Does injury compensation lead to worse health after whiplash? A systematic review.
Spearing, Natalie M; Connelly, Luke B; Gargett, Susan; Sterling, Michele
2012-06-01
One might expect that injury compensation would leave injured parties better off than they would otherwise have been, yet many believe that compensation does more harm than good. This study systematically reviews the evidence on this "compensation hypothesis" in relation to compensable whiplash injuries. PubMed, CINAHL, EMBASE, PEDro, PsycInfo, CCTR, Lexis, and EconLit were searched from the date of their inception to April 2010 to locate longitudinal studies, published in English, comparing the health outcomes of adults exposed/not exposed to compensation-related factors. Studies concerning serious neck injuries, using claimants only, or using proxy measures of health outcomes were excluded. Eleven studies were included. These examined the effect of lawyer involvement, litigation, claim submission, or previous claims on pain and other health outcomes. Among the 16 results reported were 9 statistically significant negative associations between compensation-related factors and health outcomes. Irrespective of the compensation-related factor involved and the health outcome measured, the quality of these studies was similar to studies that did not find a significant negative association: most took some measures to address selection bias, confounding, and measurement bias, and none resolved the potential for reverse causality bias that arises in the relationship between compensation-related factors and health. Unless ambiguous causal pathways are addressed, one cannot draw conclusions from statistical associations, regardless of their statistical significance and the extent of measures to address other sources of bias. Consequently, there is no clear evidence to support the idea that compensation and its related processes lead to worse health. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
Peipert, Benjamin J; Goswami, Sneha; Helenowski, Irene; Yount, Susan E; Sturgeon, Cord
2017-12-01
Health-related quality of life and financial burden among patients with multiple endocrine neoplasia type 1 is poorly described. It is not known how financial burden influences health-related quality of life in this population. We hypothesized that the financial burden attributable to multiple endocrine neoplasia type 1 is associated with worse health-related quality of life. United States adults (≥18 years) with multiple endocrine neoplasia type 1 were recruited from the AMENSupport MEN online support group. Patient demographics, clinical characteristics, and financial burden were assessed via an online survey. The instrument Patient-Reported Outcomes Measurement Information System 29-item profile measure was used to assess health-related quality of life. Multivariable linear regression was used to identify significant variables in each Patient-Reported Outcomes Measurement Information System domain. Out of 1,378 members in AMENSupport, our survey link was accessed 449 times (33%). Of 153 US respondents who completed our survey, 84% reported financial burden attributable to multiple endocrine neoplasia type 1. The degree of financial burden had a linear relationship with worse health-related quality of life across all Patient-Reported Outcomes Measurement Information System domains (r = 0.36-0.55, P financial event(s). Borrowing money from friends/family (30%), unemployment (13%), and spending >$100/month out-of-pocket on prescription medications (46%) were associated consistently with impaired health-related quality of life (ß = 3.75-6.77, P times more likely to be unemployed and declare bankruptcy than the US population, respectively. This study characterizes the financial burden in patients with multiple endocrine neoplasia type 1. Individuals with multiple endocrine neoplasia type 1 report a high degree of financial burden, negative financial events, and unemployment. Each of these factors was associated with worse health-related quality of life
Chung, Roger Yat-Nork; Chung, Gary Ka-Ki; Gordon, David; Wong, Samuel Yeung-Shan; Chan, Dicken; Lau, Maggie Ka-Wai; Tang, Vera Mun-Yu; Wong, Hung
2018-05-14
In studying health inequality, poverty as measured by income is frequently used; however, this omits the aspects of non-monetary resources and social barriers to achieving improved living standard. Therefore, our study aimed to examine the associations of individual-level deprivation of material and social necessities with general physical and mental health beyond that of income poverty. A territory-wide two-stage stratified random sample of 2282 community-dwelling Hong Kong adults was surveyed between 2014 and 2015. Income poverty and a Deprivation Index were used as the main independent variables. General health was assessed using the validated 12-item Short-Form Health Survey version 2, from which physical component summary and mental component summary were derived. Our results in multivariable ordinal logistic regressions consistently showed that, after adjusting for income poverty, socio-demographic and lifestyle factors, being deprived was significantly associated with worse physical (OR 1.66; CI 1.25-2.20) and mental health (OR 1.83; CI 1.43-2.35). Being income poor was also significantly associated with worse mental health (OR 1.63; CI 1.28-2.09) but only marginally with physical health (OR 1.34; CI 1.00-1.80) after adjustments. Income does not capture all aspects of poverty that are associated with adverse health outcomes. Deprivation of non-monetary resources has an independent effect on general health above and beyond the effect of income poverty. Policies should move beyond endowment and take into account the multidimensionality of poverty, in order to address the problem of health inequality.
Smith, Sabrina E; Vargas, Gray; Cucchiara, Andrew J; Zelonis, Sarah J; Beslow, Lauren A
2015-04-01
Perinatal and childhood stroke result in neurological impairment in the majority of survivors, but less is known about patient and parent perception of function following stroke in children. Our aim was to characterize parent-proxy and child-reported health status in children following unilateral arterial ischemic stroke or intraparenchymal hemorrhage. Fifty-nine children 2-18 years (30 girls, 29 boys) with unilateral arterial ischemic stroke or spontaneous intraparenchymal hemorrhage at least 6 months before evaluation were enrolled from a single center. The PedsQL version 4.0 Generic Short Form and PedsQL version 3.0 Cerebral Palsy Module were administered to childhood stroke subjects and parents. Generic PedsQL Inventory scores were compared between children with stroke and published data from healthy children. Reported health status scores for children with varying degrees of hemiparesis were compared. Children with stroke had lower reported health status scores on the Generic PedsQL Inventory than healthy children. Children with moderate-severe hemiparesis had worse scores than children without hemiparesis on several measures of the Cerebral Palsy Module as reported by both parents and children. The parents of children with epilepsy reported worse scores on several measures compared with children without epilepsy, and the parent scores were lower on several measures for children with lower intelligence quotients. Agreement between parent and child scores was better on the Cerebral Palsy Module than on the Generic Inventory. Children with stroke have worse reported health status than healthy controls. Degree of hemiparesis, epilepsy, and lower intelligence quotient affect reported health status on some measures. Agreement between parent-proxy and child scores ranges from slight to good which suggests that both provide useful information. Copyright © 2015 Elsevier Inc. All rights reserved.
Insomnia in epilepsy is associated with continuing seizures and worse quality of life.
Quigg, Mark; Gharai, Sean; Ruland, Jeff; Schroeder, Catherine; Hodges, Matthew; Ingersoll, Karen S; Thorndike, Frances P; Yan, Guofen; Ritterband, Lee M
2016-05-01
To evaluate how insomnia is associated with seizure control and quality of life in patients with epilepsy. Consecutive patients with epilepsy attending clinical visits were surveyed with the Insomnia Severity Index (ISI). Patients had to be treated with at least one anticonvulsant and could not have had documented psychogenic pseudoseizure. The presence or absence of seizures and quality of life (QOLIE-P-10) within the past 4 weeks was recorded. Other variables included demographic and clinical data, sleep-wake timing, the Hörne-Östberg Morningness-Eveningness Questionnaire (MEQ), sleepiness (Epworth Sleepiness Scale (ESS), and mood (Center for Epidemiologic Studies Depression Scale, CES-D). 207 patients completed surveys. 43% had clinically significant insomnia, and 51% had at least mild insomnia. 58% were seizure free. Mean ISI scores were significantly worse for those with continuing seizures, and more severe ISI scores correlated strongly with worse QOL. Younger age, shorter duration of epilepsy, use of sedative/hypnotics, medical and sleep comorbidities, delayed sleep timing and chronotype, excessive sleepiness, and depression were all associated with more severe insomnia. Those with unexpected health care visits over the most recent 4 weeks had worse insomnia. After adjustment for these covariates, more severe insomnia remained significantly associated with lack of seizure freedom and with worse QOL. Insomnia is common in epilepsy, and is associated with short term poor seizure control and worse QOL. Future studies must evaluate cause-and-effect relationships. Assessment of insomnia may be important in the comprehensive care of epilepsy and may influence control of epileptic seizures. Copyright © 2016 Elsevier B.V. All rights reserved.
Shi, Quan; Zhang, Bin; Xing, Helin; Yang, Shuo; Xu, Juan; Liu, Hongchen
2018-01-01
Background and Objective: It is widely accepted that there is an association between chronic obstructive pulmonary disease (COPD) and periodontitis. However, whether the periodontal status of the COPD patients is worse than that of the non-COPD subjects is seldom assessed. The findings currently available are inconsistent, some even contradictory. Therefore, we performed this meta-analysis to compare the periodontal health status of COPD patients and non-COPD subjects. Methods: PubMed and Embase were searched for all of the eligible studies which comparing the periodontal status between COPD patients and non-COPD subjects. The results of periodontal parameters in each study were extracted and the mean differences and 95% confidence intervals (CIs) for each parameter were calculated to determine their overall effects. Results: In total, 14 studies involving 3348 COPD patients and 20612 non-COPD controls were included and 9 periodontal indexes were analyzed. The mean differences (95% CIs) between COPD and non-COPD subjects for probing depth, clinical attachment loss, level of alveolar bone loss, plaque index, oral hygiene index, bleeding index, bleeding on probing, gingival index, and remaining teeth were 0.261 (0.020-0.501), 0.480 (0.280-0.681), 0.127 (0.000-0.254), 0.226 (0.043-0.408), 0.802 (0.326-1.279), 0.241 (-0.106 to 0.588), 6.878 (5.489-8.266), 0.364 (0.036-0.692), and -3.726 (-5.120 to -2.331), respectively. Conclusion: In summary, this meta-analysis demonstrates that the COPD patients suffer from worse periodontal health status, indicated by deeper periodontal pockets, high level of clinical attachment loss, worse oral hygiene, more inflammation and bleeding in the gingival tissue, and lower number of remaining teeth. Nevertheless, considering the limitations in our meta-analysis, more high-quality, and well-designed studies focusing on the periodontal health of the COPD patients are required to validate our conclusion.
Wiener, Lori; Viola, Adrienne; Kearney, Julia; Mullins, Larry L; Sherman-Bien, Sandra; Zadeh, Sima; Farkas-Patenaude, Andrea; Pao, Maryland
2016-09-01
Caregiving stress has been associated with changes in the psychological and physical health of parents of children with cancer, including both partnered and single parents. While parents who indicate "single" on a demographic checklist are typically designated as single parents, a parent can be legally single and still have considerable support caring for an ill child. Correspondingly, an individual can be married/partnered and feel alone when caring for a child with serious illness. In the current study, we report the results from our exploratory analyses of parent self-reports of behavior changes during their child's treatment. Parents (N = 263) of children diagnosed with cancer were enrolled at 10 cancer centers. Parents reported significant worsening of all their own health behaviors surveyed, including poorer diet and nutrition, decreased physical activity, and less time spent engaged in enjoyable activities 6 to 18 months following their child's diagnosis. More partnered parents found support from friends increased or stayed the same since their child's diagnosis, whereas a higher proportion of lone parents reported relationships with friends getting worse. More lone parents reported that the quality of their relationship with the ill child's siblings had gotten worse since their child's diagnosis. Spiritual faith increased for all parents. © 2015 by Association of Pediatric Hematology/Oncology Nurses.
Hong Kong men with low incomes have worse health-related quality of life as judged by SF-36 scores.
Ko, G T C; Wai, H P S; Tsang, P C C; Chan, H C K
2006-10-01
To analyse the association between income and health-related quality of life using the Medical Outcome Study Short Form 36 (SF-36) Chinese version in Hong Kong Chinese working population. Cross-sectional observation study. A commercial company in Hong Kong. All clerical and administrative staff of a commercial company was invited to participate; 876 of the 1003 staff agreed. The subjects were categorised into three income groups according to monthly income in Hong Kong dollars (low, 10,000-25,000; high, >25,000). The mean age of the 288 men and 588 women was 34.9 (standard deviation, 7.9; median, 34.0; range, 18-71) years. SF-36 scores on health-related quality of life. The distribution of income was 30% in high-, 54.8% in middle-, and 15.2% in low-income groups. Women had similar SF-36 scores among different income groups. In men, for most variables there was a significant positive linear correlation between income and SF-36 scores. Low income is associated with a worse health-related quality of life in Hong Kong Chinese men.
Malnutrition is associated with worse health-related quality of life in children with cancer.
Brinksma, Aeltsje; Sanderman, Robbert; Roodbol, Petrie F; Sulkers, Esther; Burgerhof, Johannes G M; de Bont, Eveline S J M; Tissing, Wim J E
2015-10-01
Malnutrition in childhood cancer patients has been associated with lower health-related quality of life (HRQOL). However, this association has never actually been tested. Therefore, we aimed to determine the association between nutritional status and HRQOL in children with cancer. In 104 children, aged 2-18 years and diagnosed with hematological, solid, or brain malignancies, nutritional status and HRQOL were assessed at diagnosis and at 3, 6, and 12 months using the child- and parent-report versions of the PedsQL 4.0 Generic scale and the PedsQL 3.0 Cancer Module. Scores on both scales range from 0 to 100. Undernourished children (body mass index (BMI) or fat-free mass children on the domains physical functioning (-13.3), social functioning (-7.0), cancer summary scale (-5.9), and nausea (-14.7). Overnourished children (BMI or fat mass >2 SDS) reported lower scores on emotional (-8.0) and cognitive functioning (-9.2) and on the cancer summary scale (-6.6), whereas parent-report scores were lower on social functioning (-7.5). Weight loss (>0.5 SDS) was associated with lower scores on physical functioning (-13.9 child-report and -10.7 parent-report), emotional (-7.4) and social functioning (-6.0) (child-report), pain (-11.6), and nausea (-7.8) (parent-report). Parents reported worse social functioning and more pain in children with weight gain (>0.5 SDS) compared with children with stable weight status. Undernutrition and weight loss were associated with worse physical and social functioning, whereas overnutrition and weight gain affected the emotional and social domains of HRQL. Interventions that improve nutritional status may contribute to enhanced health outcomes in children with cancer.
Fixation Characteristics of Severe Amblyopia Subtypes: Which One is Worse?
Koylu, Mehmet Talay; Ozge, Gokhan; Kucukevcilioglu, Murat; Mutlu, Fatih Mehmet; Ceylan, Osman Melih; Akıncıoglu, Dorukcan; Ayyıldız, Onder
2017-01-01
To determine differences in macular sensitivity and fixation patterns in different subtypes of severe amblyopia. This case-control study enrolled a total of 73 male adults, including 18 with pure strabismic severe amblyopia, 19 with pure anisometropic severe amblyopia, 18 with mixed (strabismic plus anizometropic) severe amblyopia, and 18 healthy controls. MP-1 microperimetry was used to evaluate macular sensitivity, location of fixation, and stability of fixation. Mean macular sensitivity, stability of fixation, and location of fixation were significantly worse in all amblyopia subtypes when compared with healthy controls. Intergroup comparisons between amblyopia subtypes revealed that mean macular sensitivity, stability of fixation, and location of fixation were significantly worse in pure strabismic and mixed amblyopic eyes when compared with pure anisometropic amblyopic eyes. Strabismus seems to be a worse prognostic factor in severe amblyopia than anisometropia in terms of fixation characteristics and retinal sensitivity.
Park, M Jane; Scott, Jazmyn T; Adams, Sally H; Brindis, Claire D; Irwin, Charles E
2014-07-01
Adolescence and young adulthood are unique developmental periods that present opportunities and challenges for improving health. Health at this age can affect health throughout the lifespan. This review has two aims: (1) to examine trends in key indicators in outcomes, behaviors, and health care over the past decade for U.S. adolescents and young adults; and (2) to compare U.S. adolescents and young adults on these indicators. The review also assesses sociodemographic differences in trends and current indicators. Guided by our aims, previous reviews, and national priorities, the present review identified 21 sources of nationally representative data to examine trends in 53 areas and comparisons of adolescents and young adults in 42 areas. Most health and health care indicators have changed little over the past decade. Encouraging exceptions were found for adolescents and young adults in unintentional injury, assault, and tobacco use, and, for adolescents, in sexual/reproductive health. Trends in violence and chronic disease and related behaviors were mixed. Review of current indicators demonstrates that young adulthood continues to entail greater risk and worse outcomes than adolescence. Young adults fared worse on about two-thirds of the indicators examined. Differences among sociodemographic subgroups persisted for both trends and current indicators. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Being worse off - but in comparison with what?
DEFF Research Database (Denmark)
Petersen, Thomas Søbirk
2014-01-01
Several liberal philosophers and penal theorists have argued that the state has a reason to prohibit acts that harm individuals. But what is harm? According to one specification of harm, a person P is harmed by an act (or an event) a iff, as a result of a, P is made worse off in terms of well......-being. One central question here involves the baseline against which we assess whether someone is ‘worse off’. In other words, when a person is harmed he is worse off, certainly—but what is worse off a variation from? A central part of the paper critically discusses different answers to this question based...
Health-related Quality of Life and Mental Health in the Process of Active and Passive Ageing.
Dajak, Lidija; Mastilica, Miroslav; Orešković, Stjepan; Vuletić, Gorka
2016-12-01
To analyse the differences in the self-estimate of life quality depending on the ageing type - passive, active. Life-quality linked to health was measured with an SF-36 survey, which gives multi-dimensional criteria of health and life-quality. SF-36 survey represents a theoretically based and empirically proven operationalization of two overal health concepts, which are body and mental health, and its two general manifestations, functioning, and welfare. 200 examinees in total, aged from 55 to 92, were included in the research. Divided by sex, in the research participated 148 women and 52 men. Depending on the ageing way, the examinees were divided into 2 categories: passive ageing (n=100), active ageing (n=100), and for these groups a detailed result analysis was done. Statistical analysis includes descriptive statistics, Hi-square test, Spearman's correlation coefficient, and Mann-Whitney U test. In all dimensions of health, examinees from the category Active ageing achieve higher scores, which indicates better health and better functioning. Between the groups, a statistically significant difference was determined, on the following dimensions: Overall health, Pains, Energy and vitality, Social operations, and Limits due to emotional difficulties. With the Hi-square test, it was determined that there are differences between the groups. The biggest difference can be seen in the reply categories related to health deterioration (χ 2 =10.391; df=4; p=0.034). Examinees from the Active ageing group mention significantly less that their health has gotten worse compared to the previous year (26% of the active ones state that their health is somewhat worse, and only 2% that their health is significantly worse, compared to the passive ones where 36% state that their health is worse, and 9% that it's much worse compared to the year before). Tested was the difference between arithmetic middles on the issue of mental health based on the ageing type (p>0.05), and the results
Directory of Open Access Journals (Sweden)
Berge Jerica M
2012-04-01
Full Text Available Abstract Background Having a significant other has been shown to be protective against physical and psychological health conditions for adults. Less is known about the period of emerging young adulthood and associations between significant others’ weight and weight-related health behaviors (e.g. healthy dietary intake, the frequency of physical activity, weight status. This study examined the association between significant others’ health attitudes and behaviors regarding eating and physical activity and young adults’ weight status, dietary intake, and physical activity. Methods This study uses data from Project EAT-III, a population-based cohort study with emerging young adults from diverse ethnic and socioeconomic backgrounds (n = 1212. Logistic regression models examining cross-sectional associations, adjusted for sociodemographics and health behaviors five years earlier, were used to estimate predicted probabilities and calculate prevalence differences. Results Young adult women whose significant others had health promoting attitudes/behaviors were significantly less likely to be overweight/obese and were more likely to eat ≥ 5 fruits/vegetables per day and engage in ≥ 3.5 hours/week of physical activity, compared to women whose significant others did not have health promoting behaviors/attitudes. Young adult men whose significant other had health promoting behaviors/attitudes were more likely to engage in ≥ 3.5 hours/week of physical activity compared to men whose significant others did not have health promoting behaviors/attitudes. Conclusions Findings suggest the protective nature of the significant other with regard to weight-related health behaviors of young adults, particularly for young adult women. Obesity prevention efforts should consider the importance of including the significant other in intervention efforts with young adult women and potentially men.
Worse and Worse and Worse: Essential Tremor Patients’ Longitudinal Perspectives on their Condition
Directory of Open Access Journals (Sweden)
Jesus Gutierrez
2016-10-01
-half or more of the time; furthermore, one-in-four reported worsening at each and every assessment, indicating that they felt they were inexorably getting worse and worse with time. That there is so much self-reported worsening in ET argues against the notion that this is a static and benign condition. It suggests that patients experience it as a condition that worsens regularly and consistently.
Differences Among Patients That Make Their Tinnitus Worse or Better
Tyler, Richard S.; Ji, Haihong; Coelho, Claudia; Gogel, Stephanie A.
2015-01-01
Purpose Our objective was to identify activities that influence tinnitus and to determine if conditional probabilities exist among such variables. Method Two hundred fifty-eight patients were asked the following two questions: “When you have your tinnitus, which of the following makes it worse?” and “Which of the following reduces your tinnitus?” Results Things that made tinnitus better included noise (31%) and relaxation (15%). Things that made tinnitus worse included being in a quiet place (48%), stress (36%), being in a noisy place (32%), and lack of sleep (27%). Almost 6% of patients suggested coffee/tea and 4% said certain foods made their tinnitus worse. Conditional probabilities indicated that for those whose tinnitus is not worse in quiet, it is usually not reduced by noise. For those whose tinnitus is not worse in noise, it is usually not reduced in quiet. Conclusion There are dramatic differences among patients. Such differences need to be considered in planning treatments. PMID:26649850
Directory of Open Access Journals (Sweden)
André Hajek
Full Text Available To investigate the effect of health comparisons on functional health and depressive symptoms in a longitudinal approach. Gender differences were examined.The German Ageing Survey (DEAS is a nationwide, representative longitudinal study of community dwelling individuals living in Germany aged 40 and older. The surveys in 2008 and 2011 were used, with n = 3,983 respondents taking part in both waves. Health comparisons were quantified by the question "How would you rate your health compared with other people your age" (Much better; somewhat better; the same; somewhat worse, much worse. Functional health was assessed by the subscale "physical functioning" of the 36-Item Short Form Health Survey (SF-36 and depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D.Adjusting for sociodemographic factors, self-assessed health, social network, self-efficacy and optimism, and morbidity, fixed effects regressions revealed that functional health decreased significantly and considerably with negative health comparisons in the total sample (transitions from 'the same' to 'much worse': β = -11.8, predominantly in men. The effects of negative health comparisons (transitions from 'the same' to 'much worse': β = 4.8 on depressive symptoms were comparable (in terms of significance to the effects on functional health, with stronger effects in women. Positive comparisons did not affect functional health and depressive symptoms.Our findings underline the relevance of negative health comparisons on functional health (men and depressive symptoms (women. Comparison effects are asymmetric and mostly upwards.
Kobau, Rosemarie; Cui, Wanjun; Zack, Matthew M
2017-07-01
Healthy People 2020, a national health promotion initiative, calls for increasing the proportion of U.S. adults who self-report good or better health. The Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Scale (GHS) was identified as a reliable and valid set of items of self-reported physical and mental health to monitor these two domains across the decade. The purpose of this study was to examine the percentage of adults with an epilepsy history who met the Healthy People 2020 target for self-reported good or better health and to compare these percentages to adults with history of other common chronic conditions. Using the 2010 National Health Interview Survey, we compared and estimated the age-standardized prevalence of reporting good or better physical and mental health among adults with five selected chronic conditions including epilepsy, diabetes, heart disease, cancer, and hypertension. We examined response patterns for physical and mental health scale among adults with these five conditions. The percentages of adults with epilepsy who reported good or better physical health (52%) or mental health (54%) were significantly below the Healthy People 2020 target estimate of 80% for both outcomes. Significantly smaller percentages of adults with an epilepsy history reported good or better physical health than adults with heart disease, cancer, or hypertension. Significantly smaller percentages of adults with an epilepsy history reported good or better mental health than adults with all other four conditions. Health and social service providers can implement and enhance existing evidence-based clinical interventions and public health programs and strategies shown to improve outcomes in epilepsy. These estimates can be used to assess improvements in the Healthy People 2020 Health-Related Quality of Life and Well-Being Objective throughout the decade. Published by Elsevier Inc.
Directory of Open Access Journals (Sweden)
Galbraith P Diane
2004-05-01
Full Text Available Abstract Background Although there have been substantial medical advances that improve the outcomes following cardiac ischemic events, gender differences in the treatment and course of recovery for patients with coronary artery disease (CAD continue to exist. There is a general paucity of data comparing the health related quality of life (HRQOL in men and women undergoing treatment for CAD. The purpose of this study was to compare HRQOL outcomes of men and women in Alberta, at one-year following initial catheterization, after adjustment for known demographic, co-morbid, and disease severity predictors of outcome. Method The HRQOL outcome data were collected by means of a self-reported questionnaire mailed to patients on or near the one-year anniversary of their initial cardiac catheterization. Using the Seattle Angina Questionnaire (SAQ, 5 dimensions of HRQOL were measured: exertional capacity, anginal stability, anginal frequency, quality of life and treatment satisfaction. Data from the APPROACH registry were used to risk-adjust the SAQ scale scores. Two analytical strategies were used including general least squares linear modeling, and proportional odds modeling sometimes referred to as the "ordinal logistic modeling". Results 3392 (78.1% patients responded to the follow-up survey. The adjusted proportional odds ratios for men relative to women (PORs > 1 = better indicated that men reported significantly better HRQOL on all 5 SAQ dimensions as compared to women. (PORs: Exertional Capacity 3.38 (2.75–4.15, Anginal Stability 1.23 (1.03–1.47, Anginal Frequency 1.70 (1.43–2.01, Treatment Satisfaction 1.27 (1.07–1.50, and QOL 1.74 (1.48–2.04. Conclusions Women with CAD consistently reported worse HRQOL at one year follow-up compared to men. These findings underline the fact that conclusions based on research performed on men with CAD may not be valid for women and that more gender-related research is needed. Future studies are needed to
Havelin, Leif I; Furnes, Ove; Baste, Valborg; Nordsletten, Lars; Hovik, Oystein; Dimmen, Sigbjorn
2014-01-01
Background The surgical approach in total hip arthroplasty (THA) is often based on surgeon preference and local traditions. The anterior muscle-sparing approach has recently gained popularity in Europe. We tested the hypothesis that patient satisfaction, pain, function, and health-related quality of life (HRQoL) after THA is not related to the surgical approach. Patients 1,476 patients identified through the Norwegian Arthroplasty Register were sent questionnaires 1–3 years after undergoing THA in the period from January 2008 to June 2010. Patient-reported outcome measures (PROMs) included the hip disability osteoarthritis outcome score (HOOS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), health-related quality of life (EQ-5D-3L), visual analog scales (VAS) addressing pain and satisfaction, and questions about complications. 1,273 patients completed the questionnaires and were included in the analysis. Results Adjusted HOOS scores for pain, other symptoms, activities of daily living (ADL), sport/recreation, and quality of life were significantly worse (p < 0.001 to p = 0.03) for the lateral approach than for the anterior approach and the posterolateral approach (mean differences: 3.2–5.0). These results were related to more patient-reported limping with the lateral approach than with the anterior and posterolateral approaches (25% vs. 12% and 13%, respectively; p < 0.001). Interpretation Patients operated with the lateral approach reported worse outcomes 1–3 years after THA surgery. Self-reported limping occurred twice as often in patients who underwent THA with a lateral approach than in those who underwent THA with an anterior or posterolateral approach. There were no significant differences in patient-reported outcomes after THA between those who underwent THA with a posterolateral approach and those who underwent THA with an anterior approach. PMID:24954494
The moral problem of worse actors
Directory of Open Access Journals (Sweden)
Scott Wisor
2014-05-01
Full Text Available Individuals and institutions sometimes have morally stringent reasons to not do a given action. For example, an oil company might have morally stringent reasons to refrain from providing revenue to a genocidal regime, or an engineer might have morally stringent reasons to refrain from providing her expertise in the development of weapons of mass destruction. But in some cases, if the agent does not do the action, another actor will do it with much worse consequences. For example, the oil company might know their assets will be bought by a company with worse environmental and labor practices. Or the engineer might know her position will be filled by a more ambitious and amoral engineer. I call this the moral problem of worse actors (MPWA. MPWA gives reason, at least some of the time, to consider otherwise morally impermissible actions permissible or even obligatory. On my account, doing the action in the circumstances of MPWA remains morally objectionable even if permissible or obligatory, and this brings additional moral responsibilities and obligations to the actor. Similarly, not doing the action in the circumstances of MPWA may also bring additional (but different moral responsibilities and obligations. Acknowledging MPWA creates considerable challenges, as many bad actors may appeal to it to justify morally objectionable action. In this paper, I develop a set of strategies for individuals and institutions to handle MPWA. This includes appeals to integrity and the proper attribution of expressive responsibility, regulatory responsibility, and compensatory responsibility. I also address a set of related concerns, including worries about incentivizing would-be bad actors, concerns about epistemic uncertainty, and the problem of mala in se exceptions.
Association of parental health literacy with oral health of Navajo Nation preschoolers.
Brega, A G; Thomas, J F; Henderson, W G; Batliner, T S; Quissell, D O; Braun, P A; Wilson, A; Bryant, L L; Nadeau, K J; Albino, J
2016-02-01
Health literacy is 'the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions'. Although numerous studies show a link between health literacy and clinical outcomes, little research has examined the association of health literacy with oral health. No large-scale studies have assessed these relationships among American Indians, a population at risk for limited health literacy and oral health problems. This analysis was conducted as part of a clinical trial aimed at reducing dental decay among preschoolers in the Navajo Nation Head Start program. Using baseline data for 1016 parent-child dyads, we examined the association of parental health literacy with parents' oral health knowledge, attitudes, and behavior, as well as indicators of parental and pediatric oral health. More limited health literacy was associated with lower levels of oral health knowledge, more negative oral health attitudes, and lower levels of adherence to recommended oral health behavior. Parents with more limited health literacy also had significantly worse oral health status (OHS) and reported their children to have significantly worse oral health-related quality of life. These results highlight the importance of oral health promotion interventions that are sensitive to the needs of participants with limited health literacy. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
... make it worse. That's why the health of homeless people in the United States is worse than that of the general population. Common health problems include Mental health problems Substance abuse ... and skin infections Many homeless women are victims of domestic or sexual abuse. ...
Hessel, Philipp; Avendano, Mauricio
2013-11-01
To examine whether economic conditions at the time of leaving school or college are associated with physical functioning in later life among cohorts in 11 European countries. Data came from 10,338 participants in the Survey of Health, Ageing and Retirement in Europe (SHARE) aged 50-74 who left school or college between 1956 and 1986. Data on functional limitations, as well as employment, marriage, and fertility retrospective histories were linked to national unemployment rates during the year individuals left school. Models included country-fixed effects and controls for early-life circumstances. Greater unemployment rates during the school-leaving year were associated with fewer functional limitations at ages 50-74 among men (rate ratio 0.63, 95% confidence interval 0.47-0.83), but more physical functioning limitations among women (rate ratio 1.30, 95% confidence interval 1.13-1.50), particularly among those with (post-)secondary education. Economic conditions at the age of leaving school were associated with several labor market, marriage, fertility, and health behavior outcomes, but controlling for these factors did not attenuate associations. Results were similar in models that controlled for selection into higher education due to measured covariates. Worse economic conditions during the school-leaving year predicted better health at later life among men but worse health among women. Both selection and causation mechanisms may explain this association. Copyright © 2013 Elsevier Inc. All rights reserved.
From Bad to Worse: Anemia on Admission and Hospital-Acquired Anemia.
Koch, Colleen G; Li, Liang; Sun, Zhiyuan; Hixson, Eric D; Tang, Anne S; Phillips, Shannon C; Blackstone, Eugene H; Henderson, J Michael
2017-12-01
Anemia at hospitalization is often treated as an accompaniment to an underlying illness, without active investigation, despite its association with morbidity. Development of hospital-acquired anemia (HAA) has also been associated with increased risk for poor outcomes. Together, they may further heighten morbidity risk from bad to worse. The aims of this study were to (1) examine mortality, length of stay, and total charges in patients with present-on-admission (POA) anemia and (2) determine whether these are exacerbated by development of HAA. In this cohort investigation, from January 1, 2009, to August 31, 2011, a total of 44,483 patients with POA anemia were admitted to a single health system compared with a reference group of 48,640 without POA anemia or HAA. Data sources included the University HealthSystem Consortium database and electronic medical records. Risk-adjustment methods included logistic and linear regression models for mortality, length of stay, and total charges. Present-on-admission anemia was defined by administrative coding. Hospital-acquired anemia was determined by changes in hemoglobin values from the electronic medical record. Approximately one-half of the patients experienced worsening of anemia with development of HAA. Risk for death and resource use increased with increasing severity of HAA. Those who developed severe HAA had 2-fold greater odds for death; that is, mild POA anemia with development of severe HAA resulted in greater mortality (odds ratio, 2.57; 95% confidence interval, 2.08-3.18; P < 0.001), increased length of stay (2.23; 2.16-2.31; P < 0.001), and higher charges (2.09; 2.03-2.15; P < 0.001). Present-on-admission anemia is associated with increased mortality and resource use. This risk is further increased from bad to worse when patients develop HAA. Efforts to address POA anemia and HAA deserve attention.
Determinants of self-rated health of Warsaw inhabitants.
Supranowicz, Piotr; Wysocki, Mirosław J; Car, Justyna; Debska, Anna; Gebska-Kuczerowska, Anita
2012-01-01
Self-rated health is a one-point measure commonly used for recognising subjectively perceived health and covering a wide range of individual's health aspects. The aim of our study was to examine the extent to which self-rated health reflects the differences due to demographic characteristics, physical, psychical and social well-being, health disorders, occurrence of chronic disease and negative life events in Polish social and cultural conditions. Data were collected by non-addressed questionnaire methods from 402 Warsaw inhabitants. The questionnaire contained the questions concerning self-rated health, physical, psychical and social well-being, the use of health care services, occurrence of chronic disease and contact with negative life events. The analysis showed that worse self-rated health increased exponentially with age and less sharply with lower level of education. Pensioners were more likely to assess their own health worse then employed or students. Such difference was not found for unemployed. Compared to married, the self-rated health of divorced or widowed respondents was lower. Gender does not differentiate self-rated health. In regard to well-being, self-rated health linearly decreased for physical well-being, for social and, especially, for psychical well-being the differences were significant, but more complicated. Hospitalisation, especially repeated, strongly determined worse self-rated health. In contrast, relationship between self-rated health and sickness absence or frequency of contact with physician were lower. Chronic diseases substantially increased the risk of poorer self-rated health, and their co-morbidity increased the risk exponentially. The patients with cancer were the group, in which the risk several times exceeded that reported for the patients of other diseases. Regarding negative life events, only experience with violence and financial difficulties were resulted in worse self-rated health. Our findings confirmed the usefulness
For Better or For Worse: Environmental Health Promotion in ...
Environmental Health Education (EHE) is most effective when it incorporates environmental science, risk education, and health education. When paired with the local knowledge of community members, EHE can promote health equity and community action, especially for socially disadvantaged communities, which are disproportionately exposed to environmental hazards. Developing EHE programs that inform residents about toxic exposures that damage their health and affect their quality of life is critical for them to understand their true risk. The community of interest is a public housing development surrounded by landfills, hazardous waste sites, and manufacturing facilities located in a Midwestern city of the United States (Chicago, Illinois). An environmental justice organization, People for Community Recovery (PCR), was the community partner. Data was collected during one week in March 2009 from community residents using both qualitative and quantitative research methods, including both a focus group and a survey instrument provided to two different resident groups, to understand their attitudes/beliefs about environmental hazards, including exposure to hazardous wastes, landfills, and lead, and their preferences for EHE. The data was analyzed using standard qualitative analytical procedures and statistical software, when appropriate. This research assesses the impact that Environmental Health Education (EHE) can have on: improved civic engagement (i.e., increased int
Cytoplasmic TRADD Confers a Worse Prognosis in Glioblastoma
Directory of Open Access Journals (Sweden)
Sharmistha Chakraborty
2013-08-01
Full Text Available Tumor necrosis factor receptor 1 (TNFR1-associated death domain protein (TRADD is an important adaptor in TNFR1 signaling and has an essential role in nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB activation and survival signaling. Increased expression of TRADD is sufficient to activate NF-κB. Recent studies have highlighted the importance of NF-κB activation as a key pathogenic mechanism in glioblastoma multiforme (GBM, the most common primary malignant brain tumor in adults.We examined the expression of TRADD by immunohistochemistry (IHC and find that TRADD is commonly expressed at high levels in GBM and is detected in both cytoplasmic and nuclear distribution. Cytoplasmic IHC TRADD scoring is significantly associated with worse progression-free survival (PFS both in univariate and multivariate analysis but is not associated with overall survival (n = 43 GBMs. PFS is a marker for responsiveness to treatment. We propose that TRADD-mediated NF-κB activation confers chemoresistance and thus a worse PFS in GBM. Consistent with the effect on PFS, silencing TRADD in glioma cells results in decreased NF-κB activity, decreased proliferation of cells, and increased sensitivity to temozolomide. TRADD expression is common in glioma-initiating cells. Importantly, silencing TRADD in GBM-initiating stem cell cultures results in decreased viability of stem cells, suggesting that TRADD may be required for maintenance of GBM stem cell populations. Thus, our study suggests that increased expression of cytoplasmic TRADD is both an important biomarker and a key driver of NF-κB activation in GBM and supports an oncogenic role for TRADD in GBM.
Making detailed predictions makes (some) predictions worse
Kelly, Theresa F.
In this paper, we investigate whether making detailed predictions about an event makes other predictions worse. Across 19 experiments, 10,895 participants, and 415,960 predictions about 724 professional sports games, we find that people who made detailed predictions about sporting events (e.g., how many hits each baseball team would get) made worse predictions about more general outcomes (e.g., which team would win). We rule out that this effect is caused by inattention or fatigue, thinking too hard, or a differential reliance on holistic information about the teams. Instead, we find that thinking about game-relevant details before predicting winning teams causes people to give less weight to predictive information, presumably because predicting details makes information that is relatively useless for predicting the winning team more readily accessible in memory and therefore incorporated into forecasts. Furthermore, we show that this differential use of information can be used to predict what kinds of games will and will not be susceptible to the negative effect of making detailed predictions.
Phillips, Katie M; Heiser, Alyssa; Gaudin, Robert; Hadlock, Tessa A; Jowett, Nate
2017-12-01
The incidence of Bell's palsy (BP) is elevated in the late phases of pregnancy. Controversy exists as to whether pregnancy is a risk factor for worse outcomes in BP, and whether such outcomes are the result of factors intrinsic to pregnancy or the tendency to withhold medical therapy in this cohort. Long-term facial function outcomes in cases of pregnancy-associated BP (PABP) were compared against outcomes in cases affecting nonpregnant adult women of child-bearing age by a blinded expert using the electronic clinician-graded facial function scale (eFACE) facial grading system. Fifty-one pregnancy-associated cases and 58 nonpregnancy-associated cases were included. Among patients who received early corticosteroid therapy, significantly worse static, synkinesis, and composite facial function eFACE scores were demonstrated among cases of PABP compared to nonpregnancy-associated cases (static median = 86 vs. 92.5, P = 0.005; synkinesis median = 79 vs. 86, P = 0.007; composite median = 78 vs. 84, P = 0.023). Among those not treated with corticosteroids, significantly worse dynamic and composite facial function eFACE scores were demonstrated in cases of PABP compared to those for nonpregnancy-associated cases (dynamic median = 74 vs. 92.5, P = 0.038; composite median = 73 vs. 86.5, P = 0.038). A trend toward improved outcomes was demonstrated within both groups for those treated with corticosteroids compared to those who were not. In comparison to cases unrelated to pregnancy, late-term PABP is associated with worse long-term outcomes to a degree that cannot solely be explained by differences in medical therapy. 4. Laryngoscope, 127:2854-2859, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Peer Victimization in Fifth Grade and Health in Tenth Grade
Elliott, Marc N.; Klein, David J.; Tortolero, Susan R.; Mrug, Sylvie; Peskin, Melissa F.; Davies, Susan L.; Schink, Elizabeth T.; Schuster, Mark A.
2014-01-01
BACKGROUND AND OBJECTIVES: Children who experience bullying, a type of peer victimization, show worse mental and physical health cross-sectionally. Few studies have assessed these relationships longitudinally. We examined longitudinal associations of bullying with mental and physical health from elementary to high school, comparing effects of different bullying histories. METHODS: We analyzed data from 4297 children surveyed at 3 time points (fifth, seventh, and tenth grades) in 3 cities. We used multivariable regressions to test longitudinal associations of bullying with mental and physical health by comparing youth who experienced bullying in both the past and present, experienced bullying in the present only, experienced bullying in the past only, or did not experience bullying. RESULTS: Bullying was associated with worse mental and physical health, greater depression symptoms, and lower self-worth over time. Health was significantly worse for children with both past and present bullying experiences, followed by children with present-only experiences, children with past-only experiences, and children with no experiences. For example, 44.6% of children bullied in both the past and present were at the lowest decile of psychosocial health, compared with 30.7% of those bullied in the present only (P = .005), 12.1% of those bullied in the past only (P bullied (P bullying are associated with substantially worse health. Clinicians who recognize bullying when it first starts could intervene to reverse the downward health trajectory experienced by youth who are repeated targets. PMID:24534401
Performance Needs Assessment of Maternal and Newborn Health ...
African Journals Online (AJOL)
AJRH Managing Editor
African Journal of Reproductive Health June 2014; 18(2): 105 ... The study aimed to determine performance and compare gaps in maternal and newborn health ... in MNH service performance and this was worse in the rural areas. ... particularly disadvantaged in terms of social .... significance was determined at p < 0.05.
Smith, Ashley Wilder; Bellizzi, Keith M; Keegan, Theresa H M; Zebrack, Brad; Chen, Vivien W; Neale, Anne Victoria; Hamilton, Ann S; Shnorhavorian, Margarett; Lynch, Charles F
2013-06-10
Adolescents and young adults (AYAs) diagnosed with cancer face numerous physical, psychosocial, and practical challenges. This article describes the health-related quality of life (HRQOL) and associated demographic and health-related characteristics of this developmentally diverse population. Data are from the Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE) study, a population-based cohort of 523 AYA patients with cancer, ages 15 to 39 years at diagnosis from 2007 to 2009. Comparisons are made by age group and with general and healthy populations. Multiple linear regression models evaluated effects of demographic, disease, health care, and symptom variables on multiple domains of HRQOL using the Pediatric Quality of Life Inventory (PedsQL) and the Short-Form Health Survey 12 (SF-12). Overall, respondents reported significantly worse HRQOL across both physical and mental health scales than did general and healthy populations. The greatest deficits were in limitations to physical and emotional roles, physical and social functioning, and fatigue. Teenaged patients (ages 15 to 17 years) reported worse physical and work/school functioning than patients 18 to 25 years old. Regression models showed that HRQOL was worse for those in treatment, with current/recent symptoms, or lacking health insurance at any time since diagnosis. In addition, sarcoma patients, Hispanic patients, and those with high school or lower education reported worse physical health. Unmarried patients reported worse mental health. Results suggest that AYAs with cancer have major decrements in several physical and mental HRQOL domains. Vulnerable subgroups included Hispanic patients, those with less education, and those without health insurance. AYAs also experienced higher levels of fatigue that were influenced by current symptoms and treatment. Future research should explore ways to address poor functioning in this understudied group.
Happell, Brenda; Platania-Phung, Chris; Scott, David; Hanley, Christine
2015-01-01
People with serious mental illness experience higher rates of oral and dental health problems than the wider population. Little is known about how dental health is viewed or addressed by nurses working with mental health consumers. This paper presents the views of nurses regarding the nature and severity of dental health problems of consumers with serious mental illness, and how often they provide advice on dental health. Mental health sector nurses (n=643) completed an online survey, including questions on dental and oral health issues of people with serious mental illness. The majority of nurses considered the oral and dental conditions of people with serious mental illness to be worse than the wider community. When compared with a range of significant physical health issues (e.g. cardiovascular disease), many nurses emphasised that dental and oral problems are one of the most salient health issues facing people with serious mental illness, their level of access to dental care services is severely inadequate and they suffer significantly worse dental health outcomes as a result. This study highlights the need for reforms to increase access to dental and oral health care for mental health consumers.
Nolet, Paul S; Côté, Pierre; Kristman, Vicki L; Rezai, Mana; Carroll, Linda J; Cassidy, J David
2015-04-01
Current evidence suggests that neck pain is negatively associated with health-related quality of life (HRQoL). However, these studies are cross-sectional and do not inform the association between neck pain and future HRQoL. The purpose of this study was to investigate the association between increasing grades of neck pain severity and HRQoL 6 months later. In addition, this longitudinal study examines the crude association between the course of neck pain and HRQoL. This is a population-based cohort study. Eleven hundred randomly sampled Saskatchewan adults were included. Outcome measures were the mental component summary (MCS) and physical component summary (PCS) of the Short-Form-36 (SF-36) questionnaire. We formed a cohort of 1,100 randomly sampled Saskatchewan adults in September 1995. We used the Chronic Pain Questionnaire to measure neck pain and its related disability. The SF-36 questionnaire was used to measure physical and mental HRQoL 6 months later. Multivariable linear regression was used to measure the association between graded neck pain and HRQoL while controlling for confounding. Analysis of variance and t tests were used to measure the crude association among four possible courses of neck pain and HRQoL at 6 months. The neck pain trajectories over 6 months were no or mild neck pain, improving neck pain, worsening neck pain, and persistent neck pain. Finally, analysis of variance was used to examine changes in baseline to 6-month PCS and MCS scores among the four neck pain trajectory groups. The 6-month follow-up rate was 74.9%. We found an exposure-response relationship between neck pain and physical HRQoL after adjusting for age, education, arthritis, low back pain, and depressive symptomatology. Compared with participants without neck pain at baseline, those with mild (β=-1.53, 95% confidence interval [CI]=-2.83, -0.24), intense (β=-3.60, 95% CI=-5.76, -1.44), or disabling (β=-8.55, 95% CI=-11.68, -5.42) neck pain had worse physical HRQoL 6
An examination of sleep health, lifestyle and mental health in junior high school students.
Tanaka, Hideki; Taira, Kazuhiko; Arakawa, Masashi; Masuda, Atushi; Yamamoto, Yukari; Komoda, Yoko; Kadegaru, Hathuko; Shirakawa, Shuichiro
2002-06-01
The factors that influence sleep health and mental health in junior high school students' lifestyles was examined. The proportion of students who replied that they feel bad in the morning, and who do not have breakfast was significantly higher in poor sleepers. The proportion of students who regularly take exercise was significantly lower among poor sleepers. Compared with good sleepers, poor sleepers had a higher number of illnesses and their General Health Questionnaire score was worse. The study's results suggest that sleep health is closely related to both physical and mental health, and that habits such as exercise, and regular sleeping and eating, are important for maintaining and improving students' sleep health.
Directory of Open Access Journals (Sweden)
Luciana Balester Mello de Godoy
Full Text Available To compare sleep quality and sustained attention of patients with Upper Airway Resistance Syndrome (UARS, mild Obstructive Sleep Apnea (OSA and normal individuals.UARS criteria were presence of excessive daytime sleepiness (Epworth Sleepiness Scale-ESS-≥ 10 and/or fatigue (Modified Fatigue Impact Scale-MFIS-≥ 38 associated to Apnea/hypopnea index (AHI ≤ 5 and Respiratory Disturbance Index (RDI > 5 events/hour of sleep or more than 30% of total sleep time with flow limitation. Mild OSA was considered if the presence of excessive daytime sleepiness (ESS ≥ 10 and/or fatigue (MFIS ≥ 38 associated to AHI ≥ 5 and ≤ 15 events/hour. "Control group" criteria were AHI < 5 events/hour and RDI ≤ 5 events/hour and ESS ≤ 9, without any sleep, clinical, neurological or psychiatric disorder. 115 individuals (34 UARS and 47 mild OSA patients and 34 individuals in "control group", adjusted for age, gender, body mass index (BMI and schooling years, performed sleep questionnaires and sustained attention evaluation. Psychomotor Vigilance Task (PVT was performed five times (each two hours from 8 a.m. to 4 p.m.UARS patients had worse sleep quality (Functional Outcomes of Sleep Questionnaire-FOSQ-and Pittsburgh Sleep Quality Index-PSQI: p < 0.05 and more fatigue than mild OSA patients (p = 0.003 and scored significantly higher in both Beck inventories than "control group" (p < 0.02. UARS patients had more lapses early in the morning (in time 1 compared to the results in the afternoon (time 5 than mild OSA (p = 0.02. Mild OSA patients had more lapses in times 2 than in time 5 compared to "control group" (p = 0.04.UARS patients have a worse sleep quality, more fatigue and a worse early morning sustained attention compared to mild OSA. These last had a worse sustained attention than controls.
What does society owe me if I am responsible for being worse off?
DEFF Research Database (Denmark)
Andersen, Martin Marchman
2014-01-01
Luck egalitarians need to address the question of cost-responsibility: If an indi- vidual is responsible for being worse off than others, then what benefits, if any, is that individual uniquely cost-responsible for? By applying luck egalitarianism to justice in health I discuss different answers...... to this question inspired by two different interpretations of luck egalitarianism, namely ‘standard luck egalitarianism’ and ‘all luck egalitarianism’, respectively. Even though I argue that the latter is more plausible than the former, I ultimately suggest and defend a third interpretation of luck egalitarianism......, which I label ‘universal luck egalitarianism’. Finally, I adjust my findings to a (all things considered) more plausible currency, namely welfare....
Things get worse before getting better : outsourcing NPD activities
Smets, L.P.M.; Oorschot, van K.E.; Langerak, F.
2011-01-01
To sustain the pace of new product development (NPD), manufacturers are increasingly outsourcing parts of the NPD process, such as design and engineering. However, by outsourcing design and engineering activities, things often get worse before getting better in terms of cycle time, development
Directory of Open Access Journals (Sweden)
Per Fink
Full Text Available BACKGROUND: Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. METHODOLOGY/PRINCIPAL FINDINGS: 1785 consecutive primary care patients aged 18-65 consulting their family physicians (FPs for a new illness were followed-up for two years. A stratified subsample of 701 patients was assessed by the Schedules for Clinical Assessment in Neuropsychiatry interview. Patients with mild (N = 21 and severe Health anxiety (N = 81 and Hypochondriasis according to the DSM-IV (N = 59 were compared with a comparison group of patients who had a well-defined medical condition according to their FPs and a low score on the screening questionnaire (N = 968. Self-rated health was measured by questionnaire at index and at three, 12, and 24 months, and health care use was extracted from patient registers. Compared with the 968 patients with well-defined medical conditions, the 81 severe Health anxiety patients and the 59 DSM-IV Hypochondriasis patients continued during follow-up to manifest significantly more Health anxiety (Whiteley-7 scale. They also continued to have significantly worse self-rated functioning related to physical and mental health (component scores of the SF-36. The severe Health anxiety patients used about 41-78% more health care per year in total, both during the 3 years preceding inclusion and during follow-up, whereas the DSM-IV Hypochondriasis patients did not have statistically significantly higher total use. A poor outcome of Health anxiety was not explained by comorbid depression, anxiety disorder or well-defined medical condition. Patients with mild Health anxiety did not have a worse outcome on physical health and incurred
Health-related profiles of people with lower limb loss.
Amtmann, Dagmar; Morgan, Sara J; Kim, Jiseon; Hafner, Brian J
2015-08-01
To construct profiles of self-reported health indicators to examine differences and similarities between people with lower limb loss and a normative sample (hereafter called the norm) and to compare health indicators between subgroups based on level and etiology of limb loss. Survey. General community. Adults with unilateral lower limb loss (N=1091) participated in this study. Eligibility criteria included lower limb loss due to trauma or dysvascular complications and regular use of a prosthesis. Not applicable. The Patient-Reported Outcomes Measurement Information System 29-item Health Profile version 1.0 measures physical function, pain interference, fatigue, sleep disturbance, anxiety, depression, and satisfaction with participation in social roles. The norm includes 5239 individuals representative of the U.S. general population in sex, age, race, ethnicity, and education. People with lower limb loss reported statistically significantly worse physical function, pain interference, and satisfaction with participation in social roles and significantly less fatigue than did the norm. People with transfemoral (ie, above-knee) amputation significantly differed in physical function from people with transtibial (ie, below-knee) amputation. Similarly, people with amputation due to trauma and dysvascular etiology significantly differed in physical function and satisfaction with social roles after adjusting for relevant clinical characteristics. People with lower limb loss generally report worse physical function, pain interference, and satisfaction with social roles than do the norm. People with dysvascular amputation reported worse physical function and satisfaction with social roles than did people with traumatic amputation. Health indicator profiles are an efficient way of providing clinically meaningful information about numerous aspects of self-reported health in people with lower limb loss. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by
International Nuclear Information System (INIS)
Akimoto, Tetsuo; Muramatsu, Hiroyuki; Takahashi, Mitsuhiro; Saito, Jun-ichi; Kitamoto, Yoshizumi; Harashima, Koichi; Miyazawa, Yasushi; Yamada, Masami; Ito, Kazuto; Kurokawa, Kouhei; Yamanaka, Hidetoshi; Nakano, Takashi; Mitsuhashi, Norio; Niibe, Hideo
2004-01-01
Purpose: To investigate the incidence and severity of rectal bleeding after high-dose hypofractionated radiotherapy (RT) for prostate cancer, and to explore the factors affecting the incidence of Grade 2 or worse rectal bleeding. Methods and materials: The data of 52 patients who had been treated by external beam RT for localized prostate cancer between 1999 and 2002 were analyzed. All the patients had received hypofractionated external beam RT to a total dose of 69 Gy in 3-Gy fractions, three fractions weekly. The clinical and dosimetric factors affecting the incidence of Grade 2 or worse late rectal bleeding were analyzed by univariate and multivariate analyses. The effect of the percentage of the whole rectal volume receiving 30%, 50%, 80%, and 90% of the prescribed radiation dose (V 30 , V 50 , V 80 , and V 90 , respectively) on the incidence of rectal bleeding was evaluated. Results: Of the 52 patients, 13 (25%) developed Grade 2 or worse rectal bleeding. One patient who needed laser coagulation and blood transfusion for the treatment of rectal bleeding was classified as having Grade 3 rectal bleeding. The median time to the development of Grade 2 or worse rectal bleeding was 11 months. The results of the univariate analysis revealed that the presence of a history of diabetes mellitus (p 30 ≥ 60%, V 50 ≥ 40% (p 80 ≥ 25%, and V 90 ≥ 15% (p < 0.001) were statistically significant risk factors for the occurrence of Grade 2 or worse rectal bleeding. The results of the multivariate analysis revealed that a history of diabetes mellitus was the most statistically significant risk factor for the occurrence of rectal bleeding after hypofractionated RT for prostate cancer (p < 0.05). Conclusion: A history of diabetes mellitus was the most statistically significant risk factor for the occurrence of Grade 2 or worse rectal bleeding after high-dose hypofractionated RT, although dosimetric factors were also closely associated with the risk of rectal bleeding
Seelman, Kristie L.; Colón-Diaz, Matthew J.P.; LeCroix, Rebecca H.; Xavier-Brier, Marik; Kattari, Leonardo
2017-01-01
Abstract Purpose: There are many barriers to reliable healthcare for transgender people that often contribute to delaying or avoiding needed medical care. Yet, few studies have examined whether noninclusive healthcare and delaying needed medical care because of fear of discrimination are associated with poorer health among transgender adults. This study aims to address these gaps in the knowledge base. Methods: This study analyzed secondary data from a statewide survey of 417 transgender adults in the Rocky Mountain region of the United States. Independent variables included noninclusive healthcare from a primary care provider (PCP) and delay of needed medical care because of fear of discrimination. Dependent variables assessed general health and mental health. Results: Transgender individuals who delayed healthcare because of fear of discrimination had worse general health in the past month than those who did not delay or delayed care for other reasons (B=−0.26, pdiscrimination, having a noninclusive PCP was not significantly associated with either general health or mental health. Conclusion: This study suggests a significant association between delaying healthcare because of fear of discrimination and worse general and mental health among transgender adults. These relationships remain significant even when controlling for provider noninclusivity, suggesting that fear of discrimination and consequent delay of care are at the forefront of health challenges for transgender adults. The lack of statistical significance for noninclusive healthcare may be related to the measurement approach used; future research is needed to develop an improved tool for measuring transgender noninclusive healthcare. PMID:28861545
Konda, Sanjit R; Driesman, Adam; Manoli, Arthur; Davidovitch, Roy I; Egol, Kenneth A
2017-07-01
To examine 1-year functional and clinical outcomes in patients with tibial plateau fractures with tibial eminence involvement. Retrospective analysis of prospectively collected data. Academic Medical Center. All patients who presented with a tibial plateau fracture (Orthopaedic Trauma Association (OTA) 41-B and 41-C). Patients were divided into fractures with a tibial eminence component (+TE) and those without (-TE) cohorts. All patients underwent similar surgical approaches and fixation techniques for fractures. No tibial eminence fractures received fixation specifically. Short musculoskeletal functional assessment (SMFA), pain (Visual Analogue Scale), and knee range-of-motion (ROM) were evaluated at 3, 6, and 12 months postoperatively and compared between cohorts. Two hundred ninety-three patients were included for review. Patients with OTA 41-C fractures were more likely to have an associated TE compared with 41-B fractures (63% vs. 28%, P knee ROM (75.16 ± 51 vs. 86.82 ± 53 degree, P = 0.06). At 6 months, total SMFA and knee ROM was significantly worse in the +TE cohort (29 ± 17 vs. 21 ± 18, P ≤ 0.01; 115.6 ± 20 vs. 124.1 ± 15, P = 0.01). By 12 months postoperatively, only knee ROM remained significantly worse in the +TE cohort (118.7 ± 15 vs. 126.9 ± 13, P time points. Knee ROM remains worse throughout the postoperative period in the +TE cohort. Functional outcome improves less rapidly in the +TE cohort but achieves similar results by 1 year. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Directory of Open Access Journals (Sweden)
Pang CH
2017-02-01
Full Text Available Chunhong Pang,1,2 Amy LaLonde,3 Tony E Godfrey,4 Jianwen Que,5,6 Jun Sun,7 Tong Tong Wu,3 Zhongren Zhou2 1Department of Pathology, China-Japan Friendship Hospital, 2Department of Pathology and Laboratory Medicine, 3Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, 4Department of Surgery, Boston University Medical Center, Boston, MA, 5Center for Human Development, 6Division of Digestive and Liver Diseases, Columbia University, New York, NY, 7Division of Gastroenterology and Hepatology, University of Illinois College of Medicine, Chicago, IL, USA Abstract: Bile acid reflux in the esophagus plays an important role in the carcinogenesis of esophageal adenocarcinoma (EAC. The G-protein coupled bile acid receptor (TGR5 has been associated with the development of gastrointestinal cancer. However, little is known regarding the role of TGR5 in esophageal carcinoma and precancerous lesions. We analyzed genomic DNA from 116 EACs for copy number aberrations via Affymetrix SNP6.0 microarrays. The TGR5 gene locus was amplified in 12.7% (14/116 of the EACs. The TGR5 protein expression was also assessed using immunohistochemistry from tissue microarrays, including Barrett’s esophagus (BE, low- (LGD and high-grade dysplasia (HGD, columnar cell metaplasia (CM, squamous epithelium (SE, EAC and squamous cell carcinoma. The TGR5 protein was highly expressed in 71% of EAC (75/106, 100% of HGD (11/11, 72% of LGD (13/18, 66% of BE (23/35, 84% of CM (52/62, and 36% of SE (30/83. The patients with high expression of TGR5 exhibited significantly worse overall survival compared to the patients with nonhigh expression. TGR5 high expression was significantly increased in the males compared to the females in all cases with an odds ratio of 1.9 times. The vitamin D receptor (VDR was significantly correlated with TGR5 expression. Our findings indicated that TGR5 may play an important role in the development and prognosis of EAC
Petrelli, Alessio; Di Napoli, Anteo; Rossi, Alessandra; Costanzo, Gianfranco; Mirisola, Concetta; Gargiulo, Lidia
2017-06-12
The effects of the recent global economic and financial crisis especially affected the most vulnerable social groups. Objective of the study was to investigate variation of self-perceived health status in Italians and immigrants during the economic global crisis, focusing on demographic and socioeconomic factors. Through a cross-sectional design we analyzed the national sample of multipurpose surveys "Health conditions and use of health services" (2005 and 2013) conducted by the Italian National Institute of Statistics (ISTAT). Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, derived from SF-12 questionnaire, were assumed as study outcome, dichotomizing variables distribution at 1 st quartile. Prevalence rate ratios (PRR) were estimated through log-binomial regression models, stratified by citizenship and gender, evaluating the association between PCS and MCS with surveys' year, adjusting for age, educational level, employment status, self-perceived economic resources, smoking habits, body mass index. From 2005 to 2013 the proportion of people not employed or reporting scarce/insufficient economic resources increased, especially among men, in particular immigrants. Compared with 2005 we observed in 2013 among Italians a significant lower probability of worse PCS (PRR = 0.96 both for males and females), while no differences were observed among immigrants; a higher probability of worse MCS was observed, particularly among men (Italians: PRR = 1.26;95%CI:1.22-1.29; immigrants: PRR = 1.19;95%CI:1.03-1.38). Self-perceived scarce/insufficient economic resources were strongly and significantly associated with worse PCS and MCS for all subgroups. Lower educational level was strongly associated with worse PCS in Italians and slightly associated with worse MCS for all subgroups. Being not employed was associated with worse health status, especially mental health among men. Our findings support the hypothesis that economic global crisis
Fink, Per; Ørnbøl, Eva; Christensen, Kaj Sparle
2010-03-24
Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. 1785 consecutive primary care patients aged 18-65 consulting their family physicians (FPs) for a new illness were followed-up for two years. A stratified subsample of 701 patients was assessed by the Schedules for Clinical Assessment in Neuropsychiatry interview. Patients with mild (N = 21) and severe Health anxiety (N = 81) and Hypochondriasis according to the DSM-IV (N = 59) were compared with a comparison group of patients who had a well-defined medical condition according to their FPs and a low score on the screening questionnaire (N = 968). Self-rated health was measured by questionnaire at index and at three, 12, and 24 months, and health care use was extracted from patient registers. Compared with the 968 patients with well-defined medical conditions, the 81 severe Health anxiety patients and the 59 DSM-IV Hypochondriasis patients continued during follow-up to manifest significantly more Health anxiety (Whiteley-7 scale). They also continued to have significantly worse self-rated functioning related to physical and mental health (component scores of the SF-36). The severe Health anxiety patients used about 41-78% more health care per year in total, both during the 3 years preceding inclusion and during follow-up, whereas the DSM-IV Hypochondriasis patients did not have statistically significantly higher total use. A poor outcome of Health anxiety was not explained by comorbid depression, anxiety disorder or well-defined medical condition. Patients with mild Health anxiety did not have a worse outcome on physical health and incurred significantly less health care costs than the group of
The spiritual health of veterans with a history of suicide ideation
Kopacz, Marek S.
2014-01-01
Introduction: In recent years, considerable empirical attention has been devoted to examining the increased risk of suicide observed in some Veteran populations. This has led to a renewed focus on developing novel support options which can be used to respond to Veterans in distress, reducing their risk of suicide. Spirituality and religion, however, have been largely absent from any public discourse related to suicide prevention, not least of all in Veteran populations. Aim: The aim of this cross-sectional study is to compare the self-rated spiritual health of Veterans with and without suicide ideation. Identifying differences which may exist between these two groups could highlight the relevance of spiritual well-being to Veteran suicide prevention efforts. Materials and Methods: Data were collected using pencil-and-paper surveys, called Spiritual Assessments, distributed within the general population of in- and outpatients at a U.S. Department of Veterans Affairs Medical Center. Using Likert-type scales, this study examines the self-rated spiritual health, spiritual devotion, and significance ascribed to spirituality in a sample of 5378 Veterans. Statistical analysis took place using chi-squared to examine differences in the distribution of responses between ideators and non-ideators. Results: Ideators significantly more often rated their spiritual health as worse than that of non-ideators. Even with similar levels of spiritual devotion or significance ascribed to spiritual life, ideators continued to significantly more often rate their spiritual health as worse than that of non-ideators. Conclusion: The results show that Veterans with suicide ideation more often rate their spiritual health as worse than that of Veterans without suicide ideation. This suggests that spiritual well-being may indeed be relevant to suicide prevention efforts in Veteran populations. PMID:25750787
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Wei YC
2018-05-01
Full Text Available Yu-Ching Wei,1,2 Sheau-Fang Yang,2,3 Shih-Lun Chang,4,5 Tzu-Ju Chen,5,6 Sung-Wei Lee,7 Hung-Sung Chen,1 Li-Ching Lin,8 Chien-Feng Li6,9,10 1Department of Pathology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; 2Department of Pathology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 4Department of Otolaryngology, Chi Mei Medical Center, Tainan, Taiwan; 5Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan; 6Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan; 7Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan; 8Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan; 9National Institute of Cancer Research, National Health Research Institute, Tainan, Taiwan; 10Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan Purpose: Nasopharyngeal carcinoma (NPC is a heterogeneous disease. We searched for genes that function in cell adhesion in GSE12452, a published transcriptomic database. We found that POSTN, which encodes periostin (POSTN, was significantly upregulated in NPC tumorigenesis. Herein, we sought to analyze the expression of POSTN and its prognostic significances in patients with NPC. Materials and methods: In this single-institution retrospective study, we determined and analyzed POSTN expression by immunohistochemistry and H-score method, respectively, in 124 patients with NPC. The results indicated that POSTN expression was correlated with the clinicopathologic features, disease-specific survival (DSS, distant metastasis-free survival (DMFS, and local recurrence-free survival (LRFS of NPC. We performed univariate and multivariate analyses to determinate the statistical significance. Results: High POSTN expression was significantly associated with lymph node metastasis
Natural course of subarachnoid hemorrhage is worse in elderly patients
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Felix Hendrik Pahl
2014-11-01
Full Text Available Aging is a major risk factor for poor outcome in patients with ruptured or unruptured intracranial aneurysms (IA submitted to treatment. It impairs several physiologic patterns related to cerebrovascular hemodynamics and homeostasis. Objective Evaluate clinical, radiological patterns and prognostic factors of subarachnoid hemorrhage (SAH patients according to age. Method Three hundred and eighty nine patients with aneurismal SAH from a Brazilian tertiary institution (Hospital do Servidor Público Estadual de São Paulo were consecutively evaluated from 2002 to 2012 according to Fisher and Hunt Hess classifications and Glasgow Outcome Scale. Results There was statistically significant association of age with impaired clinical, radiological presentation and outcomes in cases of SAH. Conclusion Natural course of SAH is worse in elderly patients and thus, proper recognition of the profile of such patients and their outcome is necessary to propose standard treatment.
Health habits, attitudes and behavior towards oral health of children with epilepsy
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Jovanović Svetlana
2007-01-01
Full Text Available Introduction: Children suffering from epilepsy are high at risk of oral diseases primarily due to their underlying medical condition which can have an impact on the maintenance level of oral hygiene, but also due to adverse effects of antiepileptic drugs. Objective. The aim of this paper was to identify habits, attitudes and behavior of children with epilepsy and parents in respect to oral health. Method. The experimental group consisted of 50 children with epilepsy, 24 boys and 26 girls, 7-14 years old, mean age 11.2±2.2 years. The control group consisted of healthy children, matched by age and gender. The instruments of investigation consisted of the structured interview of children and parents concerning oral health habits, attitudes and behavior. We used medical records of children with epilepsy as a source of information on their diagnosis, duration of the illness and current therapy. Statistical analysis was performed by chi-squared test, nonparametric correlation, Wilcoxon’s signed rank test and logistic regression. Results. Results showed that more children with epilepsy and their parents had inappropriate habits and attitudes towards oral health, as well as nutrition habits (p<0.001. Compared to healthy controls, children with epilepsy washed their teeth less often and shorter, they had less knowledge about causes of oral diseases and about influence of oral diseases on general health, and they had worse self-rating of teeth and gum condition. In addition, significantly more children with epilepsy used an incorrect technique of teeth brushing (p<0.001. Characteristics of children’s epilepsy and educational degree of parents had no influence on these differences. Conclusion. Study results showed that children with epilepsy and their parents had worse habits, attitudes and behavior towards oral health than healthy controls and their parents. This difference can be explained primarily by worse parental estimation of oral health and
Perception of quality of health delivery and health insurance subscription in Ghana.
Amo-Adjei, Joshua; Anku, Prince Justin; Amo, Hannah Fosuah; Effah, Mavis Osei
2016-07-29
National health insurance schemes (NHIS) in developing countries and perhaps in developed countries as well is a considered a pro-poor intervention by helping to bridge the financial burden of access to quality health care. Perceptions of quality of health service could have immense impacts on enrolment. This paper shows how perception of service quality under Ghana's insurance programme contributes to health insurance subscription. The study used the 2014 Ghana Demographic and Health Survey (GDHS) dataset. Both descriptive proportions and binary logistic regression techniques were applied to generate results that informed the discussion. Our results show that a high proportion of females (33 %) and males (35 %) felt that the quality of health provided to holders of the NHIS card was worse. As a result, approximately 30 % of females and 22%who perceived health care as worse by holding an insurance card did not own an insurance policy. While perceptions of differences in quality among females were significantly different (AOR = 0.453 [95 % CI = 0.375, 0.555], among males, the differences in perceptions of quality of health services under the NHIS were independent in the multivariable analysis. Beyond perceptions of quality, being resident in the Upper West region was an important predictor of health insurance ownership for both males and females. For such a social and pro-poor intervention, investing in quality of services to subscribers, especially women who experience enormous health risks in the reproductive period can offer important gains to sustaining the scheme as well as offering affordable health services.
Penson, David F; Latini, David M; Lubeck, Deborah P; Wallace, Katrine L; Henning, James M; Lue, Tom F
2003-04-01
Little is known regarding how diabetic men with erectile dysfunction (ED) differ from the general population of impotent men. The primary objective of this study was to compare disease-specific health-related quality of life (HRQOL) and severity of ED in impotent men with and without diabetes. Validated functional and HRQOL questionnaires (including the International Index of Erectile Function, the Sexual Self-Efficacy Scale, and the Psychological Impact of Erectile Dysfunction scales) were administered to patients in an ED disease registry. Men with ED and a history of diabetes (n = 20) were compared with men with ED and no history of diabetes (n = 90) at baseline and at the 12-month follow-up. Diabetic impotent men reported worse erectile function and intercourse satisfaction at baseline, and ED had a greater impact on their emotional life. Diabetic men with ED had significantly different trends over time in the Erectile Function (P Emotional Life-Psychological Impact domain (P < 0.067). Impotent men with diabetes present with worse ED than nondiabetic men with ED, resulting in worse disease-specific HRQOL in the diabetic men. Although diabetic patients initially respond well to ED treatment, responses do not appear to be durable over time. Therefore, clinicians must provide longer-term follow-up when treating ED in diabetic patients.
Sleep Quality and Health-Related Quality of Life in Pregnancy.
Sut, Hatice Kahyaoglu; Asci, Ozlem; Topac, Nalan
The aim of this study was to investigate sleep quality and health-related quality of life in pregnancy. In a cross-sectional design, 492 women (292 pregnant and 200 nonpregnant healthy controls) were included in this study between November 2014 and June 2015. Participants completed a survey on sociodemographic characteristics, the Pittsburgh Sleep Quality Index (PSQI), and the European Quality of Life-5 Dimensions (EQ-5D). The PSQI total and EQ-5D scores of pregnant women were significantly worse than the controls (P = .017 and P sleep quality increased 2.11-fold in the second trimester (P = .048) and 1.86-fold in the third trimester (P = .054). Compared with the first trimester, EQ-5D scores significantly decreased in the second (P = .038) and third (P Sleep quality and health-related quality of life of pregnant women were worse than those of nonpregnant healthy controls. Healthcare professionals need to be aware of deteriorations in sleep quality and health-related quality of life of pregnant women.
DEFF Research Database (Denmark)
Frausing, Kristian Park; Smærup, Michael; Maibom, Kirsten
living alone. Social and psychological needs were of primary concern whereas practical needs were of lesser concern. The second study showed older men living alone with no/short education to rate their health significantly worse on almost all items compared to men of higher education. The third study......Background: Being male, living alone and being of low socioeconomic status (SES) are all risk factors for health inequities, including a shorter lifespan. Not much is known, however, about older low-SES men living alone. This study maps their health. Methods: Three studies were conducted. First......, an electronic survey with municipal preventive home visitors nationwide inquiring into their perception of the health and needs of old men living alone. The second study compared older men's self-rated health according to their living arrangements and educational level using data from 29.791 older men from...
Skill set or mind set? Associations between health literacy, patient activation and health.
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Samuel G Smith
Full Text Available There is ongoing debate on whether health literacy represents a skill-based construct for health self-management, or if it also more broadly captures personal 'activation' or motivation to manage health. This research examines 1 the association between patient activation and health literacy as they are most commonly measured and 2 the independent and combined associations of patient activation and health literacy skills with physical and mental health.A secondary analysis of baseline cross-sectional data from the LitCog cohort of older adults was used. Participants (n = 697 were recruited from multiple US-based health centers. During structured face-to-face interviews, participants completed the Test of Functional Health Literacy in Adults (TOFHLA, the Patient Activation Measure (PAM, the SF-36 physical health summary subscale, and Patient Reported Outcomes Measurement Information Service (PROMIS short form subscales for depression and anxiety.The relationship between health literacy and patient activation was weak, but significant (r = 0.11, p<0.01. In models adjusted for participant characteristics, lower health literacy was associated with worse physical health (β = 0.13, p<0.001 and depression (β = -0.16, p<0.001. Lower patient activation was associated with worse physical health (β = 0.19, p<0.001, depression (β = -0.27, p<0.001 and anxiety (β-0.24, p<0.001.The most common measures of health literacy and patient activation are weakly correlated with each other, but also independently correlated with health outcomes. This suggests health literacy represents a distinct skill-based construct, supporting the Institute of Medicine's definition. Deficits in either construct could be useful targets for behavioral intervention.
Mycotoxins: significance to global economics and health
Mycotoxins are fungal metabolites produced my micro-fungi (molds and mildews) that have significant impacts on global economics and health. Some of these metabolites are beneficial, but most are harmful and have been associated with well-known epidemics dating back to medieval times. The terms ‘myco...
Shulzhenko, Nikita O; Zens, Tiffany J; Beems, Megan V; Jung, Hee Soo; O'Rourke, Ann P; Liepert, Amy E; Scarborough, John E; Agarwal, Suresh K
2017-04-01
There have been conflicting reports regarding whether the number of rib fractures sustained in blunt trauma is associated independently with worse patient outcomes. We sought to investigate this risk-adjusted relationship among the lesser-studied population of older adults. A retrospective review of the National Trauma Data Bank was performed for patients with blunt trauma who were ≥65 years old and had rib fractures between 2009 and 2012 (N = 67,695). Control data were collected for age, sex, injury severity score, injury mechanism, 24 comorbidities, and number of rib fractures. Outcome data included hospital mortality, hospital and intensive care unit durations of stay, duration of mechanical ventilation, and the occurrence of pneumonia. Multiple logistic and linear regression analyses were performed. Sustaining ≥5 rib fractures was associated with increased intensive care unit admission (odds ratio: 1.14, P rib fractures was associated with an increased incidence of pneumonia (odds ratio: 1.32, P rib fractures was associated with increased mortality (odds ratio: 1.51, P rib fractures is a significant predictor of worse outcomes independent of patient characteristics, comorbidities, and trauma burden. Copyright © 2016 Elsevier Inc. All rights reserved.
Health significance and statistical uncertainty. The value of P-value.
Consonni, Dario; Bertazzi, Pier Alberto
2017-10-27
The P-value is widely used as a summary statistics of scientific results. Unfortunately, there is a widespread tendency to dichotomize its value in "P0.05" ("statistically not significant"), with the former implying a "positive" result and the latter a "negative" one. To show the unsuitability of such an approach when evaluating the effects of environmental and occupational risk factors. We provide examples of distorted use of P-value and of the negative consequences for science and public health of such a black-and-white vision. The rigid interpretation of P-value as a dichotomy favors the confusion between health relevance and statistical significance, discourages thoughtful thinking, and distorts attention from what really matters, the health significance. A much better way to express and communicate scientific results involves reporting effect estimates (e.g., risks, risks ratios or risk differences) and their confidence intervals (CI), which summarize and convey both health significance and statistical uncertainty. Unfortunately, many researchers do not usually consider the whole interval of CI but only examine if it includes the null-value, therefore degrading this procedure to the same P-value dichotomy (statistical significance or not). In reporting statistical results of scientific research present effects estimates with their confidence intervals and do not qualify the P-value as "significant" or "not significant".
Brown, J; McGowan, J A; Chouial, H; Capocci, S; Smith, C; Ivens, D; Johnson, M; Sathia, L; Shah, R; Lampe, F C; Rodger, A; Lipman, M
2017-09-01
We sought to evaluate whether people living with HIV (PLWH) using effective antiretroviral therapy (ART) have worse respiratory health status than similar HIV-negative individuals. We recruited 197 HIV-positive and 93 HIV-negative adults from HIV and sexual health clinics. They completed a questionnaire regarding risk factors for respiratory illness. Respiratory health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and the Medical Research Council (MRC) breathlessness scale. Subjects underwent spirometry without bronchodilation. PLWH had worse respiratory health status: the median SGRQ Total score was 12 [interquartile range (IQR) 6-25] in HIV-positive subjects vs. 6 (IQR 2-14) in HIV-negative subjects (P respiratory health appears more common in HIV-positive adults, and has a significant impact on health-related quality of life. © 2017 The Authors HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.
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Liutsyna Preuss-Kukhta
2017-04-01
Full Text Available The article deals with pedagogical tools of educational system. The principle of separation of students into better and worse is analyzed. It is said that even the worst students should be trained in such a way that in the future they could realize themselves. Such reflections have potentially hypothetical category.Key words: education system, good students, bad students, school.
[How do the obese persons perceive their overall health?].
Ríos-Martínez, Blanca P; Rangel-Rodríguez, Gabriela; Pedraza-Moctezuma, Luis G
2013-01-01
the purpose was to investigate how the obese person perceives their health in different areas of their life. the SF-36 instrument, which measures various dimensions (social and physical functioning, mental and physical health, bodily pain, limitations due to physical and/or emotional problems, vitality and general health), was applied to 224 patients. It was analyzed whether there were differences between gender, which were channeled to the treatment (surgical and nonsurgical) and the degree of obesity (overweight, obesity and morbid obesity). A descriptive analysis, Student t test, Anova and Tukey t test were used. significant differences (p < 0.05) were found in some dimensions, like tendency to feel tired, exhausted and feeling that their health has been and will continue to deterioration. Women had a worse social and emotional functioning than men; patients with gastric bypass reported more fatigue than patients with gastric band; in regards to the degree of obesity, those who had morbid obesity showed less physical functioning, more pain and worse overall health than those who were just obese. the perception of the obese patients was that their health had deteriorated. Women were more affected in social and emotional functioning than men.
Yeh, Hsin-Chih; Jan, Hau-Chern; Wu, Wen-Jeng; Li, Ching-Chia; Li, Wei-Ming; Ke, Hung-Lung; Huang, Shu-Pin; Liu, Chia-Chu; Lee, Yung-Chin; Yang, Sheau-Fang; Liang, Peir-In; Huang, Chun-Nung
2015-01-01
To investigate the impact of preoperative hydronephrosis and flank pain on prognosis of patients with upper tract urothelial carcinoma. In total, 472 patients with upper tract urothelial carcinoma managed by radical nephroureterectomy were included from Kaohsiung Medical University Hospital Healthcare System. Clinicopathological data were collected retrospectively for analysis. The significance of hydronephrosis, especially when combined with flank pain, and other relevant factors on overall and cancer-specific survival were evaluated. Of the 472 patients, 292 (62%) had preoperative hydronephrosis and 121 (26%) presented with flank pain. Preoperative hydronephrosis was significantly associated with age, hematuria, flank pain, tumor location, and pathological tumor stage. Concurrent presence of hydronephrosis and flank pain was a significant predictor of non-organ-confined disease (multivariate-adjusted hazard ratio = 2.10, P = 0.025). Kaplan-Meier analysis showed significantly poorer overall and cancer-specific survival in patients with preoperative hydronephrosis (P = 0.005 and P = 0.026, respectively) and in patients with flank pain (P hydronephrosis and flank pain independently predicted adverse outcome (hazard ratio = 1.98, P = 0.016 for overall survival and hazard ratio = 1.87, P = 0.036 for and cancer-specific survival, respectively) in multivariate Cox proportional hazards models. In addition, concurrent presence of hydronephrosis and flank pain was also significantly predictive of worse survival in patient with high grade or muscle-invasive disease. Notably, there was no difference in survival between patients with hydronephrosis but devoid of flank pain and those without hydronephrosis. Concurrent preoperative presence of hydronephrosis and flank pain predicted non-organ-confined status of upper tract urothelial carcinoma. When accompanied with flank pain, hydronephrosis represented an independent predictor for worse outcome in patients with upper tract
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Yuli Park
Full Text Available To evaluate health-related quality of life (HRQoL in Korean adults with visual impairment(VI using various measures based on a nationally distributed sample.Using the Korea National Health and Nutrition Examination Survey (KNHANES, 2008-2012 data, we compared EuroQol five-dimensional questionnaire (EQ-5D and EQ-visual analogue scale (VAS scores after adjusting for socio-demographic and psychosocial factors as well as for comorbidities with VI. Logistic regressions were used to elucidate determinants for the lowest quintile HRQoL scales according to VI severity. Uncorrected visual acuity (VA which implies vision of ordinary life was measured using an international standard vision chart based on Snellen scale.28,825 participants (sum of weights; 37,562,376 were included in the analysis. The mean EQ-5D and EQ-VAS scores were significantly lower in the VI groups than in the normal vision (defined as VA 20/20-20/25 group based on the better or worse seeing eye (P<.0001 and P<.0001, respectively. Participants with moderate (VA 20/80-20/160 and severe VI (VA ≤20/200 had higher scores of multivariate-adjusted odd ratios (aORs for the lowest quintile than did the normal vision group which was particularly evident in the results from EQ-5D, whereas the results of the mild VI (VA 20/32-20/63 group did not identify significant differences from the normal vision group independent of classification according to the better or the worse seeing eye. Conversely, EQ-VAS revealed significantly higher score of multivariate-aORs for the lowest quintile in participants with mild VI either for the better or worse seeing eye.The severity of VI was definitely associated with impaired HRQoL compared with the normal vision population. The analyses presented here elicited even mild VI could potentially deteriorate the health-related quality of life (or subjective perception of health quality and therefore, therapeutic approaches should also focus on the subjective
Hyponatremia Is Associated with Worse Outcomes from Fall Injuries in the Elderly
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Spencer C. H. Kuo
2017-04-01
Full Text Available Background: Hyponatremia has been proposed as a contributor to falls in the elderly, which have become a major global issue with the aging of the population. This study aimed to assess the clinical presentation and outcomes of elderly patients with hyponatremia admitted due to fall injuries in a Level I trauma center. Methods: We retrospectively reviewed data obtained from the Trauma Registry System for trauma admissions from January 2009 through December 2014. Hyponatremia was defined as a serum sodium level <135 mEq/L, and only patients who had sustained a fall at ground level (<1 m were included. We used Chi-square tests, Student t-tests, and Mann-Whitney U tests to compare elderly patients (age ≥65 years with hyponatremia (n = 492 to those without (n = 2002, and to adult patients (age 20–64 years with hyponatremia (n = 125. Results: Significantly more elderly patients with hyponatremia presented to the emergency department (ED due to falls compared to elderly patients without hyponatremia (73.7% vs. 52.6%; OR: 2.5, 95% CI: 2.10–3.02; p < 0.001. Elderly patients with hyponatremia presented with a worse outcome, measured by significantly higher odds of intubation (OR: 2.4, 95% CI: 1.15–4.83; p = 0.025, a longer in-hospital length of stay (LOS (11 days vs. 9 days; p < 0.001, higher proportion of intensive care unit (ICU admission (20.9% vs. 16.2%; OR: 1.4, 95% CI: 1.07–1.76; p = 0.013, and higher mortality (OR: 2.5, 95% CI: 1.53–3.96; p < 0.001, regardless of adjustment by Injury Severity Scores (ISS (AOR: 2.4, 95% CI: 1.42–4.21; p = 0.001. Conclusions: Our results show that hyponatremia is associated with worse outcome from fall-related injuries in the elderly, with an increased ISS, longer LOS, and a higher risk of death.
Unified Health Gamification can significantly improve well-being in corporate environments.
Shahrestani, Arash; Van Gorp, Pieter; Le Blanc, Pascale; Greidanus, Fabrizio; de Groot, Kristel; Leermakers, Jelle
2017-07-01
There is a multitude of mHealth applications that aim to solve societal health problems by stimulating specific types of physical activities via gamification. However, physical health activities cover just one of the three World Health Organization (WHO) dimensions of health. This paper introduces the novel notion of Unified Health Gamification (UHG), which covers besides physical health also social and cognitive health and well-being. Instead of rewarding activities in the three WHO dimensions using different mHealth competitions, UHG combines the scores for such activities on unified leaderboards and lets people interact in social circles beyond personal interests. This approach is promising in corporate environments since UHG can connect the employees with intrinsic motivation for physical health with those who have quite different interests. In order to evaluate this approach, we realized an app prototype and we evaluated it in two corporate pilot studies. In total, eighteen pilot users participated voluntarily for six weeks. Half of the participants were recruited from an occupational health setting and the other half from a treatment setting. Our results suggest that the UHG principles are worth more investigation: various positive health effects were found based on a validated survey. The mean mental health improved significantly at one pilot location and at the level of individual pilot participants, multiple other effects were found to be significant: among others, significant mental health improvements were found for 28% of the participants. Most participants intended to use the app beyond the pilot, especially if it would be further developed.
Reinert, Katia G; Campbell, Jacquelyn C; Bandeen-Roche, Karen; Sharps, Phyllis; Lee, Jerry
2015-07-01
This study aimed to determine gender and race variations in regards to the influence of religious involvement (RI) as a moderator of the effects of early traumatic stress (ETS) on health-related quality of life among adult survivors of child abuse. A cross-sectional predictive design was used to study Seventh-day Adventist adults in North America (N = 10,283). A secondary analysis of data collected via questionnaires was done using multiple regression. Data revealed that women had a significantly higher prevalence of any or all ETS subtypes, except for physical abuse prevalence, which was the same for both genders. Blacks reported a significantly higher prevalence of at least one ETS subtype than did Whites, except for neglect, where Whites had a higher prevalence. Exposure to at least one ETS subtype was associated with worse negative effect on mental health (B = -2.08, p gender-RI-ETS showed a significant buffering effect. Among those with high levels of negative religious coping (RC), women exposed to ETS had significantly worse physical health (B = -1.28) than men. Results give evidence of gender and racial differences on the magnitude of the ETS-health effect, as well as gender differences in ETS-health buffering by RC. Findings suggest gender and racial differences must be considered when devising holistic nursing interventions for improving health outcomes of early trauma survivors. © 2015 Sigma Theta Tau International.
Yun, Young Ho; Sim, Jin Ah; Park, Eun-Gee; Park, June Dong; Noh, Dong-Young
2016-09-01
To perform a comparison between health behaviors and health status of employees with those of the general population, to evaluate the association between employee health behaviors, health status, and absenteeism. Cross-sectional study enrolled 2433 employees from 16 Korean companies in 2014, and recruited 1000 general population randomly in 2012. The distribution of employee health behaviors, health status, and association with absenteeism were assessed. Employees had significantly worse health status and low rates of health behaviors maintenance compared with the general population. Multiple logistic regression model revealed that regular exercise, smoking cessation, work life balance, proactive living, religious practice, and good physical health status were associated with lower absenteeism. Maintaining health behaviors and having good health status were associated with less absenteeism. This study suggests investment of multidimensional health approach in workplace health and wellness (WHW) programs.
Does buccal cancer have worse prognosis than other oral cavity cancers?
Camilon, P Ryan; Stokes, William A; Fuller, Colin W; Nguyen, Shaun A; Lentsch, Eric J
2014-06-01
To determine whether buccal squamous cell carcinoma has worse overall survival (OS) and disease-specific survival (DSS) than cancers in the rest of the oral cavity. Retrospective analysis of a large population database. We began with a Kaplan-Meier analysis of OS and DSS for buccal versus nonbuccal tumors with unmatched data, followed by an analysis of cases matched for race, age at diagnosis, stage at diagnosis, and treatment modality. This was supported by a univariate Cox regression comparing buccal cancer to nonbuccal cancer, followed by a multivariate Cox regression that included all significant variables studied. With unmatched data, buccal cancer had significantly lesser OS and DSS values than cancers in the rest of the oral cavity (P cancer versus nonbuccal oral cancer were no longer significant. Univariate Cox regression models with respect to OS and DSS showed a significant difference between buccal cancer and nonbuccal cancer. However, with multivariate analysis, buccal hazard ratios for OS and DSS were not significant. With the largest series of buccal carcinoma to date, our study concludes that the OS and DSS of buccal cancer are similar to those of cancers in other oral cavity sites once age at diagnosis, tumor stage, treatment, and race are taken into consideration. The previously perceived poor prognosis of buccal carcinoma may be due to variations in tumor presentation, such as later stage and older patient age. 2b. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.
Is delayed surgery related to worse outcomes in native left-sided endocarditis?
Tepsuwan, Thitipong; Rimsukcharoenchai, Chartaroon; Tantraworasin, Apichat; Woragidpoonpol, Surin; Schuarattanapong, Suphachai; Nawarawong, Weerachai
2016-05-01
Timing of surgery in the management of infective endocarditis is controversial, and there is still no definite conclusion on how early the surgery should be performed. This study focuses on the outcomes of surgery during the active period of infective endocarditis in consideration of the duration after diagnosis. One hundred and thirty-four patients with active native valve infective endocarditis who underwent surgery from January 2006 to December 2013 were reviewed retrospectively. They were divided in 2 groups based on timing of surgery: early group (first week after diagnosis, n = 37) and delayed group (2 to 6 weeks after diagnosis, n = 97). Compared to the delayed group, the early group had significantly more patients in New York Heart Association class IV (81% vs. 43.3%), more mechanically ventilated (54.1% vs. 18.6%), more on inotropic support (62.2% vs. 38.1%), and hence a worse EuroSCORE II (14.8% vs. 8.8%). Operative mortality was comparable (5.4% vs. 10.3%) and 7-year survival was similar (77.4% vs. 74.6%). On multivariable regression analysis, delayed surgery did not impact on short- and long-term outcomes. Preoperative cardiac arrest and infection with Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, or Kingella were risk factors for higher operative mortality. Predictors of poor 7-year survival were diabetes mellitus and acute renal failure. Delayed surgery is not associated with worse outcomes. Both early and delayed approaches are safe and provide acceptable results. Timing of surgery should be tailored to each patient's clinical status, not based on duration of endocarditis alone. © The Author(s) 2016.
Paulin, Laura M; Diette, Gregory B; Blanc, Paul D; Putcha, Nirupama; Eisner, Mark D; Kanner, Richard E; Belli, Andrew J; Christenson, Stephanie; Tashkin, Donald P; Han, MeiLan; Barr, R Graham; Hansel, Nadia N
2015-03-01
Links between occupational exposures and morbidity in individuals with established chronic obstructive pulmonary disease (COPD) remain unclear. To determine the impact of occupational exposures on COPD morbidity. A job exposure matrix (JEM) determined occupational exposure likelihood based on longest job in current/former smokers (n = 1,075) recruited as part of the Subpopulations and Intermediate Outcomes in COPD Study, of whom 721 had established COPD. Bivariate and multivariate linear regression models estimated the association of occupational exposure with COPD, and among those with established disease, the occupational exposure associations with 6-minute-walk distance (6MWD), the Modified Medical Research Council Dyspnea Scale (mMRC), the COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), 12-item Short-Form Physical Component (SF-12), and COPD exacerbations requiring health care utilization, adjusting for demographics, current smoking status, and cumulative pack-years. An intermediate/high risk of occupational exposure by JEM was found in 38% of participants. In multivariate analysis, those with job exposures had higher odds of COPD (odds ratio, 1.44; 95% confidence interval, 1.04-1.97). Among those with COPD, job exposures were associated with shorter 6MWDs (-26.0 m; P = 0.006); worse scores for mMRC (0.23; P = 0.004), CAT (1.8; P = 0.003), SGRQ (4.5; P = 0.003), and SF-12 Physical (-3.3; P Accounting for smoking, occupational exposure was associated with COPD risk and, for those with established disease, shorter walk distance, greater breathlessness, worse quality of life, and increased exacerbation risk. Clinicians should obtain occupational histories from patients with COPD because work-related exposures may influence disease burden.
Fernández-Prada, María; González-Cabrera, Joaquín; Torres G, Francisco; Iribar-Ibabe, Concepción; María Peinado, José
2014-02-01
The high emotional burden of physicians working in emergency departments may affect their quality of life perception. To evaluate health related quality of life among resident physicians performing shifts at an emergency department. Seventy one physicians aged 26,3 ± 1,7 years (47 women), working as residents in an emergency department, answered the short version of the Short-Form Health Survey Questionnaire (SF-36®). This questionnaire analyses eight domains: physical function, body pain, general health, vitality, social function, emotional role and mental health. Women had a significantly worse perception than a reference population in four dimensions of the SF-36, especially mental health and social functioning. Men had scores similar to the reference population. Among women, vitality is the best predictor of mental health and social functioning. Women working as residents in an emergency department have a worse perception of their quality of life than men performing the same job.
Modern environmental health hazards: a public health issue of increasing significance in Africa.
Nweke, Onyemaechi C; Sanders, William H
2009-06-01
Traditional hazards such as poor sanitation currently account for most of Africa's environmentally related disease burden. However, with rapid development absent appropriate safeguards for environment and health, modern environmental health hazards (MEHHs) may emerge as critical contributors to the continent's disease burden. We review recent evidence of human exposure to and health effects from MEHHs, and their occurrence in environmental media and consumer products. Our purpose is to highlight the growing significance of these hazards as African countries experience urbanization, industrial growth, and development. We reviewed published epidemiologic, exposure, and environmental studies of chemical agents such as heavy metals and pesticides. The body of evidence demonstrates ongoing environmental releases of MEHHs and human exposures sometimes at toxicologically relevant levels. Several sources of MEHHs in environmental media have been identified, including natural resource mining and processing and automobile exhaust. Biomonitoring studies provided direct evidence of human exposure to metals such as mercury and lead and pesticides such as p,p'-dichlorodiphenyltrichloroethane (DDT) and organophosphates. Land and water resource pollution and industrial air toxics are areas of significant data gaps, notwithstanding the presence of several emitting sources. Unmitigated MEHH releases and human exposure have implications for Africa's disease burden. For Africans encumbered by conditions such as malnutrition that impair resilience to toxicologic challenges, the burden may be higher. A shift in public health policy toward accommodating the emerging diversity in Africa's environmental health issues is necessary to successfully alleviate the burden of avoidable ill health and premature death for all its communities now and in the future.
Schünemann, Johannes; Strulik, Holger; Trimborn, Timo
2015-01-01
Unhealthy persons adapt to their bad state of health and persons in bad health are usually happier than estimated by healthy persons. In this paper we investigate how adaptation to a deteriorating state of health affects health spending, life expectancy, and the value of life. We set up a life cycle model in which individuals are subject to physiological aging, calibrate it with data from gerontology, and compare behavior and outcomes of adapting and non-adapting individuals. While adaptation...
Melo, Lucas Pereira de
2016-08-01
This article analyzes the significance that health professionals attribute to health education groups for people with Type 2 Diabetes Mellitus (T2DM). This ethnographic study was developed with five professionals from an Expanded Family Health team that operated in five diabetes health education groups. Information was gathered using participant observations and semi-structured interviews. Data were analyzed by means of a thematic coding technique. Three different categories emerged: (1) It is a way of educating them: groups as an educational and clinical monitoring forum; (2) they know I will be there for them: the groups as a resource to access the health system; and (3) this serves as a self-help group: after all, what purpose does this group serve? The conclusion reached is that the groups studied were a therapy and support hybrid that, by means of their structure, made it possible for the informants (perhaps, also for the patients) to construct other significance for the standardization of health policies and the dilemma of chronicity. Such hybridization made it possible to create outcomes for the specificities of health work in a "total life" context.
Health significance of metal exposures
DEFF Research Database (Denmark)
Grandjean, Philippe
2007-01-01
and written by well-respected authorities in the range of topics covered, Maxcy-Rosenau-Last Public Health and Preventive Medicine is also an outstanding guide to additional resources of information in preparing for the board exam in preventative medicine and public health. The new edition of Maxcy......An extensive, in-depth look at public health and preventive medicine topics from experts in the field This trusted one-stop resource is a completely up-to-date, all-in-one public health and preventive medicine guide. Sponsored by the Association of Teachers of Preventive Medicine and edited......-Rosenau-Last Public Health and Preventive Medicine has been completely updated to encompass many new diseases, conditions, and policy issues that continue to dramatically shape-and expand the influence of-public health and preventive medicine. New to this Edition: Important coverage of new diseases, conditions...
Broken Down by Work and Sex: How Our Health Declines
Anne C. Case; Angus Deaton
2003-01-01
Self-reported health status (SRHS) is an imperfect measure of non-fatal health, but allows examination of how health status varies over the life course. Although women have lower mortality than men, they report worse health status up to age 65. The SRHS of both men and women deteriorates with age. There are strong gradients, so that at age 20, men in the bottom quartile already report worse health than do men in the top quartile at age 50. In the bottom quartile of income, SRHS declines more ...
Stewart, Robert; Sabbah, Wael; Tsakos, Georgios; D'Aiuto, Francesco; Watt, Richard G
2008-10-01
To investigate the association between oral health and cognitive function in early-, mid-, and late-adult life. A secondary analysis was carried out of a large, well-characterized community sample (NHANES III). Analyzed variables included three measures of oral health (gingival bleeding, loss of periodontal attachment, loss of teeth) and three measures of cognitive function: the Symbol Digit Substitution Test (SDST), the Serial Digit Learning Test (SDLT) (both in 5138 participants aged 20-59 years), and a Story Recall test (in 1555 participants aged >or=70 years). Other covariates in linear regression models included age, gender, ethnicity, education and poverty, and cardiovascular risk factors. Worse scores on all three measures of oral health status were significantly associated with poorer performance on all three measures of cognitive function after adjustment for age. Education was an important confounding factor. However, after full adjustment for all other covariates, gingival bleeding (%) and loss of periodontal attachment (%) remained associated with relative impairment on SDST score (B coefficients both = 0.003), and gingival bleeding was associated with relative impairment on SDLT (B = 0.017). No effect modification by age was observed. Poor oral health is associated with worse cognitive function throughout adult life. This may, in part, be accounted for by early life education and social status. However, the possibility of direct causal pathways requires further investigation.
Kanjanahattakij, Napatt; Sirinvaravong, Natee; Aguilar, Francisco; Agrawal, Akanksha; Krishnamoorthy, Parasuram; Gupta, Shuchita
2018-01-01
In patients with heart failure with preserved ejection fraction (HFpEF), worse kidney function is associated with worse overall cardiac mechanics. Right ventricular stroke work index (RVSWI) is a parameter of right ventricular function. The aim of our study was to determine the relationship between RVSWI and glomerular filtration rate (GFR) in patients with HFpEF. This was a single-center cross-sectional study. HFpEF is defined as patients with documented heart failure with ejection fraction > 50% and pulmonary wedge pressure > 15 mm Hg from right heart catheterization. RVSWI (normal value 8-12 g/m/beat/m2) was calculated using the formula: RVSWI = 0.0136 × stroke volume index × (mean pulmonary artery pressure - mean right atrial pressure). Univariate and multivariate linear regression analysis was performed to study the correlation between RVSWI and GFR. Ninety-one patients were included in the study. The patients were predominantly female (n = 64, 70%) and African American (n = 61, 67%). Mean age was 66 ± 12 years. Mean GFR was 59 ± 35 mL/min/1.73 m2. Mean RVSWI was 11 ± 6 g/m/beat/m2. Linear regression analysis showed that there was a significant independent inverse relationship between RVSWI and GFR (unstandardized coefficient = -1.3, p = 0.029). In the subgroup with combined post and precapillary pulmonary hypertension (Cpc-PH) the association remained significant (unstandardized coefficient = -1.74, 95% CI -3.37 to -0.11, p = 0.04). High right ventricular workload indicated by high RVSWI is associated with worse renal function in patients with Cpc-PH. Further prospective studies are needed to better understand this association. © 2018 S. Karger AG, Basel.
Amlie, Einar; Havelin, Leif I; Furnes, Ove; Baste, Valborg; Nordsletten, Lars; Hovik, Oystein; Dimmen, Sigbjorn
2014-09-01
The surgical approach in total hip arthroplasty (THA) is often based on surgeon preference and local traditions. The anterior muscle-sparing approach has recently gained popularity in Europe. We tested the hypothesis that patient satisfaction, pain, function, and health-related quality of life (HRQoL) after THA is not related to the surgical approach. 1,476 patients identified through the Norwegian Arthroplasty Register were sent questionnaires 1-3 years after undergoing THA in the period from January 2008 to June 2010. Patient-reported outcome measures (PROMs) included the hip disability osteoarthritis outcome score (HOOS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), health-related quality of life (EQ-5D-3L), visual analog scales (VAS) addressing pain and satisfaction, and questions about complications. 1,273 patients completed the questionnaires and were included in the analysis. Adjusted HOOS scores for pain, other symptoms, activities of daily living (ADL), sport/recreation, and quality of life were significantly worse (p < 0.001 to p = 0.03) for the lateral approach than for the anterior approach and the posterolateral approach (mean differences: 3.2-5.0). These results were related to more patient-reported limping with the lateral approach than with the anterior and posterolateral approaches (25% vs. 12% and 13%, respectively; p < 0.001). Patients operated with the lateral approach reported worse outcomes 1-3 years after THA surgery. Self-reported limping occurred twice as often in patients who underwent THA with a lateral approach than in those who underwent THA with an anterior or posterolateral approach. There were no significant differences in patient-reported outcomes after THA between those who underwent THA with a posterolateral approach and those who underwent THA with an anterior approach.
Health Literacy, Cognitive Ability, and Functional Health Status among Older Adults
Serper, Marina; Patzer, Rachel E; Curtis, Laura M; Smith, Samuel G; O'Conor, Rachel; Baker, David W; Wolf, Michael S
2014-01-01
Objective To investigate whether previously noted associations between health literacy and functional health status might be explained by cognitive function. Data Sources/Study Setting Health Literacy and Cognition in Older Adults (“LitCog,” prospective study funded by National Institute on Aging). Data presented are from interviews conducted among 784 adults, ages 55–74 years receiving care at an academic general medicine clinic or one of four federally qualified health centers in Chicago from 2008 to 2010. Study Design Study participants completed structured, in-person interviews administered by trained research assistants. Data Collection Health literacy was measured using the Test of Functional Health Literacy in Adults, Rapid Estimate of Adult Literacy in Medicine, and Newest Vital Sign. Cognitive function was assessed using measures of long-term and working memory, processing speed, reasoning, and verbal ability. Functional health was assessed with SF-36 physical health summary scale and Patient Reported Outcomes Measurement Information System short form subscales for depression and anxiety. Principal Findings All health literacy measures were significantly correlated with all cognitive domains. In multivariable analyses, inadequate health literacy was associated with worse physical health and more depressive symptoms. After adjusting for cognitive abilities, associations between health literacy, physical health, and depressive symptoms were attenuated and no longer significant. Conclusions Cognitive function explains a significant proportion of the associations between health literacy, physical health, and depression among older adults. Interventions to reduce literacy disparities in health care should minimize the cognitive burden in behaviors patients must adopt to manage personal health. PMID:24476068
Directory of Open Access Journals (Sweden)
Godfrey Mutashambara Rwegerera
2018-06-01
Full Text Available Background: Health-related quality of life (HRQOL is an important aspect of diabetes mellitus care. The objective of the study was to determine the HRQOL of diabetes mellitus (DM patients in Botswana as little known in Africa. Materials and methods: A cross-sectional study of 380 randomly selected DM patients in a tertiary clinic in Gaborone, Botswana was conducted to obtain Data on HRQOL and structured questionnaire was used to collect information on sociodemographic and clinical characteristics. Multivariate logistic regression to determine sociodemographic and clinical characteristics associated. Results: Majority of patients were female with no formal education or primary level of education. Mean HbA1c was 7.97% (SD: 2.02 and most patients had poor glycemic control. The majority had both worse physical composite score (PCS-12 and mental composite score (MCS-12, with worse proportions of the two. Female gender, older age ≥65 years, and the presence of three or more documented diabetic complications were associated with significant worse PCS-12. Presence of two diabetic complications, three or more diabetic complications, and musculoskeletal disease were associated with significant MCS-12. Conclusions: Diabetic patients in Botswana have relatively poor HRQOL. The fact that most patients present late with complications calls for policy attention to diagnose diabetes mellitus early and prevent associated complications, ultimately improving health-related quality of life among diabetes mellitus patients. Keywords: Botswana, Diabetes mellitus, Health-related quality of life, Musculoskeletal disease
Neuron-microglia interactions in mental health disorders: 'For better, and for worse'
Directory of Open Access Journals (Sweden)
Eric S Wohleb
2016-11-01
Full Text Available Persistent cognitive and behavioral symptoms that characterize many mental health disorders arise from impaired neuroplasticity in several key corticolimbic brain regions. Recent evidence suggest that reciprocal neuron-microglia interactions shape neuroplasticity during physiological conditions, implicating microglia in the neurobiology of mental health disorders. Neuron-microglia interactions are modulated by several molecular and cellular pathways and dysregulation of these pathways often have neurobiological consequences, including aberrant neuronal responses and microglia activation. The interactions between neurons and microglia have implications for mental health disorders as rodent stress models cause concomitant neuronal dystrophy and alterations in microglia morphology and function. In this context, functional changes in microglia may be indicative of an immune state termed parainflammation in which tissue-resident macrophages (i.e., microglia respond to malfunctioning cells by initiating modest inflammation in an attempt to restore homeostasis. Thus, aberrant neuronal activity and release of damage-associated signals during repeated stress exposure may contribute to functional changes in microglia and resultant parainflammation. Furthermore, accumulating evidence shows that uncoupling neuron-microglia interactions may contribute to altered neuroplasticity and associated anxiety- or depressive-like behaviors. Additional work shows that microglia have varied phenotypes in specific brain regions, which may underlie divergent neuroplasticity observed in corticolimbic structures following stress exposure. These findings indicate that neuron-microglia interactions are critical mediators of the interface between adaptive, homeostatic neuronal function and the neurobiology of mental health disorders.
Significant unmet oral health needs of homebound elderly adults.
Ornstein, Katherine A; DeCherrie, Linda; Gluzman, Rima; Scott, Elizabeth S; Kansal, Jyoti; Shah, Tushin; Katz, Ralph; Soriano, Theresa A
2015-01-01
To assess the oral health status, use of dental care, and dental needs of homebound elderly adults and to determine whether medical diagnoses or demographic factors influenced perceived oral health. Cross-sectional analysis. Participants' homes in New York City. Homebound elderly adults (N = 125). A trained dental research team conducted a comprehensive clinical examination in participants' homes and completed a dental use and needs survey and the Geriatric Oral Health Assessment Index. Participants who reported a high level of unmet oral health needs were more likely to be nonwhite, although this effect was not significant in multivariate analysis. Individual medical diagnoses and the presence of multiple comorbidities were not associated with unmet oral health needs. The oral health status of homebound elderly adults was poor regardless of their medical diagnoses. High unmet oral health needs combined with strong desire to receive dental care suggests there is a need to improve access to dental care for this growing population. In addition to improving awareness of geriatricians and primary care providers who care for homebound individuals, the medical community must partner with the dental community to develop home-based programs for older adults. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
Ayano, Getinet
2018-03-29
Mental health legislation (MHL) is required to ensure a regulatory framework for mental health services and other providers of treatment and care, and to ensure that the public and people with a mental illness are afforded protection from the often-devastating consequences of mental illness. To provide an overview of evidence on the significance of MHL for successful primary care for mental health and community mental health servicesMethod: A qualitative review of the literature on the significance of MHL for successful primary care for mental health and community mental health services was conducted. In many countries, especially in those who have no MHL, people do not have access to basic mental health care and treatment they require. One of the major aims of MHL is that all people with mental disorders should be provided with treatment based on the integration of mental health care services into the primary healthcare (PHC). In addition, MHL plays a crucial role in community integration of persons with mental disorders, the provision of care of high quality, the improvement of access to care at community level. Community-based mental health care further improves access to mental healthcare within the city, to have better health and mental health outcomes, and better quality of life, increase acceptability, reduce associated social stigma and human rights abuse, prevent chronicity and physical health comorbidity will likely to be detected early and managed. Mental health legislation plays a crucial role in community integration of persons with mental disorders, integration of mental health at primary health care, the provision of care of high quality and the improvement of access to care at community level. It is vital and essential to have MHL for every country.
Comparison of Health Outcomes Among Children with Different Levels of Motor Competence
Directory of Open Access Journals (Sweden)
Chagas Daniel V.
2017-06-01
Full Text Available Purpose. While evidence suggests that children with the developmental coordination disorder (DCD have worse health outcomes than their typically developing peers, it remains unclear whether children with low motor competence but without DCD are also characterized by worse health outcomes than those with average motor competence. The main purpose of this study was to compare health outcomes between children with low motor competence without DCD and those with average motor competence.
DEFF Research Database (Denmark)
Øzhayat, Esben Boeskov
2013-01-01
NA would be associated with worse OHRQoL.Methods: OHRQoL measured by the Oral Health Impact Profile 49 (OHIP-49), self-esteem measured by the Rosenberg Self-Esteem Scale (RSES), NA measured by the Eysenck Personality Inventory Questionnaire (EPI-Q), global oral rating of oral comfort and controlling......To meaningfully interpret oral health-related quality of life (OHRQoL) measures, the influence of personality traits must be investigated. Objectives:To investigate and quantify the influence of self-esteem and negative affectivity (NA) on OHRQoL. It was hypothesized that low self-esteem and high...... and clinically significantly higher and self-esteem was statistically significantly lower in patients reporting worse oral comfort. Conclusion: NA had the strongest and most clinically meaningful influence, but both NA and self-esteem was found to influence OHRQoL; low self-esteem and high NA was associated...
The Symptoms Get Worse after Pregnancy in Sheehan's Syndrome: A Case Report
Directory of Open Access Journals (Sweden)
Jingwen Hao
2012-01-01
Full Text Available Sheehan’s syndrome, which is pituitary necrosis after severe postpartum hemorrhage and hypovolemia, may cause hypopituitarism immediately or several years later, depending on the degree of tissue destruction. We report an unusual case, in which a 55-year-old woman with Sheehan's syndrome got worse symptoms after spontaneous labor. In 1998, she had severe postpartum hemorrhage and pituitary necrosis during the third delivery, thus it was diagnosed as Sheehan’s syndrome by clinical manifestations, laboratory tests, and magnetic resonance imaging. She was treated by replacement therapy including hydrocortisone and levothyroxine sodium. However, she had the fourth spontaneous pregnancy in 2000 and got worse symptoms after delivery. We carefully concluded that pregnancy provided no evidence against the diagnosis of Sheehan’s syndrome because pregnancy might improve hypopituitarism by stimulating the pituitary remnant to undergo hyperplasia and irritating the placenta to secrete hormone. However, pregnancy might aggravate the symptoms by inducing autoimmunity as well. All in all, early diagnosis and adequate medical treatment are important to provide a good prognosis of Sheehan’s syndrome.
DEFF Research Database (Denmark)
Windeløv, Nis A; Welling, Karen-Lise; Ostrowski, Sisse R
2011-01-01
Coagulopathy in patients with intracranial haemorrhage or traumatic brain injury (TBI) is associated with clinical deterioration and worse outcome. Whole blood viscoelastic haemostatic assays, like thrombelastography (TEG), might aid conventional coagulation assays in identification of patients w...... prognosis. Low concordance with conventional coagulation assays indicates that TEG might be valuable in identifying patients with clinically relevant coagulopathy....
de Godoy, Luciana Balester Mello; Luz, Gabriela Pontes; Palombini, Luciana Oliveira; E Silva, Luciana Oliveira; Hoshino, Wilson; Guimarães, Thaís Moura; Tufik, Sergio; Bittencourt, Lia; Togeiro, Sonia Maria
2016-01-01
To compare sleep quality and sustained attention of patients with Upper Airway Resistance Syndrome (UARS), mild Obstructive Sleep Apnea (OSA) and normal individuals. UARS criteria were presence of excessive daytime sleepiness (Epworth Sleepiness Scale-ESS-≥ 10) and/or fatigue (Modified Fatigue Impact Scale-MFIS-≥ 38) associated to Apnea/hypopnea index (AHI) ≤ 5 and Respiratory Disturbance Index (RDI) > 5 events/hour of sleep or more than 30% of total sleep time with flow limitation. Mild OSA was considered if the presence of excessive daytime sleepiness (ESS ≥ 10) and/or fatigue (MFIS ≥ 38) associated to AHI ≥ 5 and ≤ 15 events/hour. "Control group" criteria were AHI sleep, clinical, neurological or psychiatric disorder. 115 individuals (34 UARS and 47 mild OSA patients and 34 individuals in "control group"), adjusted for age, gender, body mass index (BMI) and schooling years, performed sleep questionnaires and sustained attention evaluation. Psychomotor Vigilance Task (PVT) was performed five times (each two hours) from 8 a.m. to 4 p.m. UARS patients had worse sleep quality (Functional Outcomes of Sleep Questionnaire-FOSQ-and Pittsburgh Sleep Quality Index-PSQI: p sleep quality, more fatigue and a worse early morning sustained attention compared to mild OSA. These last had a worse sustained attention than controls.
The Decoy Effect as a Nudge: Boosting Hand Hygiene With a Worse Option.
Li, Meng; Sun, Yan; Chen, Hui
2018-05-01
This article provides the first test of the decoy effect as a nudge to influence real-world behavior. The decoy effect is the phenomenon that an additional but worse option can boost the appeal of an existing option. It has been widely demonstrated in hypothetical choices, but its usefulness in real-world settings has been subject to debate. In three longitudinal experiments in food-processing factories, we tested two decoy sanitation options that were worse than the existing sanitizer spray bottle. Results showed that the presence of a decoy, but not an additional copy of the original sanitizer bottle in a different color, drastically increased food workers' hand sanitizer use from the original sanitizer bottle and, consequently, improved workers' passing rate in hand sanitary tests from 60% to 70% to above 90% for 20 days. These findings indicate that the decoy effect can be a powerful nudge technique to influence real-world behavior.
Kobau, R; Cui, W; Kadima, N; Zack, MM; Sajatovic, M; Kaiboriboon, K; Jobst, B
2015-01-01
Objective This study provides population-based estimates of psychosocial health among U.S. adults with epilepsy from the 2010 National Health Interview Survey. Methods Multinomial logistic regression was used to estimate the prevalence of the following measures of psychosocial health among adults with and those without epilepsy: 1) the Kessler-6 scale of Serious Psychological Distress; 2) cognitive limitation; the extent of impairments associated with psychological problems; and work limitation; 3) Social participation; and 4) the Patient Reported Outcome Measurement Information System Global Health scale. Results Compared with adults without epilepsy, adults with epilepsy, especially those with active epilepsy, reported significantly worse psychological health, more cognitive impairment, difficulty in participating in some social activities, and reduced health-related quality of life (HRQOL). Conclusions These disparities in psychosocial health in U.S. adults with epilepsy serve as baseline national estimates of their HRQOL, consistent with Healthy People 2020 national objectives on HRQOL. PMID:25305435
Religiosity, health and happiness: significant relations in adolescents from Qatar.
Abdel-Khalek, Ahmed M
2014-11-01
Several studies have revealed positive associations between religiosity, health and happiness. However, the vast majority of these studies were carried out on native English-speaking participants. The objective of this study was to estimate the relations between religiosity, health and happiness among a sample (N = 372) of Qatari adolescents (M age = 15.2). The students responded to five self-rating scales to assess religiosity, mental health, physical health, happiness and satisfaction with life. Boys obtained a higher mean score on mental health than did their female counterparts. All the correlations between the rating scales were significant and positive. Principal component analysis disclosed one component and labelled 'Religiosity, health and happiness' in both sexes. The multiple stepwise regression indicated that the predictors of religiosity were the self-ratings of satisfaction with life and happiness in boys, whereas the predictors among girls were satisfaction with life and physical health. On the basis of the responses of the present sample, it was concluded that those who consider themselves as religious were more happy, satisfied with their life and healthy. © The Author(s) 2013.
Zhang, Luwen; Liu, Shuaishuai; Zhang, Guoying; Wu, Shaolong
2015-07-28
China had 236 million internal migrants in 2012 and the majority of them migrated from rural to urban areas. The research based on medical and epidemical records found that the migrants had worse health than the urban residents, but the household and working place investigations reported better health status. The sick or unhealthy migrants are likely to return to their hometowns, which in turn may cause a report bias or over-estimation of the health status of rural-to-urban migrants in China. This paper explores the association of migration status and the physical and psychological health of Chinese internal migrants. Nationally representative household survey data from the China Labor-force Dynamics Survey 2012 (CLDS) were used to analyze the association between the migration status and the health status of internal migrants in China. Migration status of the respondents was measured by hukou status and migration experience and all respondents were divided into four groups: returned population, migrant population, urban residents, and rural residents. Health status of respondents was measured by self-reported physical and psychological health. Migration experience was associated with the physical health of the returned population. The physical health of the returned population was worse than the migrant population and was distinguished by age and sex. The physical health status of migrant population was significantly better than rural residents, but not significantly better than urban residents. However, the association between migration status and psychological health was not statistically significant. Besides migration status, the socioeconomic status (SES) had a positive correlation with both physical and psychological health status, while occupational hazards exerted negative influence. The results indicate a tight association between migration experience and health status. The internal unhealthy migrants were more likely to return to their hometown and the
Cannabis Use and Mental Health Problems
van Ours, J.C.; Williams, J.
2009-01-01
This paper investigates whether cannabis use leads to worse mental health. To do so, we account for common unobserved factors affecting mental health and cannabis consumption by modeling mental health jointly with the dynamics of cannabis use. Our main finding is that using cannabis increases the
[Self-rated health status and its implications. Population study of pregnant women in Brno].
Bouchalová, M; Kukla, L; Okrajek, P
2012-12-01
situation. In partner relationships conflicts were present frequently including violence. They also suffered from depression, anxiety, neuroses, phobias and social isolation more often. They also attempted to become pregnant longer than other women and tolerated pregnancy worse. They noted more changes to themselves and experiences more stress. The worse their feelings were during the first months of pregnancy, the higher frequency of pregnancy difficulties, delivery pathologies and post-natal complications were present according to the health-status documentation. This paper brings a whole series of original findings of factors associated with self-rated health-status. The socio-economic position in the families of their own had a more substantial influence on the health-status of the monitored women compared to the position in the families where they grew up. The indicators - e.g. stress, social isolation, work, social support, education, income and household created gradients on the health-status scale which were overall highly significant.
Association between cultural distance and migrant self-rated health.
Detollenaere, Jens; Baert, Stijn; Willems, Sara
2018-03-01
We study whether migrant health in Europe is associated with the cultural distance between their host country and country of origin. To this end, we run multilevel regression models on data merging self-rated health and social background of ≥3800 migrants from the European Social Survey with an index of cultural distance based on country differences in values, norms and attitudes measured in the World Values Survey. We find that higher levels of cultural distance are associated with worse migrant health. This association is comparable in size with the negative association between health and female (compared with male) gender but less important than the association between health and education level. In addition, this association is less significant among second-generation than first-generation migrants.
Is Insecurity Worse for Well-Being in Turbulent Times? Mental Health in Context
Lam, Jack; Fan, Wen; Moen, Phyllis
2014-01-01
Using General Social Survey data, we examine whether any association between job insecurity and well-being is contingent on economic climate (comparing those interviewed in turbulent 2010 vs. pre-recessionary 2006), as well as income and gender. We find respondents with higher levels of job insecurity in 2010 reported lower levels of happiness compared to those similarly insecure in 2006. The positive relationship between job insecurity and days of poor mental health becomes more pronounced for those in the 3rd quartile of personal income in 2010, suggesting middle-class vulnerability during the economic downturn. Men (but not women) with higher insecurity report more days of poor mental health in both 2006 and 2010. These findings reinforce a “cycles of control” theoretical approach, given the mental health-job insecurity relationship is heightened for workers in turbulent times. PMID:25436177
Health, Disability Insurance and Retirement in Denmark
DEFF Research Database (Denmark)
Bingley, Paul; Datta Gupta, Nabanita; Jørgensen, Michael
2014-01-01
There are large differences in labor force participation rates by health status. We examine to what extent these differences are determined by the provisions of Disability Insurance and other pension programs. Using administrative data for Denmark we find that those in worse health and with less...... schooling are more likely to receive DI. The gradient of DI participation across health quintiles is almost twice as steep as for schooling - moving from having no high school diploma to college completion. Using an option value model that accounts for different pathways to retirement, applied to a period...... spanning a major pension reform, we find that pension program incentives in general are important determinants of retirement age. Individuals in poor health and with low schooling are significantly more responsive to economic incentives than those who are in better health and with more schooling. Similar...
Junge, S. (Sibylle); Görlich, D. (Dennis); Reijer, M.D. (Martijn Den); B. Wiedemann (Baerbel); B. Tümmler (Burkhard); H. Ellemunter; Dübbers, A. (Angelika); Küster, P. (Peter); M. Ballmann; Koerner-Rettberg, C. (Cordula); Große-Onnebrink, J. (Jörg); Heuer, E. (Eberhardt); Sextro, W. (Wolfgang); Mainz, J.G. (Jochen G.); Hammermann, J. (Jutta); Riethmüller, J. (Joachim); Graepler-Mainka, U.M. (Ute M.); Staab, D. (Doris); Wollschläger, B. (Bettina); Szczepanski, R. (Rüdiger); A. Schuster (Antje); Tegtmeyer, F.-K. (Friedrich-Karl); Sutharsan, S. (Sivagurunathan); Wald, A. (Alexandra); Nofer, J.-R. (Jerzy-Roch); W.J.B. van Wamel (Willem); Becker, K. (Karsten); Peters, G. (Georg); Kahl, B.C. (Barbara C.)
2016-01-01
textabstractBackground Staphylococcus aureus is an important pathogen in cystic fibrosis (CF). However, it is not clear which factors are associated with worse lung function in patients with persistent S. aureus airway cultures. Our main hypothesis was that patients with high S. aureus density in
Directory of Open Access Journals (Sweden)
Daniel Martin
2017-09-01
Full Text Available Peripheral blood leukocytosis has been implicated in promoting tumor progression leading to worse survival, but the mechanisms behind this phenomenon remain unexplored. Here, we examined the prognostic role of pretreatment white blood cell (WBC count and clinicopathologic parameters in the context of CD8+ tumor-infiltrating lymphocytes (TIL and myeloperoxidase+ tumor-associated neutrophils (TANs in patients with anal squamous cell carcinoma (ASCC treated with definitive chemoradiotherapy (CRT. After a median follow-up of 26 months, leukocytosis correlated with advanced T-stage (p < 0.001 and N-stage (p < 0.001, and predicted for worse distant-metastasis-free survival (p = 0.006, disease-free-survival (DFS, p = 0.029, and overall survival (p = 0.013. Importantly, leukocytosis was associated with a lower intraepithelial CD8+ TIL density (p = 0.014, whereas low CD8+ TIL expression in the intraepithelial compartment was associated with worse DFS (p = 0.028. Additionally, high TAN expression in the peritumoral compartment was associated with a significantly lower density of CD8+ TIL (p = 0.039, albeit, TAN expression lacked prognostic value. In conclusion, leukocytosis constitutes an important prognostic marker in ASCC patients treated with CRT. In conjunction with intratumoral TIL and TAN, these data provide for the first time important insight on the correlation of peripheral blood leukocytosis with the intratumoral immune contexture and could be relevant for future patient stratification using immunotherapies in ASCC.
Effects of industrial wind turbine noise on sleep and health
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Michael A Nissenbaum
2012-01-01
Full Text Available Industrial wind turbines (IWTs are a new source of noise in previously quiet rural environments. Environmental noise is a public health concern, of which sleep disruption is a major factor. To compare sleep and general health outcomes between participants living close to IWTs and those living further away from them, participants living between 375 and 1400 m (n = 38 and 3.3 and 6.6 km (n = 41 from IWTs were enrolled in a stratified cross-sectional study involving two rural sites. Validated questionnaires were used to collect information on sleep quality (Pittsburgh Sleep Quality Index - PSQI, daytime sleepiness (Epworth Sleepiness Score - ESS, and general health (SF36v2, together with psychiatric disorders, attitude, and demographics. Descriptive and multivariate analyses were performed to investigate the effect of the main exposure variable of interest (distance to the nearest IWT on various health outcome measures. Participants living within 1.4 km of an IWT had worse sleep, were sleepier during the day, and had worse SF36 Mental Component Scores compared to those living further than 1.4 km away. Significant dose-response relationships between PSQI, ESS, SF36 Mental Component Score, and log-distance to the nearest IWT were identified after controlling for gender, age, and household clustering. The adverse event reports of sleep disturbance and ill health by those living close to IWTs are supported.
Effects of industrial wind turbine noise on sleep and health.
Nissenbaum, Michael A; Aramini, Jeffery J; Hanning, Christopher D
2012-01-01
Industrial wind turbines (IWTs) are a new source of noise in previously quiet rural environments. Environmental noise is a public health concern, of which sleep disruption is a major factor. To compare sleep and general health outcomes between participants living close to IWTs and those living further away from them, participants living between 375 and 1400 m (n = 38) and 3.3 and 6.6 km (n = 41) from IWTs were enrolled in a stratified cross-sectional study involving two rural sites. Validated questionnaires were used to collect information on sleep quality (Pittsburgh Sleep Quality Index - PSQI), daytime sleepiness (Epworth Sleepiness Score - ESS), and general health (SF36v2), together with psychiatric disorders, attitude, and demographics. Descriptive and multivariate analyses were performed to investigate the effect of the main exposure variable of interest (distance to the nearest IWT) on various health outcome measures. Participants living within 1.4 km of an IWT had worse sleep, were sleepier during the day, and had worse SF36 Mental Component Scores compared to those living further than 1.4 km away. Significant dose-response relationships between PSQI, ESS, SF36 Mental Component Score, and log-distance to the nearest IWT were identified after controlling for gender, age, and household clustering. The adverse event reports of sleep disturbance and ill health by those living close to IWTs are supported.
Yampolskaya, Svetlana; Sharrock, Patty J; Clark, Colleen; Hanson, Ardis
2017-10-01
This longitudinal study examined the parallel trajectories of mental health service use and mental health status among children placed in Florida out-of-home care. The results of growth curve modeling suggested that children with greater mental health problems initially received more mental health services. Initial child mental health status, however, had no effect on subsequent service provision when all outpatient mental health services were included. When specific types of mental health services, such as basic outpatient, targeted case management, and intensive mental health services were examined, results suggested that children with compromised functioning during the baseline period received more intensive mental health services over time. However, this increased provision of intensive mental health services did not improve mental health status, rather it was significantly associated with progressively worse mental health functioning. These findings underscore the need for regular comprehensive mental health assessments focusing on specific needs of the child.
Self-reported health and gender: The role of social norms.
Caroli, Eve; Weber-Baghdiguian, Lexane
2016-03-01
The role of social norms in accounting for the different attitudes of men and women with respect to health is still an open issue. In this research, we investigate the role of social norms associated with specific gender environments in the workplace in accounting for differences in health-reporting behaviours across men and women. Using the 2010 European Working Conditions Survey, we build a database containing 30,124 observations. We first replicate the standard result that women report worse health than men, whatever the health outcome we consider. We then proxy social norms by the gender structure of the workplace environment and study how the latter affects self-reported health for men and women separately. Our findings indicate that individuals in workplaces where women are a majority tend to report worse health than individuals employed in male-dominated work environments, be they men or women. These results are robust to controlling for a large array of working condition indicators, which allows us to rule out that the poorer health status reported by individuals working in female-dominated environments could be due to worse job quality. This evidence suggests that social norms associated with specific gender environments play an important role in explaining differences in health-reporting behaviours across gender, at least in the workplace. Copyright © 2016 Elsevier Ltd. All rights reserved.
Immunological Effects of Probiotics and their Significance to Human Health
Gill, Harsharn S.; Grover, Sunita; Batish, Virender K.; Gill, Preet
Probiotics are defined as live microorganisms which when administered in adequate amounts confer a health benefit upon the host (FAO/WHO, 2001). Lactic acid bacteria, particularly Lactobacillus and Bifidobacterium species are commonly used as probiotics. Other less commonly used probiotics include the yeast Sacchromyces cerevisiae and some non-pathogenic Escherichia coli and Bacillus species. Studies over the past 20 years have demonstrated that probiotic intake is able to confer a range of health benefits including modulation of the immune system, protection against gastrointestinal and respiratory tract infections, lowering of blood cholesterol levels, attenuation of overt immuno-inflammatory disorders (such as inflammatory bowel disease, allergies) and anti-cancer effects. However, the strongest clinical evidence for probiotics relates to their effectiveness in improving gut health and modulating (via stimulation or regulation) the host immune system. This chapter provides an overview of the current status of our knowledge regarding the immunostimulatory and immunoregulatory effects of probiotics on the immune system and their significance to human health.
Chavez, Luis O; Einav, Sharon; Varon, Joseph
2017-11-01
To investigate how a terminal illness may affect the health-care providers' resuscitation preferences. We conducted a cross-sectional survey in 9 health-care institutions located in 4 geographical regions in North and Central America, investigating attitudes toward end-of-life practices in health-care providers. Statistical analysis included descriptive statistics and χ 2 test for the presence of associations ( P < 0.05 being significant) and Cramer V for the strength of the association. The main outcome measured the correlation between the respondents' present code status and their preference for cardiopulmonary resuscitation (CPR) in case of terminal illness. A total of 852 surveys were completed. Among the respondents, 21% (n = 180) were physicians, 36.9% (n = 317) were nurses, 10.5% (n = 90) were medical students, and 265 participants were other staff members of the institutions. Most respondents (58.3%; n = 500) desired "definitely full code" (physicians 73.2%; n = 131), only 13.8% of the respondents (physicians 8.33%; n = 15) desired "definitely no code" or "partial support," and 20.9% of the respondents (n = 179; among physicians 18.4%; n = 33) had never considered their code status. There was an association between current code status and resuscitation preference in case of terminal illness ( P < .001), but this association was overall quite weak (Cramer V = 0.180). Subgroup analysis revealed no association between current code status and terminal illness code preference among physicians ( P = .290) and nurses ( P = .316), whereupon other hospital workers were more consistent ( P < .01, Cramer V = .291). Doctors and nurses have different end-of-life preferences than other hospital workers. Their desire to undergo CPR may change when facing a terminal illness.
Directory of Open Access Journals (Sweden)
Piette JD
2011-04-01
Full Text Available John D Piette1, Ann Marie Rosland1, Maria J Silveira1, Rodney Hayward1, Colleen A McHorney21Ann Arbor VA Healthcare System, Ann Arbor, MI, USA; 2US Outcomes Research, Merck and Co, Inc, North Wales, PA, USAAbstract: A national internet survey was conducted between March and April 2009 among 27,302 US participants in the Harris Interactive Chronic Illness Panel. Respondents reported behaviors related to cost-related medication non-adherence (CRN and the impacts of medication costs on other aspects of their daily lives. Among respondents aged 40–64 and looking for work, 66% reported CRN in 2008, and 41% did not fill a prescription due to cost pressures. More than half of respondents aged 40–64 and nearly two-thirds of those in this group who were looking for work or disabled reported other impacts of medication costs, such as cutting back on basic needs or increasing credit card debt. More than one-third of respondents aged 65+ who were working or looking for work reported CRN. Regardless of age or employment status, roughly half of respondents reporting medication cost hardship said that these problems had become more frequent in 2008 than before the economic recession. These data show that many chronically ill patients, particularly those looking for work or disabled, reported greater medication cost problems since the economic crisis began. Given links between CRN and worse health, the financial downturn may have had significant health consequences for adults with chronic illness.Keywords: medication adherence, cost-of-care, access to care, chronic disease
Hosogoshi, Hiroki; Kodama, Masahiro
2009-02-01
The mental and physical health of defensive pessimists (DPs) is generally worse than that of optimists. However, some DPs who accept their pessimistic thinking style are in good health. This study examined the health of college students who were DPs related to how they accepted their thinking style. In Study 1 (F = 211, M = 131), self-esteem was compared among DPs, strategic optimists (SOs), and depressed persons (DEPs). In Study 2 (F = 376, M = 251, not indicated = 5), the General Health Questionnaire (GHQ28) was compared among these groups. ANOVAs revealed that DPs were healthier than DEPs in self-esteem and on the GHQ28, but worse than SOs in self-esteem. However, ANCOVA examining self-esteem with acceptance of their thinking style as a covariate showed that DPs were better than DEPs and as good as SOs in health. Regarding the acceptance of their thinking style, DPs scored worse than SOs. This study concluded that DPs in better health had better acceptance of their pessimistic thinking style.
Prognostic Significance of Blood Type A in Patients with Renal Cell Carcinoma.
Ko, Kyungtae; Park, Young Hyun; Jeong, Chang Wook; Ku, Ja Hyeon; Kim, Hyeon Hoe; Kwak, Cheol
2016-08-25
In this study, we evaluated the prognostic significance of the ABO blood type in patients with renal cell carcinoma (RCC) who had undergone partial or radical nephrectomy. Information on the ABO blood type was obtained from 1750 patients with RCC. A total of 1243 men and 507 women (mean age, 55.41 ± 12.43 years) with RCC who had undergone partial or radical nephrectomy were enrolled in this study. The median follow-up duration was 35.0 months (interquartile range [IQR], 16.0-67.0). During the follow-up period, 271 patients experienced RCC recurrence, and 137 patients died from RCC. Type A was the most common blood type (568, 32.5%), followed by type O (525, 30.0%), type B (464, 26.5%), and type AB (193, 11.0%). Generally, blood type was not associated with any clinicopathological factors. Unlike blood type O, the multivariate analysis of progression-free survival (PFS) showed that blood type non-O (A, B, and AB) was an independent prognostic factor for a worse outcome (95% confidence interval [CI]: 1.24- 2.37, hazard ratio [HR] = 1.71, P = .001; 95% CI: 1.08-2.13, HR = 1.51, P = .016; 95% CI: 1.03-2.43, HR = 1.58, P = .037, respectively). Cancer-specific survival (CSS) analysis showed that blood type A was an independent factor associated with a worse prognosis for CSS (95% CI: 1.05-2.64, HR 1.66, P = .031, respectively). The ABO blood type is significantly associated with PFS and CSS in patients with RCC following partial or radical nephrectomy. Blood type non-O (A, B, and AB) is an independent prognostic factor for a worse PFS outcome, and blood type A is an independent factor associated with a worse CSS prognosis. .
Abraído-Lanza, Ana F; White, Kellee; Armbrister, Adria N; Link, Bruce G
2006-06-15
To document disparities in health status, activity limitations, and disability in work and housework between Latinos and non-Latino whites with arthritis. We examined whether sociodemographic factors (age, income, and education) account for the disparities between the ethnic groups, and whether comorbid conditions, disease duration, health care utilization, and functional abilities predict health status, activity limitations, and work and housework disability after controlling for sociodemographic variables. We analyzed data from the Condition file of the 1994 National Health Interview Survey on Disability, Phase I. The risk of worse health, activity limitations, and work and housework disability was >2 times greater among Latinos compared with non-Latino whites. In the regression models accounting for potential confounders, Latino ethnicity remained significantly associated with poorer health status, but not activity limitations or disability in work or housekeeping. Of the socioeconomic status variables, education had a significant protective effect on work disability and health status. Comorbid conditions and health care utilization increased the likelihood of worse health, activity limitations, and work disability. Limitations in physical function were associated with poorer health and disability in work and homemaking. Social status differences between Latinos and non-Latinos may account for disparities in activity limitations and disability in work and housework. Education may provide various health benefits, including access to a range of occupations that do not require physical demands. The findings help to address the great gap in knowledge concerning factors related to the health and disability status of Latinos with arthritis.
Human Health Screening and Public Health Significance of ...
The source water and treated drinking water from twenty five drinking water treatment plants (DWTPs) across the United States were sampled in 2010 – 2012. Samples were analyzed for 247 contaminants using 15 chemical and microbiological methods. Most of these contaminants are not regulated currently either in drinking water or in discharges to ambient water by the United States Environmental Protection Agency (EPA) or other U.S. regulatory agencies. This analysis shows that there is little public health concern for most of the contaminants detected in treated water from the 25 DWTPs participating in this study. For vanadium, the calculated MOE was less than the screening MOE in two DWTPs. Additional study, for example a national survey may be needed to determine the number of people ingesting vanadium above a level of concern. In addition, the concentrations of lithium found in treated water from several DWTPs are within the range previous research has suggested to have a human health effect. Additional investigation of this issue may also be appropriate. Finally, new toxicological data suggests that exposure to manganese at levels in public water supplies may present a public health concern which may warrant a more robust assessment of this information. This paper provides a screening-level human health risk assessment using the margin of exposure of exposure approach, of contaminants of emerging concern detected in drinking water. As far as we are a
Zhang, Li-Min; Li, Rui; Zhao, Xiao-Chun; Zhang, Qian; Luo, Xing-Liao
2017-08-01
The fresh frozen plasma (FFP) transfusion threshold and timing for traumatic brain injury (TBI)-associated coagulopathy are controversial. Thus, a multicenter retrospective study was conducted to determine whether or not FFP transfusion is associated with poor outcomes after severe TBI. Data from decompressive craniotomy after blunt force trauma that took place between December 2013 and June 2016 were collected in a multicenter chart. The primary outcomes were mortality and survival, as well as worse outcomes (defined as a Glasgow Outcome Scale [GOS] score ≤3) and better outcomes (GOS score ≥4). Secondary outcomes included 90-day survival rates in all patients with or without FFP transfusion, as well as length of hospital stay in patients with a better prognosis (GOS score ≥4). Univariate analysis, bivariate logistic regression, Spearman rank correlation, and Kaplan-Meier analysis were performed to account for the association between perioperative FFP transfusion and different outcomes. Bivariate logistic analysis showed that mortality and worse outcomes were correlated with FFP transfusion and Glasgow Coma Scale score (P < 0.05). Kaplan-Meier analysis suggested that mortality was statistically higher in the FFP transfusion groups compared with the no FFP transfusion groups, regardless of the severity of TBI (P < 0.05). The overall complications, acute respiratory distress syndrome, and pneumonia rate were significantly higher for patients receiving FFP transfusion (P < 0.05). Increased perioperative FFP infusion was independently associated with mortality or worse outcomes across a spectrum of surgical risk profiles. Copyright © 2017 Elsevier Inc. All rights reserved.
Biofuels. Is the curse worse than the disease?
International Nuclear Information System (INIS)
Doornbosch, R.; Steenblik, R.
2007-09-01
Biofuels have been championed as an energy source that can increase security of supply, reduce vehicle emissions and provide a new income stream for farmers. These claims are contested, however. Critics assert that biofuels will increase energy-price volatility, food prices and even life-cycle emissions of greenhouse gases. This paper presents salient facts and figures to shed light on these controversial issues and asks whether biofuels offer a cure that is worse than the disease they seek to heal. The information gathered in this paper gives rise to two fundamental questions: (1) Do the technical means exist to produce biofuels in ways that enable the world to meet demand for transportation energy in more secure and less harmful ways, on a meaningful scale and without compromising the ability to feed a growing population?; and (2) Do current national and international policies that promote the production of biofuels represent the most cost-effective means of using biomass and the best way forward for the transport sector?
Coley, Sheryl L; Mendes de Leon, Carlos F; Ward, Earlise C; Barnes, Lisa L; Skarupski, Kimberly A; Jacobs, Elizabeth A
2017-12-01
Emerging data suggest that African-American women may fare worse than African-American men in health-related quality-of-life (HRQOL). Perceived discrimination is an important contributor to poor health overall among African Americans, but few studies examined the intersecting effects of perceived discrimination and gender in explaining HRQOL disparities. We investigated gender differences in HRQOL and tested whether perceived discrimination accounted for these differences. We examined data from the Chicago Health and Aging Project in which 5652 African-American adults aged 65 and older completed structured questionnaires about demographic and socioeconomic characteristics, HRQOL, perceived discrimination, and health-related variables. Logistic regression models were used to identify associations between perceived discrimination and gender differences in poor HRQOL outcomes (defined as 14+ unhealthy days in overall, physical, or mental health over the past 30 days) when controlling for the other variables. More women reported poor overall HRQOL than men (24 vs. 16% respectively). Higher perceived discrimination was significantly associated with worse overall HRQOL (OR 1.11; 95% CI 1.08, 1.15), with stronger effects for women in overall and mental HRQOL. These gender disparities remained significant until controlling for potentially confounding variables. Perceived discrimination did not account for gender differences in poor physical HRQOL. Perceived discrimination is associated with poor HRQOL in older African Americans, with this association appearing stronger in women than men for mental HRQOL. These findings warrant further investigation of effects of perceived discrimination in gender disparities in overall health, and such research can inform and guide efforts for reducing these disparities.
Social Relationships and Health: A Flashpoint for Health Policy
Umberson, Debra; Montez, Jennifer Karas
2011-01-01
Social relationships—both quantity and quality—affect mental health, health behavior, physical health, and mortality risk. Sociologists have played a central role in establishing the link between social relationships and health outcomes, identifying explanations for this link, and discovering social variation (e.g., by gender and race) at the population level. Studies show that social relationships have short- and long-term effects on health, for better and for worse, and that these effects emerge in childhood and cascade throughout life to foster cumulative advantage or disadvantage in health. This article describes key research themes in the study of social relationships and health, and it highlights policy implications suggested by this research. PMID:20943583
Directory of Open Access Journals (Sweden)
Sibylle Junge
Full Text Available Staphylococcus aureus is an important pathogen in cystic fibrosis (CF. However, it is not clear which factors are associated with worse lung function in patients with persistent S. aureus airway cultures. Our main hypothesis was that patients with high S. aureus density in their respiratory specimens would more likely experience worsening of their lung disease than patients with low bacterial loads.Therefore, we conducted an observational prospective longitudinal multi-center study and assessed the association between lung function and S. aureus bacterial density in respiratory samples, co-infection with other CF-pathogens, nasal S. aureus carriage, clinical status, antibiotic therapy, IL-6- and IgG-levels against S. aureus virulence factors.195 patients from 17 centers were followed; each patient had an average of 7 visits. Data were analyzed using descriptive statistics and generalized linear mixed models. Our main hypothesis was only supported for patients providing throat specimens indicating that patients with higher density experienced a steeper lung function decline (p<0.001. Patients with exacerbations (n = 60, S. aureus small-colony variants (SCVs, n = 84 and co-infection with Stenotrophomonas maltophilia (n = 44 had worse lung function (p = 0.0068; p = 0.0011; p = 0.0103. Patients with SCVs were older (p = 0.0066 and more often treated with trimethoprim/sulfamethoxazole (p = 0.0078. IL-6 levels positively correlated with decreased lung function (p<0.001, S. aureus density in sputa (p = 0.0016, SCVs (p = 0.0209, exacerbations (p = 0.0041 and co-infections with S. maltophilia (p = 0.0195 or A. fumigatus (p = 0.0496.In CF-patients with chronic S. aureus cultures, independent risk factors for worse lung function are high bacterial density in throat cultures, exacerbations, elevated IL-6 levels, presence of S. aureus SCVs and co-infection with S. maltophilia.ClinicalTrials.gov NCT00669760.
... way of protecting itself. When you have chronic stress, your body stays alert, even though there is no danger. Over time, this puts you at risk for health problems, including: ... condition, chronic stress can make it worse. SIGNS OF TOO MUCH ...
International Nuclear Information System (INIS)
Namiki, Shunichi
2004-01-01
We performed a retrospective survey of general and disease specific health-related quality of life (HRQOL) after radical prostatectomy (RP) and external beam radiotherapy (XRT) in Japanese men. A total of 186 patients underwent RP and 78 underwent XRT for clinically localized prostate cancer between 2000 and 2002. We measured the general and disease specific HRQOL with the Medical Outcomes Study (MOS) 36-Item Health Survey and the University of California, Los Angeles Prostate Cancer Index, respectively. Each treatment group was further divided into four subgroups according to the time scale. Patients from the RP group were significantly younger than those from the XRT group. The tumor characteristics differed significantly in their distributions among the treatment groups. Patients undergoing XRT had low scores in most of the general measures of HRQOL just after treatment, but after 6 months there were no differences between the treatment groups, except for the physical domains. The RP group was associated with worse urinary function, whereas the XRT group had worse bowel function and bother during the first 6 months after treatment. Thereafter, however, urinary and bowel domain did not differ between the groups. Both groups reported poor sexual function, although the RP group scored lower sexual bother. The patients who underwent RP had significantly worse urinary and better bowel function than those treated with XRT. Both treatment groups had decrements in sexual function throughout the post-treatment period; careful attention should be paid to this side-effect in preoperative counselling, especially in younger patients, regardless of the primary treatments. (author)
Camelo, Lidyane do Valle; Giatti, Luana; Barreto, Sandhi Maria
2016-01-01
To investigate whether social relations, sociodemographic characteristics, lifestyle, and health conditions are associated with health-related quality of life (HRQOL) among elderly persons living in regions classified as high vulnerable in terms of health. A cross-sectional study conducted with a population-based random sample of 366 elderly (≥ 60 years of age) persons registered at a primary health-care unit in Belo Horizonte, Minas Gerais, Brazil. HRQOL was measured using the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) and the scores obtained in the physical component score (PCS) and mental component score (MCS) were our response variables. Social relations, sociodemographic characteristics, lifestyle, and health conditions were considered our groups of explanatory variables. Multiple linear regression models were used for the analysis. In the final multivariate models, we found that elevated number of diagnosis of chronic diseases, and being bedridden for the last 15 days were variables associated with worse PCS and MCS. However, lack of education, dissatisfaction with personal relationships, lack of support and help when bedridden or to go to the doctor, and to prepare meals were associated with worse HRQOL only in MCS. Participants who reported black race/color, absence of work activity, lack of physical activity, no alcohol consumption, and hospitalization in the last 12 months had worse HRQOL only in PCS. In addition to the aspects related to social adversity, lifestyle, and health conditions, some functional aspects of social relations were important for understanding the HRQOL in elderly persons living in social vulnerability.
Preventing the cure from being worse than the disease: special issues in hospital outsourcing.
Beardwood, John; Alleyne, Andrew
2004-01-01
Like private sector organizations, hospitals are increasingly outsourcing services from food/cafeteria and security and facilities maintenance to the consulting and training of personnel and information technology (IT) functions. Also like private sector organizations, while hospitals seek the cure that will improve services at less cost, without careful management, the cure can be worse than the disease.
Health and health-related indicators in slum, rural, and urban communities: a comparative analysis.
Mberu, Blessing U; Haregu, Tilahun Nigatu; Kyobutungi, Catherine; Ezeh, Alex C
2016-01-01
It is generally assumed that urban slum residents have worse health status when compared with other urban populations, but better health status than their rural counterparts. This belief/assumption is often because of their physical proximity and assumed better access to health care services in urban areas. However, a few recent studies have cast doubt on this belief. Whether slum dwellers are better off, similar to, or worse off as compared with rural and other urban populations remain poorly understood as indicators for slum dwellers are generally hidden in urban averages. The aim of this study was to compare health and health-related indicators among slum, rural, and other urban populations in four countries where specific efforts have been made to generate health indicators specific to slum populations. We conducted a comparative analysis of health indicators among slums, non-slums, and all urban and rural populations as well as national averages in Bangladesh, Kenya, Egypt, and India. We triangulated data from demographic and health surveys, urban health surveys, and special cross-sectional slum surveys in these countries to assess differences in health indicators across the residential domains. We focused the comparisons on child health, maternal health, reproductive health, access to health services, and HIV/AIDS indicators. Within each country, we compared indicators for slums with non-slum, city/urban averages, rural, and national indicators. Between-country differences were also highlighted. In all the countries, except India, slum children had much poorer health outcomes than children in all other residential domains, including those in rural areas. Childhood illnesses and malnutrition were higher among children living in slum communities compared to those living elsewhere. Although treatment seeking was better among slum children as compared with those in rural areas, this did not translate to better mortality outcomes. They bear a disproportionately
Alexandre, Tiago da Silva; Scholes, Shaun; Ferreira Santos, Jair Licio; Duarte, Yeda Aparecida de Oliveira; de Oliveira, Cesar
2017-10-02
The concept of dynapenic obesity has been gaining great attention recently. However, there is little epidemiological evidence demonstrating that dynapenic abdominal obese individuals have worse trajectories of disability than those with dynapenia and abdominal obesity alone. Our aim was to investigate whether dynapenia combined with abdominal obesity can result in worse trajectories of instrumental activities of daily living (IADL) among English and Brazilian older adults over eight and ten years of follow-up, respectively. We used longitudinal data from 3374 participants from the English Longitudinal Study of Ageing (ELSA) and 1040 participants from the Brazilian Health, Well-being and Aging Study (SABE) who were free from disability as assessed by IADL at baseline. IADL disability was defined herein as a difficulty to perform the following: preparing meals, managing money, using transportation, shopping, using the telephone, house cleaning, washing clothes, and taking medications according to the Lawton IADL modified scale. The study population in each country was categorized into non-dynapenic/non-abdominal obese (reference group), abdominal obese, dynapenic and dynapenic abdominal obese according to their handgrip strength (102 cm for men and >88 cm for women). We used generalized linear mixed models with IADL as the outcome. The estimated change over time in IADL disability was significantly higher for participants with dynapenic abdominal obesity compared to those with neither condition in both cohorts (ELSA: +0.023, 95% CI = 0.012-0.034, p < 0.001; SABE: +0.065, 95% CI = 0.038-0.091, p < 0.001). Abdominal obesity was also associated with changes over time in IADL disability (ELSA: +0.009, 95% CI = 0.002-0.015, p < 0.05; SABE: +0.021, 95% CI = 0.002-0.041, p < 0.05), which was not observed for dynapenia. Abdominal obesity is an important risk factor for IADL decline but participants with dynapenic abdominal obesity had the highest rates
Older adults rate their mental health better than their general health
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Elena M. Magwene
2017-09-01
Full Text Available Background. Self-rated health (SRH shows strong associations with measures of health and well-being. Increasingly, studies have used self-rated mental health (SRMH as a predictor of various outcomes, independently or together with SRH. Research has not firmly established if and how these two constructs differ. We sought to characterize the relationship between SRH and SRMH, and to determine how this relationship differed across subgroups defined by sociodemographic and health-related characteristics.Design and methods. We analyzed data from the 2012 CAHPS Medicare Advantage Survey. SRH and SRMH ratings were crosstabulated to determine the distribution of responses across response categories. The expected joint probability distribution was computed and compared to the observed distribution. A constructed variable indicated whether SRMH was better, the same, or worse than SRH. We analyzed the distribution of this variable across various subgroups defined by sociodemographic and health-related factors. Results. A total of 114,905 Medicare Advantage beneficiaries responded to both the SRH and SRMH questions. Both in general and within all subgroups, SRMH was usually rated as better than SRH, and rarely as worse. Conclusions. Within a large group of Medicare recipients, the overwhelming trend was for recipients to rate their mental health as at least as good as their overall health, regardless of any sociodemographic and health-related factors. This finding of a shifted distribution encourages caution in the analytic use of selfrated mental health, particularly the use of both SRH and SRMH for adjustment. Additional research is needed to help clarify the complex relationship between these variables.
Sex differences in health and mortality in Moscow and Denmark
DEFF Research Database (Denmark)
Oksuzyan, A; Shkolnikova, M; Vaupel, J W
2014-01-01
and a male advantage in self-rated health, physical functioning, and depression symptomatology. Only on cognitive tests males performed similarly to or worse than women. Nevertheless, Muscovite males had more than twice higher mortality at ages 55-69 years compared to Muscovite women, almost double the ratio......In high income countries females outlive men, although they generally report worse health, the so-called male-female health-survival paradox. Russia has one of the world's largest sex difference in life expectancy with a male disadvantage of more than 10 years. We compare components of the paradox...... between Denmark and Moscow by examining sex differences in mortality and several health measures. The Human Mortality Database and the Russian Fertility and Mortality Database were used to examine sex differences in all-cause death rates in Denmark, Russia, and Moscow in 2007-2008. Self-reported health...
Sticca, Fabio; Perren, Sonja
2013-05-01
Cyberbullying, a modern form of bullying performed using electronic forms of contact (e.g., SMS, MMS, Facebook, YouTube), has been considered as being worse than traditional bullying in its consequences for the victim. This difference was mainly attributed to some specific aspect that are believed to distinguish cyberbullying from traditional bullying: an increased potential for a large audience, an increased potential for anonymous bullying, lower levels of direct feedback, decreased time and space limits, and lower levels of supervision. The present studies investigated the relative importance of medium (traditional vs. cyber), publicity (public vs. private), and bully's anonymity (anonymous vs. not anonymous) for the perceived severity of hypothetical bullying scenarios among a sample of Swiss seventh- and eight-graders (study 1: 49% female, mean age = 13.7; study 2: 49% female, mean age = 14.2). Participants ranked a set of hypothetical bullying scenarios from the most severe one to the least severe one. The scenarios were experimentally manipulated based on the aspect of medium and publicity (study 1), and medium and anonymity (study 2). Results showed that public scenarios were perceived as worse than private ones, and that anonymous scenarios were perceived as worse than not anonymous ones. Cyber scenarios generally were perceived as worse than traditional ones, although effect sizes were found to be small. These results suggest that the role of medium is secondary to the role of publicity and anonymity when it comes to evaluating bullying severity. Therefore, cyberbullying is not a priori perceived as worse than traditional bullying. Implications of the results for cyberbullying prevention and intervention are discussed.
Gender Differences in Adult Health: An International Comparison.
Rahman, Omar; And Others
1994-01-01
Used data from United States, Jamaica, Malaysia, and Bangladesh to explore gender differences in adult health. Found that women fared worse than men across variety of self-reported health measures in all four countries. Data from Jamaica indicated that gender disparities in adult health arose early and persisted throughout the life cycle, with…
Bielewicz, Joanna; Kurzepa, Jacek; Czekajska-Chehab, Elżbieta; Kamieniak, Piotr; Daniluk, Beata; Bartosik-Psujek, Halina; Rejdak, Konrad
2016-04-01
High serum albumin levels during ischemic stroke (IS) decrease the risk of a poor outcome. This study aimed to determine whether serum albumin levels within the first days after IS correlate with radiological and biochemical markers of brain tissue damage. Fifty-six IS patients were enrolled into the study. Neurological examinations were based on the National Institute of Health Stroke Scale. Serum albumin levels and S100BB were evaluated using commercially available ELISA kits. The albumin decrease index (ADI) was calculated as the difference between serum albumin levels measured on days 1 and 10 of IS. All parameters were estimated on the 1st, 3rd, 5th, and 10th days of IS, and the volume of ischemic focus was measured on the 10th day. Mean serum albumin levels were decreased during acute IS. There were correlations between the ADI and mean S100BB serum levels (r = 0.36, p albumin levels during the acute phase of IS corresponds to a worse neurological state as a result of a large ischemic focus with intense catabolic processes.
Improving quality of life and physical health in patients with schizophrenia
DEFF Research Database (Denmark)
Hjorth, Peter; Medici, Clara Reece; Juel, Anette
2017-01-01
BACKGROUND: Patients with schizophrenia experience low quality of life (QoL) and poor physical health, which is explained, in part, by unhealthy lifestyle, tobacco smoking, poor diet and sedentary behavior. AIM: To measure QoL and physical health in patients with schizophrenia and to quantify...... associations between QoL and physical health. METHODS: This was a naturalistic longitudinal 30-month follow-up study including individual guidance, group sessions and treatment as usual. RESULTS: We included 190 patients. QoL was low among newly diagnosed patients. Higher body mass index was significantly...... associated with lower QoL. Newly diagnosed male patients showed lower QoL compared with females. Newly diagnosed patients experienced worsened health during the study period. In contrast, long-term schizophrenic patients started with worse physical health but improved with regard to weight, waist...
Psychosocial correlates of health practices in black South African ...
African Journals Online (AJOL)
... very occasional or no alcohol, limited red meat, and never sunbathed or used suncreen in that order. Formal education of the mother, internal locus of control and worse health status were positively associated with the health practices index. Other sociodemographic (age, SES, religion) and psychological (health value, ...
Santric-Milicevic, M; Vasic, V; Terzic-Supic, Z
2016-08-15
In times of austerity, the availability of econometric health knowledge assists policy-makers in understanding and balancing health expenditure with health care plans within fiscal constraints. The objective of this study is to explore whether the health workforce supply of the public health care sector, population number, and utilization of inpatient care significantly contribute to total health expenditure. The dependent variable is the total health expenditure (THE) in Serbia from the years 2003 to 2011. The independent variables are the number of health workers employed in the public health care sector, population number, and inpatient care discharges per 100 population. The statistical analyses include the quadratic interpolation method, natural logarithm and differentiation, and multiple linear regression analyses. The level of significance is set at P Total health expenditure increased by 1.21 standard deviations, with an increase in health workforce growth rate by 1 standard deviation. Furthermore, this rate decreased by 1.12 standard deviations, with an increase in (negative) population growth rate by 1 standard deviation. Finally, the growth rate increased by 0.38 standard deviation, with an increase of the growth rate of inpatient care discharges per 100 population by 1 standard deviation (P < 0.001). Study results demonstrate that the government has been making an effort to control strongly health budget growth. Exploring causality relationships between health expenditure and health workforce is important for countries that are trying to consolidate their public health finances and achieve universal health coverage at the same time.
Kidwell, Katherine M; Nelson, Timothy D; Van Dyk, Tori
2015-11-01
This study examined child anxiety as a potential moderator of the relationship between parenting stress and child physical health. Low-income youth (N = 109, M = 9.51 years old) and their parents completed measures of anxiety, health-related quality of life, and parenting stress in an outpatient clinic. As an objective measure of physical health, medical service utilization was extracted from medical records. Parenting stress was associated significantly with worse health-related quality of life and higher service utilization. Child anxiety moderated the relationship between stress and health. Health psychologists should target both family stress and child anxiety in promoting better health outcomes among low-income families. © The Author(s) 2013.
Hong, Keun-Sik; Lee, Juneyoung; Bae, Hee-Joon; Lee, Ji Sung; Kang, Dong-Wha; Yu, Kyung-Ho; Han, Moon-Ku; Cho, Yong-Jin; Song, Pamela; Park, Jong-Moo; Oh, Mi-Sun; Koo, Jaseong; Lee, Byung-Chul
2013-11-01
Cardioembolic (CE) strokes are more disabling and more fatal than non-CE strokes. Multiple prognostic factors have been recognized, but the magnitude of their relative contributions has not been well explored. Using a prospective stroke outcome database, we compared the 3-month outcomes of CE and non-CE strokes. We assessed the relative contribution of each prognostic factor of initial stroke severity, poststroke complications, and baseline characteristics with multivariable analyses and model fitness improvement using -2 log-likelihood and Nagelkerke R2. This study included 1233 patients with acute ischemic stroke: 193 CE strokes and 1040 non-CE strokes. Compared with the non-CE group, CE group had less modified Rankin Scale (mRS) 0-2 outcomes (47.2% versus 68.5%; odds ratio [95% confidence interval], .41 [.30-.56]), less mRS 0-1 outcomes (33.7% versus 53.5%; .44 [.32-.61]), more mRS 5-6 outcomes (32.1% versus 10.9%; 3.88 [2.71-5.56]), and higher mortality (19.2% versus 5.2%; 4.33 [2.76-6.80]) at 3 months. When adjusting either baseline characteristics or poststroke complications, the outcome differences between the 2 groups remained significant. However, adjusting initial National Institute of Health Stroke Scale (NIHSS) score alone abolished all outcome differences except for mortality. For mRS 0-2 outcomes, the decrement of -2 log-likelihood and the Nagelkerke R2 of the model adjusting initial NIHSS score alone approached 70.2% and 76.7% of the fully adjusting model. Greater stroke severity predominates over all other factors for the worse outcome of CE stroke. Primary prevention and more efficient acute therapy for stroke victims should be given top priorities to reduce the burden of CE strokes. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.
A Consumer Health Information System to Assist Patients Select Quality Home Health Services
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Dimitrios Zikos
2017-11-01
Full Text Available Patients evaluate the quality of home health agencies (HHAs using the Health Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey. This paper describes a prototype community health information system to help patients select appropriate and quality HHAs, according to the location, proprietary status, type of service, and year of HHA establishment. Five HCAHPS indicators were selected: “summary rating”, “quality of care”, “professional care”, “communication”, and “recommend agency”. Independent t-test analysis showed that agencies offering Speech Pathology, Medical-Social, or Home Health Aide services, receive significantly worse HCAHPS ratings, while mean ratings vary significantly across different US states. Multiple comparisons with post hoc ANOVA revealed differences between and within HHAs of different proprietary status (p < 0.001: governmental HHAs receiving higher ratings than private HHAs. Finally, there was observed a relationship between all five quality rating variables and the HHA year of establishment (Pearson, p < 0.001. The older the agency is, the better the HCAPS summary ratings. Findings provided the knowledge to design of a consumer health information system, to provide rankings filtered according to user criteria, comparing the quality rankings of eligible HHAs. Users can also see how a specific agency is ranked against eligible HHAs. Ultimately, the system aims to support the patient community with contextually realistic comparisons in an effort to choose optimal HH service.
Wealth, Health Expenditure, and Cancer: A National Perspective.
Chahoud, Jad; Semaan, Adele; Rieber, Alyssa
2016-08-01
The US health care system is characterized by high health expenditures with penultimate outcomes. This ecological study evaluates the associations between wealth, health expenditure, and cancer outcomes at the state level. We extracted gross domestic product (GDP) and health expenditure per capita from the 2009 Bureau of Economic Analysis and the Centers for Medicare & Medicaid Services, respectively. Using data from the NCI, we retrieved colorectal cancer (CRC), breast cancer, and all-cancer age-adjusted rates and computed mortality/incidence (M/I) ratios. We used the Spearman's rank correlation to determine the association between the financial indicators and cancer outcomes, and we constructed geographic distribution maps to describe these associations. GDP per capita significantly correlated with lower M/I ratios for all cancers, breast cancer, and CRC. As for health expenditure per capita, preliminary analysis highlighted a rift between the Northeastern and Southern states, which translated into worse breast and all-cancer outcomes in Southern states. Further analysis showed that higher health expenditure significantly correlated with decreased breast cancer M/I ratio. However, CRC outcomes were not significantly affected by health expenditure, nor were all-cancer outcomes. All cancers, breast cancer, and CRC outcomes significantly correlated with wealth, whereas only breast cancer correlated with higher health expenditure. Future research is needed to evaluate the potential role of policies in optimizing resource allocation in the states' efforts against CRC and minimizing disparities in interstate cancer outcomes. Copyright © 2016 by the National Comprehensive Cancer Network.
Jackson, Chazeman S; Gracia, J Nadine
2014-01-01
Despite major advances in medicine and public health during the past few decades, disparities in health and health care persist. Racial/ethnic minority groups in the United States are at disproportionate risk of being uninsured, lacking access to care, and experiencing worse health outcomes from preventable and treatable conditions. As reducing these disparities has become a national priority, insight into the social determinants of health has become increasingly important. This article offers a rationale for increasing the diversity and cultural competency of the health and health-care workforce, and describes key strategies led by the U.S. Department of Health and Human Services' Office of Minority Health to promote cultural competency in the health-care system and strengthen community-level approaches to improving health and health care for all.
Legal Marriage, Unequal Recognition, and Mental Health among Same-Sex Couples.
LeBlanc, Allen J; Frost, David M; Bowen, Kayla
2018-04-01
The authors examined whether the perception of unequal relationship recognition, a novel, couple-level minority stressor, has negative consequences for mental health among same-sex couples. Data came from a dyadic study of 100 ( N = 200) same-sex couples in the U.S. Being in a legal marriage was associated with lower perceived unequal recognition and better mental health; being in a registered domestic partnership or civil union - not also legally married - was associated with greater perceived unequal recognition and worse mental health. Actor Partner Interdependence Models tested associations between legal relationship status, unequal relationship recognition, and mental health (nonspecific psychological distress, depressive symptomatology, and problematic drinking), net controls (age, gender, race/ethnicity, education, and income). Unequal recognition was consistently associated with worse mental health, independent of legal relationship status. Legal changes affecting relationship recognition should not be seen as simple remedies for addressing the mental health effects of institutionalized discrimination.
Health related quality of life in parents of children with speech and hearing impairment.
Aras, Ivana; Stevanović, Ranko; Vlahović, Sanja; Stevanović, Siniša; Kolarić, Branko; Kondić, Ljiljana
2014-02-01
Hearing impairment and specific language disorder are two entities that seriously affect language acquisition in children and reduce their communication skills. These children require specific treatment and higher levels of care than healthy children. Their language abilities also strongly influence parent-child interactions. The purpose of our study was to evaluate the health-related quality of life (HRQOL) of the parents of hearing-impaired children and the parents of children with speech difficulties (specific language disorder). Our study subjects included 349 parents (182 mothers and 167 fathers) of preschool-aged children with receptive expressive language disorder and 131 parents (71 mothers and 60 fathers) of children with severe hearing impairment. A control group was composed of 146 parents (82 mothers and 64 fathers) of healthy children of the same age. HRQOL was assessed using the SF-36 questionnaire. For all groups of parents, the mothers had poorer scores compared with the fathers, but large differences were apparent depending on the child's impairment. In the control group, the scores of the mothers were significantly lower than the fathers' scores in only two (of eight) health domains. In contrast, the scores were lower in three domains for the mothers of speech-impaired children and in six domains for the mothers of hearing-impaired children, representing the greatest difference between the parents. When compared with the control group, both the mothers and fathers of speech-impaired children scored significantly worse in five health domains. Fathers of hearing-impaired children scored significantly worse than controls in three health domains. The lowest scores, indicating the poorest HRQOL, were observed for mothers of hearing-impaired children, who obtained significantly lower scores than the control mothers in all health domains except the emotional role. The parents of preschool-aged speech-and hearing-impaired children experience poorer HRQOL
Altered mitochondrial genome content signals worse pathology and prognosis in prostate cancer.
Kalsbeek, Anton M F; Chan, Eva K F; Grogan, Judith; Petersen, Desiree C; Jaratlerdsiri, Weerachai; Gupta, Ruta; Lyons, Ruth J; Haynes, Anne-Maree; Horvath, Lisa G; Kench, James G; Stricker, Phillip D; Hayes, Vanessa M
2018-01-01
Mitochondrial genome (mtDNA) content is depleted in many cancers. In prostate cancer, there is intra-glandular as well as inter-patient mtDNA copy number variation. In this study, we determine if mtDNA content can be used as a predictor for prostate cancer staging and outcomes. Fresh prostate cancer biopsies from 115 patients were obtained at time of surgery. All cores underwent pathological review, followed by isolation of cancer and normal tissue. DNA was extracted and qPCR performed to quantify the total amount of mtDNA as a ratio to genomic DNA. Differences in mtDNA content were compared for prostate cancer pathology features and disease outcomes. We showed a significantly reduced mtDNA content in prostate cancer compared with normal adjacent prostate tissue (mean difference 1.73-fold, P-value Prostate cancer with increased mtDNA content showed unfavorable pathologic characteristics including, higher disease stage (PT2 vs PT3 P-value = 0.018), extracapsular extension (P-value = 0.02) and a trend toward an increased Gleason score (P-value = 0.064). No significant association was observed between changes in mtDNA content and biochemical recurrence (median follow up of 107 months). Contrary to other cancer types, prostate cancer tissue shows no universally depleted mtDNA content. Rather, the change in mtDNA content is highly variable, mirroring known prostate cancer genome heterogeneity. Patients with high mtDNA content have an unfavorable pathology, while a high mtDNA content in normal adjacent prostate tissue is associated with worse prognosis. © 2017 Wiley Periodicals, Inc.
Directory of Open Access Journals (Sweden)
Knopp Katarzyna A.
2016-12-01
Full Text Available This study investigates the relationship between EI and the state of mental health of unemployed persons. Gender differences were also identified in terms of mental health and its correlation with EI. A sample of 160 Polish unemployed persons aged 35 to 45 years filled in self-descriptive measures of EI and mental health. Significant gender differences were found - unemployed women were characterised by a greater intensity of mental health disorders than unemployed men. EI was negatively correlated with mental health disorders, but the correlations were few and weaker than expected. However, when unemployed persons with a low, average and high EI were compared, it turned out that participants with a low EI were characterised by a significantly worse condition of mental health than participants with a average or high EI.
Doll, Kemi M; Kalinowski, Alison K; Snavely, Anna C; Irwin, Debra E; Bensen, Jeannette T; Bae-Jump, Victoria L; Kim, Kenneth H; Van Le, Linda; Clarke-Pearson, Daniel L; Gehrig, Paola A
2015-02-01
The objective of the current study was to evaluate the effect of obesity on pretreatment quality of life (QoL) in gynecologic oncology patients. The authors analyzed collected data from an institution-wide cohort study of women with gynecologic cancers enrolled from August 2012 to June 2013. The Functional Assessment of Cancer Therapy-General, site-specific symptom scales, and the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) global mental and physical health tools were administered. Survey results were linked to clinical data abstracted from medical records (demographics and comorbid conditions). Bivariate tests and multivariate linear regression models were used to evaluate factors associated with QoL scores. A total of 182 women with ovarian, uterine, cervical, and vulvar/vaginal cancers were identified; of these, 152 (84%) were assessed before surgery. Mean body mass index was 33.5 kg/m(2) and race included white (120 patients [79%]), black (22 patients [15%]), and other (10 patients [6.5%]). A total of 98 patients (64.5%) were obese (body mass index ≥30). On multivariate analysis, subscales for functional (17 vs 19; P = .04), emotional (16 vs 19; P = .008), and social (22 vs 24; P = .02) well-being as well as overall Functional Assessment of Cancer Therapy-General scores (77 vs 86; P = .002) and Patient-Reported Outcomes Measurement Information System global physical health scores (45 vs 49; P = .003) were found to be significantly lower in obese versus nonobese patients. Before cancer treatment, obese patients with gynecologic malignancies appear to have worse baseline QoL than their normal-weight counterparts. Emerging models of QoL-based cancer outcome measures may disproportionately affect populations with a high obesity burden. The potential disparate impact of cancer therapy on longitudinal QoL in the obese versus nonobese patients needs to be evaluated. © 2014 American Cancer
Psychosocial factors and pre-abortion psychological health: The significance of stigma.
Steinberg, Julia R; Tschann, Jeanne M; Furgerson, Dorothy; Harper, Cynthia C
2016-02-01
Most research in mental health and abortion has examined factors associated with post-abortion psychological health. However, research that follows women from before to after their abortion consistently finds that depressive, anxiety, and stress symptoms are highest just before an abortion compared to any time afterwards. This finding suggests that studies investigating psychosocial factors related to pre-abortion mental health are warranted. The current study uses data from 353 women seeking abortions at three community reproductive health clinics to examine predictors of pre-abortion psychological health. Drawing from three perspectives in the abortion and mental health literature, common risks, stress and coping, and sociocultural context, we conducted multivariable analyses to examine the contribution of important factors on depressive, anxiety, and stress symptoms just before an abortion, including sociodemographics, abortion characteristics, childhood adversities, recent adversities with an intimate partner, relationship context, future pregnancy desires, and perceived abortion stigma. Childhood and partner adversities, including reproductive coercion, were associated with negative mental health symptoms, as was perceived abortion stigma. Before perceived abortion stigma was entered into the model, 18.6%, 20.7%, and 16.8% of the variance in depressive, anxiety, and stress symptoms respectively, was explained. Perceived abortion stigma explained an additional 13.2%, 9.7%, and 10.7% of the variance in depressive, anxiety, and stress symptoms pre-abortion. This study, one of the first to focus on pre-abortion mental health as an outcome, suggests that addressing stigma among women seeking abortions may significantly lower their psychological distress. Copyright © 2015 Elsevier Ltd. All rights reserved.
Factors associated with self-rated health in older people living in institutions
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Pastor-Barriuso Roberto
2008-02-01
Full Text Available Abstract Background Although self-rated health has been extensively studied in community older people, its determinants have seldom been investigated in institutional settings. We carried out a cross-sectional study to describe the physical, mental, and social factors associated with self-rated health in nursing homes and other geriatric facilities. Methods A representative sample of 800 subjects 65 years of age and older living in 19 public and 30 private institutions of Madrid was randomly selected through stratified cluster sampling. Residents, caregivers, physicians, and nurses were interviewed by trained geriatricians using standardized instruments to assess self-rated health, chronic illnesses, functional capacity, cognitive status, depressive symptoms, vision and hearing problems, and social support. Results Of the 669 interviewed residents (response rate 84%, 55% rated their health as good or very good. There was no association with sex or age. Residents in private facilities and those who completed primary education had significantly better health perception. The adjusted odds ratio (95% confidence interval for worse health perception was 1.18 (1.07–1.28 for each additional chronic condition, 2.37 (1.38–4.06 when comparing residents with moderate dependency to those functionally independent, and 10.45 (5.84–18.68 when comparing residents with moderate/severe depressive symptoms to those without symptoms. Visual problems were also associated with worse health perception. Similar results were obtained in subgroup analyses, except for inconsistencies in cognitively impaired individuals. Conclusion Chronic conditions, functional status, depressive symptoms and socioeconomic factors were the main determinants of perceived health among Spanish institutionalized elderly persons. Doubts remain about the proper assessment of subjective health in residents with altered cognition.
Lundberg, Evelina; Svaleryd, Helena
2017-01-01
Previous research has established that birth order affects outcomes such as educational achievements, IQ and earnings. The mechanisms behind these effects are, however, still largely unknown. In this paper, we examine birth-order effects on health, and whether health at young age could be a transmission channel for birth-order effects observed later in life. We find no support for the birth-order effect having a biological origin; rather firstborns have worse health at birth. This disadvantag...
Sexual Harassment: Health Care, It Is #YouToo.
Ladika, Susan
2018-02-01
There's no question that sexual harassment-and worse-is common at the country's hospitals, clinics, research labs, and doctor's offices. Health care's gender imbalances create situations that are ripe for abuse: Women make up the majority of the workforce in health care but men still dominate positions of authority.
Health and health-related indicators in slum, rural, and urban communities: a comparative analysis
Mberu, Blessing U.; Haregu, Tilahun Nigatu; Kyobutungi, Catherine; Ezeh, Alex C.
2016-01-01
Background It is generally assumed that urban slum residents have worse health status when compared with other urban populations, but better health status than their rural counterparts. This belief/assumption is often because of their physical proximity and assumed better access to health care services in urban areas. However, a few recent studies have cast doubt on this belief. Whether slum dwellers are better off, similar to, or worse off as compared with rural and other urban populations remain poorly understood as indicators for slum dwellers are generally hidden in urban averages. Objective The aim of this study was to compare health and health-related indicators among slum, rural, and other urban populations in four countries where specific efforts have been made to generate health indicators specific to slum populations. Design We conducted a comparative analysis of health indicators among slums, non-slums, and all urban and rural populations as well as national averages in Bangladesh, Kenya, Egypt, and India. We triangulated data from demographic and health surveys, urban health surveys, and special cross-sectional slum surveys in these countries to assess differences in health indicators across the residential domains. We focused the comparisons on child health, maternal health, reproductive health, access to health services, and HIV/AIDS indicators. Within each country, we compared indicators for slums with non-slum, city/urban averages, rural, and national indicators. Between-country differences were also highlighted. Results In all the countries, except India, slum children had much poorer health outcomes than children in all other residential domains, including those in rural areas. Childhood illnesses and malnutrition were higher among children living in slum communities compared to those living elsewhere. Although treatment seeking was better among slum children as compared with those in rural areas, this did not translate to better mortality
Health and health-related indicators in slum, rural, and urban communities: a comparative analysis
Directory of Open Access Journals (Sweden)
Blessing U. Mberu
2016-12-01
Full Text Available Background: It is generally assumed that urban slum residents have worse health status when compared with other urban populations, but better health status than their rural counterparts. This belief/assumption is often because of their physical proximity and assumed better access to health care services in urban areas. However, a few recent studies have cast doubt on this belief. Whether slum dwellers are better off, similar to, or worse off as compared with rural and other urban populations remain poorly understood as indicators for slum dwellers are generally hidden in urban averages. Objective: The aim of this study was to compare health and health-related indicators among slum, rural, and other urban populations in four countries where specific efforts have been made to generate health indicators specific to slum populations. Design: We conducted a comparative analysis of health indicators among slums, non-slums, and all urban and rural populations as well as national averages in Bangladesh, Kenya, Egypt, and India. We triangulated data from demographic and health surveys, urban health surveys, and special cross-sectional slum surveys in these countries to assess differences in health indicators across the residential domains. We focused the comparisons on child health, maternal health, reproductive health, access to health services, and HIV/AIDS indicators. Within each country, we compared indicators for slums with non-slum, city/urban averages, rural, and national indicators. Between-country differences were also highlighted. Results: In all the countries, except India, slum children had much poorer health outcomes than children in all other residential domains, including those in rural areas. Childhood illnesses and malnutrition were higher among children living in slum communities compared to those living elsewhere. Although treatment seeking was better among slum children as compared with those in rural areas, this did not translate to
Gender inequities in health: an exploratory qualitative study of Saudi women's perceptions.
Alyaemni, Asmaa; Theobald, Sally; Faragher, Brian; Jehan, Kate; Tolhurst, Rachel
2013-01-01
This study aimed to explore Saudi Arabian women's perceptions of how gendered social structures affect their health by understanding their perceptions of these influences on their health relative to those on men's health. Qualitative methods, including focus group discussions (FGDs) and in-depth individual interviews (IDIs) were conducted with 66 married women in Riyadh, the capital city. Participants were purposively sampled for maximum variation, including consideration of socio-economic status, age, educational level, health status and the use of healthcare. The majority of women perceived their health to be worse than men's and attributed this to their childbearing, domestic and care-giving roles, restrictions on their mobility, poverty and psychological stress related to their responsibilities for children, and marital conflict. A minority of participants felt that men's health was worse than women's and related this to their gendered roles as "breadwinners," greater mobility and masculine norms and identities. Gender equity should be a health policy priority to improve women's health.
Junge, S. (Sibylle); Görlich, D. (Dennis); Reijer, M.D. (Martijn Den); Wiedemann, Baerbel; Tümmler, Burkhard; Ellemunter, H.; Dübbers, A. (Angelika); Küster, P. (Peter); Ballmann, M.; Koerner-Rettberg, C. (Cordula); Große-Onnebrink, J. (Jörg); Heuer, E. (Eberhardt); Sextro, W. (Wolfgang); Mainz, J.G. (Jochen G.); Hammermann, J. (Jutta)
2016-01-01
textabstractBackground Staphylococcus aureus is an important pathogen in cystic fibrosis (CF). However, it is not clear which factors are associated with worse lung function in patients with persistent S. aureus airway cultures. Our main hypothesis was that patients with high S. aureus density in their respiratory specimens would more likely experience worsening of their lung disease than patients with low bacterial loads. Methods Therefore, we conducted an observational prospective longitudi...
Do Elderly Patients With Non-hematologic Malignancies Have A Worse Outcome in the ICU?
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Tzu-Tao Chen
2009-12-01
Conclusion: The main cause of death and survival rates, both short-term and long-term, were not worse in elderly patients with non-hematologic malignancies in the ICU, and the main reasons for patient death were sepsis and respiratory failure, rather than the malignancy itself. Therefore, an ICU admission policy should not exclude elderly patients with non-hematologic malignancies merely because of concerns about survival rate or life expectancy.
Coalfield health effects: Variation in health across former coalfield areas in England
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Riva, M.; Terashima, M.; Curtis, S.; Shucksmith, J.; Carlebach, S. [University of Durham, Durham (United Kingdom)
2011-03-15
Regions affected by deindustrialisation are often characterised by unfavourable local health profiles. This was the situation in coalfield areas in England, where the scale and suddenness of the job losses in the 1980s and 1990s left these communities experiencing difficult socioeconomic conditions, and associated poor health status. Using data from the Health Survey for England, this paper examines whether poorer health outcomes still characterise coalfield areas today. Findings confirm a 'coalfield health effect' related to limiting long-term illness. With regards to self reported general health and mental health outcomes, results are less clear. The population health profile of coalfield communities is not homogeneous, with some coalfield communities faring worse than others, indicating more localised health issues.
Sprauve-Holmes, Nancy E; Gaughan, John; Kaslow, Nadine J.
2009-01-01
Abstract Background Family violence among older women encompasses intimate partner violence (IPV) and elder maltreatment, both linked to poor health status. Little is known about the association between family violence and the health status of older innercity African American women. Methods One hundred fifty-eight African American women, aged ≥50, were interviewed in the ambulatory clinics of a large public hospital. Lifetime family violence exposure as an adult was measured by the Family Violence against Older Women (FVOW) scale; physical and mental health status were measured by the physical and mental component summary scores of the Short Form 8® scale. Results Mean participant age was 61.5 years (SD 7.1). Participants with FVOW scores in the top quartile were considered to have high lifetime family violence exposure. Participants with higher family violence exposure and those younger, unemployed, or disabled reported worse physical and mental health status. Lower income and not having Medicare were associated with worse physical and mental health status, respectively. Using stepwise linear regression techniques, only employment status and high family violence exposure were associated with worse physical (F = 7.16, p = 0.0011) and mental health (f = 7.09, p = 0.0012) status. Women with high FVOW scores reported physical and mental component summary scores that were 4.18 and 4.6 points lower, respectively, than those of women with lower FVOW scores. Conclusions Among older, innercity, African American women, lack of employment and high levels of family violence exposure as an adult are associated with worse physical and mental health status. Clinicians caring for older African American women need to be cognizant of the role both current and prior violence exposure may play in their patients' current health status. PMID:19183088
Lincoln, Alisa; Paasche-Orlow, Michael K; Cheng, Debbie M; Lloyd-Travaglini, Christine; Caruso, Christine; Saitz, Richard; Samet, Jeffrey H
2006-08-01
Health literacy has been linked to health status in a variety of chronic diseases. However, evidence for a relationship between health literacy and mental health outcomes is sparse. We hypothesized that low literacy would be associated with higher addiction severity, higher levels of depressive symptoms, and worse mental health functioning compared with those with higher literacy in adults with alcohol and drug dependence. The association of literacy with multiple mental health outcomes was assessed using multivariable analyses. Measurement instruments included the Rapid Estimate of Adult Literacy in Medicine (REALM), the Center for Epidemiologic Studies-Depression (CES-D) scale, the Mental Component Summary scale of the Short Form Health Survey, and the Addiction Severity Index for drug and alcohol addiction. Subjects included 380 adults recruited during detoxification treatment and followed prospectively at 6-month intervals for 2 years. Based on the REALM, subjects were classified as having either low ( or = 9th grade) literacy levels. In longitudinal analyses, low literacy was associated with more depressive symptoms. The adjusted mean difference in CES-D scores between low and high literacy levels was 4 (Pmental health-related quality of life or addiction severity. In people with alcohol and drug dependence, low literacy is associated with worse depressive symptoms. The mechanisms underlying the relationship between literacy and mental health outcomes should be explored to inform future intervention efforts.
VDR mRNA overexpression is associated with worse prognostic factors in papillary thyroid carcinoma
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June Young Choi
2017-03-01
Full Text Available The purpose of this study was to assess the relationship between vitamin D receptor gene (VDR expression and prognostic factors in papillary thyroid cancer (PTC. mRNA sequencing and somatic mutation data from The Cancer Genome Atlas (TCGA were analyzed. VDR mRNA expression was compared to clinicopathologic variables by linear regression. Tree-based classification was applied to find cutoff and patients were split into low and high VDR group. Logistic regression, Kaplan–Meier analysis, differentially expressed gene (DEG test and pathway analysis were performed to assess the differences between two VDR groups. VDR mRNA expression was elevated in PTC than that in normal thyroid tissue. VDR expressions were high in classic and tall-cell variant PTC and lateral neck node metastasis was present. High VDR group was also associated with classic and tall cell subtype, AJCC stage IV and lower recurrence-free survival. DEG test reveals that 545 genes were upregulated in high VDR group. Thyroid cancer-related pathways were enriched in high VDR group in pathway analyses. VDR mRNA overexpression was correlated with worse prognostic factors such as subtypes of papillary thyroid carcinoma that are known to be worse prognosis, lateral neck node metastasis, advanced stage and recurrence-free survival.
Health Status and Psychological Distress in Patients with Non-compaction Cardiomyopathy
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Brouwers, Corline; Caliskan, Kadir; Bos, Sven
2015-01-01
patients and 42 DCM patients. Outcome measures were health status (Short Form Health Survey-12), anxiety (Generalized Anxiety Disorder 7-item scale) and depression (Patient Health Questionnaire 9-item scale). RESULTS: NCCM patients showed significantly worse health status (Physical Component Score F(1...... from DCM patients (Physical Component Score F(1,82) = 2,61, P = .11; Mental Component Score F(1,82) = .55, P = .46), anxiety (F(1,82) = 1.16, P = .28) and depression scores (F(1,82) = 1,95, P = .17). CONCLUSION: Cardiac symptoms are likely to play a role in the observed poor health status and elevated......BACKGROUND: Non-compaction cardiomyopathy (NCCM) is a cardiomyopathy characterized by left ventricular tribeculae and deep intertrabecular recesses. Because of its genetic underpinnings and physical disease burden, noncompaction cardiomyopathy is expected to be associated with a lower health status...
Racial/ethnic disparities and culturally competent health care among youth and young men.
Vo, Dzung X; Park, M Jane
2008-06-01
Racial/ethnic disparities in health and health care are receiving increasing national attention from the fields of public health and medicine. Efforts to reduce disparities should adopt a life-span approach and recognize the role of gender. During adolescence, young people make increasingly independent decisions about health-related behavior and health care, while developing gender identity. Little is known about how cultural context shapes gender identity and gender identity's influence on health-related behavior and health care utilization. The authors review disparities in health status and health care among adolescents, especially young men, by reviewing health care access, clinical services, and issues related to culture, identity, and acculturation. Significant differences in health status by gender exist in adolescence, with young men faring worse on many health markers. This article discusses gaps in research and offers recommendations for improving health care quality and strengthening the research base on gender and disparities during adolescence.
Junge, Sibylle; G?rlich, Dennis; den Reijer, Martijn; Wiedemann, B?rbel; T?mmler, Burkhard; Ellemunter, Helmut; D?bbers, Angelika; K?ster, Peter; Ballmann, Manfred; Koerner-Rettberg, Cordula; Gro?e-Onnebrink, J?rg; Heuer, Eberhardt; Sextro, Wolfgang; Mainz, Jochen G.; Hammermann, Jutta
2016-01-01
Background Staphylococcus aureus is an important pathogen in cystic fibrosis (CF). However, it is not clear which factors are associated with worse lung function in patients with persistent S. aureus airway cultures. Our main hypothesis was that patients with high S. aureus density in their respiratory specimens would more likely experience worsening of their lung disease than patients with low bacterial loads. Methods Therefore, we conducted an observational prospective longitudinal multi-ce...
Health-related quality of life in a binational population with diabetes at the Texas-Mexico border.
Mier, Nelda; Bocanegra-Alonso, Anabel; Zhan, Dongling; Zuniga, Miguel A; Acosta, Rosa I
2008-03-01
To examine physical and mental health domains of health-related quality of life (HRQL) in a binational adult population with type 2 diabetes at the Texas-Mexico border, and to explore individual and social correlates to physical and mental health status. Adults 18 years and older with type 2 diabetes residing in the South Texas Lower Rio Grande Valley and in Reynosa, Tamaulipas, Mexico, were recruited using a convenience sampling technique and interviewed face-to-face with a structured survey. HRQL was measured using physical and mental health summary components of the Medical Outcomes Study Short Form. HRQL correlates included demographic characteristics, health factors, access to healthcare, and family support. Samples characteristics were compared using the Student's t-test or Mann-Whitney U test. Associations between dependent and independent variables were examined using unadjusted and adjusted (multiple variable) logistic regression models. There were no significant differences between Valley and Reynosa respondents in physical or mental health status scores. Valley participants with lower socioeconomic status and those perceiving their supportive relative's level of diabetes-related knowledge as "low" were more likely to report worse physical health than those lacking those characteristics. In the Reynosa group, lower physical health status was associated with duration of diabetes and insulin use. Both sample populations with clinical depressive symptoms were more likely to have worse physical and mental health than those without such symptoms. HRQL is an important outcome in monitoring health status. Understanding the levels and influences of HRQL in U.S.-Mexico border residents with diabetes may help improve diabetes management programs.
Gecková, Andrea Madarasová; Babinská, Ingrid; Bobáková, Daniela; Veselská, Zuzana Dankulincová; Bosáková, Lucia; Kolarcik, Peter; Jarcuska, Peter; Pella, Daniel; Halánová, Monika
2014-03-01
The aim of this study was to compare socioeconomic characteristics of the Roma population living in Roma settlements with the majority population. Moreover, it was aimed to assess socioeconomic differences in health and health-related behaviour within the population living in Roma settlements. Data from the cross-sectional HepaMeta study conducted in Slovakia in 2011 were used. The sample consisted of 452 Roma (mean age = 34.7; 35.2% men) and 403 non-Roma (mean age = 33.5; 45.9% men) respondents. Roma in selected settlements were recruited by local Roma community workers. Respondents from the major population were randomly selected from a list of patients from general practitioners. Data were collected via questionnaire, anthropometric measures and analysed blood samples. Differences in socioeconomic characteristics between the population living in Roma settlements and the majority population were tested using the chi-square test. The contribution of selected socioeconomic characteristics on health and health-related behaviour of the population living in Roma settlements was assessed by logistic regression models adjusted for age and gender. The population living in Roma settlements is characterised by significantly lower socioeconomic standards, and the living conditions are significantly worse compared with the majority. With few exceptions, the study did not confirm any significant association between socioeconomic indicators and health and health-related behaviour within the population living in Roma settlements. The deteriorating effect of living in Roma settlement on health and health-related behaviour seems to be immense regardless differences in socioeconomic characteristics or living condition within the settlement population.
International Nuclear Information System (INIS)
Fang, Fu-Min; Chien, Chih-Yen; Wang, Chong-Jong; Tsai, Wen-Ling; Chiu, Herng-Chia
2004-01-01
Health-related quality of life (HRQL) data are becoming an important supplement to information pertaining to treatment outcome for cancer patients. The purpose of this study was to evaluate the HRQL outcome for oral cancer survivors after surgery plus postoperative radiotherapy (RT) and to investigate the variables associated with their HRQL. Sixty-six oral cancer patients with cancer-free survival after surgery plus postoperative RT of >2 years were enrolled. The Short Form-36 (SF-36) questionnaire in the Taiwan Chinese version was self-reported by all participants at the clinics. The linear regression model was used to analyze the socio-demographic and medical-related variables correlated with the physical component summary (PCS) and mental component summary (MCS) in SF-36. The mean scores of the eight functional domains in the SF-36 were markedly lower for oral cancer survivors compared with the Taiwanese and US norms. Those with older age, lower annual family income, more advanced cancer stage and flap reconstruction had significantly worse PCS, and those with lower annual family income, unemployment and more advanced cancer stage reported significantly worse MCS. This model accounts for 63% of variance in PCS, and 51% in MCS. These results provided patient-reported evidence that oral cancer survivors lived with a worse HRQL compared with the general Taiwanese population. Socio-economic factors and cancer stage were important factors correlated with their HRQL. (authors)
Haipeng Wang; Chengxiang Tang; Shichao Zhao; Qingyue Meng; Xiaoyun Liu
2017-01-01
Background: The lower job satisfaction of health-care staff will lead to more brain drain, worse work performance, and poorer health-care outcomes. The aim of this study was to identify patterns of job satisfaction among health-care staff in rural China, and to investigate the association between the latent clusters and health-care staff’s personal and professional features; Methods: We selected 12 items of five-point Likert scale questions to measure job satisfaction. A latent-class analysis...
Skin Diseases: Questions for Your Health Care Provider
Skip Navigation Bar Home Current Issue Past Issues Skin Diseases Questions for Your Health Care Provider Past ... dermatitis worse? What are the most common irritants? Skin cancer What type of skin cancer do I ...
[Health and health-related behaviors according to sexual attraction and behavior].
Pérez, Glòria; Martí-Pastor, Marc; Gotsens, Mercè; Bartoll, Xavier; Diez, Elia; Borrell, Carme
2015-01-01
to Describe perceived health, mental health and certain health-related behaviors according to sexual attraction and behavior in the population residing in Barcelona in 2011. Perceived health, mental health, chronic conditions and health-related behaviors were analyzed in 2675 people aged 15 to 64 years. The Barcelona Health Survey for 2011 was used, which included questions on sexual attraction and behavior. Multivariate robust Poisson regression models were fitted to obtain adjusted prevalence ratios. People feeling same-sex attraction reported a higher prevalence of worse perceived and mental health. These people and those who had had sex with persons of the same sex more frequently reported harmful health-related behaviors. Lesbian, gay, transgender and bisexual people may have health problems that should be explored in depth, prevented, and attended. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.
Health-related quality of life of patients of Brazilian primary health care
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Bruna de Oliveira Ascef
2017-11-01
Full Text Available ABSTRACT OBJECTIVE To analyze the Health-Related Quality of Life (HRQoL of patients of the primary health care of the Brazilian Unified Health System (SUS and its associated factors. METHODS This is a cross-sectional study with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015. Data were collected with a questionnaire that included the EuroQol 5 Dimensions (EQ-5D instrument. Patients from the five regions of Brazil were interviewed. Multiple linear regression was used to analyze their Health-Related Quality of Life and its associated factors. RESULTS Of the total of 8,590 patients, the most frequent dimensions were pain/discomfort (50.7% and anxiety/depression (38.8%. About 10% of the patients reported extreme problems in these dimensions. The following factors were significantly associated with a worse quality of life: being female; having arthritis, osteoarthritis, or rheumatism; cerebrovascular accident; heart disease; depression; health self-assessment as poor or very poor; drinking alcoholic beverages once or more per month; dieting to lose weight, avoiding salt consumption, and reducing fat intake. Significant association was observed between a better quality of life and: living in the North and Southeast regions of Brazil; practicing physical activities; and having a higher educational level. No association was observed with factors related to the health services. CONCLUSIONS The Health-Related Quality of Life of patients was influenced by demographic and socioeconomic factors that were related to health conditions and lifestyle, being useful to guide specific actions for promoting health and the integral care to patients of the Brazilian Unified Health System.
History of violence and subjective health of mother and child.
Tomasdottir, Margret O; Kristjansdottir, Hildur; Bjornsdottir, Amalia; Getz, Linn; Steingrimsdottir, Thora; Olafsdottir, Olof A; Sigurdsson, Johann A
2016-12-01
To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child's health. In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5-6 months after delivery. Data were collected by postal questionnaires. Women's reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child's perceived health. In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p violence. Their pregnancies were more frequently unplanned (p violence considered their child's general health as worse (p = 0.008). Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18-24 months after birth. KEY POINTS Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda. • The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland. • Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history. • Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history. • The findings of this study support the
Human, Lauren J.; Biesanz, Jeremy C.; Miller, Gregory E.; Chen, Edith; Lachman, Margie E.; Seeman, Teresa E.
2013-01-01
Objective Personality change is emerging as an important predictor of health and well-being. Extending previous research, we examined whether two types of personality change, directional and absolute, are associated with both subjective and objective indicators of health. Method Utilizing the longitudinal Midlife in the United States Survey (MIDUS) data, we examined whether both types of change over 10 years were associated with psychological well-being, self-reported global health, and the presence of metabolic syndrome (MetS) components and diagnosis. Results Socially undesirable personality change (e.g., becoming less conscientious and more neurotic) and absolute personality change were independently associated with worse perceived health and well-being at Time 2. Notably, absolute personality change, regardless of the direction, was also associated with having a greater number of MetS components and a greater probability of diagnosis at Time 2. Conclusions In sum, too much personality change may be bad for one’s health: socially undesirable and absolute personality change were both associated with worse psychological health and worse metabolic profiles over 10 years. These findings suggest that personality change may contribute to psychological and physical health, and provide initial insight into potential intermediate links between personality change and distal outcomes such as mortality. PMID:22924900
Human, Lauren J; Biesanz, Jeremy C; Miller, Gregory E; Chen, Edith; Lachman, Margie E; Seeman, Teresa E
2013-06-01
Personality change is emerging as an important predictor of health and well-being. Extending previous research, we examined whether two types of personality change, directional and absolute, are associated with both subjective and objective indicators of health. Utilizing the longitudinal Midlife in the United States survey (MIDUS) data, we examined whether both types of change over 10 years were associated with psychological well-being, self-reported global health, and the presence of metabolic syndrome (MetS) components and diagnosis. Socially undesirable personality change (e.g., becoming less conscientious and more neurotic) and absolute personality change were independently associated with worse perceived health and well-being at Time 2. Notably, absolute personality change, regardless of the direction, was also associated with having a greater number of MetS components and a greater probability of diagnosis at Time 2. In sum, too much personality change may be bad for one's health: Socially undesirable and absolute personality change were both associated with worse psychological health and worse metabolic profiles over 10 years. These findings suggest that personality change may contribute to psychological and physical health, and provide initial insight into potential intermediate links between personality change and distal outcomes such as mortality. © 2012 Wiley Periodicals, Inc.
Bowers, Hannah; Wroe, Abigail L; Pincus, Tamar
2017-05-01
Beliefs about the unacceptability of experiencing and expressing emotions have been found to be related to worse outcomes in people with persistent physical symptoms. The current study tested mediation models regarding emotional suppression, beliefs about emotions, support-seeking and global impact in fibromyalgia. One hundred eighty-two participants took part in an online questionnaire testing potential mechanisms of this relationship using mediation analysis. The model tested emotional suppression and affective distress as serial mediators of the relationship between beliefs about emotions and global impact. In parallel paths, two forms of support-seeking were tested (personal/emotional and symptom-related support-seeking) as mediators. Emotional suppression and affective distress significantly serially mediated the relationship between beliefs about emotions and global impact. Neither support-seeking variable significantly mediated this relationship. Results indicate a potential mechanism through which beliefs about emotions and global impact might relate which might provide a theoretical basis for future research on treatments for fibromyalgia.
Malnutrition is associated with worse health-related quality of life in children with cancer
Brinksma, Aeltsje; Sanderman, Robbert; Roodbol, Petrie F.; Sulkers, Esther; Burgerhof, Johannes G. M.; de Bont, Eveline S. J. M.; Tissing, Wim J. E.
2015-01-01
Malnutrition in childhood cancer patients has been associated with lower health-related quality of life (HRQOL). However, this association has never actually been tested. Therefore, we aimed to determine the association between nutritional status and HRQOL in children with cancer. In 104 children,
Malnutrition is associated with worse health-related quality of life in children with cancer
Brinksma, A.; Sanderman, Robbert; Roodbol, P.F.; Sulkers, E.; Burgerhof, J.G.M.; de Bont, E.S.J.M.; Tissing, W.J.E.
2015-01-01
Purpose: Malnutrition in childhood cancer patients has been associated with lower health-related quality of life (HRQOL). However, this association has never actually been tested. Therefore, we aimed to determine the association between nutritional status and HRQOL in children with cancer. Methods:
Dental Environmental Noise Evaluation and Health Risk Model Construction to Dental Professionals.
Ma, Kuen Wai; Wong, Hai Ming; Mak, Cheuk Ming
2017-09-19
Occupational noise is unavoidably produced from dental equipment, building facilities, and human voices in the dental environment. The purpose of this study was to investigate the effect of occupational noise exposure on the dental professionals' health condition. The psychoacoustics approach noise exposure assessment followed by the health risk assessment was carried on at the paediatric dentistry clinic and the dental laboratory in the Prince Philip Dental Hospital of Hong Kong. The A-weighted equivalent sound level, total loudness, and sharpness values were statistically significantly higher for the noise at the laboratory than that at the clinic. The degree of perceived influences and sharpness of noise were found to have the impacts on the dental professionals' working performance and health. Moreover, the risk of having a bad hearing state would a have 26% and 31% higher chance for a unit increment of the short-term and long-term impact scores, respectively. The dental professionals with the service length more than 10 years and the daily working hours of more than eight showed the highest risk to their hearing state. The worse the hearing state was, the worse the health state was found for the dental professionals. Also, the risk of dissatisfaction would be increased by 4.41 and 1.22 times for those who worked at the laboratory and a unit increment of the long-term impact score. The constructed health risk mode with the scientific and statistical evidence is hence important for the future noise management of environmental improvement.
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Ann-Sophie Hansson
2006-12-01
Full Text Available
Background: Stress is a major cause of sickness absence and the health care sector appears to be especially at risk. This cross sectional study aimed to identify the risk factors for absence due to self-reported stress among health care employees. Methods: 225 health care employees were categorized into two groups based on presence or not of self-rated sickness absence for stress. Questionnaire data and stress sensitive hormones measurements were used.
Results: Employees with stress related sick leave experienced worse health, poorer work satisfaction as well as worse social and home situations than those employees without stress-related sick leave. No-significant differences were identified regarding stress-sensitive hormones. The risk for employees, not satisfied at work, of becoming absent due to stress was approximately three fold compared to those who reported being satisfied (OR 2.8, 95% confidence interval; (CI 1.3 - 5.9. For those not satisfied with their social situation, the risk for sickness absence appeared to be somewhat higher (OR 3.2; CI 1.2 - 8.6. Individual factors such as recovery potential and meaning of life as well as work related factors such as skill development and work tempo predicted employee’ s work satisfaction.
Conclusions: Based on cross sectional data, work-site and individual factors as well as social situations appear to increase the risk for absence due to stress among health care employees. Lower recovery potential, higher work tempo and poor leadership appeared to be related to the high degree of work related exhaustion experienced by employees.
Workload, mental health and burnout indicators among female physicians.
Győrffy, Zsuzsa; Dweik, Diana; Girasek, Edmond
2016-04-01
Female doctors in Hungary have worse indicators of physical and mental health compared with other professional women. We aimed to cast light on possible indicators of mental health, workload, and burnout of female physicians. Two time-points (T) were compared, in 2003 (T1 n = 408) and 2013 (T2 n = 2414), based on two nationally representative surveys of female doctors, and comparison made with data from other professional control groups. Independent samples t test or chi-squared test was used both for the two time-point comparison and the comparison between the index and the control groups. The background factors of sleep disorders and burnout were assessed by binary logistic regression analysis. No significant differences in the rates of depressive symptoms and suicidal thoughts and attempts were detected between the 2003 and 2013 cohorts, but the prevalence of sleep disorders increased. The workload increased, and there was less job satisfaction in 2013 than in 2003, coupled to more stressful or difficult work-related situations. The personal accomplishment component of burnout significantly decreased in line with the declining work-related satisfaction. Compared to the professional control groups, the prevalence of depressive symptoms, suicide attempts, and sleep disorders was higher among female physicians at both time-points. The number of workplaces, frequency of work-related stressful situations, and intensive role conflict was associated with sleep disorders and decreased personal accomplishment. In comparison with the other professional groups, female doctors had worse mental health indicators with regard to depression, suicidal ideas, and sleep disorders both in 2003 and 2013 while within professional strata the changes seemed to be less. Increasing workload had a clear impact on sleep disorders and the personal accomplishment dimension of burnout.
Corrigan, Virginia K; Pierce, Bess J; Hosig, Kathy
The primary objective of this cross-sectional study was to examine the relationship between dog ownership and physical activity in veterinary students. The secondary objective was to gain an understanding of veterinary students' health-related quality of life (HRQOL), and whether dog ownership and/or physical activity were associated with HRQOL measures. Veterinary students were invited to complete surveys between September and November 2015. The primary outcome for multivariate analyses was self-reported physical activity. Bivariate analyses and descriptive statistics were performed to assess student HRQOL. The survey response rate was 33% (152/460). Self-efficacy to exercise (pstudents had significantly worse self-reported mental health scores when compared to both national and state averages. Neither dog ownership nor meeting physical activity guidelines were significantly associated with measures of HRQOL. The poor mental health status of veterinary students remains a significant issue for the profession to address. Longitudinal studies are needed that examine the relationship between physical activity and mental health outcomes in this population.
Socioeconomic differences in the development of self-rated health amongst adolescents
DEFF Research Database (Denmark)
Andersen, Johan Hviid; Hansen, Claus D.
2009-01-01
questionnaires in 2004 and 2007. 2140 participants answered in 2007 (response rate 61%). Information on the social background of the participants (e.g. household income, parents’ highest education etc) was derived from a national register. For the analysis three variables indicating the change in the three...... perceived stress on average remained stable. Children of parents’ with the longest education had significantly worse development of all three health indicators compared with children of parents’ with primary school education. Participants who reduced their levels of physical exercise had a significant...... 15 to 18 years in a cohort study of Danish adolescents. The aim was to study predictors for health change among children with different social background. Methods Information from a birth cohort study of all adolescents born in 1989 (n = 3058) living in Ringkoebing County, Denmark was collected from...
Dust, Climate, and Human Health
Maynard, Nancy G.
2003-01-01
Air pollution from both natural and anthropogenic causes is considered to be one of the most serious world-wide environment-related health problems, and is expected to become worse with changes in the global climate. Dust storms from the atmospheric transport of desert soil dust that has been lifted and carried by the winds - often over significant distances - have become an increasingly important emerging air quality issue for many populations. Recent studies have shown that the dust storms can cause significant health impacts from the dust itself as well as the accompanying pollutants, pesticides, metals, salt, plant debris, and other inorganic and organic materials, including viable microorganisms (bacteria, viruses and fungi). For example, thousands of tons of Asian desert sediments, some containing pesticides and herbicides from farming regions, are commonly transported into the Arctic during dust storm events. These chemicals have been identified in animal and human tissues among Arctic indigenous populations. Millions of tons of airborne desert dust are being tracked by satellite imagery, which clearly shows the magnitude as well as the temporal and spatial variability of dust storms across the "dust belt" regions of North Africa, the Middle East, and China. This paper summarizes the most recent findings on the effects of airborne desert dust on human health as well as potential climate influences on dust and health.
Hypochondriasis, somatization, and perceived health and utilization of health care services.
Hollifield, M; Paine, S; Tuttle, L; Kellner, R
1999-01-01
The authors determined the different effects of hypochondriasis and somatization on health perceptions, health status, and service utilization in a primary care population. The subjects with hypochondriacal responses (HR) on the Illness Attitudes Scales or high somatic concern (HSC) on the Symptom Questionnaire had a worse perception of health and variably used more health services than the control subjects, even though the HR and HSC subjects had the same level of chronic medical disorders. Regression analyses determined that somatization contributed more to negative health perception and service utilization than did hypochondriasis, although an interaction between the two contributed to the use of psychiatric care. The authors discuss the boundary between hypochondriasis and somatization for its implications for research and clinical practice.
Kadin, Marshall E.; Pavlov, Igor; Delgado, Julio C.; Vonderheid, Eric C.
2011-01-01
Histopathology alone cannot predict outcome of patients with CD30+ primary cutaneous lymphoproliferative disorders (CD30CLPD) and early mycosis fungoides (MF). To test the hypothesis that serum cytokines/cytokine receptors provide prognostic information in these disorders, we measured soluble CD30 (sCD30), sCD25, and selected cytokines in cell cultures and sera of 116 patients with CD30CLPD and 96 patients with early MF followed up to 20 years. Significant positive correlation was found between sCD30 levels and sCD25, CD40L, IL-6, and IL-8, suggesting CD30+ neoplastic cells secrete these cytokines, but not Th2 cytokines. In vitro studies confirmed sCD30, sCD25, IL-6 and IL-8 are secreted by CD30CLPD-derived cell lines. CD30CLPD patients with above normal sCD30 and sCD25 had worse overall and disease-related survivals, but only sCD30 retained significance in Cox models that included advanced age. High sCD30 also identified patients with worse survival in early MF. Increased IL-6 and IL-8 correlated with poor disease-related survival in CD30CLPD patients, We conclude that: (1) neoplastic cells of some CD30CLPD patients do not resemble Th2 cells, (2) high serum sCD30, sCD25, IL-6, and perhaps IL-8 levels may provide prognostic information useful for patient management. PMID:22071475
Disparities in chronic conditions and health status by type of disability.
Horner-Johnson, Willi; Dobbertin, Konrad; Lee, Jae Chul; Andresen, Elena M
2013-10-01
Prior research has established health disparities between people with and without disabilities. However, disparities within the disability population, such as those related to type of disability, have been much less studied. To examine differences in chronic conditions and health status between subgroups of people with different types of disability. We analyzed Medical Expenditure Panel Survey annual data files from 2002 to 2008. Logistic regression analyses considered disparity from three perspectives: 1) basic differences, unadjusted for other factors; 2) controlling for key demographic and health covariates; and 3) controlling for a larger set of demographic variables and socioeconomic status as well as health and access to healthcare. Individuals with vision, physical, cognitive, or multiple disability types fared worse than people with hearing impairment on most health outcomes. This was most consistently true for people with multiple disabilities. Even when all covariates were accounted for, people with multiple types of disability were significantly more likely (p disability types were reduced when controlling for other factors, some differences remained significant. This argues for a more individualized approach to understanding and preventing chronic conditions and poor health in specific disability groups. Copyright © 2013 Elsevier Inc. All rights reserved.
Birth order and health of newborns
DEFF Research Database (Denmark)
Brenøe, Anne Ardila; Molitor, Ramona
2017-01-01
We examine birth order differences in health of newborns and follow the children throughout childhood using high-quality administrative data on individuals born in Denmark between 1981 and 2010. Family fixed effects models show a positive and robust effect of birth order on health at birth......; firstborn children are less healthy at birth. During earlier pregnancies, women are more likely to smoke, receive more prenatal care, and are more likely to suffer a medical pregnancy complication, suggesting worse maternal health. We further show that the health disadvantage of firstborns persists...
Abdul-Sattar, Amal B; Abou El Magd, Sahar
2017-12-01
To investigate the role of perceived neighborhood characteristics, socioeconomic status (SES) and rural residency in influencing the health status outcome of Egyptian patients with systemic lupus erythematosus (SLE). Eighty patients affected with SLE were consecutively included in this a single-center cross-sectional study from July, 2011 to July, 2013. Outcome measures included the Systemic Lupus Activity Questionnaire (SLAQ) score, the Medical Outcomes Study Short Form-36 Health Survey physical functioning score and Center for Epidemiologic Studies-Depression (CES-D score of ≥ 19 points). Multivariate logistic regression analyses were conducted. Results from multivariate logistic regression analyses, a separate adjusted model of each perceived neighborhood characteristic, indicate associations of worse perceived social cohesion with higher SLAQ scores (P socioeconomic status and rural residency with health status outcomes, the results found association of poor socioeconomic status with the three health status outcome measures and association between rural residency and depression symptoms. Individuals had increased odds of depressive symptoms if they perceived worse neighborhood social cohesion (odds ratio [OR]: 2.14; CI: 1.42-2.80), if they perceived worse neighborhood safety (OR: 1.64; CI: 1.02-2.40) and if they perceived worse neighborhood aesthetic characteristics (OR: 2.79; CI: 1.84-3.38). Study findings indicate that poor socioeconomic status, rural residency and perceived neighborhood characteristics are associated with depression; worse perceived neighborhood aesthetics and safety are associated with lower SF-36 physical functioning, and worse neighborhood social cohesion is associated with higher disease activity among patients with SLE. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.
Income inequality and health in China: A panel data analysis.
Bakkeli, Nan Zou
2016-05-01
During the last decades, the level of income inequality in China has increased dramatically. Despite rapid economic growth and improved living conditions, the health performance in China has dropped compared to the period before the economic reform. The "Wilkinson hypothesis" suggests that increased income inequality in a society is correlated to worse health performance. China is a particular interesting case due to the rapid socioeconomic change in the country. This study uses the China Health and Nutrition Survey (CHNS) to address the question of whether income inequality has an impact on individuals' risks of having health problems in China. Unlike previous studies with health measures such as self-reported health or mortality rate, our study uses physical functions to measure individual health. By analysing panel data using county/city-level dummies and year fixed-effects, we found that income inequality does not have a significant impact on individuals' risks of having health problems. This result is robust when changing between different indicators for income inequality. Copyright © 2016 Elsevier Ltd. All rights reserved.
The high price of debt: household financial debt and its impact on mental and physical health.
Sweet, Elizabeth; Nandi, Arijit; Adam, Emma K; McDade, Thomas W
2013-08-01
Household financial debt in America has risen dramatically in recent years. While there is evidence that debt is associated with adverse psychological health, its relationship with other health outcomes is relatively unknown. We investigate the associations of multiple indices of financial debt with psychological and general health outcomes among 8400 young adult respondents from the National Longitudinal Study of Adolescent Health (Add Health). Our findings show that reporting high financial debt relative to available assets is associated with higher perceived stress and depression, worse self-reported general health, and higher diastolic blood pressure. These associations remain significant when controlling for prior socioeconomic status, psychological and physical health, and other demographic factors. The results suggest that debt is an important socioeconomic determinant of health that should be explored further in social epidemiology research. Copyright © 2013 Elsevier Ltd. All rights reserved.
42 CFR 137.142 - What is a “significant danger” or “risk” to the public health?
2010-10-01
... 42 Public Health 1 2010-10-01 2010-10-01 false What is a âsignificant dangerâ or âriskâ to the public health? 137.142 Section 137.142 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE...
O'Connor, Michelle Y.; Thoreson, Caroline K.; Ricks, Madia; Courville, Amber B.; Thomas, Francine; Yao, Jianhua; Katzmarzyk, Peter T.; Sumner, Anne E.
2014-01-01
Background: The healthy immigrant effect is a phrase that has been used for decades to describe better cardiometabolic health in African immigrants than African Americans. The recent global increase in cardiometabolic diseases raises the possibility that immigrant health may be changing. Therefore, a new assessment of cardiometabolic health in African immigrants is warranted.
International Nuclear Information System (INIS)
Choe, Kevin S.; Jani, Ashesh B.; Liauw, Stanley L.
2010-01-01
Purpose: To characterize the bleeding toxicity associated with external beam radiotherapy for prostate cancer patients receiving anticoagulation (AC) therapy. Methods and Materials: The study cohort consisted of 568 patients with adenocarcinoma of the prostate who were treated with definitive external beam radiotherapy. Of these men, 79 were receiving AC therapy with either warfarin or clopidogrel. All patients were treated with three-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Bleeding complications were recorded during treatment and subsequent follow-up visits. Results: With a median follow-up of 48 months, the 4-year actuarial risk of Grade 3 or worse bleeding toxicity was 15.5% for those receiving AC therapy compared with 3.6% among those not receiving AC (p < .0001). On multivariate analysis, AC therapy was the only significant factor associated with Grade 3 or worse bleeding (p < .0001). For patients taking AC therapy, the crude rate of bleeding was 39.2%. Multivariate analysis within the AC group demonstrated that a higher radiotherapy dose (p = .0408), intensity-modulated radiotherapy (p = 0.0136), and previous transurethral resection of the prostate (p = .0001) were associated with Grade 2 or worse bleeding toxicity. Androgen deprivation therapy was protective against bleeding, with borderline significance (p = 0.0599). Dose-volume histogram analysis revealed that Grade 3 or worse bleeding was minimized if the percentage of the rectum receiving ≥70 Gy was <10% or the rectum receiving ≥50 Gy was <50%. Conclusion: Patients taking AC therapy have a substantial risk of bleeding toxicity from external beam radiotherapy. In this setting, dose escalation or intensity-modulated radiotherapy should be used judiciously. With adherence to strict dose-volume histogram criteria and minimizing hotspots, the risk of severe bleeding might be reduced.
Directory of Open Access Journals (Sweden)
Sheng Chen
Full Text Available BACKGROUND: To evaluate the relationship between body mass index (BMI and response to neoadjuvant chemotherapy (NCT for breast cancer among Chinese women. PATIENTS AND METHODS: A total of 307 eligible patients were assigned to receive four cycles of paclitaxel and carboplatin before standard surgery for breast cancer from 2007 to 2011 at Shanghai Cancer Hospital. The patients were categorized as obese, overweight, normal weight, or underweight based on BMI according to World Health Organization (WHO criteria. Pathological complete response (pCR was defined as no invasive cancer in the breast or axillary tissue. A logistic regression and the Chi-squared test were used for detecting the predictors of pCR and determining the relationship between BMI category and pCR rate in the subgroup analysis with respect to other variables. RESULTS: Categorical BMI, estrogen receptor (ER, and progesterone receptor (PR status were independent predictors of pCR according to the multivariate analysis. Patients with BMI≥25 were less likely to achieve a pCR to NCT compared with patients with BMI<25 (Odds ratio: 0.454, p = 0.033, multivariate analysis. In the subgroup analysis, the predictive value of BMI for pCR to NCT was significantly shown in post-menopausal patients (p = 0.004 and hormonal receptor status-negative patients (p = 0.038. The incidence of treatment-induced toxicity was similar among the different BMI categories. CONCLUSION: Higher BMI was associated with worse pCR to NCT. Further approaches to investigating the mechanism of this influence of BMI on treatment response and a more appropriate schedule for calculating NCT dose for high-BMI-patients should be considered.
Grice, Mira M; Feda, Denise; McGovern, Patricia; Alexander, Bruce H; McCaffrey, David; Ukestad, Laurie
2007-10-01
Since 1970, women of childbearing age have increasingly participated in the workforce. However, literature on work-family conflict has not specifically addressed the health of postpartum women. This study examined the relationship between work-family conflict and mental and physical health of employed mothers 11 weeks after childbirth. Employed women, 18 years and older, were recruited while in the hospital for childbirth (N = 817; 71% response rate). Mental and physical health at 11 weeks postpartum was measured using SF-12 version 2. General linear models estimated the associations between the independent variables and health. A priori causal models and directed acyclic graphs guided selection of confounding variables. Analyses revealed that high levels of work interference with family were associated with significantly lower mental health scores. Medium and high levels of family interference with work revealed a dose-response relationship resulting in significantly worse mental health scores. Coworker support was strongly and positively associated with better physical health. Work-family conflict was negatively associated with mental health but not significantly associated with physical health. Availability of social support may relieve the burden women can experience when balancing work roles and family obligations.
Davies, Lorraine; Ford-Gilboe, Marilyn; Willson, Andrea; Varcoe, Colleen; Wuest, Judith; Campbell, Jacquelyn; Scott-Storey, Kelly
2015-01-01
Drawing on the Women's Health Effects Study, a community sample of women (N = 309) who recently left an abusive partner, this study examines patterns of cumulative abuse experiences over the life course, their socioeconomic correlates, and associations with a range of health outcomes. Latent class analysis identified four groups of women with differing cumulative abuse profiles: Intimate Partner Violence (IPV) Dominant, Child Abuse and IPV, All Forms, and All Forms Extreme. We find a relationship pattern between cumulative abuse and socioeconomic circumstances, and significantly worse health outcomes among women with the All Forms Extreme profile. Implications for research and practice are discussed. © The Author(s) 2014.
Predictors of burnout and health status in Samaritans' listening volunteers.
Roche, Adeline; Ogden, Jane
2017-12-01
Samaritan listening volunteers provide emotional support to people in distress or suicidal. Samaritans' has high volunteer turnover, which may be due to burnout. This study evaluated the role of demographic and psychosocial factors in predicting Samaritans listening volunteers' burnout and health status. Samaritans' listening volunteers (n = 216) from seven branches across UK completed an online survey to assess their levels of burnout (emotional exhaustion, depersonalisation, personal accomplishment), subjective health status, coping, empathy and social support. Overall, listeners showed low levels of burnout and good health. Regression analysis revealed that higher emotional exhaustion was predicted by younger age and avoidant coping style; higher depersonalisation was predicted by lower empathy fantasy and higher avoidant coping style; lower personal accomplishment scores were predicted by higher empathy personal distress and worse health status was predicted by more hours per week spent on listening duties, lower social support and higher avoidant coping style. Overall, different factors influenced different facets of burnout. However, higher use of avoidant coping style consistently predicted higher burnout and worse health status, suggesting avoidant coping is an important target for intervention.
Chattopadhyay, Kaushik; Chattopadhyay, Chaitali; Kaltenthaler, Eva
2015-03-20
During the past decade, coal-based sponge iron plants, a highly polluted industry, have grown rapidly in Barjora, India. The toxic effects of particulate matters and gaseous pollutants include various respiratory diseases. Understanding workers' perception of respiratory health is essential in people-centred healthcare. The aim of the study was to assess their respiratory health status and to determine its predictors. Cross-sectional study. Coal-based sponge iron plants in Barjora, India. 258 coal-based sponge iron plant workers. Respiratory health status was measured using the St. George's respiratory questionnaire (SGRQ) total score. 100 and 0 represent the worst and best possible respiratory health status, respectively. The two-part model (frequency (any worse respiratory health status) and severity (amount of worse respiratory health status)) was developed for the score, as the data were positively skewed with many zeros. The mean (SD) SGRQ total score was 7.7 (14.5), the median (IQR) was 0.9 (9.0), and the observed range was 0-86.6. The best possible SGRQ total score was reported by 46.9% of workers. Independent predictors of worse respiratory health status were cleaner domestic cooking fuel (coefficient -0.76, 95% CI -1.46 to -0.06, p=0.034) and personal history of any respiratory disease (1.76, 1.04 to 2.47, pworkers in Barjora have the best possible respiratory health status. The predictors of worse respiratory health status were identified. The study findings could be taken into consideration in future interventional studies aimed at improving the respiratory health status of these workers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Fuentes Chacón, Rosa M; Simón Saiz, M José; Garrido Abejar, Margarita; Serrano Parra, M Dolores; Larrañaga Rubio, M Elisa; Yubero Jiménez, Santiago
2017-12-04
To analyze, in a population of adolescents in school, the relationship between psychosomatic symptoms and the perception of health-related quality of life (HRQoL), differentiating by gender and age group. Transversal study. Five Secondary Schools. Eight hundred and forty four adolescents between the ages of 15 and 18 in secondary school. HRQoL using KIDSCREEN-52 and psychosomatic symptoms with the psychosomatic problems scale (PSP). Girls and adolescents aged 17-18 years presented significantly higher psychosomatic symptoms, both groups also scored worse in all dimensions of HRQoL, although only the dimensions related to physical and mental wellness, mood and stress reached significance. All psychosomatic symptoms were inversely associated with the ten dimensions of KIDSCREEN-52. The regression models showed that sadness, concentrating difficulties and sleeping difficulties were the predictors of worse HRQoL in both sexes and age groups and these variables explained between 30 and 41% of the HRQoL variance of the adolescents. Psychosomatic symptoms are frequent especially in girls and in older adolescents and predictors of worse HRQoL. It is important to distinguish them from medical conditions to avoid unnecessary interventions. As expressions of emotional discomfort they must be evaluated and treated in an integral way because they interfere with daily life and increase the vulnerability proper of adolescence. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
Limato, Ralalicia; Ahmed, Rukhsana; Magdalena, Amelia; Nasir, Sudirman; Kotvojs, Fiona
2018-02-01
Maternal health promotion is a defined activity in the community integrated posts (Posyandu) in Indonesia. However, it is often neglected due to limited knowledge and skills of the community health workers (kader). We conducted health promotion training for the kader and village midwives in four villages in Cianjur district. This study describes the use of "most significant change" (MSC) technique to evaluate impact of health promotion to the beneficiaries and community at large. The MSC uses stories as raw data. Through interviews focused on perception of change, stories were collected from four pregnant women, eight kader and three village midwives. A Panel consisting of policy and programme managers and implementers read all the stories. The story by a pregnant woman who routinely attended Posyandu was selected as the story with most significant change. Her story highlighted changes in kader's knowledge and communication of health messages and attitude towards pregnant women. She expressed these changes impacted community awareness about health and to seek help from kader.The MSC technique enabled stakeholders to view raw data and evaluate the impact of health promotion from the beneficiary's perspective. At the same time, recipients of health promotion contributed to the decision process of evaluation through their stories. The different perspectives on the MSC reflected individual's objectives of the health promotion. The application of this technique is limited in maternal health promotion programme in Indonesia, and none have been published in peer reviewed journals. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
Posttraumatic Stress Disorder Is Associated With Worse Endothelial Function Among Veterans.
Grenon, S Marlene; Owens, Christopher D; Alley, Hugh; Perez, Sandra; Whooley, Mary A; Neylan, Thomas C; Aschbacher, Kirstin; Gasper, Warren J; Hilton, Joan F; Cohen, Beth E
2016-03-23
Current research in behavioral cardiology reveals a significant association between posttraumatic stress disorder (PTSD) and increased risk for cardiovascular disease and mortality; however, the underlying mechanisms remain poorly understood. We hypothesized that patients with PTSD would exhibit endothelial dysfunction, a potential mechanism involved in the development and progression of cardiovascular disease. A total of 214 outpatients treated at the San Francisco Veterans Affairs Medical Center underwent tests of endothelial function and evaluation for PTSD. Flow-mediated vasodilation of the brachial artery was performed to assess endothelial function, and current PTSD status was defined by the PTSD Checklist, based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), with a score ≥40. Multivariable linear regression models were used to estimate the association between PTSD status and endothelial function. Patients with PTSD (n=67) were more likely to be male (99% versus 91%, P=0.04) and to have depression (58% versus 8%, P<0.0001) and were less likely to be on an angiotensin-converting enzyme inhibitor (17% versus 36%, P=0.007) or β-blocker treatment (25% versus 41%, P=0.03). Univariate analysis demonstrated that patients with PTSD had significantly lower flow-mediated vasodilation (5.8±3.4% versus 7.5±3.7%; P=0.003); furthermore, lower flow-mediated vasodilation was associated with increasing age (P=0.008), decreasing estimated glomerular filtration rate (P=0.003), hypertension (P=0.002), aspirin (P=0.03), and β-blocker treatments (P=0.01). In multivariable analysis, PTSD remained independently associated with lower flow-mediated vasodilation (P=0.0005). After adjusting for demographic, comorbidity, and treatment characteristics, PTSD remained associated with worse endothelial function in an outpatient population. Whether poor endothelial function contributes to the higher risk of cardiovascular disease in patients with PTSD
Impact of middle-of-the-night awakenings on health status, activity impairment, and costs
Directory of Open Access Journals (Sweden)
Moline M
2014-07-01
reported significantly worse mental and physical health status and worse health utilities relative to insomnia-free matched controls (all P<0.05. Annual per-employee indirect costs were also significantly higher ($4,328 vs $3,000; P<0.05. Among only MOTN awakenings respondents, 74.6% were considered only symptomatic (ie, they did not report having insomnia or having been diagnosed with insomnia. Conclusion: These findings collectively highlight the prevalence and socioeconomic impact of specific types of insomnia symptoms, including MOTN awakenings, experienced by adults in the US. Keywords: insomnia, nocturnal awakenings, work productivity, health outcomes, sleep quality, sleep symptoms
Directory of Open Access Journals (Sweden)
Zissi Anastasia
2010-01-01
Full Text Available Abstract Background Socioeconomic health inequalities in adolescence are not consistently reported. This may be due to the measurement of self-reported general health, which probably fails to fully capture the psychological dimension of health, and the reliance on traditional socio-economic indicators, such as parental education or occupational status. The present study aimed at investigating this issue using simple questions to assess both the physical and psychological dimension of health and a broader set of socioeconomic indicators than previously used. Methods This was a cross-sectional survey of 5614 adolescents aged 16-18 years-old from 25 senior high schools in Greece. Self-reported general and psychological health were both measured by means of a simple Likert-type question. We assessed the following socio-economic variables: parents' education, parents' employment status, a subjective assessment of the financial difficulties experienced by the family and adolescents' own academic performance as a measure of the personal social position in the school setting. Results One out of ten (10% and one out of three (32% adolescents did not enjoy good general and psychological health respectively. For both health variables robust associations were found in adolescents who reported more financial difficulties in the family and had worse academic performance. The latter was associated with psychological health in a more linear way. Father's unemployment showed a non-significant trend for an association with worse psychological health in girls only. Conclusions Socioeconomic inequalities exist in this period of life but are more easily demonstrated with more subjective socioeconomic indicators, especially for the psychological dimension of health.
Directory of Open Access Journals (Sweden)
Amanda A. Price
2016-01-01
Full Text Available Although poor health-related behaviors that impact development of chronic diseases begin much earlier than when actual disease is evident, few studies have examined health behaviors in college students, who may be at an important transitional period where early intervention could prevent development of chronic diseases. The purpose of this study was to examine health-related factors in female college students ( N = 61 by race/ethnicity and weight status. We found significant differences in health profiles between non-Hispanic White (White and African American students, including greater physical fitness and healthier diets among White students. Overweight/obese students had worse health profiles than healthy BMI students. Furthermore, weight status was significantly associated with cardiovascular fitness. This supports a focus on PA promotion for interventions in the period of emerging adulthood, alongside the other healthy behaviors, to elicit improvements in weight status and potential reduction of chronic disease risks.
Koyanagi, Ai; Vancampfort, Davy; Carvalho, André F; DeVylder, Jordan E; Haro, Josep Maria; Pizzol, Damiano; Veronese, Nicola; Stubbs, Brendon
2017-11-28
Depression in tuberculosis increases the risk for adverse health outcomes. However, little is known about comorbid depression and tuberculosis in the general population. Thus, we assessed the association between depression and tuberculosis, and the decrements in health status associated with this comorbidity in 48 low- and middle-income countries. Cross-sectional, community-based data from the World Health Survey on 242,952 individuals aged ≥ 18 years were analyzed. Based on the World Mental Health Survey version of the Composite International Diagnostic Interview, past 12-month depression was categorized into depressive episode, brief depressive episode, subsyndromal depression, and no depression. Health status across six domains (cognition, interpersonal activities, sleep/energy, self-care, mobility, pain/discomfort) was assessed. Multivariable logistic and linear regression analyses were performed to assess the associations. The prevalence of depressive episode among those with and without tuberculosis was 23.7% and 6.8%, respectively (P Tuberculosis was associated with a 1.98 (95% CI 1.47-2.67), 1.75 (95% CI 1.26-2.42), and 3.68 (95% CI 3.01-4.50) times higher odds for subsyndromal depression, brief depressive episode, and depressive episode, respectively. Depressive episode co-occurring with tuberculosis was associated with significantly worse health status across all six domains compared to tuberculosis alone. Interaction analysis showed that depression significantly amplifies the association between TB and difficulties in self-care but not in other health domains. Depression is highly prevalent in adults with tuberculosis, and is associated with worse health status compared to tuberculosis without depression. Public health efforts directed to the recognition and management of depression in people with tuberculosis may lead to better outcomes.
Poor oral health as an obstacle to employment for Medicaid beneficiaries with disabilities.
Hall, Jean P; Chapman, Shawna L Carroll; Kurth, Noelle K
2013-01-01
To inform policy with better information about the oral health-care needs of a Medicaid population that engages in employment, that is, people ages 16 to 64 with Social Security-determined disabilities enrolled in a Medicaid Buy-In program. Statistically test for significant differences among responses to a Medicaid Buy-In program satisfaction survey that included oral health questions from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System and the Oral Health Impact Profile (OHIP) to results for the state's general population and the US general population. All measures of dental care access and oral health were significantly worse for the study population as compared with a state general population or a US general population. Differences were particularly pronounced for the OHIP measure for difficulty doing one's job due to dental problems, which was almost five times higher for the study population. More comprehensive dental benefits for the study population could result in increased oral and overall health, and eventual cost savings to Medicaid as more people work, have improved health, and pay premiums for coverage. © 2012 American Association of Public Health Dentistry.
Murphy, Jessica E; Smock, Laura; Hunter-Adams, Jo; Xuan, Ziming; Cochran, Jennifer; Paasche-Orlow, Michael K; Geltman, Paul L
2018-06-15
Little is known about the impacts of health literacy and English proficiency on the health status of Somali refugees. Data came from interviews in 2009-2011 of 411 adult Somali refugees recently resettled in Massachusetts. English proficiency, health literacy, and physical and mental health were measured using the Basic English Skills Test Plus, the Short Test of Health Literacy in Adults, and the Physical and Mental Component Summaries of the Short Form-12. Associations were analyzed using multiple linear regression. In adjusted analyses, higher English proficiency was associated with worse mental health in males. English proficiency was not associated with physical health. Health literacy was associated with neither physical nor mental health. Language proficiency may adversely affect the mental health of male Somali refugees, contrary to findings in other immigrant groups. Research on underlying mechanisms and opportunities to understand this relationship are needed.
Belief in the paranormal and modern health worries
Utinans A.; Ancane G.
2014-01-01
It has been found, that despite the improvement of the objective health indicators, people's subjective perception of health is that health indicators are getting worse (Barsky A.J., 1988), which is one of the reasons why a new term “modern health worries” is coming into use in medical literature (Petrie K.J., Wessely S., 2002). People are worried and scared of the effect of new high tech innovations (effect of cell phone radiation, environmental pollution, ozone layer depletion, etc.), chang...
Kim, Young-An; Collins, Timothy W; Grineski, Sara E
2014-05-01
Prior research suggests that immigrant enclaves provide respiratory health benefits for US Hispanic residents. We test if immigrant enclaves provide differential respiratory health benefits for Hispanic children in El Paso (Texas) based on individual-level factors. Results reveal that higher neighborhood immigrant density is associated with reduced odds of wheezing, but that the protective immigrant enclave effect is modified by poverty, general health status, body mass index (BMI), and caretaker nativity. Higher immigrant density is significantly more protective for poor children and those with foreign-born caretakers; conversely, it is significantly less protective for children in worse health and those with higher BMI. These findings foster a novel understanding of how immigrant enclaves may be differentially protective for Hispanic children based on individual-level factors. Copyright © 2014 Elsevier Ltd. All rights reserved.
2016-10-01
Reports an error in "When Does Making Detailed Predictions Make Predictions Worse" by Theresa F. Kelly and Joseph P. Simmons ( Journal of Experimental Psychology: General , Advanced Online Publication, Aug 8, 2016, np). In the article, the symbols in Figure 2 were inadvertently altered in production. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2016-37952-001.) In this article, we investigate whether making detailed predictions about an event worsens other predictions of the event. Across 19 experiments, 10,896 participants, and 407,045 predictions about 724 professional sports games, we find that people who made detailed predictions about sporting events (e.g., how many hits each baseball team would get) made worse predictions about more general outcomes (e.g., which team would win). We rule out that this effect is caused by inattention or fatigue, thinking too hard, or a differential reliance on holistic information about the teams. Instead, we find that thinking about game-relevant details before predicting winning teams causes people to give less weight to predictive information, presumably because predicting details makes useless or redundant information more accessible and thus more likely to be incorporated into forecasts. Furthermore, we show that this differential use of information can be used to predict what kinds of events will and will not be susceptible to the negative effect of making detailed predictions. PsycINFO Database Record (c) 2016 APA, all rights reserved
Nageswaran, Savithri; Silver, Ellen Johnson; Stein, Ruth E K
2008-05-01
The goal was to evaluate whether having a functional limitation was associated with health care needs and experiences of children with special health care needs. We used caregivers' responses in the National Survey of Children with Special Health Care Needs (2001). Functional limitation was categorized as severe, some, or no limitation. We performed analyses of the relationships of functional limitation to measures of health care needs and experiences. Children with special health care needs with severe functional limitation were more likely to have received specialized educational services, to have had physician visits, and to have needed health services, compared with those with no limitation. They had significantly greater odds of delayed care, unmet health care and care-coordination needs, referral problems, dissatisfaction, and difficulty using health services, compared with those without limitation. Caregivers of children with special health care needs with severe limitation were twice as likely as those with no limitation to report that providers did not spend enough time, listen carefully, provide needed information, and make family members partners in the child's care. Compared with children with special health care needs without limitation, those with severe limitation had worse health insurance experiences, in terms of insurance coverage, copayments, being able to see needed providers, and problems with health insurance. The impact on families (financial problems, need to provide home care, or need to stop or to cut work) of children with special health care needs with severe functional limitation was much greater than the impact on families of children with special health care needs without limitation. For most measures examined, results for some limitation were between those for severe limitation and no limitation. Functional limitation is significantly associated with the health care needs and experiences of children with special health care needs.
Somkotra, Tewarit
2011-06-01
This study aimed to quantify the extent to which socioeconomic-related inequality in self-reported oral health status among Thais is present after the country implemented the Universal Coverage policy and to decompose the determinants and their associations with inequality in self-reported oral health status in particular with the worse condition. The study employed a concentration index to measure socioeconomic-related inequality in self-reported oral health status, and the decomposition method to identify the determinants and their associations with inequality in oral health-related measures. Data from 32,748 Thai adults aged 15-75 years from the nationally representative Health &Welfare Survey and Socio-Economic Survey 2006 were used in analyses. Reports of worse oral health status of the lower socioeconomic-status group were more common than their higher socioeconomic-status counterparts. The concentration index (equaling -0.208) corroborates the finding of pro-poor inequality in self-reported worse oral health. Decomposition analysis demonstrated certain demographic-, socioeconomic-, and geographic characteristics are particularly associated with poor-rich differences in self-reported oral health status among Thai adults. This study demonstrated socioeconomic-related inequality in oral health is discernable along the entire spectrum of socioeconomic status. Inequality in perceived oral health status among Thais is present even while the country has virtually achieved universality of health coverage. The study also indicates population subgroups, particularly the poor, should receive consideration for improving oral health status as revealed by underlying determinants.
Urinary incontinence, mental health and loneliness among community-dwelling older adults in Ireland
DEFF Research Database (Denmark)
Stickley, Andrew; Santini, Ziggi Ivan; Koyanagi, Ai
2017-01-01
Background Urinary incontinence (UI) is associated with worse health among older adults. Little is known however, about its relation with loneliness or the role of mental health in this association. This study examined these factors among older adults in Ireland. Methods Data were analyzed from 6...... community-dwelling adults but this association is largely explained by comorbid mental health problems, in particular, depression.......Background Urinary incontinence (UI) is associated with worse health among older adults. Little is known however, about its relation with loneliness or the role of mental health in this association. This study examined these factors among older adults in Ireland. Methods Data were analyzed from...... 6903 community-dwelling adults aged ≥ 50 collected in the first wave of The Irish Longitudinal Study on Ageing (TILDA) in 2009–11. Information was obtained on the self-reported occurrence (yes/no) and severity (frequency/activity limitations) of UI in the past 12 months. Loneliness was measured using...
Viewpoint: Prevention is missing: is China's health reform reform for health?
Yang, Le; Zhang, Xiaoli; Tan, Tengfei; Cheng, Jingmin
2015-02-01
Ancient China emphasized disease prevention. As a Chinese saying goes, 'it is more important to prevent the disease than to cure it'. Traditional Chinese medicine posits that diseases can be understood, thus, prevented. In today's China, the state of people's health seems worse than in the past. Thus the Chinese government undertook the creation of a new health system. Alas, we believe the results are not very satisfactory. The government seems to have overlooked rational allocation between resources for treatment and prevention. Public investment has been gradually limited to the domain of treatment. We respond to this trend, highlighting the importance of prevention and call for government and policymakers to adjust health policy and work out a solution suitable for improving the health of China's people.
Wilson, James
2016-06-01
Much work in public health ethics is shaped by an 'autonomy first' view, which takes it to be axiomatic that it is difficult to justify state interference in the lives of competent adults unless the behaviours interfered with are compromised in terms of their autonomy, or would wrongfully infringe on the autonomy of others. However, such an approach is difficult to square with much of traditional public heath practice. Recent years have seen running battles between those who assume that an 'autonomy first' approach is basically sound (and so much the worse for public health practice) and those who assume that public health practice is basically sound (and so much the worse for the 'autonomy first' approach). This paper aims to reconcile in a normatively satisfying way what is best about the 'autonomy first' approach with what is best about a standard public health approach. It develops a positive case for state action to promote and protect health as a duty that is owed to each individual. According to this view, the state violates individuals' rights if it fails to take cost-effective and proportionate measures to remove health threats from the environment. It is thus a mistake to approach public health in the way that 'autonomy first' accounts do, as primarily a matter of individual entitlements versus the common good. Too little state intervention in the cause of improving population health can violate individuals' rights, just as too much can. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Directory of Open Access Journals (Sweden)
Rowe Heather
2012-08-01
Full Text Available Abstract Background Australia’s Early Parenting Services support families and intervene early in mental health problems in parents. The Victorian Early Parenting Strategy, a platform for government policy recommended a stronger evidence base for early parenting services. Tweddle Child and Family Health Service (TCFHS is a not-for-profit public sector early parenting centre, which provides residential, day stay, home visiting and outreach programs. This study aimed i to examine the health, social circumstances and presenting needs of clients attending the Tweddle Day Stay Program (DSP with infants under 12 months old and ii to assess the parent mental health and infant behaviour outcomes and the factors associated with program success. Methods A cohort of clients was recruited prior to admission and followed-up 8 weeks after discharge. Data were collected using standardised measures in a study specific questionnaire at baseline, participant’s Tweddle records and a follow-up telephone interview. Health, social circumstances and presenting needs of clients were described. Changes in parents’ symptoms of depression and infants’ sleep and settling between admission and follow-up were calculated. Multiple regression analyses were conducted to examine factors associated with changes in primary outcomes. Results Of the total 162 clients who were eligible and invited to participate, 115 (72% were recruited. Parents admitted to the DSP had worse general self-reported physical and mental health than community samples. Infants of DSP participants were no more likely to be premature or have low birth weight, but significantly more unsettled than other community samples. Participants’ mental health and their infants’ behaviours were significantly improved after DSP admission. In multivariate analysis, higher depression score at baseline and greater educational attainment were significantly associated with improvements in parents’ mental
Determinants of the most significant characteristics of reproductive health
Directory of Open Access Journals (Sweden)
Miljković Snežana
2010-01-01
Full Text Available Introduction. Reproductive health of women is determined by females’ demographic and socio-economic characteristics, their behavior, and the complex of environmental factors. Objective. The paper examines the predictive impact of personal and environmental characteristics, health and healthcare characteristics regarding the most important aspects of reproductive health. Methods From a sample of 2,718 women, aged 20-49 years, we collected information on various characteristics using a structured questionnaire. Based on factorial analysis (principal components method, Kaisser Varimax criterion we selected representative variables (factors, describing personal (demographic and socio-economic characteristics of women, their environment (family, household, community, health (attitudes towards health, life-style, health status, healthcare (independent and the characteristics of reproductive health (dependent variables. The predictors were analyzed by multiple regression and correlation. Results. Sexual behavior was determined by socio-economic status, personal tidiness, rest, presence of risk factor(s, health evaluation and attitude toward personal responsibility, trust in physicians etc. The predictors of contraception involved satisfaction with one’s own health, serious health problems, health evaluation. The presence and number of abortions were determined by personal psychological maturity, rest, risk factors, life-style, health evaluation and its manifestations, and the continuity and timely healthcare. The predictors of adequate protection of reproductive health involved the cultural level of the community, financial standing of the household, satisfaction with one’s own life, tidiness and rest, presence of risk factors, health evaluation, attitude towards personal responsibility, and trust in physicians. HIV control was determined by satisfaction with one’s own life, physical activity of women, presence of serious health problems, and
Mastebroek, M.
2017-01-01
People with intellectual disabilities (ID) have a considerably worse health than people without ID, for a great part related to the quality of healthcare provision and health communication. This research studied health information exchange (HIE) between people with ID, their support network, and
Maulik, PK; Kallakuri, S; Devarapalli, S; Vadlamani, VK; Jha, V; Patel, A
2017-01-01
BACKGROUND: About 25% of the Indian population experience common mental disorders (CMD) but only 15-25% of them receive any mental health care. Stigma, lack of adequate mental health professionals and mental health services account for this treatment gap, which is worse in rural areas. Our project evaluated task shifting and mobile-technology based electronic decision support systems to enhance the ability of primary care health workers to provide evidence-based mental health care for stress,...
Parity and parents' health in later life: the gendered case of Ismailia, Egypt.
Engelman, Michal; Agree, Emily M; Yount, Kathryn M; Bishai, David
2010-07-01
We investigate the relationship between reproduction and functional health in later life among women and men in the resource-poor and gender-stratified setting of Ismailia governorate, Egypt. Analyses of survey data collected in 2003 show a statistically significant positive association between parity and difficulty with activities of daily living (ADLs), controlling for demographic and socio-economic factors and other co-morbid conditions. We also find that the number of daughters (but not sons) is associated with worse physical functioning, and this association is more pronounced for older fathers than for older mothers. Our results indicate that both biological and social pathways link fertility and later-life health in this context, and that prescribed familial roles may underlie the differential impact of sons and daughters on the health of mothers and fathers in later life.
Porter, Michael E; Kaplan, Robert S
2016-01-01
The United States stands at a crossroads in how to pay for health care. Fee for service, the dominant payment model in the U.S. and many other countries, is now widely recognized as perhaps the single biggest obstacle to improving health care delivery. A battle is currently raging, outside of the public eye, between the advocates of two radically different payment approaches: capitation and bundled payments. The stakes are high, and the outcome will define the shape of the health care system for many years to come, for better or for worse. In this article, the authors argue that although capitation may deliver modest savings in the short run, it brings significant risks and will fail to fundamentally change the trajectory of a broken system. The bundled payment model, in contrast, triggers competition between providers to create value where it matters--at the individual patient level--and puts health care on the right path. The authors provide robust proof-of-concept examples of bundled payment initiatives in the U.S. and abroad, address the challenges of transitioning to bundled payments, and respond to critics' concerns about obstacles to implementation.
Sun, Sun; Irestig, Robert; Burström, Bo; Beijer, Ulla; Burström, Kristina
2012-03-01
To describe and compare health-related quality of life (HRQoL) among homeless persons with a general population sample in Stockholm County, 2006, and to analyse the importance of certain social determinants of health among the homeless. Face-to-face interviews with 155 homeless persons and a postal survey to a general population sample, mainly based on the same questionnaire, including questions on social determinants of health and HRQoL measured with the EQ-5D. Chronic illness was three times more common among the homeless. HRQoL was worse among homeless persons than in the general population sample: the homeless reported more problems, especially more severe problems, in all the EQ-5D dimensions and had considerably lower EQ-5D(index) and EQ(VAS) score than the general population. Most problems were reported in the dimension anxiety/depression. Among the homeless, longer duration and more severe degree of homelessness lowered HRQoL, but few determinants were statistically significantly related to HRQoL. Having mental disease significantly lowered HRQoL. This study was an attempt to include hard-to-reach groups in an assessment of population health. Homeless persons had considerably worse HRQoL than the general population and reported most problems in the dimension anxiety/depression. Some diseases may contribute to causing homelessness; others may be seen as consequences. Homeless persons are a vulnerable group in society. Further interview studies are needed based on larger sample of homeless persons to explore health determinants such as sex, age, socioeconomic factors, duration and degree of homelessness, and health-related behaviours among the homeless persons.
A dyadic analysis of relationships and health: does couple-level context condition partner effects?
Barr, Ashley B; Simons, Ronald L
2014-08-01
Adding to the growing literature explicating the links between romantic relationships and health, this study examined how both couple-level characteristics, particularly union type (e.g., dating, cohabiting, or marriage) and interracial pairing, and interpersonal characteristics (e.g., partner strain and support), predicted young adults' physical and mental health. Using dyadic data from a sample of 249 young, primarily Black couples, we hypothesized and found support for the importance of couple-level context, partner behavior, and their interaction in predicting health. Interracial couples (all Black/non-Black pairings) reported worse health than monoracial Black couples. Union type, however, did not directly predict health but was a significant moderator of partner strain. That is, the negative association between partner strain and self-reported health was stronger for cohabiting and married couples versus their dating counterparts, suggesting that coresidence, more so than marital status, may be important for understanding partner effects on physical health. For psychological distress, however, partner support proved equally beneficial across union types.
A Dyadic Analysis of Relationships and Health: Does Couple-Level Context Condition Partner Effects?
Barr, Ashley B.; Simons, Ronald L.
2014-01-01
Adding to the growing literature explicating the links between romantic relationships and health, this study examined how both couple-level characteristics, particularly union type (e.g. dating, cohabiting, or marriage) and interracial pairing, and interpersonal characteristics (e.g. partner strain and support) predicted young adults’ physical and mental health. Using dyadic data from a sample of 249 young, primarily African American couples, we hypothesized and found support for the importance of couple-level context, partner behavior, and their interaction in predicting health. Interracial couples (all Black/non-Black pairings) reported worse health than monoracial Black couples. Union type, however, did not directly predict health but was a significant moderator of partner strain. That is, the negative association between partner strain and self-reported health was stronger for cohabiting and married couples versus their dating counterparts, suggesting that coresidence more so than marital status may be important for understanding partner effects on physical health. For psychological distress, however, partner support proved equally beneficial across union types. PMID:25090254
Cedrés, Susana; Nuñez, Isaac; Longo, Marina; Martinez, Pablo; Checa, Eva; Torrejón, Davis; Felip, Enriqueta
2011-05-01
Serum tumor markers are considered a negative prognostic factor in early-stages NSCLC but its role in advanced disease is controversial. The aim of this study is to analyze the prognostic value of tumor markers in advanced NSCLC. Two hundred and seventy seven patients diagnosed in our institution were retrospectively reviewed. Baseline prognostic factors analyzed were gender, histology and brain metastases. Baseline patients characteristics: median age 63 years (30-81 years); males 84.4%, stage IV: 61.7%; adenocarcinoma 38.6%, squamous carcinoma 22.4%. High levels of CEA, CYFRA21-1, and CA125 levels were detected in 179 (55.9%), 119 (65%), and 129 (46.6%) patients respectively. Significant higher levels of CEA and CA125 at baseline were present in adenocarcinoma (P CEA, CYFRA21-1, and CA125 was 5.3 months (m), 3.5 m and 4.6 m versus 7.4 m, 6.2 m and 7.5 m in patients with normal levels (P tumor markers was 10.0 m vs 14.0 m (P = 0.085) for CEA; 5.6 vs 12.1 m for CYFRA21-1 (P = .002), and 8.7 vs 14.0 (P = .03) for CA125. In the multivariate analysis high levels of tumor markers, histology and clinical stage were significant correlated with worse prognostic. Patients with all the tumor markers elevated presented the worst prognosis (3.6 m for PFS and 7.1 m for OS, P tumor markers at baseline are correlated with worse survival in stage III-IV NSCLC patients. Copyright © 2011 Elsevier Inc. All rights reserved.
Plass-Christl, Angela; Otto, Christiane; Klasen, Fionna; Wiegand-Grefe, Silke; Barkmann, Claus; Hölling, Heike; Schulte-Markwort, Michael; Ravens-Sieberer, Ulrike
2017-11-24
Children of parents with mental health problems (CPM) have an increased risk for behavioral and psychological problems. This study investigated the age- and gender-specific course as well as predictors of mental health problems in CPM using the longitudinal data (baseline 1- and 2-year follow-ups) of a German general population sample from the BELLA study. Children and adolescents aged 11-17 years (at baseline) who had a parent with mental health problems (n = 325) were analyzed. The mental health problems of the children were assessed by the self-reported version of the strengths and difficulties questionnaire (SDQ). We used individual growth modeling to investigate the age- and gender-specific course, and the effects of risk as well as personal, familial and social protective factors on self-reported mental health problems in CPM. Additionally, data were examined differentiating internalizing and externalizing mental health problems in CPM. Results indicated that female compared to male CPM showed increasing mental health problems with increasing age. Mental health problems in CPM were associated with lower self-efficacy, worse family climate and less social competence over time. Internalizing problems were associated with lower self-efficacy, less social competence and more severe parental mental health problems. Externalizing problems were associated with lower self-efficacy, worse family climate and lower social competence. The main limitations of the study are the short time period (2 years) covered and the report of mental health problems by only one parent. Our findings should be considered in the development of treatment and prevention programs for mental health problems in CPM.
The Association of Minority Self-Rated Health with Black versus White Gentrification.
Gibbons, Joseph; Barton, Michael S
2016-12-01
There exists controversy as to the impact gentrification of cities has on the well-being of minorities. Some accuse gentrification of causing health disparities for disadvantaged minority populations residing in neighborhoods that are changing as a result of these socioeconomic shifts. Past scholarship has suggested that fears of displacement and social isolation associated with gentrification lead to poorer minority health. However, there is a lack of research that directly links gentrification to minority health outcomes. We address this gap with individual data from the 2008 Philadelphia Health Management Corporation's Southeastern Pennsylvania Household Health Survey and census tract data from the 2000 Decennial Census and the 2006-2010 American Community Survey. We implement logistic multilevel models to determine whether and how a resident's self-rated health is affected by gentrification of their neighborhoods. We find that while gentrification does have a marginal effect improving self-rated health for neighborhood residents overall, it leads to worse health outcomes for Blacks. Accounting for racial change, while gentrification leading to increases in White population has no measurable effect on minority health, "Black gentrification" leads to marginally worse health outcomes for Black respondents. These results demonstrate the limitations that improvements of neighborhood socioeconomic character have in offsetting minority health disparities.
Tu, Hans T H; Campbell, Bruce C V; Christensen, Soren; Desmond, Patricia M; De Silva, Deidre A; Parsons, Mark W; Churilov, Leonid; Lansberg, Maarten G; Mlynash, Michael; Olivot, Jean-Marc; Straka, Matus; Bammer, Roland; Albers, Gregory W; Donnan, Geoffrey A; Davis, Stephen M
2015-06-01
Atrial fibrillation is associated with greater baseline neurological impairment and worse outcomes following ischemic stroke. Previous studies suggest that greater volumes of more severe baseline hypoperfusion in patients with history of atrial fibrillation may explain this association. We further investigated this association by comparing patients with and without atrial fibrillation on initial examination following stroke using pooled multimodal magnetic resonance imaging and clinical data from the Echoplanar Imaging Thrombolytic Evaluation Trial and the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution studies. Echoplanar Imaging Thrombolytic Evaluation Trial was a trial of 101 ischemic stroke patients randomized to intravenous tissue plasminogen activator or placebo, and Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution was a prospective cohort of 74 ischemic stroke patients treated with intravenous tissue plasminogen activator at three to six hours following symptom onset. Patients underwent multimodal magnetic resonance imaging before treatment, at three to five days and three-months after stroke in Echoplanar Imaging Thrombolytic Evaluation Trial; before treatment, three to six hours after treatment and one-month after stroke in Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution. Patients were assessed with the National Institutes of Health Stroke Scale and the modified Rankin scale before treatment and at three-months after stroke. Patients were categorized into definite atrial fibrillation (present on initial examination), probable atrial fibrillation (history but no atrial fibrillation on initial examination), and no atrial fibrillation. Perfusion data were reprocessed with automated magnetic resonance imaging analysis software (RAPID, Stanford University, Stanford, CA, USA). Hypoperfusion volumes were defined using time to maximum delays in two-second increments from >4 to
Health-related quality-of-life in low-income, uninsured men with prostate cancer.
Krupski, Tracey L; Fink, Arlene; Kwan, Lorna; Maliski, Sally; Connor, Sarah E; Clerkin, Barbara; Litwin, Mark S
2005-05-01
The objective was to describe health-related quality-of-life (HRQOL) in low-income men with prostate cancer. Subjects were drawn from a statewide public assistance prostate cancer program. Telephone and mail surveys included the RAND 12-item Health Survey and UCLA Prostate Cancer Index Short Form and were compared with normative age-matched men without cancer from the general population reported on in the literature. Of 286 eligible men, 233 (81%) agreed to participate and completed the necessary items. The sample consisted of 51% Hispanics, 23% non-Hispanic whites, and 17% African Americans. The low-income men had worse scores in every domain of prostate-specific and general HRQOL than had the age-matched general population controls. The degree of disparity indicated substantial clinical differences in almost every domain of physical and emotional functioning between the sample group and the control group. Linear regression modeling determined that among the low-income men, Hispanic race, and income level were predictive of worse physical functioning, whereas only comorbidities predicted mental health. Low-income patients with prostate cancer appear to have quality-of-life profiles that are meaningfully worse than age-matched men from the general population without cancer reported on in the literature.
Directory of Open Access Journals (Sweden)
Mario Guitérrez-Bedmar
2009-01-01
Full Text Available We aimed to evaluate the association between smoking, changes in smoking, and quality of life in a cohort of Spanish university graduates. Smoking habits were self-reported at baseline and four years later. Quality of life was assessed using the Short Form-36 (SF-36 at year 4. Statistical differences in SF-36 scores between groups were determined using ANCOVA with age and sex as covariates. Out of 5,234 eligible participants over 2000-2006, there were 2,639 non-smoker participants, 1,419 ex-smokers, and 1,048 smokers. Within the previous four years, 435 participants became recent quitters and 205 starters. Comparing smoking and health status in year 4, non-smokers showed better scores than the other categories of ever smoking in all dimensions except in the vitality scale value, which was similar in non-smokers and in those smoking less than 15 cigarettes/day. Comparing changes in smoking and health in year 4, continuing smokers had statistically significant worse scores than non-smokers in general health, social functioning, role-emotional and mental health, whereas recent quitters showed statistically significant improvements in role-emotional and mental health over those who had continued smoking or those who became smokers. Our findings support a dose-response relationship between cigarette consumption and a worse quality of life in general and mental health in particular. They also support that changes in smoking have an impact on health.
Gum, Jeffrey L; Glassman, Steven D; Carreon, Leah Y
2013-11-01
Health-related quality of life (HRQOL) measures have become the mainstay for outcome appraisal in spine surgery. Clinically meaningful interpretation of HRQOL improvement has centered on the minimum clinically important difference (MCID). The purpose of this study was to calculate clinically important deterioration (CIDET) thresholds and determine a CIDET value for each HRQOL measure for patients undergoing lumbar fusion. Seven hundred twenty-two patients (248 males, 127 smokers, mean age 60.8 years) were identified with complete preoperative and 1-year postoperative HRQOLs including the Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36), and numeric rating scales (0-10) for back and leg pain following primary, instrumented, posterior lumbar fusion. Anchor-based and distribution-based methods were used to calculate CIDET for each HRQOL. Anchor-based methods included change score, change difference, and receiver operating characteristic curve analysis. The Health Transition Item, an independent item of the SF-36, was used as the external anchor. Patients who responded "somewhat worse" and "much worse" were combined and compared with patients responding "about the same." Distribution-based methods were minimum detectable change and effect size. Diagnoses included spondylolisthesis (n = 332), scoliosis (n = 54), instability (n = 37), disc pathology (n = 146), and stenosis (n = 153). There was a statistically significant change (p < 0.0001) for each HRQOL measure from preoperatively to 1-year postoperatively. Only 107 patients (15%) reported being "somewhat worse" (n = 81) or "much worse" (n = 26). Calculation methods yielded a range of CIDET values for ODI (0.17-9.06), SF-36 physical component summary (-0.32 to 4.43), back pain (0.02-1.50), and leg pain (0.02-1.50). A threshold for clinical deterioration was difficult to identify. This may be due to the small number of patients reporting being worse after surgery and the variability across
Menstruation, objectification and health-related quality of life: A questionnaire study.
Sveinsdóttir, Herdís
2018-02-01
To explore young women's health-related quality of life (HRQOL) and investigate whether menstrual and menarche experiences and objectification predict mental and physical health components of HRQOL. Menstruation plays a fundamental role in female biology, in women's relationship to their bodies and consequently in women's health and their HRQOL. Cross-sectional explorative survey design. A questionnaire that included the SF-36v2, the Self-objectification Questionnaire (SOQ), the Body Surveillance and Body Shame subscales of the Objectified Body Consciousness Scale, the Belief and Attitudes Towards Menstruation Questionnaire (four subscales), and questions on menarche and menstruation was administered at the end of 2013 to 319 Icelandic women who represented the population by age. The SF-36v2 includes eight dimensions addressing the mental and physical components of HRQOL. Scores are presented as raw data scores and scores based on standardised score of American women and range from 0 to 100 with higher scores indicating better HRQL. A hierarchical multiple linear regression model was employed to calculate significant predictors of mental and physical health components of HRQOL. Mean raw data scores on SF36-v2 dimensions ranged from 54.7 to 91.5. The participants scored below the standardised, mean norm-based score for all dimensions. Secrecy of menstruation, experience of body shame and pain during menstruation predicted worse mental HRQOL. To believe in the proscriptive role and the unpleasantness of menstruation, experience of body shame, medication for menstrual pain and not holding a university education predicted worse physical HRQOL. These two models explained 30% and 22% of the variance of the mental and physical components of SF36-v2, respectively. Young women's mental and physical HRQOL is influenced by the specific context of their lives. Women's health education should take into account the various relationships women may have with their bodies. © 2017
The badness of death and priorities in health.
Solberg, Carl Tollef; Gamlund, Espen
2016-04-14
The state of the world is one with scarce medical resources where longevity is not equally distributed. Given such facts, setting priorities in health entails making difficult yet unavoidable decisions about which lives to save. The business of saving lives works on the assumption that longevity is valuable and that an early death is worse than a late death. There is a vast literature on health priorities and badness of death, separately. Surprisingly, there has been little cross-fertilisation between the academic fields of priority setting and badness of death. Our aim is to connect philosophical discussions on the badness of death to contemporary debates in health priorities. Two questions regarding death are especially relevant to health priorities. The first question is why death is bad. Death is clearly bad for others, such as family, friends and society. Many philosophers also argue that death can be bad for those who die. This distinction is important for health priorities, because it concerns our fundamental reasons for saving lives. The second question is, 'When is the worst time to die?' A premature death is commonly considered worse than a late death. Thus, the number of good life years lost seems to matter to the badness of death. Concerning young individuals, some think the death of infants is worse than the death of adolescents, while others have contrary intuitions. Our claim is that to prioritise between age groups, we must consider the question of when it is worst to die. Deprivationism provides a more plausible approach to health priorities than Epicureanism. If Deprivationism is accepted, we will have a firmer basis for claiming that individuals, in addition to having a health loss caused by morbidity, will have a loss of good life years due to mortality. Additionally, Deprivationism highlights the importance of age and values for health priorities. Regarding age, both variants of Deprivationism imply that stillbirths are included in the Global
Transforming EQ-5D utilities for use in cost–value analysis of health programs.
Nord, Erik; Johansen, Rune
2015-04-01
In a number of jurisdictions there is increasing interest in incorporating concerns for fairness in models for economic evaluation of health interventions. Cost–value analysis is a name for evaluations with such a broader aim. The most widely held concern for fairness is a concern for the worse off, i.e. the idea that severity of illness should count in determining priorities. In economic evaluations of improvements in health-related quality of life this concern may be taken into account by replacing conventional health state utilities with societal values for health states that are characterised by strong upper end compression and decreasing marginal value of utility gains. We review evidence on the strength of concerns for the worse off--measured at the cardinal level--in 15 articles published in peer-reviewed journals in the time period 1978–2010, with reports from altogether 20 individual studies in nine different countries. We report 116 individual observations of paired comparisons of utility improvements with different start levels. Concerns for severity show up quite strongly across countries, sample types and question framings. By means of regression analyses we fit a societal value function to the data that has the property of decreasing marginal value of utility gains. Using the central tendency in the data we present two plausible transformations of EQ-5D utilities into societal values that reflect concerns for the worse off.
Late life changes in mental health: a longitudinal study of 9683 women.
Leigh, Lucy; Byles, Julie E; Chojenta, Catherine; Pachana, Nancy A
2016-10-01
To identify latent subgroups of women in late life who are alike in terms of their mental health trajectories. Longitudinal data are for 9683 participants in the 1921-1926 cohort of the Australian Longitudinal Study on Women's Health, who completed at least two surveys between 1999 (aged 73-78 years) and 2008 (aged 82-87 years). Mental health was measured using the five-item mental health inventory (MHI-5). Latent profile analysis uncovered patterns of change in MHI-5 scores. Three patterns of change were identified for women who were still alive in 2008 (n = 7061), and three similar patterns for deceased women (n = 2622): (1) 'poor mental health' representing women with low MHI-5 scores, (2) 'good mental health' and (3) 'excellent' mental health, where scores remained very high. Deceased women had lower mental health scores for each class. Remote areas of residence, higher education, single marital status, higher Body Mass Index (BMI) and falls were the covariates associated with mental health in the survivor group. For the deceased group, education, BMI and falls were significant. Arthritis, stroke, heart disease, bronchitis/emphysema, diabetes and osteoporosis were associated with worse mental health for both groups, while asthma increased these odds significantly for the survivor group only. Hypertension and cancer were not significant predictors of poor mental health. The results show associations between chronic disease and level of mental health in older age, but no evidence of a large decline in mental health in the period prior to death.
Self-Reported Health and Gender: The Role of Social Norms
Caroli, Eve; Weber-Baghdiguian, Lexane
2016-01-01
We investigate the role of social norms in accounting for differences in self-reported health as reported by men and women. Using the European Working Conditions Survey (EWCS, 2010), we first replicate the standard result that women report worse health than men, whatever the health outcome we consider – i.e. general self-assessed health but also more specific symptoms such as skin problems, backache, muscular pain in upper and lower limbs, headache and eyestrain, stomach ache, respiratory dif...
Bosdriesz, J R; Stam, M; Smits, C; Kramer, S E
2018-06-01
This study aimed to examine the psychosocial health status of adult cochlear implant (CI) users, compared to that of hearing aid (HA) users, hearing-impaired adults without hearing aids and normally hearing adults. Cross-sectional observational study, using both self-reported survey data and a speech-in-noise test. Data as collected within the Netherlands Longitudinal Study on Hearing (NL-SH) between September 2011 and June 2016 were used. Data from 1254 Dutch adults (aged 23-74), selected in a convenience sample design, were included for analyses. Psychosocial health measures included emotional and social loneliness, anxiety, depression, distress and somatisation. Psychosocial health, hearing status, use of hearing technology and covariates were measured by self-report; hearing ability was assessed through an online digit triplet speech-in-noise test. After adjusting for the degree of hearing impairment, HA users (N = 418) and hearing-impaired adults (N = 247) had significantly worse scores on emotional loneliness than CI users (N = 37). HA users had significantly higher anxiety scores than CI users in some analyses. Non-significant differences were found between normally hearing (N = 552) and CI users for all psychosocial outcomes. Psychosocial health of CI users is not worse than that of hearing-impaired adults with or without hearing aids. CI users' level of emotional loneliness is even lower than that of their hearing-impaired peers using hearing aids. A possible explanation is that CI patients receive more professional and family support, and guidance along their patient journey than adults who are fitted with hearing aids. © 2017 The Authors. Clinical Otolaryngology Published by John Wiley & Sons Ltd.
Shaffer, Kelly M; Jacobs, Jamie M; Nipp, Ryan D; Carr, Alaina; Jackson, Vicki A; Park, Elyse R; Pirl, William F; El-Jawahri, Areej; Gallagher, Emily R; Greer, Joseph A; Temel, Jennifer S
2017-03-01
Caregiver, relational, and patient factors have been associated with the health of family members and friends providing care to patients with early-stage cancer. Little research has examined whether findings extend to family caregivers of patients with incurable cancer, who experience unique and substantial caregiving burdens. We examined correlates of mental and physical health among caregivers of patients with newly-diagnosed incurable lung or non-colorectal gastrointestinal cancer. At baseline for a trial of early palliative care, caregivers of participating patients (N = 275) reported their mental and physical health (Medical Outcome Survey-Short Form-36); patients reported their quality of life (Functional Assessment of Cancer Therapy-General). Analyses used hierarchical linear regression with two-tailed significance tests. Caregivers' mental health was worse than the U.S. national population (M = 44.31, p caregiver, relational, and patient factors simultaneously revealed that younger (B = 0.31, p = .001), spousal caregivers (B = -8.70, p = .003), who cared for patients reporting low emotional well-being (B = 0.51, p = .01) reported worse mental health; older (B = -0.17, p = .01) caregivers with low educational attainment (B = 4.36, p family caregivers of patients with incurable cancer, caregiver demographics, relational factors, and patient-specific factors were all related to caregiver mental health, while caregiver demographics were primarily associated with caregiver physical health. These findings help identify characteristics of family caregivers at highest risk of poor mental and physical health who may benefit from greater supportive care.
The Young and the Stressed: Stress, Impulse Control, and Health in College Students.
Leppink, Eric W; Odlaug, Brian L; Lust, Katherine; Christenson, Gary; Grant, Jon E
2016-12-01
High levels of stress are common among young adults, particularly those enrolled in college. These degrees of stress have shown numerous deleterious effects across both academic and health variables. Findings regarding the role of stress in the presentation of impulse control disorders, particular among college students, are limited. This study examined potential associations between perceived stress, academic achievement, physical/mental health, and impulse control disorders in young adults. A total of 1805 students completed an online survey and were included in the analysis. Responders were grouped by their overall score on the Perceived Stress Scale into mild, moderate, or severe. Severe perceived stress was associated with worse academic achievement and worse physical health, as well as higher rates of psychiatric and impulsive disorders. These findings may suggest associations between stress and numerous aspects of mental/physical health in young adults, which could be an important consideration for individuals working with college students.
Hispanic parents' reading language preference and pediatric oral health-related quality of life.
Yazicioglu, Iffet; Jones, Judith A; Cortés, Dharma; Rich, Sharron; Garcia, Raul
2013-01-01
This study compared scores and psychometric properties from self-identified Hispanic parents who completed Pediatric Oral Health-related Quality of life (POQL) parent report-on-child questionnaires in Spanish or English. The study hypothesized that there were no differences in psychometric properties or POQL scores by parent reading language preference, controlling for dental needs, child's place of birth, age, insurance and use of care. POQL scores were computed, and the internal consistency, feasibility, factor structure and construct validity of the Spanish language version assessed. Hispanic parents (N = 387) of 8-14 year old children (mean age 10.2) completed the survey; 237 in Spanish and 150 in English. Internal consistency scores were higher (Cronbach α range = .86-.93) among Hispanic parents who completed the questionnaire in Spanish than in English (.66-.86). POQL scores from parents who completed questionnaires in Spanish were higher (worse) overall (6.03 vs. 3.82, P = 0.022), as were physical (11.61 vs. 6.54, P = 0.001) and role functioning domains (1.87 vs. 0.82, P = 0.029). Items for crying, pain, and eating were higher (P parent reports of dental visit in the last year (P = 0.05) and worse oral health than a year ago (P = 0.002), controlling for reading language (not significant) and visit in last year in the final multivariate linear regression. © 2013 American Association of Public Health Dentistry.
Relationship of weight status with mental and physical health in female fibromyalgia patients.
Aparicio, Virginia A; Ortega, Francisco B; Carbonell-Baeza, Ana; Camiletti, Daniel; Ruiz, Jonatan R; Delgado-Fernández, Manuel
2011-01-01
To analyze the association of weight status with anxiety, depression, quality of life and physical fitness in fibromyalgia (FM) patients. The sample comprised 175 Spanish female FM patients (51.2 ± 7 years). We assessed quality of life by means of the Short-Form-36 Health Survey (SF36) and anxiety and depression by means of the Hospital Anxiety and Depression Scale (HADS). We used standardized fieldbased fitness tests to assess cardiorespiratory fitness, muscular strength, flexibility, agility, and static and dynamic balance. BMI was calculated and categorized using the international criteria. 33% of the sample was normal-weight, 35% overweight and 33% obese. HADS-anxiety and HADS-depression levels increased across the weight status categories. Obese patients had higher anxiety and depression levels compared to normal-weight patients (p < 0.05) whereas no differences were observed between overweight and obese patients. Physical functioning, bodily pain, general health (all p < 0.01) and mental health (p < 0.05) subscales from the SF36 were worse across the weight status categories. Likewise, levels of cardiorespiratory fitness, dynamic balance/motor agility (both p < 0.05) and upper-body flexibility (p < 0.001) decreased as the weight status increased. Pairwise comparisons showed significant differences mainly between the normal-weight versus obese groups. Obese female FM patients displayed higher levels of anxiety and depression and worse quality of life, cardiorespiratory fitness, dynamic balance/motor agility and upper-body flexibility than their normal-weight peers. Copyright © 2011 S. Karger AG, Basel.
Housing and respiratory health at older ages.
Webb, E; Blane, D; de Vries, Robert
2013-03-01
A large proportion of the population of England live in substandard housing. Previous research has suggested that poor-quality housing, particularly in terms of cold temperatures, mould, and damp, poses a health risk, particularly for older people. The present study aimed to examine the association between housing conditions and objectively measured respiratory health in a large general population sample of older people in England. Data on housing conditions, respiratory health and relevant covariates were obtained from the second wave of the English Longitudinal Study of Ageing. Multivariate regression methods were used to test the association between contemporary housing conditions and respiratory health while accounting for the potential effect of other factors; including social class, previous life-course housing conditions and childhood respiratory health. Older people who were in fuel poverty or who did not live in a home they owned had significantly worse respiratory health as measured by peak expiratory flow rates. After accounting for covariates, these factors had no effect on any other measures of respiratory health. Self-reported housing problems were not consistently associated with respiratory health. The housing conditions of older people in England, particularly those associated with fuel poverty and living in rented accommodation, may be harmful to some aspects of respiratory health. This has implications for upcoming UK government housing and energy policy decisions.
DEFF Research Database (Denmark)
Jensen, Kirsten Egebjerg; Schmiedel, Sven; Frederiksen, Kirsten
2012-01-01
were also conducted. Hazard ratios (HRs) for a diagnosis of cervical intraepithelial neoplasia grade 3 or worse/high-grade squamous intraepithelial lesions or worse (CIN3+) and the corresponding 95% confidence intervals (CIs) were calculated in the 2 groups. RESULTS: Among high-risk HPV positive women......BACKGROUND: Smoking has been associated with cervical cancer. We examined whether smoking increases the risk for high-grade cervical lesions in women with high-risk human papillomavirus (HPV) infection. METHODS: In a population-based cohort study, 8,656 women underwent a structured interview......, and subsequently cervical cells were obtained for HPV DNA testing. Women with high-risk HPV infection and no prevalent cervical disease at baseline (n=1,353) were followed through the Pathology Data Bank for cervical lesions for up to 13 years. Separate analyses of women with persistent high-risk HPV infection...
The influence of socioeconomic factors on health parameters in overweight and obese adults.
Directory of Open Access Journals (Sweden)
Nathalie T Burkert
Full Text Available The prevalence of being overweight and of obesity is increasing worldwide, and is associated with a high risk to health. Therefore, the aim of our study was to investigate whether normal weight, overweight and obese subjects of low, middle or high socioeconomic status (SES differ with regard to their health behavior, health, quality of life, and the use of medical care. Data from the Austrian Health Interview Survey (ATHIS 2006/07, comprising 3 groups of 1,077 individuals, each of whom were normal weight, overweight, or obese, respectively, and matched according to their age, sex and SES, were analyzed concerning health outcomes. The results show that subjects with a low SES differ significantly from those of high SES in terms of their health behavior, self-perceived health, levels of impairment, chronic conditions, quality of life, and health care. Additionally, obesity in adults is associated with sub-optimal dietary practices and worse health, poorer quality of life and medical care than normal weight and overweight individuals. A significant interaction between the weight class and SES was found concerning physical exercise, impairment due to health problems and chronic diseases. A low SES has a strong negative impact on health, especially in obese individuals. Therefore a continuous target group-oriented, non-discriminatory public health program is required, prioritizing obese subjects with low SES.
The influence of socioeconomic factors on health parameters in overweight and obese adults.
Burkert, Nathalie T; Rásky, Éva; Großschädl, Franziska; Muckenhuber, Johanna; Freidl, Wolfgang
2013-01-01
The prevalence of being overweight and of obesity is increasing worldwide, and is associated with a high risk to health. Therefore, the aim of our study was to investigate whether normal weight, overweight and obese subjects of low, middle or high socioeconomic status (SES) differ with regard to their health behavior, health, quality of life, and the use of medical care. Data from the Austrian Health Interview Survey (ATHIS) 2006/07, comprising 3 groups of 1,077 individuals, each of whom were normal weight, overweight, or obese, respectively, and matched according to their age, sex and SES, were analyzed concerning health outcomes. The results show that subjects with a low SES differ significantly from those of high SES in terms of their health behavior, self-perceived health, levels of impairment, chronic conditions, quality of life, and health care. Additionally, obesity in adults is associated with sub-optimal dietary practices and worse health, poorer quality of life and medical care than normal weight and overweight individuals. A significant interaction between the weight class and SES was found concerning physical exercise, impairment due to health problems and chronic diseases. A low SES has a strong negative impact on health, especially in obese individuals. Therefore a continuous target group-oriented, non-discriminatory public health program is required, prioritizing obese subjects with low SES.
Mykhalovskiy, Eric
2011-09-01
Using criminal law powers to respond to people living with HIV (PHAs) who expose sexual partners to HIV or transmit the virus to them is a prominent global HIV public policy issue. While there are widespread concerns about the public health impact of HIV-related criminalization, the social science literature on the topic is limited. This article responds to that gap in knowledge by reporting on the results of qualitative research conducted with service providers and PHAs in Canada. The article draws on a studies in the social organization of knowledge perspective and insights from critical criminology and work on the "medico-legal borderland." It investigates the role played by the legal concept of "significant risk" in coordinating criminal law governance and its interface with public health and HIV prevention. In doing so, the article emphasizes that exploring the public health impact of criminalization must move past the criminal law--PHA dyad to address broader social and institutional processes relevant to HIV prevention. Drawing on individual and focus group interviews, this article explores how criminal law governance shapes the activities of providers engaged in HIV prevention counseling, conceptualized as a complex of activities linking clinicians, public health officials, front-line counselors, PHAs, and others. It emphasizes three key findings: (1) the concept of significant risk poses serious problems to risk communication in HIV counseling and contributes to contradictory advice about disclosure obligations; (2) criminalization discourages PHAs' openness about HIV non-disclosure in counseling relationships; and (3) the recontextualization of public health interpretations of significant risk in criminal proceedings can intensify criminalization. Copyright © 2011 Elsevier Ltd. All rights reserved.
Priority for the worse-off and the social cost of carbon
Adler, Matthew; Anthoff, David; Bosetti, Valentina; Garner, Greg; Keller, Klaus; Treich, Nicolas
2017-06-01
The social cost of carbon (SCC) is a key tool in climate policy. The SCC expresses in monetary terms the social impact of the emission of a ton of CO2 in a given year. The SCC is calculated using a `social welfare function’ (SWF): a method for assessing social welfare. The dominant SWF in climate policy is the discounted-utilitarian SWF. Individuals’ well-being numbers (utilities) are summed, and the values for later generations are reduced (`discounted’). This SWF has been criticized for ignoring the distribution of well-being and including an arbitrary time preference. Here, we use a `prioritarian’ SWF, with no time discount, to calculate the SCC. This SWF gives extra weight (`priority’) to worse-off individuals. Prioritarianism is a well-developed concept in ethics and welfare economics, but has been rarely used in climate scholarship. We find substantial differences between the discounted-utilitarian and non-discounted prioritarian SCCs.
Ding, Bo; DiBonaventura, Marco; Karlsson, Niklas; Ling, Xia
2016-01-01
Research has suggested a significant burden for patients with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS). However, few studies have studied this population in the People's Republic of China, a region in the midst of rapid epidemiological change with respect to respiratory disease. The aim of this study was to assess the prevalence of ACOS and its association with patient outcomes in urban China. Data from the 2010, 2012, and 2013 China National Health and Wellness Survey, an Internet-based survey of adults in urban China, were used (N=59,935). Respondents were categorized into one of four groups based on self-reported physician diagnoses: ACOS, asthma only, COPD only, or control (ie, no asthma or COPD). A propensity score matching procedure was conducted to cull the control group into a subgroup (ie, matched controls) who resembled patients with ACOS, asthma only, and COPD only. These four groups (ACOS, asthma only, COPD only, matched controls) were then compared with respect to health status (Short Form-12 version 2/Short Form-36 version 2), work productivity, and health care resource use using generalized linear models. Patients with ACOS (N=366) comprised 0.61% of the adult population, 30.73% of the asthma population, and 18.60% of the COPD population in the People's Republic of China. Patients with ACOS reported significantly worse health status (eg, health utilities =0.63, 0.66, 0.63, and 0.69 for ACOS, COPD only, asthma only, and matched controls, respectively) and significantly greater work impairment (eg, overall work impairment =43.65%, 35.19%, 48.55%, and 29.80%, respectively) and health care resource use (eg, physician visits in the past 6 months =5.13, 3.84, 4.65, and 2.39, respectively) compared with matched controls and patients with COPD only. Few significant differences were observed between patients with ACOS and asthma only. Patients with ACOS have a greater comorbidity burden and significantly worse health
Dahlin, Johanna; Härkönen, Juho
2013-12-01
Multiple studies have found that women report being in worse health despite living longer. Gender gaps vary cross-nationally, but relatively little is known about the causes of comparative differences. Existing literature is inconclusive as to whether gender gaps in health are smaller in more gender equal societies. We analyze gender gaps in self-rated health (SRH) and limiting longstanding illness (LLI) with five waves of European Social Survey data for 191,104 respondents from 28 countries. We use means, odds ratios, logistic regressions, and multilevel random slopes logistic regressions. Gender gaps in subjective health vary visibly across Europe. In many countries (especially in Eastern and Southern Europe), women report distinctly worse health, while in others (such as Estonia, Finland, and Great Britain) there are small or no differences. Logistic regressions ran separately for each country revealed that individual-level socioeconomic and demographic variables explain a majority of these gaps in some countries, but contribute little to their understanding in most countries. In yet other countries, men had worse health when these variables were controlled for. Cross-national variation in the gender gaps exists after accounting for individual-level factors. Against expectations, the remaining gaps are not systematically related to societal-level gender inequality in the multilevel analyses. Our findings stress persistent cross-national variability in gender gaps in health and call for further analysis. Copyright © 2013 Elsevier Ltd. All rights reserved.
Directory of Open Access Journals (Sweden)
Ashley Wilder Smith
2013-04-01
Full Text Available Introduction: Cancer for adolescents and young adults (AYA differs from younger and older patients; AYA face medical challenges while navigating social and developmental transitions. Research suggests that these patients are under- or inadequately served by current support services, which may affect health-related quality of life (HRQOL.Methods: We examined unmet service needs and HRQOL in the National Cancer Institute’s Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE study, a population-based cohort (n=484, age 15-39, diagnosed with cancer 6-14 months prior, in 2007-2009. Unmet service needs were psychosocial, physical, spiritual, and financial services where respondents endorsed that they needed, but did not receive, a listed service. Linear regression models tested associations between any or specific unmet service needs and HRQOL, adjusting for demographic, medical and health insurance variables.Results: Over one-third of respondents reported at least one unmet service need. The most common were financial (16%, mental health (15%, and support group (14% services. Adjusted models showed that having any unmet service need was associated with worse overall HRQOL, fatigue, physical, emotional, social, and school/work functioning, and mental health (p’s<0.0001. Specific unmet services were related to particular outcomes (e.g., needing pain management was associated with worse overall HRQOL, physical and social functioning (p’s<0.001. Needing mental health services had the strongest associations with worse HRQOL outcomes; needing physical/occupational therapy was most consistently associated with poorer functioning across domains.Discussion: Unmet service needs in AYAs recently diagnosed with cancer are associated with worse HRQOL. Research should examine developmentally appropriate, relevant practices to improve access to services demonstrated to adversely impact HRQOL, particularly physical therapy and mental
Trailin, Andriy V; Ostapenko, Tetyana I; Nykonenko, Tamara N; Nesterenko, Svitlana N; Nykonenko, Olexandr S
2017-01-01
We aimed to determine whether serum soluble CD30 (sCD30) could identify recipients at high risk for unfavorable early and late kidney transplant outcomes. Serum sCD30 was measured on the day of kidney transplantation and on the 4th day posttransplant. We assessed the value of these measurements in predicting delayed graft function, slow graft function (SGF), acute rejection (AR), pyelonephritis, decline of allograft function after 6 months, and graft and patient survival during 5 years of follow-up in 45 recipients. We found the association between low pretransplant serum levels of sCD30 and SGF. The absence of significant decrease of sCD30 on the 4th day posttransplant was characteristic for SGF, early AR (the 8th day-6 months), late AR (>6 months), and early pyelonephritis (the 8th day-2 months). Lower pretransplant and posttransplant sCD30 predicted worse allograft function at 6 months and 2 years, respectively. Higher pretransplant sCD30 was associated with higher frequency of early AR, and worse patients' survival, but only in the recipients of deceased-donor graft. Pretransplant sCD30 also allowed to differentiate patients with early pyelonephritis and early AR. Peritransplant sCD30 is useful in identifying patients at risk for unfavorable early and late transplant outcomes.
Ostapenko, Tetyana I.; Nykonenko, Tamara N.; Nesterenko, Svitlana N.; Nykonenko, Olexandr S.
2017-01-01
Background We aimed to determine whether serum soluble CD30 (sCD30) could identify recipients at high risk for unfavorable early and late kidney transplant outcomes. Methods Serum sCD30 was measured on the day of kidney transplantation and on the 4th day posttransplant. We assessed the value of these measurements in predicting delayed graft function, slow graft function (SGF), acute rejection (AR), pyelonephritis, decline of allograft function after 6 months, and graft and patient survival during 5 years of follow-up in 45 recipients. Results We found the association between low pretransplant serum levels of sCD30 and SGF. The absence of significant decrease of sCD30 on the 4th day posttransplant was characteristic for SGF, early AR (the 8th day–6 months), late AR (>6 months), and early pyelonephritis (the 8th day–2 months). Lower pretransplant and posttransplant sCD30 predicted worse allograft function at 6 months and 2 years, respectively. Higher pretransplant sCD30 was associated with higher frequency of early AR, and worse patients' survival, but only in the recipients of deceased-donor graft. Pretransplant sCD30 also allowed to differentiate patients with early pyelonephritis and early AR. Conclusions Peritransplant sCD30 is useful in identifying patients at risk for unfavorable early and late transplant outcomes. PMID:28694560
Liang, Chengcai; Chi, Runmin; Huang, Liqun; Wang, Jinliang; Liu, Hailong; Xu, Ding; Qian, Subo; Qian, Xiaoqiang; Qi, Jun
2016-10-01
The purpose of the study was to identify predictors of clinicopathologic features and oncologic outcomes in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy (RNU). The medical records of 172 patients treated with RNU from January 2001 to September 2014 were retrospectively reviewed. Logistic regression and survival analysis methodology were respectively used to evaluate predictors of clinicopathologic features and oncologic outcomes. Of the enrolled 172 patients, 80 (46.5%) had renal pelvic tumors, 67 (39%) had ureteral tumors, and the remaining 25 (14.5%) patients had multifocal tumors. Compared with patients with renal pelvic tumors, those with ureteral and multifocal tumors were more likely to have previous or synchronous nonmuscle-invasive bladder cancer (NMIBC) and severe hydronephrosis (P = .001 and P hydronephrosis independently predicted worse renal function and positive lymph node or lymphovascular invasion status (P = .001 and P = .007, respectively). Moreover, severe hydronephrosis was an independent risk factor for overall survival and cancer-specific survival in multivariate analysis (P = .025 and P = .045, respectively). Multifocality and previous or synchronous NMIBC were significantly associated with bladder-recurrence-free survival (P = .023 and P = .001, respectively). Upper tract urothelial carcinoma accompanied by previous or synchronous NMIBC and preoperative severe hydronephrosis could have worse oncologic outcomes after RNU. These common accompanied diagnoses could be valuable for guiding preoperative planning and postoperative adjuvant therapy. Copyright © 2016 Elsevier Inc. All rights reserved.
Exposure to formaldehyde: a challenge of occupational health significance
International Nuclear Information System (INIS)
Kaonga, K.
2009-01-01
The use of formaldehyde as the fixative for general microscopic demonstration of tissues in medical laboratory establishments is as significant as the diagnosis of the underlying ailment. Instantaneous human exposure to formaldehyde elicits symptoms that may include watery eyes, headache, inflamed throat and dyspnea. The gaseous chemical is toxic, allergenic and carcinogenic. A study to determine the incidence of human exposure to formaldehyde was carried out at the University Teaching Hospital in Lusaka, Zambia from January to December, 2007. Anonymous questionnaires on various aspects of human exposure to formaldehyde were given to laboratory technical personnel. Exposure to formaldehyde was determined using general consideration model comprising points awarded to participants according to their responses. Five points represented the maximum level of exposure, while one point denoted the minimum encounter. There were 8 incidents of formaldehyde pollution, with five being emissions from 210-litre formalin receptacles whose stoppers were inadvertently left loose overnight, while three involved accidental breakage of Winchester bottles of formalin. A total of 115 people were exposed during the year. Fifteen (13.0 percent) participants scored one point each, while 20 (17.4 percent) participants obtained 2 points each. Thirty-five (30.4 percent) participants got 3 points each, while 30 (26.0 percent) participants received 4 points each. Twenty-five (21.7 percent) participants attained 5 points each. Human exposure to formaldehyde is an issue of occupational health concern. Participants with a score of 3 points or more need regular medical check ups in order to safeguard their health. Programs on effective management of hazardous chemicals are worth setting up.(author)
Diabetes in young adult men: social and health-related correlates
Directory of Open Access Journals (Sweden)
Rachel L. Koelmeyer
2016-10-01
Full Text Available Abstract Background Diabetes is a global public health issue. It is associated with significant disability, morbidity and mortality risks and substantial healthcare costs. Of great concern is the fact that its prevalence is rising, particularly amongst the young, while epidemiological data regarding the incidence, prevalence and complications of early-onset type 2 diabetes is noted to be sparse. Methods We used data from the baseline wave of Ten to Men, a national cohort study of Australian males, to investigate the social and health-related correlates of Australian males aged 18–49 years reporting being diagnosed with diabetes. Results The estimated prevalence of a self-reported diabetes diagnosis amongst Australian males aged 18–49 years was 2.95 % (95 % CI: 2.54–3.43 %. Within this age group, approximately 75 % of those diagnosed with diabetes are expected to be living with a known diagnosis of type 2 diabetes; the remainder are expected to be living with type 1 diabetes. Of the 20 social and health-related factors considered, we found evidence to support the association of eighteen factors after adjusting for age and body mass index. The strongest correlates of reporting a diabetes diagnosis, associated with a ≥2-fold increase in the odds of reporting diabetes were being aged 35–49 years, being unemployed, being obese, seeing a doctor for a check-up more frequently, reporting comorbid high blood pressure or physical or mental health comorbidities and worse self-rated and physical health status. Conclusion Australian males aged 18–49 years who are living with a known diagnosis of diabetes are more likely to be socio-economically disadvantaged and suffer substantially worse health status than Australian males aged 18–49 years living without a diabetes diagnosis. Based on the associations detected in this study, older, single males living in regional areas who are socioeconomically disadvantaged, obese and/or who have other
Cerulli, Catherine; Cerulli, Jennifer; Santos, Elizabeth J; Lu, Najii; He, Hua; Kaukeinen, Kimberly; White, Anne Marie; Tu, Xin
To explore whether the health status of intimate partner violence (IPV) victims warrants pharmacies to be portals for public health promotion. Specific objectives included (1) identifying prevalence of IPV including domestic violence (DV) and sexual assault (SA) in a community sample, (2) describing characteristics and correlates of DV/SA between participants who reported and did not report DV/SA, and (3) exploring whether DV/SA status is related to mental health medication use. Cross sectional. Upstate New York during 2006. English- and Spanish-speaking respondents younger than 65 years of age answering four questions to assess DV/SA. Secondary analysis of a countywide random telephone survey, the 2006 Monroe County Adult Health Survey, which collects prevalence data on health behaviors and health status indicators. To determine whether those reporting DV/SA are at increased odds for mental health medication use, controlling for other sociodemographic- and health-related variables. The survey response rate was 30.3%, with 1,881 respondents meeting inclusion criteria. Those reporting DV/SA were almost twice as likely to use mental health medications. However, when controlling for other variables, only poor mental and physical health were significant in increasing the odds of mental health medication use. The analyses reported here suggest that DV/SA victims in a community sample use mental health medications. When controlling for other variables, survey respondents reported worse physical and mental health. If pharmacies are suitable portals for DV/SA outreach, curricula would need to provide the knowledge and skills needed to take an active role in this public health promotion.
Colledge, Lisa; Hickson, Ford; Reid, David; Weatherburn, Peter
2015-09-01
Bisexual- and lesbian-identified women have significantly worse mental health than heterosexual women. Less evidence exists about mental health differences between lesbian and bisexual women. Self-completion survey with community-based, opportunistic sampling recruited 937 bisexual-identified and 4769 lesbian-identified women. Associations between sexual identity and mental health indicators were assessed by logistic regression, controlling for age, income, student status and employment. As a group, bisexual women were younger, poorer, and more likely to be trans-identified, minority ethnic identified and to use marijuana, compared with lesbians. Bisexuals were more likely than lesbians to report eating problems (adjusted odds ratio (AOR) = 1.64, P women attended lesbian or bisexual social events, were 'out', or had experienced any sexuality-related discrimination, compared with lesbians. More bisexual women reported poor mental health or psychological distress than did lesbians. Bisexual women may be more likely to experience social stress due to the 'double discrimination' of homophobia and biphobia. This stress, experienced mainly as internalized and felt stigma, could result in greater risk for poor mental health compared with lesbians. Addressing both biphobia and homophobia within UK society has important preventative mental health implications. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Okombo, Florence A.
2017-01-01
Racial/ethnic minority groups experience a higher mortality rate, a lower life expectancy, and worse mental health outcomes than non-Hispanic in the United States. There is a scarcity of qualitative studies on racial/ethnic health disparities. The purpose of this hermeneutic phenomenological study was to explore the personal experiences,…
Munakata, T
1989-06-01
This paper is an attempt to explore the socio-cultural significance of deliberately disguising schizophrenia as neurasthenia, neurosis or malfunction of autonomic nervous system. To understand its significance, the socio-cultural background of Japanese attitudes toward mental illness and Japan's mental health care system is also examined from a non-Western standpoint.
The relationship between self-control and health: The mediating effect of avoidant coping.
Boals, Adriel; Vandellen, Michelle R; Banks, Jonathan B
2011-08-01
Trait self-control is related to a number of positive outcomes, including mental health, interpersonal success, academic success and health-related behaviours. This study sought to explore the relationships between self-control, reports of mental and physical health symptoms and coping styles. The results revealed that higher self-control was related to fewer mental and physical health symptoms and less avoidance coping. There was not a significant relationship between self-control and problem-focused or emotion-focused coping styles. Further, the relationships between self-control and mental and physical health outcomes were partially mediated by avoidance coping style. Specifically, the data suggest lower self-control is associated with unhealthy coping strategies (avoidance coping), which in turn are associated with worse mental health outcomes and greater reports of physical health symptoms. Thus lower trait self-control can serve as an indicator, suggesting circumstances in which individuals' tendencies to engage in unhealthy coping strategies are increased. These findings add to a growing body of literature underscoring the importance of trait self-control.
Saeed, Bashiru Ii; Xicang, Zhao; Yawson, Alfred Edwin; Nguah, Samuel Blay; Nsowah-Nuamah, Nicholas N N
2015-03-20
This study attempts to examine the impact of socioeconomic and medical conditions in health and healthcare utilization among older adults in Ghana. Five separate models with varying input variables were estimated for each response variable. Data (Wave 1 data) were drawn from the World Health Organization Global Ageing and Adult Health (SAGE) conducted during 2007-2008 and included a total of 4770 respondents aged 50+ and 803 aged 18-49 in Ghana. Ordered logits was estimated for self-rated health, and binary logits for functional limitation and healthcare utilization. Our results show that the study provides enough grounds for further research on the interplay between socioeconomic and medical conditions on one hand and the health of the aged on the other. Controlling for socioeconomic status substantially contributes significantly to utilization. Also, aged women experience worse health than men, as shown by functioning assessment, self-rated health, chronic conditions and functional limitations. Women have higher rates of healthcare utilization, as shown by significantly higher rates of hospitalization and outpatient encounters. Expansion of the national health insurance scheme to cover the entire older population--for those in both formal and informal employments--is likely to garner increased access and improved health states for the older population.
DEFF Research Database (Denmark)
Pisinger, Charlotta Holm; Toft, Ulla; Aadahl, Mette
2009-01-01
OBJECTIVES: The aim of this paper is to describe the relationship between smoking status, dietary habits, physical activity and alcohol intake, and mental and physical self-reported health in a general population. MEASURES: A large population-based study Inter99, Copenhagen, Denmark, 1999......-2006. Self-reported health-related quality of life was measured by Short Form 12 (SF-12). Mental and physical health component scores were computed. RESULTS: At baseline, SF-12 was completed by 6305 (92.3%) participants in the intervention groups, and 3017 (72.4%) persons in the control group. In cross......-sectional analyses, persons with an unhealthy lifestyle reported significantly worse physical and mental health than persons with a healthier lifestyle. In longitudinal data, using adjusted multivariate analyses (N=3,084), we found an association between increased physical activity at five-year follow...
Sexual Orientation, Parental Support, and Health during the Transition to Young Adulthood
Needham, Belinda L.; Austin, Erika L.
2010-01-01
Some recent studies suggest that sexual minorities may have worse health-related outcomes during adolescence because they report lower levels of family connectedness, a key protective resource. Using data from wave 3 of the National Longitudinal Study of Adolescent Health (n = 11,153; 50.6% female; mean age = 21.8 years), this study extends prior…
Significant differences in the use of healthcare resources of native-born and foreign born in Spain
Carrasco-Garrido, Pilar; Jiménez-García, Rodrigo; Barrera, Valentin Hernández; de Andrés, Ana López; de Miguel, Ángel Gil
2009-01-01
Background In the last decade, the number of foreign residents in Spain has doubled and it has become one of the countries in the European Union with the highest number of immigrants There is no doubt that the health of the immigrant population has become a relevant subject from the point of view of public healthcare. Our study aimed at describing the potential inequalities in the use of healthcare resources and in the lifestyles of the resident immigrant population of Spain. Methods Cross-sectional, epidemiological study from the Spanish National Health Survey (NHS) in 2006, from the Ministry of Health and Consumer Affairs. We have worked with individualized secondary data, collected in the Spanish National Health Survey carried out in 2006 and 2007 (SNHS-06), from the Ministry of Health and Consumer Affairs. The format of the SNHS-06 has been adapted to the requirements of the European project for the carrying out of health surveys. Results The economic immigrant population resident in Spain, present diseases that are similar to those of the indigenous population. The immigrant population shows significantly lower values in the consumption of alcohol, tobacco and physical activity (OR = 0.76; CI 95%: 0.65–0.89, they nonetheless perceive their health condition as worse than that reported by the autochthonous population (OR = 1.63, CI 95%: 1.34–1.97). The probability of the immigrant population using emergency services in the last 12 months was significantly greater than that of the autochthonous population (OR = 1.31, CI 95%: 1.12–1.54). This situation repeats itself when analyzing hospitalization data, with values of probability of being hospitalized greater among immigrants (OR = 1.39, CI 95%: 1.07–1.81). Conclusion The economic immigrants have better parameters in relation to lifestyles, but they have a poor perception of their health. Despite the fact that immigrant population shows higher percentages of emergency attendance and hospitalization than
Toussaint, Loren; Shields, Grant S; Dorn, Gabriel; Slavich, George M
2016-06-01
To examine risk and resilience factors that affect health, lifetime stress exposure histories, dispositional forgiveness levels, and mental and physical health were assessed in 148 young adults. Greater lifetime stress severity and lower levels of forgiveness each uniquely predicted worse mental and physical health. Analyses also revealed a graded Stress × Forgiveness interaction effect, wherein associations between stress and mental health were weaker for persons exhibiting more forgiveness. These data are the first to elucidate the interactive effects of cumulative stress severity and forgiveness on health, and suggest that developing a more forgiving coping style may help minimize stress-related disorders. © The Author(s) 2014.
Comín-Colet, Josep; Anguita, Manuel; Formiga, Francesc; Almenar, Luis; Crespo-Leiro, María G; Manzano, Luis; Muñiz, Javier; Chaves, José; de Frutos, Trinidad; Enjuanes, Cristina
2016-03-01
Although heart failure negatively affects the health-related quality of life of Spanish patients there is little information on the clinical factors associated with this issue. Cross-sectional multicenter study of health-related quality of life. A specific questionnaire (Kansas City Cardiomyopathy Questionnaire) and a generic questionnaire (EuroQoL-5D) were administered to 1037 consecutive outpatients with systolic heart failure. Most patients with poor quality of life had a worse prognosis and increased severity of heart failure. Mobility was more limited and rates of pain/discomfort and anxiety/depression were higher in the study patients than in the general population and patients with other chronic conditions. The scores on both questionnaires were very highly correlated (Pearson r =0.815; P < .001). Multivariable linear regression showed that being older (standardized β=-0.2; P=.03), female (standardized β=-10.3; P < .001), having worse functional class (standardized β=-20.4; P < .001), a higher Charlson comorbidity index (standardized β=-1.2; P=.005), and recent hospitalization for heart failure (standardized β=6.28; P=.006) were independent predictors of worse health-related quality of life. Patients with heart failure have worse quality of life than the general Spanish population and patients with other chronic diseases. Female sex, being older, comorbidity, advanced symptoms, and recent hospitalization are determinant factors in health-related quality of life in these patients. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.
Farsi, Deema J; Farsi, Nada J; El-Housseiny, Azza A; Turkistani, Jihan M; Farsi, Najat M
2018-04-01
Aim: The aim of this study is to compare the effect of dental rehabilitation on oral health-related quality-of-life (OHRQoL) in children with special health care needs (CSHCN) and healthy children. Materials and methods: The prospective study's sample consisted of 213 parents of caries-affected children, who were aged 6 years or younger and were scheduled for dental rehabilitation under general anesthesia (DRGA). The parent-child dyads were recruited from three public hospitals in Jeddah between October 2014 and May 2016. They comprised healthy children (n = 133) and CSHCN (n = 80). Parents self-completed the early childhood oral health impact scale (ECOHIS) before and 1 month after DRGA. The parents also rated the overall oral health status of their children by answering a global question before and after DRGA. Results: At baseline, the CSHCN had significantly worse OHRQoL in most of the scale domains at 25.9 [standard deviation (SD) 11.3] and 19.9 (SD 10.3) respectively. The OHRQoL significantly improved in both groups postoperatively (p = 0.005, Wilcoxon rank-sum test). The effect size of the improvement in the CSHCN group (+1.8) was greater than that in the healthy group (+1.5) in all domains, except for the family impact and parental distress sections. Conclusion: The DRGA markedly improves OHRQoL in children aged 6 years or younger, and the improvement is even greater in CSHCN. Clinical significance: The substantial improvement in OHRQoL after DRGA highlights the importance of oral health care in young children, which should receive higher priority than it has been done to date. Keywords: Children with special health care needs, Dental caries, Early childhood oral health impact scale, General anesthesia, Oral health-related quality-of-life.
Krouse, Robert S; Herrinton, Lisa J; Grant, Marcia; Wendel, Christopher S; Green, Sylvan B; Mohler, M Jane; Baldwin, Carol M; McMullen, Carmit K; Rawl, Susan M; Matayoshi, Eric; Coons, Stephen Joel; Hornbrook, Mark C
2009-10-01
Intestinal stomas can pose significant challenges for long-term (> or = 5 years) rectal cancer (RC) survivors. Specifying common challenges and sociodemographic or clinical differences will further the development of tailored interventions to improve health-related quality of life (HRQOL). This was a matched cross-sectional study of long-term RC survivors conducted in three Kaiser Permanente regions. The mailed questionnaire included the modified City of Hope Quality of Life-Ostomy (mCOH-QOL-Ostomy) and Medical Outcomes Study 36-Item Short-Form Health Survey, version 2 (SF-36v2). Groups surveyed were permanent ostomates (cases) and those who did not require an ostomy (controls). RC survivors were matched on sex, age, and time since diagnosis. Comparisons between groups used regression analysis with adjustment for age, comorbidity score, history of radiation therapy, income, and work status. Response rate was 54% (491 of 909). Cases and controls had similar demographic characteristics. On the basis of the mCOH-QOL-Ostomy, both male and female cases had significantly worse social well-being compared with controls, while only female cases reported significantly worse overall HRQOL and psychological well-being. For younger females (ostomy had a greater impact on physical well-being compared with older females. Based on the SF-36v2, statistically significant and meaningful differences between female cases and controls were observed for seven of the eight scales and on the physical and mental component summary scores. Men and women report a different profile of challenges, suggesting the need for targeted or sex-specific interventions to improve HRQOL in this population. This may include focus on physical HRQOL for female ostomy survivors younger than age 75.
[Significance of proper oral hygiene for health condition of mouth and teeth].
Ljaljević, Agima; Matijević, Snezana; Terzić, Natasa; Andjelić, Jasmina; Mugosa, Boban
2012-01-01
Proper mouth and teeth hygiene has influence on the prevention of a great number of diseases and very often some of them are not related only to oral cavity. Most frequent diseases of mouth and teeth such as caries and periodontal diseases are caused, among other factors, by poor oral hygiene. They are also more frequent in young population. The aim of this study was to estimate the influence of sociodemographic characteristics and hygienic habit on oral health in children aged 11-15 years. This cross-sectional study was conducted by the dental teams in dentist surgeries in Tivat Health Center between May and September 2009. The sample consisted of patients 11 to 15 years of age. A questionnaire and dental examination of mouth and teeth were used as research instruments. The examinations were conducted in accordance with the World Health Organization methodology and criteria. The data obtained from the interviews were correlated with those obtained from the clinical examinations. The results show that the majority of respondents brush their teeth twice a day and visit the dentist once in every six months. The research also shows that 57% respondents have caries of deciduous teeth and over 63% respondents of permanent teeth. Gingivitis was found in 14% and orthodontic anomalies in 44.7% respondents. A half of respondents who brush their teeth rarely have problems with gingivitis. There is a highly statistically significant difference between the occurrence of gingivitis and the frequency of teeth brushing. There is a significant difference between mouth and oral hygiene and sex as well as other sociodemographic characteristics of respondents. The study showed the correlation between occurrence of caries and the gingivitis and frequency of teeth brushing and dental visits.
Significance of proper oral hygiene for health condition of mouth and teeth
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Ljaljević Agima
2012-01-01
Full Text Available Background/Aim. Proper mouth and teeth hygiene has influence on the prevention of a great number of diseases and very often some of them are not related only to oral cavity. Most frequent diseases of mouth and teeth such as caries and periodontal diseases are caused, among other factors, by poor oral hygiene. They are also more frequent in young population. The aim of this study was to estimate the influence of sociodemographic characteristics and hygienic habit on oral health in children aged 11-15 years. Methods. This crosssectional study was conducted by the dental teams in dentist surgeries in Tivat Health Center between May and September 2009. The sample consisted of patients 11 to 15 years of age. A questionnaire and dental examination of mouth and teeth were used as research instruments. The examinations were conducted in accordance with the World Health Organization methodology and criteria. The data obtained from the interviews were correlated with those obtained from the clinical examinations. Results. The results show that the majority of respondents brush their teeth twice a day and visit the dentist once in every six months. The research also shows that 57% respondents have caries of deciduous teeth and over 63% respondents of permanent teeth. Gingivitis was found in 14% and orthodontic anomalies in 44.7% respondents. A half of respondents who brush their teeth rarely have problems with gingivitis. There is a highly statistically significant difference between the occurrence of gingivitis and the frequency of teeth brushing. Conclusion. There is a significant difference between mouth and oral hygiene and sex as well as other sociodemographic characteristics of respondents. The study showed the correlation between occurrence of caries and the gingivitis and frequency of teeth brushing and dental visits.
Ponticelli, E; Clari, M; Frigerio, S; De Clemente, A; Bergese, I; Scavino, E; Bernardini, A; Sacerdote, C
2017-03-01
The aim of the study was to evaluate taste disorders in patients receiving chemotherapy and to assess the impact of dysgeusia on patients' health-related quality of life (HRQOL). A total of 289 patients with a diagnosis of malignant solid or haematological cancer undergoing chemotherapy completed a questionnaire assessing dysgeusia and HRQOL. Sixty-four per cent of patients developed dysgeusia after and during chemotherapy. A statistically significant correlation was found between type of cancer and dysgeusia (p = .012), moreover a statistically significant association was found between type of chemotherapy and occurrence of dysgeusia (p = .031). Patients with dysgeusia had a worse overall HRQOL than those who did not have dysgeusia, and the association between HRQOL and dysgeusia was also statistically significant (p = .003). Patients with dysgeusia had a higher probability of having a worse HRQOL (p = .002). In line with previous studies, we observed a significant correlation between chemotherapy and dysgeusia. Furthermore, this study found that cancer patients with dysgeusia have a lower quality of life. In particular the domains "role," "social aspect," "nausea-vomiting" and "appetite" are most influenced by dysgeusia. Improving the communication and information to patients considered at higher risk of developing dysgeusia can have a positive impact on patients' quality of life. © 2017 John Wiley & Sons Ltd.
Petrič, Gregor; Atanasova, Sara; Kamin, Tanja
2017-10-04
.9%, 109/644), and low-engaged users (3%, 19/644). Analysis of the research question showed statistically significant differences among user types across all six dimensions of eHEALS-E. Most notably, core relational users performed worse than lurkers on the validating information dimension (P=.01) and worse than active help-seekers on the being smart on the Net dimension (P=.05). Active help-seekers have the highest scores in all dimensions of the eHEALS-E, whereas low-engaged users have statistically significantly lower scores on all dimensions of the eHEALS-E in comparison with the other groups. Those who are looking for advice and support in OHCs by making queries are well equipped with eHealth literacy skills to filter potential misinformation and detect bad advice. However, core relational users (who produce the most content in OHCs) have less-developed skills for cross-validating the information obtained and navigating successfully through the perils of the online world. Site managers should monitor their activity to avoid the spread of misinformation that might lead to unhealthy practices. ©Gregor Petrič, Sara Atanasova, Tanja Kamin. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 04.10.2017.
Significance of postoperative irradiation for breast cancer
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Murai, Nobuko; Ogami, Koji; Nishikawa, Kiyoshi; Koga, Kenji; Waki, Norio; Higashi, Hidefumi; Hayashi, Asami; Shibata, Koichiro; Watanabe, Katsuji
1986-01-01
From 1978 through 1983, 27 patients were treated with surgery followed by irradiation (irradiated group) and 29 with surery alone (non-irradiated group). In the irradiated group, 10 had stage II and 17 stage III; in the non-irradiated group, 25 had stage II and 4 stage III. The most common histology was medullary tubular carcinoma (MTC). There was no significant difference in survivals at 3 years and 5 years between the groups. Similarly, no significant difference was seen among stage II patients. Patients with MTC tended to have worse survivals in the irradiated group than in the non-irradiated group, with no statistically significant difference. Among stage II patients, no major differences in local recurrence were seen between the groups; the incidence of distant metastases tended to be high in the irradiated group. The incidence of both local recurrence and distant metastases for stage III patients showed a tendency to be higher in the irradiated group than in the non-irradiated group. The results indicated no apparent benifit of postoperative irradiation for breast cancer. A randomized clinical trial is needed for the evaluation of postoperative irradiation for breast cancer. (Namekawa, K.)
Health related quality of life and influencing factors among welders.
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Jingxiang Qin
Full Text Available BACKGROUND: Occupational exposure to welding fumes is a serious occupational health problem all over the world. Welders are exposed to many occupational hazards; these hazards might cause some occupational diseases. The aim of the study was to assess the health related quality of life (HRQL of electric welders in Shanghai China and explore influencing factors to HRQL of welders. METHODS: 301 male welders (without pneumoconiosis and 305 non-dust male workers in Shanghai were enrolled in this study. Short Form-36 (SF-36 health survey questionnaires were applied in this cross-sectional study. Socio-demographic, working and health factors were also collected. Multiple stepwise regress analysis was used to identify significant factors related to the eight dimension scores. RESULTS: Six dimensions including role-physical (RP, bodily pain (BP, general health (GH, validity (VT, social function (SF, and mental health (MH were significantly worse in welders compared to non-dust workers. Multiple stepwise regress analysis results show that native place, monthly income, quantity of children, drinking, sleep time, welding type, use of personal protective equipment (PPE, great events in life, and some symptoms including dizziness, discomfort of cervical vertebra, low back pain, cough and insomnia may be influencing factors for HRQL of welders. Among these factors, only sleep time and the use of PPE were salutary. CONCLUSIONS: Some dimensions of HRQL of these welders have been affected. Enterprises which employ welders should take measures to protect the health of these people and improve their HRQL.
Directory of Open Access Journals (Sweden)
Ahmet Yüksel
Full Text Available Abstract Objective: To investigate the impact of gender difference in early postoperative outcomes in elderly patients (aged 70 or older undergoing coronary artery bypass grafting surgery. Methods: Between October 2009 and December 2013, a total of 223 elderly patients (aged 70 or older undergoing isolated primary coronary artery bypass grafting surgery were included in this retrospective observational cohort study. Patients were divided into two groups according to their gender. The patients' medical records were collected, their baseline preoperative characteristics, operative data, and postoperative outcomes were retrospectively reviewed, and the effect of gender difference in the early postoperative outcomes was analyzed. Results: Group 1 (female patients and Group 2 (male patients consisted of 71 and 152 patients, respectively. Mean age of patients was 74.4±3.6 years (range: 70-84 years. The level of EuroSCORE I, the incidence of hypertension and hyperlipidemia were significantly higher in Group 1, while the rate of smoking was significantly higher in Group 2. Mean postoperative intubation time, length of intensive care unit and hospital stay were longer in female patients than in male patients, but these differences were not statistically significant. No statistically significant difference between two groups in terms of the transfusion of blood products was observed. The rates of in-hospital mortality and major postoperative complications were statistically similar between the two groups. Conclusion: In conclusion, the female gender was not associated with worse early postoperative outcomes in elderly patients undergoing coronary artery bypass grafting surgery.
Acute health effects of the Sea Empress oil spill.
Lyons, R A; Temple, J M; Evans, D; Fone, D L; Palmer, S R
1999-05-01
To investigate whether residents in the vicinity of the Sea Empress tanker spill suffered an increase in self reported physical and psychological symptoms, which might be attributable to exposure to crude oil. Retrospective cohort study; postal questionnaire including demographic details, a symptom checklist, beliefs about health effects of oil and the Hospital Anxiety and Depression and SF-36 mental health scales. Populations living in four coastal towns on the exposed south Pembrokeshire coast and two control towns on the unexposed north coast. 539 exposed and 550 unexposed people sampled at random from the family health services authority age-sex register who completed questionnaires. Adjusted odds ratios for self reported physical symptoms; scores on the Hospital Anxiety and Depression and SF-36 mental health scales, in 1089 people who responded out of a possible 1585 (69%). Living in areas exposed to the crude oil spillage was significantly associated with higher anxiety and depression scores, worse mental health; and self reported headache (odds ratio = 2.35, 95% CI 1.56, 3.55), sore eyes (odds ratio = 1.96, 95% CI 1.06, 3.62), and sore throat (odds ratio = 1.70, 95% CI 1.12, 2.60) after adjusting for age, sex, smoking status, anxiety, and the belief that oil had affected health. People living in exposed areas reported higher rates of physical and psychological symptoms than control areas. Symptoms significantly associated with exposure after adjustment for anxiety and health beliefs were those expected from the known toxicological effect of oil, suggesting a direct health effect on the exposed population.
Cherepanov, Dasha; Palta, Mari; Dunham, Nancy Cross; Feeny, David; Fryback, Dennis G.
2009-01-01
Objectives We examine whether multiple health-related quality of life (HRQoL) measures are stratified by socioeconomic status (SES) and age in the United States. Methods Data are from the 2005/2006 National Health Measurement Study, a telephone survey of a nationally representative sample of U.S. adults. We plot mean HRQoL scores by SES within age groups. Regression analyses test whether education, income, and assets each have independent associations with three “preference-based” HRQoL measures and self-rated health (SRH). We test whether these associations vary by age. Results There are SES disparities in HRQoL and SRH among adults in the United States at all age groups. Income differentials in HRQoL are strong across current adult age cohorts, except the 75–89 age cohort. Education and assets have statistically significant but weaker associations with HRQoL. All three SES measures are associated with SRH (net of each other) at every age group. Those in the lowest income and education groups in the 35–44 age cohort have worse HRQoL and SRH than those in higher SES groups in the 65+ age cohort. Discussion Significant improvements in HRQoL at the population level will only be possible if we improve the HRQoL of people at the lowest end of the socioeconomic distribution. PMID:19307286
Monden, C.W.S.; Uunk, W.J.G.
2013-01-01
We investigate the association between union dissolution and self-assessed health in European panel data. Previous studies suggest that this association might be negative, yet it is unclear to what extent this reflects causation (an effect of union dissolution of health) and/or selection (an effect
International Nuclear Information System (INIS)
Hashine, Katsuyoshi; Kusuhara, Yoshito; Miura, Noriyoshi; Shirato, Akitomi; Sumiyoshi, Yoshiteru; Kataoka, Masaaki
2009-01-01
The health-related quality of life (HRQOL) after treatment of prostate cancer is examined using a new HRQOL tool. HRQOL, based on the expanded prostate cancer index composite (EPIC) and SF-8 questionnaires, was prospectively compared after either a radical retropubic prostatectomy (RRP) or a permanent prostate brachytherapy (PPB) at a single institute. Between October 2005 and June 2007, 96 patients were treated by an RRP and 88 patients were treated by a PPB. A HRQOL survey was completed at baseline, and at 1, 3, 6 and 12 months after treatment, prospectively. The general HRQOL in the RRP and PPB groups was not different after 3 months. However, at baseline and 1 month after treatment, the mental component summary was significantly better in the PPB group than in the RRP group. Moreover, the disease-specific HRQOL was worse regarding urinary and sexual functions in the RRP group. Urinary irritative/obstructive was worse in the PPB group, but urinary incontinence was worse in the RRP group and had not recovered to baseline after 12 months. The bowel function and bother were worse in the PPB group than in the RRP group after 3 months. In the RRP group, the patients with nerve sparing demonstrated the same scores in sexual function as the PPB group. This prospective study revealed the differences in the HRQOL after an RRP and PPB. Disease-specific HRQOL is clarified by using EPIC survey. These results will be helpful for making treatment decisions. (author)
WTP for a QALY and health states: More money for severer health states?
Shiroiwa, Takeru; Igarashi, Ataru; Fukuda, Takashi; Ikeda, Shunya
2013-01-01
In economic evaluation, cost per quality-adjusted life year (QALY) is generally used as an indicator for cost-effectiveness. Although JPY 5 million to 6 million (USD 60, 000 to 75,000) per QALY is frequently referred to as a threshold in Japan, do all QALYs have the same monetary value? To examine the relationship between severity of health status and monetary value of a QALY, we obtained willingness to pay (WTP) values for one additional QALY in eight patterns of health states. We randomly sampled approximately 2,400 respondents from an online panel. To avoid misunderstanding, we randomly allocated respondents to one of 16 questionnaires, with 250 responses expected for each pattern. After respondents were asked whether they wanted to purchase the treatment, double-bounded dichotomous choice method was used to obtain WTP values. The results clearly show that the WTP per QALY is higher for worse health states than for better health states. The slope was about JPY -1 million per 0.1 utility score increase. The mean and median WTP values per QALY for 16 health states were JPY 5 million, consistent with our previous survey. For respondents who wanted to purchase the treatment, WTP values were significantly correlated with household income. This survey shows that QALY based on the EQ-5D does not necessarily have the same monetary value. The WTP per QALY should range from JPY 2 million (USD 20,000) to JPY 8 million (USD 80,000), corresponding to the severity of health states.
Le, Minh T H; Holton, Sara; Nguyen, Huong T; Wolfe, Rory; Fisher, Jane
2016-11-04
In high and upper-middle income countries poly-victimisation (exposure to multiple forms of victimisation) is associated with worse health-related quality of life (HRQoL) among adolescents. There is a lack of empirical evidence about these associations from low- and lower-middle income countries. The aims of this study were to examine the associations between exposure to 1) individual forms of victimisation and 2) poly-victimisation and the HRQoL of adolescents in Vietnam. A cross-sectional, anonymously-completed survey of high school students in Hanoi, Vietnam. Lifetime exposure to eight individual forms of victimisation and poly-victimisation were assessed using the Juvenile Victimisation Questionnaire Revised-2 (JVQ R2). Health-related quality of life was assessed using the Duke Health Profile Adolescent Version (DHP-A). Bi-variate analyses and multiple linear regressions were conducted to assess the associations between individual forms of victimisation, poly-victimisation and HRQoL among girls and boys. In total 1616/1745 students (92.6 %) completed the questionnaire. Adolescent girls had significantly worse HRQoL than boys in all domains, except disability. Different forms of victimisation were associated with different HRQoL domains among girls and boys. Cyber victimisation was the most detrimental to girls' HRQoL while for boys maltreatment was the most detrimental. Experiences of poly-victimisation were associated with worse HRQoL in physical, mental, social and general health, lower levels of self-esteem and increased levels of anxiety, depression and pain domains among both sexes. Among Vietnamese adolescents, experiences of individual forms of victimisation were associated with poorer HRQoL in specific domains; the most detrimental forms of victimisation varied for girls and boys. However, it was experiences of poly-victimisation that had the most detrimental impacts on the HRQoL of both sexes. Recognition of violence, including poly-victimisation, is
Burgess, Diana; Tran, Alisia; Lee, Richard; van Ryn, Michelle
2007-01-01
Previous research has found that lesbian, gay, bisexual and transgender (LGBT) individuals are at risk for a variety of mental health disorders. We examined the extent to which a recent experience of a major discriminatory event may contribute to poor mental health among LGBT persons. Data were derived from a cross-sectional strata-cluster survey of adults in Hennepin County, Minnesota, who identified as LGBT (n=472) or heterosexual (n=7,412). Compared to heterosexuals, LGBT individuals had poorer mental health (higher levels of psychological distress, greater likelihood of having a diagnosis of depression or anxiety, greater perceived mental health needs, and greater use of mental health services), more substance use (higher levels of binge drinking, greater likelihood of being a smoker and greater number of cigarettes smoked per day), and were more likely to report unmet mental healthcare needs. LGBT individuals were also more likely to report having experienced a major incident of discrimination over the past year than heterosexual individuals. Although perceived discrimination was associated with almost all of the indicators of mental health and utilization of mental health care that we examined, adjusting for discrimination did not significantly reduce mental health disparities between heterosexual and LGBT persons. LGBT individuals experienced more major discrimination and reported worse mental health than heterosexuals, but discrimination did not account for this disparity. Future research should explore additional forms of discrimination and additional stressors associated with minority sexual orientation that may account for these disparities.
The Health Significance of Positive Emotions in Adulthood and Later Life.
Ong, Anthony D; Mroczek, Daniel K; Riffin, Catherine
2011-08-01
A growing body of literature supports a link between positive emotions and health in older adults. In this article, we review evidence of the effects of positive emotions on downstream biological processes and meaningful clinical endpoints, such as adult morbidity and mortality. We then present relevant predictions from lifespan theories that suggest changes in cognition and motivation may play an important role in explaining how positive emotions are well maintained in old age, despite pervasive declines in cognitive processes. We conclude by discussing how the application of psychological theory can inform greater understanding of the adaptive significance of positive emotions in adulthood and later life.
Aboussaleh, Y; Capone, R; Bilali, H El
2017-11-01
The Mediterranean dietary patterns comply better with recommended nutrient and micronutrient intakes. The Mediterranean diet (MD) was associated with reduced mortality and lower risk for metabolic chronic diseases. It has also low ecological, carbon and water footprints due to its high share of plant-based foods. In fact, the share of plant-based dietary energy is higher in the Mediterranean than in Northern Europe. The Mediterranean hotspot is a major centre of plant and crop diversity. Mediterranean people gather and consume about 2300 plant species. This review paper aims at highlighting the nutrition-health benefits of the MD and analysing the main environmental impacts of the Mediterranean food consumption patterns. There is a growing body of scientific evidence that the MD has significant health-nutrition benefits and low environmental footprints, so there is urgent need to reverse the ongoing erosion of the MD heritage and to promote it as a sustainable diets model.
Effects of obesity on health-related quality of life in juvenile-onset systemic lupus erythematosus.
Mina, R; Klein-Gitelman, M S; Nelson, S; Eberhard, B A; Higgins, G; Singer, N G; Onel, K; Tucker, L; O'Neil, K M; Punaro, M; Levy, D M; Haines, K; Ying, J; Brunner, H I
2015-02-01
This study evaluated the effects of obesity on health-related quality of life (HRQOL) measures in juvenile-onset systemic lupus erythematosus (jSLE). Obesity was defined as a body mass index (BMI) ≥ 95 th percentile according to the Sex-specific Center for Disease Control BMI-For-Age Charts and determined in a multicenter cohort of jSLE patients. In this secondary analysis, the domain and summary scores of the Pediatric Quality of Life (PedsQL) Inventory and the Child Health Questionnaire (CHQ) of obese jSLE patients were compared to those of non-obese jSLE patients as well as historical obese and non-obese healthy controls. Mixed-effects modeling was performed to evaluate the relationship between obesity and HRQOL measures. Among the 202 jSLE patients, 25% (n = 51) were obese. Obesity had a significant negative impact on HRQOL in jSLE, even after adjusting for differences in current corticosteroid use, disease activity, disease damage, gender and race between groups. Obese jSLE patients had lower physical functioning compared to non-obese jSLE patients, and to non-obese and obese healthy controls. Compared to their non-obese counterparts, obese jSLE patients also had worse school functioning, more pain, worse social functioning and emotional functioning. Parents of obese jSLE patients worry more. The CHQ scores for obese jSLE patients were also worse compared to non-obese jSLE patients in several other domains. Our study demonstrates the detrimental effects of obesity on patient-reported outcomes in jSLE. This supports the importance of weight management for the therapeutic plan of jSLE. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Eneriz-Wiemer, Monica; Sanders, Lee M; Barr, Donald A; Mendoza, Fernando S
2014-01-01
One in 10 US adults of childbearing age has limited English proficiency (LEP). Parental LEP is associated with worse health outcomes among healthy children. The relationship of parental LEP to health outcomes for children with special health care needs (CSHCN) has not been systematically reviewed. To conduct a systematic review of peer-reviewed literature examining relationships between parental LEP and health outcomes for CSHCN. PubMed, Scopus, Cochrane Library, Social Science Abstracts, bibliographies of included studies. Key search term categories: language, child, special health care needs, and health outcomes. US studies published between 1964 and 2012 were included if: 1) subjects were CSHCN; 2) studies included some measure of parental LEP; 3) at least 1 outcome measure of child health status, access, utilization, costs, or quality; and 4) primary or secondary data analysis. Three trained reviewers independently screened studies and extracted data. Two separate reviewers appraised studies for methodological rigor and quality. From 2765 titles and abstracts, 31 studies met eligibility criteria. Five studies assessed child health status, 12 assessed access, 8 assessed utilization, 2 assessed costs, and 14 assessed quality. Nearly all (29 of 31) studies used only parent- or child-reported outcome measures, rather than objective measures. LEP parents were substantially more likely than English-proficient parents to report that their CSHCN were uninsured and had no usual source of care or medical home. LEP parents were also less likely to report family-centered care and satisfaction with care. Disparities persisted for children with LEP parents after adjustment for ethnicity and socioeconomic status. Parental LEP is independently associated with worse health care access and quality for CSHCN. Health care providers should recognize LEP as an independent risk factor for poor health outcomes among CSHCN. Emerging models of chronic disease care should integrate and
Health numeracy: the importance of domain in assessing numeracy.
Levy, Helen; Ubel, Peter A; Dillard, Amanda J; Weir, David R; Fagerlin, Angela
2014-01-01
Existing research concludes that measures of general numeracy can be used to predict individuals' ability to assess health risks. We posit that the domain in which questions are posed affects the ability to perform mathematical tasks, raising the possibility of a separate construct of "health numeracy" that is distinct from general numeracy. The objective was to determine whether older adults' ability to perform simple math depends on domain. Community-based participants completed 4 math questions posed in 3 different domains: a health domain, a financial domain, and a pure math domain. Participants were 962 individuals aged 55 and older, representative of the community-dwelling US population over age 54. We found that respondents performed significantly worse when questions were posed in the health domain (54% correct) than in either the pure math domain (66% correct) or the financial domain (63% correct). Our experimental measure of numeracy consisted of only 4 questions, and it is possible that the apparent effect of domain is specific to the mathematical tasks that these questions require. These results suggest that health numeracy is strongly related to general numeracy but that the 2 constructs may not be the same. Further research is needed into how different aspects of general numeracy and health numeracy translate into actual medical decisions.
Pre-existing psychiatric disorder in the burn patient is associated with worse outcomes.
Hudson, Alexandra; Al Youha, Sarah; Samargandi, Osama A; Paletz, Justin
2017-08-01
To compare patient and burn characteristics between patients who had a pre-existing psychiatric diagnosis and patients who did not in a Burn Unit at an academic hospital. Psychosocial issues are common in patients recovering from a burn; however, little is known regarding hospital course and discharge outcomes in patients with a pre-existing psychiatric diagnosis presenting with a burn. Baseline medical comorbidities of burn patients have been shown to be a significant risk for in-hospital mortality. A retrospective chart review of 479 consecutive patients admitted to the Burn Unit of an academic hospital in Halifax, Nova Scotia between March 2nd 1995 and June 1st 2013 was performed. Extensive data regarding patient and burn characteristics and outcomes was collected. Patients with and without pre-existing psychiatric diagnoses at the time of hospital admission were compared. Sixty-three (13%) patients had a psychiatric diagnosis, with the most common being depression (52%). Forty-percent (n=25/63) of these patients had multiple pre-existing psychiatric diagnoses. Patients with a psychiatric diagnosis had a greater total-body-surface-area (TBSA)% covered by a third-degree burn (p=0.001), and were more likely to have an inhalation injury (pBurn Unit (p=0.01). The risk of death in burn patients with pre-existing psychiatric disorders was about three times the risk of death in patients with no psychiatric disorders when adjusting for other potential confounders (95% CI, 1.13-9.10; p-value 0.03). Presence of a pre-existing psychiatric disorder in the burn patient was associated with worse outcomes and was a significant predictor of death. Psychiatric diagnoses should be identified early in burn treatment and efforts should be made to ensure a comprehensive approach to inpatient support and patient discharge to reduce unfavorable burn outcomes and placement issues. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.
Sarkar, Madhurima; Earley, Elizabeth R; Asti, Lindsey; Chisolm, Deena J
This study explores comparative differentials in health care needs, health care utilization, and health status between Medicaid and private/employer-sponsored insurance (ESI) among a statewide population of children with special health care needs (CSHCN) in Ohio. We used data from the 2012 Ohio Medicaid Assessment Survey to examine CSHCN's health care needs, utilization, status, and health outcomes by insurance type. Adjusted multivariable logistic regression models were used to explore associations between public and private health insurance, as well as the utilization and health outcome variables. Bivariate analyses indicate that the Medicaid population had higher care coordination needs (odds ratio [OR] = 1.6; 95% confidence interval [CI], 1.1-2.2) as well as need for mental/educational health care services (OR = 1.5; 95% CI; 1.1-2.0). They also reported higher unmet dental care needs (OR = 2.2; 95% CI, 1.2-4.0), higher emergency department (ED) utilization (OR = 2.3; 95% CI, 1.7-3.2), and worse overall health (OR = 0.6; 95% CI, 0.4-0.7), oral health (OR = 0.4; 95% CI, 0.3-0.5), and vision health (OR = 0.4; 95% CI, 0.2-0.6). After controlling for demographic variables, CSHCN with Medicaid insurance coverage were more likely to need mental health and education services (adjusted odds ratio [AOR] = 1.8; 95% CI; 1.2-2.6), had significantly more ED visits (AOR = 2.3; 95% CI, 1.5-3.5), and were less likely to have excellent overall health (AOR = 0.64; 95% CI, 0.4-0.9), oral health (AOR = 0.43; 95% CI, 0.3-0.7), and vision health (AOR = 0.38; 95% CI, 0.2-0.6) than those with private insurance/ESI. The CSHCN population is a highly vulnerable population. While Ohio's Medicaid provides greater coverage to CSHCN, disparities continue to exist within access and services that Medicaid provides versus the ones provided by private insurance/ESI.
SOCIAL MARGINALIZATION AND HEALTH
Directory of Open Access Journals (Sweden)
Marjana Bogdanović
2007-04-01
Full Text Available The 20th century was characterized by special improvement in health. The aim of WHO’s policy EQUITY IN HEALTH is to enable equal accessibility and equal high quality of health care for all citizens. More or less some social groups have stayed out of many social systems even out of health care system in the condition of social marginalization. Phenomenon of social marginalization is characterized by dynamics. Marginalized persons have lack of control over their life and available resources. Social marginalization stands for a stroke on health and makes the health status worse. Low socio-economic level dramatically influences people’s health status, therefore, poverty and illness work together. Characteristic marginalized groups are: Roma people, people with AIDS, prisoners, persons with development disorders, persons with mental health disorders, refugees, homosexual people, delinquents, prostitutes, drug consumers, homeless…There is a mutual responsibility of community and marginalized individuals in trying to resolve the problem. Health and other problems could be solved only by multisector approach to well-designed programs.
Worse Prognosis in Heart Failure Patients with 30-Day Readmission
Tung, Ying-Chang; Chou, Shing-Hsien; Liu, Kuan-Liang; Hsieh, I-Chang; Wu, Lung-Sheng; Lin, Chia-Pin; Wen, Ming-Shien; Chu, Pao-Hsien
2016-01-01
Background Heart failure (HF) readmission results in substantial expenditure on HF management. This study aimed to evaluate the readmission rate, outcome, and predictors of HF readmission. Methods Patients with reduced left ventricular ejection fraction (LVEF readmission rate, mortality and predictors of readmission. Results A total of 433 de novo HF patients with LVEF readmission rates were 10.9% and 27%, respectively. At the end of the 6-month follow-up, the readmission group had higher mortality than the non-readmission group (27.66% vs. 10.36%; p = 0.001). The survivors of the 30-day readmission had similar mortality rates at 6 months, regardless of the cause of readmission (cardiovascular vs. non-cardiovascular: 25% vs. 30.43%, p = 0.677). Among all the parameters, prescription of beta blockers independently reduced the risk of 30-day readmission (odds ratio 0.15; 95% confidence interval 0.02-0.99; p = 0.049). Conclusions Those HF patients who suffered from 30-day readmission had worse prognosis at the 6-month follow-up. Regardless of the readmission causes, the patients surviving the 30-day readmission had similar mortality rates at 6-month follow-up. These results underscored the importance of reducing readmission as a means to improve HF outcome. PMID:27899857
Trzesniewski, Kali H.; Donnellan, M. Brent; Moffitt, Terrie E.; Robins, Richard W.; Poulton, Richie; Caspi, Avshalom
2006-01-01
Using prospective data from the Dunedin Multidisciplinary Health and Development Study birth cohort, the authors found that adolescents with low self-esteem had poorer mental and physical health, worse economic prospects, and higher levels of criminal behavior during adulthood, compared with adolescents with high self-esteem. The long-term…
Rising U.S. income inequality, gender and individual self-rated health, 1972-2004.
Zheng, Hui
2009-11-01
The effect of income inequality on health has been a contested topic among social scientists. Most previous research is based on cross-sectional comparisons rather than temporal comparisons. Using data from the General Social Survey and the U.S. Census Bureau, this study examines how rising income inequality affects individual self-rated health in the U.S. from 1972 to 2004. Data are analyzed using hierarchical generalized linear models. The findings suggest a significant association between income inequality and individual self-rated health. The dramatic increase in income inequality from 1972 to 2004 increases the odds of worse self-rated health by 9.4 percent. These findings hold for three measures of income inequality: the Gini coefficient, the Atkinson Index, and the Theil entropy index. Results also suggest that overall income inequality and gender-specific income inequality harm men's, but not women's, self-rated health. These findings also hold for the three measures of income inequality. These findings suggest that inattention to gender composition may explain apparent discrepancies across previous studies.
Deterioration in health: What is the role of unemployment and poverty?
Vaalavuo, Maria
2016-06-01
There is powerful evidence on the association between ill health and low income or low socioeconomic position of the individual. In this article we study the deterioration in self-assessed health and its determinants, focusing on unemployment and poverty status of the person. A special focus on worsening health status gives more information on the link between health and socioeconomic characteristics than static analysis of health status. The longitudinal EU Statistics on Income and Living Conditions (EU-SILC) data covering years from 2008 to 2013 for 26 EU Member States is used to follow people for whom we have data for 4 consecutive years. We will use information on the self-rated health status of the person. Logistic regression analysis is employed to study the determinants of transition to worse health status. The results show that unemployment (OR 1.23) and poverty (OR 1.19) before the health transition are significantly associated with worsening health even when controlled for the prior health status of the person. CONCLUSIONS THE RESULTS SUPPORT CAUSAL LINK BETWEEN UNEMPLOYMENT AND POVERTY STATUS AND SUBSEQUENT HEALTH STATUS, WHILE WE CANNOT EXCLUDE THE ROLE OF SELECTION IN THE MECHANISM UNDERSTANDING BETTER THE LINK BETWEEN HEALTH AND UNEMPLOYMENT OR POVERTY IS IMPORTANT FOR BETTER DESIGN OF HEALTH AND SOCIAL POLICIES. © 2016 the Nordic Societies of Public Health.
DEFF Research Database (Denmark)
Gosvig, Camilla F; Huusom, Lene D; Andersen, Klaus K
2015-01-01
Little research has been conducted on the long-term value of human papillomavirus (HPV) testing after conization. We investigated whether cytology adds to the value of a negative HPV test for long-term prediction of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). In addition, we...
Problematic mobile phone use of Swiss adolescents: is it linked with mental health or behaviour?
Roser, Katharina; Schoeni, Anna; Foerster, Milena; Röösli, Martin
2016-04-01
To investigate the associations between problematic mobile phone use and mental health and behavioural problems in 412 Swiss adolescents owning a mobile phone while controlling for amount of mobile phone use. Problematic mobile phone use was determined by the MPPUS-10 (Mobile Phone Problem Use Scale) and related to health and behavioural problems by means of multivariable regression modelling. MPPUS-10 was 4.7 (95 % CI 1.8, 7.6) units higher in girls than in boys, increased significantly with age and was significantly decreased with increasing educational level of the parents. Furthermore, problematic mobile phone use was associated with impaired psychological well-being, impaired parent and school relationships and more behavioural problems but was not related to peer support and social acceptance. Our study indicates that problematic mobile phone use is associated with external factors such as worse home and school environment and internal factors such as impaired mental health and behavioural problems of the adolescents and thus problematic mobile phone use should be addressed, in particular when dealing with adolescents showing behavioural or emotional problems.
Caprine brucellosis: A historically neglected disease with significant impact on public health
Arenas-Gamboa, Angela M.; Maurizio, Estefanía
2017-01-01
Caprine brucellosis is a chronic infectious disease caused by the gram-negative cocci-bacillus Brucella melitensis. Middle- to late-term abortion, stillbirths, and the delivery of weak offspring are the characteristic clinical signs of the disease that is associated with an extensive negative impact in a flock’s productivity. B. melitensis is also the most virulent Brucella species for humans, responsible for a severely debilitating and disabling illness that results in high morbidity with intermittent fever, chills, sweats, weakness, myalgia, abortion, osteoarticular complications, endocarditis, depression, anorexia, and low mortality. Historical observations indicate that goats have been the hosts of B. melitensis for centuries; but around 1905, the Greek physician Themistokles Zammit was able to build the epidemiological link between “Malta fever” and the consumption of goat milk. While the disease has been successfully managed in most industrialized countries, it remains a significant burden on goat and human health in the Mediterranean region, the Middle East, Central and Southeast Asia (including India and China), sub-Saharan Africa, and certain areas in Latin America, where approximately 3.5 billion people live at risk. In this review, we describe a historical evolution of the disease, highlight the current worldwide distribution, and estimate (by simple formula) the approximate costs of brucellosis outbreaks to meat- and milk-producing farms and the economic losses associated with the disease in humans. Successful control leading to eradication of caprine brucellosis in the developing world will require a coordinated Global One Health approach involving active involvement of human and animal health efforts to enhance public health and improve livestock productivity. PMID:28817647
Predictors of anxiety in centenarians: health, economic factors, and loneliness.
Ribeiro, Oscar; Teixeira, Laetitia; Araújo, Lia; Afonso, Rosa Marina; Pachana, Nancy
2015-07-01
Centenarians' psychological well-being is presently of great interest in psychogeriatric research but little is known about factors that specifically account for the presence of clinically relevant anxiety symptoms in this age group. This study examined the presence of anxiety and its predictors in a sample of centenarians and aims to contribute to a better understanding of anxiety determinants in extreme old age. We examined how socio-demographic, health, functional, and social factors contribute to the presence of clinically significant anxiety symptoms in centenarians recruited from two Portuguese centenarian studies. The Geriatric Anxiety Inventory - Short Form (GAI-SF) was used to assess anxiety symptoms. A total of 97 centenarians (mean age 101.1 years; SD = 1.5 years; range = 100-108) with no/minor cognitive impairment were included. Clinically significant anxiety symptoms (GAI-SF ≥3) were present in 45.4% (n = 44) of the sample. Main predictive factors included worse health perception, higher number of medical conditions, financial concerns related to medical expenses (income inadequacy) and loneliness. Results suggest that along with health status (subjective and objective), income inadequacy related to medical expenses and feeling lonely may predispose centenarians to clinically significant anxiety and be important to their overall well-being. Further research is needed on the repercussions of clinical anxiety in centenarians' quality of life and on co-morbid conditions (e.g. depression) at such advanced ages.
International Nuclear Information System (INIS)
Namiki, Shunichi; Ishidoya, Shigeto; Tochigi, Tatsuo
2006-01-01
No previous studies have reported the longitudinal health-related quality of life (HRQOL) for intensity modulated radiation therapy (IMRT). We compared HRQOL after IMRT with that after conventional and after conformal radiation therapy (XRT). A total of 110 patients underwent XRT (34 patients underwent conventional radiation therapy and 76 underwent conformal radiation therapy) and 30 underwent IMRT for clinically localized prostate cancer between 2000 and 2002. We measured the general and disease-specific HRQOL using the Medical Outcomes Study 36-Item Health Survey and University of California, Los Angeles, Prostate Cancer Index, respectively. There were no significant differences in the preoperative characteristics and HRQOL scores of the two groups. Repeated measure analyses of variance revealed significantly different patterns of alteration in several general HRQOL domains between XRT and the IMRT groups. In the urinary domain, there was no difference in the alteration patterns between the two groups. The XRT group suffered worse bowel function at 3 and 6 months than the IMRT group (P<0.05). In the XRT group, sexual function decreased at 3 months and remained substantially lower than the baseline level. However, the IMRT group showed no significant difference from the baseline level at any of the observation periods. At 18 months the XRT group showed worse sexual function than the IMRT group. The two approaches showed different longitudinal profiles regarding general and disease-specific HRQOL during the first 2 years after treatment. The IMRT approach produced little impairment in bowel and sexual function. (author)
Pappa, Evelina; Chatzikonstantinidou, Simela; Chalkiopoulos, George; Papadopoulos, Angelos; Niakas, Dimitris
2015-06-12
The aim was to assess the health-related quality of life (HRQL) of the Roma and further to detect the significant determinants that are associated with their HRQL. The cross-sectional study involved 1068 Roma adults living in settlements (mean age 36). HRQL was measured by the Greek version of SF-36 Health Survey and further socio-demographic characteristics (sex, age, marital status, education, permanent occupation etc.) and housing conditions (stable housing, access to basic amenities such as drinkable water, drainage, electricity which compose material deprivation) were involved. Non parametric tests and multiple linear regression models were applied to identify the factors that have significant association with HRQL. After controlling for socio-demographic characteristics, health status and housing conditions, sex, age, education, chronic diseases, stable housing and material deprivation were found to be significant determinants of the Roma's HRQL. Men reported significantly better health than women as well as those who attended school compared to the illiterate. Chronic diseases were remarkably associated with poor HRQL from 10 units in MH (Mental Health) to 34 units in RP (Role Physical). Material deprivation was related to lower GH (General Health), and VT (Vitality) scores and higher RP (Role Physical) and RE (Role Emotional) scores. Chronic conditions and illiteracy are two key areas that contribute significantly to worse HRQL. Policies should be part of a comprehensive and holistic strategy for the Roma through intervention to education, housing and public health.
Ho, Kwok M; Honeybul, Stephen; Yip, Cheng B; Silbert, Benjamin I
2014-09-01
The authors assessed the risk factors and outcomes associated with blood-brain barrier (BBB) disruption in patients with severe, nonpenetrating, traumatic brain injury (TBI) requiring decompressive craniectomy. At 2 major neurotrauma centers in Western Australia, a retrospective cohort study was conducted among 97 adult neurotrauma patients who required an external ventricular drain (EVD) and decompressive craniectomy during 2004-2012. Glasgow Outcome Scale scores were used to assess neurological outcomes. Logistic regression was used to identify factors associated with BBB disruption, defined by a ratio of total CSF protein concentrations to total plasma protein concentration > 0.007 in the earliest CSF specimen collected after TBI. Of the 252 patients who required decompressive craniectomy, 97 (39%) required an EVD to control intracranial pressure, and biochemical evidence of BBB disruption was observed in 43 (44%). Presence of disruption was associated with more severe TBI (median predicted risk for unfavorable outcome 75% vs 63%, respectively; p = 0.001) and with worse outcomes at 6, 12, and 18 months than was absence of BBB disruption (72% vs 37% unfavorable outcomes, respectively; p = 0.015). The only risk factor significantly associated with increased risk for BBB disruption was presence of nonevacuated intracerebral hematoma (> 1 cm diameter) (OR 3.03, 95% CI 1.23-7.50; p = 0.016). Although BBB disruption was associated with more severe TBI and worse long-term outcomes, when combined with the prognostic information contained in the Corticosteroid Randomization after Significant Head Injury (CRASH) prognostic model, it did not seem to add significant prognostic value (area under the receiver operating characteristic curve 0.855 vs 0.864, respectively; p = 0.453). Biochemical evidence of BBB disruption after severe nonpenetrating TBI was common, especially among patients with large intracerebral hematomas. Disruption of the BBB was associated with more severe
Directory of Open Access Journals (Sweden)
Benjawan Tawatsupa
2010-05-01
Full Text Available Background: Occupational heat stress is a well-known problem, particularly in tropical countries, affecting workers, health and well-being. There are very few recent studies that have reported on the effect of heat stress on mental health, or overall health in workers, although socioeconomic development and rapid urbanization in tropical developing countries like Thailand create working conditions in which heat stress is likely. Objective: This study is aimed at identifying the relationship between self-reported heat stress and psychological distress, and overall health status in Thai workers. Results: 18% of our large national cohort (>40,000 subjects often works under heat stress conditions and males are exposed to heat stress more often than females. Furthermore, working under heat stress conditions is associated with both worse overall health and psychological distress (adjusted odds ratios ranging from 1.49 to 1.84. Conclusions: This association between occupational heat stress and worse health needs more public health attention and further development on occupational health interventions as climate change increases Thailand's temperatures.
Clinical and Biologic Significance of MYC Genetic Mutations in De Novo Diffuse Large B-cell Lymphoma
DEFF Research Database (Denmark)
Xu-Monette, Zijun Y; Deng, Qipan; Manyam, Ganiraju C
2016-01-01
.1% at the protein level (nonsynonymous mutations). Most of the nonsynonymous mutations correlated with better survival outcomes; in contrast, T58 and F138 mutations (which were associated with MYC rearrangements), as well as several mutations occurred at the 3' untranslated region, correlated with significantly...... worse survival outcomes. However, these mutations occurred infrequently (only in approximately 2% of DLBCL). A germline SNP encoding the Myc-N11S variant (observed in 6.5% of the study cohort) was associated with significantly better patient survival, and resulted in reduced tumorigenecity in mouse...
Chronic health conditions and school performance in first graders: A prospective cohort study.
Hoffmann, Isabell; Diefenbach, Christiane; Gräf, Christine; König, Jochem; Schmidt, Martina F; Schnick-Vollmer, Kathleen; Blettner, Maria; Urschitz, Michael S
2018-01-01
Children with chronic health conditions may perform poorer at school. Associations may be confounded by numerous social factors. We aimed to estimate the effects of a chronic health condition on overall school performance in first graders with an emphasis on rigorous adjustment for potential confounders. A population-based cohort study was performed in the area of Mainz-Bingen (Germany). In 2015 all preschoolers were approached and the presence of a chronic health condition was assessed by parental questionnaires and preschool health examination data. The identification of a chronic health condition was based on special health care needs and presence of a doctor's diagnosis out of 24 school-relevant diseases. At the end of the first school year, overall school performance was assessed by teachers and rated on a 5-item scale ranging from -10 to +10. Of 3683 children approached, 2003 were enrolled. Overall school performance was available for 1462 children (51% boys). Of these, 52% suffered from a chronic health condition. Compared to children without a chronic health condition, children with special health care needs (15%) performed worse at school (adjusted mean difference: -0.95, 95% CI: [-1.55; -0.35], P = 0.002). Children with a doctor's diagnosis but without special health care needs (37%) did not perform worse at school. The effect was further analysed considering the extent of special health care needed. Chronic health conditions affect overall school performance early in primary school. To identify academically at-risk children, a chronic health condition identification based on special health care needs may be used.
Directory of Open Access Journals (Sweden)
Ugo Lucca
Full Text Available BACKGROUND: In the elderly persons, hemoglobin concentrations slightly below the lower limit of normal are common, but scant evidence is available on their relationship with significant health indicators. The objective of the present study was to cross-sectionally investigate the association of mild grade anemia with cognitive, functional, mood, and quality of life (QoL variables in community-dwelling elderly persons. METHODS: Among the 4,068 eligible individuals aged 65-84 years, all persons with mild anemia (n = 170 and a randomly selected sample of non-anemic controls (n = 547 were included in the study. Anemia was defined according to World Health Organization (WHO criteria and mild grade anemia was defined as a hemoglobin concentration between 10.0 and 11.9 g/dL in women and between 10.0 and 12.9 g/dL in men. Cognition and functional status were assessed using measures of selective attention, episodic memory, cognitive flexibility and instrumental and basic activities of daily living. Mood and QoL were evaluated by means of the Geriatric Depression Scale-10, the Short-Form health survey (SF-12, and the Functional Assessment of Cancer Therapy-Anemia. RESULTS: In univariate analyses, mild anemic elderly persons had significantly worse results on almost all cognitive, functional, mood, and QoL measures. In multivariable logistic regressions, after adjustment for a large number of demographic and clinical confounders, mild anemia remained significantly associated with measures of selective attention and disease-specific QoL (all fully adjusted p<.046. When the lower limit of normal hemoglobin concentration according to WHO criteria was raised to define anemia (+0.2 g/dL, differences between mild anemic and non anemic elderly persons tended to increase on almost every variable. CONCLUSIONS: Cross-sectionally, mild grade anemia was independently associated with worse selective attention performance and disease-specific QoL ratings.
Unified health gamification can significantly improve well-being in corporate environments
Shahrestani, A.; Van Gorp, P.M.E.; Le Blanc, P.M.; Greidanus, F.; de Groot, K.; Leermakers, J.
2017-01-01
There is a multitude of mHealth applications that aim to solve societal health problems by stimulating specific types of physical activities via gamification. However, physical health activities cover just one of the three World Health Organization (WHO) dimensions of health. This paper introduces
Badawy, Sherif M; Thompson, Alexis A; Lai, Jin-Shei; Penedo, Frank J; Rychlik, Karen; Liem, Robert I
2017-06-01
Complications related to sickle cell disease (SCD) result in significant declines in health-related quality of life (HRQOL). While hydroxyurea reduces SCD complications, adherence remains suboptimal. The study's objectives were to assess the feasibility of Internet-based electronic assessment of HRQOL in SCD clinic and to examine the relationship between HRQOL and hydroxyurea adherence in adolescents and young adults (AYAs) with SCD. A cross-sectional survey was administered on tablets to 34 AYAs (12-22 years old) in a SCD clinic from January through December 2015. Study measures included Patient Reported Outcomes Measurement Information System (PROMIS ® ) computerized adaptive testing and ©Modified Morisky Adherence Scale 8-items (©MMAS-8). Participants (59% male, 91% Black) had median age of 13.5 (range 12-18) years. Ninety-one percent completed PROMIS® measures electronically in the clinic, meeting our feasibility criterion of ≥85% completion rate. ©MMAS-8 scores positively correlated with fetal hemoglobin (HbF) (r s = 0.34, P = 0.04) and mean corpuscular volume (MCV) (r s = 0.42, P = 0.01) and inversely correlated with fatigue (r s = -0.45, P = 0.01), depression (r s = -0.3, P = 0.08), and social isolation (r s = -0.78, P = 0.02). Low ©MMAS-8 scores, indicating poor adherence, were associated with worse fatigue (P = 0.001) and trended toward significance for pain (P = 0.07) and depression (P = 0.06). Homozygous hemoglobin S disease patients with low HbF (<16%) had worse social isolation (P = 0.04) and those with low MCV (<102 fl) reported worse fatigue (P = 0.001), pain (P = 0.01), mobility (P = 0.01), and social isolation (P = 0.04). HRQOL assessment in the SCD clinic is feasible. SCD patients with low hydroxyurea adherence and/or low HbF or MCV levels had worse HRQOL scores, particularly fatigue. Future prospective studies examining the relationship between HRQOL and hydroxyurea adherence are warranted. © 2016 Wiley Periodicals, Inc.
Dong, Y; Zhou, M; Ba, X J; Si, J W; Li, W T; Wang, Y; Li, D; Li, T
2016-10-18
To determine the clinicopathological significance of the DNA methyltransferase 3B (DNMT3B) overexpression in endometrial carcinomas and to evaluate its correlation with hormone receptor status. Immunohistochemistry was performed to assess the expression of DNMT3B and hormone receptors in 104 endometrial carcinomas. DNMT3B overexpression occurred frequently in endometrioid carcinoma (EC, 54.8%) more than in nonendometrioid carcinoma (NEC, 30.0%) with statistical significance (P=0.028). Furthermore, there was a trend that EC with worse clinico-pathological variables and shorter survival had a higher DNMT3B expression, and the correlation between DNMT3B and tumor grade reached statistical significance (P=0.019).A negative correlation between DNMT3B and estrogen receptor (ER) or progesterone receptor (PR) expression was found in EC. NMT3B overexpression occurred frequently in the ER or PR negative subgroups (78.9%, 86.7%) more than in the positive subgroups (47.7%, 47.8%) with statistical significance (P=0.016, P=0.006). In addition, the DNMT3B overexpression increased in tumors with both ER and PR negative expression (92.9%, P=0.002). However, no such correlation was found in NEC (P>0.05). Sequence analyses demonstrated multiple ER and PR binding sites in the promoter regions of DNMT3B gene. This study showed that the expression of DNMT3B in EC and NEC was different. DNMT3B overexpression in EC was associated with the worse clinicopathological variables and might have predictive value. The methylation status of EC and NEC maybe different. In addition, in EC, DNMT3B overexpression negatively correlated with ER or PR expression. In NEC, the correlation between DNMT3B and ER or PR status was not present.
Directory of Open Access Journals (Sweden)
Jessica M. Perkins
2016-09-01
Full Text Available Abstract Background Previous research has demonstrated health benefits of marriage and the potential for worse outcomes during widowhood in some populations. However, few studies have assessed the relevance of widowhood and widowhood duration to a variety of health-related outcomes and chronic diseases among older adults in India, and even fewer have examined these relationships stratified by gender. Methods Using a cross-sectional representative sample of 9,615 adults aged 60 years or older from 7 states in diverse regions of India, we examine the relationship between widowhood and self-rated health, psychological distress, cognitive ability, and four chronic diseases before and after adjusting for demographic characteristics, socioeconomic status, living with children, and rural–urban location for men and women, separately. We then assess these associations when widowhood accounts for duration. Results Being widowed as opposed to married was associated with worse health outcomes for women after adjusting for other explanatory factors. Widowhood in general was not associated with any outcomes for men except for cognitive ability, though men who were widowed within 0–4 years were at greater risk for diabetes compared to married men. Moreover, recently widowed women and women who were widowed long-term were more likely to experience psychological distress, worse self-rated health, and hypertension, even after adjusting for other explanatory variables, whereas women widowed 5–9 years were not, compared to married women. Conclusions Gender, the duration of widowhood, and type of outcome are each relevant pieces of information when assessing the potential for widowhood to negatively impact health. Future research should explore how the mechanisms linking widowhood to health vary over the course of widowhood. Incorporating information about marital relationships into the design of intervention programs may help better target potential
A generic standard for assessing and managing activities with significant risk to health and safety
International Nuclear Information System (INIS)
Wilde, T.S.; Sandquist, G.M.
2005-01-01
Some operations and activities in industry, business, and government can present an unacceptable risk to health and safety if not performed according to established safety practices and documented procedures. The nuclear industry has extensive experience and commitment to assessing and controlling such risks. This paper provides a generic standard based upon DOE Standard DOE-STD-3007- 93, Nov 1993, Change Notice No. 1, Sep 1998. This generic standard can be used to assess practices and procedures employed by any industrial and government entity to ensure that an acceptable level of safety and control prevail for such operations. When any activity and operation is determined to involve significant risk to health and safety to workers or the public, the organization should adopt and establish an appropriate standard and methodology to ensure that adequate health and safety prevail. This paper uses DOE experience and standards to address activities with recognized potential for impact upon health and safety. Existing and future assessments of health and safety issues can be compared and evaluated against this generic standard for insuring that proper planning, analysis, review, and approval have been made. (authors)
Onarheim, Kristine Husøy; Norheim, Ole Frithjof; Miljeteig, Ingrid
2018-03-30
High healthcare costs make illness precarious for both patients and their families' economic situation. Despite the recent focus on the interconnection between health and financial risk at the systemic level, the ethical conflict between concerns for potential health benefits and financial risk protection at the household level in a low-income setting is less understood. Using a seven-step ethical analysis, we examine a real-life dilemma faced by families and health workers at the micro level in Ethiopia and analyse the acceptability of limiting treatment for an ill newborn to protect against financial risk. We assess available evidence and ethical issues at stake and discuss the dilemma with respect to three priority setting criteria: health maximisation, priority to the worse-off and financial risk protection. Giving priority to health maximisation and extra priority to the worse-off suggests, in this particular case, that limiting treatment is not acceptable even if the total well-being gain from reduced financial risk is taken into account. Our conclusion depends on the facts of the case and the relative weight assigned to these criteria. However, there are problematic aspects with the premise of this dilemma. The most affected parties-the newborn, family members and health worker-cannot make free choices about whether to limit treatment or not, and we thereby accept deprivations of people's substantive freedoms. In settings where healthcare is financed largely out-of-pocket, families and health workers face tragic trade-offs. As countries move towards universal health coverage, financial risk protection for high-priority services is necessary to promote fairness, improve health and reduce poverty. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Is religion the forgotten variable in maternal and child health? Evidence from Zimbabwe.
Ha, Wei; Salama, Peter; Gwavuya, Stanley; Kanjala, Chifundo
2014-10-01
The Apostolic faith, a rapidly growing and increasingly influential force in Zimbabwe, has received attention in the literature due to its potential role in shaping its followers' attitudes and behaviours towards health. Existing literature, however, has only examined small cross-section samples from a few confined survey sites or has failed to adequately control for the many factors that may mediate the effects of religion. This paper examines the effects of the Apostolic faith on the usage of maternal health and child immunization services in Zimbabwe. It is based on a nationally representative sample from the 2009 Multi-Indicator Monitoring Survey and employs the established Andersen model on access to health services. Well controlled multivariate logit regression models derived from these data show that an affiliation with the Apostolic faith is a substantial and significant risk factor in reducing the utilization of both maternal and child health services. Moreover, even when the services were least costly and readily available and when gaps along other social and economic factors were limited, as in the case of Bacillus Calmette-Guérin vaccination and one visit to antenatal care, women and children from Apostolic faith families still fared significantly worse than others in accessing them. Copyright © 2014 Elsevier Ltd. All rights reserved.
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El Chediak A
2017-06-01
Full Text Available Alissar El Chediak,1 Raafat S Alameddine,1 Ayman Hakim,1 Lara Hilal,2 Sarah Abdel Massih,1 Lana Hamieh,3 Deborah Mukherji,1 Sally Temraz,1 Maya Charafeddine,1 Ali Shamseddine1 1Division of Hematology/Oncology, Department of Internal Medicine, 2Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon; 3Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, USA Background: Several retrospective studies have reported that younger age at presentation is associated with a worse prognosis for nonmetastatic breast cancer patients. In this study, we prospectively assessed the association between different baseline characteristics (age, tumor characteristics, mode of treatment, etc and outcomes among newly diagnosed nonmetastatic Lebanese breast cancer patients.Methods: We recruited a sample of 123 women newly diagnosed with nonmetastatic breast cancer presenting to American University of Beirut Medical Center. Immunohistochemical, molecular (vitamin D receptor, methylene tetrahydrofolate reductase polymorphisms, and genetic assays were performed. Patient characteristics were compared by age group (<40 and ≥40 years. A Cox regression analysis was performed to evaluate the variables affecting the disease-free survival (DFS. Outcome data were obtained, and DFS was estimated.Results: Among the 123 patients, 47 were 40 years of age or younger, and 76 were older than 40 years. Median follow-up duration was 58 months. Nine out of 47 patients <40 years (19.1% experienced disease relapse in contrast to four out of 76 patients >40 years (5.2%. A wide immunohistochemical panel included Ki-67, cyclin B1, p53, platelet-derived growth factor receptor, and vascular endothelial growth factor receptor, and did not reveal any significant difference in these markers between the two age groups. Older patients had a larger percentage of Luminal A than younger patients. On multivariate analysis
Income-related inequality in health and health care utilization in Chile, 2000-2009.
Vásquez, Felipe; Paraje, Guillermo; Estay, Manuel
2013-02-01
To measure and explain income-related inequalities in health and health care utilization in the period 2000 - 2009 in Chile, while assessing variations within the country and determinants of inequalities. Data from the National Socioeconomic Characterization Survey for 2000, 2003, and 2009 were used to measure inequality in health and health care utilization. Income-related inequality in health care utilization was assessed with standardized concentration indices for the probability and total number of visits to specialized care, generalized care, emergency care, dental care, mental health care, and hospital care. Self-assessed health status and physical limitations were used as proxies for health care need. Standardization was performed with demographic and need variables. The decomposition method was applied to estimate the contribution of each factor used to calculate the concentration index, including ethnicity, employment status, health insurance, and region of residence. In Chile, people in lower-income quintiles report worse health status and more physical limitations than people in higher quintiles. In terms of health service utilization, pro-rich inequities were found for specialized and dental visits with a slight pro-rich utilization for general practitioners and all physician visits. All pro-rich inequities have decreased over time. Emergency room visits and hospitalizations are concentrated among lower-income quintiles and have increased over time. Higher education and private health insurance contribute to a pro-rich inequity in dentist, general practitioner, specialized, and all physician visits. Income contributes to a pro-rich inequity in specialized and dentist visits, whereas urban residence and economic activity contribute to a pro-poor inequity in emergency room visits. The pattern of health care utilization in Chile is consistent with policies implemented in the country and in the intended direction. The significant income inequality in the
Tucker, Phebe; Pfefferbaum, Betty; Nitiéma, Pascal; Wendling, Tracy L; Brown, Sheryll
2016-03-01
In this study, we explore directly exposed terrorism survivors' mental health and health status, healthcare utilization, alcohol and tobacco use, and posttraumatic growth 18½ years postdisaster. Telephone surveys compared terrorism survivors and nonexposed community control subjects, using Hopkins Symptom Checklist, Breslau's PTSD screen, Posttraumatic Growth Inventory, and Health Status Questionnaire 12. Statistical analyses included multivariable logistic regression and linear modeling. Survivors, more than 80% injured, reported more anxiety and depression symptoms than did control subjects, with survivors' anxiety and depression associated with heavy drinking (≥5 drinks) and worse mental health and social functioning. While survivors had continued posttraumatic stress disorder symptoms (32 [23.2%] met probable posttraumatic stress disorder threshold), they also reported posttraumatic growth. Survivors had more care from physical, speech, respiratory, and occupational therapists. In this unprecedented long-term assessment, survivors' psychiatric symptoms, alcohol use, and ancillary health service utilization suggest unmet mental health and health needs. Extended recovery efforts might benefit from maximizing positive growth and coping.
Kim, Myoung-Hee; Kim, Chang-Yup; Park, Jin-Kyung; Kawachi, Ichiro
2008-12-01
We aimed to evaluate the health effects of precarious employment based on a counterfactual framework, using the Korea Labor and Income Panel Survey data. At the 4th wave (2001), information was obtained on 1991 male and 1378 female waged workers. Precarious work was defined on the basis of workers employed on a temporary or daily basis, part-time, or in a contingent (fixed short-term) job. The outcome was self-rated health with five response categories. Confounding factors included age, marital status, education, industry and occupation of current employment, household income, residential area, and prior health status. Propensity scores for each individual to be a precarious worker were calculated from logistic models including those covariates, and based on them, precarious workers were matched to non-precarious workers. Then, we examined the effects of precarious employment on health and explored the potential intermediary variables, using ordered logistic Generalized Estimating Equations models. All analyses were performed separately by gender. Precarious workers were found to be in a lower socioeconomic position and to have worse health status. Univariate matched analyses showed that precarious employment was associated with worse health in both men and women. By further controlling for socio-demographic covariates, the odds ratios were attenuated but remained significant. Job satisfaction, especially as related to job insecurity, and monthly wage further attenuated the effects. This suggests that to improve health status of precarious workers in Korea, policy strategies need to tackle the channeling of the socially disadvantaged into precarious jobs. Also, regulations to eliminate discrimination against precarious workers in working conditions or material reward should be introduced and enforced. There is no doubt that job insecurity, which is pervasive among workers in Korea, should be minimized by suspending market-oriented labor policies which rely on
Yusuke Kamiya
2010-01-01
Though gender equity is widely considered to be a key to improving maternal health in developing countries, little empirical evidence has been presented to support this claim. This paper investigates whether or not and how female autonomy within the household affects women's use of reproductive health care in Tajikistan, where the situation of maternal health and gender equity is worse compared with neighbouring countries. Estimation is performed using bivariate probit models in which woman's...
Compston, Juliet E; Flahive, Julie; Hooven, Frederick H; Anderson, Frederick A; Adachi, Jonathan D; Boonen, Steven; Chapurlat, Roland D; Cooper, Cyrus; Díez-Perez, Adolfo; Greenspan, Susan L; LaCroix, Andrea Z; Lindsay, Robert; Netelenbos, J Coen; Pfeilschifter, Johannes; Roux, Christian; Saag, Kenneth G; Silverman, Stuart; Siris, Ethel S; Watts, Nelson B; Gehlbach, Stephen H
2014-02-01
Fractures may be associated with higher morbidity in obese postmenopausal women than in nonobese women. We compared health-care utilization, functional status, and health-related quality of life (HRQL) in obese, nonobese, and underweight women with fractures. Information from the GLOW study, started in 2006, was collected at baseline and at 1, 2, and 3 years. In this subanalysis, self-reported incident clinical fractures, health-care utilization, HRQL, and functional status were recorded and examined. Women in GLOW (n = 60,393) were aged ≥55 years, from 723 physician practices at 17 sites in 10 countries. Complete data for fracture and body mass index were available for 90 underweight, 3,270 nonobese, and 941 obese women with one or more incident clinical fractures during the 3-year follow-up. The median hospital length of stay, adjusted for age, comorbidities, and fracture type, was significantly greater in obese than nonobese women (6 vs. 5 days, p = 0.017). Physical function and vitality score were significantly worse in obese than in nonobese women, both before and after fracture; but changes after fracture were similar across groups. Use of antiosteoporosis medication was significantly lower in obese than in nonobese or underweight women. In conclusion, obese women with fracture undergo a longer period of hospitalization for treatment and have poorer functional status and HRQL than nonobese women. Whether these differences translate into higher economic costs and adverse effects on longer-term outcomes remains to be established.
Sociology of health textbooks and narratives: historical significance.
Nunes, Everardo Duarte
2016-03-01
This article has as its starting point two central ideas: textbooks as a means of production and dissemination of knowledge and narrative as an approach. After a brief review of studies on health/medical sociology textbooks, I analyze a few of these textbooks from the 1900-2012 period, produced in the United States and England. I have selected eleven textbooks which I thought were representative. In addition to a content analysis, the textbooks are located within the process of constitution of the health/medical sociology with brief references to the biographies of the authors. The textbooks analyzed were classified according to the main narrative features: doctor-centered; interdisciplinary; pedagogical; analytical; almost autobiographical; critical; and synthetic-reflective. In the final remarks, some points about the textbooks, limits and possibilities are presented.
Özhayat, Esben B
2013-10-01
To meaningfully interpret oral health-related quality of life (OHRQoL) measures, the influence of personality traits must be investigated. To investigate and quantify the influence of self-esteem and negative affectivity (NA) on OHRQoL. It was hypothesized that low self-esteem and high NA would be associated with worse OHRQoL. OHRQoL measured by the Oral Health Impact Profile 49 (OHIP-49), self-esteem measured by the Rosenberg Self-Esteem Scale (RSES), NA measured by the Eysenck Personality Inventory Questionnaire (EPI-Q), global oral rating of oral comfort and controlling variables (gender, age, number of teeth, experience of wearing removable dental prostheses (RDP), location of missing teeth and zone of missing teeth) were collected from 81 patients with partial tooth loss, signed in for treatment with RDP. Bivariate analyses showed that the EPI-Q score had the highest correlation with OHIP-49 score (R = 0.5). Both EPI-Q and RSES score had a stronger correlation with psychosocial items than physical/functional items of the OHIP-49. In the multivariate analyses, the controlling variables alone explained 17.75% of the variance in OHIP-49 score, while addition of EPI-Q score, RSES score and both EPI-Q and RSES score explained additionally 11.64%, 6.07% and 14.12%, respectively. For each unit increase in EPI-Q score, the OHIP-49 score increased 5.1 units and for each unit increase in RSES score, the OHIP-49 score decreased 1.1. NA was statistically and clinically significantly higher and self-esteem was statistically significantly lower in patients reporting worse oral comfort. NA had the strongest and most clinically meaningful influence, but both NA and self-esteem was found to influence OHRQoL; low self-esteem and high NA was associated with worse OHRQoL. This indicates the possibility to explain some of the impact of tooth loss on OHRQoL based on personality traits. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
When mothers have serious mental health problems: parenting as a proximal mediator.
Oyserman, Daphna; Bybee, Deborah; Mowbray, Carol; Hart-Johnson, Tamera
2005-08-01
Maternal mental health (MMH) problems are associated with lack of confidence in one's parenting, overly lax or too harsh discipline, and child academic underperformance. We asked if parenting mediates the effect of MMH problems on academic outcomes even among mothers with serious mental illness (n=164). Structural equation analyses show a significant association between MMH problems and permissive (lack of parenting confidence, lack of follow through) parenting and verbal hostility as well as worse academic outcomes (school recorded grades, teacher reported behaviour). Permissive parenting completely mediated the direct effect of MMH on academic outcomes. Further analyses showed that the mediation effect was attributed to a single component of permissive parenting-lack of parenting confidence.
Chao, Ming-Che; Jou, Rong-Chang; Liao, Cing-Chu; Kuo, Chung-Wei
2015-03-01
Workplace stress (WS) has been found to affect job satisfaction (JS), performance, and turnover intentions (TIs) in developed countries, but there is little evidence from other countries and especially rural areas. In rural Taiwan, especially, there is an insufficient health care workforce, and the situation is getting worse. To demonstrate the relationship, we used a cross-sectional structured questionnaire, and data from 344 licensed professionals in 1 rural regional hospital were analyzed using the structural equation model. The results showed that WS had a positive effect on both TI and job performance (JP) but a negative effect on satisfaction. JS did improve performance. For the staff with an external locus of control, stress affected JP and satisfaction significantly. For the staff with lower perceived job characteristics, JS affected performance significantly. The strategies to decrease stress relating to work load, role conflict, family factors, and working environment should be focused and implemented urgently to lower the turnover rate of health care workers in rural Taiwan. © 2013 APJPH.
Koroukian, Siran M; Basu, Jayasree; Schiltz, Nicholas K; Navale, Suparna; Bakaki, Paul M; Warner, David F; Dor, Avi; Given, Charles W; Stange, Kurt C
2018-01-01
Recent studies suggest that managed care enrollees (MCEs) and fee-for-service beneficiaries (FFSBs) have become similar in case-mix over time; but comparisons of health outcomes have yielded mixed results. To examine changes in differentials between MCEs and FFSBs both in case-mix and health outcomes over time. Temporal study of the linked Health and Retirement Study (HRS) and Medicare data, comparing case-mix and health outcomes between MCEs and FFSBs across 3 time periods: 1992-1998, 1999-2004, and 2005-2011. We used multivariable analysis, stratified by, and pooled across the study periods. The unit of analysis was the person-wave (n=167,204). HRS participants who were also enrolled in Medicare. Outcome measures included self-reported fair/poor health, 2-year self-rated worse health, and 2-year mortality. Our main covariate was a composite measure of multimorbidity (MM), MM0-MM3, defined as the co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. The case-mix differential between MCEs and FFSBs persisted over time. Results from multivariable models on the pooled data and incorporating interaction terms between managed care status and study period indicated that MCEs and FFSBs were as likely to die within 2 years from the HRS interview (P=0.073). This likelihood remained unchanged across the study periods. However, MCEs were more likely than FFSBs to report fair/poor health in the third study period (change in probability for the interaction term: 0.024, P=0.008), but less likely to rate their health worse in the last 2 years, albeit at borderline significance (change in probability: -0.021, P=0.059). Despite the persistence of selection bias, the differential in self-reported fair/poor status between MCEs and FFSBs seems to be closing over time.
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Eleanor E. MacPherson
2014-06-01
Full Text Available Background: Gender inequalities are important social determinants of health. We set out to critically review the literature relating to gender equity and sexual and reproductive health (SRH in Eastern and Southern Africa with the aim of identifying priorities for action. Design: During November 2011, we identified studies relating to SRH and gender equity through a comprehensive literature search. Results: We found gender inequalities to be common across a range of health issues relating to SRH with women being particularly disadvantaged. Social and biological determinants combined to increase women's vulnerability to maternal mortality, HIV, and gender-based violence. Health systems significantly disadvantaged women in terms of access to care. Men fared worse in relation to HIV testing and care with social norms leading to men presenting later for treatment. Conclusions: Gender inequity in SRH requires multiple complementary approaches to address the structural drivers of unequal health outcomes. These could include interventions that alter the structural environment in which ill-health is created. Interventions are required both within and beyond the health system.
The health and well-being of older people in Nairobi's slums
Directory of Open Access Journals (Sweden)
Catherine Kyobutungi
2010-09-01
Full Text Available Background: Globally, it is estimated that people aged 60 and over constitute more than 11% of the population, with the corresponding proportion in developing countries being 8%. Rapid urbanisation in sub-Saharan Africa (SSA, fuelled in part by rural–urban migration and a devastating HIV/AIDS epidemic, has altered the status of older people in many SSA societies. Few studies have, however, looked at the health of older people in SSA. This study aims to describe the health and well-being of older people in two Nairobi slums. Methods: Data were collected from residents of the areas covered by the Nairobi Urban Health and Demographic Surveillance System (NUHDSS aged 50 years and over by 1 October 2006. Health status was assessed using the short SAGE (Study on Global AGEing and Adult Health form. Mean WHO Quality of Life (WHOQoL and a composite health score were computed and binary variables generated using the median as the cut-off. Logistic regression was used to determine factors associated with poor quality of life (QoL and poor health status. Results: Out of 2,696 older people resident in the NUHDSS surveillance area during the study period, data were collected on 2,072. The majority of respondents were male, aged 50–60 years. The mean WHOQoL score was 71.3 (SD 6.7 and mean composite health score was 70.6 (SD 13.9. Males had significantly better QoL and health status than females and older respondents had worse outcomes than younger ones. Sex, age, education level and marital status were significantly associated with QoL, while slum of residence was significantly associated with health status. Conclusion: The study adds to the literature on health and well-being of older people in SSA, especially those in urban informal settlements. Further studies are needed to validate the methods used for assessing health status and to provide comparisons from other settings. Health and Demographic Surveillance Systems have the potential to conduct such
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Carlos K H Wong
Full Text Available BACKGROUND: The aims of the study were to assess the health preference and health-related quality of life (HRQOL in patients with colorectal neoplasms (CRN, and to determine the clinical correlates that significantly influence the HRQOL of patients. METHODS: Five hundred and fifty-four CRN patients, inclusive of colorectal polyp or cancer, who attended the colorectal specialist outpatient clinic at Queen Mary Hospital in Hong Kong between October 2009 and July 2010, were included. Patients were interviewed with questionnaires on socio-demographic characteristics, and generic and health preference measures of HRQOL using the SF-12 and SF-6D Health Surveys, respectively. Clinical information on stage of disease at diagnosis, time since diagnosis, primary tumour site was extracted from electronic case record. Mean HRQOL and health preference scores of CRN patients were compared with age-sex matched controls from the Chinese general population using independent t-test. Multiple linear regression analyses were conducted to explore the associations of clinical characteristics with HRQOL measures with the adjustment of socio-demographic characteristics. RESULTS: Cross-sectional data of 515 eligible patients responded to the whole questionnaires were included in outcome analysis. In comparison with age-sex matched normative values, CRN patients reported comparable physical-related HRQOL but better mental-related HRQOL. Amongst CRN patients, time since diagnosis was positively associated with health preference score whilst patients with rectal neoplasms had lower health preference and physical-related HRQOL scores than those with sigmoid neoplasms. Health preference and HRQOL scores were significantly lower in patients with stage IV colorectal cancer than those with other less severe stages, indicating that progressive decline from low-risk polyp to stage IV colorectal cancer was observed in HRQOL scores. CONCLUSION: In CRN patients, a more advanced
How Have Health Insurers Performed Financially Under the ACA' Market Rules?
McCue, Michael J; Hall, Mark A
2017-10-01
The Affordable Care Act (ACA) transformed the market for individual health insurance, so it is not surprising that insurers' transition was not entirely smooth. Insurers, with no previous experience under these market conditions, were uncertain how to price their products. As a result, they incurred significant losses. Based on this experience, some insurers have decided to leave the ACA’s subsidized market, although others appear to be thriving. Examine the financial performance of health insurers selling through the ACA's marketplace exchanges in 2015--the market’s most difficult year to date. Analysis of financial data for 2015 reported by insurers from 48 states and D.C. to the Centers for Medicare and Medicaid Services. Although health insurers were profitable across all lines of business, they suffered a 10 percent loss in 2015 on their health plans sold through the ACA's exchanges. The top quarter of the ACA exchange market was comfortably profitable, while the bottom quarter did much worse than the ACA market average. This indicates that some insurers were able to adapt to the ACA's new market rules much better than others, suggesting the ACA's new market structure is sustainable, if supported properly by administrative policy.
Worse cardiac remodeling in response to pressure overload in type 2 diabetes mellitus.
Gonçalves, N; Gomes-Ferreira, C; Moura, C; Roncon-Albuquerque, R; Leite-Moreira, A F; Falcão-Pires, I
2016-08-15
Diabetic cardiomyopathy is characterized by cardiac structural and functional abnormalities. Additionally, chronic pressure overload conditions are highly prevalent amongst diabetic population and this association leads to a more severe myocardial impairment. The differences in myocardial pathophysiology between type 1 and type 2 diabetes mellitus (DM) still remain to be clarified. Thus, we aimed to investigate biventricular structural and functional changes promoted by the two types of DM and the impact of concomitant chronic pressure overload. Wistar rats were injected with streptozotocin (Type 1 DM, T1DM) or fed with a hypercaloric diet (Type 2 DM, T2DM). Pressure overload was imposed in DM animals by aortic constriction and after 5weeks of DM the cardiac function and structure were evaluated. Both types of DM promoted hypertrophy, increased fibrosis and advanced glycation end-products deposition, in the two ventricles. Interestingly, the induced myocardial alterations were distinct. While T1DM stimulated a pronounced hypertrophy and extracellular matrix remodeling, T2DM induced functional impairment. The negative impact of the association of DM with aortic constriction was more pronounced in T2DM, promoting impaired function and increased stiffness, particularly in the right ventricle. Our study demonstrated that the two types of diabetes induce distinct cardiac alterations per se or when combined with chronic pressure overload. T1DM promoted a more extensive remodeling in cardiac structure while T2DM significantly impaired ventricular function. The impact of pressure overload was more notorious in T2DM as observed by worse myocardial remodeling, suggesting a higher susceptibility to the deleterious effects of chronic pressure overload, namely hypertension, among this diabetic population. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
PD-L1 expression associated with worse survival outcome in malignant pleural mesothelioma.
Nguyen, Bella Hai; Montgomery, Renn; Fadia, Mitali; Wang, Jiali; Ali, Sayed
2018-02-01
There is currently a need to identify prognostic biomarkers to assist in a risk adopted approach in treatment of malignant pleural mesothelioma (MPM). Expression of programmed death ligand 1 (PD-L1) has been studied as a prognostic biomarker in a number of tumors given its central role in antitumoral immune response evasion. Four previously published analyses found PD-L1 positivity to be an adverse survival prognostic factor in MPM. This study aims to further investigate the relationship between PD-L1 expression in mesothelioma tissues and survival outcome. Clinical data of MPM patients from a single institution between 2006 and 2016 were reviewed. Patient's archived tissues were stained with PD-L1 (Clone Ventana SP263). PD-L1 positivity was defined as > 1% membranous staining regardless of intensity. Data from fifty eight patients were analyzed. Median age was 73, majority was male (49, 84%) and had ECOG between 0 and 2 (46, 79%). Most common histopathological subtype was epithelioid (42, 72%), 9 (16%) biphasic subtype and 7 (12%) sarcomatoid. Thirty one patients (53%) received best supportive care and twenty seven patients (47%) received chemotherapy or combination treatment. Forty-two patients had positive PD-L1 expression (72.4%). The median survival time for PD-L1 negative group is 15.5 months and 6 months for the positive group. Positive PD-L1 expression is independently correlated with worse prognosis (HR = 2.02; 95% CI, 1.005-4.057; P-value = 0.0484). Our analysis found a higher percentage of MPM patients with positive PD-L1 (> 1%) compared to other studies. Highly positive PD-L1 expression was associated with statistically significantly lower median survival time. © 2017 John Wiley & Sons Australia, Ltd.
Sleep and health in oil rig workers--before and after a two week work period offshore.
Waage, Siri; Pallesen, Ståle; Moen, Bente Elisabeth; Bjorvatn, Bjørn
2013-01-01
This study compared subjective sleep and subjective health complaints among Norwegian oil rig workers, before and after a two week work period. The study also compared differences between two different work schedules. The workers worked either two weeks of day shift (n=90) or two weeks of a swing shift schedule (n=93), involving one week of night shifts, immediately followed by one week of day shifts. Overall, the workers reported significantly poorer sleep quality and more complaints of insomnia at the end compared to the start of the work period. However, there was no significant difference in terms of subjective health complaints. Furthermore, there were no clear differences in changes in sleep quality, insomnia or subjective health complaints during the work period between day- and swing shift workers. However, at the end of the work period a higher proportion of insomniacs were seen among swing shift workers compared with day workers. To conclude, sleep quality and complaints of insomnia became worse during the work period. However, there were few differences in changes in terms of sleep or subjective health complaints between day- and swing shift, suggesting that 12 h day shift affected sleep and health similarly to the schedule involving night work.
Jen, Min Hua; Jones, Kelvyn; Johnston, Ron
2009-02-01
This international comparative study analyses individual-level data derived from the World Values Survey to evaluate Wilkinson's [(1996). Unhealthy societies: The afflictions of inequality. London: Routledge; (1998). Mortality and distribution of income. Low relative income affects mortality [letter; comment]. British Medical Journal, 316, 1611-1612] income inequality hypothesis regarding variations in health status. Random-coefficient, multilevel modelling provides a direct test of Wilkinson's hypothesis using micro-data on individuals and macro-data on income inequalities analysed simultaneously. This overcomes the ecological fallacy that has troubled previous research into links between individual self-rated health, individual income, country income and income inequality data. Logic regression analysis reveals that there are substantial differences between countries in self-rated health after taking account of age and gender, and individual income has a clear effect in that poorer people report experiencing worse health. The Wilkinson hypothesis is not supported, however, since there is no significant relationship between health and income inequality when individual factors are taken into account. Substantial differences between countries remain even after taking account of micro- and macro-variables; in particular the former communist countries report high levels of poor health.
Lungu, Edgar Arnold; Biesma, Regien; Chirwa, Maureen; Darker, Catherine
2018-06-01
In many developing countries including Malawi, health indicators are on average better in urban than in rural areas. This phenomenon has largely prompted Governments to prioritize rural areas in programs to improve access to health services. However, considerable evidence has emerged that some population groups in urban areas may be facing worse health than rural areas and that the urban advantage may be waning in some contexts. We used a descriptive study undertaking a comparative analysis of 13 child health indicators between urban and rural areas using seven data points provided by nationally representative population based surveys-the Malawi Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Rate differences between urban and rural values for selected child health indicators were calculated to denote whether urban-rural differentials showed a trend of declining urban advantage in Malawi. The results show that all forms of child mortality have significantly declined between 1992 and 2015/2016 reflecting successes in child health interventions. Rural-urban comparisons, using rate differences, largely indicate a picture of the narrowing gap between urban and rural areas albeit the extent and pattern vary among child health indicators. Of the 13 child health indicators, eight (neonatal mortality, infant mortality, under-five mortality rates, stunting rate, proportion of children treated for diarrhea and fever, proportion of children sleeping under insecticide-treated nets, and children fully immunized at 12 months) show clear patterns of a declining urban advantage particularly up to 2014. However, U-5MR shows reversal to a significant urban advantage in 2015/2016, and slight increases in urban advantage are noted for infant mortality rate, underweight, full childhood immunization, and stunting rate in 2015/2016. Our findings suggest the need to rethink the policy viewpoint of a disadvantaged rural and much better-off urban in child health
Lifestyle-related attitudes: do they explain self-rated health and life-satisfaction?
Pickard, A Simon; Jalundhwala, Yash J; Bewsher, Helen; Sharp, Lisa K; Walton, Surrey M; Schumock, Glen T; Caskey, Rachel N
2018-05-01
Strategies to improve public health may benefit from targeting specific lifestyles associated with poor health behaviors and outcomes. The aim of this study was to characterize and examine the relationship between health and lifestyle-related attitudes (HLAs) and self-rated health and life-satisfaction. Secondary analyses were conducted on data from a 2012 community wellness survey in Kirklees, UK. Using a validated HLA tool, respondents (n = 9130) were categorized into five segments: health conscious realists (33%), balanced compensators (14%), live-for-todays (18%), hedonistic immortals (10%), and unconfident fatalists (25%). Multivariate regression was used to examine whether HLAs could explain self-rated health using the EQ-5D visual analog scale (EQ-VAS) and life-satisfaction. Health conscious realists served as the reference group. Self-rated health differed by HLA, with adjusted mean EQ-VAS scores being significantly higher (better) among balanced compensators (1.15, 95% CI 0.27, 2.03) and lower scores among unconfident fatalists (- 9.02, 95% CI - 9.85, - 8.21) and live-for-todays (- 1.96, 95% CI - 2.80, - 1.14). Balanced compensators were less likely to report low life-satisfaction (OR 0.75, 95% CI 0.62, 0.90), while unconfident fatalists were most likely to have low life-satisfaction (OR 3.51, 95% CI 2.92, 4.23). Segmentation by HLA explained differences in self-rated health and life-satisfaction, with unconfident fatalists being a distinct segment with significantly worse health perceptions and life-satisfaction. Health promotion efforts may benefit from considering the HLA segment that predominates a patient group, especially unconfident fatalists.
Asthma-COPD overlap syndrome: recent advances in diagnostic criteria and prognostic significance.
Sorino, Claudio; Scichilone, Nicola; D'Amato, Maria; Patella, Vincenzo; DI Marco, Fabiano
2017-06-01
The term asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) has been proposed for individuals with features of both asthma and COPD. Several attempts have been done to define ACOS on the basis of medical history, symptoms, and functional findings. The main diagnostic criteria include airflow obstruction with a strong although incomplete reversibility to bronchodilation tests, a significant exposure to cigarette or biomass smoke, and a history of atopy or asthma. Additional diagnostic elements include eosinophilic airway and systemic inflammation, a good response to corticosteroid treatment, and a high concentration of exhaled nitric oxide. ACOS should be distinguished from asthma with not fully reversible bronchial obstruction due to airway remodeling, thus the lack of smoking exposure should exclude the diagnosis of ACOS. In patients without a documented history of asthma before 40 years of age, an increase in FEV1 after bronchodilator >400 mL should be required to diagnose ACOS. ACOS has been found to be associated with impaired physical performance, functional ability, and health-related quality of life. The prevalence of ACOS increases with aging, then it is relatively stable in elderly individuals (>65 years). Long-term mortality of subjects with ACOS is similar to COPD, and worse than asthma and healthy controls. Future research is still needed to improve the understanding and management of ACOS.
The impact of obesity on health-related quality of life in Spain.
Busutil, Rafael; Espallardo, Olga; Torres, Antonio; Martínez-Galdeano, Lucía; Zozaya, Néboa; Hidalgo-Vega, Álvaro
2017-10-10
It is well documented that obesity is strongly associated with mortality and morbidity, but less is known about its impact on functional status and health-related quality of life (HRQOL). The purpose of this study was to calculate the impact of the Body Mass Index (BMI) on the HRQOL of the Spanish adult population, with special emphasis on BMI ≥ 35. We used the Spanish National Health Survey (SNHS) 2011-2012 to assess the statistical association between HRQOL, measured through the EuroQol-5D-5L questionnaire, and the BMI. We conducted linear regression analysis for the EuroQol-5D-5L Visual Analogue Scale (VAS) and probit regressions for each of the five dimensions of the EuroQol-5D-5L. Self-perceived problems in the five dimensions of the EuroQol-5D-5L increased along the BMI, especially in the mobility and pain/discomfort dimensions. Having a BMI ≥ 35 reduced HRQOL even in the absence of chronic diseases. After controlling for comorbidities, severe obesity decreased the VAS score by an average of 1.9 points and increased the probability of reporting any HRQOL problem in mobility (11.8%), self-care (2.2%), usual activities (4.3%) and pain/discomfort (7.4%). No association was found between obesity and mental problems. All the parameters analysed suggest that HRQOL in women and people aged 65 years and over was significantly worse than average. BMI is an explanatory factor of self-perceived quality of life. Obesity is associated with a worse HRQOL, especially in women and people aged over 64 years. These results may be useful for designing prevention or treatment health policies to target obesity among the Spanish population.
Cao, Yuping; Li, Wen; Shen, Jingjin; Zhang, Yalin
2011-02-01
To investigate the association between health related quality of life (HRQoL) and severity of depression in patients with major depressive disorder (MDD). Short Form 36 Health Survey Questionnaire (SF-36) was administered to 103 MDD patients at the baseline and 6-week follow-up. Hamilton Depression Rating for Depression (HAMD) and Clinical Global Impression (CGI) were administered at the baseline, 2- and 6-week follow-up, respectively. All SF-36 component scores in the 6-week follow-up were significantly higher than those at the baseline (Pphysical, general health, vitality, social functioning, role-emotion and mental health were significantly higher in the remission group than those in the non-remission group (Phealth transition was significantly associated with higher scores of HAMD and sleep disturbance at the baseline (Phealth and role-emotion were strongly associated with higher score of anxiety/somatization at the baseline (both Phealth was positively associated with reduction rate of cognitive disturbance at the 2-week endpoint (Phealth transition were positively associated with the reduction rate of sleep disturbance at the 2-week endpoint (both Pdepression was significantly associated with a worse HRQoL in patients with MDD. A 6-week antidepressant treatment may result in comparable HRQoL improvements. The components of HRQoL vary with severity of various symptoms of depression at the baseline and their early improvement after the treatment.
Tal-Jasper, Ruthy; Katz, David E; Amrami, Nadav; Ravid, Dor; Avivi, Dori; Zaidenstein, Ronit; Lazarovitch, Tsilia; Dadon, Mor; Kaye, Keith S; Marchaim, Dror
2016-05-01
Carbapenems are considered the treatment of choice for Acinetobacter baumannii infections. Many facilities implement preventive measures toward only carbapenem-resistant A. baumannii (CRAB). However, the independent role of the carbapenem resistance determinant on patient outcomes remains controversial. In a 6-year analysis of adults with A. baumannii bloodstream infection (BSI), the outcomes of 149 CRAB isolates were compared to those of 91 patients with carbapenem-susceptible A. baumannii In bivariable analyses, CRAB BSIs were significantly associated with worse outcomes and with a delay in the initiation of appropriate antimicrobial therapy (DAAT). However, in multivariable analyses, carbapenem resistance status was no longer associated with poor outcomes, while DAAT remained an independent predictor. The epidemiological significance of A. baumannii should not be determined by its resistance to carbapenems. Copyright © 2016, American Society for Microbiology. All Rights Reserved.
The social class gradient in health in Spain and the health status of the Spanish Roma.
La Parra Casado, Daniel; Gil González, Diana; de la Torre Esteve, María
2016-10-01
To determine the social class gradient in health in general Spain population and the health status of the Spanish Roma. The National Health Survey of Spanish Roma 2006 (sample size = 993 people; average age: 33.6 years; 53.1% women) and the National Health Surveys for Spain 2003 (sample size: 21,650 people; average age: 45.5 years; 51.2% women) and 2006 (sample size: 29,478 people; average age: 46 years; 50.7% women) are compared. Several indicators were chosen: self-perceived health, activity limitation, chronic diseases, hearing and sight problems, caries, and obesity. Analysis was based on age-standardised rates and logistic regression models. According to most indicators, Roma's health is worse than that of social class IV-V (manual workers). Some indicators show a remarkable difference between Roma and social class IV-V: experiencing three or more health problems, sight problems, and caries, in both sexes, and hearing problems and obesity, in women. Roma people are placed on an extreme position on the social gradient in health, a situation of extreme health inequality.
Urban poverty and utilization of maternal and child health care services in India.
Prakash, Ravi; Kumar, Abhishek
2013-07-01
Drawing upon data from the third round of the National Family Health Survey (NFHS-3) conducted in India during 2005-06, this study compares the utilization of selected maternal and child health care services between the urban poor and non-poor in India and across selected Indian states. A wealth index was created, separately for urban areas, using Principal Component Analysis to identify the urban poor. The findings suggest that the indicators of maternal and child health care are worse among the urban poor than in their non-poor counterparts. For instance, the levels of antenatal care, safe delivery and childhood vaccinations are much lower among the urban poor than non-poor, especially in socioeconomically disadvantageous states. Among all the maternal and child health care indicators, the non-poor/poor difference is most pronounced for delivery care in the country and across the states. Other than poverty status, utilization of antenatal services by mothers increases the chances of safe delivery and child immunization at both national and sub-national levels. The poverty status of the household emerged as a significant barrier to utilization of health care services in urban India.
Directory of Open Access Journals (Sweden)
Brian W Pence
Full Text Available In high income nations, traumatic life experiences such as childhood sexual abuse are much more common in people living with HIV/AIDS (PLWHA than the general population, and trauma is associated with worse current health and functioning. Virtually no data exist on the prevalence or consequences of trauma for PLWHA in low income nations.We recruited four cohorts of Tanzanian patients in established medical care for HIV infection (n = 228, individuals newly testing positive for HIV (n = 267, individuals testing negative for HIV at the same sites (n = 182, and a random sample of community-dwelling adults (n = 249. We assessed lifetime prevalence of traumatic experiences, recent stressful life events, and current mental health and health-related physical functioning. Those with established HIV infection reported a greater number of childhood and lifetime traumatic experiences (2.1 and 3.0 respectively than the community cohort (1.8 and 2.3. Those with established HIV infection reported greater post-traumatic stress disorder (PTSD symptomatology and worse current health-related physical functioning. Each additional lifetime traumatic experience was associated with increased PTSD symptomatology and worse functioning.This study is the first to our knowledge in an HIV population from a low income nation to report the prevalence of a range of potentially traumatic life experiences compared to a matched community sample and to show that trauma history is associated with poorer health-related physical functioning. Our findings underscore the importance of considering psychosocial characteristics when planning to meet the health needs of PLWHA in low income countries.
Pence, Brian W; Shirey, Kristen; Whetten, Kathryn; Agala, Bernard; Itemba, Dafrosa; Adams, Julie; Whetten, Rachel; Yao, Jia; Shao, John
2012-01-01
In high income nations, traumatic life experiences such as childhood sexual abuse are much more common in people living with HIV/AIDS (PLWHA) than the general population, and trauma is associated with worse current health and functioning. Virtually no data exist on the prevalence or consequences of trauma for PLWHA in low income nations. We recruited four cohorts of Tanzanian patients in established medical care for HIV infection (n = 228), individuals newly testing positive for HIV (n = 267), individuals testing negative for HIV at the same sites (n = 182), and a random sample of community-dwelling adults (n = 249). We assessed lifetime prevalence of traumatic experiences, recent stressful life events, and current mental health and health-related physical functioning. Those with established HIV infection reported a greater number of childhood and lifetime traumatic experiences (2.1 and 3.0 respectively) than the community cohort (1.8 and 2.3). Those with established HIV infection reported greater post-traumatic stress disorder (PTSD) symptomatology and worse current health-related physical functioning. Each additional lifetime traumatic experience was associated with increased PTSD symptomatology and worse functioning. This study is the first to our knowledge in an HIV population from a low income nation to report the prevalence of a range of potentially traumatic life experiences compared to a matched community sample and to show that trauma history is associated with poorer health-related physical functioning. Our findings underscore the importance of considering psychosocial characteristics when planning to meet the health needs of PLWHA in low income countries.
Worse survival after breast cancer in women with anorexia nervosa.
Bens, Annet; Papadopoulos, Fotios C; Pukkala, Eero; Ekbom, Anders; Gissler, Mika; Mellemkjær, Lene
2018-04-01
A history of anorexia nervosa has been associated with a reduced risk of developing breast cancer. We investigated survival after breast cancer among women with a prior anorexia nervosa diagnosis compared with women in a population comparison group. This register-based study included combined data from Sweden, Denmark and Finland. A total of 76 and 1462 breast cancer cases identified among 22,654 women with anorexia nervosa and 224,619 women in a population comparison group, respectively, were included in the study. Hazard ratios (HR) for overall and breast cancer-specific mortality after breast cancer diagnosis were estimated using Cox regression. Cause of death was available only for Swedish and Danish women; therefore, the analysis on breast cancer-specific mortality was restricted to these women. We observed 23 deaths after breast cancer among anorexia nervosa patients and 247 among population comparisons. The overall mortality after the breast cancer diagnosis was increased in women with a history of anorexia nervosa compared with population comparisons (HR 2.5, 95% CI 1.6-3.9) after adjustment for age, period and extent of disease. Results were similar for overall (HR 2.3, 95% CI 1.4-3.6) and breast cancer-specific mortality (HR 2.1, 95% CI 1.3-3.6) among Swedish and Danish women. We found that female breast cancer patients with a prior diagnosis of anorexia nervosa have a worse survival compared with other breast cancer patients.
Frank, Richard G; McGuire, Thomas G
2017-09-01
Two important individual health insurance markets-Medicare Advantage and the Marketplaces-are tightly regulated but rely on competition among insurers to supply and price health insurance products. Many local health insurance markets have little competition, which increases prices to consumers. Furthermore, both markets are highly subsidized in ways that can exacerbate the impact of market power-that is, the ability to set price above cost-on health insurance prices. Policy makers need to foster robust competition in both sectors and avoid designing subsidies that make the market-power problem worse. Project HOPE—The People-to-People Health Foundation, Inc.
Chiou, Shyh-Shin; Jang, Ren-Chin; Liao, Yu-Mei; Yang, Pinchen
2010-12-01
Long-term survival of childhood leukemia has become a reality with treatment advancement; hence, the need to assess the survivors' health-related quality of life (HRQL) is essential. Although a growing number of Western studies have documented the considerable impact of diagnosis and treatment on HRQL in pediatric leukemia survivors, little finding has been reported in non-Western developing countries. We used a previously validated 14-dimensional questionnaire, Child Health Questionnaire 50-item Parent Form (CHQ-PF 50), to examine the perceived HRQL of 32 child/adolescent survivors, currently aged 13.17 ± 2.49 years, who had experienced first complete continuous remission from leukemia for at least 3 years. The HRQL status was compared with that obtained from community subjects (N = 154) and survivors' nonadult siblings (N = 30). Intelligence quotients (IQ) and computerized neuropsychological assessments were performed for subjects. The HRQL of leukemia survivors was noted to be worse than that of community children and nonadult siblings as reflected by significantly lower scores in both the physical summary and the psychosocial summary score of CHQ-PF 50. 15.6% of the survivors had impaired intelligence (estimated IQ below 70). 27.8% of the adolescents were impaired in the cognitive domains as assessed by neuropsychological tests. In this Taiwanese single institution experience, pediatric leukemia survivors carried a morbidity burden into their teen years as reflected by worse HRQL than controls. These findings may guide the support required by this population.
Health-related quality of life in melanoma patients
DEFF Research Database (Denmark)
Gjorup, Caroline A.; Groenvold, Mogens; Hendel, Helle W.
2017-01-01
in the associations between lymphoedema and HRQoL: younger patients and women with lymphoedema had worse social functioning and women had significantly more impaired body image. CONCLUSIONS: The negative impact of melanoma-related limb lymphoedema on HRQoL emphasises the importance of developing strategies......AIM: To explore health-related quality of life (HRQoL) in recurrence-free melanoma patients, with a focus on the association between melanoma-related limb lymphoedema and HRQoL. METHODS: HRQoL was evaluated using the European Organisation for Research and Treatment of Cancer Quality of Life...... Questionnaire (EORTC QLQ-C30), the breast cancer module (EORTC QLQ-BR23) subscales body image and future perspective, the Functional Assessment for Cancer Therapy-General subscale social/family well-being and the Hospital Anxiety and Depression Scale. Data were analysed using linear and ordinal logistic...
General Health Status Among Students of Islamic Azad University: A Cross-Sectional Study from Iran
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Mohammad Taghi Savadpour
2015-06-01
Full Text Available Background & Aims of the Study: Health is one of the basic needs of human. There is a close relationship between physical and mental health. Human psyche is directly affected by his physical condition, and mutually his body and actions of human systems are influenced by psychological and mental space. Students because of their particular circumstances are vulnerable to mental health problems. The purpose of this study is to determine the general health status of students of Islamic Azad University. Materials & Methods: This descriptive analytical research was conducted on 478 students of Khalkhal Islamic Azad University. Simple random sampling method was used. General health questionnaire (GHQ-28 was used as research tool. Following data collection, data were analyzed using SPSS Software 13. Results: The results show that mean score of general health of the subjects is higher than cutoff. In this study, 21.3 percent of students were suspected of impaired health. Also, status of general health of female students was worse than male students and significant statistical relationship was observed between general health status and all its sub-scales except depression and gender (P < 0.5. Conclusions: G eneral health of students especially female students is impaired which may considerably affect their learning and performance and academic achievement.
Lebrun-Harris, Lydie A; Baggett, Travis P; Jenkins, Darlene M; Sripipatana, Alek; Sharma, Ravi; Hayashi, A Seiji; Daly, Charles A; Ngo-Metzger, Quyen
2013-01-01
Objective To examine health status and health care experiences of homeless patients in health centers and to compare them with their nonhomeless counterparts. Data Sources/Study Setting Nationally representative data from the 2009 Health Center Patient Survey. Study Design Cross-sectional analyses were limited to adults (n = 2,683). We compared sociodemographic characteristics, health conditions, access to health care, and utilization of services among homeless and nonhomeless patients. We also examined the independent effect of homelessness on health care access and utilization, as well as factors that influenced homeless patients' health care experiences. Data Collection Computer-assisted personal interviews were conducted with health center patients. Principal Findings Homeless patients had worse health status—lifetime burden of chronic conditions, mental health problems, and substance use problems—compared with housed respondents. In adjusted analyses, homeless patients had twice the odds as housed patients of having unmet medical care needs in the past year (OR = 1.98, 95 percent CI: 1.24–3.16) and twice the odds of having an ED visit in the past year (OR = 2.00, 95 percent CI: 1.37–2.92). Conclusions There is an ongoing need to focus on the health issues that disproportionately affect homeless populations. Among health center patients, homelessness is an independent risk factor for unmet medical needs and ED use. PMID:23134588
Migrant Workers and Their Occupational Health and Safety.
Moyce, Sally C; Schenker, Marc
2018-04-01
In 2015, approximately 244 million people were transnational migrants, approximately half of whom were workers, often engaged in jobs that are hazardous to their health. They work for less pay, for longer hours, and in worse conditions than do nonmigrants and are often subject to human rights violations, abuse, human trafficking, and violence. Worldwide, immigrant workers have higher rates of adverse occupational exposures and working conditions, which lead to poor health outcomes, workplace injuries, and occupational fatalities. Health disparities of immigrant workers are related to environmental and occupational exposures and are a result of language/cultural barriers, access to health care, documentation status, and the political climate of the host country. Recommendations on global and local scales are offered as potential solutions to improving the health of immigrant workers.
[Stress after labour - significance for maternal health behaviour].
Grieshop, M; Schücking, B
2012-04-01
Maternal stress and lack of social support in the postpartum period have a negative impact on health behaviour of new mothers. Midwives can enhance mother's coping with stress and improve their social support by early interventions in postpartum care. © Georg Thieme Verlag KG Stuttgart · New York.
[Dependent relative: Effects on family health].
Estrada Fernández, M Eugenia; Gil Lacruz, Ana I; Gil Lacruz, Marta; Viñas López, Antonio
2018-01-01
The purpose of this work is to analyse the effects on informal caregiver's health and lifestyle when living with a dependent person at home. A comparison will be made between this situation and other situations involving commitment of time and energy, taking into account gender and age differences in each stage of the life cycle. Cross-sectional study analysing secondary data. The method used for collecting information is the computer assisted personal interview carried out in selected homes by the Ministry of Health, Social Services and Equality. The study included 19,351 participants aged over 25 years who completed the 2011-2012 Spanish National Health Survey. This research is based on demographic information obtained from a Spanish National Health Survey (2011/12). Using an empirical framework, the Logit model was select and the data reported as odds ratio. The estimations were repeated independently by sub-groups of age and gender. The study showed that the health of people who share their lives with a dependent person is worse than those who do not have any dependent person at home (they are 5 times at higher risk of developing health problems). The study found that being a woman, advance age, low educational level and does not work, also has an influence. Being a caregiver reduces the likelihood of maintaining a healthy lifestyle through physical exercise, relaxation, or eating a balanced diet. Living with a dependent person reduces the likelihood of maintaining healthy lifestyles and worsens the state of health of family members. Significant differences in gender and age were found. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
Litzelman, Kristin; Skinner, Halcyon G; Gangnon, Ronald E; Nieto, F Javier; Malecki, Kristen; Witt, Whitney P
2014-06-01
Informal caregivers play a critical role in the care of individuals who are aging or have disabilities and are at increased risk for poor health outcomes. This study sought to determine whether and to what extent: (1) global stress and health-related quality of life (HRQoL) differed between caregivers and non-caregivers; (2) global stress mediated the relationship between caregiving status and HRQoL; and (3) caregiver strain (i.e., stress attributable to caregiving) was associated with worse HRQoL after accounting for global stress. Cross-sectional data were from the 2008-2010 Survey of the Health of Wisconsin, a representative sample of adults aged 21-74 years. Participants (n = 1,364) completed questionnaires about caregiving status, sociodemographics, global stress, and HRQoL. Staged generalized additive models assessed the impact of caregiving on HRQoL and the role of caregiver strain and global stress in this relationship. In the last 12 months, 17.2% of the sample reported caregiving. Caregivers reported worse mental HRQoL than non-caregivers (β -1.88, p = 0.02); global stress mediated this relationship (p stress (p stress, rather than caregiving per se, contributes to poor HRQoL among caregivers, above and beyond the effect of caregiving strain. Screening, monitoring, and reducing stress in multiple life domains presents an opportunity to improve HRQoL outcomes for caregivers.
Public mental health – using the Mental Health Gap Action Program to put all hands to the pumps
Directory of Open Access Journals (Sweden)
RICHARD eUWAKWE
2014-04-01
Full Text Available Mental ill health constitutes a huge portion of the GBD but the majority of people with mental health problems do not receive any treatment, a scenario much worse in developing countries where mental health personnel are in gross short supply. The mhGAP was launched to address this gap, especially by training non-mental health professionals to deliver effective services for selected priority mental health problems. Especially in developing countries, people with mental health problems consult traditional healers either as a first step in the pathway to biomedical mental health care or as the sole mental health service providers. Bridging the gap between mental health needs and available services in developing countries must incorporate traditional healers, who are ubiquitously available, easily accessible and acceptable to the natives. Although there are barriers in forging collaborations between traditional and biomedical mental health care providers, with mutual respect, understanding and adapted training using the mhGAP guide it should be possible to get some traditional healers to understand the core principles of some priority mental health problems identification, treatment and referral.
DEFF Research Database (Denmark)
Villesen, Christine; Hojsted, Jette; Kjeldsen, Lene Juel
2014-01-01
to a mutual agreement on the level of clinical significance. However, to what degree does the panel agree?Purpose To compare the agreement between different health care professionals who have evaluated the clinical significance of DRPs.Materials and methods DRPs were identified in 30 comprehensive medicines...... reviews conducted by a clinical pharmacist. Two hospital pharmacists, a general practitioner and two specialists in pain management from hospital care (the Panel) evaluated each DRP considering the potential clinical outcome for the patient. The DRPs were rated either nil, low, minor, moderate or highly...... clinically significant. Agreement was analysed using Kappa statistics. A Kappa value of 0.8 to 1.0 indicated nearly perfect agreement between ratings of the Panel members.Results The Panel rated 45 percent of the total 162 DRPs as of moderate clinical significance. However, the overall kappa score was 0...
Health-related quality of life in melanoma patients: Impact of melanoma-related limb lymphoedema.
Gjorup, Caroline A; Groenvold, Mogens; Hendel, Helle W; Dahlstroem, Karin; Drzewiecki, Krzysztof T; Klausen, Tobias W; Hölmich, Lisbet R
2017-11-01
To explore health-related quality of life (HRQoL) in recurrence-free melanoma patients, with a focus on the association between melanoma-related limb lymphoedema and HRQoL. HRQoL was evaluated using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the breast cancer module (EORTC QLQ-BR23) subscales body image and future perspective, the Functional Assessment for Cancer Therapy-General subscale social/family well-being and the Hospital Anxiety and Depression Scale. Data were analysed using linear and ordinal logistic regression adjusting for age and gender. A total of 431 melanoma patients who had undergone wide local excision and axillary or inguinal sentinel lymph node biopsy (SLNB) and/or complete lymph node dissection (CLND) participated. No patients had had recurrence of the disease or had received adjuvant radiotherapy. The HRQoL scores improved with time after surgery. Melanoma-related limb lymphoedema was present in 109 patients (25%). Patients with lymphoedema had significantly worse HRQoL scores in the EORTC QLQ-C30 subscales global health status/quality of life, role and social functioning, fatigue, pain and financial difficulties, as well as in the QLQ-BR23 body image subscale. No associations were found between the limb affected (upper or lower limb), clinical stage of lymphoedema, duration of lymphoedema or type of surgery (SLNB or CLND) and HRQoL. We found an interaction with age and gender in the associations between lymphoedema and HRQoL: younger patients and women with lymphoedema had worse social functioning and women had significantly more impaired body image. The negative impact of melanoma-related limb lymphoedema on HRQoL emphasises the importance of developing strategies for increasing awareness and improving prevention and treatment of lymphoedema. Copyright © 2017 Elsevier Ltd. All rights reserved.
Miquilin, Isabella de Oliveira Campos; Marín-León, Leticia; Luz, Verônica Gronau; La-Rotta, Ehideé Isabel Gómez; Corrêa Filho, Heleno Rodrigues
2015-09-01
The objectives of this study were to describe the work done by Brazilian children and adolescents and compare the socioeconomic and health profile of those that worked (or were looking for work) versus non-working youngsters. Based on the 2008 Brazilian National Sample Household Survey (PNAD/2008), we selected children and adolescents 5 to 17 years of age, divided into two analytical categories: "workers" (working or looking for employment) and "non-workers". We calculated prevalence rates for the characteristics of their main work, as well as socioeconomic and health variables comparing the two categories. Poisson regression was used to estimate prevalence ratios, adjusted by health characteristics, with "non-workers" as the reference category. Compared to "non-workers", the "workers" category was associated with a higher proportion of boys; age 14 to 17 years; black or brown skin color; lower school attendance; and worse housing conditions. Child labor was associated with worse self-rated health; chronic backache; arthritis or rheumatism; and depression. Effective policies to support families need to be strengthened to effectively fight child labor.
Black, Carolyn; Tesfaigzi, Yohannes; Bassein, Jed A; Miller, Lisa A
2017-10-01
Understanding the effect of wildfire smoke exposure on human health represents a unique interdisciplinary challenge to the scientific community. Population health studies indicate that wildfire smoke is a risk to human health and increases the healthcare burden of smoke-impacted areas. However, wildfire smoke composition is complex and dynamic, making characterization and modeling difficult. Furthermore, current efforts to study the effect of wildfire smoke are limited by availability of air quality measures and inconsistent air quality reporting among researchers. To help address these issues, we conducted a substantive review of wildfire smoke effects on population health, wildfire smoke exposure in occupational health, and experimental wood smoke exposure. Our goal was to evaluate the current literature on wildfire smoke and highlight important gaps in research. In particular we emphasize long-term health effects of wildfire smoke, recovery following wildfire smoke exposure, and health consequences of exposure in children. Copyright © 2017 Elsevier B.V. All rights reserved.
Muntaner, C; Davis, O; McIsaack, K; Kokkinen, L; Shankardass, K; O'Campo, P
2017-07-01
This article builds on recent work that has explored how welfare regimes moderate social class inequalities in health. It extends research to date by using longitudinal data from the EU-SILC (2003-2010) and examines how the relationship between social class and self-reported health and chronic conditions varies across 23 countries, which are split into five welfare regimes (Nordic, Anglo-Saxon, Eastern, Southern, and Continental). Our analysis finds that health across all classes was only worse in Eastern Europe (compared with the Nordic countries). In contrast, we find evidence that the social class gradient in both measures of health was significantly wider in the Anglo-Saxon and Southern regimes. We suggest that this evidence supports the notion that welfare regimes continue to explain differences in health according to social class location. We therefore argue that although downward pressures from globalization and neoliberalism have blurred welfare regime typologies, the Nordic model may continue to have an important mediating effect on class-based inequalities in health.
Pay Matters: The Piece Rate and Health in the Developing World.
Davis, Mary E
Piece rate pay remains a common form of compensation in developing-world industries. While the piece rate may boost productivity, it has been shown to have unintended consequences for occupational safety and health, including increased accident and injury risk. This paper explores the relationship between worker pay and physical and emotional health, and questions the modern day business case for piece rate pay in the developing world. The relationship between piece rate and self-reported measures of physical and emotional health is estimated using a large survey of garment workers in 109 Vietnamese factories between 2010 and 2014. A random effects logit model controls for factory and year, predicting worker health as a function of pay type, demographics, and factory characteristics. Workers paid by the piece report worse physical and emotional health than workers paid by the hour (OR = 1.38-1.81). Wage incentives provide the most consistently significant evidence of all demographic and factory-level variables, including the factory's own performance on occupational safety and health compliance measures. These results highlight the importance of how workers are paid to understanding the variability in worker health outcomes. More research is needed to better understand the business case supporting the continued use of piece rate pay in the developing world. Copyright © 2016 The Author. Published by Elsevier Inc. All rights reserved.
Waldhauer, Julia; Kuntz, Benjamin; Lampert, Thomas
2018-04-01
Social inequalities in health can already be found among children and adolescents to the disadvantage of socially deprived population groups. This paper aims to detect, whether differences in subjective health, mental health and health behavior among young people are due to the secondary school type attended and whether these associations exist independently of the family's socioeconomic position (SEP). The data basis was the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 1, 2009-2012). Data of 11- to 17-year-old girls and boys (n = 4665) who attend different types of secondary schools in Germany were analyzed. The dependent variables were self-rated health, findings of the Strengths and Difficulties Questionnaire (SDQ) for the detection of psychological abnormalities, as well as self-reported information regarding leisure sport, tobacco, and alcohol consumption. Prevalence and odds ratios (ORs) based on logistic regressions are shown. For the majority of the examined indicators, it can be shown that adolescents in lower secondary schools are more likely to report worse self-rated health and mental problems and engage in unhealthy behavior than peers in grammar schools ("Gymnasium"). The differences decrease after controlling for family's SEP but mostly remain statistically significant. Adolescents who don't attend grammar schools are most strongly disadvantaged in terms of inattention/hyperactivity for both gender (OR: 2.29 [1.70-3.08]), smoking among girls (2.91 [1.85-4.57]) and physical inactivity (no leisure sport) among boys (OR: 2.71 [1.85-3.95]). Unequal health opportunities should be viewed in relation to people's living conditions. For adolescents, school constitutes an important setting for learning, experience, and health. The results indicate divergent needs of school-based health promotion and prevention regarding differences among gender and type of school.
What's God Got to Do with It? How Religiosity Predicts Atheists' Health.
Speed, David; Fowler, Ken
2016-02-01
The relationship between atheism and health is poorly understood within the Religion/Spirituality-health literature. While the extant literature promotes the idea that Attendance, Prayer, and Religiosity are connected to positive health outcomes, these relationships have not been established when controlling for whether a person is an atheist. Data from the 2008-2012 American General Social Survey (n = 3210) were used to investigate this relationship. Results indicated that atheists experienced Religiosity more negatively than non-atheists. Additionally, results demonstrated that non-belief in God was not related to better or worse perceived global health, suggesting that belief in God is not inherently linked to better reported health.
Freed, Christopher R; Hansberry, Shantisha T; Arrieta, Martha I
2013-09-01
To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States. Data derive from 13 semi-structured focus groups, plus three semi-structured interviews, and were analyzed inductively consistent with a grounded theory approach. Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, non-physician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers. Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power. This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.
Overview of the health care system in Hong Kong and its referential significance to mainland China.
Kong, Xiangyi; Yang, Yi; Gao, Jun; Guan, Jian; Liu, Yang; Wang, Renzhi; Xing, Bing; Li, Yongning; Ma, Wenbin
2015-10-01
Hong Kong's health system was established within the framework of a perfect market-oriented economic matrix, where there are wide-ranging social security and medical service systems. There are many differences in the economic foundations, social systems, and ideologies between Hong Kong and mainland China, therefore, it would probably be entirely impossible to copy Hong Kong's health care system mode. However, under the framework of one country, two systems, the referential significance of relevant concepts of Hong Kong's medical service system to mainland China cannot be ignored, and merits further study. Copyright © 2015. Published by Elsevier Taiwan.
Migration processes and self-rated health among marriage migrants in South Korea.
Chang, Hsin-Chieh; Wallace, Steven P
2016-01-01
Research on migrant health mostly examines labor migrants, with some attention paid to the trauma faced by refugees. Marriage migrants represent an understudied vulnerable population in the migration and health literature. Drawing on a Social Determinants of Health (SDH) approach, we use a large Korean national survey and stratified multivariate regressions to examine the link between migration processes and the self-rated health of Korea's three largest ethnic groups of marriage migrants: Korean-Chinese, Vietnamese, and Han Chinese. We find that post-migration socioeconomic status and several social integration factors are associated with the health of marriage migrants of all three groups. Specifically, having more social relationships with Koreans is associated with good health among marriage migrants, while having more social relationships with co-ethnics is associated with worse health. Marriage migrants' perceived social status of their natal and marital families is a better predictor of their health than more objective measures such as their education attainment and that of their Korean husbands. The post-migration social gradients among all ethnic groups demonstrate a dose-response effect of marital family's social standing on marriage migrants' health, independent of their own education and the social standing of their natal families. Lastly, we find some ethnicity-specific predictors such as the association between higher educational level and worse health status among the Vietnamese. This variability by group suggests a more complex set of SDH occurred during the marriage migration processes than a basic SDH framework would predict. Using a new immigrant destination, South Korea, as an example, we conclude that migration and health policies that reduce ethnicity-specific barriers and offer integration programs in early post-migration stages may offer a pathway to good health among marriage migrants.
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Getinet Ayano
2018-03-01
Conclusion: Mental health legislation plays a crucial role in community integration of persons with mental disorders, integration of mental health at primary health care, the provision of care of high quality and the improvement of access to care at community level. It is vital and essential to have MHL for every country.
Harnois, Catherine E; Bastos, João L
2018-06-01
This study examines the extent to which discrimination and harassment contribute to gendered health disparities. Analyzing data from the 2006, 2010, and 2014 General Social Surveys ( N = 3,724), we ask the following: (1) To what extent are perceptions of workplace gender discrimination and sexual harassment associated with self-reported mental and physical health? (2) How do multiple forms of workplace mistreatment (e.g., racism, ageism, and sexism) combine to structure workers' self-assessed health? and (3) To what extent do perceptions of mistreatment contribute to the gender gap in self-assessed health? Multivariate analyses show that among women, but not men, perceptions of workplace gender discrimination are negatively associated with poor mental health, and perceptions of sexual harassment are associated with poor physical health. Among men and women, perceptions of multiple forms of mistreatment are associated with worse mental health. Gender discrimination partially explains the gender gap in self-reported mental health.
Mölsä, Mulki; Punamäki, Raija-Leena; Saarni, Samuli I; Tiilikainen, Marja; Kuittinen, Saija; Honkasalo, Marja-Liisa
2014-08-01
Mental and somatic health was compared between older Somali refugees and their pair-matched Finnish natives, and the role of pre-migration trauma and post-migration stressors among the refugees. One hundred and twenty-eight Somalis between 50-80 years of age were selected from the Somali older adult population living in the Helsinki area (N = 307). Participants were matched with native Finns by gender, age, education, and civic status. The BDI-21 was used for depressive symptoms, the GHQ-12 for psychological distress, and the HRQoL was used for health-related quality of life. Standard instruments were used for sleeping difficulties, somatic symptoms and somatization, hypochondria, and self-rated health. Clinically significant differences in psychological distress, depressive symptoms, sleeping difficulties, self-rated health status, subjective quality of life, and functional capacity were found between the Somali and Finnish groups. In each case, the Somalis fared worse than the Finns. No significant differences in somatization were found between the two groups. Exposure to traumatic events prior to immigrating to Finland was associated with higher levels of mental distress, as well as poorer health status, health-related quality of life, and subjective quality of life among Somalis. Refugee-related traumatic experiences may constitute a long lasting mental health burden among older adults. Health care professionals in host countries must take into account these realities while planning for the care of refugee populations. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Zhu, Yujia; Wu, Jizhou; Feng, Xue; Chen, Huanhuan; Lu, Huaxiang; Chen, Li; Luo, Liuhong; Rui, Chao
2017-04-01
To explore demographics, clinical and medication profiles, patients' social support, and perceived health status in HIV/TB coinfected patients in Guangxi, China.We performed a cross-sectional study in the HIV clinic of the Guigang City People's Hospital (N = 150). Health professionals conducted face-to-face interviews and collected data from patients' electronic medical records regarding patients' demographic, clinical, and medication information, as well as their social support and perceived health status. We classified all HIV/AIDS patients into HIV monoinfected and TB coinfected, at a ratio of 2:1.Compared with the HIV monoinfected, patients with HIV/TB coinfection were more likely to be older, male, less educated, unemployed, carrying health insurance, having advanced stage of HIV infection, longer history with HIV, and other opportunistic infections. Patients coinfected with TB were also more likely to hold a negative belief that their HIV treatment could prevent exacerbations, and reported significantly worse emotional/informational support, social interaction, and perceived health status. Better social support and better self-efficacy to the HIV treatment adherence was significantly associated with better perceived health status among patients with HIV and TB coinfection.Having HIV/TB coinfection was associated with poorer perceived general well-being and mental health, particularly in those undergoing TB therapy. Our findings suggest the need for mental health referrals and medication management for coinfected individuals, as well as further efforts and policies to improve coordinated care.
Characteristics of adolescents with poor mental health after bariatric surgery.
Järvholm, Kajsa; Karlsson, Jan; Olbers, Torsten; Peltonen, Markku; Marcus, Claude; Dahlgren, Jovanna; Gronowitz, Eva; Johnsson, Per; Flodmark, Carl-Erik
2016-05-01
About 20% of adolescents experience substantial mental health problems after bariatric surgery. The aim of this study was to explore differences between adolescents with poor mental health (PMH) 2 years after surgery and those with average/good mental health. Three university hospitals in Sweden. Mental health and health-related quality of life were assessed in 82 of 88 adolescents (mean age: 16.8 yr, 67% female) at baseline and 1 and 2 years after laparoscopic gastric bypass. Possible associations among mental health, weight, and biochemical outcomes were explored. Two years after surgery 16 (20%) adolescents were identified as having PMH. More symptoms of anxiety and depression and worse mental health at baseline significantly predicted PMH 2 years later. The decline in mental health for the PMH group happened mainly during the second year after surgery. Suicidal ideation was reported in 14% of the total sample 2 years postsurgery and was more frequent in the PMH group. Weight outcomes between groups were comparable at all time points, and physical health was equally improved 2 years after surgery. Although adolescents with PMH after surgery lose as much weight and have similar improvements in physical health compared with other adolescents, special attention should be given to adolescents who report mental health problems at baseline and follow-up, especially during the second year after gastric bypass. The high prevalence of suicidal ideation in adolescents 2 years after bariatric surgery is another indication that longer follow-up is necessary. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Population health and medicine: Policy and financial drivers.
Lavigne, Jill E; Brown, Jack; Matzke, Gary R
2017-09-15
The financial and policy levers of population health and potential opportunities for pharmacists are described. Three long-standing problems drive the focus on population health: (1) the United States suffers far worse population health outcomes compared with those of other developed nations that spend significantly less on healthcare, (2) the U.S. healthcare system's focus on "sick care" fails to address upstream prevention and population health improvement, and (3) financial incentives for healthcare delivery are poorly aligned with improvements in population health outcomes. The Patient Protection and Affordable Care Act of 2010 (ACA) was arguably the first major healthcare legislation since 1965 and had 3 main strategies for improving population health: expand health insurance coverage, control healthcare costs, and improve the healthcare delivery system. Federal and state legislation as well as Medicare and Medicaid financing strategies have designated mechanisms to reward advances in population outcomes since the passage of the ACA. States are responsible for many of the factors that affect population health, and a bipartisan effort that builds upon state and federal collaboration will likely be needed to implement the necessary health policy initiative. Population health issues affect productivity in the United States; conversely, improvements in population health may increase productivity, helping to offset the rising federal debt. Employers are in a position to improve population health and consequently help reduce the federal debt by addressing lifestyle, chronic disease, poverty, and inequality. National pharmacy organizations, regulatory bodies, and journal editors need to collectively agree to a threshold of quality and rigor for publication and endorsement. Knowledge of the policy and financial drivers of population health may both support pharmacists' efforts to improve population outcomes and identify opportunities for professional advancement
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Palomo-López P
2018-04-01
Full Text Available Patricia Palomo-López,1 Ricardo Becerro-de-Bengoa-Vallejo,2 Marta Elena Losa-Iglesias,3 David Rodríguez-Sanz,4 César Calvo-Lobo,5 Daniel López-López6 1Department of Nursing, University Center of Plasencia, Universidad de Extremadura, Spain; 2School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Spain; 3Faculty of Health Sciences, Universidad Rey Juan Carlos, Spain; 4Physiotherapy Department, Faculty of Health, Exercise and Sport, European University of Madrid, Villaviciosa de Odón, Madrid, Spain; 5Nursing and Physical Therapy Department, Faculty of Health Sciences, University of León, Ponferrada, León, Spain; 6Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain Background and purpose: Plantar fasciitis (PF is a foot disorder in adults secondary to an inflammatory response caused by repetitive micro-trauma. We evaluated and compared the impact on quality of life (QoL related to foot health and general health between males and females with PF. Methods: In this cross-sectional descriptive study, patients with PF were recruited from a podiatry clinic. Physical examination, sociodemographic data, and the self-reported Foot Health Status Questionnaire (FHSQ were recorded. The FHSQ has three sections and provides two composite scores from 0 to 100. Higher scores (close to 100 reflect better QoL related to foot health and health in general; lower scores (close to 0 denote a worse QoL related to these health items. Results: One hundred patients (49 males [42.38 ± 14.065 years old] and 51 females [43.90 ± 14.305 years old] were recruited. Section one of the FHSQ evaluates four foot domains, and significant differences (P<0.05 were shown for foot pain and footwear, with males having higher scores than females, but not for foot function and general foot health (P>0.05. Section two assesses four domains of general wellbeing, and significant
Oral health in patients taking psychotropic medications: Results from a pharmacy-based pilot study.
Heaton, Lisa J; Swigart, Kimberly; McNelis, Gavin; Milgrom, Peter; Downing, Donald F
2016-01-01
Individuals with mental illness face an increased risk of oral disease compared with those without mental illness. The goals of this study were to examine the self-reported oral health and dental access of individuals filling psychotropic medication prescriptions and to determine whether pharmacy patients would choose to speak with a pharmacist about their oral health if given the option to do so. Pharmacists across 6 community pharmacies within a local chain identified and surveyed adult patients filling prescriptions for psychotropic medications. Surveys included questions about oral health, dry mouth, and dental care utilization. Six community pharmacy locations. Adults (≥18 years of age) filling prescriptions for psychotropic medications. Not applicable. Self-reported oral health, dental utilization, desire to discuss oral health with a pharmacist. Participants (N = 178) filling prescriptions were mostly (65.9%) female with a mean age of 48.2 years (SD 14.3, range 19-82 years). One in 4 (24.9%) said their mouths "always" or "frequently" felt dry; these individuals were significantly more likely to have last seen a dentist for emergency (rather than routine) treatment (P oral health as significantly worse (P oral health; they reported poorer oral health than those who opted not to speak with a pharmacist (P oral health than patients without dry mouth. Although dry mouth and poor oral health were common in this sample of individuals taking psychotropic medications, this did not consistently translate into seeking information regarding oral health. Future research will focus on pharmacist-initiated oral health interventions with high-risk patients. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
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Jon Ivar Elstad
2012-12-01
Full Text Available Studies have revealed that relative poverty is associated with ill health, but the interpretations of this correlation vary. This article asks whether relative poverty among Norwegian adolescents is causally related to poor subjective health, i.e., self-reported somatic and mental symptoms. Data consist of interview responses from a sample of adolescents (N = 510 and their parents, combined with register data on the family’s economic situation. Relatively poor adolescents had significantly worse subjective health than non-poor adolescents. Relatively poor adolescents also experienced many other social disadvantages, such as parental unemployment and parental ill health. Comparisons between the relatively poor and the non-poor adolescents, using propensity score matching, indicated a negative impact of relative poverty on the subjective health among those adolescents who lived in families with relatively few economic resources. The results suggest that there is a causal component in the association between relative poverty and the symptom burden of disadvantaged adolescents. Relative poverty is only one of many determinants of adolescents’ subjective health, but its role should be acknowledged when policies for promoting adolescent health are designed.
Kalyva, Efrosini; Abdul-Rasoul, Majedah; Kehl, Dániel; Barkai, László; Lukács, Andrea
2016-04-01
This study investigated whether culture can affect self- and proxy-reports of perceived diabetes-specific health-related quality of life of children and adolescents with type 1 diabetes when taking into account glycemic control, gender and age. A total of 416 patients aged between 8 and 18 years--84 (Greece), 135 (Hungary) and 197 (Kuwait)--and their parents completed the Pediatric Quality of Life Inventory 3.0. Diabetes Module. Gender and age did not have any effect on perceived diabetes-specific health-related quality of life. Significant differences were detected among countries in self- and proxy-reports of diabetes-specific health-related quality of life when controlling for glycemic control. More specifically, Greek patients with type 1 diabetes and their parents reported significantly worse disease-specific health-related quality of life than their peers from Kuwait and Hungary. Moreover, culture affected the level of agreement between self- and proxy-reports with parents from Kuwait underestimating their children's diabetes-specific health-related quality of life. The impact of culture on self- and proxy-reports of diabetes-specific health-related quality of life warrants further investigation, since it might suggest the need for differential psychosocial treatment. Copyright © 2016 Elsevier Inc. All rights reserved.
Whitson, Heather E; Whitaker, Diane; Sanders, Linda L; Potter, Guy G; Cousins, Scott W; Ansah, Deidra; McConnell, Eleanor; Pieper, Carl F; Landerman, Lawrence; Steffens, David C; Cohen, Harvey J
2012-11-01
To examine whether performance on a brief memory test is related to functional outcomes in older individuals undergoing low-vision rehabilitation (LVR) for macular disease. Observational cohort study of individuals receiving outpatient LVR. Academic center. Ninety-one individuals (average age 80.1) with macular disease. Memory was assessed at baseline using a 10-word list; memory deficit was defined as immediate recall of two or fewer words. Vision-related function was measured using the 25-item Visual Function Questionnaire (VFQ-25) administered at baseline and during subsequent interviews (mean follow-up, 115 days). Linear mixed models were constructed to compare average trajectories of four VFQ-25 subscales: near activities, distance activities, dependency, and role difficulty. The 29.7% of participants with memory deficits tended to decline in ability to accomplish activities that involved near vision. Controlling for age, sex, and education, the functional trajectory of participants with memory deficit differed significantly from that of those with better memory (P = .002), who tended to report improvements in ability to accomplish near activities. Of older adults receiving LVR for macular disease, those with memory deficits experienced worse functional trajectories in their ability to perform specific visually mediated tasks. A brief memory screen may help explain variability in rehabilitation outcomes and identify individuals who might require special accommodations. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
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Janusz Kocjan
2017-08-01
[Conclusions] The study provides evidence about moderate intensification of health anxiety among polish adolescent. Health anxiety level was significantly higher among medical students versus non-medical students group.
Chiu, Maria; Rahman, Farah; Kurdyak, Paul; Cairney, John; Jembere, Nathaniel; Vigod, Simone
2017-05-01
Lone parenthood is associated with poorer health; however, the vast majority of previous studies have examined lone mothers and only a few have focused on lone fathers. We aimed to examine the self-rated health and mental health status among a large population-based cross-sectional sample of Canadian lone fathers compared with both partnered fathers and lone mothers. We investigated differences in self-rated health and mental health among 1058 lone fathers compared with 20 692 partnered fathers and 5725 lone mothers using the Ontario component of the Canadian Community Health Survey (2001-2013). Multivariable logistic regression was used to compare the odds of poor/fair self-rated health and mental health between the study groups while adjusting for a comprehensive list of sociodemographic factors, stressors and lifestyle factors. Lone fathers and lone mothers showed similar prevalence of poor/fair self-rated health (11.6% and 12.5%, respectively) and mental health (6.2% and 8.4%, respectively); the odds were similar even after multivariable adjustment. Lone fathers showed higher odds of poor/fair self-rated health (OR 1.53, 95% CI 1.07 to 2.17) and mental health (OR 2.09, 95% CI 1.26 to 3.46) than partnered fathers after adjustment for sociodemographic factors; however, these differences were no longer significant after accounting for stressors, including low income and unemployment. In this large population-based study, lone fathers had worse self-rated health and mental health than partnered fathers and similarly poor self-rated health and mental health as lone mothers. Interventions, supports and social policies designed for single parents should also recognise the needs of lone fathers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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Marilisa Carneiro Leão Gabardo
2015-05-01
Full Text Available The aim of this study was to investigate the association between sociodemographic, socioeconomic, psychosocial, and behavioral variables and oral health as assessed using the 14-question short version of the Oral Health Impact Profile (OHIP-14. A cross-sectional study was performed with 1095 adult residents from 38 census tracts in the municipality of São Leopoldo, State of Rio Grande do Sul, Brazil. Responses to the OHIP-14 were dichotomized, and bivariate (Chi-square and multivariate analysis (logistic regression and Wald's test were performed. In the bivariate analysis, the worse effects were reported by female individuals, the elderly, those with low family income, less schooling, those reporting a lower quality of life and social support, and smokers. In the multivariate analysis the following variables maintained their statistical significance: gender (female, age (50-59 years, family income (low, quality of life (low, social support (low, moderate, and smoking (smokers. Individuals' self-perception of their oral health was related to sociodemographic, socioeconomic, psychosocial, and behavioral variables, thus confirming that emphasis should be placed on social factors when addressing oral health problems.
Data liquidity in health information systems.
Courtney, Paul K
2011-01-01
In 2001, the Institute of Medicine report Crossing the Quality Chasm and the National Committee on Vital and Health Statistics report Information for Health were released, and they provided the context for the development of information systems used to support health-supporting processes. Both had as their goals, implicit or explicit, to ensure the right data are provided to the right person at the right time, which is one definition of "data liquidity." This concept has had some traction in recent years as a shorthand way to express a system property for health information technology, but there is not a well-defined characterization of what properties of a system or of its components give it better or worse data liquidity. This article looks at some recent work that help to identify those properties and perhaps can help to ground the concept with metrics that are assessable.
Pérez-Castro, Sonia; Lorenzo-Mahía, Yolanda; Iñarrea Fernández, Amparo; Lamas-González, María José; Sarán-Díez, María Teresa; Rubio-Alarcón, Joaquín; Reboredo-Reboredo, María Consuelo; Mosteiro-Lobato, Sonia; López-Miragaya, Isabel; Torres-Piñón, Julio; Melón-García, Santiago
2014-10-01
The etiology of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) can influence the efficacy of Public Health preventive strategies. This study aimed to determine the high-risk papillomavirus (HR-HPV) prevalence in CIN2+ cases in unvaccinated women in Galicia (Spain), the expected impact of bivalent vaccination, and the distribution of HPV 16 in squamous lesions. Ninety-four histologically confirmed cases of CIN2+ (2009-2010) were retrospectively studied: 23 CIN2, 58 CIN3- squamous carcinoma in situ (CIN3-CIS), 5 adenocarcinoma in situ (AIS), and 8 invasive squamous cervical cancer (SCC). Linear Array HPV Genotyping Test (Roche Diagnostics, Mannheim, Germany) was performed on the cervical specimens. Bivalent vaccination impact was calculated, based on regional vaccination coverage data, local HR-HPV prevalence, and reported efficacy (direct and cross-protection) of the vaccine. HR-HPV prevalence was 96.8%. The most frequent genotypes were HPV 16 (48.8-58.2%) and HPV 31 (9.3%-12.1%), considering single infections or single-multiple infections, respectively (hierarchical attribution). In squamous lesions, HPV 16 prevalence in women younger than 45 years of age increased in severe lesions (CIN3-CIS/SCC, OR 4.2), and was higher than in older women (OR 5.5). The vaccine could reduce the cumulative incidence of CIN2+ by 50.6% (direct protection), or by 62.7% (direct and cross-protection). HPV vaccination could have a great impact in women younger than 45 years of age due to the high prevalence of HPV 16 in their lesions. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.
Marti-Pastor, Marc; Perez, Gloria; German, Danielle; Pont, Angels; Garin, Olatz; Alonso, Jordi; Gotsens, Mercè; Ferrer, Montse
2018-01-01
Studies on health-related quality of life (HRQoL) inequalities according to sexual orientation are scarce. The aim of this study was to assess HRQoL inequalities between lesbian, gay, and bisexual (LGB) people and heterosexuals in the 2011 Barcelona population, to describe the extent to which sociodemographic characteristics, health-related behaviors, and chronic conditions could explain such inequalities, and to understand if they are sexual orientation inequities. In the 2011 Barcelona Health Interview Survey 3277 adults answered the EQ-5D, which measures five dimensions of HRQoL summarized into a single utility index (1 = perfect health, 0 = death). To assess HRQoL differences by sexual orientation we constructed Tobit models for the EQ-5D index, and Poisson regression models for the EQ-5D dimensions. In both cases, nested models were constructed to assess the mediator role of selected variables. After adjusting by socio-demographic variables, the LGB group presented a significantly lower EQ-5D index than heterosexuals, and higher prevalence ratios of problems in physical EQ-5D dimensions among both genders: adjusted prevalence ratio (aPR) = 1.70 for mobility (p = 0.046) and 2.11 for usual activities (p = 0.019). Differences in mental dimensions were only observed among men: aPR = 3.15 for pain/discomfort (p = 0.003) and 2.49 for anxiety/depression (p = 0.030). All these differences by sexual orientation disappeared after adding chronic conditions and health-related behaviors in the models. The LGB population presented worse HRQoL than heterosexuals in the EQ-5D index and most dimensions. Chronic conditions, health-related behaviors and gender play a major role in explaining HRQoL differences by sexual orientation. These findings support the need of including sexual orientation into the global agenda of health inequities.
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Marc Marti-Pastor
Full Text Available Studies on health-related quality of life (HRQoL inequalities according to sexual orientation are scarce. The aim of this study was to assess HRQoL inequalities between lesbian, gay, and bisexual (LGB people and heterosexuals in the 2011 Barcelona population, to describe the extent to which sociodemographic characteristics, health-related behaviors, and chronic conditions could explain such inequalities, and to understand if they are sexual orientation inequities.In the 2011 Barcelona Health Interview Survey 3277 adults answered the EQ-5D, which measures five dimensions of HRQoL summarized into a single utility index (1 = perfect health, 0 = death. To assess HRQoL differences by sexual orientation we constructed Tobit models for the EQ-5D index, and Poisson regression models for the EQ-5D dimensions. In both cases, nested models were constructed to assess the mediator role of selected variables.After adjusting by socio-demographic variables, the LGB group presented a significantly lower EQ-5D index than heterosexuals, and higher prevalence ratios of problems in physical EQ-5D dimensions among both genders: adjusted prevalence ratio (aPR = 1.70 for mobility (p = 0.046 and 2.11 for usual activities (p = 0.019. Differences in mental dimensions were only observed among men: aPR = 3.15 for pain/discomfort (p = 0.003 and 2.49 for anxiety/depression (p = 0.030. All these differences by sexual orientation disappeared after adding chronic conditions and health-related behaviors in the models.The LGB population presented worse HRQoL than heterosexuals in the EQ-5D index and most dimensions. Chronic conditions, health-related behaviors and gender play a major role in explaining HRQoL differences by sexual orientation. These findings support the need of including sexual orientation into the global agenda of health inequities.
Nogueira, Eduardo Lopes; Rubin, Leonardo Librelotto; Giacobbo, Sara de Souza; Gomes, Irenio; Cataldo Neto, Alfredo
2014-06-01
OBJECTIVE To analyze the prevalence of depression in older adults and associated factors. METHODS Cross-sectional study using a stratified random sample of 621 individuals aged ≥ 60 from 27 family health teams in Porto Alegre, RS, Southern Brazil, between 2010 and 2012. Community health agents measured depression using the 15-item Geriatric Depression Scale. Scores of ≥ 6 were considered as depression and between 11 and 15 as severe depression. Poisson regression was used to search for independent associations of sociodemographic and self-perceived health with both depression and its severity. RESULTS The prevalence of depression was 30.6% and was significantly higher in women (35.9% women versus 20.9% men, p education, especially illiteracy (PR = 1.8, 95%CI 1.2;2 6); regular self-rated health (OR = 2.2, 95%CI 1.6;3.0); and poor/very poor self-rated health (PR = 4.0, 95%CI 2.9;5.5). Except for education, the strength of association of these factors increases significantly in severe depression. CONCLUSIONS A high prevalence of depression was observed in the evaluations conducted by community health agents, professionals who are not highly specialized. The findings identified using the 15-item Geriatric Depression Scale in this way are similar to those in the literature, with depression more associated with low education, female gender and worse self-rated health. From a primary health care strategic point of view, the findings become still more relevant, indicating that community health agents could play an important role in identifying depression in older adults.
DEFF Research Database (Denmark)
Nolet, P. S.; Cote, P.; Kristman, V. L.
2015-01-01
BACKGROUND CONTEXT: Current evidence suggests that neck pain is negatively associated with health-related quality of life (HRQoL). However, these studies are cross-sectional and do not inform the association between neck pain and future HRQoL. PURPOSE: The purpose of this study was to investigate...... of future poor physical HRQoL in the population. Raising awareness of the possible future impact of neck pain on physical HRQoL is important for health-care providers and policy makers with respect to the management of neck pain in populations.......BACKGROUND CONTEXT: Current evidence suggests that neck pain is negatively associated with health-related quality of life (HRQoL). However, these studies are cross-sectional and do not inform the association between neck pain and future HRQoL. PURPOSE: The purpose of this study was to investigate...... Saskatchewan adults were included. OUTCOME MEASURES: Outcome measures were the mental component summary (MCS) and physical component summary (PCS) of the Short-Form-36 (SF-36) questionnaire. METHODS: We formed a cohort of 1,100 randomly sampled Saskatchewan adults in September 1995. We used the Chronic Pain...
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Christina Darviri
2012-03-01
Full Text Available Self-rated health (SRH is a health measure related to future health, mortality, healthcare services utilization and quality of life. Various sociodemographic, health and lifestyle determinants of SRH have been identified in different populations. The aim of this study is to extend SRH literature in the Greek population. This is a cross-sectional study conducted in rural communities between 2001 and 2003. Interviews eliciting basic demographic, health-related and lifestyle information (smoking, physical activity, diet, quality of sleep and religiosity were conducted. The sample consisted of 1,519 participants, representative of the rural population of Tripoli. Multinomial regression analysis was conducted to identify putative SRH determinants. Among the 1,519 participants, 489 (32.2%, 790 (52% and 237 (15.6% rated their health as “very good”, “good” and “poor” respectively. Female gender, older age, lower level of education and impaired health were all associated with worse SRH, accounting for 16.6% of SRH variance. Regular exercise, healthier diet, better sleep quality and better adherence to religious habits were related with better health ratings, after adjusting for sociodemographic and health-related factors. BMI and smoking did not reach significance while exercise and physical activity exhibited significant correlations but not consistently across SRH categories. Our results support previous findings indicating that people following a more proactive lifestyle pattern tend to rate their health better. The role of stress-related neuroendocrinologic mechanisms on SRH and health in general is also discussed.
Vaz, Sharmila; Cordier, Reinie; Falkmer, Marita; Ciccarelli, Marina; Parsons, Richard; McAuliffe, Tomomi; Falkmer, Torbjorn
2015-01-01
The literature on whether students with disabilities have worse physical and mental health, social adjustment, and participation outcomes when compared to their peers without disabilities is largely inconclusive. While the majority of case control studies showed significantly worse outcomes for students with disabilities; the proportion of variance accounted for is rarely reported. The current study used a population cross-sectional approach to determine the classification ability of commonly used screening and outcome measures in determining the disability status. Furthermore, the study aimed to identify the variables, if any, that best predicted the presence of disability. Results of univariate discriminant function analyses suggest that across the board, the sensitivity of the outcome/screening tools to correctly identify students with a disability was 31.9% higher than the related Positive Predictive Value (PPV). The lower PPV and Positive Likelihood Ratio (LR+) scores suggest that the included measures had limited discriminant ability (17.6% to 40.3%) in accurately identifying students at-risk for further assessment. Results of multivariate analyses suggested that poor health and hyperactivity increased the odds of having a disability about two to three times, while poor close perceived friendship and academic competences predicted disability with roughly the same magnitude. Overall, the findings of the current study highlight the need for researchers and clinicians to familiarize themselves with the psychometric properties of measures, and be cautious in matching the function of the measures with their research and clinical needs.
Health, work and working conditions: a review of the European economic literature.
Barnay, Thomas
2016-07-01
Economists have traditionally been very cautious when studying the interaction between employment and health because of the two-way causal relationship between these two variables: health status influences the probability of being employed and, at the same time, working affects the health status. Because these two variables are determined simultaneously, researchers control endogeneity skews (e.g., reverse causality, omitted variables) when conducting empirical analysis. With these caveats in mind, the literature finds that a favourable work environment and high job security lead to better health conditions. Being employed with appropriate working conditions plays a protective role on physical health and psychiatric disorders. By contrast, non-employment and retirement are generally worse for mental health than employment, and overemployment has a negative effect on health. These findings stress the importance of employment and of adequate working conditions for the health of workers. In this context, it is a concern that a significant proportion of European workers (29 %) would like to work fewer hours because unwanted long hours are likely to signal a poor level of job satisfaction and inadequate working conditions, with detrimental effects on health. Thus, in Europe, labour-market policy has increasingly paid attention to job sustainability and job satisfaction. The literature clearly invites employers to take better account of the worker preferences when setting the number of hours worked. Overall, a specific "flexicurity" (combination of high employment protection, job satisfaction and active labour-market policies) is likely to have a positive effect on health.
Tobacco and oral health--the role of the world health organization.
Petersen, Poul Erik
2003-01-01
In addition to several other chronic diseases, tobacco use is a primary cause of many oral diseases and adverse oral conditions. For example, tobacco is a risk factor for oral cancer, periodontal disease, and congenital defects in children whose mothers smoke during pregnancy. The epidemic of tobacco use is one of the greatest threats to global health; sadly the future appears worse because of the globalization of marketing. The World Health Organization (WHO) has strengthened the work for effective control of tobacco use. At the World Health Assembly in May 2003 the Member States agreed on a groundbreaking public health treaty to control tobacco supply and consumption. The treaty covers tobacco taxation, smoking prevention and treatment, illicit trade, advertising, sponsorship and promotion, and product regulation. Oral health professionals and dental associations worldwide should consider this platform for their future work for tobacco prevention since in several countries they play an important role in communication with patients and communities. The WHO Oral Health Programme gives priority to tobacco control in many ways through the development of national and community programmes which incorporates oral health and tobacco issues, tobacco prevention through schools, tobacco risk assessment in countries, and design of modern surveillance systems on risk factors and oral health. Systematic evaluation of coordinated efforts should be carried out at country and inter-country levels.
Park, Yuli; Shin, Jeong Ah; Yang, Suk Woo; Yim, Hyeon Woo; Kim, Hyun Seung; Park, Young-Hoon
2015-01-01
Introduction To evaluate health-related quality of life (HRQoL) in Korean adults with visual impairment(VI) using various measures based on a nationally distributed sample. Methods Using the Korea National Health and Nutrition Examination Survey (KNHANES, 2008–2012) data, we compared EuroQol five-dimensional questionnaire (EQ-5D) and EQ-visual analogue scale (VAS) scores after adjusting for socio-demographic and psychosocial factors as well as for comorbidities with VI. Logistic regressions were used to elucidate determinants for the lowest quintile HRQoL scales according to VI severity. Uncorrected visual acuity (VA) which implies vision of ordinary life was measured using an international standard vision chart based on Snellen scale. Results 28,825 participants (sum of weights; 37,562,376) were included in the analysis. The mean EQ-5D and EQ-VAS scores were significantly lower in the VI groups than in the normal vision (defined as VA 20/20-20/25) group based on the better or worse seeing eye (Pimpaired HRQoL compared with the normal vision population. The analyses presented here elicited even mild VI could potentially deteriorate the health-related quality of life (or subjective perception of health quality) and therefore, therapeutic approaches should also focus on the subjective perception and better management of health condition. PMID:26192763
Directory of Open Access Journals (Sweden)
Ding B
2016-06-01
Full Text Available Bo Ding,1 Marco DiBonaventura,2 Niklas Karlsson,1 Xia Ling31Department of Global Medical Affairs, AstraZeneca, Gothenburg, Sweden; 2Department of Health Outcomes Practice, Kantar Health, New York, NY, USA; 3Department of Medical Affairs China, AstraZeneca, Shanghai, People’s Republic of ChinaBackground: Research has suggested a significant burden for patients with asthma-chronic obstructive pulmonary disease (COPD overlap syndrome (ACOS. However, few studies have studied this population in the People’s Republic of China, a region in the midst of rapid epidemiological change with respect to respiratory disease. The aim of this study was to assess the prevalence of ACOS and its association with patient outcomes in urban China.Methods: Data from the 2010, 2012, and 2013 China National Health and Wellness Survey, an Internet-based survey of adults in urban China, were used (N=59,935. Respondents were categorized into one of four groups based on self-reported physician diagnoses: ACOS, asthma only, COPD only, or control (ie, no asthma or COPD. A propensity score matching procedure was conducted to cull the control group into a subgroup (ie, matched controls who resembled patients with ACOS, asthma only, and COPD only. These four groups (ACOS, asthma only, COPD only, matched controls were then compared with respect to health status (Short Form-12 version 2/Short Form-36 version 2, work productivity, and health care resource use using generalized linear models.Results: Patients with ACOS (N=366 comprised 0.61% of the adult population, 30.73% of the asthma population, and 18.60% of the COPD population in the People’s Republic of China. Patients with ACOS reported significantly worse health status (eg, health utilities =0.63, 0.66, 0.63, and 0.69 for ACOS, COPD only, asthma only, and matched controls, respectively and significantly greater work impairment (eg, overall work impairment =43.65%, 35.19%, 48.55%, and 29.80%, respectively and health care
Significance of Pirogov`s scientific ideas for modern organization of Public Health
Directory of Open Access Journals (Sweden)
Semenova L.S.
2015-03-01
Full Text Available This article is about Nikolay Ivanovich Pirogov, a surgeon and anatomist, prominent scientist and educator, founder of field surgery. He was the first to learn field surgery and military administration in practice. He was the first to use famous triage (the wounded were sorted according to the severity of injuries. N.I.Pirogov considered that well organized triage at dressing stations and temporary military hospitals is the main tool to provide proper care and to prevent harmful consequences. He organized training of medical nurses to help the wounded. He also published the work on the problems of pedagogy in which he proposed reforms of education system. The authors of the article have analyzed N.I.Pirogov`s works and showed their significance for modern social medicine and organization of Public Health.
Directory of Open Access Journals (Sweden)
Maria Fernanda Lima-Costa
Full Text Available Self-rated health is influenced by socioeconomic circumstances, but related differences in its structure have received little attention. The objective of this study was to examine whether self-rated health structure differs according to socioeconomic circumstances in later life. The study included 1,505 individuals (86.4% residing in Bambui and aged 60 years or older. Correlates of self-rated health among lower-income older adults (monthly household income < US$ 240.00 and higher-income seniors were assessed. Social network stood out as a major factor in the structure of self-rated health among the poorest. Psychological distress was independently associated with worse self-rated health among the poorest, while perceptions by the wealthiest were broader, including psychological distress, insomnia, Trypanosoma cruzi infection, use of medications, and access to health services. Physician visits and hospitalizations were associated with self-rated health in both groups. Our results show important differences in the structure of self-rated health according to socioeconomic circumstances and reinforce the need for policies to reduce health inequalities in later life.
Longitudinal associations between bullying and mental health among adolescents in Vietnam.
Le, Ha Thi Hai; Nguyen, Huong Thanh; Campbell, Marilyn A; Gatton, Michelle L; Tran, Nam T; Dunne, Michael P
2017-02-01
This study measured bullying roles across an academic year and examined how change in bullying experiences is associated with symptoms of depression, psychological distress, and suicidal ideation among adolescents in Vietnam. 1424 students in middle and high schools completed two self-administered questionnaires, six months apart in 2014-2015. Students who were victimised often and those who were classified as highly involved as both victims and bullies at one or both survey times showed significantly higher levels of depression, psychological distress, and suicidal ideation than other students. The mental health of adolescents who were involved in bullying as a victim or bully remained at low levels was generally similar to those not involved in any bullying. However, females who had stable but low level in victimisation or bully-victim status had worse mental health than males with stable-low-level exposure. This is the first longitudinal analysis of bullying among adolescents in Vietnam. Persistent and frequent bullying was strongly linked with poor mental health for males and females. A new observation is that Vietnamese girls appear to be more sensitive to low level but long-term bullying involvement than were boys.
Patterns of healthy lifestyle and positive health attitudes in older Europeans
DEFF Research Database (Denmark)
Kozlowska, Katarzyna; Szczecinka, A.; Roszkowski, Wojciech
2008-01-01
) the association between healthy lifestyle behaviors and positive attitudes to health. Design: two distinct healthy behavioral measures were developed: (i) healthy lifestyles based on physical activity, no cigarette smoking, no/moderate alcohol drinking, maintaining a "healthy" weight and having no sleeping......Objectives: To determine (i) the extent to which recommended lifestyle healthy behaviors are adopted and the existence of positive attitudes to health; (ii) the relative influence of socio-demographic variables on multiple healthy lifestyle behaviors and positive attitudes to health; (iii...... problems and (ii) positive health attitudes based on having positive emotional attitudes, such as: self-perceived good health status, being calm, peaceful and happy for most of the time, not expecting health to get worse and regular health check-ups. A composite healthy lifestyle index, ranging from 0...
Oral Health in a Sample of Pregnant Women from Northern Appalachia (2011–2015
Directory of Open Access Journals (Sweden)
Katherine Neiswanger
2015-01-01
Full Text Available Background. Chronic poor oral health has a high prevalence in Appalachia, a large region in the eastern USA. The Center for Oral Health Research in Appalachia (COHRA has been enrolling pregnant women and their babies since 2011 in the COHRA2 study of genetic, microbial, and environmental factors involved in oral health in Northern Appalachia. Methods. The COHRA2 protocol is presented in detail, including inclusion criteria (healthy, adult, pregnant, US Caucasian, English speaking, and nonimmunocompromised women, recruiting (two sites: Pittsburgh, Pennsylvania, and West Virginia, USA, assessments (demographic, medical, dental, psychosocial/behavioral, and oral microbial samples and DNA, timelines (longitudinal from pregnancy to young childhood, quality control, and retention rates. Results. Preliminary oral health and demographic data are presented in 727 pregnant women, half from the greater Pittsburgh region and half from West Virginia. Despite similar tooth brushing and flossing habits, COHRA2 women in West Virginia have significantly worse oral health than the Pittsburgh sample. Women from Pittsburgh are older and more educated and have less unemployment than the West Virginia sample. Conclusions. We observed different prevalence of oral health and demographic variables between pregnant women from West Virginia (primarily rural and Pittsburgh (primarily urban. These observations suggest site-specific differences within Northern Appalachia that warrant future studies.
Janssens, B; Vanobbergen, J; Petrovic, M; Jacquet, W; Schols, J M G A; De Visschere, L
2017-09-01
A study was conducted of nursing home residents with limited access to regular oral health care services to evaluate their oral health status, to perform an assessment of the need for oral treatment and to determine the possible predicting value of age, gender, care dependency and income level on their oral health status and treatment needs. Three experienced dentists collected clinical oral health data with a mobile dental unit in 23 nursing homes. Socio-demographic data were extracted from the residents' records in the nursing home. Besides the descriptive and bivariate analysis, a general linear mixed model analysis was also performed with the nursing home as random effect. The study sample consisted of 1,226 residents with a mean age of 83.9 years, of which 41.9% were edentulous. The mean D₃MFt in the dentate group was 24.5 and 77% needed extractions or fillings. In the group of residents wearing removable dentures, 36.9% needed repair, rebasing or renewal of the denture. The mixed model analysis demonstrated that with each year a resident gets older, the oral health outcomes get worse and that men have worse oral health and higher treatment needs than women. However, the level of income and care dependency had a less extensive role in predicting the oral health outcomes. The nursing home residents presented a poor overall oral health status and high dental and prosthetic treatment needs. Gender and age were important predicting variables for the oral health outcomes. Copyright© 2017 Dennis Barber Ltd.
International Nuclear Information System (INIS)
Fang, F.-M.; Chiu, H.-C.; Kuo, W.-R.; Wang, C.-J.; Leung, Stephen W.; Chen, H.-C.; Sun, L.-M.; Hsu, H.-C.
2002-01-01
Purpose: To evaluate the health-related quality of life (HR-QOL) of nasopharyngeal cancer (NPC) patients with cancer-free survival after treatment and to investigate the factors correlated with their HR-QOL. Methods and Materials: One hundred eighty-two NPC patients with cancer-free survival of more than 2 years after treatment were enrolled in the study. Data from the same number of people without a history of cancer, who had come to the hospital for health checkups, were also collected for comparison. The Chinese SF-36 questionnaire and nine items about head-and-neck functional impairments (HNFI) were self-reported by all participants at the clinics. Data relating to sociodemographic factors, cancer stage, and treatment of NPC survivors were analyzed. Results: Psychometric tests revealed the excellent internal reliability (Cronbach's α: 0.87-0.96) and discriminative validity of the Chinese SF-36 used in Taiwan. Most functional domains of the Chinese SF-36 and all nine HNFI items were significantly worse in NPC survivors than in control subjects. No cancer or treatment-related variables significantly correlated with any functional domains of SF-36 or any items of HNFI for NPC survivors. Economic status, educational level, occupational status, and the number of comorbidities were the variables that significantly correlated with most functional domains of SF-36 for NPC survivors. Patients with more sufficient economic status, higher educational levels, with employment, or without comorbidity tended to enjoy better HR-QOL as detected by the SF-36. Salivation, hearing, and swallowing dysfunctions were the top three HNFI that disturbed NPC survivors. Economic status remained the most significant variable correlated with HNFI, including salivation, swallowing, neck stiffness, taste, and phonation. Survivors with better economic status reported less severe HNFI. Conclusions: NPC survivors had worse HR-QOL than healthy control subjects in the study. Socioeconomic status
Comparative study of the health-related quality of life of children with epilepsy and their parents.
Bompori, Eleni; Niakas, Dimitrios; Nakou, Iliada; Siamopoulou-Mavridou, Antigoni; Tzoufi, Meropi S
2014-12-01
We aimed to evaluate the health-related quality of life (HRQoL) of schoolchildren with epilepsy and its determinants and the HRQoL of their parents in comparison with those of healthy children and their parents. The study sample comprised 100 children with epilepsy (58 males), 8-16 years of age, diagnosed at least 6 months earlier. The children with epilepsy were divided into two subgroups: A, with well controlled idiopathic epilepsy, and B, with drug-resistant or symptomatic epilepsy and with concomitant neurodevelopmental problems. A control group consisted of 100 healthy age- and gender-matched children. One parent in each family completed two questionnaires standardized for use in Greece: KIDSCREEN-27 (version for parents) to assess the HRQoL of the children and SF-12 to assess the parental HRQoL. For each of the five dimensions of KIDSCREEN-27 and for the physical and mental component scales of the SF-12 tool, the standardized mean difference (SMD) was used for comparison between the various groups and subgroups. Linear regression analysis was used to explore the effect of specific illness-related factors on the five dimensions of KIDSCREEN-27 in the children with epilepsy. The parent-reported scores on KIDSCREEN-27 of the children with epilepsy were worse overall than those of healthy children, but the difference reached statistical significance only for the dimensions of "physical well-being" (p = 0.001) and "school environment" (p children with severe epilepsy, in the dimensions "physical well-being" (p children with resistant epilepsy and accompanying neurodevelopmental problems scored significantly worse on the SF-12 mental health scale than those of healthy children (p Epilepsy, particularly severe epilepsy with concomitant neurodevelopmental problems, adversely affects the HRQoL of both schoolchildren and their parents. Copyright © 2014 Elsevier Inc. All rights reserved.
Nagatomo, I; Takigawa, M
1998-01-01
One hundred and ninety elderly people receiving home health service were investigated. The intellectual levels, depressive state evaluated by the Cornell scale for depression in dementia (CSDD) scale, abnormal behaviors evaluated by the dementia behavior disturbance (DBD) scale, and activities of daily living (ADL) were examined. These assessments were performed by 72 skilled home helpers who also assessed the severity of their own level of stress using the Burnout scale. The intellectual level and mood-related signs, based on the CSDD scale, of the elderly living with families or with a spouse were diminished significantly as compared to the elderly living alone. The elderly living with families also performed worse on all ADL categories except for visual acuity as compared to the elderly living with a spouse or living alone. There was no significant correlation between the Burnout scale score and age or frequency of working as a home helper. These results suggest that elderly people living with families as compared to the elderly living with a spouse or living alone have greater mental health needs as well as more profound physical limitations.
Setia, Maninder Singh; Quesnel-Vallee, Amelie; Abrahamowicz, Michal; Tousignant, Pierre; Lynch, John
2011-01-01
Immigrants often lose their health advantage as they start adapting to the ways of the new society. Having access to care when it is needed is one way that individuals can maintain their health. We assessed the healthcare access in Canadian immigrants and the socioeconomic factors associated with access over a 12-year period. We compared two measures of healthcare access (having a regular doctor and reporting an unmet healthcare need in the past 12 months) among immigrants and Canadian-born men and women, aged more than 18 years. We applied a logistic random effects model to evaluate these outcomes separately, in 3081 males and 4187 females from the National Population Health Survey (1994-2006). Adjusting for all covariates, immigrant men and women (white and non-white) had similar odds of having a regular doctor than the Canadian-born individuals (white immigrants: males OR: 1.32, 95% C.I.: 0.89-1.94, females OR: 1.14, 95% C.I.: 0.78-1.66; non-white immigrants: males OR: 1.28, 95% C.I.: 0.73-2.23, females OR: 1.23, 95% C.I.: 0.64-2.36). Interestingly, non-white immigrant women had significantly fewer unmet health needs (OR: 0.32, 95% C.I.: 0.17-0.59). Among immigrants, time since immigration was associated with having access to a regular doctor (OR per year: 1.02, 95% C.I.: 1.00-1.04). Visible minority female immigrants were least likely to report an unmet healthcare need. In general, there is little evidence that immigrants have worse access to health-care than the Canadian-born population. © 2010 Blackwell Publishing Ltd.
Matsaganis, Matthew D; Wilkin, Holley A
2015-04-01
This article contributes to the burgeoning literature on the social determinants of health disparities. The authors investigate how communication resources and collective efficacy, independently and in combination, shape residents' access to health enhancing resources (including healthcare services, sources of healthier food options, and public recreation spaces) in their communities. Using random digit dial telephone survey data from 833 residents of South Los Angeles communities the authors show that communicative social capital-that is, an information and problem-solving resource that accrues to residents as they become more integrated into their local communication network of neighbors, community organizations, and local media-plays a significant role in access to health resources. This relationship is complicated by individuals' health insurance and health status, as communicative social capital magnifies the sense of absence of resources for those who are in worse health and lack insurance. Communicative social capital builds collective efficacy, which is positively related to access to health-enhancing resources, but it also mediates the negative relationship between communicative social capital and access to health resources. Residents with richer stores of communicative social capital and collective efficacy report better access to health resources. The authors conclude with a discussion of implications of these findings and suggestions for future research.
Gard, Tracy L; Hoover, Donald R; Shi, Qiuhu; Cohen, Mardge H; Mutimura, Eugene; Adedimeji, Adebola A; Anastos, Kathryn
2013-10-01
We examined whether established associations between HIV disease and HIV disease progression on worse health-related quality of life (HQOL) were applicable to women with severe trauma histories, in this case Rwandan women genocide survivors, the majority of whom were HIV-infected. Additionally, this study attempted to clarify whether post-traumatic stress symptoms were uniquely associated with HQOL or confounded with depression. The Rwandan Women's Interassociation Study and Assessment was a longitudinal prospective study of HIV-infected and uninfected women. At study entry, 922 women (705 HIV+ and 217 HIV-) completed measures of symptoms of post-traumatic stress and HQOL as well as other demographic, clinical, and behavioral characteristics. Even after controlling for potential confounders and mediators, HIV+ women, in particular those with the lowest CD4 counts, scored significantly worse on HQOL and overall quality of life (QOL) than did HIV- women. Even after controlling for depression and HIV disease progression, women with more post-traumatic stress symptoms scored worse on HQOL and overall QOL than women with fewer post-traumatic stress symptoms. This study demonstrated that post-traumatic stress symptoms were independently associated with HQOL and overall QOL, independent of depression and other confounders or potential mediators. Future research should examine whether the long-term impact of treatment on physical and psychological symptoms of HIV and post-traumatic stress symptoms would generate improvement in HQOL.
Sivakumar, Haran; Hanoch, Yaniv; Barnes, Andrew J; Federman, Alex D
2016-01-01
Poor Medicare knowledge is associated with worse health outcomes, especially in low-income patients. We examined the association of health literacy and cognition with actual and perceived Medicare knowledge in a sample of inner-city older adults. We conducted a cross-sectional analysis of data on 336 adults ages 65 years and older with Medicare coverage recruited from senior centers and low-income housing facilities in Manhattan, New York. Actual Medicare knowledge was determined by a summary score of 9 true/false questions about the Medicare program and perceived Medicare knowledge with a single item. Validated measures were used to assess health literacy and general cognition. Among respondents, 63.1% had high actual Medicare knowledge, and 36.0% believed that they knew what they needed to know about Medicare. Actual and perceived Medicare knowledge were poorly correlated (r = -.01, p > .05). In multivariable models, low health literacy was significantly associated with actual Medicare knowledge (β = -8.30, SE = 2.71, p information about the Medicare program and diminish their ability to make fully informed choices.
Koopman, Cheryl; Wanat, Stanley F; Whitsell, Shelly; Westrup, Darrah; Matano, Robert A
2003-01-01
The relationships of drinking, stress, life satisfaction, coping style, and antidepressant use to mental health were examined in a highly educated workforce. This study used a one-time mail-out, mail-back cross-sectional survey design to examine the relationships of mental health with three kinds of stress (life events, work stress, home stress); two kinds of life satisfaction (work and home); use of avoidance coping; and antidepressant use. This study was conducted at a large worksite in northern California in which the workforce was comprised of predominantly highly educated employees. Questionnaires were mailed to a random sample of 10% of 8567 employees, and 504 were completed and returned by participants (59%). Complete data were provided by 460 participants (53%). Respondents completed the Mental Health Index, the Alcohol Use Disorders Identification Test (AUDIT), and measures of coping style, work and home stress and satisfaction, stressful life events, and antidepressant use. Mean Mental Health Index scores were at the 32nd percentile of the U.S. population-based norms, with low percentile values associated with worse mental health. Using multiple regression analysis, the factors examined in this study were significantly related to Mental Health Index scores as the dependent variable [F(16, 443) = 27.41, p stress at work (p home (p work (p home life (p = .01); engaging in avoidance coping (p stress, home satisfaction and work stress, home satisfaction and avoidance coping, and home satisfaction and use of antidepressants. Mental health status was poorer on average in a highly educated workforce compared with general U.S. norms. Most of the factors that were found to be associated with poorer mental health were ones that are potentially modifiable, such as experiencing more stress and less satisfaction in work and home life and engaging in current hazardous or harmful drinking. The findings that mental health is worse among individual employees who exhibit
Collaborating with Public Housing Residents and Staff to Improve Health: A Mixed-Methods Analysis.
Noonan, Devon; Hartman, Ann Michelle; Briggs, Joyce; Biederman, Donna J
2017-01-01
This study described the health behaviors and barriers and facilitators of those behaviors in elderly and/or disabled residents of public housing. A mixed-methods design was used. Residents (N = 88) completed a survey with validated measures of health behaviors. A sub-sample (N = 16) participated in three focus groups. Residents scored worse than population norms on the majority of behaviors measured. Qualitative results framed in an ecological model indicated the majority of facilitators and barriers to health behaviors were perceived as occurring at the intrapersonal and interpersonal levels. Interventions to promote health should consider the unique barriers and facilitators to health behaviors among residents.
Seelman, Kristie L
2018-02-01
This study addresses a gap in the knowledge base regarding whether there are differences in mental, cognitive, and functional health between sexual minority women aged 65 and older and their heterosexual counterparts, as well as whether disparities are moderated by age, socioeconomic status, and race/ethnicity. This study analyzes 2015 Behavioral Risk Factor Surveillance System data from 21 states. Multivariate logistic regression is used to test the hypotheses. Compared to heterosexual women, lesbian/gay women aged 65 and older report worse functional health and bisexual women report worse cognitive health and more difficulties with instrumental activities of daily living. Disparities are particularly present for women in their late 60s and those in their 70s. While the likelihood of a depression diagnosis tends to be lower for heterosexual women with higher income, the inverse is true of sexual minority women. Additionally, sexual minority women with less education have lower odds of frequent mental distress and activity limitations than those with some college education. Sexual minority women of color have significantly lower odds of frequent mental distress, activity limitations, and use of special equipment compared to white sexual minority women. Findings indicate a need for gerontological services that provide support to older sexual minority women, particularly in relation to cognitive and functional health. Future research is needed to understand risk and protective factors contributing to these disparities, including forms of resilience that occur among older sexual minority women of color. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Health-Related Quality of Life in Cervical Cancer Survivors: A Population-Based Survey
International Nuclear Information System (INIS)
Korfage, Ida J.; Essink-Bot, Marie-Louise; Mols, Floortje; Poll-Franse, Lonneke van de; Kruitwagen, Roy; Ballegooijen, Marjolein van
2009-01-01
Purpose: In a population-based sample of cervical cancer survivors, health-related quality of life (HRQoL) was assessed 2-10 years postdiagnosis. Methods and Materials: All patients given a diagnosis of cervical cancer in 1995-2003 in the Eindhoven region, The Netherlands, and alive after Jan 2006 were identified through the cancer registry. Generic HRQoL (36-Item Short-Form Health Survey, EQ-5D), cervical cancer-specific HRQoL (European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire cervical cancer module), and anxiety (6-item State Trait Anxiety Inventory) were assessed and compared with a reference population (n = 349). Data for tumor characteristics at diagnosis and disease progression were available. Results: A total of 291 women responded (69%), with a mean age of 53 ± 13 (SD) years (range, 31-88 years). Treatment had consisted of surgery (n = 195) or a combination of therapies (n = 75); one woman had not been treated. Of all women, 85% were clinically disease free, 2% had a recurrence/metastasis, and in 13%, this was unknown. After controlling for background characteristics (age, education, job and marital status, having children, and country of birth), generic HRQoL scale scores were similar to the reference population, except for worse mental health in survivors. The most frequent symptoms were crampy pain in the abdomen or belly (17%), urinary leakage (15%), menopausal symptoms (18%), and problems with sexual activity. Compared with the 6-10-year survivors, more sexual worry and worse body image were reported by the 2-5-year survivors. Compared with surgery only, especially primary radiotherapy was associated with an increased frequency of treatment-related side effects, also after controlling for age and disease stage at diagnosis and follow-up. Conclusions: Most cervical cancer survivors were coping well, although their mental health was worse than in the reference population. Even after 2-10 years, radiotherapy was
The Great Recession and health risks in African American youth.
Chen, Edith; Miller, Gregory E; Yu, Tianyi; Brody, Gene H
2016-03-01
In the present study, we investigated associations of macro-economic conditions - the Great Recession - with cellular epigenetic aging, allostatic load, and self-reported health, in a group that experiences significant health disparities, African Americans. A sample of 330 African American adolescents in Georgia was followed from pre-recession (2007, M age=16.6) to post-recession (2010, M age=19.3). Economic data were collected in both 2007 and 2010. Three groups were formed to represent economic trajectories across the period of the Great Recession (stable low economic hardship, downward mobility, and stable high economic hardship). At age 19, measures of cellular epigenetic aging (derived from leukocyte DNA methylation profiles, reflecting the disparity between a person's biological and chronological age), allostatic load (composite of blood pressure, C reactive protein, cortisol, epinephrine, norepinephrine, and body mass index), and adolescent self-report of health were obtained. Linear trend analyses documented significant differences across all outcomes. The more time adolescents spent under economic hardship, the higher their epigenetic aging [estimate=1.421, SE=0.466, p=.002] and allostatic load [estimate=1.151, SE=0.375, p=.002] scores, and the worse their self-report of health [estimate=4.957, SE=1.800, p=.006]. Specific group comparisons revealed that adolescents in the downward mobility group had higher levels of allostatic load than adolescents in the stable low hardship group [p<.05]. Overall, these findings suggest that the health profiles of African American youth may in part be shaped by environmental macro-economic societal conditions, and that effects on biological markers can be detected relatively early in life. Copyright © 2015 Elsevier Inc. All rights reserved.
Piovesan, Chaiana; Marquezan, Macela; Kramer, Paulo F; Bönecker, Marcelo; Ardenghi, Thiago M
2011-06-01
We assessed how socioeconomic and clinical conditions could affect parents' perceptions of their child's oral health. A cross-sectional study was conducted in a sample of 455 children, aged 1-5 years, representative of Santa Maria, a southern city in Brazil. Participants were randomly selected among children attending a National Day of Children's Vaccination. Clinical examinations provided information on the prevalence of caries, dental trauma, and occlusion. The caregivers' perception of children's oral health and socioeconomic status were assessed by means of a questionnaire. A Poisson regression model using robust variance (Prevalence ratio: PR; 95% CI, P ≤ 0.05) was performed to assess the association between the predictor variables and outcomes. Parents were more likely to rate their child's oral health as 'poor' if the former earned a lower income and the latter had anterior open bite and dental caries. Parents of black children with anterior open bite and dental caries were more likely to rate their child's oral health as 'worse than that of other children'. Clinical and socioeconomic characteristics are significantly associated with parents' perceptions of their child's oral health. Understanding the caregivers' perceptions of children's oral health and the factors affecting this could be useful in the planning of public health polices, in view of the inequity in the oral health pattern. © 2010 John Wiley & Sons A/S.
[Self-perceived health status among immigrants in Italy].
Petrelli, Alessio; Di Napoli, Anteo; Rossi, Alessandra; Gargiulo, Lidia; Mirisola, Concetta; Costanzo, Gianfranco
2017-01-01
to evaluate self-perceived health status of immigrants in Italy. cross-sectional study based on the representative national samples of the multipurpose surveys "Health conditions and use of health services" conducted in 2005 and 2013 by the Italian National Institute of Statistics (Istat). the study was conducted on the age group of 18-64: No. 80,661 in 2005, among which 3.2% were immigrants, and No. 72,476 in 2013, among which 7.1% were immigrants. prevalence rate ratios (PRR) calculated through log-binomial regression models, stratified by survey edition and gender, by evaluating the association between the Physical Component Score (PCS), the Mental Component Score (MCS), and the overall health index and citizenship. Adjustment for the following confounding factors was performed: age, educational level, working condition, perceived economic resources, body mass index (BMI). in 2005, immigrants had a lower probability of poor-perceived physical health, both among men (PRR: 0.79; 95%CI 0.70-0.89) and women (PRR: 0.89; 95%CI 0.82- 0.97), compared to Italians. In 2013, the perceived health advantage of immigrants was reduced for both genders (PRR males: 0.87; 95%CI 0.80-0.95; PRR females: 0.94; 95%CI 0.88-0.99). In the considered period, the prevalence of people with worse mental health conditions increases, with lower PRR among immigrants, compared to Italians. Higher probability of «NOT good» overall perceived health was also observed among immigrants residing in Italy for at least 10 years (PRR men: 1.24; PRR women: 1.15) and among immigrants men from America (PRR: 1.35). from 2005 to 2013, immigrants seemed to maintain a better perception of health status than Italians. Nevertheless, study results show a decrease in self-perceived health, particularly mental health, in the considered period - apart from demographic, socioeconomic, and lifestyle factors - as well as a worse overall self-perceived health status among immigrants who stayed in Italy longer. Such
Thongsai, S; Gray, R; Bressington, D
2016-06-01
WHAT IS KNOWN ON THE SUBJECT?: Physical health problems, especially cardiovascular disease and metabolic disorders are far more common in people with severe mental illness (SMI) than the general population. While there are a considerable number of studies that have examined the physical health and health behaviours of people with SMI in Western countries, there have been few studies that have done this in Asia. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Unhealthy body mass index (BMI) values were observed in 44% of Thai service users diagnosed with schizophrenia despite desirable levels of exercise and relatively good diets being reported by the majority of participants. Being prescribed two or more antipsychotics was significantly associated with greater body weight and a higher BMI than in people prescribed only one antipsychotic. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health professionals in Asia should be particularly aware of the additional risks of obesity that seem to be associated with antipsychotic polypharmacy when they are promoting the physical health of people with schizophrenia. Introduction People with schizophrenia have worse physical health than the general population, and studies in developed countries demonstrate that their health behaviours are often undesirable. However, as no similar studies have been conducted in Asian countries with emerging healthcare systems, the physical health promotion challenges in these settings is unknown. Aim To identify and explore relationships between cardiometabolic health risks, lifestyle and treatment characteristics in people with schizophrenia in Thailand. Method This cross-sectional study reports the baseline findings from a physical health check programme using the Thai version of the Health Improvement Profile. Results Despite desirable levels of exercise and relatively good diets being reported by most of the 105 service users, unhealthy body mass index values were observed in 44% of
Hyman, Steve Alan; Shotwell, Matthew S; Michaels, Damon R; Han, Xue; Card, Elizabeth Borg; Morse, Jennifer L; Weinger, Matthew B
2017-12-01
Burnout affects all medical specialists, and concern about it has become common in today's health care environment. The gold standard of burnout measurement in health care professionals is the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), which measures emotional exhaustion, depersonalization (DP), and personal accomplishment. Besides affecting work quality, burnout is thought to affect health problems, mental health issues, and substance use negatively, although confirmatory data are lacking. This study evaluates some of these effects. In 2011, the American Society of Anesthesiologists and the journal Anesthesiology cosponsored a webinar on burnout. As part of the webinar experience, we included access to a survey using MBI-HSS, 12-item Short Form Health Survey (SF-12), Social Support and Personal Coping (SSPC-14) survey, and substance use questions. Results were summarized using sample statistics, including mean, standard deviation, count, proportion, and 95% confidence intervals. Adjusted linear regression methods examined associations between burnout and substance use, SF-12, SSPC-14, and respondent demographics. Two hundred twenty-one respondents began the survey, and 170 (76.9%) completed all questions. There were 266 registrants total (31 registrants for the live webinar and 235 for the archive event), yielding an 83% response rate. Among respondents providing job titles, 206 (98.6%) were physicians and 2 (0.96%) were registered nurses. The frequency of high-risk responses ranged from 26% to 59% across the 3 MBI-HSS categories, but only about 15% had unfavorable scores in all 3. Mean mental composite score of the SF-12 was 1 standard deviation below normative values and was significantly associated with all MBI-HSS components. With SSPC-14, respondents scored better in work satisfaction and professional support than in personal support and workload. Males scored worse on DP and personal accomplishment and, relative to attending physicians
Health equity monitoring for healthcare quality assurance.
Cookson, R; Asaria, M; Ali, S; Shaw, R; Doran, T; Goldblatt, P
2018-02-01
Population-wide health equity monitoring remains isolated from mainstream healthcare quality assurance. As a result, healthcare organizations remain ill-informed about the health equity impacts of their decisions - despite becoming increasingly well-informed about quality of care for the average patient. We present a new and improved analytical approach to integrating health equity into mainstream healthcare quality assurance, illustrate how this approach has been applied in the English National Health Service, and discuss how it could be applied in other countries. We illustrate the approach using a key quality indicator that is widely used to assess how well healthcare is co-ordinated between primary, community and acute settings: emergency inpatient hospital admissions for ambulatory care sensitive chronic conditions ("potentially avoidable emergency admissions", for short). Whole-population data for 2015 on potentially avoidable emergency admissions in England were linked with neighborhood deprivation indices. Inequality within the populations served by 209 clinical commissioning groups (CCGs: care purchasing organizations with mean population 272,000) was compared against two benchmarks - national inequality and inequality within ten similar populations - using neighborhood-level models to simulate the gap in indirectly standardized admissions between most and least deprived neighborhoods. The modelled inequality gap for England was 927 potentially avoidable emergency admissions per 100,000 people, implying 263,894 excess hospitalizations associated with inequality. Against this national benchmark, 17% of CCGs had significantly worse-than-benchmark equity, and 23% significantly better. The corresponding figures were 11% and 12% respectively against the similar populations benchmark. Deprivation-related inequality in potentially avoidable emergency admissions varies substantially between English CCGs serving similar populations, beyond expected statistical
Local house prices and mental health.
Joshi, Nayan Krishna
2016-03-01
This paper examines the impact of local (county-level) house prices on individual self-reported mental health using individual level data from the United States Behavioral Risk Factor Surveillance System between 2005 and 2011. Exploiting a fixed-effects model that relies on within-county variations, relative to the corresponding changes in other counties, I find that while individuals are likely to experience worse self-reported mental health when local house prices decline, this association is most pronounced for individuals who are least likely to be homeowners. This finding is not consistent with a prediction from a pure wealth mechanism but rather with the hypothesis that house prices act as an economic barometer. I also demonstrate that the association between self-reported mental health and local house prices is not driven by unemployment or foreclosure. The primary result-that lower local house prices have adverse impact on self-reported mental health of homeowners and renters-is consistent with studies using data from the United Kingdom.
Heggebø, Kristian; Dahl, Espen
2015-11-04
Unemployment and health selection in diverging economic conditions: Compositional changes? Evidence from 28 european countries. People with ill health tend to be overrepresented among the unemployment population. The relationship between health and unemployment might, however, be sensitive to the overall economic condition. Specifically, the health composition of the unemployment population could change dramatically when the economy takes a turn for the worse. Using EU-SILC cross sectional data from 2007 (pre-crisis) and 2011 (during crisis) and linear regression models, this paper investigates the relationship between health and unemployment probabilities under differing economic conditions in 28 European countries. The countries are classified according to (i) the level of and (ii) increase in unemployment rate (i.e. >10 percent and doubling of unemployment rate = crisis country). Firstly, the unemployment likelihood for people with ill health is remarkably stable over time in Europe: the coefficients are very similar in pre-crisis and crisis years. Secondly, people with ill health have experienced unemployment to a lesser extent than those with good health status in the crisis year (when we pool the data and compare 2007 and 2011), but only in the countries with a high and rising unemployment rate. The health composition of the unemployment population changes significantly for the better, but only in those European countries that have been severely hit by the current economic crisis.
Epidemiology and Health-Related Quality of Life in Hypoparathyroidism in Norway.
Astor, Marianne C; Løvås, Kristian; Debowska, Aleksandra; Eriksen, Erik F; Evang, Johan A; Fossum, Christian; Fougner, Kristian J; Holte, Synnøve E; Lima, Kari; Moe, Ragnar B; Myhre, Anne Grethe; Kemp, E Helen; Nedrebø, Bjørn G; Svartberg, Johan; Husebye, Eystein S
2016-08-01
The epidemiology of hypoparathyroidism (HP) is largely unknown. We aimed to determine prevalence, etiologies, health related quality of life (HRQOL) and treatment pattern of HP. Patients with HP and 22q11 deletion syndrome (DiGeorge syndrome) were identified in electronic hospital registries. All identified patients were invited to participate in a survey. Among patients who responded, HRQOL was determined by Short Form 36 and Hospital Anxiety and Depression scale. Autoantibodies were measured and candidate genes (CaSR, AIRE, GATA3, and 22q11-deletion) were sequenced for classification of etiology. We identified 522 patients (511 alive) and estimated overall prevalence at 102 per million divided among postsurgical HP (64 per million), nonsurgical HP (30 per million), and pseudo-HP (8 per million). Nonsurgical HP comprised autosomal dominant hypocalcemia (21%), autoimmune polyendocrine syndrome type 1 (17%), DiGeorge/22q11 deletion syndrome (15%), idiopathic HP (44%), and others (4%). Among the 283 respondents (median age, 53 years [range, 9-89], 75% females), seven formerly classified as idiopathic were reclassified after genetic and immunological analyses, whereas 26 (37% of nonsurgical HP) remained idiopathic. Most were treated with vitamin D (94%) and calcium (70%), and 10 received PTH. HP patients scored significantly worse than the normative population on Short Form 36 and Hospital Anxiety and Depression scale; patients with postsurgical scored worse than those with nonsurgical HP and pseudo-HP, especially on physical health. We found higher prevalence of nonsurgical HP in Norway than reported elsewhere. Genetic testing and autoimmunity screening of idiopathic HP identified a specific cause in 21%. Further research is necessary to unravel the causes of idiopathic HP and to improve the reduced HRQOL reported by HP patients.
Jonker, Marcel F; Attema, Arthur E; Donkers, Bas; Stolk, Elly A; Versteegh, Matthijs M
2017-12-01
Health state valuations of patients and non-patients are not the same, whereas health state values obtained from general population samples are a weighted average of both. The latter constitutes an often-overlooked source of bias. This study investigates the resulting bias and tests for the impact of reference dependency on health state valuations using an efficient discrete choice experiment administered to a Dutch nationally representative sample of 788 respondents. A Bayesian discrete choice experiment design consisting of eight sets of 24 (matched pairwise) choice tasks was developed, with each set providing full identification of the included parameters. Mixed logit models were used to estimate health state preferences with respondents' own health included as an additional predictor. Our results indicate that respondents with impaired health worse than or equal to the health state levels under evaluation have approximately 30% smaller health state decrements. This confirms that reference dependency can be observed in general population samples and affirms the relevance of prospect theory in health state valuations. At the same time, the limited number of respondents with severe health impairments does not appear to bias social tariffs as obtained from general population samples. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Health-state utilities in a prisoner population: a cross-sectional survey
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Levy Michael H
2009-08-01
Full Text Available Abstract Background Health-state utilities for prisoners have not been described. Methods We used data from a 1996 cross-sectional survey of Australian prisoners (n = 734. Respondent-level SF-36 data was transformed into utility scores by both the SF-6D and Nichol's method. Socio-demographic and clinical predictors of SF-6D utility were assessed in univariate analyses and a multivariate general linear model. Results The overall mean SF-6D utility was 0.725 (SD 0.119. When subdivided by various medical conditions, prisoner SF-6D utilities ranged from 0.620 for angina to 0.764 for those with none/mild depressive symptoms. Utilities derived by the Nichol's method were higher than SF-6D scores, often by more than 0.1. In multivariate analysis, significant independent predictors of worse utility included female gender, increasing age, increasing number of comorbidities and more severe depressive symptoms. Conclusion The utilities presented may prove useful for future economic and decision models evaluating prison-based health programs.
Return Migration to Mexico: Does Health Matter?
Arenas, Erika; Goldman, Noreen; Pebley, Anne R; Teruel, Graciela
2015-12-01
We use data from three rounds of the Mexican Family Life Survey to examine whether migrants in the United States returning to Mexico in the period 2005-2012 have worse health than those remaining in the United States. Despite extensive interest by demographers in health-related selection, this has been a neglected area of study in the literature on U.S.-Mexico migration, and the few results to date have been contradictory and inconclusive. Using five self-reported health variables collected while migrants resided in the United States and subsequent migration history, we find direct evidence of higher probabilities of return migration for Mexican migrants in poor health as well as lower probabilities of return for migrants with improving health. These findings are robust to the inclusion of potential confounders reflecting the migrants' demographic characteristics, economic situation, family ties, and origin and destination characteristics. We anticipate that in the coming decade, health may become an even more salient issue in migrants' decisions about returning to Mexico, given the recent expansion in access to health insurance in Mexico.
Does cognitive decline decrease health utility value in older adult patients with cancer?
Akechi, Tatsuo; Aiki, Sayo; Sugano, Koji; Uchida, Megumi; Yamada, Atsuro; Komatsu, Hirokazu; Ishida, Takashi; Kusumoto, Shigeru; Iida, Shinsuke; Okuyama, Toru
2017-05-01
Cognitive decline is common among older adults with cancer. The present study aimed to investigate the impact of cognitive decline on health utility value in older adults suffering from cancer. Consecutive patients aged 65 years or older with a primary diagnosis of malignant lymphoma or multiple myeloma were recruited. Patients were asked to complete the EuroQoL-5 (EQ-5D) scale to measure health utility and the Mini-Mental State Examination to assess cognitive decline. The potential impact of cognitive decline was investigated with univariate analysis. A multivariate regression analysis was conducted to control for potential confounding factors. Complete data were obtained from 87 patients, 29% of whom had cognitive decline. The mean ± SE EQ-5D score for patients with cognitive decline was significantly lower than that for those without cognitive decline (0.67 ± 0.04 vs 0.79 ± 0.03, t = 2.38, P = 0.02). However, multiple regression analysis showed that cognitive decline was not significantly associated with EQ-5D scores. Female sex and lower performance scores (worse physical condition) were significantly associated with EQ-5D scores. Cognitive decline may be involved in decreased health utility value in older adult patients with cancer. However, this effect does not seem to be independent, and the patient's physical condition may be a relevant confounding factor. © 2016 The Authors. Psychogeriatrics © 2016 Japanese Psychogeriatric Society.
Sellers, Sherrill L; Cherepanov, Dasha; Hanmer, Janel; Fryback, Dennis G; Palta, Mari
2013-08-01
We assessed associations between discrimination and health-related quality of life among black and white men and women in the United States. We examined data from the National Health Measurement Study, a nationally representative sample of 3,648 adults aged 35-89 in the non-institutionalized US population. These data include self-reported lifetime and everyday discrimination as well as several health utility indexes (EQ-5D, HUI3, and SF-6D). Multiple regression was used to compute mean health utility scores adjusted for age, income, education, and chronic diseases for each race-by-gender subgroup. Black men and women reported more discrimination than white men and women. Health utility tended to be worse as reported discrimination increased. With a few exceptions, differences between mean health utility scores in the lowest and highest discrimination groups exceeded the 0.03 difference generally considered to be a clinically significant difference. Persons who experienced discrimination tended to score lower on health utility measures. The study also revealed a complex relationship between experiences of discrimination and race and gender. Because of these differential social and demographic relationships caution is urged when interpreting self-rated health measures in research, clinical, and policy settings.
Effect of Different Flooring Designs on the Performance and Foot Pad Health in Broilers and Turkeys.
Chuppava, Bussarakam; Visscher, Christian; Kamphues, Josef
2018-05-03
Litter quality has a significant influence on the performance and foot pad health in poultry. The objective of this study was to evaluate the effects of different types of flooring designs on the performance and foot pad health in fattening broilers and turkeys. Three trials were conducted for each species using a total of 720 Ross 308 broilers and 720 Big 6 turkeys. After day seven, animals were randomly assigned to four groups with three subgroups each: G1—floor pens with litter, G2—floor pens with litter and floor heating, G3—partially-slatted flooring, including a littered area, and G4—fully-slatted flooring with a sand bath (900 cm²). Animals of both species had a significantly higher final body weight at dissection (day 36) after being reared on fully-slatted floors compared to common littered floors. In turkeys, the feed conversion ratio was worse in G4 (1.53 ± 0.04) than in G1 (1.47 ± 0.02) and G2 (1.48 ± 0.03). Water to feed ratio was significantly higher in G2 than other groups. Turkeys’ foot pad health was significantly better in G4 than in other groups beginning at day 21. In turkeys, platforms with slatted floors that allow for temporary separation of the feet from the litter could lead to improvements in foot pad health which could better enable the realization of species-specific behaviours and activities in littered areas.
Effect of Different Flooring Designs on the Performance and Foot Pad Health in Broilers and Turkeys
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Bussarakam Chuppava
2018-05-01
Full Text Available Litter quality has a significant influence on the performance and foot pad health in poultry. The objective of this study was to evaluate the effects of different types of flooring designs on the performance and foot pad health in fattening broilers and turkeys. Three trials were conducted for each species using a total of 720 Ross 308 broilers and 720 Big 6 turkeys. After day seven, animals were randomly assigned to four groups with three subgroups each: G1—floor pens with litter, G2—floor pens with litter and floor heating, G3—partially-slatted flooring, including a littered area, and G4—fully-slatted flooring with a sand bath (900 cm2. Animals of both species had a significantly higher final body weight at dissection (day 36 after being reared on fully-slatted floors compared to common littered floors. In turkeys, the feed conversion ratio was worse in G4 (1.53 ± 0.04 than in G1 (1.47 ± 0.02 and G2 (1.48 ± 0.03. Water to feed ratio was significantly higher in G2 than other groups. Turkeys’ foot pad health was significantly better in G4 than in other groups beginning at day 21. In turkeys, platforms with slatted floors that allow for temporary separation of the feet from the litter could lead to improvements in foot pad health which could better enable the realization of species-specific behaviours and activities in littered areas.
Mackey, Tim K; Strathdee, Steffanie A
2015-01-01
Peace and stability in Eastern Europe is now at a crossroads with the rapidly deteriorating foreign policy crisis continuing to unfold in the Ukraine. However, largely overlooked in the context of other foreign policy and diplomatic priorities are the serious public health consequences for the region following the annexation of Crimea and the subsequent decision to ban opioid substitution therapy in the disputed territory. On 1 May 2014, the Republic of Crimea officially announced it would end access to opioid substitution therapy, an essential harm reduction tool recognized by international organizations and virtually all other European countries. The policy development marks a critical reversal in the region's fight against its growing HIV epidemic and also threatens years of public health gains aimed at providing evidence-based and integrated treatment approaches to combat drug dependence and HIV. Beyond these risks, the Ukrainian conflict could also negatively impact control of other infectious diseases that are converging with HIV and injection drug use, such as multidrug-resistant tuberculosis and hepatitis C virus. The continuing conflict is also likely to have a significant negative impact on Ukraine's fragile public health system leading to even worse population health outcomes than currently experienced by the country. In response to this crisis, the application of global health diplomacy principles represents a possible route of advocacy to ensure that HIV prevention, humane treatment of substance using populations, and improving public health outcomes in the region are pursued among concerned international stakeholders. In order to be effective, global health diplomacy efforts must be coordinated and advocated in all forms of diplomatic engagement, including at the core, multistakeholder and informal levels and through existing channels such as the different human rights bodies of the United Nations as well as amongst other actors. Hence, the Ukraine
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Bakshi N
2018-02-01
Full Text Available Nitya Bakshi,1,2 Diana Ross,1 Lakshmanan Krishnamurti1,2 1Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA; 2Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA Abstract: While acute episodic pain is the hallmark of sickle cell disease (SCD, transition to chronic pain is a major cause of morbidity and impaired quality of life. One of the core diagnostic criteria used by Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks-American Pain Society Pain Taxonomy (AAPT to define chronic SCD pain is the presence of pain on a “majority of days” in the past 6 months in one or more locations. The frequency characteristic of “majority of days” is adapted from the criteria of 15 days or more per month, used to define chronic migraine, but there are inadequate data to support this cutoff in SCD. Using an existing dataset of adults with SCD who completed patient-reported outcomes of pain interference, physical functioning, anxiety, depression, and fatigue using the National Institutes of Health (NIH patient-reported outcomes measures information system (PROMIS short-form instruments, we examined the association of the presence of pain on 3 or more days per week with patient-reported outcomes of functioning. In unadjusted analyses, presence of pain on 3 or more days a week was associated with higher median PROMIS scores of pain interference, anxiety, and depression. Median PROMIS scores of fatigue and physical function were worse in women compared with men in unadjusted analyses. We did not find any difference in median PROMIS pain scores between adults aged ≤35 years compared with those aged ≥35 years. In linear regression models, after adjustment for age and sex, the presence of pain on 3 or more days a week was found to be associated with worse pain interference and anxiety. These data support
Prognostic Significance of Signet Ring Gastric Cancer
Taghavi, Sharven; Jayarajan, Senthil N.; Davey, Adam; Willis, Alliric I.
2012-01-01
Purpose Studies in Asia have questioned the dictum that signet ring cell carcinoma (SRC) has a worse prognosis than other forms of gastric cancer. Our study determined differences in presentation and outcomes between SRC and gastric adenocarcinoma (AC) in the United States. Patients and Methods The National Cancer Institute Surveillance, Epidemiology, and End Results database was reviewed for SRC and AC from 2004 to 2007. Results We reviewed 10,246 cases of patients with gastric cancer, including 2,666 of SRC and 7,580 of AC. SRC presented in younger patients (61.9 v 68.7 years; P < .001) and less often in men (52.7% v 68.7%; P < .001). SRC patients were more frequently black (11.3% v 10.9%), Asian (16.4% v 13.2%), American Indian/Alaska Native (0.9% v 0.8%), or Hispanic (23.3% v 14.0%; P < .001). SRC was more likely to be stage T3-4 (45.8% v 33.3%), have lymph node spread (59.7% v 51.8%), and distant metastases (40.2% v 37.6%; P < .001). SRC was more likely to be found in the lower (30.7% v 24.2%) and middle stomach (30.6% v 20.7%; P < .001). Median survival was not different between the two (AC, 14.0 months v SRC, 13.0 months; P = .073). Multivariable analyses demonstrated SRC was not associated with mortality (hazard ratio [HR], 1.05; 95% CI, 0.96 to 1.11; P = .150). Mortality was associated with age (HR, 1.01; 95% CI, 1.01 to 1.02; P < .001), black race (HR, 1.10; 95% CI, 1.01 to 1.20; P = .026), and tumor grade. Variables associated with lower mortality risk included Asian race (HR, 0.83; 95% CI, 0.77 to 0.91; P < .001) and surgery (HR, 0.37; 95% CI, 0.34 to 0.39; P < .001). Conclusion In the United States, SRC significantly differs from AC in extent of disease at presentation. However, when adjusted for stage, SRC does not portend a worse prognosis. PMID:22927530
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Wu Xiang-Yun
2008-05-01
Full Text Available Abstract Background Studying mitochondrial (mt genomics has important implications for various fundamental areas, including mt biochemistry, physiology and molecular biology. In addition, mt genome sequences have provided useful markers for investigating population genetic structures, systematics and phylogenetics of organisms. Toxocara canis, Toxocara cati and Toxocara malaysiensis cause significant health problems in animals and humans. Although they are of importance in human and animal health, no information on the mt genomes for any of Toxocara species is available. Results The sizes of the entire mt genome are 14,322 bp for T. canis, 14029 bp for T. cati and 14266 bp for T. malaysiensis, respectively. These circular genomes are amongst the largest reported to date for all secernentean nematodes. Their relatively large sizes relate mainly to an increased length in the AT-rich region. The mt genomes of the three Toxocara species all encode 12 proteins, two ribosomal RNAs and 22 transfer RNA genes, but lack the ATP synthetase subunit 8 gene, which is consistent with all other species of Nematode studied to date, with the exception of Trichinella spiralis. All genes are transcribed in the same direction and have a nucleotide composition high in A and T, but low in G and C. The contents of A+T of the complete genomes are 68.57% for T. canis, 69.95% for T. cati and 68.86% for T. malaysiensis, among which the A+T for T. canis is the lowest among all nematodes studied to date. The AT bias had a significant effect on both the codon usage pattern and amino acid composition of proteins. The mt genome structures for three Toxocara species, including genes and non-coding regions, are in the same order as for Ascaris suum and Anisakis simplex, but differ from Ancylostoma duodenale, Necator americanus and Caenorhabditis elegans only in the location of the AT-rich region, whereas there are substantial differences when compared with Onchocerca volvulus
Health Inequities among Lesbian, Gay, and Bisexual Adults in North Carolina, 2011–2014
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Melissa M. Barnhill
2017-07-01
Full Text Available Inequalities in health have been identified for lesbian, gay, and bisexual (LGB populations nationally. Policies in the U.S. South offer fewer protections for LGB people than in other regions, yet, limited data exist for this region. North Carolina (NC BRFSS data from 2011 to 2014 were combined (LGB n = 604; heterosexual n = 33,170 and analyzed using SAS survey procedures to estimate health characteristics by sexual orientation within gender. Many examined indicators were not different by sexual orientation, however, other results were significant and consistent with findings from state population surveys in other regions of the country. Both genders showed inequities in mental health, having over twice the odds of five or more poor mental health days in the past month and of having ever been diagnosed with a depressive disorder. Sexual minority women had higher odds compared with heterosexual women for ever having smoked cigarettes, current smoking, exposure to secondhand smoke both in the workplace and at home, and both alcohol risk factors, binge and heavy drinking. Being part of the LGB population in NC is associated with worse health. The implementation of anti-LGB policies in the NC warrants ongoing monitoring of LGB health inequities in NC and in other southeastern states for potential effects on the health and well-being of sexual minorities.
Tuin, Janneke; Sanders, Jan-Stephan F; Buhl, Birgit M; van Beek, André P; Stegeman, Coen A
2013-01-01
Low testosterone levels in men are associated with fatigue, limited physical performance and reduced health-related quality of life (HRQOL); however, this relationship has never been assessed in patients with anti-neutrophil cytoplasmic antibodies (ANCA) -associated vasculitides (AAV). The aim of this study was to assess the prevalence of androgen deficiency and to investigate the role of testosterone in fatigue, limited physical condition and reduced HRQOL in men with AAV. Male patients with AAV in remission were included in this study. Fatigue and HRQOL were assessed by the multi-dimensional fatigue inventory (MFI)-20 and RAND-36 questionnaires. Seventy male patients with a mean age of 59 years (SD 12) were included. Scores of almost all subscales of both questionnaires were significantly worse in patients compared to controls. Mean total testosterone and free testosterone levels were 13.8 nmol/L (SD 5.6) and 256 pmol/L (SD 102), respectively. Androgen deficiency (defined according to Endocrine Society Clinical Practice Guidelines) was present in 47% of patients. Scores in the subscales of general health perception, physical functioning and reduced activity were significantly worse in patients with androgen deficiency compared to patients with normal androgen levels. Testosterone and age were predictors for the RAND-36 physical component summary in multiple linear regression analysis. Testosterone, age, vasculitis damage index (VDI) and C-reactive protein (CRP) were associated with the MFI-20 subscale of general fatigue. This study showed that androgen deficiency was present in a substantial number of patients with AAV. Testosterone was one of the predictors for physical functioning and fatigue. Testosterone may play a role in fatigue, reduced physical performance and HRQOL in male patients with AAV.
Complication amoebic liver abscess still a significant health problem ...
African Journals Online (AJOL)
Amoebic liver abscess still poses a serious clinical problem in tropical countries. Here we describe three complicated cases to illustrate the magnitude this disease condition could assume in the tropics. Limited access to health facilities as well as poverty and ignorance result in patients presenting late, often with ...
DEFF Research Database (Denmark)
Jensen, Kirsten E; Thomsen, Louise T; Schmiedel, Sven
2014-01-01
Some studies suggest that Chlamydia trachomatis (CT) enhances cervical carcinogenesis; however, a possible confounding effect of persistent human papillomavirus (HPV) infection was not addressed. We examined the potential role of CT infection in the development of subsequent cervical intraepithel...... intraepithelial neoplasia grade 3 or worse (CIN3+) in women with prevalent HPV infection and in a subgroup of women with persistent HPV infection.......Some studies suggest that Chlamydia trachomatis (CT) enhances cervical carcinogenesis; however, a possible confounding effect of persistent human papillomavirus (HPV) infection was not addressed. We examined the potential role of CT infection in the development of subsequent cervical...
Tsukamoto, Erika; Abe, Takeru; Ono, Michikazu
2015-01-01
Emotional labour increases among long-term care workers because providing care and services to impaired elders causes conflicting interpersonal emotions. Thus, we investigated the associations between emotional labour, general health and job satisfaction among long-term care workers. We conducted a cross-sectional study among 132 established, private day care centres in Tokyo using a mail survey. The outcome variables included two health-related variables and four job satisfaction variables: physical and psychological health, satisfaction with wages, interpersonal relationships, work environment and job satisfaction. We performed multiple regression analyses to identify significant factors. Directors from 36 facilities agreed to participate. A total of 123 responses from long-term care workers were analysed. Greater emotional dissonance was associated with better physical and psychological health and worse work environment satisfaction (partial regression coefficient: -2.93, p = .0389; -3.32, p = .0299; -1.92, p = .0314, respectively). Fewer negative emotions were associated with more job satisfaction (partial regression coefficient: -1.87, p = .0163). We found that emotional labour was significantly inversely associated with health and job satisfaction. Our findings indicated that the emotional labour of long-term care workers has a negative and positive influence on health and workplace satisfaction, and suggests that care quality and stable employment among long-term care workers might affect their emotional labour. Therefore, we think a programme to support emotional labour among long-term care workers in an organized manner and a self-care programme to educate workers regarding emotional labour would be beneficial.
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Toyoko Kugimoto
2017-01-01
Full Text Available Objective: This study illuminates the degree of psychological stress response experienced by spouses of cancer patients when given bad news at three different times (notification of the name of the disease, notification of recurrence, and notification of terminality as well as the factors that influence the response and the health status of the spouse as measured by health-related quality of life (QOL. Methods: A total of 203 individuals (57 men and 146 women who had received the three types of news were surveyed using a self-report questionnaire on psychological stress response, marital satisfaction, and health-related QOL scales. Results: The degree of the psychological stress response was the highest for notification of terminality, followed by notification of the name of the disease, and notification of recurrence. The influencing factors varied depending on the notification period. Although no significant difference was observed for health-related QOL among the three notification types, significant differences were observed for certain items when compared with national standard values. Conclusions: When a notification of terminality, which produced the highest psychological stress response, is given, providing care that considers health-related QOL is necessary not only for patients but also for their spouses.
Rylands, Joseph; Lowe, Derek; Rogers, Simon N
2016-01-01
Oral cancer patients from lower socio-economic backgrounds have worse outcomes of survival and health related quality of life. The mechanism of cause is not fully understood. The purpose of the paper is to report treatment selection, survival, health related quality of life, cause and place of death in relation to deprivation status. 553 patients treated for oral cancer between 2008 and 2012 were identified from records at University hospital. Mortality was tracked via the Office of National Statistics (ONS) and health-related quality of life was measured using the University Washington quality of life questionnaire (UW-QoLv4). Postcodes of residence at diagnosis were used to obtain index of multiple deprivation (IMD) 2010 scores. Nearly half of the sample (47%) lived in the 'most deprived' IMD 2010 quartile of residential areas in England and such patients when treated with curative intent using surgery with or without adjuvant radiotherapy had worse survival than patients living elsewhere, p=0.01 after adjusting for pathological staging and age group. There were no notable differences by IMD group in cancer being mentioned anywhere in part 1 or part 2 of the death certificate or in place of death. After adjustment for patient and clinical factors patients residing in more deprived areas had worse quality of life outcomes in regard to social-emotional functioning and overall quality of life but not in regard to physical oral function. Addressing inequalities in health care related to deprivation is a priority for patients with oral cancer. Copyright © 2015 Elsevier Ltd. All rights reserved.
Employment insecurity and employees' health in Denmark.
Cottini, Elena; Ghinetti, Paolo
2018-02-01
We use register data for Denmark (IDA) merged with the Danish Work Environment Cohort Survey (1995, 2000, and 2005) to estimate the effect of perceived employment insecurity on perceived health for a sample of Danish employees. We consider two health measures from the SF-36 Health Survey Instrument: a vitality scale for general well-being and a mental health scale. We first analyse a summary measure of employment insecurity. Instrumental variables-fixed effects estimates that use firm workforce changes as a source of exogenous variation show that 1 additional dimension of insecurity causes a shift from the median to the 25th percentile in the mental health scale and to the 30th in that of energy/vitality. It also increases by about 6 percentage points the probability to develop severe mental health problems. Looking at single insecurity dimensions by naïve fixed effects, uncertainty associated with the current job is important for mental health. Employability has a sizeable relationship with health and is the only insecurity dimension that matters for the energy and vitality scale. Danish employees who fear involuntary firm internal mobility experience worse mental health. Copyright © 2017 John Wiley & Sons, Ltd.
Poor caregiver mental health predicts mortality of patients with neurodegenerative disease.
Lwi, Sandy J; Ford, Brett Q; Casey, James J; Miller, Bruce L; Levenson, Robert W
2017-07-11
Dementia and other neurodegenerative diseases cause profound declines in functioning; thus, many patients require caregivers for assistance with daily living. Patients differ greatly in how long they live after disease onset, with the nature and severity of the disease playing an important role. Caregiving can also be extremely stressful, and many caregivers experience declines in mental health. In this study, we investigated the role that caregiver mental health plays in patient mortality. In 176 patient-caregiver dyads, we found that worse caregiver mental health predicted greater patient mortality even when accounting for key risk factors in patients (i.e., diagnosis, age, sex, dementia severity, and patient mental health). These findings highlight the importance of caring for caregivers as well as patients when attempting to improve patients' lives.
Associations Between County Wealth, Health and Social Services Spending, and Health Outcomes.
McCullough, J Mac; Leider, Jonathon P
2017-11-01
Each year, the County Health Rankings rate the health outcomes of each county in the U.S. A common refrain is that poor counties perform worse than wealthier ones. This article examines that assumption and specifically analyzes characteristics of counties that have performed better in terms of health outcomes than their wealth alone would suggest. Data from the 2013 County Health Rankings were used, as were 2012 financial and demographic information collected by the U.S. Census Bureau. A logistic model was constructed to examine the odds of a county "overperforming" in the rankings relative to community wealth. Analyses were performed in 2016. Communities that were wealthier performed better on the rankings. However, more than 800 of 3,141 counties overperformed by ranking in a better health outcomes quartile than their county's wealth alone would suggest. Regression analyses found that for each additional percentage point of total public spending that was allocated toward community health care and public health, the odds of being an overperformer increased by 3.7%. Community wealth correlates with health, but not always. Population health outcomes in hundreds of counties overperform what would be expected given community wealth alone. These counties tend to invest more in community health care and public health spending and other social services. Although the level of a community's wealth is outside the control of practitioners, shifting the proportion of spending to certain social services may positively impact population health. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Puett, Robin; Teas, Jane; España-Romero, Vanesa; Artero, Enrique Garcia; Lee, Duck-chul; Baruth, Meghan; Sui, Xuemei; Montresor-López, Jessica; Blair, Steven N
2014-11-01
The importance of physical activity for health is well-established. Questions remain whether outdoor exercise additionally benefits overall mental and physical well-being. Using cross-sectional data from the Aerobics Center Longitudinal Study, we examined relationships of physical activity environment (PAE) with reported tension, stress, emotional outlook, and health. 11,649 participants were included. 18% exercised indoors, 54% outdoors, and 28% in both. Participants who exercised partially or entirely outdoors exercised more. In fully adjusted models, for women combined PAE was protective for worse emotional outlook (OR: 0.72; 95% CI: 0.52-0.98). Combined PAE was also protective for reported poor health (OR for women: 0.63; 95% CI: 0.44-0.91; OR for men: 0.75; 95% CI: 0.61-0.92). Amount of physical activity modified PAE relationships with outcomes. Combined and outdoor PAE were more consistently protective for worse outcomes among high activity participants. Regardless of PAE, better outcomes were observed in active versus inactive participants. The current study suggests addition of outdoor PAE may be linked with better stress management, outlook and health perceptions for more active populations, whereas indoor PAE may be more important for low active populations. Further research should examine the order of causation and whether type of outdoor PAE (eg, urban, natural) is important.
Impact of working hours on sleep and mental health.
Afonso, P; Fonseca, M; Pires, J F
2017-07-01
The number of hours people are required to work has a pervasive influence on both physical and mental health. Excessive working hours can also negatively affect sleep quality. The impact at work of mental health problems can have serious consequences for individuals' as well as for organizations' productivity. To evaluate differences in sleep quality and anxiety and depression symptoms between longer working hours group (LWHG) and regular working hours group (RWHG). To examine factors influencing weekly working hours, sleep quality and anxiety and depressive symptoms. Participants were divided into two groups, RWHG and LWHG, based on working hours, with a cut-off of 48 h per week. We used the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression symptoms and the Pittsburgh Sleep Quality Index (PSQI) to measure the quality and patterns of sleep. The response rate was 23%. Among the 429 study participants, those in the LWHG group (n = 256, 53%) had significantly more depressive and anxiety symptoms and worse sleep quality than those in RWHG (n = 223, 47%). Working time was significantly positively correlated with higher corporate position and HADS scores. Moreover, HADS scores were positively correlated with PSQI scores and negatively correlated with age. This study suggests that longer working hours are associated with poorer mental health status and increasing levels of anxiety and depression symptoms. There was a positive correlation between these symptoms and sleep disturbances. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com
Putrik, Polina; de Vries, Nanne K; Mujakovic, Suhreta; van Amelsvoort, Ludovic; Kant, Ijmert; Kunst, Anton E; van Oers, Hans; Jansen, Maria
2015-02-01
Characteristics of an individual alone cannot exhaustively explain all the causes of poor health, and neighborhood of residence have been suggested to be one of the factors that contribute to health. However, knowledge about aspects of the neighborhood that are most important to health is limited. The main objective of this study was to explore associations between certain features of neighborhood environment and self-rated health and depressive symptoms in Maastricht (The Netherlands). A large amount of routinely collected neighborhood data were aggregated by means of factor analysis to 18 characteristics of neighborhood social and physical environment. Associations between these characteristics and self-rated health and presence of depressive symptoms were further explored in multilevel logistic regression models adjusted for individual demographic and socio-economic factors. The study sample consisted of 9,879 residents (mean age 55 years, 48 % male). Residents of unsafe communities were less likely to report good health (OR 0.88 95 % CI 0.80-0.97) and depressive symptoms (OR 0.81 95 % CI 0.69-0.97), and less cohesive environment was related to worse self-rated health (OR 0.81 95 % CI 0.72-0.92). Residents of neighborhoods with more car traffic nuisance and more disturbance from railway noise reported worse mental health (OR 0.79 95 % CI 0.68-0.92 and 0.85 95 % CI 0.73-0.99, respectively). We did not observe any association between health and quality of parking and shopping facilities, facilities for public or private transport, neighborhood aesthetics, green space, industrial nuisance, sewerage, neighbor nuisance or satisfaction with police performance. Our findings can be used to support development of integrated health policies targeting broader determinants of health. Improving safety, social cohesion and decreasing traffic nuisance in disadvantaged neighborhoods might be a promising way to improve the health of residents and reduce health inequalities.
Does dental indifference influence the oral health-related quality of life of prisoners?
Marshman, Zoe; Baker, Sarah R; Robinson, Peter G
2014-10-01
Prisoners have worse oral health and greater unmet dental treatment needs than the general population. However, little is known about the impact of the mouth, or attitudes such as dental indifference and consequent patterns of dental service use in this disadvantaged group. The aim was to determine whether dental indifference was associated with the oral health-related quality of life (OHQoL) of prisoners using Andersen's behavioural model of service utilization as the theoretical framework. The sample was male prisoners aged 20-35 years attending three prisons in the north of England. Participants took part in interviews and oral examinations. The variables were selected to populate Andersen's model including: predisposing characteristics (socioeconomic status), enabling resources (dental indifference and dental attendance patterns before prison), perceived need (perceived treatment need, satisfaction with appearance of teeth, global rating of oral health), evaluated need (number of decayed teeth), health behaviours (use of dental services while in prison) and health outcomes (OHQoL). Structural equation modelling was used to estimate direct and indirect pathways between variables. Of the 700 men approached, 659 completed the interview and clinical examination. Worse OHQoL was associated with less dental indifference (i.e. greater interest in oral health), previous regular use of dental services, perceived need for treatment and use of prison dental services. The number of decayed teeth and predisposing factors such as qualifications and employment did not predict OHQoL. Dental indifference was related to the OHQoL of prisoners in addition to previous regular use of dental services, a perceived need for treatment and use of dental services while in prison. Dental services in prisons might incorporate methods to address dental indifference in their attempts to improve oral health. The findings also have general implications for the assessment of population oral
Hsieh, Ning; Ruther, Matt
2016-06-01
Although population studies have documented the poorer health outcomes of sexual minorities, few have taken an intersectionality approach to examine how sexual orientation, gender, and race jointly affect these outcomes. Moreover, little is known about how behavioral risks and healthcare access contribute to health disparities by sexual, gender, and racial identities. Using ordered and binary logistic regression models in 2015, data from the 2013 and 2014 National Health Interview Surveys (n=62,302) were analyzed to study disparities in self-rated health and functional limitation. This study examined how gender and race interact with sexual identity to create health disparities, and how these disparities are attributable to differential exposure to behavioral risks and access to care. Conditional on sociodemographic factors, all sexual, gender, and racial minority groups, except straight white women, gay white men, and bisexual non-white men, reported worse self-rated health than straight white men (pnon-white men, were more likely to report a functional limitation than straight white men (pgender, and racial minority groups. Sexual, gender, and racial identities interact with one another in a complex way to affect health experiences. Efforts to improve sexual minority health should consider heterogeneity in health risks and health outcomes among sexual minorities. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
The effect of special health care needs and health status on school functioning.
Reuben, Cynthia A; Pastor, Patricia N
2013-10-01
Past studies have shown that specific child conditions are associated with poor school outcomes. A national health survey with noncategorical measures of health and indicators of school functioning offers the opportunity to examine this association. To compare links between two health measures (children with special health care needs and general health status) and multiple school outcomes. The analysis was based on 59,440 children aged 6-17 years from the 2007 National Survey of Children's Health. Child health was assessed using the Children with Special Health Care Needs (CSHCN) screener and a question on general health status. CSHCN were classified by the complexity of their health care needs. Indicators of school functioning included special education use, many problem reports, repeated a grade, lack of school engagement, and many missed school days. Overall 22% of children were identified as CSHCN: 13% with more complex needs (C-CSHCN) and 9% with medication use only (CSHCN-RX). Approximately 17% of children were in less than optimal health. After controlling for a child's sociodemographic characteristics C-CSHCN had an increased risk of all of the negative school outcomes compared to children without SHCN, while CSHCN-RX had an increased risk of only one school outcome (many missed school days). Children in less than optimal health were at an increased risk of all negative school outcomes compared to children in optimal health. The CSHCN screener and health status question identify related, but distinct, groups of children with worse outcomes on the indicators of school functioning. Published by Elsevier Inc.
Social capital and self-rated health in Colombia: the good, the bad and the ugly.
Hurtado, David; Kawachi, Ichiro; Sudarsky, John
2011-02-01
Although there is increasing evidence supporting the associations between social capital and health, less is known of potential effects in Latin American countries. Our objective was to examine associations of different components of social capital with self-rated health in Colombia. The study had a cross-sectional design, using data of a survey applied to a nationally representative sample of 3025 respondents, conducted in 2004-2005. Stratified random sampling was performed, based on town size, urban/rural origin, age, and sex. Examined indicators of social capital were interpersonal trust, reciprocity, associational membership, non-electoral political participation, civic activities and volunteering. Principal components analysis including different indicators of social capital distinguished three components: structural-formal (associational membership and non-electoral political participation), structural-informal (civic activities and volunteering) and cognitive (interpersonal trust and reciprocity). Multilevel analyses showed no significant variations of self-rated health at the regional level. After adjusting for sociodemographic covariates, interpersonal trust was statistically significantly associated with lower odds of poor/fair health, as well as the cognitive social capital component. Members of farmers/agricultural or gender-related groups had higher odds of poor/fair health, respectively. Excluding these groups, however, associational membership was associated with lower odds of poor/fair health. Likewise, in Colombians with educational attainment higher than high school, reciprocity was associated with lower odds of fair/poor health. Nevertheless, among rural respondents non-electoral political participation was associated with worse health. In conclusion, cognitive social capital and associational membership were related to better health, and could represent important notions for health promotion. Human rights violations related to political violence
Esan, Oluwaseun T; Fatusi, Adesegun O
2014-06-01
The study aimed to determine performance and compare gaps in maternal and newborn health (MNH) services in urban and rural areas of Osun State, Nigeria, to inform decisions for improved services. This study involved 14 urban and 10 rural-based randomly selected PHC facilities. Using a Performance Needs Assessment framework, desired performances were determined by key stakeholders and actual performances measured by conducting facility survey. Questionnaire interview of 143 health workers and 153 antenatal clients were done. Performance gaps were determined for the urban and rural areas and compared using Chi-square tests with SPSS version 17. PHC facilities and health workers in Osun State, Nigeria, were found to have significant gaps in MNH service performance and this was worse in the rural areas. Root cause of most of the performance gaps was poor political will of local government authorities. Improved government commitment to MNH is needful to address most of the gaps.
Kim, Sook-Young; Sok, Sohyune R
2012-08-01
The objective of this study was to examine the perceived health status, family support and life satisfaction of older Korean adults and the relationships among them. This study was designed to be a descriptive correlation study using questionnaire. Subjects were 246 older people who were over 65 years of age in Seoul and Daegu metropolitan city, Korea. Measures were the Cornell Medical Index-Simple Korean Form to measure the perceived health status, the Family Support Instrument to measure the family support and the Standard Life Satisfaction Instrument for Korean people to measure the life satisfaction. Perceived health state was worse as average 3.3, family support was good as average 3.4 and life satisfaction was low as average 3.1. There were statistically significant positive correlations among perceived health state, family support and life satisfaction and between family support and life satisfaction. The predictors of life satisfaction in elderly were family support, age, monthly allowance and perceived health state. These factors explained 37.5% of the total variance. The major influencing factor was family support. This cross-sectional study provides preliminary evidence that to develop nursing strategy to increase family support of older Korean adults is needed. © 2012 Blackwell Publishing Asia Pty Ltd.
The causal effect of multitasking on work-related mental health: The more you do, the worse you feel
Pikos, Anna Katharina
2017-01-01
This paper analyses whether there is a causal relationship between work-related mental health problems and multitasking, the number of tasks performed at work. The data comes from two cross sectional surveys on the German working population. The empirical strategies uses technological change as an instrument for multitasking. In the first stage, the introduction of new production and information technologies is associated with increases in multitasking. Production technology adoption has larg...
Does the Perception that Stress Affects Health Matter? The Association with Health and Mortality
Keller, Abiola; Litzelman, Kristin; Wisk, Lauren E.; Maddox, Torsheika; Cheng, Erika Rose; Creswell, Paul D.; Witt, Whitney P.
2012-01-01
Objective This study sought to examine the relationship among the amount of stress, the perception that stress affects health, and health and mortality outcomes in a nationally-representative sample of U.S. adults. Methods Data from the 1998 National Health Interview Survey were linked to prospective National Death Index mortality data through 2006. Separate logistic regression models were used to examine the factors associated with current health status and psychological distress. Cox proportional hazard models were used to determine the impact of perceiving that stress affects health on all-cause mortality. Each model specifically examined the interaction between the amount of stress and the perception that stress affects health, controlling for sociodemographic, health behavior, and access to healthcare factors. Results 33.7% of nearly 186 million (n=28,753) U.S. adults perceived that stress affected their health a lot or to some extent. Both higher levels of reported stress and the perception that stress affects health were independently associated with an increased likelihood of worse health and mental health outcomes. The amount of stress and the perception that stress affects health interacted such that those who reported a lot of stress and that stress impacted their health a lot had a 43% increased risk of premature death (HR = 1.43, 95% CI [1.20, 1.71]). Conclusions High amounts of stress and the perception that stress impacts health are each associated with poor health and mental health. Individuals who perceived that stress affects their health and reported a large amount of stress had an increased risk of premature death. PMID:22201278
Nakash, Ora; Nagar, Maayan; Shoshani, Anat; Zubida, Hani; Harper, Robin A
2012-07-01
This study examines the role of acculturation, perceived discrimination, and self-esteem in predicting the mental health symptoms and risk behaviors among 1.5 and second generation non-Jewish adolescents born to migrant families compared with native-born Jewish Israeli adolescents in Israel. Participants included n = 65 1.5 migrant adolescents, n = 60 second generation migrant adolescents, and n = 146 age, gender, and socioeconomic matched sample of native-born Jewish Israelis. Participants completed measures of acculturation pattern, perceived discrimination, and self-esteem as well as measures of mental health symptoms and risk behaviors. Results show that migrant adolescents across generations reported worse mental health symptoms compared with native-born Jewish Israelis. However, only the 1.5 generation migrants reported higher engagement in risk behaviors compared with second generation migrants and native-born Jewish Israelis. Our findings further showed that acculturation plays an important role in predicting the mental health status of migrant youth, with those characterized with integrated acculturative pattern reporting lower mental health symptoms compared with assimilated acculturation pattern. Importantly, contextual factors, such as higher perception of discrimination in the receiving culture as well as individual factors such as lower self-esteem and female gender were strongly associated with worse mental health symptoms. The findings manifest the complex relationship between contextual factors and individual level variables in the acculturative process of migrants as well as the importance of examining the effect of migration generation on mental health outcomes.
Vázquez, María Luisa; Vargas, Ingrid; Aller, Marta-Beatriz
2014-06-01
Despite the economic crisis, the immigrant population of Spain continues to be high, with 5.7 million persons (11.4%). This population, whose health needs are similar to those of the general population, is more vulnerable due to their exposure to worse social determinants (living and working conditions together with a higher risk of exclusion from social services). In this article, we analyze how the economic crisis affects or can affect the health of the immigrant population in Spain by examining distinct population-specific or institutional factors that influence the effects of the crisis and the available data. The available evidence is limited, but several effects can be identified: firstly, some social determinants, such as higher unemployment rates and worse working conditions, have deteriorated, which can be expected to lead to a worsening of health status. These consequences have already been described for mental health or have been estimated for infectious diseases. Secondly, political decisions have had a direct impact, excluding-with some exceptions-undocumented immigrants from the right to health care. Finally, the lower priority given to adapting health services to the specific characteristics of the immigrant population (most of whom are documented) together with the introduction of new barriers, has hampered or will hamper access to health care. As a result, the economic crisis can be expected to have a greater impact on the immigrant population. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.
Sellers, Sherrill; Cherepanav, Dasha; Hanmer, Janel; Fryback, Dennis G; Palta, Mari
2013-08-01
We assessed associations between discrimination and health-related quality of life among black and white men and women in the United States. We examined data from the National Health Measurement Study, a nationally representative sample of 3,648 adults aged 35-89 in the non-institutionalized US population. These data include self-reported lifetime and everyday discrimination as well as several health utility indexes (EQ-5D, HUI3, and SF-6D). Multiple regression was used to compute mean health utility scores adjusted for age, income, education, and chronic diseases for each race-by-gender subgroup. Black men and women reported more discrimination compared to white men and women. Health utility tended to be worse as reported discrimination increased. With a few exceptions, differences between mean health utility scores in the lowest and highest discrimination groups exceeded the 0.03 difference generally considered to be a clinically significant difference. Persons who experienced discrimination tended to score lower on health utility measures. The study also revealed a complex relationship between experiences of discrimination and race and gender. Because of these differential social and demographic relationships caution is urged when interpreting self-rated health measures in research, clinical, and policy settings.
Witt, Whitney P; Litzelman, Kristin; Spear, Hilary A; Wisk, Lauren E; Levin, Nataliya; McManus, Beth M; Palta, Mari
2012-11-01
This study aimed to determine the health-related quality of life (HRQoL) in mothers of 5-year-old very low birth weight (VLBW) and normal birth weight (NBW) children, with a focus on the role of stress. This cohort study is ancillary to the Newborn Lung Project. A telephone interview collected information on symptoms of stress and HRQoL from 297 mothers of VLBW children and 290 mothers of NBW children who were enrolled in the Newborn Lung Project Statewide Cohort Study. Staged multiple regression analyses were used to evaluate the relationship between caregiver status and maternal HRQoL and the role stress played in this relationship. Additional multiple regression analyses were also used to evaluate the correlates of poor maternal HRQoL among VLBW mothers. Mothers of VLBW children experienced worse physical and mental HRQoL than mothers of NBW children. Adjusted analyses showed that physical HRQoL was significantly different between these mothers (β: -1.87, P = 0.001); this relationship was attenuated by maternal stress. Among the mothers of VLBW children, stress significantly contributed to adverse HRQoL outcomes when children were aged five. Child behavior problems at the age of two were also associated with worse subsequent maternal mental HRQoL (β: -0.18, P = 0.004), while each week of neonatal intensive care unit stay was associated with worse physical HRQoL (β: -0.26, P = 0.02). Caring for a VLBW child is negatively associated with the HRQoL of mothers; this relationship might be, in part, explained by maternal stress. Addressing maternal stress may be an important way to improve long-term HRQoL.
McInerney, Melissa; Mellor, Jennifer M
2012-09-01
A number of studies report that U.S. state mortality rates, particularly for the elderly, decline during economic downturns. Further, several prior studies use microdata to show that as state unemployment rates rise, physical health improves, unhealthy behaviors decrease, and medical care use declines. We use data on elderly mortality rates and data from the Medicare Current Beneficiary Survey from a time period that encompasses the start of the Great Recession. We find that elderly mortality is countercyclical during most of the 1994-2008 period. Further, as unemployment rates rise, seniors report worse mental health and are no more likely to engage in healthier behaviors. We find suggestive evidence that inpatient utilization increases perhaps because of an increased physician willingness to accept Medicare patients. Our findings suggest that either elderly individuals respond differently to recessions than do working age adults, or that the relationship between unemployment and health has changed. Copyright © 2012 Elsevier B.V. All rights reserved.
Mantel, Hendrik T J; Wiggers, Jim K; Verheij, Joanne; Doff, Jan J; Sieders, Egbert; van Gulik, Thomas M; Gouw, Annette S H; Porte, Robert J
2015-12-01
Lymph node metastases on routine histology are a strong negative predictor for survival after resection of hilar cholangiocarcinoma. Additional immunohistochemistry can detect lymph node micrometastases in patients who are otherwise node negative, but the prognostic value is unsure. The objective of this study was to assess the effect on survival of immunohistochemically detected lymph node micrometastases in patients with node-negative (pN0) hilar cholangiocarcinoma on routine histology. Between 1990 and 2010, a total of 146 patients underwent curative-intent resection of hilar cholangiocarcinoma with regional lymphadenectomy at two university medical centers in the Netherlands. Ninety-one patients (62 %) without lymph node metastases at routine histology were included. Micrometastases were identified by multiple sectioning of all lymph nodes and additional immunostaining with an antibody against cytokeratin 19 (K19). The association with overall survival was assessed in univariable and multivariable analysis. Median follow-up was 48 months. Micrometastases were identified in 16 (5 %) of 324 lymph nodes, corresponding to 11 (12 %) of 91 patients. There were no differences in clinical variables between K19 lymph node-positive and -negative patients. Five-year survival rates in patients with lymph node micrometastases were significantly lower compared to patients without micrometastases (27 vs. 54 %, P = 0.01). Multivariable analysis confirmed micrometastases as an independent prognostic factor for survival (adjusted Hazard ratio 2.4, P = 0.02). Lymph node micrometastases are associated with worse survival after resection of hilar cholangiocarcinoma. Immunohistochemical detection of lymph node micrometastases leads to better staging of patients who were initially diagnosed with node-negative (pN0) hilar cholangiocarcinoma on routine histology.
Battaglia, Marco; Garon-Carrier, Gabrielle; Côté, Sylvana M; Dionne, Ginette; Touchette, Evelyne; Vitaro, Frank; Tremblay, Richard E; Boivin, Michel
2017-10-01
Separation anxiety disorder is the most prevalent childhood anxiety condition, but no study assessed children for separation anxiety at preschool age and followed them longitudinally and directly until mid-childhood/early adolescence. Multi-informant (children, teachers, family), multipoint (at age 8, 10, 12, 13) assessments of 1,290 children of the Quebec Longitudinal Study of Child Development, who had been categorized between age 1.5 and 6 into four specific separation anxiety trajectories (1, low-persistent; 2, low-increasing; 3, high-decreasing, and the less common: 4, high-increasing) by growth mixture modeling. Participants in the high-increasing trajectory were compared to participants in the other three trajectories for: (a) child's internalizing and externalizing problem behavior; (b) physical health; (c) academic achievement; (d) maternal anxiety. Multivariate analyses of variance/covariance at separate time points showed the high-increasing trajectory mostly associated with: (a) higher internalizing, but not externalizing, behavior; (b) worse academic achievement (most consistently by comparisons to the normative low-persistent trajectory; (c) higher rates of maternal panic/agoraphobic anxiety; (d) worse physical health (most consistently by comparisons to the low-persistent trajectory). The high-increasing trajectory had twofold to threefold higher incidences of physical illnesses than the normative low-persistent group; this was specific for headaches at age 12 years, chronic asthma at age 10 and 13, and having received asthma-related medication during the past 12 months. High-increasing separation anxiety in preschool maintains longitudinal relationships to independent health and academic outcomes, at least until preadolescence. This knowledge can inform the deployment of clinical resources at the earlier signs of the more impairing manifestations. © 2017 Wiley Periodicals, Inc.
Prazeres, Filipe; Santiago, Luiz
2016-11-11
Multimorbidity has a high prevalence in the primary care context and it is frequently associated with worse health-related quality of life (HRQoL). Few studies evaluated the variables that could have a potential effect on HRQoL of primary care patients with multimorbidity. The purpose of this study, the first of its kind ever undertaken in Portugal, is to analyse the relationship between multimorbidity, health-related quality of life, perceived family support and unmet health needs in adult patients attending primary care. Multicentre, cross-sectional survey conducted among primary care patients with multimorbidity. It included 521 participants (64.1 % females) who met the inclusion criteria. HRQoL was evaluated using the Portuguese Short Form-12 Health Status Questionnaire. The Portuguese Family APGAR was used to measure the perceived family support. A patients' unmet health needs questionnaire was used. The unmet needs for medical, surgical and dental care; prescription medications; mental healthcare or counselling; and eyeglasses or other technical aid was assessed. Descriptive and multivariate analyses were performed. The sample had an overall average of 4.5 chronic health problems. Increased multimorbidity levels were linked to worse health-related quality of life, particularly the physical health. Some variables were confirmed as playing a role on health-related quality of life. Male patients with high monthly incomes and highly functional families had better physical and mental health. High levels of education and the presence of asthma were also associated with better physical health. Contrariwise, elderly patients with high levels of multimorbidity and with osteoarthritis had lower physical health. The majority of the patients did not have unmet health needs. When health needs were stated they were mostly for generalist medical care, dental care, and eyeglasses/other technical aid. Financial insufficiency was the primary reason for not fulfilling their
Racial differences in health-related quality of life and functional ability in patients with gout.
Singh, Jasvinder A; Bharat, Aseem; Khanna, Dinesh; Aquino-Beaton, Cleopatra; Persselin, Jay E; Duffy, Erin; Elashoff, David; Khanna, Puja P
2017-01-01
To compare the health-related quality of life (HRQOL) and the functional ability by race in patients with gout. In a 9-month prospective cohort multicentre study, patients with gout self-reported race, dichotomized as Caucasian or African American (others excluded). We calculated HRQOL/function scores adjusted for age, study site and college education for Short Form-36 (SF-36; generic HRQOL), Gout Impact Scale (GIS; disease-specific HRQOL) and HAQ-disability index (HAQ-DI; functional ability). Longitudinally adjusted scores were computed using multivariable mixed-effect regression models with a random patient effect and fixed sequential visit effect (3-monthly visits). Compared with Caucasians (n = 107), African Americans (n = 60) with gout were younger (61.1 vs 67.3 years) and had higher median baseline serum urate (9.0 vs 7.9 mg/dl) (P gout had worse HRQOL scores on three SF-36 domains, the mental component summary (MCS) and two of the five GIS scales than Caucasians [mean (se); P ⩽ 0.02 for all]: SF-36 mental health, 39.7 (1.1) vs 45.2 (0.9); SF-36 role emotional, 42.1 (4.2) vs 51.4 (4.2); SF-36 social functioning, 36.0 (1.1) vs 40.0 (0.9) (P = 0.04); SF-36 MCS, 43.2 (3.1) vs 50.0 (3.2); GIS unmet treatment need, 37.6 (1.6) vs 31.5 (1.4); and GIS concern during attacks, 53.3 (3.7) vs 47.4 (3.7). Differences between the respective HAQ-DI total scores were not statistically significant; 0.98 (0.1) vs 0.80 (1.0) (P = 0.11). Racial differences in SF-36 mental health, role emotional and MCS scales exceeded, and for HAQ-DI approached, the minimal clinically important difference thresholds. African Americans with gout have significantly worse HRQOL compared with Caucasians. Further research is necessary in the form of studies targeted at African Americans on how best to improve these outcomes. Published by Oxford University Press on behalf of the British Society for Rheumatology 2016. This work is written by US Government employees and is in the public domain in the
Directory of Open Access Journals (Sweden)
Bíró Éva
2011-11-01
Full Text Available Abstract Background Future public health professionals are especially important among students partly because their credibility in light of their professional messages and activities will be tested daily by their clients; and partly because health professionals' own lifestyle habits influence their attitudes and professional activities. A better understanding of public health students' health and its determinants is necessary for improving counselling services and tailoring them to demand. Our aim was to survey public health students' health status and behaviour with a focus on mental health. Methods A cross-sectional study was carried out among public health students at 1-5-years (N = 194 with a self-administered questionnaire that included standardized items on demographic data, mental wellbeing characterized by sense of coherence (SoC and psychological morbidity, as well as health behaviour and social support. Correlations between social support and the variables for mental health, health status and health behaviour were characterized by pairwise correlation. Results The response rate was 75% and represented students by study year, sex and age in the Faculty. Nearly half of the students were non-smokers, more than one quarter smoked daily. Almost one-fifth of the students suffered from notable psychological distress. The proportion of these students decreased from year 1 to 5. The mean score for SoC was 60.1 and showed an increasing trend during the academic years. 29% of the students lacked social support from their student peers. Significant positive correlation was revealed between social support and variables for mental health. Psychological distress was greater among female public health students than in the same age female group of the general population; whereas the lack of social support was a more prevalent problem among male students. Conclusions Health status and behaviour of public health students is similar to their non
Schluter, Philip J; Kanagaratnam, Sathananthan; Taylor, Steve; Tautolo, El-Shadan
2017-06-01
Immigration and acculturation are increasingly recognized as important explanatory factors for health disparities, although their impact on oral health is less well understood. This study investigates the relationship between Pacific children's cultural orientation and oral health, after adjusting for potentially moderating and confounding variables. The Pacific Islands Families (PIF) study follows a cohort of Pacific infants born in 2000. PIF study participants' data from their last dental examination were extracted from service records, and matched to the cohort. A bi-directional acculturation classification, derived from maternal reports, was related to children's oral health indices in crude and adjusted analyses. 1,376 children were eligible, of whom 922 (67.0 percent) had mothers born outside New Zealand. Matching was successful for 970 (70.5 percent) children, with mean age 12.2 years (range: 6.8, 15.4 years). Significant differences were found between acculturation groups for children's tooth brushing frequency and school dental service enrollments but these differences did not moderate relationships between acculturation and oral health status. Unmet treatment need was significantly different between acculturation groups, with children of mothers having higher Pacific orientation having worse unmet needs than those with lower Pacific orientation. No other significant differences were noted. Pacific children carry a disproportionate oral health burden, particularly amongst those with mothers more aligned to their Pacific culture. Strategies which enable Pacific people to re-shape their oral health understanding, together with reducing barriers to accessing dental health care, are needed to prevent a legacy of poor oral health in Pacific people within New Zealand. © 2017 American Association of Public Health Dentistry.
Calvo, Adriana Maria; Trindade-Suedam, Ivy Kiemle; da Silva Filho, Omar Gabriel; Carvalho, Roberta Martineli; de Souza Faco, Renato André; Ozawa, Terumi Okada; Cintra, Flávia; Trindade, Alceu Sergio; Trindade, Inge Elly Kiemle
2014-03-01
This prospective study aimed at evaluating the surgical outcomes of alveolar bone grafting (ABG) in subjects with bilateral cleft lip and palate treated at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil, by means of cone-beam computed tomography. Twenty-five patients with bilateral complete cleft lip and palate, resulting in 50 clefts, were analyzed. Subjects were divided into 2 groups according to the dentition status at the time of surgery: (1) SABG group: subjects with mixed dentition operated on before or immediately after eruption of the permanent canine (10-13 years); (2) TABG group: subjects with permanent dentition (15-23 years). Cone-beam computed tomography analysis was performed in the buccal, intermediate, and palatal views, 2 and 6 to 12 months postoperatively. In the SABG group, 96% of the grafts were classified as successful, and no failure cases were observed. In the TABG group, successful cases decreased to 65%, and failures were seen in 27% of the cleft sites. In both postoperative periods, significantly better outcomes (lower mean scores) were observed for the SABG group in all the cone-beam computed tomography views (P < 0.05). Results show that the timing of surgery is an important factor in determining the outcomes of ABG in patients with bilateral cleft lip and palate, with increasing age being associated with the worse outcomes.
Health and health care of employed women and homemakers: family factors.
Muller, C
1986-01-01
Women's increasing participation in the labor force has resulted from availability of fertility control, changed attitudes toward family size, a strong demand for occupations traditionally filled by women, and other factors. Despite many social changes, employed women continue to be concentrated in lower-income pursuits and frequently have major responsibility for the household. This paper is drawn from a study that explored the association of occupation and home responsibilities with the health of employed women and men and compared them with female homemakers. It also examined variations in the use of physician and hospital services. The principal data source was the National Health Interview Survey tapes for 1975-77. Nurturant role responsibilities were derived from records of members of the index adult's household. This paper reports on comparisons of employed women with homemakers using multiple regression analysis, and also on direct comparisons of the three work-sex groups. Study findings suggest that better health is associated with desired, positive roles such as marriage and married parenthood. Worse health is associated with unwelcome role expansions such as single parenthood, child disability, having a sick spouse and marital dissolution. Effects vary by both sex and work status. It is suggested that it is not the number of activities that may be burdensome to women's health but inability to choose one's roles and organize one's resources to meet their demands.
Lorenzo-Blanco, Elma I; Meca, Alan; Unger, Jennifer B; Romero, Andrea; Gonzales-Backen, Melinda; Piña-Watson, Brandy; Cano, Miguel Ángel; Zamboanga, Byron L; Des Rosiers, Sabrina E; Soto, Daniel W; Villamar, Juan A; Lizzi, Karina M; Pattarroyo, Monica; Schwartz, Seth J
2016-12-01
Latino parents can experience acculturation stressors, and according to the Family Stress Model (FSM), parent stress can influence youth mental health and substance use by negatively affecting family functioning. To understand how acculturation stressors come together and unfold over time to influence youth mental health and substance use outcomes, the current study investigated the trajectory of a latent parent acculturation stress factor and its influence on youth mental health and substance use via parent-and youth-reported family functioning. Data came from a 6-wave, school-based survey with 302 recent (stress loaded onto a latent factor of acculturation stress at each of the first 4 time points. Earlier levels of and increases in parent acculturation stress predicted worse youth-reported family functioning. Additionally, earlier levels of parent acculturation stress predicted worse parent-reported family functioning and increases in parent acculturation stress predicted better parent-reported family functioning. While youth-reported positive family functioning predicted higher self-esteem, lower symptoms of depression, and lower aggressive and rule-breaking behavior in youth, parent-reported family positive functioning predicted lower youth alcohol and cigarette use. Findings highlight the need for Latino youth preventive interventions to target parent acculturation stress and family functioning. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Tachibana, Takayoshi; Andou, Taiki; Tanaka, Masatsugu; Ito, Satomi; Miyazaki, Takuya; Ishii, Yoshimi; Ogusa, Eriko; Koharazawa, Hideyuki; Takahashi, Hiroyuki; Motohashi, Kenji; Aoki, Jun; Nakajima, Yuki; Matsumoto, Kenji; Hagihara, Maki; Hashimoto, Chizuko; Taguchi, Jun; Fujimaki, Katsumichi; Fujita, Hiroyuki; Fujisawa, Shin; Kanamori, Heiwa; Nakajima, Hideaki
2018-06-01
A multicenter retrospective analysis was performed to evaluate the clinical significance of serum ferritin at diagnosis in patients with acute myeloid leukemia (AML). The study cohort included 305 patients who were newly diagnosed with AML from 2000 to 2015 and received standard induction chemotherapy. Transplantation was performed in 168 patients. The median ferritin value was 512 ng/mL (range, 8-9475 ng/mL). Ferritin correlated with lactate dehydrogenase, C-reactive protein, white blood cell count, and blast count, and elevation of ferritin was associated with poor performance status. The median follow-up period was 58 months (range, 4-187 months) among survivors. The high ferritin group (≥ 400 ng/mL) demonstrated inferior event-free survival (EFS) at the 5-year interval (30% vs. 40%; P = .033) compared to the low ferritin group. Multivariate analysis in the high-risk karyotype revealed that high ferritin levels predicted worse EFS (hazard ratio = 2.07; 95% confidence interval, 1.28-3.33; P = .003). Elevated ferritin at diagnosis may indicate tumor burden in patients with AML and predict worse EFS in the high-risk group. Copyright © 2018 Elsevier Inc. All rights reserved.
Risky sexual behaviors, mental health, and history of childhood abuse among adolescents.
Tsutsumi, Atsuro; Izutsu, Takashi; Matsumoto, Toshihiko
2012-03-01
Although it seems evident that attention should be paid to risky sexual behaviors and their association with mental health among young people, this topic has not been thoroughly investigated. The present study aims to explore the relationship between sexual risk behaviors and mental health among adolescents. The participants were 251 adolescents in a juvenile detention facility (221 males and 31 females) as the "delinquent" group and 367 high school students (167 males and 200 females) as the "non-delinquent" group. A questionnaire including the Kessler 10, the Impact of Event Scale-Revised, and the Adolescent Dissociative Experience Scale was employed to measure mental health status as well as sexual risk behaviors, suicidal ideation/attempts, and abuse history. Having a history of sexual abuse or of physical abuse was associated with age when one first had sex among males with delinquent behaviors, while same tendency was observed among males without delinquent behaviors. Among the female with delinquent behaviors group, past abuse history was significantly associated with higher number of sex partners. In the non-delinquent group, better mental health among males and, contrarily, worse mental health among females were associated with having more sex partners. The results highlight the importance of addressing abuse history among females and males. Given that poor mental health status in the adolescents was associated with risky sexual behaviors, adolescents are a vulnerable group that requires attention in terms of sexual and reproductive health that integrates mental health and psychosocial components. Copyright © 2011 Elsevier B.V. All rights reserved.
Long, Qian; Xu, Ling; Bekedam, Henk; Tang, Shenglan
2013-06-13
China's health system reform launched in early 2000s has achieved better coverage of health insurance and significantly increased the use of healthcare for vast majority of Chinese population. This study was to examine changes in the structure of total health expenditures in China in 2000-2011, and to investigate the financial burden of healthcare placed on its population, particularly between urban and rural areas and across different socio-economic development regions. Health expenditures data came from the China National Health Accounts study in 1990-2011, and other data used to calculate the financial burden of healthcare were from China Statistical Yearbook and China Population Statistical Yearbook. Total health expenditures were divided into government and social expenditure, and out-of-pocket payment. The financial burden of healthcare was estimated as out-of-pocket payment per capita as a percentage of annual household living consumption expenditure per capita. Between 2000 and 2011, total health expenditures in China increased from Chinese yuan 319 to 1888 (United States dollars 51 to 305), with average annual increase of 17.4%. Government and social health expenditure increased rapidly being 22.9% and 18.8% of average annual growth rate, respectively. The share of out-of-pocket payment in total health expenditure for the urban population declined from 53% in 2005 to 36% in 2011, but had only a slight decrease for the rural population from 53% to 50%. Out-of-pocket payment, as a percentage of annual household living consumption, has continued to rise, particularly in the rural population from the less developed region (6.1% in 2000 to 8.8% in 2011). The rapid increase of public funding to subsidize health insurance in China, as part of the reform strategy, did not mitigate the out-of-pocket payment for healthcare over the past decade. Financial burden of healthcare on the rural population increased. Affordability among the rural households with sick
Jim, Heather S L; Small, Brent J; Minton, Susan; Andrykowski, Michael; Jacobsen, Paul B
2012-06-01
Data are scarce about whether past history of major depressive disorder in the absence of current depression places breast cancer patients at risk for worse quality of life. The current study prospectively examined quality of life during chemotherapy in breast cancer patients with a history of resolved major depressive disorder (n = 29) and no history of depression (n = 144). Women with Stages 0-II breast cancer were assessed prior to and at the completion of chemotherapy. Major depressive disorder was assessed via structured interview and quality of life with the SF-36. Patients with past major depressive disorder displayed greater declines in physical functioning relative to patients with no history of depression (p ≤ 0.01). Findings suggest that breast cancer patients with a history of resolved major depressive disorder are at increased risk for declines in physical functioning during chemotherapy relative to patients with no history of depression.
Tucker, Phebe; Jeon-Slaughter, Haekyung; Sener, Ugur; Arvidson, Megan; Khalafian, Andrey
2015-01-01
We explored the theory that measures of medical students' well-being and stress from different types of preclinical curricula are linked with performance on standardized assessment. Self-reported stress and quality of life among sophomore medical students having different types of preclinical curricula will vary in their relationships to USMLE Step 1 scores. Voluntary surveys in 2010 and 2011 compared self-reported stress, physical and mental health, and quality of life with Step 1 scores for beginning sophomore students in the final year of a traditional, discipline-based curriculum and the 1st year of a revised, systems-based curriculum with changed grading system. Wilcoxon rank sum tests and Spearman rank correlations were used to analyze data, significant at p students reported worse physical health, subjective feelings, leisure activities, social relationships and morale, and more depressive symptoms and life stress than traditional curriculum students. However, among curriculum-related stressors, few differences emerged; revised curriculum sophomores reported less stress working with real and standardized patients than traditional students. There were no class differences in respondents' Step 1 scores. Among emotional and physical health measures, only feelings of morale correlated negatively with Step 1 performance. Revised curriculum students' Step 1 scores correlated negatively with stress from difficulty of coursework. Although revised curriculum students reported worse quality of life, general stress, and health and less stress from patient interactions than traditional students, few measures were associated with performance differences on Step 1. Moreover, curriculum type did not appear to either hinder or help students' Step 1 performance. To identify and help students at risk for academic problems, future assessments of correlates of Step 1 performance should be repeated after the new curriculum is well established, relating them also to performance
Improving reproductive health in rural China through participatory planning.
Kaufman, Joan; Liu, Yunguo; Fang, Jing
2012-01-01
China's new health reform initiative aims to provide quality accessible health care to all, including remote rural populations, by 2020. Public health insurance coverage for the rural poor has increased, but rural women have fared worse because of lower status and lack of voice in shaping the services they need. Use of prenatal care, safe delivery and reproductive tract infections (RTIs) services is inadequate and service seeking for health problems remains lower for men. We present findings from a study of gender and health equity in rural China from 2002 to 2008 and offer recommendations from over a decade of applied research on reproductive health in rural China. Three studies, conducted in poor counties between 1994 and 2008, identified problems in access and pilot tested interventions and mechanisms to increase women's participation in health planning. They were done in conjunction with a World Bank programme and the global Gender and Health Equity Network (GHEN). Reproductive health service-seeking improved and the study interventions increased local government commitment to providing such services through new health insurance mechanisms. Findings from the studies were summarised into recommendations on gender and health for inclusion in new health reform efforts.
The effect of perceived discrimination on the health of immigrant workers in Spain.
Agudelo-Suárez, Andrés A; Ronda-Pérez, Elena; Gil-González, Diana; Vives-Cases, Carmen; García, Ana M; Ruiz-Frutos, Carlos; Felt, Emily; Benavides, Fernando G
2011-08-17
Discrimination is an important determinant of health inequalities, and immigrants may be more vulnerable to certain types of discrimination than the native-born. This study analyses the relationship between immigrants' perceived discrimination and various self-reported health indicators. A cross-sectional survey was conducted (2008) amongst a non-random sample of 2434 immigrants from Ecuador, Morocco, Romania and Colombia in four Spanish cities: Barcelona, Huelva, Madrid and Valencia. A factorial analysis of variables revealed three dimensions of perceived discrimination (due to immigrant status, due to physical appearance, and workplace-related). The association of these dimensions with self-rated health, mental health (GHQ-12), change in self-rated health between origin and host country, and other self-reported health outcomes was analysed. Logistic regression was used adjusting for potential confounders (aOR-95%CI). Subjects with worsening self-reported health status potentially attributable to perceived discrimination was estimated (population attributable proportion, PAP %). 73.3% of men and 69.3% of women immigrants reported discrimination due to immigrant status. Moroccans showed the highest prevalence of perceived discrimination. Immigrants reporting discrimination were at significantly higher risk of reporting health problems than those not reporting discrimination. Workplace-related discrimination was associated with poor mental health (aOR 2.97 95%CI 2.45-3.60), and the worsening of self-rated health (aOR 2.20 95%CI 1.73- 2.80). 40% (95% CI 24-53) PAP of those reporting worse self-rated health could be attributable to discrimination due to immigrant status. Discrimination may constitute a risk factor for health in immigrant workers in Spain and could explain some health inequalities among immigrant populations in Spanish society.
Hall, Martin; Christian, Bradley
2017-10-01
Despite the best efforts and commitment of oral health programs, there is no evidence that the current surgical output-based model of oral health care is delivering better oral health outcomes to the community. In fact, Australian evidence indicates the oral health of the community could be getting worse. It is now well-understood that this traditional surgical model of oral health care will never successfully manage the disease itself. It is proposed that a health-promoting, minimally invasive oral disease management model of care may lead to a sustainable benefit to the oral health status of the individual and community groups. The aim of this paper is to describe such a model of oral health care (MoC) currently being implemented by the North Richmond Community Health Oral Health (NRCH-OH) program in Melbourne, Victoria, Australia; this model may serve as a template for other services to re-orient their healthcare delivery towards health promotion and prevention. The paper describes the guiding principles and theories for the model and also its operational components, which are: pre-engagement while on the waitlist; client engagement at the reception area; the assessment phase; oral health education (high-risk clients only); disease management; and reviews and recall.
Kampeerawipakorn, Ormrat; Navasumrit, Panida; Settachan, Daam; Promvijit, Jeerawan; Hunsonti, Potchanee; Parnlob, Varabhorn; Nakngam, Netnapa; Choonvisase, Suppachai; Chotikapukana, Passaornrawan; Chanchaeamsai, Samroeng; Ruchirawat, Mathuros
2017-01-01
Emissions from petrochemical industries may contain toxic and carcinogenic compounds that can pose health risk to human populations. The scenario may be worse in developing countries where management of such exposure-health problems is typically not well-implemented and the public may not be well-informed about such health risk. In Thailand, increasing incidences of respiratory diseases and cancers have been reported for the population around a major petrochemical complex, the Map Ta Phut Industrial Estate (MTPIE). This study aimed to systematically investigate an exposure-health risk among these populations. One-hundred and twelve healthy residents living nearby MTPIE and 50 controls located approximately 40km from MTPIE were recruited. Both external and internal exposure doses to benzene and 1,3-butadiene, known to be associated with the types of cancer that are of concern, were measured because they represent exposure to industrial and/or traffic-related emissions. Health risk was assessed using the biomarkers of early biological effects for cancer and inflammatory responses, as well as biomarkers of exposure for benzene and 1,3-butadiene. The exposure levels of benzene and 1,3-butadiene were similar for both the exposed and control groups. This was confirmed by a non-significant difference in the levels of specific urinary metabolites for benzene (trans,trans-muconic acid, t,t-MA) and 1,3-butadiene (monohydroxy-butyl mercapturic acid, MHBMA). Levels of 8-hydroxydeoxyguanosine (8-OHdG) and DNA strand breaks between the two groups were not statistically significantly different. However, functional biomarkers, interleukin-8 (IL-8) expression was significantly higher (pindustrial complex could be causing these functional abnormalities. Copyright © 2016 Elsevier Inc. All rights reserved.
College student mental health and quality of workplace relationships.
Vaughn, Allison A; Drake, Richard R; Haydock, Sarah
2016-01-01
The goal of this study was to examine the effect of quality of workplace relationships on the mental health of employed undergraduates, with work-related variables as a potential mechanism. Participants were 170 employed students (76% female, average age = 19.9) recruited in March 2011. Most worked part-time and had been at their jobs over a year. Students were recruited from an undergraduate introductory psychology course and completed online surveys about the quality of workplace relationships, mental health (ie, somatic stress symptoms, depression, anxiety, and life satisfaction), and work-related variables (ie, job satisfaction, support, turnover and burnout). Students who reported having workplace relationships with co-occurring positivity and negativity had worse self-reported mental health outcomes than students reporting having wholly positive relationships. The relationship between workplace relationship quality and mental health was mediated by negative work-related variables. Workplace relationships-even in part-time employment settings-influence college students' mental health.
Fourquet, Jessica; Báez, Lorna; Figueroa, Michelle; Iriarte, R Iván; Flores, Idhaliz
2011-07-01
To quantify the impact of endometriosis-related symptoms on physical and mental health status, health-related quality of life, and work-related aspects (absenteeism, presenteeism, work productivity, and activity impairment). Cross-sectional quantitative study. Academic and research institution. Women (n = 193) with self-reported surgically diagnosed endometriosis from the Endometriosis Patient Registry at Ponce School of Medicine and Health Sciences (PSMHS). Anonymous questionnaire divided into three sections consisting of questions from the Patient Health Survey (SF-12), the Endometriosis Health Profile (EHP-5), and the Work Productivity and Activity Impairment Survey (WPAI). Quantification of impact of endometriosis symptoms on physical and mental health status, health-related quality of life, absenteeism, presenteeism, work productivity, and activity impairment. Patients had SF-12 scores denoting statistically significant disability in the physical and mental health components. They also reported an average of 7.41 hours (approximately one working day) of work time lost during the week when the symptoms are worse. In addition, the WPAI scores showed a high impact on work-related domains: 13% of average loss in work time (absenteeism), 65% of work impaired (presenteeism), 64% of loss in efficiency levels (work productivity loss), and 60% of daily activities perturbed (activity impairment). Endometriosis symptoms such as chronic, incapacitating pelvic pain and infertility negatively and substantially impact the physical and mental health status, health-related quality of life, and productivity at work of women. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Zeng, Zhi; Guo, Yan; Lu, Liming; Han, Lu; Chen, Wen; Ling, Li
2014-11-12
Small- and medium-sized enterprises (SMEs) generate nearly 80% of the jobs in China, but the dangerous work environment often found in these enterprises poses a major concern for public health. Psychosocial pressure and mental health problems among the workers are also common in SMEs. However, mental health of workers in SMEs is largely neglected in occupational health research and practice in China. The purpose of this study is to assess mental health of the workers and to explore the associations between physical and psychosocial work environment and workers' mental health in SMEs in South China. Data were collected in 2012 through a cross-sectional survey among 1200 workers working in small- and medium-sized enterprises (SMEs) in Guangdong, China. Mental health was measured by psychological well-being in the current study. Job Demand-Control-Support (JDCS) model was used as a theoretical framework to examine the psychosocial factors associated with workers' psychological well-being. Data were analyzed using SPSS 20.0 and analysis was performed using bivariate analyses and multivariate logistic regression. About three in ten workers (35.3%) in the sample had poor psychological well-being. Those who were men, younger in age, or migrant workers had worse psychological outcome in bivariate analyses. After controlling for individual variables (gender, age, marital status, and household registration), we found that longer weekly work hours (OR = 1.30, 95% CI: 1.13 ~ 1.50), more exposure to hazardous work environment (OR = 1.26, 95% CI: 1.10 ~ 1.44), higher job demands (OR = 1.29, 95% CI: 1.12 ~ 1.49), and lower job autonomy (OR = 0.70, 95% CI: 0.60 ~ 0.81) were significant associated with worse psychological well-being. The results were consistent with predictions of the JDCS model. The results indicate that the JDCS model is a useful framework in predicting psychological well-being among Chinese workers in SMEs. Future mental health promotion should focus on young
2018-05-05
Achieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040. We extracted historical data on gross domestic product (GDP) and health spending for 188 countries from 1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last, we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a measure of a country's UHC service coverage. Finally, we estimated future UHC performance and the number of people covered under the three future scenarios. In the reference scenario, global health spending was projected to increase from US$10 trillion (95% uncertainty interval 10 trillion to 10 trillion) in 2015 to $20 trillion (18 trillion to 22 trillion) in 2040. Per capita health spending was projected to increase fastest in upper-middle-income countries, at 4·2% (3·4-5·1) per year, followed by lower-middle-income countries (4·0%, 3·6-4·5) and low-income countries (2·2%, 1·7-2·8). Despite global growth, per capita health spending was projected to range from only $40 (24-65) to $413 (263-668) in 2040 in low-income countries, and from $140 (90-200) to $1699 (711-3423) in lower-middle-income countries. Globally, the share of health spending
Sun, Jian
2017-08-29
The aim of this study was to assess the equality in the distribution of health material and human resources in Guangxi, and put forward proposal to improve the equality status of the health material and human resources. We used concentration index to evaluate the degree of income-related equality of health material and human resources. The concentration index values of the five resources ranged from -0.0847 to 0.1416 from 2011 to 2015. Health institution was concentrated among the poorer populations, while other four resources were concentrated among the richer populations. Overall, the equality status of health institutions, health care beds, health technical personnel, and certified nurses got better from 2011 to 2015. However, the equality status of practicing physicians has got worse since 2014.
Hem, Marit Helene; Molewijk, Bert; Gjerberg, Elisabeth; Lillemoen, Lillian; Pedersen, Reidar
2018-06-05
Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of 'bricolage' which means our approach was inductive. Most participants report positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices.
Bigger is better and worse: on the intricate relationship between hippocampal size and memory.
Molnár, Katalin; Kéri, Szabolcs
2014-04-01
The structure-function relationship between the hippocampal region and memory is a debated topic in the literature. It has been suggested that larger hippocampi are associated with less effective memory performance in healthy young adults because of a partial synaptic pruning. Here, we tested this hypothesis in individuals with Fragile X Syndrome (FXS) with known abnormal pruning and IQ- and age-matched individuals with hypoxic brain injury, preterm birth, and obstetric complications. Results revealed larger normalized hippocampal volume in FXS compared with neurotypical controls, whereas individuals with hypoxic injury had smaller hippocampi. In neurotypical controls and individuals with hypoxic injury, better general memory, as indexed by the Wechsler Memory Scale-Revised, was associated with larger hippocampus. In contrast, in FXS we observed the opposite relationship: larger hippocampus was associated with worse general memory. Caudate volume did not correlate with memory in either group. These results suggest that incomplete pruning in young healthy adults may not contribute to less efficient memory capacity, and hippocampal size is positively associated with memory performance. However, abnormally large and poorly pruned hippocampus may indeed be less effective in FXS. Copyright © 2014 Elsevier Ltd. All rights reserved.
Educational Level, Underachievement, and General Mental Health Problems in 10,866 Adolescents.
Tempelaar, Wanda M; de Vos, Nelleke; Plevier, Carolien M; van Gastel, Willemijn A; Termorshuizen, Fabian; MacCabe, James H; Boks, Marco P M
2017-08-01
Previous research suggests that cognitive functioning is associated with the risk of several adult psychiatric disorders. In this study we investigated whether adolescents who perform worse than expected at secondary school are at a higher risk for general mental health problems. In a cross-sectional survey comprising 10,866 Dutch adolescents aged 13 to 16 years, underachievement at secondary school was defined as the discrepancy between predicted school grade and actual grade 1 or 3 years later. Mental health problems were assessed using the Strengths and Difficulties Questionnaire. We investigated the association of underachievement with mental health problems using logistic regression, adjusting for potential confounders. Underachievement was associated with general psychopathology in pupils aged 13 to 14 years (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.47-2.37) and in pupils aged 15 to 16 years (OR, 2.05; 95% CI, 1.67-2.52) in a multivariate analysis including sociodemographic factors. The association between underachievement and mental health problems was attenuated when school factors such as teacher advice and interaction between underachievement and teacher advice were added, but underachievement remained significantly associated with mental health problems in adolescents in the higher educational tracks (pupils aged 13-14 years: OR, 2.22; 95% CI, 1.07-4.60 and OR, 2.41; 95% CI, 1.10-5.30, age 15-16 years: OR, 2.63; 95% CI, 1.38-5.03). In the multivariate analysis including the interaction between underachievement and teacher advice, a significant interaction effect occurs between underachievement and teacher advice in the higher tracks. Values of OR and CI are given for each significant interaction term. In the younger age group (pupils aged 13-14 years) this results in 2 sets of OR and CI. This association was most pronounced for the hyperactivity subscale of the Strengths and Difficulties Questionnaire. Underachievement at secondary school
Löckenhoff, Corinna E.; Terracciano, Antonio; Ferrucci, Luigi; Costa, Paul T.
2011-01-01
We examined the influence of personality traits on mean levels and age trends in four single-item measures of self-rated health: General rating, comparison to age peers, comparison to past health, and expectations for future health. Community-dwelling participants (N = 1,683) completed 7,474 self-rated health assessments over a period of up to 19-years. In hierarchical linear modeling analyses, age-associated declines differed across the four health items. Across age groups, high neuroticism and low conscientiousness, low extraversion, and low openness were associated with worse health ratings, with notable differences across the four health items. Furthermore, high neuroticism predicted steeper declines in health ratings involving temporal comparisons. We consider theoretical implications regarding the mechanisms behind associations among personality traits and self-rated health. PMID:21299558
[Motivation of Men to Participate in Physical Activity Programs for Health Promotion].
Wollesen, Bettina; Lorf, Sarah; Bischoff, Laura Luise; Menzel, Josefine
2017-10-25
Study aim The rate of men participating in health promotion programs is lower than that of women. The reasons and barriers for the different motivation of men as well as wishes and perception for prevention are not yet sufficiently analyzed. This quantitative survey examines motives and barriers of men for participation in primary prevention. Thus, the sample was subdivided into 2 groups, namely motivated vs. non-motivated regarding being active for health promotion. Differences between the 2 groups concerning current health status, health beliefs and health behavior were analyzed to plan more suitable programs in the future. Methods A sample of N=243 men (motivated n=147, non-motivated n=96) participated in the standardized online-survey. The quantitative data analysis integrated the BMZI, KKG, SF-12, TICS and the MGV-39. The examination of the differences between the sub-groups was done with Chi²-Tests and analysis of variance (one-way ANOVA) with IBM SPSS 22 (Armonk, NY: IBM Corp). Results The group of motivated men reported worse health status, especially in psychological well being compared to the non-motivated group (SF-12: F=6.3, p=0.013, eta²=0.025). Both groups named refusal to use harmful substances (e.g. drugs, alcohol), good nutrition and active life-style as important factors for health. Non-motivated men showed a higher score for the fatalistic externality of health (KKG: F=7.609, p=0.006, eta²=0.031) and rated health promotion as paternalism (Chi²=17.693, p≤0.001, C=0.261). Conclusion The men of this study who were motivated to join health promotion programs had a worse health status that might explain their compliance. For the non-motivated men, there was a discrepancy between their own beliefs in health behavior and their real daily activities (e.g. physical activity). In order to reach this target group of men before their health status worsens, prevention programs should integrate incentive systems that integrate features for overcoming
Health needs of the Roma population in the Czech and Slovak Republics.
Koupilová, I; Epstein, H; Holcík, J; Hajioff, S; McKee, M
2001-11-01
In the growing literature on the human rights of Roma people in Central Europe, their relatively poor health status is often mentioned. However, little concrete information exists about the contemporary health status of the Roma in this region. We sought information on the health of the Roma in two of countries with significant Roma minorities, the Czech and Slovak Republics, by means of systematic searches for literature on the health of Roma people published in Czech or Slovak or by authors from the two countries. Published research on health of the Roma population is sparse. The topics that have received attention suggest a focus on concepts of contagion or social Darwinism, indicating a greater concern with the health needs of the majority populations with which they live. What limited evidence exists indicates that the health needs of the Roma population are considerable. With very few exceptions, the health status of Roma is worse than that of non-Roma population in both countries. The burden of communicable disease among Roma is high and diseases associated with poor hygiene seem to be particularly important. Evidence on health care suggests poor communication between Roma and health workers and low uptake of preventative care. The health needs of Roma lack visibility, not only because of the absence of research but also the absence of advocacy on their behalf. Since 1989, Czech and Slovak researchers have largely turned away from health research on particular ethnic groups. This probably reflects a growing sensitivity about stigmatising Roma, but it also makes it difficult to know how their circumstances might be improved. There is a need for further research into the health of Roma people with particular emphasis on non-communicable disease and for interventions that would improve their health.
Winter, Laraine; Parker, Barbara
2007-10-01
As a substantial body of research attests, the acceptability of life-prolonging treatment (e.g., tube feeding) tends to be greater among people in worse health than among healthier ones. Because a decision for or against a life-prolonging treatment represents a choice between two prospects-life (usually in poor health) and death-we propose a decision model, Prospect Theory, as a theoretical account of this phenomenon. Prospect Theory postulates that pairs of distant prospects are less distinguishable than pairs of closer ones. Thus, to healthy individuals, the prospects of death and life in poor health would both be remote, and therefore, the distinction between them, small. To less healthy individuals, however, the difference between the same pairs of prospects would appear greater, and therefore, life-prolonging treatment may be more acceptable. In a cross-sectional study of 304 community-dwelling people, aged 60 years and over in the Philadelphia area, USA, preferences for 4 life-prolonging treatments in 9 health scenarios were examined in relation to participants' current health, operationalized as number of deficits in physical functioning. As predicted, less healthy people expressed stronger preferences for all life-prolonging treatments compared with healthier ones, with differences greatest in the worse-health scenarios. Preferences also varied by health scenario, with any treatment preferred in the better health scenarios. Treatment preferences did not differ by type of treatment, depressed mood or any demographic characteristic except race, with African-Americans expressing stronger treatment preferences. Implications for advance care planning are discussed.
Childhood health: trends and consequences over the life course.
Delaney, Liam; Smith, James P
2012-01-01
This article first documents evidence on the changing prevalence of childhood physical and mental health problems, focusing on the development of childhood health conditions in the United States. Authors Liam Delaney and James Smith present evidence on the changing prevalence of childhood chronic conditions over time using recalled data as well as contemporaneous accounts of these childhood health problems. The raw data from both sources show sharp increases in the prevalence of most childhood physical health problems (such as asthma, allergies, respiratory problems, and migraines) over time. However, inferring trends is difficult because such data are also consistent with improved detection of childhood disease, and many of the causes of childhood disease have not worsened over time. Conclusions about rapidly rising rates of childhood physical health problems over time are premature at best, especially concerning the magnitude of trends. Documenting real changes in the prevalence of specific diseases is a high-priority research topic. In contrast, the evidence is much stronger that childhood mental health problems are becoming worse. The authors next present new evidence on the effects of early childhood physical and mental problems on health and economic status in adulthood. They find that both childhood physical and mental health problems contribute significantly to poorer adult health. However, they also find that childhood mental health problems have much larger impacts than do childhood physical health problems on four critical areas of socioeconomic status as an adult: education, weeks worked per year, individual earnings, and family income. Finally, the authors examine evidence regarding the efficacy of early mental health treatment for children in terms of promoting good health later on. Existing studies suggest that a combination of cognitive behavioral therapy and medication appears to be effective in the treatment of both anxiety and depression in
International Nuclear Information System (INIS)
Harsolia, Asif; Kestin, Larry; Grills, Inga; Wallace, Michelle; Jolly, Shruti; Jones, Cortney; Lala, Moinaktar; Martinez, Alvaro; Schell, Scott; Vicini, Frank A.
2007-01-01
Purpose: We have previously demonstrated that intensity-modulated radiotherapy (IMRT) with a static multileaf collimator process results in a more homogenous dose distribution compared with conventional wedge-based whole breast irradiation (WBI). In the present analysis, we reviewed the acute and chronic toxicity of this IMRT approach compared with conventional wedge-based treatment. Methods and Materials: A total of 172 patients with Stage 0-IIB breast cancer were treated with lumpectomy followed by WBI. All patients underwent treatment planning computed tomography and received WBI (median dose, 45 Gy) followed by a boost to 61 Gy. Of the 172 patients, 93 (54%) were treated with IMRT, and the 79 patients (46%) treated with wedge-based RT in a consecutive fashion immediately before this cohort served as the control group. The median follow-up was 4.7 years. Results: A significant reduction in acute Grade 2 or worse dermatitis, edema, and hyperpigmentation was seen with IMRT compared with wedges. A trend was found toward reduced acute Grade 3 or greater dermatitis (6% vs. 1%, p = 0.09) in favor of IMRT. Chronic Grade 2 or worse breast edema was significantly reduced with IMRT compared with conventional wedges. No difference was found in cosmesis scores between the two groups. In patients with larger breasts (≥1,600 cm 3 , n = 64), IMRT resulted in reduced acute (Grade 2 or greater) breast edema (0% vs. 36%, p <0.001) and hyperpigmentation (3% vs. 41%, p 0.001) and chronic (Grade 2 or greater) long-term edema (3% vs. 30%, p 0.007). Conclusion: The use of IMRT in the treatment of the whole breast results in a significant decrease in acute dermatitis, edema, and hyperpigmentation and a reduction in the development of chronic breast edema compared with conventional wedge-based RT
Small, Brent J.; Minton, Susan; Andrykowski, Michael; Jacobsen, Paul B.
2012-01-01
Background Data are scarce about whether past history of major depressive disorder in the absence of current depression places breast cancer patients at risk for worse quality of life. Purpose The current study prospectively examined quality of life during chemotherapy in breast cancer patients with a history of resolved major depressive disorder (n=29) and no history of depression (n=144). Methods Women with Stages 0–II breast cancer were assessed prior to and at the completion of chemotherapy. Major depressive disorder was assessed via structured interview and quality of life with the SF-36. Results Patients with past major depressive disorder displayed greater declines in physical functioning relative to patients with no history of depression (p≤0.01). Conclusions Findings suggest that breast cancer patients with a history of resolved major depressive disorder are at increased risk for declines in physical functioning during chemotherapy relative to patients with no history of depression. PMID:22167580
Huang, Chiung-Yu; Sousa, Valmi D; Perng, Shao-Jen; Hwang, Mei-Yi; Tsai, Chun-Ching; Huang, Mei-Huang; Yao, Shu-Ying
2009-02-01
This study examined the relationships among stressors, social support, depressive symptoms and the general health status of Taiwanese caregivers of individuals with stroke or Alzheimer's disease. Caring for a disabled or cognitively impaired person can be extremely stressful and often has adverse effects on caregivers' health. While research on caregiving in Taiwan has examined caregivers' characteristics, caregivers' need and caregivers' burden in caring for older people in general, little is known about Taiwanese caregivers of individuals with stroke or Alzheimer's disease. Cross-sectional, descriptive correlation design. Data were obtained from a convenience sample of 103 Taiwanese informal caregivers in the South of Taiwan and analysed using descriptive statistics, Pearson's correlations, multiple and hierarchical regressions and t-tests. Caregivers who had lower household incomes and were taking care of individuals with more behaviour problems had more depressive symptoms. In addition, caregivers who were older and were taking care of individuals with more behaviour problems had worse general health. Caregivers who had more emotional support had less depressive symptoms. Caregivers of persons with Alzheimer's disease had more depressive symptoms and worse general health than caregivers of persons with stroke. Only emotional support moderated the relationship between one of the stressors (household income) and depressive symptoms. The findings of this study may be helpful for nurses and other health care professionals in designing effective interventions to minimise the negative impacts of stressors on the psychological and general health of caregivers in Taiwan.
Bogart, Laura M; Wagner, Glenn J; Galvan, Frank H; Klein, David J
2010-10-01
African-Americans show worse HIV disease outcomes compared to Whites. Health disparities may be aggravated by discrimination, which is associated with worse health and maladaptive health behaviors. We examined longitudinal effects of discrimination on antiretroviral treatment adherence among 152 HIV-positive Black men who have sex with men. We measured adherence and discrimination due to HIV-serostatus, race/ethnicity, and sexual orientation at baseline and monthly for 6 months. Hierarchical repeated-measures models tested longitudinal effects of each discrimination type on adherence. Over 6 months, participants took 60% of prescribed medications on average; substantial percentages experienced discrimination (HIV-serostatus, 38%; race/ethnicity, 40%; and sexual orientation, 33%). Greater discrimination due to all three characteristics was significantly bivariately associated with lower adherence (all p's discrimination was significant (p < 0.05). Efforts to improve HIV treatment adherence should consider the context of multiple stigmas, especially racism.
Economic downturn, health, and well-being in workers with disabilities
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Carlos-María Alcover
2017-07-01
Full Text Available This study's aim is to analyze the consequences of the deterioration of working conditions caused by the economic downturn on occupational health, well-being, perceptions, and job attitudes in workers with disabilities. A sample of 31 workers with disabilities in ordinary firms (i.e., not in protégé employment organizations was used, with repeated measures being taken in 2013 and 2014. After identifying objective indicators and expert assessments of these workers' working conditions, we tested these workers' relationships with perceived organizational support, supervisors and coworker support, job satisfaction, intention to quit, perceived stress, burnout, and life satisfaction. Parametric and non-parametric analyses indicate that these variables are sensitive, with statistically significant differences, to the worse working conditions perceived in 2014 compared to 2013. The consequences of these results are discussed in relation to the effects of the economic downturn on the quality of working life of people with disabilities, and on the increase of discrimination towards them.
Huang, C-J; Hu, H-T; Fan, Y-C; Liao, Y-M; Tsai, P-S
2010-04-01
This study investigated the associations of breakfast skipping with obesity and health-related quality of life (QOL). We also tested the hypothesis that there is a dose-dependent relationship between frequency of breakfast consumption and prevalence of obesity. This cross-section study used a national representative sample (n=15 340) from the 2005 Taiwan National Health Interview Survey. Breakfast skippers were defined as those who ate breakfast about once a week or less often and those who never ate breakfast. Individuals were classified as 'obese' if their body mass index was >or=27. Health-related QOL was assessed using the Medical Outcome Studies 36-Item Short-Form (SF-36) Health Survey. Logistic regression was used to examine the odds ratio of obesity and associated 95% confidence intervals (CIs) in breakfast skippers compared with breakfast eaters. Multivariable logistic regression modeling was used to adjust all risk estimates for covariates. The unadjusted odds ratio of obesity in breakfast skippers was 1.23 (95% CI: 1.06, 1.43). The odds of developing obesity for breakfast skippers was 1.34 (95% CI: 1.15, 1.56) controlling for age, sex, marital status, educational level, monthly income, smoking, alcohol, betel nut chewing and exercise habit. The Cochran-Armitage trend test revealed that the prevalence rate of obesity decreased as the frequency of breakfast consumption increased (P=0.005). Breakfast skippers had significantly worse health-related QOL than breakfast eaters (Pbreakfast skippers had significantly lower scores in 5 out of 8 domain scores of the SF-36, namely general health perceptions (Pmental health (Pbreakfast eating in obesity prevention.
The 'dark side' of social capital: trust and self-rated health in European countries.
Campos-Matos, Inês; Subramanian, S V; Kawachi, Ichiro
2016-02-01
Generalized interpersonal trust (as an indicator of social capital) has been linked to health status at both the individual and ecological level. We sought to examine how changes in contextual and individual trust are associated with changes in self-rated health in the European Social Surveys 2002-12. A multilevel analysis using a variance components model was performed on 203 452 individuals nested within 145 country cohorts covering 35 countries. Conditional on sociodemographic covariates, we sought to examine the association between self-rated health and individual trust, country average trust and a cross-level interaction between the two. Although individual trust perceptions were significantly correlated with self-rated health [OR = 0.95, 95% confidence interval (0.94-0.96)], country-level trust was not associated [OR = 1.12, 95% confidence interval (0.95-1.32)]. There was, however, a strong crosslevel interaction between contextual and individual trust (P < 0.001), such that individuals with high interpersonal trust reported better health in contexts in which other individuals expressed high average interpersonal trust. Conversely, low trust individuals reported worse health in high trust contexts. Our findings suggest that contexts with increasing average trust can be harmful for low trust individuals, which might reflect the negative impact that social capital can have in certain groups. These findings suggest that contextual trust has a complex role in explaining health inequalities and individual self-rated health. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Age-related inequalities in health and healthcare: the life stages approach.
Jecker, Nancy S
2017-05-16
How should healthcare systems prepare to care for growing numbers and proportions of older people? Older people generally suffer worse health than younger people do. Should societies take steps to reduce age-related health inequalities? Some express concern that doing so would increase age-related inequalities in healthcare. This paper addresses this debate by (1) presenting an argument in support of three principles for distributing scarce resources between age groups; (2) framing these principles of age group justice in terms of life stages; and (3) indicating policy implications that merit further attention in light of rapidly aging societies. © 2017 John Wiley & Sons Ltd.
Framing Mechanisms Linking HIV-Related Stigma, Adherence to Treatment, and Health Outcomes
Hatcher, Abigail M.; Weiser, Sheri D.; Johnson, Mallory O.; Rice, Whitney S.; Turan, Janet M.
2017-01-01
We present a conceptual framework that highlights how unique dimensions of individual-level HIV-related stigma (perceived community stigma, experienced stigma, internalized stigma, and anticipated stigma) might differently affect the health of those living with HIV. HIV-related stigma is recognized as a barrier to both HIV prevention and engagement in HIV care, but little is known about the mechanisms through which stigma leads to worse health behaviors or outcomes. Our conceptual framework posits that, in the context of intersectional and structural stigmas, individual-level dimensions of HIV-related stigma operate through interpersonal factors, mental health, psychological resources, and biological stress pathways. A conceptual framework that encompasses recent advances in stigma science can inform future research and interventions aiming to address stigma as a driver of HIV-related health. PMID:28426316
Perruccio, Anthony V; Gandhi, Rajiv; Lau, Johnny T C; Syed, Khalid A; Mahomed, Nizar N; Rampersaud, Y Raja
2016-01-01
Improving health-related quality of life (HRQoL) necessitates an understanding of the influence of patient characteristics on, and interrelationship among, HRQoL domains. In osteoarthritis (OA), these associations have predominantly been examined in hip/knee populations. We investigated whether there were differences in these associations between foot/ankle and knee OA samples. Individuals seeking orthopedic care for foot/ankle or knee OA completed a questionnaire pre-consultation, including HRQoL domains (bodily pain [BP], physical [PF] and social functioning [SF], and mental [MH] and general health [GH]), obesity, comorbidity, and sociodemographic characteristics. Associations were examined via stratified path analysis (foot/ankle vs knee). Foot/ankle: n = 180, mean age = 55 (range: 25 to 82), 52% female. Knee: n = 253, mean age = 62 (range: 26 to 92), 51% female. The interrelationship among HRQoL domains was generally similar between groups. However, the influence of patient characteristics differed. Low educational status was associated with worse scores for GH, MH, and SF in the foot/ankle group, whereas no significant effects were found in the knee group. Obesity was associated with worse scores for SF, BP, and GH in the foot/ankle compared to the knee group. Patient characteristics explained considerably more of the variation in domain scores in the foot/ankle group. There are significant differences in the impact of patient characteristics on HRQoL domains in foot/ankle versus knee OA patients. Therefore, a universal approach to patient education/intervention to improve HRQoL in lower-extremity OA is not likely to achieve optimal results. Based on these findings, we recommend joint-specific patient education, with a particular emphasis on patient characteristics among the foot/ankle OA population. Level III, retrospective comparative study. © The Author(s) 2015.
Daniel B. Klein; Zeljka Buturovic
2011-01-01
One year ago, we reported the results of a 2008 Zogby survey that purported to gauge economic enlightenment (Buturovic and Klein 2010). Our main result was that college education bore little relationship to economic enlightenment. We also found that that self-identified Progressives and Liberals did much worse than Conservatives and Libertarians, and this finding generated a lot of controversy. Those results were based on eight questions used to gauge economic enlightenment. Most of those eig...
African Journals Online (AJOL)
dell
Bivariate analysis exhibited association of statistical significance with age (P value for trend ... CONCLUSIONS: The socioeconomic determinants of health in this study converged ... each step as one moves down the social ladder, the worse.
Cureton, Thomas K.
In this document, "middle age" is defined as the 26- to 65-year age span during which there is a steady decline of both physical and mental capabilities and a change for the worse in personality traits. The document summarizes the findings of recent training experiments in adult health and physical education that indicate possible ways of…
Significance of lymph node capsular invasion in esophageal squamous cell carcinoma.
Sakai, Makoto; Suzuki, Shigemasa; Sano, Akihiko; Tanaka, Naritaka; Inose, Takanori; Sohda, Makoto; Nakajima, Masanobu; Miyazaki, Tatsuya; Kuwano, Hiroyuki
2012-06-01
Extranodal invasion (ENI) has been reported to be associated with a poor prognosis in several malignancies. However, previous studies have included perinodal fat tissue tumor deposits in their definitions of ENI. To investigate the precise nature of ENI in esophageal squamous cell carcinoma (ESCC), we excluded these tumor deposits from our definition of ENI and defined tumor cell invasion through the lymph node capsule and into the perinodal tissues as lymph node capsular invasion (LNCI). The aim of the current study was to elucidate the significance of LNCI in ESCC. We investigated the associations between LNCI and other clinicopathologic features in 139 surgically resected ESCC. We also investigated the prognostic significance of LNCI in ESCC. LNCI was detected in 35 (25.2%) of 139 patients. The overall survival rate of the ESCC patients with LNCI was significantly lower than that of the ESCC patients with lymph node metastasis who were negative for LNCI. The survival difference between the patients with 1–3 lymph node metastases without LNCI and those with no lymph node metastasis was not significant. LNCI was significantly associated with distant organ recurrence. LNCI was also found to be an independent predictor of overall survival in addition to the number of lymph node metastases. LNCI in ESCC patients is an indicator of distant organ recurrence and a worse prognosis. LNCI could be used as a candidate marker for designing more precise staging and therapeutic strategies for ESCC.
Evaluating clinically significant changes in health-related quality of life
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Norup, Anne; Kristensen, Karin Spangsberg; Poulsen, Ingrid
2017-01-01
The objective of the study was to investigate change and predictors of change in health-related quality of life (HRQoL) in relatives of patients with severe traumatic brain injury (TBI) during rehabilitation, and to analyse associations between changes in HRQoL and symptoms of anxiety...
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Lima-Costa Maria Fernanda F.
2002-01-01
Full Text Available The aim of this cross sectional study was to investigate whether holding a private health plan affects the consumption of medical services (hospitalization and visits to a doctor and use of medications by older adults. All residents in Bambuí town (Minas Gerais, Brazil aged > or = 60 years (n = 1,742 were selected. From these, 92.2% were interviewed and 85.9% were examined (blood tests and physical measurements. After adjustments for counfounders, those under exclusive public coverage (n = 1,296, compared with those holding a private health plan (n = 310, presented some evidence of having worse health status, reported less visits to a doctor, and used a small number of prescribed medications. The main explanation for the aged holding a private health plan was economic, not health. Even though those who had only public health coverage complained more in relation to medical care (70.9%, an important proportion of the aged with a private health care plan presented some kind of complaint (45.2%. Another worrying factor was the difficulty to acquire medication because of financial problems (47.2 and 25.2% reported, respectively. Further investigations are needed to verify whether our results can be generalized to other communities of the country.
Samelli, Alessandra G; Santos, Itamar S; Moreira, Renata R; Rabelo, Camila M; Rolim, Laurie P; Bensenõr, Isabela J; Lotufo, Paulo A
2017-01-01
Although several studies have investigated the effects of diabetes on hearing loss, the relationship between these two conditions remains unclear. Some studies have suggested that diabetes may cause sensorineural hearing loss, whereas others have failed to find an association. The biggest challenge in investigating the association between diabetes and hearing loss is the presence of confounding variables and the complexity of the auditory system. Our study investigated the association between diabetes and sensorineural hearing loss. We evaluated the influence of time from diabetes diagnosis on this association after controlling for age, gender, and hypertension diagnosis and excluding those subjects with exposure to noise. This cross-sectional study evaluated 901 adult and elderly Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) participants from São Paulo, Brazil who underwent audiometry testing as part of ELSA-Brasil's baseline assessment. Hearing thresholds and speech test results were significantly worse in the group with diabetes than in the group without diabetes. However, no significant differences were found between participants with and without diabetes after adjusting for age, gender, and the presence of hypertension. Hearing thresholds were not affected by occupational noise exposure in the groups with and without diabetes. In addition, no association between the duration of diabetes and hearing thresholds was observed after adjusting for age, gender, and hypertension. We found no association between the duration of diabetes and worse hearing thresholds after models were adjusted for age, gender, and the presence of hypertension.
Qiu, Mingjing; Fang, Min; Liu, Xueyuan
2017-11-01
The aim of the study was to determine whether thyroid hormones level on admission in patients with ischemic stroke, treated with intravenous recombinant tissue type plasminogen activator (rtPA), was associated with symptomatic intracranial hemorrhage (sICH) and worse outcomes at 3 months.Patients with acute ischemic stroke (AIS) receiving intravenous rtPA thrombolytic treatment on our stroke unit between January 2015 and June 2016 were included in this study. Serum-free triiodothyronine (fT3), free thyroxine (fT4), total triiodothyronine (tT3), total thyroxine (tT4), and thyroid-stimulating hormone (TSH) were detected on admission. The endpoints were sICH, and poor functional outcomes at 3 and 6 months.In all, 159 patients (106 males; mean age 65.36 ± 10.02 years) were included. FT3 was independently associated with sICH (odds ratio [OR] 0.204, 95% confidence interval [CI] 0.065-0.642) and poor outcomes at 3 months (OR 0.396, 95% CI 0.180-1.764). The cut-off values of fT3 for sICH was 3.54 pg/mL (sensitivity 83%; specificity 83%; area under the curve 0.88). FT3 values ≤3.54 pg/mL increased risk for sICH by 3.16-fold (95% CI 0.75-1.0) compared with fT3 values >3.54 pg/mL.Low fT3 levels at admission were independently associated with sICH and worse outcomes at 3 months in AIS patients receiving rtPA thrombolytic therapy.
Violence Affects Physical and Mental Health Differently: The General Population Based Tromsø Study.
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Oddgeir Friborg
Full Text Available This general population-based study examined associations between violence and mental health, musculoskeletal pain, and early disability pension. The prevalence and consequences of good vs. poor adjustment (resilience vs. vulnerability following encounters with violence were also examined. Data were based on the sixth wave of the "Tromsø Study" (N = 12,981; 65.7% response rate, 53.4% women, M-age = 57.5 years, SD-age = 12.7 years. Self-reported data on psychological (threats and physical violence (beaten/kicked, mental health (anxiety/depression, musculoskeletal pain (MSP, and granting of disability pension (DP were collected. Men suffered more violent events during childhood than women did, and vice versa during adulthood. Psychological violence implied poorer mental health and slightly more MSP than physical violence. The risk of MSP was highest for violence occurring during childhood in women and during the last year for men. A dose-response relationship between an increasing number of violent encounters and poorer health was observed. About 58% of individuals reported no negative impact of violence (hence, resilience group, whereas 42% considered themselves as more vulnerable following encounters with violence. Regression analyses indicated comparable mental health but slightly more MSP in the resilience group compared to the unexposed group, whereas the vulnerable group had significantly worse health overall and a higher risk of early granting of DP. Resilience is not an all-or-nothing matter, as physical ailments may characterize individuals adapting well following encounters with violence.
The prostate health index selectively identifies clinically significant prostate cancer
S. Loeb (Stacy); M.G. Sanda (Martin G.); D.L. Broyles (Dennis L.); S.S. Shin (Sanghyuk S.); C.H. Bangma (Chris); J.T. Wei (John T.); A.W. Partin (Alan W.); G.G. Klee (George); K.M. Slawin (Kevin M.); L.S. Marks (Leonard S.); R.H.N. van Schaik (Ron); D.W. Chan (Daniel); L. Sokoll (Lori); A.B. Cruz (Amabelle B.); I.A. Mizrahi (Isaac A.); W.J. Catalona (William)
2015-01-01
textabstractPurpose The Prostate Health Index (phi) is a new test combining total, free and [-2]proPSA into a single score. It was recently approved by the FDA and is now commercially available in the U.S., Europe and Australia. We investigate whether phi improves specificity for detecting
Wagenaar, Alfred F; Kompier, Michiel A J; Houtman, Irene L D; van den Bossche, Seth; Smulders, Peter; Taris, Toon W
2012-10-01
We hypothesise that due to a lower quality of working life and higher job insecurity, the health and work-related attitudes of temporary workers may be less positive compared to permanent workers. Therefore, we aimed to (1) examine differences between contract groups (i.e. permanent contract, temporary contract with prospect of permanent work, fixed-term contract, temporary agency contract and on-call contract) in the quality of working life, job insecurity, health and work-related attitudes and (2) investigate whether these latter contract group differences in health and work-related attitudes can be explained by differences in the quality of working life and/or job insecurity. Data were collected from the Netherlands Working Conditions Survey 2008 (N = 21,639), and Hypotheses were tested using analysis of variance and cross-table analysis. Temporary work was associated with fewer task demands and lower autonomy and was more often passive or high-strain work, while permanent work was more often active work. Except for on-call work, temporary work was more insecure and associated with worse health and work-related attitude scores than permanent work. Finally, the quality of working life and job insecurity partly accounted for most contract differences in work-related attitudes but not in health. Especially agency workers have a lower health status and worse work-related attitudes. Job redesign measures regarding their quality of working life and job insecurity are recommended.
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Agnieszka Ćwirlej-Sozańska
2018-03-01
Regarding the studied population, it was found that many health problems become worse over the years. The state of health that deteriorates with age causes limitations in daily functioning, which lead to disability, activity limitations and participation in everyday life. The progressive ageing of the Polish population will cause an increasing demand for medical care and on the social services.
DEFF Research Database (Denmark)
Thomsen, Maria; Guren, Marianne Grønlie; Skovlund, Eva
2017-01-01
Background The aim of this study was to evaluate the effect of cetuximab on health-related quality of life (HRQoL) in the NORDIC-VII trial on metastatic colorectal cancer (mCRC), and to assess HRQoL in relation to RAS and BRAF mutation status and inflammatory biomarkers. Patient and methods HRQo....... There was a statistically significant association between reduction in IL-6 and CRP levels and improvement in HRQoL during treatment from baseline to cycle 4. Conclusion The addition of cetuximab to chemotherapy did not affect HRQoL in mCRC patients. Patients with BRAF-mutated tumours have both a worse prognosis and a poor...
Do Adolescents with T1DM Differ from Their Peers in Health, Eating Habits and Social Support?
Husárová, Daniela; Kostičová, Michaela; Kočišová, Denisa; Schusterová, Ingrid; Gecková, Andrea Madarasová
2017-12-01
The aim of this study was to analyse differences in health, eating habits and social support in adolescents with type 1 diabetes mellitus (T1DM) in comparison to peers with another long-term illness or without any medical condition. We used self-reported data from the cross-sectional Health Behaviour in School-aged Children study collected in 2014 among Slovak adolescents as well as data from adolescents with T1DM collected in outpatient settings (11 to 15 years old, N=8,910, 50.3% of boys). Logistic regression models and general linear models were used to analyse differences between adolescents with T1DM and their peers with and without long-term illness in self-rated health, life satisfaction, health complaints, regular breakfast, sweets and soft drink consumption, and perceived support from family, teachers and classmates. Adolescents with T1DM reported worse self-rated health and suffer from more health complaints, but they have lower chance of having breakfast irregularly in comparison to their peers with another long-term illness or without any medical condition. Moreover, compared with their peers, adolescents with T1DM perceived stronger support from teachers and classmates, but weaker support from their family. We did not confirm any differences in life satisfaction, sweets and soft drink consumption between adolescents with T1DM and their peers. Adolescents with T1DM reported more regular eating habits, no difference in life satisfaction and more social support outside the family in comparison to their peers. However, their worse self-rated health, more health complaints and weaker support from family should be considered in interventions targeting psychosocial adjustment of adolescents with T1DM. Copyright© by the National Institute of Public Health, Prague 2017