Respondents with depression and alcohol problems were more likely to be current vapers both daily (Adjusted odds ratio, AOR = 1.42, 95% confidence interval, CI 1.09–1.85, p < 0.05 for depression; and AOR = 1.52, 95% CI 1.02–2.27, p < 0.05 for alcohol) and monthly (AOR = 1.32, 95% CI 1.11–1.57 for depression, p < 0.01; and AOR = 1.43, 95% CI 1.06–1.90, p < 0.05 for alcohol). Vaping was more likely at monthly level for those with severe obesity (AOR = 1.77, 95% CI 1.29–2.43, p < 0.001), cancer (AOR = 5.19, 95% CI 2.20–12.24, p < 0.001), and concerns about future effects of smoking (AOR = 1.83, 95% CI 1.47–2.28, p < 0.001). Positive associations were also found between chronic pain and concerns about past health effects of smoking and daily vaping. Only having heart disease was, in this case negatively, associated with use of vaping products on their last quit attempt (AOR = 0.72, 95% CI 0.43–0.91, p < 0.05). Self-reported health condition or reduced health associated with smoking is not systematically leading to increased vaping or increased likelihood of using vaping as a quitting strategy.

Physical Health, Mental Health, and Fear of Crime Among College Students: A Consideration of Sex Differences

This article examines how physical health and mental health affect college students' fear of crime. Few studies have examined the influence of fear of crime on both objective and subjective measures of physical and mental health and-to our knowledge-none has examined how health measures vary by sex in the United States. In addition, most of the existing research targets older individuals, rather than college students. Using the ACHA-NCHA data set (American College Health Association-National College Health Assessment), we expand the fear of crime literature by examining both subjective and objective physical and mental health measures among college-aged men and women.

The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas

Stigma is a well-documented barrier to health seeking behavior, engagement in care and adherence to treatment across a range of health conditions globally. In order to halt the stigmatization process and mitigate the harmful consequences of health-related stigma (i.e. stigma associated with health conditions), it is critical to have an explicit theoretical framework to guide intervention development, measurement, research, and policy. Existing stigma frameworks typically focus on one health condition in isolation and often concentrate on the psychological pathways occurring among individuals. This tendency has encouraged a siloed approach to research on health-related stigmas, focusing on individuals, impeding both comparisons across stigmatized conditions and research on innovations to reduce health-related stigma and improve health outcomes. We propose the Health Stigma and Discrimination Framework, which is a global, crosscutting framework based on theory, research, and practice, and demonstrate its application to a range of health conditions, including leprosy, epilepsy, mental health, cancer, HIV, and obesity/overweight. We also discuss how stigma related to race, gender, sexual orientation, class, and occupation intersects with health-related stigmas, and examine how the framework can be used to enhance research, programming, and policy efforts. Research and interventions inspired by a common framework will enable the field to identify similarities and differences in stigma processes across diseases and will amplify our collective ability to respond effectively and at-scale to a major driver of poor health outcomes globally.

Self-reported health conditions and related driving reduction in older drivers

We surveyed self-reported lifetime health conditions (using National Health and Aging Trends Study questions) and related driving reduction in a large multi-site older driver cohort (n = 2990) from the AAA Longitudinal Research on Aging Drivers (LongROAD) Study's baseline assessment. Those reporting reduced driving (n = 337) largely attributed reduction to musculoskeletal (29%), neurologic (13%), and ophthalmologic (10%) conditions. Women reported health condition-related driving reduction more often than men (14% versus 8%, p<.001). Mobility affects well-being; health professionals should consider that health conditions may cause older adults to reduce driving. Gender differences deserve attention in future research and education efforts.

Prevalence of Morbidity at Extreme Old Age in Germany: An Observational Study Using Health Claims Data

We assessed the prevalence of morbidity in long-lived individuals according to age and age at death and explored the association between dementia and other diseases and surviving to age 90 and 100. Using health claims data from the largest German health insurer from 2004 to 2013, we followed birth cohorts from 1908 to 1913 from age 95 until death or survival to age 100 (n=2,865) and compared them with birth cohorts from 1918 to 1923 and their survival from age 85 to age 90 (n=17,013). We observed their exact date of death and main categories of morbidity based on International Classification of Diseases, Tenth Revision, diagnoses. For all diseases studied, when differentiated according to age at death, prevalence continued to increase with age. Nonagenarians and centenarians had significantly lower disease prevalence at each age. Dementia was associated with the highest risk of dying before becoming a centenarian (hazard ratio (HR)=1.63, 95% confidence interval (CI)=1.50-1.78), followed closely by the residual category other chronic heart disease (HR=1.42, 95% CI=1.30-1.56). Results were even stronger for the younger cohort. Our study shows that exceptionally long-lived individuals are different in terms of good health. Survival at these high ages depends primarily on the absence of dementia and chronic heart disease, with acute heart disease and pneumonia playing important roles as diseases leading directly to death.

Health Conditions in an Adult Population in Sierra Leone: Data Reported From the Sierra Leone Trial to Introduce a Vaccine Against Ebola (STRIVE)

Clinical Trials Registration

ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].

Chronic Health Conditions Among Incoming Canadian Federally Sentenced Women

Over a 13-month period, health data on all consecutive incoming Canadian federally sentenced women offenders were collected and analyzed ( N = 280). The most common health conditions cited were back pain, head injury, hepatitis C virus (HCV), and asthma. Rates of chronic health problems were generally similar to those of their male offender counterparts, with the notable exception of HCV, which was higher for women. Aboriginal women offenders had particularly high rates of HCV. The study provides valuable information on the self-reported physical health status of federally sentenced women offenders that can be used as a benchmark to examine health trends over time.