Differences In General Health Research Articles

Urinary incontinence in women is not exclusively a medical problem: A population-based study on urinary incontinence and general living conditions

The aim of the study was to analyse differences in general health and general living conditions between women with and without urinary incontinence (UI). This cross-sectional population-based study was conducted in Orebro County, Sweden. A public health questionnaire, "Life and Health", was sent to a randomly selected sample of the population. The questionnaire consisted of 87 questions on broad aspects of general and psychiatric health. An additional questionnaire was enclosed for those respondents who reported experiencing UI. The data were analysed using binary logistic regression. The final study population constituted 4609 women, 1332 of whom had completed both questionnaires. The remaining 3277 had completed only the Life and Health questionnaire. Effect measures were odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Statistically significant associations were found between UI and the occurrence of musculoskeletal pain (OR 1.45, 95% CI 1.20-1.76), fatigue and sleeping disorders (OR 1.59, 95% CI 1.30-1.95), feelings of humiliation (OR 1.29, 95% CI 1.12-1.50), financial problems (OR 1.36, 95% CI 1.11-1.66), and reluctance to seek medical care (OR 1.43, 95% CI 1.21-1.68). UI among women is commonly associated with a number of different psychosocial problems as well as an expressed feeling of vulnerability.

Deficits in social behavior and reversal learning are more prevalent in male offspring of VIP deficient female mice

Blockage of vasoactive intestinal peptide (VIP) receptors during early embryogenesis in the mouse has been shown to result in developmental delays in neonates, and social behavior deficits selectively in adult male offspring. Offspring of VIP deficient mothers (VIP +/−) also exhibited developmental delays, and reductions in maternal affiliation and play behavior. In the current study, comparisons among the offspring of VIP deficient mothers (VIP +/−) mated to VIP +/− males with the offspring of wild type (WT) mothers mated to VIP +/− males allowed assessment of the contributions of both maternal and offspring VIP genotype to general health measures, social behavior, fear conditioning, and spatial learning and memory in the water maze. These comparisons revealed few differences in general health among offspring of WT and VIP deficient mothers, and all offspring exhibited normal responses in fear conditioning and in the acquisition phase of spatial discrimination in the water maze. WT mothers produced offspring that were normal in all tests; the reduced VIP in their VIP +/− offspring apparently did not contribute to any defects in the measures under study. However, regardless of their own VIP genotype, all male offspring of VIP deficient mothers exhibited severe deficits in social approach behavior and reversal learning. The deficits in these behaviors in the female offspring of VIP deficient mothers were less severe than in their male littermates, and the extent of their impairment was related to their own VIP genotype. This study has shown that intrauterine conditions had a greater influence on behavioral outcome than did genetic inheritance. In addition, the greater prevalence of deficits in social behavior and the resistance to change seen in reversal learning in the male offspring of VIP deficient mothers indicate a potential usefulness of the VIP knockout mouse in furthering the understanding of neurodevelopmental disorders such as autism.

Older women with operable breast cancer are less likely to have surgery

Older women are less likely to receive standard management for breast cancer than younger postmenopausal women. Whether differences in general health explain variations in the rates of surgery is not known. In this prospective cohort study, 76 women aged 65 years or more attending breast units in Greater Manchester completed a survey measuring functional status (Elderly Population Health Status Survey's Activity of Daily Living), generic health status (Short Form 12) and health-related quality of life (European Organization for Research on Treatment of Cancer Quality of Life Questionnaire C30). Case-note review assessed co-morbidity (Charlson Index) and management. Primary surgery for operable breast cancer was investigated using logistic regression. A Charlson Index of 1 or more did not predict the use of surgery (P = 0.363). However, for each point increase on the 1-4 scale indicating worsening functional status, the odds of having surgery decreased by 16 times (odds ratio 0.063). The odds of a woman of 80 years or more having surgery decreased by a factor of 44 (odds ratio 0.023) compared with women aged 65-79 years, accounting for co-morbidity, functional status, pretreatment stage, social deprivation and type of hospital. Older women were less likely to have surgery for operable breast cancer than younger women, even after accounting for differences in general health and co-morbidity.

Best Timing of Birth in Placental Insufficiency

After completing this article, readers should be able to: 1. Explain the pathophysiology of fetal hypoxemia during uteroplacental circulatory insufficiency (UPI). 2. Describe the effect of UPI on nutritional substrates. 3. Delineate the potential and limitations of using Doppler flow velocity waveforms to guide delivery decisions in the presence of intrauterine growth restriction. Uteroplacental circulatory insufficiency (UPI) accounts for more than 70% of intrauterine growth restriction (IUGR) (1) and is associated with an increased risk of hypoxemic stress and nutritional deficiency. Both of these threats are concomitant and, to some extent, interrelated, but more importantly, both could lead to the feared complication of UPI—cerebral damage and secondary neurodevelopmental disabilities. To better appreciate the challenge involved in establishing the best time to deliver fetuses that have placental insufficiency, this article is divided in two parts. In the first section, present knowledge of the pathophysiology of fetal hypoxemia and nutritional deficiency in the context of UPI is reviewed briefly. The second section is devoted to a critical appraisal of the criteria currently applied to reach the decision that a fetus that has IUGR should be delivered. Fetal arterial oxygen (O2) concentrations are the result of relative proportions of blood that has different O2 saturations from various venous channels (the two venae cavae, the pulmonary veins, the coronary sinus, and the umbilical vein) draining into the cardiac cavities. Final arterial O2 saturation, therefore, predominantly is dictated by the volume of better-oxygenated blood arriving from the umbilical circulation. Normally, because of its low vascular resistance, the placenta accommodates 50% of the fetal combined cardiac output. Any change in this determinant part of venous return necessarily has a significant impact on intrauterine O2 delivery, even if Po2 in the umbilical vein is within normal range. Experimental (2)(3) and clinical (4 …

Quality of Life of Older Patients with Irritable Bowel Syndrome as Compared to Their Younger Counterparts

Purpose: Aging has potential to have impact on quality of life. There is limited data about the quality of life of older Americans with IBS in the population at large, especially a head-to-head comparison with the younger patients. Our study fills this void. Hypothesis: Older patients with IBS have poorer quality of life as compared to their younger counterparts. Methods: Without prior knowledge of their status with respect to having IBS, we collected a convenience sample of adults at various locations in our town. A total of 1000 adults from nine different sites completed self-administered questionnaire. The questionnaire asked for details regarding bowel habits and associated symptoms for diagnosing the IBS based on ROME II criteria. Quality of life was assessed by the SF-12 questionnaire. SAS® program was used for statistical analysis. All null hypotheses of interest were tested against two-directional alternatives using the 5% level of significance. Results: The study data base was divided into two groups, younger less than 50 years (n = 777) and older equal to or greater than 50 years (n = 223). The subjects were predominantly Caucasian or African Americans. The two groups were similar with respect to gender and household income. There were no differences between the two groups of IBS patients with respect race, sex, marital status, size of household, location of residence (rural versus urban), educational status and household income. The non-IBS subjects in both age groups had similar scores (33.6 vs 33.4; p = NS). The IBS patients overall had a poorer quality of life as compared to non IBS patients; p < 0.001). However, the scores for IBS patients were similar in both age groups (27.8 vs 29.5; p = NS). On further stratification of quality of life data, we found that while there were no age related differences in general health (11.6 vs 11.8; p = NS) and physical conditioning (7.2 vs 7.8; p = NS), the social functioning was significantly impaired in the younger population with IBS as compared to the older patients (9.1 vs 9.8; p < 0.01). We also found that older IBS patients were more likely to attend the church. Conclusions: While IBS affects quality of life at all ages, the social functioning is actually better amongst older as compared to younger IBS patients. The superior social functioning may in part be related to higher attendance in church by these patients providing better social support system.

Time and place: putting individual health into context. A multilevel analysis of the British household panel survey, 1991–2001

Examination of the extent to which time and place affect people's health has been constrained by the resources available to answer this question. A British longitudinal, nationally representative survey of 8301 adults aged 16 years and older living in private households was used to consider the influence of household membership, area of residence and time using multilevel logistic regression. Self-rated health was assessed by general health and limiting illness during periods characterized by economic decline (1992), economic improvement (1996) and prosperity (2000). There was modest evidence of clustering of poor general health within areas and stronger support for within household similarities in general health which increased over time. Individual, household and area level deprivation accounted for almost all the area-level variability but had little effect on household variance. There was greater evidence of clustering of limiting illness within areas: deprivation did not account for this to any great extent. Area differences in general health reduced as the economy improved but time trends in differences in limiting illness lagged behind the timing of economic recovery. Both time and place are shown to affect self-rated health although the processes may differ depending on the health outcome.

Relative contributions of reduced vision and general health to NEI-VFQ scores in patients with neovascular age-related macular degeneration.

To estimate the relative contributions of central vision loss and general health to vision-targeted quality of life as measured by the National Eye Institute Visual Function Questionnaire (NEI-VFQ). Data on quality of life (NEI-VFQ and the 36-Item Short-Form Health Survey [SF-36]) and visual acuity were collected as part of the Submacular Surgery Trials Pilot Study. Information on medical conditions was collected by patient chart review. Twenty-four-month data for 120 patients were analyzed using linear regression methods. Median patient age at the 24-month examination was 77 years; 60% were women, and 98% were non-Hispanic whites. A 3-line decrement in visual acuity in the better-seeing eye was associated with a 5.1- to 17.1-point decrement in NEI-VFQ scores after adjustment for general health (SF-36 physical component summary [PCS] and mental component summary [MCS] scores). A 10-point decrement in the PCS score was associated with a 4- to 9-point decrement in NEI-VFQ scores after adjustment for visual acuity in the better-seeing eye and MCS score. A 10-point decrement in the MCS score was associated with a 4- to 8-point decrement in NEI-VFQ scores after adjustment for visual acuity in the better-seeing eye and PCS score. Diabetes, arthritis/rheumatism, and hypertension also had large effects on NEI-VFQ scores in the adjusted analysis. The NEI-VFQ is sensitive to differences in visual acuity in the better-seeing eye, as expected, and to differences in general health. Adjustment for general health should be considered when comparing NEI-VFQ scores between patient groups.

Health Status, Reproductive Health Problems, and the Degree of Prenatal Management in Married Working Women

【Purpose: This study was to examine health status, reproductive health problems and the degree of prenatal management in working women. Method: The subjects were 902 married working women among 2,000 women selected by cluster sampling. The work area was classified to product factory, school, office, etc. After an Informed consent was obtained, participants were asked to fill out a self-administered questionnaire. The instruments included a questionnaire, parity check list, menstrual problems and gynecologic problem check list. Result: Many women have experienced menstrual cycle change during the past year. There was a significant difference in general health, menstrual regularity, reproductive health and prenatal management by occupation type. 40.6 percent of the subjects have gynecological problems such as menstrual cycle change, perineal inflammation, irregular vaginal bleeding, amenorrhea, ovarian/uterine disease, infertility, or abortion. Prenatal care was received in only 28.5% of the total subjects. In addition, 16.3% answered they had experienced low birth weight babies. Conclusion: We can conclude that working woman have changes in menstruation cycle and in reproductive health status. Therefore, we suggest that some occupational characteristics may affect subject's reproductive health, these should be clear and avoided as much as possible.】

An investigation into nonresponse bias in a postal survey on urinary symptoms.

To investigate nonresponse bias in a postal survey on urinary symptoms in people aged >or= 40 years. Nonresponders to a postal survey on incontinence and other urinary symptoms were studied. A random sample of 1050 nonresponders (stratified for age and sex) was traced by a team of interviewers. Eligible nonresponders were asked several questions from the postal questionnaire, and their reason for not participating in the postal survey. Only 1% of those not responding were not traced in person or accounted for, and 12% were identified as not eligible to be in the survey sample (moved from address, deceased, residential home). Half of the eligible nonresponders (51%) did not answer the interviewer's questions, the main reason being general unwillingness or disinterest. The number in whom poor health was the reason increased with age. Comparing nonresponders who answered the interviewer's questions with a random sample of responders from the postal survey showed little difference in the reporting of urinary symptoms, although there were differences in general health and long-term health problems. Separate analyses by age showed greater reporting of some urinary symptoms and of poorer general health in the older nonresponders (>or= 70 years). Overall, for people aged >or= 40 years there was no evidence of a nonresponse bias in the reporting of urinary symptoms, providing confidence in such prevalence rates. However, poorer general health and greater reporting of some urinary symptoms by the older nonresponders (>or= 70 years) suggests prevalence rates in this age group may be underestimated.

Limited value of routine microbiological diagnostics in patients hospitalized for community-acquired pneumonia.

Current guidelines recommend microbiological diagnostic procedures as a part of the management of patients hospitalized for community-acquired pneumonia (CAP), but the value of such efforts has been questioned. Patients hospitalized for CAP were studied retrospectively, focusing on the use of aetiological diagnostic methods and their clinical impact. Adult patients, without known human immunodeficiency virus infection, admitted to hospital for CAP during 12 months, were evaluated with regard to the importance of aetiological diagnosis for tailoring antibiotic therapy, antibiotic-associated diarrhoea, Clostridium difficile disease, length of hospital stay and mortality. Of the 605 studied patients, 482 (80%) were subjected to Mycoplasma pneumoniae and/or respiratory virus serology and/or cultures of blood and/or sputum. They had a better prognosis than patients not subjected to microbiological diagnostics (mortality within 3 months was 9% vs 24%, p = 0.001), apparently reflecting differences in general health (e.g. less dementia diagnosis) but not the outcome of diagnostics. A presumptive aetiology was obtained only in 132 of the 482 patients, Streptococcus pneumoniae and M. pneumoniae being the most common agents (in 49 and 36 patients, respectively). Establishing an aetiological diagnosis had no impact on the number of in-hospital changes of therapy, on the proportion of new regimens having a narrower antimicrobial spectrum than the initial one or on the outcome. Therapy was changed to a drug directed specifically against the identified pathogen in only 16 out of these 132 patients and again without any overall improvement in the outcome variables. In a setting with a low frequency of antibiotic-resistant respiratory tract pathogens current routine microbiological diagnostics were found to be of limited value for the clinical management of patients hospitalized for CAP. Improved diagnostics in CAP are urgently needed, as establishing an aetiological diagnosis carries a potential for optimizing the antibiotic therapy.

The NHS: who is attacking, who is defending?

7. Schensul, J. J. and Guest, B. H. (1994). Ethics, ethnicity, and health care reform. In, "It Just Ain't Fair'raThe Ethics of Health Care for African Americans, ed. by A. Dula and S. Goering, Praeger Publishers, Westport, CT. 8. Ferguson, W. (1994). The physician's responsibility to medically underserved poor people. In, 'It Just Ain't Fair'--The Ethics of Health Care for African Americans, ed. by A. Dula and S. Goering, Praeger Publishers, Westport, CT. 9. Radical Health Statistics Group (1977). In Defence of the NHS, Radical Health Statistics Group, London. 10. Hahn, B. and Flood, A. B. (1995). No insurance, public insurance, and private insurance: do these options contribute to differences in general health? Journal of Health Care for the Poor and Underserved 6, 41-59. 11. Sorlie, P. D., Backlund, E. and Keller, J. B. (1995). USA mortality by economic, demographic, and social characteristics: the national longitudinal mortality study. American Journal of Public Health 85, 949-956. 12. Veatch, R. M. (1995). Abandoning informed consent. Hastings Center Report 25, 5-12.

No Insurance, Public Insurance, and Private Insurance: Do These Options Contribute to Differences in General Health?

This paper examines the validity of two of the basic assumptions made about health care insurance and health, namely that having any insurance is associated with better health and, in particular, that having public, welfare-based insurance has better health consequences for the poor than does having no insurance. These questions were addressed using data from the National Medical Expenditure Survey, a national household-based survey in 1987 of more than 36,000 people who were asked to report in detail about their medical care use and expenditures, health insurance coverage, and health and functional status. The results of the analysis indicate that being without insurance is associated with having poorer general health compared to persons with private insurance, and that the health of persons who qualify for public insurance is the poorest of any group--poorer even than those without insurance.

Double-blind developmental evaluation at 1-year corrected age of 597 premature infants with birth weights from 500 to 1350 grams enrolled in three placebo-controlled trials of prophylactic synthetic surfactant

Infants enrolled in three clinical trials of prophylactic treatment for respiratory distress syndrome with a single dose of synthetic surfactant (Exosurf Neonatal) or air placebo were monitored through 1-year adjusted age. A total of 1046 infants with birth weights from 500 to 1350 gm were enrolled in the three trials; of the 735 infants who survived to 1 year of age, follow-up evaluations were completed for 597 (80%, air placebo group; 82%, synthetic surfactant group). Infants in the air placebo and synthetic surfactant treatment groups had no differences in general health, growth, or neurodevelopmental outcomes or impairments. These follow-up results at 1-year adjusted age for infants who received a single dose of synthetic surfactant indicate that a single dose of synthetic surfactant reduces mortality without increasing the absolute number or proportion of infants with impairments at 1 year of age. (J P EDIATR 1995;126:S5-12)