Worse Health Perception Research Articles

Psychological distress in grandparents of grandchildren who survived childhood cancer − Results from the GROkids project

IntroductionHaving a grandchild who survived childhood cancer might affect grandparents’ mental health. We aimed to A) describe the psychological distress of grandparents of childhood cancer survivors (CCS) and compare their distress to the Swiss general population, and B) explore the associations between the psychological distress of grandparents with person-, child-, and cancer-related characteristics. MethodsThis is a cross-sectional study conducted in Switzerland. Grandparents were identified from families of eligible CCS (cancer diagnosis before 18 years old; 3–10 years after diagnosis). A subsample of a representative sample for the Swiss general population was used for comparison similar in age, gender and language region. The Brief Symptom Inventory-18 (BSI-18) was administered to assess psychological distress on three domains: somatization, depression, anxiety; and a Global Severity Index [GSI]. We ran Chi-squared and t-tests to compare grandparents and comparisons, and univariable, multivariable and multilevel regressions to analyze associations. ResultsIn total, 122 grandparents (60.7% female, mean age=72.8; SD=6.8) and 354 comparisons participated (55.4% female; mean age=65.7; SD=5.5). Grandparents reported average distress levels and their scores did not differ significantly from the comparison sample (all p>.05). Grandparents with worse health perception described more psychological distress (somatization: β=6.86, p<.001; depression: β=4.17 p<.001; anxiety: β=5.87, p<.001; GSI: β=6.30, p<.001), while single grandparents experienced more depression than those in a partnership (β=-6.21, p=.013). DiscussionOur findings are encouraging, showing adequate psychological health among grandparents of CCS. However, grandparents who perceived their health as poorer encounter higher levels of distress and may benefit from access to support groups and tailored informational material.

FACTORS ASSOCIATED WITH THE INCIDENCE OF COGNITIVE IMPAIRMENT IN OLDER COSTA RICAN ADULTS

Abstract Cognitive impairment is a critical global public health problem that contributes to lower quality of life and greater medical costs. Despite the growing number of older adults in Costa Rica, few studies have examined cognitive impairment in this population. We drew data on participants (60 years+) with no cognitive impairment (Score of &amp;gt;=12 on MMSE) from wave 1 of the Costa Rican Longevity and Healthy Aging Study (CRELES; n=2,827). Guided by the diathesis-stress-model, we used logistic regression to determine social and health predictors of cognitive impairment incidence (Score &amp;lt; 12 of on MMSE) 2 years later (wave 2). Incidence of cognitive impairment was 5.8% (95% CI, 5.0-7.0). Formal school education (elementary: OR=0.32; 95% CI, 0.17-0.60; high school or more: OR=0.11; 95% CI, 0.02-0.60) and being married or living as married (OR=0.52; 95% CI, 0.28-0.96) were identified as protective against cognitive impairment. Greater age (OR=1.09; 95% CI, 1.06-1.13), consuming more than 400g of carbohydrates per day (OR=2.20; 95% CI, 1.22-3.91), and more challenges with Instrumental Activities of Daily Living (OR=1.70; 95% CI, 1.23-2.28) increased odds of developing cognitive impairment. Common predictors including biological sex, residential zone, smoking, income, bad health perception, depression, and cortisol (ug/dl) were not associated with the onset of cognitive impairment at wave 2. We consider that contextual (e.g., healthcare infrastructure), cultural factors (e.g., familism), as well as diet may help shape predictors and their effects on cognitive functioning. Researchers and practitioners should collaborate on implementation of culturally appropriate and contextually feasible interventions that address predictors of cognitive impairment.

The DS-14 questionnaire: psychometric characteristics and utility in patients with obstructive sleep apnea.

To determine the internal consistency and test-retest reliability of the DS-14 questionnaire, as well as the prevalence of type D personality in the overall OSA sample and subgroups. We assessed the influence of type D on perceived symptoms and its congruence with self-reported measures of personality, depression, fatigue, anxiety, quality of life, and quality of sleep. Patients with OSA completed the DS-14 questionnaire, Big Five Inventory-2 questionnaire, Hospital Anxiety and Depression Scale, SF-36 Health Survey Questionnaire, Epworth Sleepiness Scale and Stanford Sleepiness Scale, Pittsburgh Sleep Quality Index and Insomnia Severity Index, Fatigue Assessment Scale, and Checklist Individual Strength. After 1 month, the DS-14 questionnaire was repeated. The overall prevalence of type D personality was 32%. Internal consistency (negative affectivity: α = 0.880, social inhibition: α = 0.851) and diagnostic test-retest reliability (kappa value = 0.664) of the DS-14 questionnaire were high. Significantly more symptoms of anxiety, depression, poor sleep quality, fatigue, and a worse health perception were found in OSA with type D. Neither OSA severity nor REM predominance altered these observations. The DS-14 questionnaire showed excellent psychometric properties in patients with OSA. The prevalence of type D personality in patients with OSA was higher than in the general population. The presence of type D personality was associated with higher symptom burden.

The relationship between perceived health and psychosocial risk in women in the service sector (cleaning).

Cleaning is considered a female-dominant occupation. Women cleaning workers present a high risk of suffering impaired health probably as a result of performing low-skilled tasks. However, to date, no studies have been found that examine the health status of female cleaning workers in Spain. The objectives were to 1) determine the level of perceived health in a sample of female cleaning workers, 2) evaluate the main psychosocial risks they face, 3) explore the relationship between perceived health and psychosocial risk factors, and 4) compare the perceived health of those women who present some psychosocial risk factor and those who do not. This is a multi-centered cross-sectional study carried out in the service sector of a Spanish company. The final sample was composed of 455 female cleaning workers. Sociodemographic variables, perceived health status and psychosocial risk factors were assessed. Women presented a high perception of health status. The main psychosocial risk was lack of acknowledgement by their superiors, which affected 25.2% (n = 111) of the sample. Moderate negative correlations (r=-.222 to -.442; p < .01) were identified between perceived health and evident psychosocial risks. Those women who presented some psychosocial risk (n = 174; 38.3%) had a worse state of perceived health in all variables studied. Presence of psychosocial risk had a relationship with a worse health perception. This article highlights the need to orient preventive actions in the psychosocial field. The COVID-19 pandemic represents a new situation to renew the health promotion between cleaning workers.

Use of preventive measures, beliefs and information received about COVID-19 and their effects on mental health, in two stages of the pandemic in Colombia

Background Several studies have highlighted the effects of the COVID-19 pandemic on both physical and mental health. The aim of this study is to analyse the effects on mental health in two phases of the COVID-19 pandemic (April 2020 and February 2021) in the population of Colombia. Methods Observational, prospective, cross-sectional study along two periods, April 2020 and February 2021. The sample (N = 1309) was extracted from the Colombian population, only including individuals over the age of 18 and residing in Colombia during the pandemic. The IMPACTCOVID-19 questionnaire was used, previously validated in Spain and cross-culturally adapted to the Colombian population, which included sociodemographic data, use of preventive measures, information received and the Goldberg General Health Questionnaire (GHQ-12) for psychological distress (PD). Participants had to sign an informed consent before taking part in the investigation. Results A higher level of PD was observed among women (M = 3.99, SD = 3.39) (p < .001), in those who lived without a partner (M = 3.83, SD = 3.47) (p = .036), and in those with a worse perception of health (M = 6.27, SD = 3.51) (p < .001). PD decreased in the second period from M = 3.99 (SD = 3.36) to M = 2.98 (SD = 3.30) (p < .001), coinciding with a higher use of preventive measures, less distress caused by COVID-19 and greater confidence in healthcare professionals and clinical structures. In the second period, the time spent in getting informed decreased, but the sources of information were the same, principally social media and official sources. Conclusions Better information on the effects and preventive measures to prevent the pandemic improves confidence in the health system and its professionals, reducing the level of PD. There is a need for quality information on social networks and an adaptation of telemedicine to address the pandemic effects on mental health. Key messages Psychological distress (PD) decreased in February 2021, as compared to April 2020, due to a greater use of preventive measures against COVID-19, and the confidence on the recommendations made by health officials and professionals. Higher PD has been found in women and people who lived without a partner, in line with studies performed in other countries. The accessibility to quality information on the pandemic should be promoted by the Official Health Authorities, thus counteracting data that could be classified as “fake news”.

Fear of Covid-19 and health-related outcomes: results from two Brazilian population-based studies

Fear is a reaction that can influence multiple aspects of health and life. During the Covid-19 pandemic, there have been serious pathophysiological, social, behavioral and mental consequences that can be related to fear. This study aimed to assess the fear of Covid-19 and its association with sociodemographic, behavioral and health variables. Data were gathered from two cross-sectional population-based studies conducted in 2020 with adults from two cities from Southern Brazil. The Fear of Covid-19 scale was used to evaluate fear of Covid. Exposure variables were socioeconomic, demographic, health and pandemic-related factors. Adjusted Poisson regression was performed to assess the association between fear of Covid-19 and the exposure variables. A total of 2,152 subjects were assessed. Higher fear of Covid-19 was found among women and in individuals with symptoms of Covid-19. Living alone, being richer, and testing positive for Covid-19 were associated with lower prevalence of fear. Higher prevalence of fear of Covid-19 was related to worse sleep quality, worse health perception, sadness, higher stress, depressive symptoms, and suicidal ideation. There was a linear association between fear of Covid-19 and health outcomes. The results provide evidence that fear of Covid-19 seems to be associated with socioeconomic, demographic, health and pandemic-related factors.

Transportation Barriers and Health-Related Quality of Life in a Sample of Middle-Aged and Older Adults Living with HIV in the Deep South.

Access to reliable transportation is a social determinant of health imperative for disease management for those aging with HIV/AIDS. To what degree transportation barriers are associated with health-related quality of life (HRQOL) in middle-aged and older people living with HIV (PWH) in the Deep South region of the United States is presently unknown. PWH (n = 261, age range = 39 to 73 years old, 80.1% African American, 64.4% male) were recruited from an academic medical center in the Deep South. Variables included sociodemographics, HIV characteristics, depressive symptoms, HRQOL, and perceived transportation barriers. Spearman rho correlations and linear regressions accounting for covariates were conducted. After accounting for covariates, greater perceived transportation barriers were associated with worse health perceptions, pain, social functioning, health distress, and health transitions. Access to reliable transportation is a key factor in improving health for PWH. Considerations for healthcare and traffic safety are discussed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10461-021-03560-x.

Diabetes mellitus em idosos, prevalência e incidência: resultados do Estudo Fibra

Abstract Objective to estimate the prevalence and incidence of diabetes mellitus in a retrospective cohort of older adults, identify the main factors associated with the disease for both periods 2008-2009 and 2016-2017 and describe the prevalence of diabetes according to overweight status. Method a retrospective longitudinal study with 442 community-dwelling older adults (≥65 years old) participating in the FIBRA study (baseline 2008-2009 and follow-up 2016-2017) in Campinas and Ermelino Matarazzo (São Paulo State). Prevalences were estimated and associations were verified using Pearson’s chi-square test or Fisher’s exact test (p&lt;0.05). Crude and adjusted prevalence ratios for sex, age and education were also estimated using Poisson regression. Results the prevalence of diabetes mellitus increased from 21.95% to 27.46% in nine years (p=0.001), and the incidence was 5.51%. At baseline, the prevalence was higher among older adults who were overweight and had a worse perception of health. Overweight status remained associated at follow-up, together with the presence of two or more chronic diseases and the consumption of 3 to 5 snacks/day. Conclusion in 2008-2009, one in five older adults had diabetes and, in 2016-2017, this ratio was about one in four. The importance of being overweight in determining the disease in both periods is highlighted. Educational interventions, expansion of care coverage, greater frequency of care and multi-professional assessment that considers comorbidities, the social and family insertion of the older adult, and their support network are required.

Abstract 11670: Psychological Distress and Health Status Perception in Patients With a Previous Myocardial Infarction or Stroke

Introduction: While understanding the impact of mental health on health status perception improves patient-centered care, this relationship is not well-established in cardiac patients. We examined the association between psychological distress and health status perception in patients with a previous myocardial infarction (MI) and/or stroke. Methods: We extracted data for patients with a previous MI and/or stroke from the 2019 National Health Interview Survey (NHIS). Health perception was self-reported and grouped as poor/fair (0) or good/very good/excellent (1). Anxiety and depression were estimated using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-8 (PHQ-8) and grouped based on severity. Multivariable logistic regressions controlling for sex, age, education level, smoking status, race, and BMI were performed to assess our hypothesis that higher GAD-7 and PHQ-8 scores are associated with worse health perception in patients with a previous MI/stroke. Results: Of 31,948 individuals for whom data on MI/stroke was available, 6.8% (n=2,181) reported a previous MI and/or stroke. Of these patients, 36.6% (n=799) had scores consistent with anxiety and/or depression on the GAD-7 or PHQ-8. The odds of reporting good/very good/excellent health status were lower for individuals with anxiety (OR 0.245, 95% CI = 0.192-0.314, P &lt;0.001) or depression (OR 0.243, 95% CI = 0.197-0.298, P &lt;0.001) compared to those without anxiety/depression. Increasing severity of anxiety/depression was also associated with worse perception of health status ( Table 1 ). Respondents identifying as “Black” or “Other” race and those with lower education levels also demonstrated significantly worse perceived health status. Conclusion: Patients with previous MI/stroke and concomitant psychological distress have worse perception of health status. Understanding the range of patient health perceptions can help physicians provide more patient-centered care.

Perception of Health, Resilience, and Engagement in Spanish Police Officers During the COVID-19 Pandemic.

During the COVID-19 pandemic, the police force was one of the institutions that was most exposed to possible infections, in addition to suffering stressful situations that affect health. This study aims to independently assess the relationship between demographic, work, and COVID-19 variables, and resilience, engagement, and the perception of health, as well as to evaluate which variables are more important when predicting health perceptions. 640 Spanish police officers were evaluated through a cross-sectional design and online survey. The perception of the lack of personal protective equipment, believing that it is easy to become infected with COVID-19, or working as a police officer were associated with low levels of engagement and resilience and a worse perception of health. More years of experience in the police force was associated with worse health and lower levels of engagement and resilience. Engagement and resilience would be protective variables of health. It is necessary to promote practices related to engagement and resilience in the police force. The discussion emphasizes that more experienced police officers demonstrate less engagement and resilience.

MP52-20 THE IMPACT OF LOWER URINARY TRACT SYMPTOMS (LUTS) ON DEPRESSION AND DEPRESSIVE SYMPTOMS AMONG WOMEN 20-69 YEARS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (MP52)1 Sep 2021MP52-20 THE IMPACT OF LOWER URINARY TRACT SYMPTOMS (LUTS) ON DEPRESSION AND DEPRESSIVE SYMPTOMS AMONG WOMEN 20-69 YEARS Stephanie Gleicher, Timothy Byler, and Natasha Ginzburg Stephanie GleicherStephanie Gleicher More articles by this author , Timothy BylerTimothy Byler More articles by this author , and Natasha GinzburgNatasha Ginzburg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002082.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Studies have shown that women with LUTS have higher rates of depression, anxiety, and overall worse health perception. Correlations have been shown between symptom severity and worsened mental health status. The aim of this study was to compare the impact of varying urinary symptoms, such as SUI, UUI, and nocturia, on depression and depressive symptoms among women aged 20-69 years. METHODS: We queried NHANES between 2013-2018 for women aged 20-69 years. We defined SUI as “leakage during physical activity”, UUI as “leakage during non-physical activity” and nocturia as “≥ 2 voids/night”. Depression was defined by DSM criteria with cases reporting ≥5 symptoms from the patient health questionnaire (PHQ9) depression screening tool. We assessed various demographic and clinical variables such as age, race, education, insurance status, smoking status, hypertension (HTN), hyperlipidemia (HLD), body mass index (BMI), hemoglobin A1c (HbA1c), perceived heath status, and visits to mental health providers. We performed univariate analysis and multivariable logistic regression. RESULTS: Of the 6284 participants, 27% reported nocturia, 42% had SUI, and 9% had UUI. Depression was found in 5% of the cohort. Women with depression were significantly less educated, had less health insurance, more commonly smoked, had HTN and HLD, had higher BMI, and had higher HbA1c. Depressed women were twice as likely to have nocturia (51% vs 26%, p<0.001). 64% of depressed women had SUI and 21% had UUI (p<0.001). Depressed women were three times more likely to have negative health perception (36% vs 9%, p<0.001). Multivariate regression revealed increased risk of depression among women with SUI (OR 1.79, p=0.004) and nocturia (OR 1.65, p=0.007), but not UUI. While evaluating the impact of specific PHQ9 elements and SUI, multivariate analysis revealed significant correlations with “feeling tired” (OR 1.26) and suicidal ideation (OR 1.77). Nocturia and depression were significantly correlated with decreased interest (OR 1.39), poor sleep (OR 1.71), “feeling tired” (OR 1.26) and changes in appetite (OR 1.37). CONCLUSIONS: SUI and nocturia appear to be significantly associated with depression and depressive symptoms. These findings reinforce that LUTS cannot be considered an isolated symptom, but a factor impacting overall mental-health wellbeing. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e938-e938 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephanie Gleicher More articles by this author Timothy Byler More articles by this author Natasha Ginzburg More articles by this author Expand All Advertisement Loading ...

Long-term weight gain in obese COPD patients participating in a disease management program: a risk factor for reduced health-related quality of life

BackgroundLittle is known about how long-term weight gain affects the health perception of COPD patients.ObjectivesThe aim is to evaluate the long-term association of BMI change and health-related quality of life (HRQoL) in obese COPD patients.MethodsClaims and survey data from a COPD disease management program were used to match two groups of COPD patients with BMI ≥ 30 who have differing weight trajectories over a 5-year timespan via propensity score and genetic matching. EQ-5D-5L, including visual analog scale (VAS) and COPD Assessment Test (CAT), were used as outcomes of interest. Sociodemographic and disease-based variables were matched.ResultsOut of 1202 obese COPD patients, 126 with a weight increase of four or more BMI points were matched separately with 252 (propensity score matching) and 197 (genetic matching) control subjects who had relatively stable BMI. For the EQ-5D-5L, patients with BMI increase reported significantly worse health perception for VAS and all descriptive dimensions except pain/discomfort. For the CAT, especially the perception of ability to complete daily activities and overall energy results were significantly worse. VAS differences reach the range of minimal important differences. Stopping smoking and already being in obesity class II were the most influential risk factors for BMI increase.ConclusionObese COPD patients who gain four or more BMI points over 5 years report significantly lower results in different dimensions of generic and disease-specific HRQoL than their peers with stable BMI. To improve real-world outcomes, tracking and preventing specific BMI trajectories could constitute a clinically relevant aspect of managing COPD patients.

Stress, health and lifestyle behaviours during COVID-19 home confinement in portuguese adults

IntroductionThe confinement associated with COVID-19 pandemic was an experience with significant physical and mental health implications, including higher stress levels, decreased sleep quality, pain symptoms and changes in lifestyle behaviours.ObjectivesThe main goal of this study was to analyze the relationship between stress and health variables (sleep, health symptoms, health perception, and lifestyle behaviours) in a Portuguese university during COVID-19 home confinement.MethodsA cross-sectional online survey design was conducted. A sample of 263 Portuguese workers (64.3% females), with mean age of 48.3 years (sd=8.9), filled in the PSS10, answering questions concerning health symptoms (perceived health, pain symptoms and fatigue), lifestyle behaviours (sleep and eating habits, use of alcohol and tobacco) during COVID-19 home confinement. A descriptive statistical analysis, a Pearson correlation analyses and the t Student test, for independent samples, were performed.ResultsThe results showed significant correlations between stress and perceived health (r=-.404; p&lt;.0001), arms pain (r=.212; p=.002), legs pain (r=.201; p=.003), back pain (r=.219; p=.001), headache (r=.289; p&lt;.0001) and fatigue (r=.295; p&lt;.0001). Concerning lifestyle behaviours, the results showed significant correlations between stress and sleep (r=-.552; p&lt;.0001) and stress is significantly higher (p&lt;.0001) in individuals who have changed their eating habits.ConclusionsDuring the COVID-19 home confinement, higher stress levels are associated with a worse perception of health, more pain symptoms (legs, arms, back, headache), worse sleep quality and more fatigue. Moreover, the individuals with higher levels of stress have changed their eating habits. Lastly, health promotion interventions are needed in order to minimize the impact of home confinement in health.

Depression in the elderly of a rural region in Southern Brazil.

The aim of this study is to estimate the prevalence of depression and its associated factors in elderly residents of the rural area of Rio Grande/RS. In this cross-sectional population-based study performed with 994 elderly (≥ 60 years), whose sampling was based on the 2010 Demographic Census, the Patient Health Questionnaire 9 (PHQ-9) was used for Major Depressive Episode (EDM) screening. Descriptive, bivariate and multivariate analyses were performed using logistic regression. The overall prevalence for Major Depressive Episode screening was 8.1%. The variables independently associated with depression were: female gender, continuous use of medications, chronic diseases, body mass index and worse health perception. The creation of programs target at the elderly in the rural area, aimed at screening, early diagnosis of depression and maintenance of treatment, encompassing several factors related to health, are important actions that must be fostered by the health system.

Prevalência de insuficiência cardíaca e associação com saúde autorreferida no Brasil

A insuficiência cardíaca (IC) é um desafio na saúde mundial. A saúde autorreferida (SAR) é preditora de morbimortalidade e é categorizada em saúde autorreferida boa (SAR B) e precária (SAR P). Objetivo: Estimar a prevalência da IC e associação com a SAR no Brasil. Métodos: Este estudo utilizou dados da Pesquisa Nacional de Saúde (PNS) em 2013, com dados válidos para 59.655 adultos (≥ 18 anos). A prevalência de IC relacionou-se às características sociodemográficas, percepção do estado de saúde (SAR, percepções de saúde física e mental), diagnóstico de depressão e prática de exercício físico. Utilizou-se a regressão de Poisson com variância robusta. Resultados: O diagnóstico de IC foi referido por 1,1% dos entrevistados. Observou-se que ter o diagnóstico médico de IC aumenta em quatro vezes a chance de ter pior percepção de saúde (OR = 4,17; IC95% 3,65–4,76), contudo essa medida reduz para menos da metade, quando ajustado por faixa etária e percepção da saúde física (OR = 1,78; IC95% 1,52–2,08). Conclusão: A prevalência de IC representou 1,7 milhões de indivíduos com essa enfermidade na população brasileira. A estreita associação entre IC e SAR precária evidenciou aumento de 78% de chance do indivíduo que tenha IC relatar SAR precária.

Influência do funcionamento ocupacional e percepção de saúde na capacidade para o trabalho de trabalhadores da assistência social.

Objective: To analyze occupational functioning, health’s perception and work capacity of social assistance workers in the municipality of Uberaba, Brazil. Method: 41 workers were evaluated through a socio-demographic and occupational questionnaire, the self-evaluation scale of Occupational Functioning (SAOF) and the Index of Capacity for Work (ICT). A descriptive analysis was carried out as well as Spearman and Mann-Whitney-U correlations. Results: Sample with an average of 40 years (65,9 % female) and 56,1 % occupied higher level functions. The majority (70,8%) evaluated their health as good / very good; 29,2 %, as regular / bad / very bad. The ICT average was 38.88 points (DP = 6.8) with a significant association with the variables: sex (p = 0.028), higher level function (p = 0.039), pain (p = 0.004), and health perception (p = 0.008). WC and occupational functioning were correlated in the following fields: personal causality (p = 0.029), habits (p = 0.011), skill (p = 0.011), and environment (p = 0.006). Conclusion: Capacity for work was associated with pain, worse health perception, higher level functions, sex, worse personal causality, unhealthy habits and lower repertoire of skills and environment.

Prevalence and patterns of multimorbidity in Amazon Region of Brazil and associated determinants: a cross-sectional study

ObjectivesTo estimate the prevalence of multimorbidity and to identify factors associated with it in the adult population from the metropolitan region of Manaus.DesignCross-sectional population-based study.SettingInterviews conducted between May and August...

Decisional conflict among people with diabetes mellitus or hypertension attending primary care

Decisional conflict refers to the personal uncertainty about which course of action to take when the choice involves risk, regret, or challenge to personal life values. To determine the level of decisional conflict (DC) of people with Diabetes Mellitus (DM) or High Blood Pressure (HBP) attending primary care centers (PCC) in Chile. A Spanish version of the Decisional Conflict Scale (DCS) was applied to patients who were recruited if they had DM or HBP, were 18 years old or older, and had an appointment at the PCC the day of the recruitment. The scale was self-administered. Analysis of covariance (ANCOVA) was used to determine association between DC and other variables of interest while controlling confounding variables. The scale was answered by 1075 participants from 24 PCC aged 62 ± 14 years (74% female). Average score for the DCS scale was 16.8 ± 12.9 of a maximum of 100 points indicating a higher DC. The sub-scale "information" had the highest score (19.9 ± 20.0). Low educational level and older age were significantly associated with higher DCS scores (p < 0.05). Having a bad health perception, deciding to initiate a medical treatment and being attended by a doctor were significantly associated with higher DC. These associations persisted when confounding variables such as sex, age and education were controlled. People with DM or HBP who have a poor health perception, who initiated their treatment and were attended by a doctor had higher levels of DC, independent of their age and educational level.

Geographical variation of overweight, obesity and related risk factors: Findings from the European Health Examination Survey in Luxembourg, 2013-2015.

The analyses of geographic variations in the prevalence of major chronic conditions, such as overweight and obesity, are an important public health tool to identify “hot spots” and inform allocation of funding for policy and health promotion campaigns, yet rarely performed. Here we aimed at exploring, for the first time in Luxembourg, potential geographic patterns in overweight/obesity prevalence in the country, adjusted for several demographic, socioeconomic, behavioural and health status characteristics. Data came from 720 men and 764 women, 25–64 years old, who participated in the European Health Examination Survey in Luxembourg (2013–2015). To investigate the geographical variation, geo-additive semi-parametric mixed model and Bayesian modelisations based on Markov Chain Monte Carlo techniques for inference were performed. Large disparities in the prevalence of overweight and obesity were found between municipalities, with the highest rates of obesity found in 3 municipalities located in the South-West of the country. Bayesian approach also underlined a nonlinear effect of age on overweight and obesity in both genders (significant in men) and highlighted the following risk factors: 1. country of birth for overweight in men born in a non-European country (Posterior Odds Ratio (POR): 3.24 [1.61–8.69]) and women born in Portugal (POR: 2.44 [1.25–4.43]), 2. low educational level (secondary or below) for overweight (POR: 1.66 (1.06–2.72)] and obesity (POR:2.09 [1.05–3.65]) in men, 3. single marital status for obesity in women (POR: 2.20 [1.24–3.91]), 4.fair (men: POR: 3.19 [1.58–6.79], women: POR: 2.24 [1.33–3.73]) to very bad health perception (men: POR: 15.01 [2.16–98.09]) for obesity, 5. sleeping more than 6 hours for obesity in unemployed men (POR: 3.66 [2.02–8.03]). Protective factors highlighted were: 1. single marital status against overweight (POR: [0.60 (0.38–0.96)]) and obesity (POR: 0.39 [0.16–0.84]) in men, 2. the fact to be widowed against overweight in women (POR: [0.30 (0.07–0.86)], as well as a non European country of birth (POR: 0.49 [0.19–0.98]), tertiary level of education (POR: 0.34 [0.18–0.64]), moderate alcohol consumption (POR: 0.54 [0.36–0.90]) and aerobic physical activity practice (POR: 0.44 [0.27–0.77]) against obesity in women. A double burden of environmental exposure due to historic mining and industrial activities and past economic vulnaribility in the South-West of the country may have participated to the higher prevalence of obesity found in this region. Other demographic, socioeconomic, behavioural and health status covariates could have been involved as well.

Abuse of Rural Elders in Mansoura Districts, Dakahlia, Egypt: Prevalence, Types, Risk Factors, and Lifestyle.

This study was carried out to explore the prevalence of elderly abuse, identify its types, associated risk factors and determine quality of their life in Rural Mansoura districts, Egypt. A cross-section study was conducted on a sample of 272 elders recruited from outpatient clinicsFamily Health Centers in Shawa & Berkin villages from May 1 to September 3, 2016. 200 (73.5%) elders accepted participation. A previously designed and validated questionnaires were used to collect data from participants. 46% of the studied elders were abused. The most frequent forms of abuse were negligence (40%) followed by psychological abuse (30.5%). Abuse was significantly higher among females (56.5%), farmers (67.2%), illiterates (55.5%) and living alone elders (68.5%). Elders with chronic diseases were significantly more abused (54.9%) especially diabetic and hypertensive elders (71.4%). Concerning lifestyle of the studied elders, 21% of them had bad health perception generally. The study showed that dependent elders exposed significantly to higher rates of abuse than independents with highly statistical significant.Logistic regression analysis revealed that being a female and previously working as farmer are 2.5 and 4.6 times more likely to be abused. On the other hand, sharing house with other partner or offspring and absence of chronic diseases are protective predictors against elder abuse. Governmental and NGOS support to elders in rural areas especially females and famers is highly recommended. Health insurance is necessary for health promotion, reduction of chronic disease and or disability to decrease dependency is crucial.