Excellent Health Research Articles

Palpitations and Fatigue Post COVID: A Harbinger of Silent Thyroiditis!

Background: Subacute thyroiditis is a self-limiting condition brought about by an inflammatory reaction often linked to a recent viral infection. SARS-COV2 (COVID-19), an RNA coronavirus that started a global pandemic in December 2019 has been linked mostly to severe acute respiratory distress syndrome. However, there have been increasing reports of its effect on other organ systems. We present a case of a 32-year-old female recovering from COVID-19, only to develop silent thyroiditis afterwards. Clinical Case: A 32-year-old female with anxiety disorder but otherwise in excellent health was diagnosed with COVID-19 via nasal swab RT-PCR after experiencing low grade fever and cough. She quarantined at home and was on her way to recovery when, a few weeks later, she began to experience increasing bouts of chest pain with no relation to activity, intermittent headaches and lower extremity edema. This prompted her to visit the emergency department. Work-up done at that time was unremarkable and her symptoms were attributed mostly to anxiety. She was advised to follow-up as an outpatient with a cardiologist. One month later, due to the persistence of her fatigue, low exercise tolerance and tremors, she decided to seek consult with a cardiologist. An electrocardiogram done during that visit showed normal sinus rhythm with poor-R wave progression and early repolarization changes. Both the echocardiogram and 24-hour Holter monitoring, which were subsequently done, were unremarkable. Blood work-up, however, revealed a significantly low thyroid stimulating hormone (TSH) level of 0.17 mU/L, for which she was referred to an endocrinologist. A month later, she sought consult with an endocrinologist. Thyroid gland was non-tender on palpation. Repeat blood work-up showed an elevated TSH level (23.50 mU/L) with a low Free T4 (0.42 ng/dL) and an elevated thyroid peroxidase antibody (TPO-Ab) level (900 mU/mL), indicative of subacute thyroiditis, but without associated neck pain. Thyroid sonography done showed diffusely heterogeneous thyroid lobes with no evidence of a dominant mass or nodule. A decision was made to start her on low dose levothyroxine. Two months into treatment, she underwent repeat thyroid hormone levels. Normal TSH and normal free T4 were observed. However, TPO-Ab was still elevated. It was decided to continue her therapy for one more month before gradually tapering her levothyroxine dose. She was told to follow-up in a month for further monitoring. Conclusion: Subacute thyroiditis associated with COVID-19 infection has become a more common occurrence as more cases of COVID-19 are noted worldwide. Our patient followed the usual course of subacute thyroiditis, initially presenting with a thyrotoxicosis phase which typically lasts 4-10 weeks, then subsequently developing hypothyroidism, inadvertently needing thyroid hormone replacement. What made this case more intriguing was that she did not have severe anterior neck pain, the classic clinical presentation of subacute thyroiditis. While there is a very strong association between COVID-19 and respiratory failure, there is paucity of evidence linking COVID-19 to dysfunction of other body systems. This case of thyroiditis presenting post COVID-19 illness, buttresses the versatility of COVID-19. Physicians should keep this in mind when evaluating a COVID-19 survivor who continue to present with persistent tachycardia or palpitations with or without anterior neck pain even after a month or two from infection. Routine follow-up TSH assay on COVID-19 survivors may be a valuable consideration.

Influence of Comorbidities on Healthcare Expenditures and Perceived Physical and Mental Health Status Among Adults with Multiple Sclerosis: A Propensity Score-Matched US National-Level Study.

ObjectiveTo evaluate the effect of comorbidities on healthcare expenditures and perceived physical and mental health status among adults with multiple sclerosis (MS) compared to propensity score-matched non-MS controls.MethodsA retrospective, cross-sectional, matched cohort study was conducted using Medical Expenditure Panel Survey (2005–2015) data. The base study sample consisted of adults (age ≥18 years) who were alive and had positive total healthcare expenditures during the survey calendar year. Adults with MS were propensity-matched (1:1) to non-MS controls based on age, gender, and race/ethnicity using greedy matching algorithm. Healthcare expenditures consisted of total and subtypes of expenditures. Health status consisted of perceived physical and mental health status. Comorbidities were identified using ICD-9-CM and Clinical Classification System codes. Ordinary least squares regression and multinomial logistic regression were used to analyze the healthcare expenditures and health status variables, respectively.ResultsFinal study sample consisted of 541 adults in each MS and non-MS control groups after propensity score matching. After adjusting for potential confounders, individuals with MS had greater total and subtypes of expenditures compared to non-MS controls, and several comorbidities (eg, depression, hypertension) were significantly associated with increased healthcare expenditures. Yearly average total expenditures (expressed in 2018 US$) were significantly (p<0.001) higher for adults with MS ($29,396) than propensity score-matched non-MS adults ($7875). Moreover, after adjusting for all individual-level factors, adults with MS experienced 363% (p<0.001) higher total expenditures compared to propensity score-matched non-MS controls. Individuals with MS were more likely to report poorer physical and good mental health status compared to propensity score-matched non-MS controls, and several comorbidities (eg, anxiety, depression) were significant independent predictors of poorer health status. For example, adults with MS were four times more likely (OR: 4.10, 95% CI: 2.42–6.96) to report fair/poor physical health status compared to excellent/very good physical health status compared with non-MS controls. Adults with MS were 42% (OR: 1.42, 95% CI: 1.01–1.99) more likely than propensity score-matched non-MS controls to report good rather than very good or excellent mental health status. However, there was no difference between adults with MS and propensity score-matched non-MS controls in terms of reporting fair or poor than very good or excellent mental health status.ConclusionFindings from this study indicate substantial economic and health status burdens among adults with MS at the US national-level that are significantly influenced by comorbidities.

A Cluster Analysis with Complete Linkage and Ward's Method for Health Service Data in Makassar City

Health care facilities are a place used to organize health efforts. Health service data in Makassar City has not shown which sub-districts have excellent service criteria, good enough, and not good. Therefore, it is necessary to group sub-districts with cluster analysis using hierarchy method. The hierarchy method used in this study is only 2, namely complete linkage and ward's method. Complete linkage method is the opposite of the approach to the minimum distance principle that is the furthest distance between objects while Ward's Method is a method that aims to minimize variance between objects in one cluster. There are four health services used, namely Hospitals, Health Centers, Home Care and Telemedicine with 15 sub-districts. This study also used a validity test namely Index Davies Bouldin (IDB) to determine the criteria of health services. The results of the analysis on complete linkage formed 3 clusters, namely cluster 1 with good health services, cluster 2 with excellent health services, and cluster 3 with poor health services. In addition, ward's Method also formed 3 clusters, namely cluster 1 with good health services, clusters 2 with poor service, and cluster 3 with excellent health services.

Social stigma towards nurses taking care of patients with COVID-19 in Indonesia: A mixed-methods study.

The condition of the Indonesians' unpreparedness for the COVID-19 pandemic has caused anxiety and fear. The public's fears of COVID-19 cases have led to a negative stigma. As part of health workers in disaster management's main pillars in health services, nurses are most vulnerable to infection and not free from the stigma. This study aimed to describe the social stigma against nurses taking care of patients with COVID-19 and experiencing suspected or probable or confirmed COVID-19 cases in Indonesia. This study was a mixed-method study using a sequential explanatory design-participant selection model. The selection of respondents used the convenience sampling technique. The number of respondents in the quantitative stage was 118 respondents. For qualitative data, selected participants were respondents with a stigma score of more than 21 nurses and willing to continue the interview process. There were 11 participants in the qualitative stage. This study used the modified Stigma Scale of the Explanatory Model Interview Catalog for quantitative data and four semi-structured questions to obtain qualitative data. Quantitative data were processed in descriptive statistics, and a thematic analysis was performed to analyze the qualitative data. The highest stigma score of 118 respondents was 37, and the lowest score was zero. The stigma score had a mean of 12.28 (SD ± 7.9). The higher the score obtained leads to a higher level of stigma received. From a total of 11 participants interviewed, four main themes emerged: rejection, feeling down and afraid, sources of support, and professional vigilance. The social stigma experienced by nurses comes from colleagues and society and impacts psychological distress. Support from families and colleagues strengthens nurses in facing social stigma. Nevertheless, nurses uphold the values to remain grateful and carry out professional responsibilities in taking care of patients. Nurses should be provided with psychological support and be prepared for disasters to provide excellent health services and reduce adverse mental health.

Assessment of Cardiometabolic Health, Diet and Physical Activity in Helicopter Rescue Paramedics

Objective: Shift work is an established risk factor for weight gain, cardiovascular disease, Type II diabetes mellitus, and impaired health-related quality of life (HRQoL). Prolonged exposure to shift work is common in paramedics and other emergency medical service (EMS) providers. Sub-populations of EMS workers may have varying health outcomes when exposed to shift work, but the reasons for this have not been investigated. We sought to describe cardiometabolic health, dietary patterns, physical activity, and health-related quality of life (HRQoL) in a sample of experienced intensive care flight paramedics (ICFPs) working for a Helicopter Emergency Medical Service (HEMS). Methods: Fifteen paramedics (median age 45, IQR 42–48 years) were recruited to undertake a range of health assessments. These included a food frequency questionnaire to assess dietary patterns, sampling of biomarkers to determine cardiometabolic health risk, maximal aerobic capacity assessment via treadmill running and assessment of HRQoL via the SF-36 survey. In an extension of the study protocol, ten of the fifteen participants wore a physical activity monitor for one year. Results: Median (IQR) weight was 79.9 (72.3–89.3) kg, body fat percentage 23.3 (21.9–26.5) %, body mass index (BMI) 25.1 (21.9–27.4) kg.m2, and waist to height ratio 0.48 (0.45–0.54). Dietary analyses showed high discretionary food intake. Biomarkers of cardiometabolic health risk were all within normal range. HRQoL was 86.2/100 for physical health and 85.1/100 for mental health. V̇O2max was 47.0 (43.0–54.6) mL.kg−1.min−1. The ten participants that wore activity monitors completed 11,235 (8334–15,380) steps per day and undertook 50 (12–98) minutes per day/350 (84–686) minutes per week of moderate to vigorous physical activity. The least amount of physical activity was conducted on day shifts. Conclusions: For ICFPs included in this study, HRQoL, cardiometabolic and physical activity outcomes are representative of good health. Although shift work influences the amount of physical activity, ICFPs exceeded minimum recommendations even when rostered to duty. Despite lengthy careers in EMS, ICFPs demonstrate an excellent health profile that is likely due to high physical activity levels and healthy BMI. This information may be useful in guiding health interventions in the wider EMS workforce.

Examining the Relationship Between Physical Activity and Self-Efficacy for Exercise Among Overweight and Obese Marshallese Adults.

This study examined associations between physical activity frequency and self-efficacy for exercise (SEE) among Marshallese adults in the United States. Data were collected from overweight and obese Marshallese participants (N = 378) enrolled in a Diabetes Prevention Program trial. Logistic and ordinal logistic regressions were employed to examine associations between physical activity and SEE, adjusting for covariates. SEE was significantly associated with engaging in sufficient total physical activity [odds ratio (OR) = 1.70], moderate physical activity (OR = 2.23), and vigorous physical activity (OR = 2.13). Unemployment was associated with less frequent moderate physical activity (OR = 0.59). Younger age (OR = 0.98), being male (OR = 2.67), and reporting excellent health (OR = 3.14) or good health (OR = 2.06) were associated with more frequent vigorous physical activity. Physical activity is a modifiable lifestyle behavior associated with many chronic disease disparities faced by the Marshallese community, and the study results will be useful for practitioners and researchers working to address these disparities.

Transport to School and Mental Well-Being of Schoolchildren in Ireland.

Objectives: We explored whether modes of transport (cycling, walking, public transport or private vehicle) between home and school are associated with mental well-being in children aged 10–17 years, participating in the Irish Health Behaviour in School-aged Children (HBSC) study. Methods: Scores on the World Health Organization Well-being Index and the Mental Health Inventory five-item versions, self-reported life satisfaction, happiness with self, body satisfaction, excellent self-rated health, and multiple health complaints of 9,077 schoolchildren (mean age: 13.99 ± 1.91 years, percentage girls: 52.2%) were compared across modes of transport, unadjusted and adjusted for gender, age, family affluence and area of residence. Results: Those who reported using public transport reported poorer mental well-being than those using other means of transport, but adjusting for sociodemographic variables obscured these differences. The only exception was excellent health, where children who cycled outperformed the other three groups, even after adjustment for sociodemographic variables. Conclusions: Cycling can improve well-being in children. However, in promotion of cycling, social and environmental determinants and inequalities which influence adolescents’ and their parents’ decisions on modes of transport, need to be considered.

Assessing ecological health of mangrove ecosystems along South China Coast by the pressure-state-response (PSR) model.

The pressure-state-response (PSR) model was applied to establish a mangrove ecosystem health evaluation system combined with analytical hierarchy process (AHP) in this paper. The mangrove wetlands are divided into five ecological levels: excellent health, good health, health, sub-health and morbidity, which is based on the comprehensive health index (CHI) value. Twelve representative sites were selected for sampling to assess the ecological health condition of mangroves. As a result, the ecological health level of Gaoqiao mangrove area is excellent health; the ecological health level of Taiping mangrove area is good health; the ecological health level of Huguang and Qi'ao mangrove area is health; the ecological health level of Techeng and He'an mangrove area is sub-health; the ecological health level of Huidong mangrove area is morbidity. These results will give some advises for ecological protection and biological resource sustainable development of mangrove ecosystem in China.

Investigating the wood production and adaptability potential of Corymbia hybrid progeny in northern coastal Zululand, South Africa

During August 2013, two ‘new’ eucalypt taxa × site interaction trials were established in northern coastal Zululand. The main purpose of these trials was to investigate the commercial forestry potential of a range of Corymbia inter-specific hybrids for the region. Two sites contrasting in mean annual precipitation (850 mm and 1 155 mm respectively) and productivity potential, namely Mfezi (Mtubatuba) and Flatcrown (Kwambonambi), were selected for these trials. The 28 Corymbia hybrid seedlots comprised controlled crosses between C. torelliana and C. citriodora subsp citriodora, C. citriodora subsp variegata and C. henryi. Trees were assessed annually for the presence of pests and diseases and at mid-rotation (48 months) comprehensively measured for growth. By mid-rotation, none of the Corymbia hybrid families showed susceptibility to the suite of insect pests plaguing many of the commercial Eucalyptus hybrid clones in the region. Furthermore, no noteworthy disease infection symptoms were observed in any of the Corymbia or Eucalyptus species and hybrids in the trials. At the drier site of the two (Mfezi), at 24 months following 2 successive dry (<700 mm rainfall) years, trees of some of the Corymbia hybrid families manifested drought stress symptoms in the form of mild to moderate kino exudations from stems and branches. However, by mid-rotation, most of the Corymbia hybrid families in the trial showed excellent tree health, survival and stem volume relative to that of the commercial hybrid controls. At both sites, the seven top-ranking treatments for volume were Corymbia hybrid families. Based on the overall excellent growth performances of several of the Corymbia hybrid families in the two trials, more intensive investigations, for example in the areas of wood properties, vegetative propagation and clonal performance testing, would appear well-warranted.

Physical Health and Delinquency

While physical health can impact a variety of outcomes, little research has looked at health and delinquency. Through a lens of GST, this study examines whether health moderates the relationships between strain and delinquency and drug use. Data from the 2011 NSDUH were analyzed; results indicated that, for certain strains, very good and excellent health predicted lower risks of committing some types of delinquency and poor/fair health predicted the higher risk. For youth in “no parent” homes in very good health and from some youth with chronic illness, however, the risk of delinquency increased. The overall results dictate the expansion of health programming and the complex findings suggest increased research on the nexus of health and delinquency.

Abstract S04-03: Impact of the COVID-19 pandemic on social and health behaviors among rural and urban cancer patients at Huntsman Cancer Institute (HCI)

Abstract Purpose: The COVID-19 pandemic has disrupted many facets of life for rural and urban patients with cancer. Here, we characterize the impact of the pandemic on social and health behaviors of rural and urban cancer patients. Methods: N=1,326 adult cancer patients, who visited HCI in the last 4 years and enrolled in either Total Cancer Care or Precision Exercise Prescription studies, completed a COVID-19 survey. The survey was administered between Aug and Sept 2020 and included questions on demographic and clinical information as well as employment status, health behaviors, and COVID-19 prevention measures. Results: The mean age was 61 (19-92) years, with 54% female, 97% non-Hispanic White, 80% stage I-III, 42% employed full or part-time, 25% living in rural counties, and 85% reporting good to excellent overall health. Cancer patients in rural compared to urban counties were more likely to be older (rural=63 vs. urban=60 years; p=0.01), retired or not employed (rural=63% vs. urban=56%; p=0.04), not have health insurance coverage (rural=4% vs. urban=2%; p=0.01), and have ever smoked (rural=35% vs. urban=24%; p=0.001). However, urban patients reported “somewhat” to “a lot” of change in their daily lives more frequently than rural patients (urban=86% vs. rural=77%; p&amp;lt;0.001), but there were no differences in change in social interaction or feeling lonely between populations. Changes in health behaviors namely exercise habits due to the pandemic were more common in patients residing in urban vs. rural counties (urban=51% vs. rural=39%; p&amp;lt;0.001), with more urban patients either exercising less (urban=23% vs. rural=17%) or more frequently (urban=12% vs. rural=8%); however, there were no significant differences with respect to changes in alcohol consumption between these groups. In terms of prevention measures, urban patients compared to rural patients were more likely to use face masks “fairly” or “very often” (urban=94% vs. rural=83%; p&amp;lt;0.001) and also felt they were more likely to contract a COVID-19 infection (22% vs. 14%; p=0.003), but there were no differences for other risk mitigation behaviors, such as hand sanitizer use. Conclusion: These findings suggest that the first 6 months of the COVID-19 pandemic had disparate effects on cancer patients living in rural and urban counties. Rural patients were more likely to have risk factors associated with poor health outcomes, such as not having health insurance coverage and having a history of smoking. However, urban patients were more likely to experience larger changes in their daily lives and exercise habits. Urban patients were more likely to follow preventive measures (e.g., wearing face masks) and felt they were at a greater risk of contracting the virus. Further research is needed to better characterize the pandemic's short- and long-term effects on cancer patients in rural and urban settings and appropriate interventions. Funding: U01CA206110, R01CA211705. Citation Format: Bailee Daniels, Caroline Himbert, Cassandra A. Hathway, Tengda Lin, Karen Salas, Anjelica Ashworth, Anne C. Kirchhoff, Anna Beck, Cindy Matsen, Courtney Scaife, Cristina Christenson, Douglas Grossman, Howard Colman, Jason P. Hunt, Jennifer Ose, Jonathan Tward, Kevin B. Jones, Michael Deininger, Mikaela Larson, Paul LaStayo, Thomas Varghese, Tracy Onega, Wallace L. Akerley, Frank J. Penedo, Erin M. Siegel, Cornelia M. Ulrich, Shelley S. Tworoger, Anita R. Peoples. Impact of the COVID-19 pandemic on social and health behaviors among rural and urban cancer patients at Huntsman Cancer Institute (HCI) [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S04-03.

"It Is Like Medicine": Using Sports to Promote Adult Women's Health in Rural Kenya.

Despite the well-documented health benefits of recreational sports, few opportunities exist in lower- and middle-income countries for adult women to participate in recreational physical activities. An explanatory sequential mixed methods approach was used to explore associations between an innovative soccer program for adult women and self-reported health status. Cross-sectional survey data were collected in 2018–2019 from 702 women in the Nikumbuke Project, a health and literacy program in southeastern rural Kenya, followed by focus group discussions with 225 women who also participated in the Project’s soccer program. Quantitative findings suggest that women who participated in soccer had 67% greater odds of reporting good or excellent health than their non-soccer playing peers. Thematic analysis of qualitative data indicated that women credited soccer with less pain, fatigue, and stress, as well as weight loss and reduced dependence on medicine for hypertension, pain, and sleep problems. Women equated health benefits with greater ease and efficiency in completing chores, reduced worries, youthful energy, male-like strength, and pleased husbands. Soccer programs for adult women may be particularly effective interventions in settings where access to health care is limited and where lack of opportunity to engage in physical aerobic activity increases women’s risks for poor health outcomes.

Osteopathy students profile in Italy: A cross sectional census.

The Osteopathy Students Analysis (OSA) aims to profile osteopathy students in Italy as a target population in terms of sociodemographic characteristics, geographical distribution, health status, and previous and ongoing education specifications. The OSA used a cross-sectional design. A Web-based survey was distributed to the Italian Osteopathic Education Institutions (OEIs). The OSA survey was composed of items organised into four sections: 1. Sociodemographic characteristics (11 items); 2. Geographical distribution (5 items); 3. Health status (3 items); 4. Previous and ongoing education specifications (16 items). A descriptive sample population analysis was performed. Dichotomous and categorical variables were presented as frequencies and percentages, and continuous variables were displayed as means and standard deviations. Some variables were analysed using a pentenary distribution. 49 out of the 61 OEIs identified matched the inclusion criteria, and among these, 22 accepted to propose the enrolment of their students into the study. The survey was administered to 4,720 students from all the participant OEIs. A total of 3,762 students responded to the survey, accounting for an estimated response rate of 53.7%. The majority of respondents were men (54%), with an average age of 26.9 ± 6.5 years. Almost the totality of the sample was composed of the European ethnic group (99.1%). Respondents were predominantly born in Italy (97.2%). The majority of the sample reported being in good (49.5%) to excellent (38.6%) health. To date, osteopathy students are almost evenly distributed between the two types of curricula (T1 = 46.6%; T2 = 53.4%). The OSA is the first study that aims to profile Italian osteopathy students as a target population in terms of sociodemographic characteristics, geographical distribution, health status, and previous and ongoing education specifications. Future studies should focus on investigating the correlation between the sociodemographic characteristics of students and their academic performance.

The Conditional Effects of Health on Voter Turnout.

Voting is the central instrument of democracy, yet there are a number of impediments that affect citizens' ability to turn out to vote. Health is one such impediment. This study draws on 2012 and 2016 election data from the Cooperative Congressional Election Study and the American National Election Studies and uses objective validated measures of voter turnout as well as postelection data on respondents' reasons for nonvoting to examine the relationship between self-reported health and voter turnout. The results indicate poor health depresses turnout among low-income voters but not high-income voters. A low-income citizen in poor health is 7 points less likely to turn out to vote than a low-income citizen in excellent health is. In contrast, a high-income citizen in poor health is just as likely to vote as a high-income citizen in excellent health is. Moreover, low-income citizens in poor health are 10 points more likely to cite sickness as an impediment to voting than are otherwise similar high-income citizens who are also in poor health. The findings have implications for health policy and unequal electoral engagement and suggest that health may narrow the scope of US democracy as poor health pushes low-income citizens out of the electoral sphere while high-income citizens continue to turn out to vote regardless of their underlying health conditions.

Complications and Revisions After Spine Surgery in Patients With Skeletal Dysplasia: Have We Improved?

Retrospective case series. To report contemporary rates of complications and subsequent surgery after spinal surgery in patients with skeletal dysplasia. A case series of 25 consecutive patients who underwent spinal surgery between 2007 and 2017 were identified from a single institution's skeletal dysplasia registry. Patient demographics, medical history, surgical indication, complications, and subsequent surgeries (revisions, extension to adjacent levels, or for pathology at a non-contiguous level) were collected. Charlson comorbidity indices were calculated as a composite measure of overall health. Achondroplasia was the most common skeletal dysplasia (76%) followed by spondyloepiphyseal dysplasia (20%); 1 patient had diastrophic dysplasia (4%). Average patient age was 53.2 ± 14.7 years and most patients were in excellent cardiovascular health (88% Charlson Comorbidity Index 0-4). Mean follow up after the index procedure was 57.4 ± 39.2 months (range). Indications for surgery were mostly for neurologic symptoms. The most commonly performed surgery was a multilevel thoracolumbar decompression without fusion (57%). Complications included durotomy (36%), neurologic complication (12%), and infection requiring irrigation and debridement (8%). Nine patients (36%) underwent a subsequent surgery. Three patients (12%) underwent a procedure at a non-contiguous anatomic zone, 3 (12%) underwent a revision of the previous surgery, and another 3 (12%) required extension of their previous decompression or fusion. Surgical complication rates remain high after spine surgery in patients with skeletal dysplasia, likely attributable to inherent characteristics of the disease. Patients should be counseled on their risk for complication and subsequent surgery.

Mental Well-being and General Health in Adolescents with Asthma: The Prevention and Incidence of Asthma and Mite Allergy Birth Cohort Study

To assess whether adolescents with asthma experience a lower mental well-being and lower general health than their peers without asthma. Data from the Prevention and Incidence of Asthma and Mite Allergy study were used. At the ages of 11, 14, 17, and 20years, 2651, 2522, 2094, and 2206 participants, respectively, completed questionnaires. Their parents completed questionnaires at the ages of 11 (n=2660), 14 (n=2338), and 17years (n=1872). Asthma was defined according to the Mechanisms of the Development of Allergy criteria. Mental well-being was measured using the Mental Health Index-5 and was reported by the adolescents. General health, measured on a 4-point Likert scale, was reported by the adolescents and their parents. We estimated associations of asthma with mental well-being and perceived general health using generalized estimating equations. At ages 11, 14, 17, and 20years, 6.7%, 6.9%, 5.0%, and 6.6%, respectively, of the adolescents had asthma. Adolescents with asthma did not score differently on the Mental Health Index than their peers without asthma. Adolescents with asthma were less likely to experience good or excellent health than their peers without asthma (aOR, 0.37; 95% CI, 0.26-0.51 for intermittent asthma and 0.33; 95% CI, 0.25-0.41 for persistent asthma). These results remain similar across the different ages. The mental well-being of adolescents with asthma is similar to that of their peers without asthma, although adolescents with asthma are less likely to perceive a good or excellent general health.

Excellent Self-Rated Health among Swedish Boys and Girls and Its Relationship with Working Conditions in School: A Cross-Sectional Study.

The aim of this study was to investigate the extent to which school demands, teacher support, and classmate support were associated with excellent self-rated health among students, and to examine if any such statistical predictions differed by gender. Data were drawn from the Swedish Health Behaviour in School-aged Children (HBSC) study of 2017/18, performed among adolescents in grades five, seven, and nine (n = 3701). Linear probability models showed that school demands were negatively associated with excellent self-rated health, whereas teacher and classmate support showed positive associations. The link with school demands was stronger for girls than boys, driven by the finding that in grades five and nine, school demands were associated with excellent self-rated health only among girls. In conclusion, the study suggests that working conditions in school in terms of manageable school demands and strong teacher and classmate support may benefit adolescents’ positive health. The finding that the link between school demands and excellent self-rated health was more evident among girls than among boys may be interpreted in light of girls’ on average stronger focus on schoolwork and academic success. The study contributes with to knowledge about how working conditions in school may impede or promote students’ positive health.

Stratification in Post-Secondary Education and Self-Rated Health among Canadian Adults

Two-thirds of Canadian adults have post-secondary credentials, ranging from trade certificates to bachelor’s and advanced degrees. Yet, little is known about health across these levels, partly because the extensive literature on the education–health gradient has often grouped all post-secondary credentials into one or two broad categories. This is an important gap because it obscures social stratification at the post-secondary level. We provide the first comprehensive study of health across educational attainment levels in Canada, focusing on detailed post-secondary credentials. Data from the 2014–2016 Canadian General Social Survey for adults aged 25 years and older are used to assess self-rated health as a function of educational credentials for the total population and major population groups in relative and absolute terms, and to examine potential mechanisms that could explain the observed patterns. Analyses reveal substantively large, statistically significant differences in health across post-secondary credential levels: the predicted probability of reporting very good or excellent health is 49 percent among adults with trade certificates but 66 percent among those with advanced degrees. Such differences are evident in most although not all population groups. Taking into account social, economic, health–behavioural, and other covariates attenuates the post-secondary credential–health gradient by about 60 percent. Our findings highlight the importance of stratification in post-secondary credentials and the resulting health disparities. Understanding the reasons and implications of these disparities is important for educational, health, and social justice policies.

Factors associated with musculoskeletal pain in the past 12 months amongst female miners in a South African goldmine.

BackgroundMineworkers, including females, are prone to work-related musculoskeletal disorders and these disorders are not well reported amongst female mineworkers in South Africa.ObjectiveThis study aimed to identify the factors associated with the presence of musculoskeletal pain over a 12-month period amongst female mineworkers (n = 225) in a South African goldmine.MethodFemale mineworkers’ responses to the presence of musculoskeletal pain over the previous 12-month period and their exposure to physical and psychological factors were elicited using a standardised questionnaire. Descriptive and multivariable analytical statistics were conducted to test for associations between physical and psychological factors and the presence of musculoskeletal pain over the previous 12 months.ResultsThe median age of participants was 40 years, with 50.22% of participants reporting the presence of musculoskeletal pain over the previous 12 months. On multivariable analysis, education level and good to excellent health status were protective against the existence of pain during the previous 12 months. Participants’ perceived ratings of experiencing moderate-to-high pain intensities were significantly associated with reports of pain over the past 12 months.ConclusionThese findings may raise awareness amongst physiotherapists and occupational medicine physicians about the factors associated with musculoskeletal pain amongst female mineworkers, which they can then use in managing and developing interventions aimed at improving the physical health of female mineworkers.Clinical implicationsOur study highlights the need for medical surveillance of musculoskeletal pain in female mineworkers. A cohort study in a larger study population and across several mines will build on the existing cross-sectional information and help inform workplace interventions for female mineworkers.

Income-related health inequalities associated with the coronavirus pandemic in South Africa: A decomposition analysis

BackgroundThe coronavirus disease 2019 (COVID-19) has resulted in an enormous dislocation of society especially in South Africa. The South African government has imposed a number of measures aimed at controlling the pandemic, chief being a nationwide lockdown. This has resulted in income loss for individuals and firms, with vulnerable populations (low earners, those in informal and precarious employment, etc.) more likely to be adversely affected through job losses and the resulting income loss. Income loss will likely result in reduced ability to access healthcare and a nutritious diet, thus adversely affecting health outcomes. Given the foregoing, we hypothesize that the economic dislocation caused by the coronavirus will disproportionately affect the health of the poor.MethodsUsing the fifth wave of the National Income Dynamics Study (NIDS) dataset conducted in 2017 and the first wave of the NIDS-Coronavirus Rapid Mobile Survey (NIDS-CRAM) dataset conducted in May/June 2020, this paper estimated income-related health inequalities in South Africa before and during the COVID-19 pandemic. Health was a dichotomized self-assessed health measure, with fair and poor health categorized as “poor” health, while excellent, very good and good health were categorized as “better” health. Household per capita income was used as the ranking variable. Concentration curves and indices were used to depict the income-related health inequalities. Furthermore, we decomposed the COVID-19 era income-related health inequality in order to ascertain the significant predictors of such inequality.ResultsThe results indicate that poor health was pro-poor in the pre-COVID-19 and COVID-19 periods, with the latter six times the value of the former. Being African (relative to white), per capita household income and household experience of hunger significantly predicted income-related health inequalities in the COVID-19 era (contributing 130%, 46% and 9% respectively to the inequalities), while being in paid employment had a nontrivial but statistically insignificant contribution (13%) to health inequality.ConclusionsGiven the significance and magnitude of race, hunger, income and employment in determining socioeconomic inequalities in poor health, addressing racial disparities and hunger, income inequality and unemployment will likely mitigate income-related health inequalities in South Africa during the COVID-19 pandemic.