Excellent Health Status Research Articles

The 2016 Gilruth Prize.

The 2016 Gilruth Prize.

Assessment of Wellness Status Among a Multi-Ethnic Based Adult Sample

Wellness is an encompassing canopy harnessing multiple of activities aimed at helping individuals recognize components of lifestyle that are detrimental to health. However, the challenge still remains that most individuals seldom identify and practice positive health behaviors that can enhance fitness and wellness. Objectives: As a starting point, the present study assessed the wellness status of a multi-ethnic based adult population in Lagos, Nigeria. Methods: The wellness lifestyle Questionnaire (WLQ), which provides an initial rating of the individual’s current efforts to stay healthy and assessed six major areas, namely: emotional health, fitness and body care, environmental health, stress, nutrition and medical self-responsibility was used as the instrument for data collection. Eight hundred and thirty-eight males, as well as one thousand four hundred and sixty-two females' adults, were purposely recruited for this study. Results: It was obvious from the data collected that 61.03% of the population sampled needs improvement on their health status while only 8.04% had excellent health and wellness status with just 30.93% of the population in a good health condition. Conclusion: Providing health and wellness education by fitness experts, therefore, becomes inevitable and a challenge for health and wellness experts.

Challenges and barriers to health care and overall health in older residents of Alaska: evidence from a national survey

BackgroundFrom 1970 to 2010, the Alaskan population increased from 302,583 to 698,473. During that time, the growth rate of Alaskan seniors (65+) was 4 times higher than their national counterparts. Ageing in Alaska requires confronting unique environmental, sociodemographic and infrastructural challenges, including an extreme climate, geographical isolation and less developed health care infrastructure compared to the continental US.ObjectiveThe objective of this analysis is to compare the health needs of Alaskan seniors to those in the continental US.DesignWe abstracted 315,161 records of individuals age 65+ from the 2013 and 2014 Behavioral Risk Factor Surveillance System, of which 1,852 were residents of Alaska. To compare residents of Alaska to residents of the 48 contiguous states we used generalized linear models which allowed us to adjust for demographic differences and survey weighting procedures. We examined 3 primary outcomes – general health status, health care coverage status and length of time since last routine check-up.ResultsAlaskan seniors were 59% less likely to have had a routine check-up in the past year and 12% less likely to report excellent health status than comparable seniors in the contiguous US.ConclusionsGiven the growth rate of Alaskan seniors and inherent health care challenges this vulnerable population faces, future research should examine the specific pathways through which these disparities occur and inform policies to ensure that all US seniors, regardless of geographical location, have access to high-quality health services.

Autopercepción de salud y de red de apoyo y funcionalidad familiar, de los estudiantes que inician posgrados de medicina

The healthy universities policy seeks to improve the environments and quality of life of students. Most of the students who are part of the university population perceive deficiencies regarding their lifestyle and self-rated health care. ObjectiveTo describe the self-rated health status and family support and functioning of a cohort of students starting medical/surgical residency at the Fundación Universitaria de Ciencias de la Salud, Bogotá. MethodologyA cross-sectional study was conducted during the induction period of the residency. Students admitted to the first semester of medical residency were invited to participate. They completed a 35-question questionnaire; 25 items were on their perception of health status and past history, and 12 were on their family support and functioning. ResultsOut of 89 students, 86 (96.6%) responded to the questionnaire. The mean age was 29.8 years (SD: 4.2); 68.6% were single; 24.4% were married; 20.9% lived alone, and 39.5% had moved to Bogotá to attend postgraduate school. Good or excellent health status was rated by 96.5%; 32.6% were overweight and 41.9% were sedentary; 30.6% did not fulfil the vaccination requirements for hepatitis B, and 49% for Varicella, respectively; 33.7% reported some degree of dysfunction in their families. ConclusionMost of the residents rated their health status as good or excellent. The most common health problems were overweight, sedentary behaviours, and lack of vaccination. One third of the students perceived family support and functioning as deficient. Individual and collective intervention plans must be developed within the Healthy Universities Strategy framework, based on this information.

Faye Abdellah Model to Banishing Social Stigma of Head Lice Among School Students

In this paper, an experimental comparative study was carried out aiming to monitor the effect of Faye Abdellah Theory Model on banishing social stigma of head lice among school students and monitor its effect on their health status and self-esteem. For the study purpose a sample of convenience of 1600 school students and their mothers was recruited from 16 schools from both countries participated in the study. Four tools used, pre/post interviewing questionnaire, observation checklists, Faye Abdellah model format, self-esteem scale sheet and students/mothers guidance booklet. The results showed that the total numbers of students at 8 schools in Egypt were 800/16700, with prevalence ratio 20.8% and 800/14300 from Kingdom of Saudia Arabia with the prevalence ratio 17.8%. The study documented that there is highly significant effects of the model on students’ health status and banishing the social stigma and there is a highly positive association between self-esteem and assurance to the health behavior. It concluded that highly self-esteem had excellent health status and completely confident in coping with self-care management. And it is recommended that knowledge is power and teaching mothers and students about head lice myths and facts is key to demystifying the stigma.

A study on mental health status and its determinants in elderly people of Raipur city, Chhattisgarh, India

Background: Rapid increase in nuclear families and contemporary changes in psychosocial matrix makes vulnerable to older people to develop mental health Problems. In the above context study was done to assess mental health status and its determinants in elderly people of Raipur city, Chhattisgarh, India. Methods: Community based cross sectional study was conducted in randomly selected 32 areas of Raipur city during July 2013 to June 2014. Multi stage simple random sampling was used. A total of 640 subjects were included in study. Sample size was calculated by using statistical formula, n= Z21-α/2 P (1-P)/d.1 Predesigned and pretested proforma were used for data collection. Ethical consideration was obtained from institutional ethical Committee and Informed Consent from subject. All elderly of age 60 years and above who were residing in the study area for at least one year, and Willing to Participate in study without compulsion were included in study. Results: Out of total study population 20.31% had excellent whereas 79.68% showed average mental health status. Study observed that out of total study population 52.03% had anxiety whereas 27.65% had depression and 20.31% were normal that have excellent mental health status. Male had better mental health than female. Those who were performing physical activity during leisure time and economically independent and belong to upper socioeconomic group and married had better mental health. Conclusions: Females lives longer than male leads to feminization of ageing. It is important to improve the social capital and involve communities and families in supporting the older adults.

Masculinity, Socioeconomic Status, and Self-Reported Health among African American Men

The purpose of this study was to examine the influence of masculinity and socioeconomic status (i.e., income) on the self-reported health of a sample of African American men. Study participants ( n = 122) were barbershop patrons from Chicago, Illinois, who ranged in age from 18 to 66. We used logistic regression to assess the relationship between masculinity and self-reported health. Masculinity was measured as the average of responses to a subset of 10 items from the Male Role Norms Inventory and the Male Attitude Norms Inventory II. Self-reported health was measured with a five point Likert scale and dichotomized as excellent versus other health status. Analyses suggested that masculinity, but not socioeconomic status, was positively associated with excellent self-reported health. Such results offer understanding of how masculinity and self-reported health impact health outcomes in African American men.

Characteristics of acupuncture users among internal medicine patients in Germany

To identify socio-demographic and health-related factors associated with (a) acupuncture use and (b) the rated helpfulness of acupuncture among internal medicine patients. Data from a larger cross-sectional trial were reanalyzed. Patients who had used acupuncture for managing their primary medical complaint were compared to patients who had not. Predictors for (a) acupuncture use and (b) rated helpfulness were determined using logistic regression analyses. Of 2486 included patients, 51.49% reported acupuncture use and 39.22% reported no prior use. The use of acupuncture was associated with higher age, i.e. those aged 50-64 were more likely to have used acupuncture, while those younger than 30 were less likely. Patients with spinal pain, fibromyalgia, or headache were more likely to be acupuncture users; while IBS patients were less likely. Patients with good to excellent health status, high external-social health locus of control and current smokers were less likely to have used acupuncture. Among those who had used acupuncture, 42.34% perceived the treatment as helpful, while 35.94% did not. Rated helpfulness was associated with female gender, full-time employment, high health satisfaction, and high internal health locus of control. Those with a diagnosis of osteoarthritis or inflammatory bowel disease were more likely to find acupuncture helpful; those with headache or other types of chronic pain were less likely to find acupuncture helpful. Acupuncture was used by more than half of internal medicine patients. Prevalence and rated helpfulness of acupuncture use was associated with the patients' medical condition, sociodemography, and health locus of control.

It still takes a village: an epidemiological study of the role of social supports in understanding unexpected health states in young people.

BackgroundThis study of adolescent Canadians examines two groups who are anomalous in their health experiences: (1) those with perceived low affluence yet who perceive themselves to have excellent general health status; (2) those of perceived high affluence but who are reporting poor health status. Our hope was to explore the role of social supports in explaining such anomalies. We hypothesized that cumulative levels of social support available to these young people would have an influence on their perceived health status, with more support being associated with better self reported health.MethodsYoung people (n = 26,078 from 436 schools) aged 11–15 years were administered a general health survey in classroom settings during the 2009–10 academic school year. Descriptive and regression-based cross-sectional analyses (with an affluence-social support interaction term) were used to relate both individual and cumulative levels of social support in homes, neighborhoods, schools, and peer groups to self-reported health status.ResultsSocial supports and their cumulative availability indeed were strongly related to perceived health, with more supports being associated with better self-perceived health. Less affluent children were much more likely to report excellent health in the presence of numerous social supports. More affluent children were much more likely to report poor health in the absence of such supports. The strength and dose-dependent nature of the findings were consistent and striking.ConclusionsStudy findings from this large, contemporary and national analysis affirm the importance of social supports as potential determinants of health for young people from both high and low affluent groups. Conceptually, findings affirm the wisdom of the ancient principle: “it takes a village to raise a child”.

Comprehensive health status of the empty-nest elders and demand for community service

Objective To investigate the comprehensive health status of empty-nest elders and their community service demand.Methods 137 empty-nest elders selected from urban community in Beijing were investigated by filling out health questionnaire and interviewed for service demand.Content analysis,single factor analysis and multiple linear regression model were used to analyze the influencing factors of service demand.Results The assessment of comprehensive health status indicated that the constituent ratios of excellent,general and poor health status were 7.3％,29.9％,62.8％ respectively.The top three service demands were disease prevention (86.1％),housework service demands (81.0％),and safety (62.0％).Age,empty-nest time,and comprehensive health status were associated with community service demands,and the comprehensive health status was the main influencing factor.Conclusions The comprehensive health status of empty-nest elders are poor,they have more service demands,corresponding measures should be provided to improve their need satisfaction rate. Key words: Empty-nest elder; Comprehensive geriatric assessment; Aging in place; Needs

A Cross-sectional Study of Patients' Satisfaction with Dental Care Facilities: A Survey of Adult Treatment at The University of the West Indies, School of Dentistry.

To determine the level of satisfaction with adult dental care at The University of the West Indies (UWI), School of Dentistry, using the Dental Satisfaction Questionnaire (DSQ) developed by Davies and Ware (1982) and to inferentially explore the factors associated with various patients' demographics. A cross-sectional study was performed among adult dental patients attending UWI adult dental clinics. Data were collected using a self- administered, structured questionnaire which consisted of 19 questions on three subscales of pain management, quality and access (total). Sixty-nine per cent were female, 40% were between 45 and 64 years old, and 31.3% had excellent self-rated dental health status. A Dental Satisfaction Index (DSI overall) of 76.42% satisfaction was found, with the highest satisfaction subscale for quality (81.17%), while access (72%) was the lowest occurring subscale. The mean DSI was 3.57 for the UWI emergency dental clinic and 3.87 for the polyclinic. The difference between the DSI overall in the emergency clinic compared to the polyclinic was statistically significant (p < 0.05) CONCLUSIONS: There was a high level of overall satisfaction with dental care at the UWI dental school. Self-rated oral health status may be important in patients' satisfaction. Policies and strategies promoting preventive dental advice are likely to improve patients' satisfaction with dental care and may lead to increased satisfaction with dental services.

Mobile Technology, Cancer Prevention, and Health Status among Diverse, Low-Income Adults

Characterize mobile technology ownership, use, and relationship to self-reported cancer prevention behaviors and health status in a diverse, low-income sample of callers to 2-1-1. Secondary analyses of cross-sectional survey data from a larger trial collected from June 2010 to December 2012. United Way Missouri 2-1-1 serves 99 of 114 counties and received 166,000 calls in 2011. The respondents (baseline, n = 1898; 4 month, n = 1242) were predominantly female, non-Hispanic Black, younger than 50 years, with high-school education or less and annual income <$20,000. Cell phone ownership and use and its relationship to cancer prevention services and health status were assessed via telephone-based survey, using items adapted from previous research and the Behavioral Risk Factor Surveillance System. Smartphone ownership and use were also assessed. Descriptive statistics and bivariate and multivariate associations between cell phone ownership and prevention and health status are reported. Three-fourths (74%) of study participants owned a cell phone and 23% owned a smartphone. Text messaging was the most popular use. Ownership was significantly associated with good to excellent health status and presence of smoke-free home policies in multivariate models. Cell phone ownership is growing and has potential to deliver health information to low-income populations. With 16 million calls annually, the national 2-1-1 system may be a promising model and platform.

PHS130 - Understanding The Underutilization Of Colorectal Cancer Screening Using The 2009-2011 Medical Expenditure Panel Survey (Meps)

Colorectal cancer is the third most frequently diagnosed cancer in the United States adult population with a projected mortality of more than 50,000 people in 2013. The purpose of this study was to examine patient, physician, and access-to-care factors that may influence the utilization of timely screening for colorectal cancer among US adults aged 50 years and above. The data source for this study was the 2009-2011 Medical Expenditure Panel Survey (MEPS). A multivariate binary logistic regression was used to examine the association between the predictor variables (patient demographics, physician attributes, and access-to-care characteristics) and the outcome variable (colorectal screening) for individuals in group I (50-75 years of age) as well as in group II (>75 years of age). Data were analyzed using SAS version 9.3. A total of 11,370 respondents, 50 years and above, were eligible for colorectal cancer screening as stated by the guidelines. Of these, 65% (n=7393) were adherent to recommended colorectal cancer screening guidelines. For group I, the regression analysis showed that the odds of undergoing colorectal cancer screening are significantly higher with increasing age, education, and family income, living in an urban area, and availability of health insurance and self-transportation to health services locations. Similarly for group II, the regression analysis revealed that the odds of colorectal cancer screening were higher with increasing family income and availability of self-transportation. Conversely, the odds of screening were lower in individuals with good to excellent health status for groups I and II. Developing policies and programs to educate and promote awareness in rural areas, low-income groups, among those with better health conditions, and in those seeking primary care treatment could improve the colorectal cancer screening rate.

Clinico-Pathological Caracteristics, Therapeutic Features and Post-operative Course of Colorectal Cancer in Elderly Patients.

Colorectal cancer is predominantly a disease of elderly people and is a major cause of morbidity and mortality in the elderly population. The geriatric colorectal population is a very heterogeneous group, including patients with excellent health status and others with comorbid conditions, functional dependency, and limited life expectancy. On the other hand, the effectiveness of surgery for colorectal cancer depends on it being carried out safely, which allows most patients to return to productive lives, with an improved post-operative life expectancy or at least one that is not diminished by the surgery. This work is a descriptive study of a retrospective cohort, based on administrative databases, of all patients with colorectal cancer diagnosed or treated in our institution. We extracted data on sociodemographic characteristics, comorbidity, type of cancer, stage of cancer, type of treatment received, post-operative complications and cause of post-operative death. We compared differences between an elderly group (Group A) (age >75 years) and a group of patients below 75 years (Group B). We found that elderly patients with colorectal cancer were more likely to be operated in emergent conditions, had more non-specific complications and more post-operative mortality than patients below 75 years. On the other hand, tumours stages, tumours characteristics and post-operative specific morbidity have been proved to be similar, both in Group A and Group B patients. These results suggest that surgery is feasible and can be safe for patients above 75 years, but it needs much more evaluation of comorbidities, pre- and post-operative intensive care to avoid post-operative non-specific complications.

Why Does Citizens' Knowledge of New Policy Vary Between Municipalities? The Case of the Social Support Act

Providing information to citizens is an important first step in the implementation of new policy. In this study we explain differences in the knowledge of citizens between municipalities of a newly introduced law in the Netherlands, the Social Support Act, 10 months after it became into force. This law is especially important for older people that need support in their daily functioning and participation. We focused on two aspects of knowledge related to the act, i.e. having heard of the new act, and knowing how voice with regard to policy on support is organised in the place of residence. Given that socialist local governments focus more on social topics than liberal local governments, we expected citizens of municipalities with socialist councils to have more knowledge about the new Social Support Act. Contrary to our expectations, citizens from municipalities where a liberal party or a collaboration of liberal/socialist parties is the largest, have a better understanding of how voice is organised. On the other hand, citizens in municipalities with an alderman from a combination of liberal/socialist parties have a lower chance of having heard of the Social Support Act. We argue that in view of the Social Support Act, the ideology of a local government related to citizens' responsibilities (liberal view) may have more influence on citizens' knowledge than being a government that pays attention to social issues (socialist view). As far as individual differences between citizens are concerned, as expected, older people that are more educated but in poorer health status have more knowledge about the new act. A higher educational level and an excellent mental health status are related to more knowledge about voice. Educational level is the most powerful predictor for knowledge about the act.

Perception and reality – Portuguese adults' awareness of active lifestyle

This study aims to assess awareness of physical activity levels among adults and to investigate the variables associated with different types of awareness. The participants were 1042 men and 1316 women aged 31–60 years old (43.3 ± 6.1). Data were collected on physical activity behaviour, physical activity awareness, perceptions and psychological factors. Awareness was assessed by comparing self-rated physical activity with achieving physical activity guidelines. Chi-square and logistic regression analyses were applied to the results. About 32.4% were considered active. Moreover, 61% accurately reported their physical activity (38.3% realistic inactive and 22.7% realistic active), 29.2% overestimated their physical activity (overestimators) and 9.7% incorrectly described themselves as inactive (underestimators). Perception of an excellent health status (odds ratio, OR = 4.07, 95% confidence interval, CI: 2.07–8.00, p < 0.001) was the strongest positive association with being realistic active, followed by having a high socio-economic status (SES) (OR = 1.53, 95% CI: 1.10–2.12, p < 0.05). Overestimator participants were more likely to have an excellent perception of health (OR = 2.58, 95% CI: 1.47–4.52, p < 0.01) and had a good experience in physical education (OR = 1.46, 95% CI:1.03–2.08, p < 0.05). Almost half of these participants erroneously perceived themselves as physically active. Gender, body mass index (BMI) and the quality of physical education at school were associated with those who misperceived their physical activity.

Access to care outcomes: a telephone interview study of a suburban safety net program for the uninsured.

Access DuPage (AD) currently provides primary care for about 14,000 low income, uninsured residents of suburban DuPage County, IL, an area with a very limited healthcare safety net infrastructure. A telephone interview survey evaluated health care utilization, satisfaction, and health status outcomes and compared recent enrollees to individuals in the program for at least 1year. Sequential new AD enrollees (n=158) were asked about the previous year when uninsured, while randomly selected established AD enrollees (n=135) were asked the same questions about the previous year when actively enrolled in AD. Established enrollees reported being more likely to get 'any kind of tests or treatment' (96.3 vs. 46.2%, p<0.0001), fewer cost (78.5 vs. 21.3%, p<0.0001) and transportation barriers to care, more preventive and mental health services, and better self-management care. However, established enrollees also reported 14% greater use of hospital inpatient and 9% greater use of emergency room care, as well as continued difficulty in accessing needed specialty and dental care services. Despite more (diagnosed) conditions, established enrollees were over 2.5 times more likely to report good to excellent health status and over three times more likely to rate their satisfaction with health care as good to excellent. Findings illustrate the substantial benefits of assuring access to care for the uninsured, but do not reflect immediate savings from reduced hospital utilization. Access to care programs will be an important tool to address the needs of the 30 million people who will continue to be uninsured in the United States.

Factors Associated with the Use of Different Treatment Modalities among Patients with Upper Airway Diseases in Taiwan: A Cross-Sectional Survey Study

Rhinitis is a common upper airway disease and can have great impact on patients' quality of life. Factors associated with the use of common treatment modalities among 279 Taiwanese rhinitis patients from the outpatient department of otolaryngology in a medical center were investigated using a cross-sectional survey study. Results from multiple logistic regression analysis, adjusted for etiologies of rhinitis, revealed that males were associated with surgical intervention (OR = 2.11, P = 0.009). Lower educational level was associated with oral (OR = 2.31, P = 0.024) and topical medications (OR = 2.50, P = 0.005). Poor or fair general health status was associated with topical medications (OR = 4.47, P = 0.001), whereas very good or excellent general health status was inversely associated with surgical intervention (OR = 0.32, P = 0.002). Smoking was associated with the use of nasal irrigation (OR = 2.72, P = 0.003). Worse disease-specific quality of life was associated with oral medications (OR = 2.46, P = 0.010) and traditional Chinese medicine (OR = 5.43, P < 0.001). In conclusion, the use of different treatment modalities for rhinitis was associated with different combinations of independent factors.

More than search? Informational and participatory eHealth behaviors

Few studies in the eHealth literature have paid attention to participatory eHealth behaviors. Addressing this gap, the present study examines how informational and participatory eHealth behaviors are related to eHealth literacy, Internet use and Facebook interaction, as well as user characteristics. Drawing on a sample of college students (N=540), results from Structural Equation Modeling (SEM) analysis show that eHealth literacy has a positive direct effect on informational eHealth behaviors. It also serves as a mediator suppressing the negative relationship between excellent mental health status and eHealth behaviors. While both instrumental Internet use and Facebook interaction are related to participatory eHealth behaviors, only instrumental Internet use is associated with informational eHealth behaviors. There are significant eHealth disparities by health status, gender, and class. Implications for health communication and promotion are discussed.

Characteristics of patients with internal diseases who use relaxation techniques as a coping strategy

To assess sociodemographic, clinical, and psychological characteristics of patients with internal diseases who use relaxation techniques as a coping strategy. Cross-sectional analysis among patients with internal diseases. Department of Internal and Integrative Medicine at an academic teaching hospital in Germany. Prior use of relaxation techniques (e.g. meditation, autogenic training), perceived benefit, and perceived harm. Potential predictors of relaxation techniques use (sociodemographic characteristics, health behavior, internal medicine diagnosis, general health status, mental health, satisfaction, and health locus of control) were tested using multiple logistic regression analysis. Of 2486 participants, 1075 (43.2%) reported to have used relaxation techniques, 648 (60.3%) reported benefits, and 11 (1.0%) reported harms. Use of relaxation techniques was independently associated with female gender (Odds ratio [OR]=1.43; 95% confidence interval [CI]=1.08-1.89), higher education (OR=1.32; 95%CI=1.03-1.71), fibromyalgia (OR=1.78; 95%CI=1.22-2.61), and internal health locus of control (OR=1.27; 95%CI=1.01-1.60). Use of relaxation techniques was negatively associated with age below 30 (OR=0.32; 95%CI=0.20-0.52) or above 64 (OR=0.65; 95%CI=0.49-0.88), full-time employment (OR=0.75; 95%CI=0.57-0.98), current smoking (OR=0.72; 95%CI=0.54-0.95), osteoarthritis (OR=0.51; 95%CI=0.34-0.77), rheumatic arthritis (OR=0.59; 95%CI=0.37-0.93), good to excellent health status (OR=0.70; 95%CI=0.52-0.96), and high life satisfaction (OR=0.78; 95%CI=0.62-0.98). In a German sample of patients with internal diseases, relaxation techniques were used as a coping strategy by about 43%. Users were more likely to be middle-aged, female, well-educated, diagnosed with fibromyalgia, not smoking, not full-time employed, and not to have a good health status or high life satisfaction. A high internal health locus of control predicted relaxation techniques use. Considering health locus of control might improve adherence to relaxation techniques in internal medicine patients.