Worse Health Status Research Articles

Recovery and symptom trajectories up to two years after SARS-CoV-2 infection: population based, longitudinal cohort study

ObjectiveTo evaluate longer term symptoms and health outcomes associated with post-covid-19 condition within a cohort of individuals with a SARS-CoV-2 infection.DesignPopulation based, longitudinal cohort.SettingGeneral population of canton of Zurich, Switzerland.Participants1106...

Cardio-Renal-Metabolic Overlap, Outcomes, and Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction

BackgroundCardio-renal-metabolic (CRM) conditions are individually common among patients with heart failure (HF), but the prevalence and influence of overlapping CRM conditions in this population have not been well-studied. ObjectivesThis study aims to evaluate the impact of overlapping CRM conditions on clinical outcomes and treatment effects of dapagliflozin in HF. MethodsIn this post hoc analysis of DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure), we evaluated the prevalence of comorbid CRM conditions (atherosclerotic cardiovascular disease, chronic kidney disease, and type 2 diabetes), their impact on the primary outcome (cardiovascular death or worsening HF), and treatment effects of dapagliflozin by CRM status. ResultsAmong 6,263 participants, 1,952 (31%), 2,245 (36%), and 1,236 (20%) had 1, 2, and 3 additional CRM conditions, respectively. HF alone was uncommon (13%). Greater CRM multimorbidity was associated with older age, higher body mass index, longer-duration HF, worse health status, and lower left ventricular ejection fraction. Risk of the primary outcome increased with higher CRM overlap, with 3 CRM conditions independently associated with highest risk of primary events (adjusted HR: 2.16 [95% CI: 1.72-2.72]; P < 0.001) compared with HF alone. Relative benefits of dapagliflozin on the primary outcome were consistent irrespective of the type of CRM overlap (Pinteraction = 0.773) and by the number of CRM conditions (Pinteraction = 0.734), with greatest absolute benefits among those with highest CRM multimorbidity. Estimated 2-year numbers needed to treat with dapagliflozin to prevent 1 primary event were approximately 52, 39, 33, and 24 for participants with 0, 1, 2, and 3 additional CRM conditions at baseline, respectively. Adverse events between treatment arms were similar across the CRM spectrum. ConclusionsCRM multimorbidity was common and associated with adverse outcomes among patients with HF and left ventricular ejection fraction >40% in DELIVER. Dapagliflozin was safe and effective across the CRM spectrum, with greater absolute benefits among those with highest CRM overlap (Dapagliflozin Evaluation to Improve the LIVEs of Patients With Preserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213)

Determinants of intimate partner controlling behavior targeting women in Türkiye.

Intimate partner controlling behavior toward women is an important form of intimate partner violence (IPV), both in terms of limiting women's daily lives and in terms of reproducing patriarchal culture and male dominance in societies at the micro level. A limited number of studies in the literature have identified the male intimate partner's controlling behavior as a dependent variable, which is important for understanding the determinants of this type of IPV. There is also a significant gap in the literature in terms of studies focusing on the case of Türkiye. Thus, the main aim of this study was to determine the socio-demographic, economic and violence-related factors that have an effect on women's status in terms of exposure to control behavior in Türkiye. These factors were examined by using binary logistic regression analysis, based on the micro data set collected by the Hacettepe University's Institute of Population Studies in the 2014-dated National Research on Domestic Violence against Women in Türkiye. A total of 7,462 women between the ages of 15 and 59 were interviewed face-to-face. The findings of the study revealed that women are more likely to be exposed to controlling behavior if they live in rural areas, are unmarried, speak Turkish as their mother tongue, have bad or very bad health conditions, justify men's violence and are afraid of their intimate partners. As women's age, level of education and income contribution increase, their likelihood of exposure to controlling behavior decreases. However, women's exposure to economic, physical and emotional violence also increases their likelihood of exposure to controlling behavior. The findings highlighted the importance of creating public policies that make women less vulnerable to men's controlling behavior, providing women with methods and mechanisms of resistance and raising public awareness of the exacerbating effects of controlling behavior on social inequalities.

Duration of Heart Failure With Preserved Ejection Fraction and Outcomes With Sacubitril/Valsartan: Insights From the PARAGON-HF Trial

In this post hoc analysis of the PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HFpEF) trial, we evaluated clinical outcomes and responses to sacubitril/valsartan by duration of heart failure (HF) with left ventricular ejection fraction ≥ 45% at initial diagnosis. The primary outcome was a composite of total hospitalizations due to HF and cardiovascular deaths, analyzed by using a semiparametric proportional rates method, stratified by geographic region. Among 4784 (99.7%) randomized participants in the PARAGON-HF trial for whom baseline HF duration was captured, 1359 (28%) had durations of HF of < 6 months, 1295 (27%) of 6 months-2 years, and 2130 (45%) of > 2 years. Longer HF duration was associated with higher comorbidity burdens, worse health status and lower rates of prior hospitalization due to HF. Over a median follow-up of 35 months, longer HF duration was associated with a higher risk of first and recurrent primary events (per 100 patient-years): < 6 months, 12.0 (95% CI, 10.4-14.0); 6 months-2 years, 12.2 (10.6-14.2); > 2 years, 15.8 (14.2-17.5). Relative treatment effects of sacubitril/valsartan vs valsartan were consistent, irrespective of baseline HF duration on the primary endpoint (Pinteraction = 0.112). Clinically meaningful (≥ 5 point) improvements in Kansas City Cardiomyopathy Questionnaire-Clinical Summary Scores were also similarly observed, irrespective of HF duration; (Pinteraction = 0.112). Adverse events were similar between treatment arms across HF duration categories. In PARAGON-HF, longer HF duration was independently predictive of adverse HF outcomes. Treatment effects of sacubitril/valsartan were consistent, irrespective of baseline HF duration, suggesting that even ambulatory patients with longstanding HFpEF and predominantly mild symptoms stand to benefit from treatment optimization.

One-year change in the health status predicts the subsequent hospitalization and mortality in patients waitlisted for lung transplantation in Japan

BackgroundPoor health-related quality of life (HRQL) at the registration for lung transplantation is related to waitlist mortality. We investigated the relationship between 1-year change in HRQL and subsequent outcomes in patients waitlisted for lung transplantation. MethodsIn a 5-year longitudinal study, we analyzed the factors related to waitlist mortality in 197 lung transplant patients registered on the Japan Organ Transplant Network. HRQL was assessed using St. George's Respiratory Questionnaire (SGRQ), and factors related to changes in SGRQ scores were evaluated after 1 year. We assessed the relationship between the 1-year change in SGRQ score and subsequent mortality or hospitalization. ResultsAmong 197 patients, 108 remained waitlisted during the first-year assessment. During the median follow-up period of 469 d, 28 patients died, and 54 underwent lung transplantation. Univariate Cox proportional hazards analysis revealed that the changes in all components and total score of the SGRQ after 1 year were associated with waitlist mortality (p < 0.05). Stepwise multivariate analysis revealed that the 1-year changes in SGRQ scores were significantly related to waitlist mortality. Forty-three patients with worsened HRQL after 1 year had higher likelihoods of hospitalization (p = 0.038) and mortality (p = 0.026) after 1 and 4 years of follow-up, respectively, than 61 patients without worsened HRQL. ConclusionsPatients with worsened health status during the first year after registration had higher likelihoods of hospitalization and mortality after 1 and 4 years of follow-up, respectively, than those without worsened HRQL. Strategies to improve health status while waiting are needed to reduce waitlist hospitalization or mortality.

Patient report outcomes in cryoballoon ablation of atrial fibrillation during the COVID Era: Insights from the 1STOP project.

Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of patients with symptomatic atrial fibrillation (AF). AF symptoms are highly subjective; however, they are important outcomes for the patient. The aim is to describe the use and impact of a web-based App to collect AF-related symptoms in a population of patients who underwent PVI-C in seven Italian centers. A patient App to collect AF-related symptoms and general health status was proposed to all patients who underwent an index PVI-C. Patients were divided into two groups according to the utilization of the App or the non-usage. Out of 865 patients, 353 (41%) subjects composed the App group, and 512 (59%) composed the No-App group. Baseline characteristics were comparable between the two cohorts except for age, sex, type of AF, and body mass index. During a mean follow-up of 7.9±13.8 months, AF recurrence was found in 57/865 (7%) subjects with an annual rate of 7.36% (95% CI:5.67-9.55%) in the No-App versus 10.99% (95% CI:9.67-12.48%) in the App group, p=0.007. In total, 14,458 diaries were sent by the 353 subjects in the App group and 77.1% reported a good health status and no symptoms. In only 518 diaries (3.6%), the patients reported a bad health status, and bad health status was an independent parameter of AF recurrence during follow-up. The use of a web App to record AF-related symptoms was feasible and effective. Additionally, a bad health status reporting in the App was associated with AF recurrence during follow-up.

Views and experiences of primary care among Black communities in the United Kingdom: a qualitative systematic review

ABSTRACT Background In the United Kingdom, people with non-white ethnicities are more likely to report being in worse health conditions and have poorer experiences of healthcare services than white counterparts. The voices of those of Black ethnicities are often merged in literature among other non-white ethnicities. This literature review aims to analyse studies that investigate Black participant experiences of primary care in the UK. Methods We conducted a systematic literature review searching Medline, Web of Science, EMBASE, SCOPUS, Social Policy and Practice, CINAHL plus, Psych INFO and Global Health with specific search terms for appropriate studies. No publish date limit was applied. Results 40 papers (39 articles and 1 thesis) were deemed eligible for inclusion in the review. A number of major themes emerged. Patient expectations of healthcare and the health seeking behaviour impacted their interactions with health systems in the UK. Both language and finances emerged as barriers through which some Black participants interacted with primary care services. (Mis)trust of clinicians and the health system was a common theme that often negatively impacted views of UK primary care services. The social context of the primary care service and instances of a cultural disconnect also impacted views of primary care services. Some papers detail patients recognising differential treatment based on ethnicity. The review included the voices of primary care professionals where descriptions of Black patients were overwhelmingly negative. Conclusion Views and experiences of Black groups may be radically different to other ethnic minorities and thus, should be teased out of broader umbrella terms like Black and Asian Minority Ethnic (BAME) and Black Minority Ethnic (BME). To address ethnicity-based health inequalities, culturally sensitive interventions that engage with the impacted community including co-designed interventions should be considered while acknowledging the implications of being racialised as Black in the UK.

Identification of neighborhood clusters on data balanced by a poset-based approach

The identification of territorial clusters where the population suffers from worse health conditions is an important topic in social epidemiology, in order to identify health inequalities in cities and provide health policy interventions. This objective is particularly challenging because of the mechanism of self-selection of individuals into neighborhoods, which causes selection bias. The aim of this paper consists in the identification of neighborhood clusters where elderly people living in Turin, a city in north-western Italy, are exposed to an increased risk of hospitalized fractures. The study is based on administrative data and is a retrospective, observational cohort study. It is composed by a first phase, in which the individual confounding variables are balanced across neighborhoods in order to make them comparable, and a second phase in which the neighborhoods are aggregated into clusters characterized by significantly higher health risk. In the first phase we exploited a balancing technique based on partially ordered sets (poset), called Matching on poset based Average Rank for Multiple Treatments (MARMoT). On the balanced dataset, we used a spatial scan to identify the presence of clusters and we checked whether the risk of fracture is significantly higher in some contiguous areas. The combination of both MARMoT procedure and spatial scan makes it possible to highlight two clusters of neighborhoods in Turin where the risk of incurring hospitalized fractures for elderly people is significantly higher than the mean. These results could have important implications for the implementation of health policies.

The association between social determinants of health and patient-centred outcomes in adults with heart failure with reduced ejection fraction.

To explore the associations between social determinants of health and patient-centred outcomes among adults with chronic heart failure with reduced ejection fraction. Cross-sectional online self-report survey. A survey assessing social determinants of health (demographics, socio-economic position, affordability of care and social support) and patient-centred outcomes, including the Kansas City Cardiomyopathy Questionnaire-12 and validated measures of medication adherence, treatment satisfaction, treatment burden and mental health, was completed by 512 adults with chronic heart failure with a reduced ejection fraction between 06 March and 29 June 2020. Multivariable analyses included linear and logistic regression. Female gender, having a care partner, and being offered financial assistance with medications were associated with worse health status, while perceiving medication as affordable and being married were associated with better health status. Females and having Medicaid, dual Medicaid/Medicare or no medical insurance were associated with a higher likelihood of depression, and non-white race/ethnicity was associated with less depression. Medication adherence was lower in patients having a care partner and offered financial assistance. Patients being offered financial and medication management assistance were more likely to be overwhelmed by the treatment burden, whereas those having some college education were less so. Social determinants of health are associated with patients' disease-specific health status, mental health and treatment satisfaction and burden. These findings underscore the importance of assessing social determinants of health in clinical practice and the need for developing and testing novel strategies to determine whether they improve patients' health. The relationship between social determinants of health- and patient-centred outcomes was assessed; affordability of care and social support factors were most strongly associated with outcomes for patients with chronic heart failure and reduced ejection fraction, underscoring the importance of assessing social determinants of health in routine clinical care. Social determinants of health data could potentially inform care delivery for patients with heart failure and reduced ejection fraction by helping to identify those who require additional support to manage their symptoms, access care and adhere to treatment. Social support and affordability of treatment were associated with most patient-centred outcomes, suggesting these factors may provide clinicians with an indicator of a patient's level of general well-being that could be assessed during routine follow-up care. This research followed the STROBE checklist for cross-sectional studies. Adults who have heart failure with reduced ejection fraction that consented to participate in the study provided the data used for all analyses reported on in the manuscript. Service users, caregivers or members of the public had no involvement in the study.

B-55 | Impact of Baseline Tricuspid Regurgitation on Health Status and Clinical Outcomes After Transcatheter Aortic Valve Replacement: Insights from the STS/ACC TVT Registry

Tricuspid regurgitation (TR) is associated with worse clinical outcomes after TAVR. Little is known about the association between TR and health status outcomes after TAVR. Health status was assessed with the Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) in patients enrolled in the STS/ACC TVT Registry who underwent isolated TAVR between Jan 2019-Jun 2021. Multivariable logistic and cox regression models were used to evaluate the association of TR with being alive and well and clinical outcomes (deaths and readmission) respectively at 1 year. We included 130,097 patients who underwent TAVR (mean age 79.2±8.3 years, STS score 5.3±4.6%, 56.2% men, 13.1% moderate TR, 2.3% severe TR). Mean baseline KCCQ-OS was significantly lower in patients with severe vs moderate vs none/trace/mild TR (39.4±24.2 vs 45.2±24.7 vs 51.3±25.3; p<0.0001). Greater baseline TR was also associated with lower KCCQ-OS at 30 days and 1 year (Figure A). Compared with patients with none/trace/mild TR, moderate, and severe TR had lower odds of being alive and well at 1 year after TAVR [adjOR 0.79 (0.74-0.85); adjOR 0.81 (0.70-0.94), respectively; Figure B]. Further, moderate, and severe TR were both associated with higher mortality [adjHR 1.24 (1.15-1.34); adjHR 1.65 (1.46-1.86)], and readmission [adjHR 1.07 (1.01-1.12); adjHR 1.11 (1.01-1.21)] at 1 year in comparison with none/trace/mild TR (Figure C). The presence of baseline moderate or severe TR is associated with worse health status and clinical outcomes after TAVR. Future studies should focus on whether treatment of baseline TR improves outcomes among TAVR recipients.

Sex Difference in Outcomes of Acute Myocardial Infarction in Young Patients

BackgroundYounger women experience worse health status than men after their index episode of acute myocardial infarction (AMI). However, whether women have a higher risk for cardiovascular and noncardiovascular hospitalizations in the year after discharge is unknown. ObjectivesThe aim of this study was to determine sex differences in causes and timing of 1-year outcomes after AMI in people aged 18 to 55 years. MethodsData from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, which enrolled young patients with AMI across 103 U.S. hospitals, were used. Sex differences in all-cause and cause-specific hospitalizations were compared by calculating incidence rates ([IRs] per 1,000 person-years) and IR ratios with 95% CIs. We then performed sequential modeling to evaluate the sex difference by calculating subdistribution HRs (SHRs) accounting for deaths. ResultsAmong 2,979 patients, at least 1 hospitalization occurred among 905 patients (30.4%) in the year after discharge. The leading causes of hospitalization were coronary related (IR: 171.8 [95% CI: 153.6-192.2] among women vs 117.8 [95% CI: 97.3-142.6] among men), followed by noncardiac hospitalization (IR: 145.8 [95% CI: 129.2-164.5] among women vs 69.6 [95% CI: 54.5-88.9] among men). Furthermore, a sex difference was present for coronary-related hospitalizations (SHR: 1.33; 95% CI: 1.04-1.70; P = 0.02) and noncardiac hospitalizations (SHR: 1.51; 95% CI: 1.13-2.07; P = 0.01). ConclusionsYoung women with AMI experience more adverse outcomes than men in the year after discharge. Coronary-related hospitalizations were most common, but noncardiac hospitalizations showed the most significant sex disparity.

Urban water crisis and its relationship to health inequities against black communities in the USA: Spatial analytics of the Jackson region in Mississippi

Water is one of the core elements in the urban energy-water nexus and plays key roles in urban resilience and sustainable development. Recently, there were a number of urban water crises occurred in majority-black cities in the USA, and health disparities were observed crucial in these cities. However, there is very limited research exploring the relationship between urban water crisis and health disparities. Using the Jackson region in Mississippi, USA as the study area, this study designed a research protocol for the exploration of health inequities against black communities and the contribution of urban water crisis to health inequities in the Jackson region. In addition to mental and physical health status, nine health outcomes of diseases were first applied to the spatial differentiation analysis based on the prevalence at the census tract level between Jackson and its eight peripheral cities. Two spatially and significantly differentiated regions were identified and mapped, most communities in Jackson form the critical health core, while the four peripheral cities of Madison, Ridgeland, Flowood, and Brandon composite the healthiest city belt in the Jackson region. The linear regression and spatial regression models were then designed with the prevalence of 11 types of health status as response, in addition to the percent of black people and the urban water crisis as two explanatory variables. Given the significant spatial autocorrelation in the health data and the significant Rho and Lambda in the spatial modeling process, the spatial error model fitted best with R-squared from about 0.5 to 0.9, and both the percent of black people and the urban water crisis highly contribute to the worse health status in the critical health core within Jackson on five types of diseases of high blood pressure, teeth lost, obesity, diabetes, and physical health, and their effects on asthma, kidney, coronary heart disease, mental health, chronical obstructive pulmonary, and stroke are significant too but relatively lower than the above five diseases. The Jackson city experiences social and environmental injustice and the consequent racial and health inequities, which will impede the urban resilience and sustainability. The federal and state governments need address these health inequities.

Sociobehavioral, Biological, and Health Characteristics of Riverside People in the Xingu Region, Pará, Brazil.

This study aimed to evaluate the sociodemographic, behavioral, and biological profile and its relationship with the emergence of chronic non-communicable diseases in riverside populations in the Xingu region, Pará, Brazil. Characteristics related to health indicators and which risk factors are considered most important were analyzed. This is a cross-sectional, exploratory, and descriptive study. The sample consisted of riverside people of over 18 years of both sexes. The sample size (n = 86) was calculated with a confidence level of 95% and a sample error of 5%. The K-means clustering algorithm was adopted through an unsupervised method to divide the groups, and the values were expressed as a median. For continuous and categorical data, the Mann-Whitney and chi-square tests were used, respectively, and the significance level was set at p < 5%. The multi-layer perceptron algorithm was applied to classify the degree of importance of each variable. Based on this information, the sample was divided into two groups: the group with low or no education, with bad habits and worse health conditions, and the group with opposite characteristics. The risk factors considered for cardiovascular diseases and diabetes in the groups were low education (p < 0.001), sedentary lifestyle (p < 0.01), smoking, alcoholism, body mass index (p < 0.05), and waist-hip ratio, with values above the expected being observed in both groups. The factors considered important so as to be considered to have good health condition or not were the educational and social conditions of these communities, and one part of the riverside population was considered healthier than the other.

The moderating role of neighborhood disadvantage on the link between functional limitations and self-rated health.

Self-rated health is an important health outcome and determinant of health. Improvements to our understanding on self-rated health could help design plans and strategies to improve self-rated health and achieve other preferred health outcomes. This study examined whether the link between functional limitations and self-rated health varies by neighborhood socioeconomic status. This study used the Midlife in the United States study linked with the Social Deprivation Index developed by the Robert Graham Center. Our sample consist of noninstitutionalized middle to older adults in the United States (n = 6,085). Based on stepwise multiple regression models, we computed adjusted odds ratios to examine the relationships between neighborhood socioeconomic status, functional limitations, and self-rated health. Respondents in the socioeconomically disadvantaged neighborhoods were older, had higher percentage of females, non-White respondents, lower educational attainment, lower perceived neighborhood quality, and worse health status with greater number of functional limitations than those in socioeconomically advantaged neighborhoods. Results showed a significant interaction was found where neighborhood-level discrepancies in self-rated health was biggest among individuals with highest number of functional limitations (B = -0.28, 95% CI[0.53, -0.04], p = 0.025). Specifically, individuals with the highest number of functional limitations from the disadvantaged neighborhoods had higher self-rated health compared to those from advantaged neighborhoods. Our study findings highlight that neighborhood discrepancy in self-rated health is underestimated particularly among those with severe functional limitations. Moreover, when interpreting self-rated health status, values should not be taken face value, and should be considered together with the environmental conditions of where one resides.

Assessment of the awareness of patients with type 2 diabetes of their disease: A multi-center cross-sectional study in Lebanon

Background: This study aims to estimate the knowledge, attitude, and practices of patients with diabetes towards the disease and to assess the predictors of a higher awareness of diabetes. Methods: A multi-center cross-sectional study was performed targeting 384 patients from five endocrinology clinics in Lebanon. A self-reported survey was developed and validated and an awareness score was generated. Results: Around 18% of patients reported that they stopped taking diabetes medication when feeling good and 21.1% stopped them when in bad health status. In the case of hyperglycemia, 16.6% said that they doubled the dose of medication, and 14.6% stopped taking it when fasting. The mean awareness score of patients was 15.7±3.9 over 25. After adjusting for covariates, The odds for higher awareness were 2.24 and 3.11 times higher among patients with higher education levels. These odds were 38% lower among patients with medical assistance at home. Physical activity significantly increased the odds of high awareness than those not practicing. Conclusion: Moderate awareness was noted among patients with lower knowledge of the symptoms of diabetes and good practices. Practice implications: Based on the findings of this study, healthcare stakeholders can explore the knowledge gaps and promote targeted interventions.

The Spatial Variability of the Sex and Age- Specific 10-Year Incidence of Cardiovascular Diseases and its Clinical Risk Factors in Athens Metropolitan Area: a Local Statistical Modelling Approach in the Context of the ATTICA Epidemiological Study

According to the published European public health policies, emphasis should be given on the identification of high-risk areas, in terms of both Cardiovascular Diseases (CVDs) incidence, as well as of its main clinical risk factors. Thus, we aimed to investigate: (a) the geographical variability of the sex and age-specific 10-year incidence of CVDs and its clinical risk factors in the Athens metropolitan area, the most urbanised city in Greece accounting for about 35% of the total Greek population, and (b) the spatial heterogeneity of the association between the main clinical risk factors and the 10-year CVD incidence at an aggregated level. Data regarding the 10-year CVD incidence (% of population in each municipality with any CVD after the 10-year period), as well as the prevalence of the risk factors (obesity, hypertension, diabetes mellitus, hypercholesterolaemia; expressed as % of population in each municipality) were provided by the ATTICA epidemiological study for 2020 individuals found during the 10-year follow-up with complete data for locality geocoding. Socio-economic, demographic, and environmental characteristics for each municipality of the Attica region, were obtained from official national and international databases. A local statistical modelling approach, namely the Geographically Weighted Regression, was implemented in order to investigate the associations at a local level and therefore give emphasis on the design of more effective public health programs, taking into account the special characteristics of each area. Hypercholesterolaemia was found to be the most prevalent clinical risk factor in the study area, while higher prevalence for all the risk factors were presented in areas of lower socioeconomic status (SES), where a significantly higher number of new CVD cases in the decade were detected as well. 10-year CVD incidence was also found to be significantly elevated in areas characterized by worse health status in terms of the risk factors’ prevalence, while the sex and age- specific CVD incidence rates were found to be differently affected by these factors. Interestingly, despite the fact that CVDs are acknowledged as a man’s disease, areas of higher (South & North) and moderate (East) SES were found to be characterized by higher CVD incidence rates in females, while in areas of lower SES (West), higher CVD incidence rates were found in males. In line with the current European policy, the identification of areas where the intensity of the studied associations is stronger, can be considered a crucial methodological aspect for the design and implementation of more effective CVD prevention programs at the community level.

The importance of disability representation to address implicit bias in the workplace.

People are disabled by barriers in society, not by their impairment. Barriers can be physical or be caused by people's implicit and explicit attitudes towards people with disabilities. We utilise the Implicit Association Test to investigate implicit attitudes towards people with disabilities among Human Resource professionals and people involved in making hiring decisions. We find no significant differences between people who work for large companies or Small- to Medium-sized Enterprises. Similarly, working in Human Resources (or making recruitment decisions) has no effect on implicit bias. We supply the first evidence linking a person's own health status (measured using EQ-5D-5L) to their implicit bias. We find that a worse health status is associated with lower implicit bias towards people with disabilities. In addition, we find women have lower implicit bias than men. The discussion reflects on the need for greater disability representation within the workplace - especially in making hiring decisions.

PENILAIAN KESEHATAN TAHURA BANTEN PADA BLOK KOLEKSI TUMBUHAN DAN ATAU SATWA

Banten Forest Park is one of the conservation areas with an area of 1,595.9 ha whose management is divided into five large blocks, one of which is a collection block of plants and or animals. Tahura Banten has the potential to have a fairly high economic and ecological value, it needs an important role in knowing the current forest conditions that allow for changes and trends in it by conducting forest health assessments. Tahura health can be assessed through biodiversity in a Region of Tahura identified as the criteria for the sustainability of forest ecosystems. The purpose of this study is to conduct a health assessment of Tahura Banten on the Plant and or Animal Collection Block which is intended to assess and report the current health condition (status) of Tahura based on ecological indicators of forest health. This research was conducted in November to December 2021 at the Plant and or Animal Collection Block in Tahura Banten. Data collection is carried out by creating a tahura health measurement plot using the Forest Health Monitoring method. Analysis of ecological indicators used in this study in the form of biodiversity, vitality (header conditions) and productivity. The results of data processing resulted in the value of the diversity status of tree types (H'), header conditions (VCRs), and productivity (LBDS) in 10 (ten) plot clusters. Tahura's health category is obtained based on the final value. The results of the data obtained can be categorized as 30% good, 40% moderate and 30% bad health conditions. The results of this study showed that the value of Tahura Health is in a moderate condition with a threshold value of 4,187-5,692 of 40%, which is able to define Tahura Banten in the Plant and or Animal Collection Block has a fairly healthy condition.

A national survey of Iranian general population to estimate a value set for the EQ-5D-5L.

The main aim of this study is to estimate a national value set of the EQ-5D-5L questionnaire for Iran. The composite time trade-off (cTTO) and discrete choice experiment (DCE) methods; and the protocol for EuroQol Portable Valuation Technology (EQ-PVT) were used to estimate the Iran national value set. 1179 face-to-face computer-assisted interviews were conducted with adults that were recruited from five Iran major cities in 2021. Generalized least squares, Tobit, heteroskedastic, logit, and hybrid models were used to analyze the data and to identify the best fitting model. According to the logical consistency of the parameters, significance levels and prediction accuracy indices of the MAE; a heteroscedastic censored Tobit hybrid model combining cTTO and DCE responses was considered as the best fitting model to estimate the final value set. The predicted values ranged from -1.19 for the worst health state (55555) to 1 for full health (11111), with 53.6% of the predicted values being negative. Mobility was the most influential dimension on health state preference values. The present study estimated a national EQ-5D-5L value set for Iranian policy makers and researchers. The value set enables the EQ-5D-5L questionnaire to use to calculate QALYs to assist the priority setting and efficient allocation of limited healthcare resources.

Meal-timing patterns and chronic disease prevalence in two representative Austrian studies

PurposeThis study aimed at describing meal-timing patterns using cluster analysis and explore their association with sleep and chronic diseases, before and during COVID-19 mitigation measures in Austria.MethodsInformation was collected in two surveys in 2017 (N = 1004) and 2020 (N = 1010) in representative samples of the Austrian population. Timing of main meals, nighttime fasting interval, last-meal-to-bed time, breakfast skipping and eating midpoint were calculated using self-reported information. Cluster analysis was applied to identify meal-timing clusters. Multivariable-adjusted logistic regression models were used to study the association of meal-timing clusters with prevalence of chronic insomnia, depression, diabetes, hypertension, obesity and self-rated bad health status.ResultsIn both surveys, median breakfast, lunch and dinner times on weekdays were 7:30, 12:30 and 18:30. One out of four participants skipped breakfast and the median number of eating occasions was 3 in both samples. We observed correlation between the different meal-timing variables. Cluster analysis resulted in the definition of two clusters in each sample (A17 and B17 in 2017, and A20 and B20 in 2020). Clusters A comprised most respondents, with fasting duration of 12–13 h and median eating midpoint between 13:00 and 13:30. Clusters B comprised participants reporting longer fasting intervals and later mealtimes, and a high proportion of breakfast skippers. Chronic insomnia, depression, obesity and self-rated bad health-status were more prevalent in clusters B.ConclusionsAustrians reported long fasting intervals and low eating frequency. Meal-timing habits were similar before and during the COVID-19-pandemic. Besides individual characteristics of meal-timing, behavioural patterns need to be evaluated in chrono-nutrition epidemiological studies.