Differences In Health Measures Research Articles

Barriers to access health facilities: a self-reported cross-sectional study of women in India

Background: Accessing healthcare facilities by the women is one of the biggest challenges in the low- and middle-income countries. The present study aimed to understand the barriers to access health facilities for women in India and examine the various determinants that interplay healthcare accessing behaviour among women in India. Methods: The study utilised the Indian National Family Health Survey 4 data from all the 29 member states and seven union territories and performed cross-tabulations with chi-square tests and multivariate logistic regression. Results: The disparity in access to health facilities for Indian women still exists for minorities and lower-income groups. Women aged 40+, living in urban areas, belonging to rich families, and women who hold bank accounts have shown better access to healthcare facilities. Women’s education was an important factor for accessing healthcare facilities. Conclusions: This significant difference in the rate of healthcare utilization among women suggests that it may contribute to more prevalent and severe health decrements among the disadvantaged group. It is also worth mentioning that the cultural and educational differences in health measures may further explain women's low utilization of healthcare facilities. Women's experiences regarding access to healthcare facilities raise essential questions about policymakers’ priorities that increasingly allow women and their families to bear the brunt of poverty and poor health.

Sexual intimate partner violence as a form of MST: An initial investigation.

Military sexual trauma (MST) is known to impact women's health, but little is known about the occurrence of MST perpetrated by a past or current intimate partner. This study identified the occurrence of intimate partner violence (IPV)-related MST in a sample of female veterans. We also examined the associations between MST history (no MST history, IPV-related MST, and MST by a nonintimate partner) and mental and physical health symptoms. Participants were 369 female veteran patients of Department of Veteran Affairs (VA) facilities in the New England region of the United States who completed a larger 2012 mail survey that included validated assessments of MST, posttraumatic stress disorder (PTSD Checklist) and depressive symptoms (CES-D), and general physical and mental health functioning (Short Form-36). Approximately half (49%) of the women in this sample reported a history of MST, of which 27 (15%) were categorized as IPV-related MST. Few differences in health measures were observed among women with IPV-related MST compared with women who experienced MST by a nonintimate partner or women with no MST history. However, women who experienced IPV-related MST had similarly severe health symptoms as women who reported MST by a nonintimate partner and more severe PTSD symptoms than women without a history of MST. Some women veterans have experienced MST at the hands of an intimate partner and face health impacts. This topic warrants additional attention in clinical and research efforts.

Dorling, D.Unequal Health: The Scandal of Our Times. Bristol: Policy Press. 2013. 400pp £24.99 ISBN 978–1‐44730513–2 (pbk)Dorling, D.Inequality and the 1%. London: Verso. 2014. 234pp £12.99 ISBN 978–1‐78168585–3 (pbk)

Dorling, D.Unequal Health: The Scandal of Our Times. Bristol: Policy Press. 2013. 400pp £24.99 ISBN 978–1‐44730513–2 (pbk)Dorling, D.Inequality and the 1%. London: Verso. 2014. 234pp £12.99 ISBN 978–1‐78168585–3 (pbk)

Domain-specific transition questions demonstrated higher validity than global transition questions as anchors for clinically important improvement

ObjectivesEstimates of minimal clinically important differences in health measures may be affected by the anchor used. We examined if domain-specific transition questions had higher construct validity than global health transition questions as anchors for measures in a given domain. Study Design and SettingIn a prospective study of 249 patients with rheumatoid arthritis, we examined changes in pain, physical function, joint swelling, stiffness, fatigue, and depression with treatment. We related these changes to a domain-specific transition question, global arthritis transition question, and the Short Form-36 (SF-36) health transition item. ResultsChanges in all six clinical measures were more highly correlated with the domain-specific transition questions than with the global arthritis question and SF-36 transition question. Discrimination between patients who improved or not was also better using domain-specific questions. Estimates of minimal clinically important improvement (MCII) differed with the anchor when these were based on mean changes. MCII estimates from receiver operating characteristic curve analysis were not influenced by the choice of anchor when anchors had high agreement. ConclusionDomain-specific transition questions had higher construct validity as anchors for determining clinically important differences in health measures focused on a single domain than either global disease or general health transition questions.

Health, Cultural and Socioeconomic Factors Related to Self-Rated Health of Long-Term Jewish Residents, Immigrants, and Arab Women in Midlife in Israel

Self-rated health (SRH) has been found to predict future health, yet its importance is unique in the information it captures, beyond more objective measures. This information can include psychosocial and cultural factors that can be important in understanding women’s health. Our goal was to test whether long-term Jewish residents (LTJR), immigrant, and Arab women differed in their SRH, whether these differences were maintained after controlling for indicators of health status, and, if so, whether the differences among the three groups reflected psychosocial or socioeconomic factors. A nationally representative sample of 814 women in Israel aged 45–64 years was interviewed (between June 2004 and March 2006) regarding socio-demographics, physical health, health behaviors, and psychosocial aspects. Both immigrant and Arab women reported poorer SRH, physical and mental health, and socioeconomic status. Differences between Arab women and LTJR were mostly explained by differences in health measures (e.g., medications and symptoms) and psychosocial measures (e.g., caregiving load and depressive symptoms) and were eliminated when socioeconomic measures were added to the multiple regression models. Differences in SRH between immigrants and LTJR remained after multiple adjustments, suggesting that they reflected unmeasured cultural factors. Even with universal healthcare coverage in a small country (i.e., with minimal financial and geographical barriers to healthcare) minority groups’ health suffers in relation to their socioeconomic and life circumstances.

Robustness in health research: Do differences in health measures, techniques, and time frame matter?

Survey-based health research is in a boom phase following an increased amount of health spending in OECD countries and the interest in ageing. A general characteristic of survey-based health research is its diversity. Different studies are based on different health questions in different datasets; they use different statistical techniques; they differ in whether they approach health from an ordinal or cardinal perspective; and they differ in whether they measure short-term or long-term effects. The question in this paper is simple: do these differences matter for the findings? We investigate the effects of life-style choices (drinking, smoking, exercise) and income on six measures of health in the US Health and Retirement Study (HRS) between 1992 and 2002: (1) self-assessed general health status, (2) problems with undertaking daily tasks and chores, (3) mental health indicators, (4) BMI, (5) the presence of serious long-term health conditions, and (6) mortality. We compare ordinal models with cardinal models; we compare models with fixed effects to models without fixed-effects; and we compare short-term effects to long-term effects. We find considerable variation in the impact of different determinants on our chosen health outcome measures; we find that it matters whether ordinality or cardinality is assumed; we find substantial differences between estimates that account for fixed effects versus those that do not; and we find that short-run and long-run effects differ greatly. All this implies that health is an even more complicated notion than hitherto thought, defying generalizations from one measure to the others or one methodology to another.

Racial and Ethnic Differences in Blood Pressure

In the last few years, much attention has been given to racial and ethnic differences in health measures. Not surprisingly, much of the work in this area is being done in the United States. Not only does our unique racial and ethnic diversity offer opportunities for study, but the social and political issues related to this diversity have driven a need to understand the disparities in health related to these differences. Article p 2780 These racial and ethnic differences in health measures are seen clearly in cardiovascular disease risk factors and outcomes for Americans of African descent, or African Americans (AAs), compared with those of European descent, or European Americans (EAs). Compared with EAs, AAs have higher mortality rates for most cardiovascular diseases, including coronary heart disease and stroke. These differences are magnified at younger ages.1 Prevalence rates for key risk factors differ for AAs, with higher rates for hypertension, obesity, and diabetes mellitus, and lower rates for dyslipidemia. Additionally, the cardiovascular consequences imposed by various risk factors differ by race. Compared with hypertensive EA men and women and AA men, AA women with hypertension have a substantially greater relative risk for heart disease. Conversely, AA women have a substantially lower relative risk for diabetes mellitus than EA women.2 The disparities in cardiovascular outcome are large and significant, and the disparities in outcome have worsened in the last 2 decades.3 Appropriately, much attention is being given to understanding these differences. For a number of years, this important area of study was hampered by a lack of interest and a lack of funding. Now that a commitment is being made in this area, other challenges of understanding the causes of these differences are becoming clearer. The science is complex.3 The challenges to understanding the science of racial …

The importance of place of residence: examining health in rural and nonrural areas.

We examined differences in health measures among rural, suburban, and urban residents and factors that contribute to these differences. Whereas differences between rural and urban residents were observed for some health measures, a consistent rural-to-urban gradient was not always found. Often, the most rural and the most urban areas were found to be disadvantaged compared with suburban areas. If health disparities are to be successfully addressed, the relationship between place of residence and health must be understood.

The health of males in New South Wales.

Gender is increasingly recognised as a significant determinant of health. Not only are there marked differences in measures of health between men and women, but also among men themselves. This article briefly describes the health of males in NSW as presented in readily available sources, in particular The Health of the People of NSW—Report of the Chief Health Officer 2000 and the 1997–1998 NSW Health Survey Report.