Differences In Overall Health Research Articles

Understanding the effects of nutrition and mental health conditions for patients with opioid use disorder (OUD).

The ravaging effects of the opioid epidemic have affected our communities locally and nationally and are multifaceted in their cause and treatment. It is imperative to locate multiple modalities of treatment options and care for patients with opioid use disorder (OUD) including developing healthy nutrition habits and addressing mental health concerns. Understanding patient perceptions of their personal nutrition habits and mental health status is imperative to providing holistic care in the OUD patient population. An anonymous 31-question Likert-scale and multiple-choice survey was administered to patients with an International Classification of Disease (ICD-10) code in their electronic medical record of OUD (N = 124). χ2 and Fisher's exact test where appropriate were performed to determine the demographics of survey participants who acknowledged history of OUD compared to those who did not acknowledge a history of OUD. Log-binomial models were used to generate adjusted prevalence ratios. Of the 117 patients identified using ICD-10 codes from their medical records as having OUD, only 63 patients acknowledged having a history of OUD, while 54 patients did not. A univariate analysis showed differences in marital status for patients with a self-identified history of OUD. They were also more likely to not be married (divorced or single) (p < 0.01). Patients also tended to be younger than 50 years of age (p < 0.01) and non-White (p < 0.01). There were no differences seen for patients with a history of OUD in the categories of employment (p = 0.31) status or sex (p = 0.51). Patients who acknowledged a history of OUD were significantly more likely to understand the relationship between a healthy diet and reducing the intensity of opioid cravings (p = 0.01) and more likely to consider using nutrition to help combat opioid cravings (p = 0.01). There were no significant differences in overall health or the use of supplements as a part of opioid use treatment. Significant differences were found between those acknowledging a history of OUD having higher rates of depression (p = 0.02) and anxiety (p = 0.02) treatment, despite there not being differences in condition rates for these two conditions (depression, p = 0.08; anxiety, p = 0.27) between the groups. Patients with patient-confirmed OUD were more likely to receive medication treatment (p = 0.03) than those without this acknowledgment. A similar disease burden of anxiety and depression existed for patients acknowledging OUD as opposed to patients denying OUD. However, significant differences existed between these groups in medication treatment, with those acknowledging OUD having higher rates of being treated for both depression and anxiety. Understanding a patient's mental health condition(s) can be impactful for the treatment of OUD. Multifaceted treatment options should include addressing nutritional deficiencies that impact cravings and long-term healing for patients. Nutrition and mental health are key parts of a multifaceted treatment modality for patients dealing with OUD. Assisting patients in treatment for depression and anxiety as well as nutrition can change the trajectory of a patient's opioid use recovery.

Assessing health, psychological distress and financial well-being in informal young adult caregivers compared to matched young adult non-caregivers

ABSTRACT Young adult caregivers (YACs) are faced with the atypical challenge of providing informal (i.e. not paid) care to a family member, while simultaneously at a critical developmental stage in which many major life decisions and milestones are taking place. Adding the challenge of caring for a family member during this already complex time period may have a detrimental impact on young adults’ (YAs) own overall health and well-being. The aim of this study was to examine differences in overall health, psychological distress, and financial strain among a propensity matched sample of YACs compared to young adult non-caregivers (YANCs) from a nationally representative database and to examine differences in these outcomes by caregiving role (caring for a child vs. other family member). YAs (aged 18–39, N = 178) identifying as a caregiver (n = 74) were matched with YANCs (n = 74) on age, gender, and race. Results revealed that YACs exhibited higher psychological distress, lower overall health and more sleep disturbance and higher financial strain compared to YANCs. YAs caring for family members other than children also reported higher anxiety and fewer hours spent caregiving compared to YAs caring for a child. YACs appear to be at risk for impairments in health and well-being compared to their matched peers. Longitudinal research is needed to understand how caregiving during young adulthood impacts health and well-being across time.

A tale of two hierarchies: Hormonal and behavioral factors underlying sex differences in social dominance in cooperative breeding callitrichids

Callitrichid primates are recognized for high levels of sociality in small groups, their great behavioral flexibility, and single-female dominant hierarchies. Previous work has highlighted that dominant, breeding callitrichids engage in behavioral and hormonal reproductive suppression of related and unrelated subordinates by both producing more offspring, having higher levels of ovulatory hormones, and accessing more sociosexual opportunities. This suppression constitutes a nexus of changes in pituitary responsiveness, ovarian cyclicity, sexual behavior, affiliation, and aggression. In this review, I will highlight important features that characterize callitrichid social hierarchies across broad social contexts. Dominant females sometimes exert reproductive suppression on subordinate nonbreeding females, but this suppression varies across callitrichids based on social stability and changes in group composition, particularly related to the number, experience, and age of nonbreeding subordinates. Meanwhile, dominant males may induce suppression of reproduction in subordinate males, but these effects occur by different behavioral and endocrine mechanisms and to a much lesser extent than their female counterparts; While dominant female callitrichids usually show higher levels of aggression relative to their male counterparts, callitrichids show a general absence of intersexual dominance, likely as an effort of maintaining a cohesive breeding pair within a stable social group and social cooperation. Future efforts are needed to identify precise neuroendocrine mechanisms underlying the presence of sex differences in callitrichid behavior separate from peripheral reproductive function. This is especially important with regard to parental experience, social relationships, development and aging, with larger implications toward understanding sex differences in overall health and wellbeing.

The posterior tibial artery free flap for head and neck reconstruction.

The posterior tibial artery free flap (PTAFF) has been a mainstay of lower extremity reconstruction. Over the past 30 years, it has been intermittently used for head and neck reconstruction with recent renewed interest given its versatility. Use of the PTAFF in head and neck reconstruction is expanding along with the continued evolution of microvascular techniques. Differences in overall health, incidence of smoking, and body habitus can impact the utility of this flap and should be taken into consideration when choosing to use it. The PTAFF for head and neck reconstruction is a useful tool for the head and neck/reconstructive surgeon. Understanding the potential pitfalls and caveats to use of the PTAFF is important for successful use of this versatile flap.

THE HIGH COST OF SOCIOECONOMICS ON RACIAL DISPARITIES IN HEALTHY AGING

Race-related differences in overall health across the age-span are well established; how differences manifest within a cohort selected for good functional status is unclear. Using data from Black and White older adults aged 70-79, in the Health, Aging and Body Composition (Health ABC) study, we created a healthy aging index (HAI) of mental health, fitness, lung capacity, bone mineral density, inflammation, and metabolic syndrome. We assessed if racial differences existed in HAI, the extent education, financial resources and stress attenuated any observed differences, and whether this varied by site (Memphis v. Pittsburgh). Blacks had lower HAI than whites, adjusted for age and site. Further adjustment for finances and education eliminated the effect of race in women and reduced the effect in men by 64%. A significant interaction between site and financial stress was observed. Future research should assess ways to reduce the harmful impact of low socioeconomic status on health.

Wide educational disparities in young adult cardiovascular health

Widening educational differences in overall health and recent stagnation in cardiovascular disease mortality rates highlight the critical need to describe and understand educational disparities in cardiovascular health (CVH) among U.S. young adults. We use two data sets representative of the U.S. population to examine educational disparities in CVH among young adults (24–34) coming of age in the 21st century: the National Health and Nutrition Examination Survey (2005–2010; N= 689) and the National Longitudinal Study of Adolescent to Adult Health (2007–2008; N=11,200). We employ descriptive statistics and regression analysis. The results show that fewer than one in four young adults had good CVH (at least 5 out of 7 ideal cardiovascular indicators). Young adults who had not attained a college degree demonstrate particularly disadvantaged CVH compared with their college-educated peers. Such educational disparities persist after accounting for a range of confounders, including individuals’ genetic propensity to develop coronary artery disease. The results indicate that the CVH of today’s young adults is troubling and especially compromised for individuals with lower levels of educational attainment. These results generate substantial concern about the future CVH of the US population, particularly for young adults with a low level of education.

Triage of spine surgery referrals through a multidisciplinary care pathway: a value-based comparison with conventional referral processes.

Retrospective medical record review. To (1) determine if outpatient referrals for low back pain (LBP) and leg pain triaged through a multidisciplinary spine care pathway (group A) were more likely to be candidates for surgery than conventional physician referrals (group B); (2) compare relevant clinical differences in the 2 groups (e.g., diagnosis, pain scores, level of disability); and (3) compare wait times for magnetic resonance imaging and surgical assessment. The Saskatchewan Spine Pathway was introduced on the basis of evidence that a co-ordinated, multidisciplinary, and stratified approach to the assessment and management of LBP may improve quality. During early implementation, some physicians began to refer patients to Saskatchewan Spine Pathway clinics, whereas others continued to refer patients directly to the surgeon through the conventional process. We retrospectively analyzed consecutive new outpatient referrals for LBP and leg pain, June 1, 2011 through May 30, 2012 for 2 surgeons. We identified 215 referrals, including 66 (30.7%) in group A and 149 (69.3%) in group B. There was no difference in overall health (mean EuroQol Group 5-Dimension Self-Report Questionnaire visual analogue scale) or lower back-related disability score (Oswestry Disability Index). Group A patients were significantly more likely to be candidates for surgery (59.1% vs. 37.6% for group B; P = 0.0034, χ test), had significantly poorer scores for EuroQol Group 5-Dimension Self-Report Questionnaire mobility, a higher proportion of leg dominant pain, and a lower proportion of back dominant pain. Group A patients also had significantly shorter wait times for magnetic resonance imaging and surgical assessment. A co-ordinated multidisciplinary pathway with a stratified approach to LBP assessment and care provided a greater proportion of surgery candidates than the conventional referral process. The implementation of such processes may allow surgeons to restrict their practices to patients who are more likely to benefit from their services, thereby reducing wait times and potentially reducing costs. 3.

Postoperative Mortality After Surgery for Brain Tumors by Patient Insurance Status in the United States

To examine whether being uninsured is associated with higher in-hospital postoperative mortality when undergoing surgery in the United States for a brain tumor. Retrospective cohort study using the Nationwide Inpatient Sample, January 1, 1999, through December 31, 2008. The Nationwide Inpatient Sample contains all inpatient records from a stratified sample of 20% of hospitals in 37 states. A total of 28,581 patients, aged 18 to 65 years, who underwent craniotomy for a brain tumor. Three groups were studied: Medicaid recipients and privately insured and uninsured patients. The main outcome measure was in-hospital postoperative death. Associations between this outcome and insurance status were examined within the full cohort and within the subset of patients with no comorbidity using Cox proportional hazards models. These models were stratified by hospital to control for any clustering effects that could arise from differing access to care. In the unadjusted analysis, the mortality rate for privately insured patients was 1.3% (95% CI, 1.1%-1.4%) compared with 2.6% for uninsured patients (95% CI, 1.9%-3.3%; P < .001) and 2.3% for Medicaid recipients (95% CI, 1.8%-2.8%; P < .001). After adjusting for patient characteristics and stratifying by hospital in patients with no comorbidity, uninsured patients still had a higher risk of experiencing in-hospital death (hazard ratio, 2.62; 95% CI, 1.11-6.14; P = .03) compared with privately insured patients. In this adjusted analysis, the disparity was not conclusively present in Medicaid recipients (hazard ratio, 2.03; 95% CI, 0.97-4.23; P = .06). Uninsured patients who underwent craniotomy for a brain tumor experienced the highest in-hospital mortality. Differences in overall health do not fully account for this disparity.

Explanatory power does not equal clinical importance: study of the use of the Brief ICF Core Sets for Spinal Cord Injury with a purely statistical approach

Psychometric study analyzing the data of a cross-sectional, multicentric study with 1048 persons with spinal cord injury (SCI). To shed light on how to apply the Brief Core Sets for SCI of the International Classification of Functioning, Disability and Health (ICF) by determining whether the ICF categories contained in the Core Sets capture differences in overall health. Lasso regression was applied using overall health, rated by the patients and health professionals, as dependent variables and the ICF categories of the Comprehensive ICF Core Sets for SCI as independent variables. The ICF categories that best capture differences in overall health refer to areas of life such as self-care, relationships, economic self-sufficiency and community life. Only about 25% of the ICF categories of the Brief ICF Core Sets for the early post-acute and for long-term contexts were selected in the Lasso regression and differentiate, therefore, among levels of overall health. ICF categories such as d570 Looking after one's health, d870 Economic self-sufficiency, d620 Acquisition of goods and services and d910 Community life, which capture changes in overall health in patients with SCI, should be considered in addition to those of the Brief ICF Core Sets in clinical and epidemiological studies in persons with SCI.

An Effective Physical Fitness Program for Small and Medium-sized Enterprises

The aim of this study is to develop a practicable worksite physical fitness program for small and medium-sized enterprises (SMEs). Community-based intervention consisting of a three-month exercise course was conducted, and its benefits evaluated. A self-administrated structured questionnaire and physical fitness examination were designed to compare the difference between pre and post intervention. A total of 133 SME workers completed the lifestyle/exercise course and filled out the questionnaire, but 16 were excluded from the exercise group due to health reasons. After the intervention, health indicators such as weight, blood pressure, resting heart rate, waistline, BMI, front and back trunk flexibility, abdominal muscle durability and back muscle strength were significantly improved, and improvements in musculoskeletal disorders were seen in reduced neck pain (18.8%), wrist pain (17.4%), and upper/lower back pain (8.7% and 21.7%, respectively). Cardiovascular risk factors (BMI and resting heart rate) showed a significant improvement related to frequent participation in the program (p=0.02), and the exercise group reported a significant difference in overall health (p=0.02). This study has demonstrated an effective approach to community-based fitness intervention through SMEs.

Growth and Survival of Zebrafish (Danio rerio) Fed Different Commercial and Laboratory Diets

The need to develop standardized diets to support zebrafish (Danio rerio) research is supported by the knowledge that specific dietary ingredients, nutrients, or antinutritional factors in diets have been shown to affect development and growth of adult D. rerio and their offspring. In this study, there were seven dietary treatments consisting of five commercially available diets and two laboratory-prepared diets, three replicates per treatment. Fish were fed ad libitum twice daily for 9 weeks. At 9 weeks, both weight and length were recorded to determine condition indices. D. rerio fed one of the laboratory-prepared diets had significantly higher weights than individuals fed any of the other diets and exhibited significantly higher lengths than those fed five of the six remaining diets. Although there were significant differences in general growth demographics (length/weight) after the 9-week feeding trial, no significant differences in overall health of D. rerio were observed for the different dietary treatments as determined by statistical analysis of condition factor indices (K = [weight x 100]/length(3)). The success achieved with the laboratory-prepared diets represents the foundation for establishing an open-formulation nutritional standard to ensure that the D. rerio model for research does not generate confounding research results caused by nutritional vagaries.

Differences in leisure-time, household, and work-related physical activity by race, ethnicity, and education

Racial and ethnic minority groups have lower levels of leisure-time physical activity (LTPA) than whites, but it is unclear how much of this is explained by differences in socioeconomic status and health. To examine differences in LTPA, work-related physical activity (WRPA; heavy household chores and strenuous job activities), and total physical activity (TPA) by race, ethnicity, and education. Cross-sectional analyses of data from the 1992 Health and Retirement Study for a nationally representative cohort of 9,621 community-dwelling adults aged 51-61 years. Physical activity scores for LTPA, WRPA, and TPA based upon self-reported frequency of light or vigorous recreational activities, heavy household chores, and strenuous job-related physical activities. LTPA was lower for blacks and Hispanics compared to whites, and LTPA steadily declined with lower levels of education. WRPA showed the reverse pattern, being lowest for whites and persons with greater education. Education was far more important than race/ethnicity as a determinant of LTPA and WRPA in multivariate analyses. After adjusting for differences in overall health and physical functioning, mean TPA scores were similar across racial/ethnic and education categories; blacks (beta=1.0; 95% confidence interval [CI], 0.5 to 1.5) and Spanish-speaking Hispanics (beta=1.1; 95% CI, 0.3 to 1.9) had slightly higher levels of TPA than whites (P<.01 and P=.01, respectively). Differences in educational attainment and health status accounted for virtually all of the racial and ethnic differences in LTPA. After accounting for WRPA, TPA was similar across race, ethnicity, and education subgroups.

Alcohol use in a continuing care retirement community.

The purpose of this study was to explore alcohol use among older adults living in a continuing care retirement community (CCRC) and to consider differences in overall health, number of chronic illnesses, falls, age, and exercise behavior between those who drink moderately versus those who do not. A one-time face-to-face interview was conducted with a total of 316 residents living in an urban CCRC in the northeast. The participants were 86.6 6 6.3 years of age, and the majority were women (79%), unmarried (75%), White (9%), and middle to upper socioeconomic status (100%). The majority of these individuals (63%) drank moderately, consuming at least one drink daily. No difference was found between men's and women's drinking behaviors (chi 2 = .47, p > .05). Adults who drank moderately were older (F = 8.7, p < .05), more likely to exercise regularly (chi 2 = 27, p < .05), and were more likely to have had a fall (F = 3.7, p < .05). No statistically significant difference was found between the groups related to perceptions of overall health, number of chronic illnesses, number of medications, overall or number of medications that interact with alcohol, or cognitive status. Although not statistically significant, a greater percentage of individuals who drink moderately had fractures (12%) when compared to the percentage of individuals who do not drink at least moderately (7%). Recognizing both benefits and risks to alcohol use in older adults suggests that an individual approach to educating these individuals about their use of alcohol should be conducted.

How White and African Americans View Their Health and Social Problems

DESPITE increases in expenditures and expansions of many US health and social welfare programs and institutions, racial disparities persist in many aspects of American society. Particularly troubling is the reality that the health of our nation's population differs so greatly by race. A number of studies in recent years have documented substantial differences between white and African Americans in health status, morbidity and mortality, access to health services, and perceptions of quality in health care services received.^1-9 Consistent with these reports of differences in overall health, national opinion surveys show that African Americans are more likely than whites to rate the health services in their communities as fair or poor (46% and 23%)¹⁰; our study also indicates that African Americans are more likely to state that the health system in this country needs to be completely rebuilt (42% vs 31%). This disparity between the assessments of African Americans

28-day inhalation study of a cross-linked polyacrylate superabsorbent in the hamster.

Male and female Syrian Golden hamsters (20 of each sex) breathed respirable cross-linked polyacrylate dust (0.3, 1.0 or 10 mg m-3) for 6 h a day, 5 days a week for 28 exposures. More than 99% of the particles were 3-4 microns or smaller. No differences in overall health or body weight were observed among the groups, nor were there deaths during exposure or during the post-exposure period. In animals killed within 24 h after the final exposure, foreign material was detected in the lungs in a dose-related manner. In animals examined 4 weeks post-exposure, much of this material had been cleared from the lungs. There was a significant alveolar macrophage and a non-significant inflammatory cell response following exposure; both responses appeared to decrease during the post-exposure period. There was no evidence of fibrosis in the low- or medium-exposure groups after the exposure or post-exposure periods. In the high-exposure group there was equivocal evidence of fibrosis in one set of lungs at the end of the exposure and in another set after the post-exposure period. These results indicate that subacute exposure of Syrian Golden hamsters to low concentrations of cross-linked polyacrylate dust in particle sizes capable of reaching deep lung structures does not cause pulmonary fibrosis in the hamsters and that resolution of the cellular response induced by these particles occurs. These results also indicate that the test material was cleared from the lung following termination of exposure.