Fair Health Status Research Articles

Perceived Health and Quality of Life in Patients With CKD, Including Those With Kidney Failure: Findings From National Surveys in France

Health-related quality of life (HRQoL) is a major outcome measure increasingly used in patients with chronic kidney disease (CKD). We evaluated the association between different stages of CKD and the physical and mental health domains of HRQoL. Cross-sectional study. 2,693 outpatients with moderate (stage 3, estimated glomerular filtration rate [eGFR], 30-60mL/min/1.73m2) or advanced (stages 4-5, estimated glomerular filtration rate<30mL/min/1.73m2, not on kidney replacement therapy [KRT]) CKD under the care of a nephrologist at 1 of 40 nationally representative facilities, 1,658 patients with a functioning kidney transplant, 1,251 patients on maintenance dialysis randomly selected from the national Renal Epidemiology and Information Network registry, and 20,574 participants in the French Decennial Health Survey, representative of the general population. Severity of kidney disease (moderate CKD, advanced CKD, maintenance dialysis as KRT, and functioning kidney transplant as KRT), compared with a sample of the general population. HRQoL scores assessed using the Medical Outcomes Study 36-Item Short Form Health Survey or the Kidney Disease Quality of Life 36 scale. Age- and sex-standardized (to the general population) prevalence of poor or fair health status was estimated for each study kidney disease group. Analysis of variance was used to estimate adjusted differences in mean physical and mental health scores between the kidney disease subgroups and the general population. Mean age was 67.2±12.6 (SD) years for patients with non-KRT-requiring CKD, 69.3±17.7 years for dialysis patients, and 55.3±14.2 years for those with functioning kidney transplants; 60% were men. Age- and sex-standardized health status was perceived as fair or poor in 27% of those with moderate CKD,>40% of those with advanced CKD or receiving dialysis, 12% with a functioning transplant, and 3% of the general population sample. HRQoL physical scores (adjusted for age, sex, education, obesity, and diabetes) were significantly lower in patients in all CKD subgroups than in the general population. For patients receiving dialysis, the magnitude of the difference in physical score versus the general population exceeded 4.5 points, the minimal clinically important difference for this score in this study; for both kidney transplant recipients and patients with advanced CKD, the magnitude of the difference was close to this threshold. For mental score, only dialysis patients had a score that differed from that of the general population by more than the minimal clinically important difference. Cross-sectional study design for each subpopulation. This study highlights the degree to which perceived physical health is lower in the setting of CKD than in the general population, even in the absence of kidney failure, and calls for greater attention to CKD-related quality of life.

Association between Health Insurance and Health among Adults with Diabetes: Evidence from Medicare.

Gaining Medicare eligibility at age 65 is associated with increased health insurance coverage and reduced medical expenditure risk, but few studies have examined changes in health outcomes among adults with a specific chronic condition. This study assessed the association between Medicare eligibility and health among adults with diabetes. Regression discontinuity design to test for discontinuities in healthcare outcomes at age 65 when most US adults become eligible for Medicare. National Health Interview Survey, 2006-2016. Respondents ages 55 to 74 with diagnosed diabetes (n = 13 455). Primary outcome measures included self-reported fair or poor general health status, any functional limitation, overweight, obese, and body mass index. Secondary outcomes included health insurance coverage, healthcare spending burden, and functional limitations by cause and type. Medicare eligibility was associated with about an 8.0 percentage point reduction in the uninsured rate (95% confidence interval [CI], -9.9 to -6.0 percentage points; P < .001) and declines in high out-of-pocket healthcare expenditures and worry about medical bills. Eligibility was also associated with reductions of about 5.2 [95% CI, -6.9 to -3.6; P < .001] and 4.7 [95% CI, -7.1 to -2.3; P = .001] percentage points in fair or poor health and any functional limitation, respectively. Declines in functional limitations appeared to be driven by reductions in limitations due to diabetes, arthritis, heart problems, and emotional or behavioral problems. Some evidence indicated that Medicare eligibility was associated with a decline in obesity, but estimates were not consistently statistically significant. Expanded health insurance coverage and gains in coverage quality may improve health outcomes among older adults with diabetes. J Am Geriatr Soc 68:388-394, 2020.

P5473Perceived well-being after acute myocardial infarction according to diabetic status and its impact long-term mortality. The FAST-MI programme

Abstract Background Little information is available regarding subjective well-being according to diabetic status in patients surviving an acute myocardial infarction (AMI). Aims and methods A health status questionnaire was sent to all patients participating in the nationwide French FAST-MI cohorts (2005, 2010 and 2015) one year after the acute episode of AMI, with a specific question on overall health condition (how do you feel: very well, well, fair, poor) (n=6082), and additional questions on the presence of any chest pain (n=4590), presence nuisance bleedings (n=3968), and reporting of perceived medication side-effects (n=2220). Answers were analysed according to diabetic status. We also analysed in the 2005 and 2010 cohorts whether subjective health status at one year was a correlate of 5-year mortality. Results Compared with non-diabetic patients (n=4692), those with diabetes (n=1390) had a poorer perceived health status (poor/fair health status: 40% vs 30%, P&lt;0.001), more presence of chest pain (31% vs 23%, P&lt;0.001), but less nuisance bleedings (47% vs 56%, P&lt;0.001) and similar reported medication side-effects (37% vs 41%, P=0.12). Using logistic regression analysis, diabetes was an independent correlate of poorer health status (any diabetes OR vs non-diabetic 1.29, 1.13–1.49, P&lt;0.001; non-insulin-treated: 1.17, 1.00–1.36, P=0.05, insulin-treated: 1.58, 1.29–1.94, P&lt;0.001). In diabetic patients, perceived health condition at one year was an independent correlate of 5-year death (Cox multivariate analysis): compared with patients reporting very good health, HR (95% CI) 2.16 (1.08–4.32) for good health, 3.06 (1.53–6.11) for fair health, and 3.63 (1.55–8.55) for poor health; in non-diabetic patients, 5-year survival was similar in those reporting good or very good health status, but lower in those reporting fair or poor health status (Figure). Figure 1. 5-year survival by health status Conclusion Compared with non-diabetic patients, patients with diabetes described a poorer general health and more residual chest pain after AMI, but had less nuisance bleedings. Health condition reported one year after AMI was an independent correlate of subsequent long-term mortality, particularly for diabetic patients. Acknowledgement/Funding Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, Servier

SNAP, Young Children's Health, and Family Food Security and Healthcare Access

The Supplemental Nutrition Assistance Program (SNAP) is the largest nutrition assistance program in the U.S. This study's objective was to examine the associations between SNAP participation and young children's health and development, caregiver health, and family economic hardships. Cross-sectional data from 2006 to 2016 were analyzed in 2017 for families with children aged <3 years in 5 cities. Generalized estimating equations and logistic regression were used to evaluate the associations of SNAP participation with child and caregiver health outcomes and food insecurity, forgone health care, and health cost sacrifices. Nonparticipants that were likely to be eligible for SNAP were compared with SNAP participants and analyses adjusted for covariates including Consumer Price Index for food to control for site-specific food prices. The adjusted odds of fair or poor child health status (AOR=0.92, 95% CI=0.86, 0.98), developmental risk (AOR=0.82, 95% CI=0.69, 0.96), underweight, and obesity in children were lower among SNAP participants than among nonparticipants. In addition, food insecurity in households and among children, and health cost sacrifices were lower among SNAP participants than among nonparticipants. Participation in SNAP is associated with reduced household and child food insecurity, lower odds of poor health and growth and developmental risk among infants and toddlers, and reduced hardships because of healthcare costs for their families. Improved SNAP participation and increased SNAP benefits that match the regional cost of food may be effective preventive health strategies for promoting the well-being of families with young children.

Health-related behaviours and perceptions among physicians: results from a cross-sectional study in Israel

ObjectivesPhysicians’ demanding work conditions may reduce the time and energy required for maintaining healthy lifestyles. This study examined health-related behaviours, perceived health status and emotional stress among physicians, and analysed...

Impact of smoking and physical inactivity on self-rated health in women in Colombia.

The aim of this study was to assess the association between poor and fair self-rested health, smoking, and leisure-time physical inactivity in Colombian women. A cross-sectional study using the data from the 2010 Colombian National Demographics and Health (ENDS) and Nutritional Situation (ENSIN) Surveys was conducted. Multivariate logistic analysis for self-perceived health status in 12,431 women aged 13–49 years old and 8224 women aged 18–64 years old were performed. Independent variables included smoking, leisure-time physical inactivity, anthropometric and socio-demographic information. Current smoking and leisure-time physical inactivity were associated with poor and fair self-rated health status (OR 1.78, CI 1.41, 2.25; OR 1.30, CI 1.03, 1.62; respectively). Other significantly associated variables were age (OR 1.68, CI 1.46, 1.92 for 30–49 years; OR 2.32, CI 1.96, 2.74 for 50–64 years), socio-economic strata (OR 7.24, CI 3.81, 13.76 for strata 1–3), educational level (OR 1.70 to 2.77 compared to technical or university), obesity (OR 0.81, CI 0.70, 0.93 for normal body mass index), geographical region (OR 0.67, CI 0.53, 0.85 for Bogotá, compared to Amazon and Orinoco regions), and no affiliation to health system (OR 1.22, CI 1.03, 1.44). Smoking and leisure-time physical inactivity were significantly associated with poor and fair self-rated health in Colombian women. Promoting leisure-time physical activity and implementing smoking cessation strategies specifically in female population, mainly from low to medium strata are suggested to improve their self-perceived health status and control chronic noncommunicable diseases.

A cross-sectional study of self-rated health among older adults: a comparison of China and the United States

ObjectivesWe used nationally representative samples of China and the US older population to investigate (1) whether factors influencing self-rated health among older Chinese were similar to those among older Americans;...

Psychiatric outcome at least 20 years after trauma: A survey on the status of subjective general health and psychiatric symptoms with a focus on posttraumatic stress disorder.

Information on long-term psychiatric sequelae after severe trauma is sparse. We therefore performed a survey addressing several symptoms related to posttraumatic stress disorder (PTSD) in patients who sustained multiple injuries more than 20 years after trauma. Patients injured between January 1, 1973, and December 31, 1990, were contacted at least 20 years later. We included multiply injured patients aged between 3 and 60 years from a single level 1 trauma center. A questionnaire based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for PTSD, including individual symptoms related to intrusion, avoidance, and hyperarousal was sent to all patients. A total of 359 patients (56.35%) received a questionnaire. Of these, 337 patients (93.87%) returned the questionnaire and were included in the study (223 males [66.17%] and 114 females [33.82%]). Mean ± SD follow-up was 29.5 ± 8.5 years. Nearly half the study population (47.18%) experienced lasting psychiatric sequelae, such as intrusive recollection (n = 65, 19.28%), avoidance (n = 92, 27.29%), or hyperarousal (n = 95, 28.18%) at least monthly. Ten patients (2.96%) fulfilled all Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for PTSD. A total of 131 patients (38.87%) reported fair or poor general health status. There was no difference in injury severity in patients with or without PTSD (injury severity score, 8.33 vs. 20.36, respectively; p = 0.52) or PTSD-related symptoms including intrusion (19.88 vs. 20.32, p = 0.74), avoidance (19.99 vs. 20.3, p = 0.79), and hyperarousal (19.36 vs. 20.68, p = 0.26). At least 20 years after injury, no correlation was found between the development of psychiatric complications and the severity of injury. While the rate of full-blown PTSD was low, nearly half the study population regularly suffered from at least one psychiatric symptom attributable to the initial trauma. Awareness for the development of psychiatric complications and early initiation of psychiatric counseling are advisable. Prognostic and epidemiologic, level II.

Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review.

We conducted a systematic literature review to identify and to update patient characteristics and contextual factors for adult frequent emergency department users (FEDUs) compared with non-FEDU in an era where the US health care system underwent substantial changes. We searched MEDLINE, CINAHL, and EMBASE to identify all relevant articles after 2010 through July 2018 that describe FEDU. We included US studies on adult FEDU only and excluded studies on specific subgroups of FEDU. We included demographic, clinical, and health care utilization information, and two reviewers independently evaluated the studies using the Joanna Briggs Institute Critical Appraisal tool. The 11 studies included in the review indicated that FEDU were 4% to 16% of total ED users but accounted for 14% to 47% of ED visits, with six to nine visits per year on average. The majority of FEDU were young or middle-aged adults, females, of low socioeconomic status and high school or less education, with public insurance, multiple primary care provider visits, and chronic conditions. Fair or poor self-perceived health status, unemployment, unmet needs from primary care providers (PCPs), mental health, and substance abuse were predictors of FEDU. FEDUs are disproportionally sicker and are also heavy users of non-ED health care service providers. The limited data for non-ED health services use in facility-specific studies of FEDU may contribute to findings in such studies that complex and unmet needs from PCPs contributed to ED visits. This suggests the need for more comprehensive data analysis beyond a few sites that can inform systemic management approaches.

ASSOCIATION BETWEEN SEXUAL SATISFACTION AND SELF-RATED HEALTH AMONG MARRIED OLDER PERSONS

This study revealed the prevalence of married older persons experienced physical contact satisfaction was 73.4% while 59.6% of them also reported emotionally satisfied with their sexual life. This study also provided evidence of both physical contact and emotional sexual satisfaction were higher in respondents with good self-rated health compared to respondents with fair health status. The findings indicated physical contact sexual satisfaction is significantly associated with self-rated health among married older persons. The findings from this study highlighted the important of having satisfaction from sexual activity with partner to improve health in later life.

Autoimagem corporal e prevalência de sobrepeso e obesidade em estudantes universitários

Objetivo: Investigar o sobrepeso/obesidade, a autopercepção da imagem corporal de universitários e as associações entre essas variáveis com características sociodemográficas, vinculadas à Universidade e aos comportamentos relacionados à saúde. Métodos: Estudo transversal, exploratório e quantitativo, realizado entre janeiro e fevereiro de 2017, com 324 universitários das áreas da Saúde, Exatas e Humanas. Utilizou-se questionário de Indicadores de Saúde e Qualidade de Vida de Acadêmicos para avaliar características sociodemográficas, vínculo com a universidade e comportamentos relacionados à saúde. Avaliou-se a autopercepção da imagem corporal, através da escala de silhuetas, e o estado nutricional, pelo índice de massa corporal. Realizaram-se análises descritivas e regressão Logística Multinominal. Resultados: A prevalência de sobrepeso/obesidade foi de 43,2% (n= 141) e de insatisfação com a imagem corporal foi de 76,5% (n= 248). As universitárias apresentaram maiores chances de sobrepeso e obesidade (IC 95%:1,0-2,7; p 0,03). Os estudantes casados (IC 95%:1,8-5,9; p 0,01), que trabalham (IC 95%:1,4-3,7; p 0,01), com renda igual ou superior a um salário mínimo (IC 95%:1,4-4,8; p 0,01), tiveram maior chance de sobrepeso. O estado de saúde regular relacionou-se com maior insatisfação com a imagem corporal (IC 95%:1,4-5,7; p 0,01). A melhor aptidão física associou-se com menor chance de insatisfação corporal (IC 95%: 0,06-0,47; p 0,01). Conclusão: Elevada prevalência de sobrepeso/obesidade e de insatisfação com a imagem corporal entre os universitários. Existe associação da prevalência de sobrepeso com faixa etária, sexo, estado civil, trabalho, renda, consumo de carne vermelha, assim como entre a autopercepção da imagem corporal com a autopercepção do estado de saúde, aptidão física e turno de estudo.

Population coverage and factors associated with participation following a mass drug administration of azithromycin for trachoma elimination in Amhara, Ethiopia.

SummaryObjectivesMass drug administration (MDA) with azithromycin is a core component of the WHO‐recommended strategy to eliminate trachoma as a public health problem, but low participation rates in MDA campaigns may undermine the effectiveness of this intervention. We explored factors associated with individual MDA participation at the individual, head of household and household levels in Amhara, Ethiopia.MethodsWe conducted four district‐level, multilevel cluster random coverage surveys to collect data on self‐reported MDA participation and predictors. Random‐effects logistic regression modelling was used to identify correlates of MDA participation while adjusting for nesting of individuals at the household and village level.ResultsThe district‐level self‐reported participation in the trachoma MDA ranged from 78.5% to 86.9%. Excellent and fair health status (Odds ratio [OR] = 5.77; 95% Confidence interval [CI]: 3.04, 10.95; OR = 7.08; 95% CI: 3.47, 14.46), advanced knowledge of the MDA campaign (OR = 2.93; 95% CI: 2.04, 4.21) and knowledge of trachoma (OR = 1.60; 95% CI: 1.17, 2.19) were all positively associated with MDA participation. When excluding heads of household from the model, correlates retained similar positive associations to participation, in addition to the head of household participation (OR = 3.34; 95% CI: 2.46, 4.54).ConclusionsTo increase the impact of MDA campaigns, MDA mobilisation strategies—including comprehensive trachoma and azithromycin messaging and MDA campaign awareness—should target heads of household, those in poorer health and older age groups.

Health-Related Quality of Life of an adult population sample in Barranquilla, Colombia.

The aim of this study was to estimate values of health-related quality of life (HRQOL) by focusing on the physical and mental health of an adult population sample in the city of Barranquilla, Colombia. Cross-sectional study with 368 adults representing an adult population. The questionnaires included the health-related quality of life "CDC-Healthy Days", the Zung Self-Rating Depression Scale, and the Overall Disability Sum Score. The prevalence of fair or poor health status (FPH), frequent physical distress (FPD), frequent mental distress (FMD), and frequent activity limitation (FAL) was estimated according to socio-demographic characteristics, presence of depression, and physical disability. The mean age of 368 adults was 45.6 ± 18.3 years; 55.7% were males. Only 21% of this population considered their general health to be fair or poor. The prevalence of FPH, FPD, FMD and FAL was higher in women than in men, and increased with greater severity of depression and higher physical disability. Moreover, 12% of the population presented with mild depression, 3.8% with moderate depression, and less than 1% with severe depression. 94% of this population did not have an arms or legs disability. This study provides HRQOL values for an adult sample of the population of Barranquilla, Colombia. Overall, the HRQOL of this population, with subtle differences, is similar to other reports from Colombia. In general, women and people with depression and physical disabilities had a worse quality of life.

Health Disparities Among American Indians/Alaska Natives - Arizona, 2017.

Compared with other racial/ethnic groups, American Indians/Alaska Natives (AI/AN) have a lower life expectancy, lower quality of life, and are disproportionately affected by many chronic conditions (1,2). Arizona has the third largest population of AI/AN in the United States (approximately 266,000 in 2017), and is home to 22 federally recognized American Indian tribal nations.* The small AI/AN sample size in previous Behavioral Risk Factor Surveillance System (BRFSS) surveys has presented analytic challenges in making statistical inferences about this population. To identify health disparities among AI/AN living in Arizona, the Arizona Department of Health Services (ADHS) and CDC analyzed data from the 2017 BRFSS survey, for which AI/AN were oversampled. Compared with whites, AI/AN had significantly higher prevalences of sugar-sweetened beverage consumption (33.0% versus 26.8%), being overweight or having obesity (76.7% versus 63.2%), diabetes (21.4% versus 8.0%), high blood pressure (32.9% versus 27.6%), report of fair or poor health status (28.7% versus 16.3%), and leisure-time physical inactivity during the past month (31.1% versus 23.0%). AI/AN also reported a lower prevalence of having a personal doctor or health care provider (63.1%) than did whites (72.8%). This report highlights the need to enhance surveillance measures at the local, state, and national levels and can inform interventions centered on confronting social inequities, developing culturally competent prevention strategies, and facilitating access to care to improve population health and work toward health equity.

Health-Related Quality of Life of an adult population sample in Barranquilla, Colombia

Objective The aim of this study was to estimate values of health-related quality of life (HRQOL) by focusing on the physical and mental health of an adult population sample in the city of Barranquilla, Colombia.Materials and methods Cross-sectional study with 368 adults representing an adult population. The questionnaires included the health-related quality of life “CDC-Healthy Days”, the Zung Self-Rating Depression Scale, and the Overall Disability Sum Score. The prevalence of fair or poor health status (FPH), frequent physical distress (FPD), frequent mental distress (FMD), and frequent activity limitation (FAL) was estimated according to socio-demographic characteristics, presence of depression, and physical disability.Results The mean age of 368 adults was 45.6 ± 18.3 years; 55.7% were males. Only 21% of this population considered their general health to be fair or poor. The prevalence of FPH, FPD, FMD and FAL was higher in women than in men, and increased with greater severity of depression and higher physical disability. Moreover, 12% of the population presented with mild depression, 3.8% with moderate depression, and less than 1% with severe depression. 94% of this population did not have an arms or legs disability.Discussion This study provides HRQOL values for an adult sample of the population of Barranquilla, Colombia. Overall, the HRQOL of this population, with subtle differences, is similar to other reports from Colombia. In general, women and people with depression and physical disabilities had a worse quality of life.

Use of antibiotics by adults: a population-based cross-sectional study.

The consumption of antibiotics has been widely discussed, mainly because of antibacterial resistance, which has become a worldwide concern. In Brazil, sale of antibiotics is currently ruled by Agência Nacional de Vigilância Sanitária (ANVISA) regulation RDC 20/2011, which restricts sales to those made under medical prescription. The aims of this study were to evaluate antibiotic use and associated factors among adults in the Metropolitan Region of Manaus, Amazonas, Brazil, and to assess the proportion of self-medication from this use. Population-based cross-sectional study conducted in the Metropolitan Region of Manaus between May and August 2015. Adults aged ≥ 18 years were selected through probabilistic sampling in three stages. Trained interviewers collected data from the participants in their homes. Antibiotic consumption over the last 15 days was reported. Bivariate analysis was used to calculate the prevalence ratio (PR) of antibiotic usage, with 95% confidence interval (95% CI). A multivariate model adjusted according to significant variables at P ≤ 0.20 using Poisson regression with robust variance was constructed. The prevalence of antibiotic use was 3.4% (95% CI 2.8-4.0%). Adjusted analysis showed that consumption was higher among women than among men (PR 1.58; 95% CI 1.11-2.24) and among people with fair health status than among those with good health (PR 1.52; 95% CI 1.08-2.15). The prevalence of self-medication was 19.0%; amoxicillin was the most self-medicated antibiotic (10/26). Antibiotic use was associated with women and individuals with fair health status. One fifth of the antibiotics were consumed through self-medication, contrary to the current Brazilian legislation.

Healthcare Disparities between Children with Developmental Disabilities and Typically Developing Children in Ohio

This article examines the effects of insurance type and Care Consistent with the Patient-Centered Medical Home (CC-PCMH) on health disparities between children with developmental disabilities (DD) and typically developing (TD) children. Data from a stratified random sample of Ohio households were used to compare children with DD (n = 419) to TD children (n = 7701) on health indicators including health status, utilization, quality, access, and unmet healthcare needs. Children with DD were more likely than TD children to have a fair or poor health status (27.7% vs. 1.1%; P < 0.001), have two or more overnight hospitalizations (8.5% vs. 0.7%; P < 0.001), experience delayed treatment (10.1% vs. 2.4%; P < 0.001), and have one or more unmet healthcare needs (19.6% vs. 5.7%; P < 0.001). The impact of insurance type and CC-PCMH on these health disparities was then explored. Although disparities remained when data were stratified by insurance type, Medicaid was associated with fewer difficulties accessing healthcare and fewer unmet healthcare needs for both groups of children. Children with DD who received CC-PCMH were less likely to report having a fair or poor health status than children with DD who did not have that model of care (18% vs. 33.1%; P = 0.005). Children with DD who had CC-PCMH experienced less delayed treatment (2.0% vs. 14.5%; P < 0.001) and fewer unmet healthcare needs compared to children with DD who did not have that model of care. This study suggests that, in Ohio, Medicaid and CC-PCMH may reduce health disparities, providing potential avenues for achieving health equity for children with DD.

The association between insured male expatriates\u2019 knowledge of health insurance benefits and lack of access to health care in Saudi Arabia

BackgroundInsufficient knowledge of health insurance benefits could be associated with lack of access to health care, particularly for minority populations. This study aims to assess the association between expatriates’ knowledge of health insurance benefits and lack of access to health care.MethodsA cross-sectional study design was conducted from March 2015 to February 2016 among 3398 insured male expatriates in Riyadh, Saudi Arabia. The dependent variable was binary and expresses access or lack of access to health care. Independent variables included perceived and validated knowledge of health insurance benefits and other variables. Data were summarized by computing frequencies and percentage of all quantities of variables. To evaluate variations in knowledge, personal and job characteristics with lack of access to health care, the Chi square test was used. Odds ratio (OR) and 95% confidence interval (CI) were recorded for each independent variable. Multiple logistic regression and stepwise logistic regression were performed and adjusted ORs were extracted.ResultsDescriptive analysis showed that 15% of participants lacked access to health care. The majority of these were unskilled laborers, usually with no education (17.5%), who had been working for less than 3 years (28.1%) in Saudi Arabia. A total of 23.3% worked for companies with less than 50 employees and 16.5% earned less than 4500 Saudi Riyals monthly ($1200). Many (20.3%) were young (< 30 years old) or older (17.9% ≥ 56 years old) and had no formal education (24.7%). Nearly half had fair or poor health status (49.5%), were uncomfortable conversing in Arabic (29.7%) or English (16.7%) and lacked previous knowledge of health insurance (18%). For perceived knowledge of health insurance, 55.2% scored 1 or 0 from total of 3. For validated knowledge, 16.9% scored 1 or 0 from total score of 4. Multiple logistic regression analysis showed that only perceived knowledge of health insurance had significant associations with lack of access to health care ((OR) = 0.393, (CI) = 0.335–0.461), but the result was insignificant for validated knowledge. Stepwise logistic regression gave similar findings.ConclusionsOur results confirmed that low perceived knowledge of health insurance in expatriates was associated with less access to health care.

High prevalence of depressive symptoms in a national sample of adults in Indonesia: Childhood adversity, sociodemographic factors and health risk behaviour.

The aim of this study was to investigate depressive symptoms and their association with sociodemographic factors, stressors and support, including childhood adversity, health status risk and behaviour in Indonesia. In a cross-sectional national population survey in 2014-15 in Indonesia, 31442 adults (mean age 37.3 years, SD = 14.9, age range 15-101 years) responded to the Centers for Epidemiologic Studies Depression Scale (CES-D-10) and various other measures. Overall, 15.0% of participants reported moderate and 6.9% severe depressive symptoms, or 21.8% moderate or severe depressive symptoms (21.4% among men and 22.3% among women). In multivariable logistic regression among both men and women, sociodemographic factors (younger age, poor subjective economic background, being unemployed, residing in Java and main island groups), stressors (childhood hunger and poor or fair self-rated health status and having experienced disasters), lack of social trust and religiosity, having one or more chronic conditions, tobacco use and soft drink consumption were positively and obesity negatively associated with moderate or severe depressive symptoms. High rates (21.8%) of depressive symptoms were found. Several risk factors including sociodemographic factors such as younger age, stressors, lack of social support, health risk status and behaviour variables were identified which can be utilized in guiding interventions.

Geographic Labor Mobility of Floating Migrant Workers in China: The Impacts of Health Status and Education on Earnings

The geographic labor mobility has been ignored in the studies related to the impacts of health status or education on floating migrant workers’ earnings in China. Based on a dataset collected by the World Bank collaborated with the Chinese Academy of Social Sciences in 2010, we initiate the assessment of geographic mobility and explore the indirect impacts from health, education, and other factors on earnings through it. A relatively poor, single, educated migrant in good health with parent at home working in the manufacturing sector presents the strongest geographic mobility. The comparative results indicate that the total health impacts on earnings are generally underestimated for migrant workers at poor or fair health status and the education advancement has a greater impact on earnings for the majority of migrant workers who exhibit the “healthy migrant effect”. Our findings not only justify the ground of mixed results in the previous studies but also provide policy making implications. Given the concave relationship between health status and geographic labor mobility, the ongoing health care reform in China should provide local affordable services to attract returning migrants and enhance their earnings.