Poor General Health Research Articles

Type 2 diabetes risk is associated with poorer general health and mental health in women and men

Abstract Background Increasing evidence points to a relation between cardiometabolic and mental health, but population-based data are scarce. We investigated the association of type 2 diabetes (T2D) risk to general and mental health with a focus on potential differences between women and men. Methods The study population comprised 5,192 adults (18+ years) without known diabetes based on data of the German Health Update (GEDA) 2022. T2D risk was assessed by the German Diabetes Risk Score (GDRS), that estimates the 5-year probability of developing T2D and was categorized into low, still low, elevated, and high risk. Sex-specific Poisson regression analyses were conducted including self-rated health (SRH), self-rated mental health (SRMH), depressive symptoms (PHQ-2) and anxiety symptoms (GAD-2) as dichotomous dependent variables and age, educational level, living alone, region of residence, and social support as covariables. Results Women had a higher prevalence of low T2D risk (66.1%) and a lower prevalence of high T2D risk (9.4 %) than men (55.3% vs. 16.3%). Compared to those with low T2D risk, women and men with a high T2D risk were less likely to report very good/good SRH (women: prevalence ratio: 0.63; 95% confidence interval: 0.51-0.79; men: 0.69; 0.57-0.84) or excellent/very good SRMH (women: 0.53, 0.39-0.73; men: 0.85, 0.63-1.15). Further, those with a high T2D risk had a higher risk of depressive symptoms (women: 1.71, 1.05-2.81; men: 2.23, 1.22-4.05) and anxiety symptoms (women: 1.84, 1.03-3.29; men: 2.73, 1.09-6.81). No statistically significant interactions between sex and T2D risk were observed regarding the included health outcomes. Conclusions A high T2D risk is associated with a lower probability of a favourable SRH and SRMH and a higher risk of depressive and anxiety symptoms in men and women. The underlying mechanisms need further identification, in order to design synergistically beneficial health promotion for cardiometabolic and mental health. Key messages • No sex-specific differences in general and mental health were found in people at high T2D risk. • Further research is needed to identify the underlying mechanism to improve general and mental health.

Psychosocial work environment in Swedish primary healthcare: a cross-sectional survey of physicians’ job satisfaction, turnover intention, social support, leadership climate and change fatigue

BackgroundPrimary healthcare, the first line of care in many countries, treats patients with diverse health problems. High workload, time pressure, poor job control and negative interpersonal experiences with supervisors have been documented in primary healthcare. The work environment in primary healthcare is also affected by several types of changes.AimWe aimed to explore the levels of job satisfaction, turnover intention, social support, leadership climate and change fatigue according to physicians in Swedish primary healthcare. We also aimed to identify and characterize physicians exhibiting both high turnover intention and low job satisfaction, i.e., “discontent with current job”.MethodsA cross-sectional survey based on a random sample of physicians working in Swedish primary healthcare.ResultsApproximately one-quarter of the respondents were discontented with their current job. Discontent was negatively associated with poor general health and change fatigue among the respondents; social support from colleagues and a favorable leadership climate showed positive associations in terms of reducing the levels of discontent with current job.ConclusionsThe findings of this study highlight the association between low levels of job satisfaction and high levels of turnover intention (i.e., discontent with current job) among physicians in primary healthcare. Moreover, these variables exhibited a strong association with physicians’ general health; poor health significantly increased the likelihood of discontent with current job. Our findings also show that experiencing change fatigue is associated with discontent with current job among physicians in primary healthcare. This knowledge can help identify and improve shortcomings within the psychosocial work environment in Swedish primary healthcare.

Characterizing Older Adults' Travel Behaviour and Unmet Needs: Findings from the Canadian Longitudinal Study on Aging (CLSA).

This study provides researchers, practitioners, and policy makers with a profile of older adults' travel behaviour and the older adult population that reports unmet travel needs. In addition, we quantified associations between reporting an unmet travel need and measures of health and social connectedness. Data came from the second follow-up survey of the Canadian Longitudinal Study on Aging, collected from 2018 to 2021 (n=14,167). Nine in ten (90.2%) older adults aged 65years and older indicated that driving is the main way they get around. Older adults with an unmet travel need were more likely to be women, have lower household incomes and education levels, and have a mobility limitation. People with an unmet travel need had 2.7 times the odds of reporting fair or poor general health (OR=2.66, 95% CI: 2.19, 3.22) and 3.1 times the odds of feeling socially isolated (OR=3.10, 95% CI: 2.57, 3.72) compared to those without an unmet need.

Work Disparities and the Health of Nurses in Long-Term Care: A Scoping Review.

Work disparities, such as unfairness in pay or unequal distribution of work experienced by nurses in long-term care (LTC), can impact the retention and health of this workforce. Background: Despite the significant impact of disparities on nurses' health in LTC, a literature review on work disparities of nurses in LTC has not been conducted. Method: This scoping review aimed to explore the nature and extent of research on meso-level work disparities experienced by nurses in LTC and its links with nurse health and well-being. Five databases were searched: MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), SCOPUS, and CINAHL (EBSCO host). Results: Of the 5652 articles retrieved, 16 studies (14 quantitative and 2 qualitative) published between 1997 and 2024 met the inclusion criteria. A total of 53 work disparities were identified. Only four articles investigated the association of a work disparity with a variable of health (e.g., physical, mental, or poor general health). Conclusions: The results suggest that more attention to how disparities impact nurses' health and lived experiences is warranted. Meso-level disparities from this review provide an initial basis to consider possibilities in the workplace, especially in supporting equity and opportunities for health and well-being at work (e.g., through fair access to professional growth opportunities and a more equitable balance of work expectations and demands of nursing staff). Future studies of the intersection of macro- and meso-level factors are needed to inform better workplace practices and social and economic policies to support the well-being, health, and safety of nurses at work in LTC.

Locus of control and the long-term effects of parental smoking on mental health

RationaleFew studies take a life course perspective to explain if exposure to second-hand smoke in childhood influences mental health in adulthood. Importantly, no study provides empirical evidence on the pathways through which exposure to second-hand smoke in childhood influences mental health in adulthood. There is also limited evidence on the factors that moderate the relationship between second-hand smoke exposure and mental health. To inform policy, it is important to explore the pathways through which second-hand smoke influences mental health and understand factors that are likely to moderate this relationship. ObjectivesThe objective of this paper is to examine if exposure to parental smoking in childhood influences mental health in adulthood. The study examines general health and smoking status in later life as potential channels and if locus of control (LoC), a personality trait developed in childhood and adolescence, moderates the relationship between exposure to parental smoking in childhood and mental health in adulthood. MethodsUsing 21 waves of longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA), the study conducts regression analyses that adjust for the potential effects of confounders and other biases. ResultsThe results show that exposure to parental smoking in childhood is associated with a decline in mental health in later life, and that general health status and smoking status in adulthood are channels through which exposure to parental smoking in childhood influences mental health in adulthood. Specifically, those who are exposed to parental smoking in childhood tend to have poorer general health and a higher probability of being smokers in adulthood, both of which negatively impact mental health. The findings point to the moderating role of LoC, such that being more internal on LoC dampens the negative effects of exposure to parental smoking on mental health. ConclusionThe findings from this study lend support to the need to address the long-term implications of behaviours that are harmful to health. The findings also suggest that LoC has implications for an individual's psychological resilience against the negative effects from exposure to parental smoking in childhood.

Oral health of Dutch primary school children in relation to social and health aspects.

This research investigated the oral health status of Dutch primary school children aged 10-12 years in Utrecht and its association with demographic characteristics, lifestyle factors, general psychosocial health, and dental treatment, to guide targeted interventions to improve children's oral and overall well-being. A cross-sectional survey was conducted at 49 primary schools in Utrecht in 2017 and 42 schools in 2019. The questionnaire covered background characteristics (7 questions), psychosocial health (14 questions), nutrition and exercise (20 questions), school and leisure time (26 questions), home situation (23 questions), and oral health (4 questions). Associations were analyzed using multivariate logistic regression. Data from 5,426 children were analyzed. Prior to the survey, 11% did not visit a dentist, 23% had a toothache, 22% had a cavity filled, and 8% had a tooth extracted. Independent predictors for increased odds of oral health problems were migration background, poor general health, drinking more than two glasses of soft drinks per day, having ever drunk alcohol, having fear of failure, experiencing problems at home and/or coming from average or low socioeconomic position group. Factors associated with increased odds of dental treatment, such as cavity filled and tooth extracted, were migration background, fear of failure and home problems. These findings emphasize the need for targeted prevention to improve the oral health of children with a migration background, average or low socioeconomic position and/or with poorer general and psychosocial health, unhealthy diets and problems in the home situation, within a community-based and transdisciplinary approach.

Exploring Longitudinal Associations between Farmer Health and Wellbeing, and Dairy Herd Subclinical Mastitis Prevalence and Productivity: The HUNT Study, Norway

The health and wellbeing of farmers is one aspect of the sustainability of agriculture, as is the health and productivity of livestock. Previous research suggests a possible association between the 2, but the complexity of the relationships between farmers and their livestock can hamper research efforts. This observational study utilizes high quality existing survey and register data from a cohort of Norwegian dairy enterprises to explore possible longitudinal associations between farmer health and wellbeing (general health, chronic disease or condition, chronic pain, anxiety or depression symptoms, or poor life satisfaction) and changes in dairy herd udder health (estimated by the proportion of milk tests with a high somatic cell count (SCC%)) or milk yield (kilograms per cow-year equivalent). We found evidence of a general trend toward increased SCC% with poor farmer health or wellbeing. If the farmer had poor self-reported general health, the odds ratio (OR) for a one-year increase in SCC% at the enterprise was 1.51 (95% CI: 0.76,2.99, OR 1.80 (0.71, 4.51) after adjustment for possible effect modifiers) compared with those with good health, and for poor life satisfaction the OR was 1.50 (0.71,3.15) (2.61 (0.92,7.39) after adjustment). We also find evidence that enterprises where a farmer was experiencing poor health or wellbeing tended to have lower odds of a decrease in milk yield than other enterprises. The OR for a one-year decrease in milk yield with any chronic disease or condition was 0.42 (0.24,0.76), and with symptoms of anxiety or depression the OR was 0.56 (0.23,1.34). Potential confounders and effect modifiers are discussed and explored. These results suggest that further longitudinal research to unravel the relationships between farmer health and wellbeing, and livestock health and productivity is needed.

Abstract B157: Mediating role of social and health factors on the relationship between sexual minority individuals living with high allostatic load and risk of cancer mortality

Abstract Purpose: Sexual minority (SM) populations (including people who are lesbian, gay, or bisexual) may have higher cancer risk attributable to social determinants of health (SDOH) such as limited healthcare access, discrimination, and a lack of culturally sensitive care. SM people have higher chronic physiological stress, or allostatic load (AL) compared to their heterosexual peers. Furthermore, SM individuals with high AL have more than twice the risk of cancer mortality than heterosexual people with high AL. Here, we examined the mediating effects of SDOH on the relationship of SM identity and AL with cancer mortality risk. Methods: We performed a retrospective analysis of 2001-2010 data from 12,470 participants in the National Health and Nutrition Examination Survey (NHANES) linked to follow-up data from the National Death Index through 12/31/2019. We calculated descriptive statistics across groups defined by SM status and AL (e.g. SM with high AL, SM with low AL, heterosexual with high AL, and heterosexual with low AL) and performed survey-weighted Cox regression to assess the association of sexual orientation/AL with cancer mortality risk. We examined the mediating effects of an individual’s SDOH including household income, self-reported general health condition, whether they attended routine health visits, whether they saw a mental health professional in the past year, location of healthcare visits, poverty to income ratio, self-reported prior health condition, and the number of health visits in the past year. Results: Compared to heterosexual individuals with low AL, SM people with high AL were more likely to report: an annual household income < $20,000 (22.7% vs. 12.8%), living in a single person household (22.5% vs. 8.7%), poor general health condition (7.1% vs. 1.3%), worse health now versus one year ago (16.3% vs. 7.8%), seeing a mental health professional within the past year (21.3% vs. 7.9%), and being in the lowest poverty to income ratio quartile (19.4% vs. 13.9%) (p values < 0.001). Among SM adults with high AL, cancer mortality risk was increased 5-fold (age adjusted HR: 4.89, 95% CI: 2.59 – 9.23) versus heterosexual adults with low AL. Upon additional adjustment for sociodemographic factors (age, race/ethnicity, education status, and gender), the association attenuated but remained significant (adjusted HR: 3.31, 95% CI: 1.77 – 6.16). The following factors all slightly mediated the relationship of SM status and high AL with cancer mortality risk: household income (% mediated = 12.35, p < 0.01), seeing a mental health provider within past year (% mediated = 9.88, p < 0.05), greater number of healthcare visits within past year (% mediated = 8.31, p < 0.05), and poor self-reported general health condition (% mediated = 14.08, p < 0.05). Conclusion: Among a nationally representative sample of more than 12,000 US adults, we observed many SDOH significantly mediate the relationship of SM status and high AL with cancer mortality risk. These results can help inform the identification of intervention points to lessen health disparities. Citation Format: Alisha Patel, Justin X. Moore, Missy Spears, Tracy Casanova, Brent Shelton, Heidi Weiss, Marvin E. Langston, Keith J. Watts, Donte Boyd, Prajakta Adsul, Meredith Duncan. Mediating role of social and health factors on the relationship between sexual minority individuals living with high allostatic load and risk of cancer mortality [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B157.

Exploring UK older adults' dietary fibre consumption habits and associated factors: a national diet and nutrition survey perspective.

The UK population is living longer; therefore, promoting healthy ageing via positive nutrition could have widespread public health implications. Moreover, dietary fibre intake is associated with health benefits; however, intake is below UK recommendations (30 g/d). Utilising national dietary survey data can provide up-to-date information on a large representative cohort of UK older adults, so that tailored solutions can be developed in the future. This study used cross-sectional data from the National Diet and Nutrition Survey (years 2008-2009 to 2018-2019) for older adults' (n 1863; 65-96 years) dietary fibre intake (three-to-four-day food diaries), top ten dietary fibre-rich foods, associated factors (demographics, dietary/lifestyle habits) and various health outcomes (anthropometric, blood and urine). Mean dietary fibre intake was 18·3 g/d (range: 2·9-55·1 g/d); therefore, below the UK dietary recommendations, with compliance at 5·7 %. In addition, there were five significant associations (P < 0·05) related to lower dietary fibre intake such as increasing age group, without own natural teeth, impaired chewing ability, lower education leaving age and poor general health. Older adults' key foods containing dietary fibre were mainly based on convenience such as baked beans, bread and potatoes. Positively, higher dietary fibre consumption was significantly associated (P = 0·007) with reduced diastolic blood pressure. In summary, the benefits of dietary fibre consumption were identified in terms of health outcomes and oral health were key modulators of intake. Future work should focus on a life course approach and the role of food reformulation to help increase dietary fibre intake.

Anticipare il futuro (di circa otto anni) per provare a cambiarlo

A 14-day-old infant was diagnosed with classical homocystinuria through extended newborn screening after detecting hypermethioninemia and elevated homocysteine levels. The infant exhibited feeding difficulties and poor general health. Following a low-methionine diet and pharmacological therapy, his condition improved rapidly. Early diagnosis enabled therapeutic intervention in the first month of life, advancing the typical diagnosis by approximately eight years.

Relationship between systolic blood pressure and renal function on clinical outcomes in patients with atrial fibrillation: a report from the prospective AF-GEN-UK Registry.

Blood pressure (BP) extremes and renal (dys)function contribute to poor outcomes in patients with atrial fibrillation (AF). Using data from the prospective AF-GEN-UK study, we investigated the effect of systolic BP and interaction with renal function for prognostication. Baseline systolic BP (SBP) values were recorded for 1580 patients (mean [SD] age 71 [11] years, 60% male) and categorized as follows: 120-129 mmHg (n = 289, reference group) <110 mmHg (n = 165), 110-119 mmHg, (n = 254), 130-139 mmHg (n = 321), 140-159 mmHg (n = 385) and ≥160 mmHg (n = 166). Cox regression analysis, adjusted for age, oral anticoagulation (OAC) and CHA2DS2-VASc score established the impact of SBP, renal function and their interaction on 1-year outcomes. SBP groups were compared using ANOVA and chi-square tests. OAC use was 84% and similar across SBP groups. Renal dysfunction [estimated baseline glomerular filtration rate (eGFR) < 60 ml/min] was present in 24%, with significantly lower eGFR values in the SBP 110-119 mmHg group. History of heart failure was significantly higher in those with SBP <110 mmHg. SBP <110 mmHg was predictive of all cause-death on univariate [hazard ratio (HR) 2.36, 95% confidence interval (CI) 1.20-4.64] and adjusted (aHR 9.71, 95% CI 1.73-54.5) regression. There was no statistically significant interaction between SBP and eGFR, no associations of SBP with haemorrhagic or thromboembolic events. In people with AF, SBP <110 mmHg was independently predictive of all-cause death, with no significant interaction between SBP and renal (dys)function. This may reflect general poor health and/or excessive antihypertensive therapy, which should be avoided.

The midlife health of only children: chronic disease indicators and biomarkers by sibship size in three nationally representative UK cohorts.

Despite persistent concerns about only children's disadvantage relative to individuals with siblings, existing health-related evidence is inconsistent. Recent evidence from Nordic countries about only children having poorer health outcomes may not apply elsewhere because selection processes differ across contexts. We investigate the midlife health of only children in the UK where one-child families tend to be socio-economically advantaged relative to large families. Using the 1946, 1958 and 1970 British birth cohort studies, we examine various biomarkers and self-reported measures of chronic disease by sibship size when respondents are aged in their mid-40s, mid-50s and mid-60s. We estimate separate linear probability models for each cohort, age and outcome, adjusting for childhood and early adulthood circumstances. We found no evidence of only children differing from those with one, two or three or more siblings, at any age, in any of the cohorts, on: heart problems, hypertension, high triglycerides, high glycated haemoglobin or high C-reactive protein. However, compared with only children, the probability for cancer (0.019, 95% confidence interval [CI]: 0.002, 0.035; age 46/1970) and poor general health (0.060, CI: 0.015, 0.127; age 55/1958; and 0.110, CI: 0.052, 0.168; age 63/1946) was higher among those with three or more siblings. There is no consistent pattern of only child health disadvantage for midlife chronic disease outcomes across ages or cohorts in the UK. Research should focus on better understanding how sibship size differentials are contingent on context.

Self-rated health and its bidirectional relationship with burnout, sleep quality and somatic symptoms in a general adult population

The aim of this study was to investigate how self-rated health (SRH) reflects ongoing ill-health and how SRH is associated with previous ill-health and/or predicts future ill-health such as burnout, disturbed sleep, and somatic symptoms. The study used two waves from the population-based Västerbotten Environmental and Health Study in which 2 336 adult persons participated by answering a questionnaire at two time points three years apart. Hierarchical and logistic regression analyses were conducted, thus treating all variables both continuously (degree) and categorically (case). The analyses were performed both cross-sectionally and longitudinally. The results showed bidirectionality between suboptimal SRH and burnout, disturbed sleep and somatic severity caseness. Moreover, degree of poor SRH was more likely to occur simultaneously to high degrees of burnout and somatic severity than to degree of poor sleep quality. Also, caseness of burnout, disturbed sleep and somatic severity increased the risk of simultaneous suboptimal SRH. Finally, the results showed that degree of burnout three years earlier, predicted degree of poor SRH, and that degree of poor SRH predicted degree of sleep three years later. In conclusion, in a population-based, normal adult sample there is a bidirectional relationship between suboptimal SRH and caseness of burnout, disturbed sleep quality and somatic symptoms, but not between degree of these symptoms. The results can have implications for health care meeting patients complaining about poor general health.

Psychosocial health of migrant careworkers from Southeast Asian countries in Israel: A mixed methods study

BackgroundIn 2018, 66,859 migrant careworkers were in Israel, most of whom originated from Southeast Asian countries and 81 % of whom are women. Stringent regulations combined with social invisibility creates vulnerabilities that may contribute to emotional distress. This study aimed to assess psychosocial status and determine mechanisms of emotional distress and resilience in this population. MethodsMixed methods were used in this cross-section study. An online survey measured demographic variables, psychosocial wellbeing using the HSCL-25 questionnaire, general health, perceived social support, cultural identity, and perceived othering. Based on the survey's results, interviews were conducted with a subpopulation of respondents (n = 15) to further understand the mechanisms of emotional distress and resilience, and were analyzed using a postcolonial feminist framework and grounded theory. Data collection took place during 2018–2019. ResultsIn total, 263 careworkers completed the survey and 15 careworkers were interviewed. The overall prevalence of emotional distress according to the HSCL-25 was 36.8 %, 22.6 % on the anxiety subscale, and 41.8 % on the depression subscale. Emotional distress was associated with female sex, not being parents, poorer general health, high perceived othering, and low perceived social support. Interviews revealed that Israeli policy, and relationships with family in their country of origin and with Israeli employers and their families can either contribute to or mitigate emotional stressors. ConclusionsSymptoms of emotional distress among Southeast Asian migrant careworkers in Israel are frequently reported, and may indicate rates of anxiety and depression higher than in careworkers’ countries of origin and host country. Increased monitoring to protect careworkers’ rights and including mental health services as part of their health insurance plan are warranted.

Limited Physical Functioning in United States Adults with Arthritis: Findings from the 2021 Medical Expenditure Panel Survey.

There is little published research on limited physical functioning in United States (US) adults with arthritis. The objective of this cross-sectional 2021 Medical Expenditure Panel Survey (MEPS) database study was to investigate the variables associated with limited physical functioning in US adults with arthritis. Logistic regression tested the associations of predisposing, enabling, and need variables with the dependent variable (limited physical functioning). This study included 5102 US adults with arthritis, reflecting an estimated weighted population of 64,136,870 US adults with arthritis. In the final multivariable logistic regression model, age ≥ 70 and ages 60-69 (vs. 18-49 years), female (vs. male) sex, having quite a bit/extreme or moderate (vs. little) pain, and having 6+ or 4-5 (vs. 0-1) comorbid conditions were all associated with higher odds of the person stating they had limited physical functioning. Whereas high school or less (vs. more than high school), being employed (vs. unemployed), being married (vs. not married), having excellent/very good or good (vs. poor) general health, and exercise (vs. no exercise) were each associated with lower odds of the person reporting they had limited physical functioning. Future work may be considered to explore these variables in greater detail.

Sigmoid volvulus with 25 episodes.

We report the case of a 74-year-old male with abdominal pain, distention and obstipation for 8 hours. He had a medical history of 24 sigmoid volvulus (SV) episodes, 23 of which treated with endoscopic detorsion, while one resolved spontaneously. Physical examination revealed abdominal distention, tenderness, hyperkinetic bowel sound and an empty rectum. Abdominal X-ray radiograph revealed dilated sigmoid loops with coffee bean sign. Computed tomography demonstrated dilated sigmoid loops with air-fluid levels and mesenteric whirl sign. Flexible colonoscopy showed a spiral-like luminal obstruction of the viable sigmoid colon at 18 cm from anal verge. A successful colonoscopic detorsion was performed. Due to the poor general health status of the patient (American Society of Anesthesiologists-ASA score 4) arising from serious comorbidities including coarctation of aorta and coronary disease, percutaneous endoscopic colostomy was suggested instead of elective sigmoid colectomy. He did not approve adjunctive therapy and was discharged following 24-hour observation.

Strengths and Merits of Transforaminal Full-Endoscopic Lumbar Spine Surgery Under the Local Anesthesia: A Review Article

In the 2 decades or so since full-endoscopic spine surgery (FESS) was introduced, the procedure has advanced considerably. There are 2 major approaches of FESS, transforaminal (TF) and interlaminar. In this review article, we discuss the key strengths and merits of TF-FESS based on a literature search. First, the minimal invasiveness of the procedure allows for early return to work. Second, minimal invasiveness of the back muscles enables athletes to make a faster return to their previous competitive level. Third, the ability to perform TF-FESS under local anesthesia means it is suitable even in the elderly with poor general health.

Suicidal Ideation in Medicinal Cannabis Patients: A 12-Month Prospective Study

Objective To document the prevalence and correlates of suicidal ideation (SI) among individuals seeking cannabis-based medicinal products (CBMPs); to test whether SI declines or intensifies after three months of CBMP treatment and to document 12-month trajectories of depression in those reporting SI and other patients. Method Observational data were available for 3781 patients at entry to treatment, 2112 at three months and 777 for 12 months. Self-reported depressed mood and SI were assessed using items from the PHQ-9. Additional data included sociodemographic characteristics and self-reported well-being. Results 25% of the sample reported SI at treatment entry and those with SI had higher levels of depressed mood (mean = 17.4 vs. 11.3; F (1,3533) = 716.5, p < .001) and disturbed sleep (mean = 13.8 vs. 12.2, F (1,3533) = 125.9, p < .001), poorer general health (mean = 43.6 vs. 52.2, F (1,3533) = 118.3, p < .001) and lower quality of life (mean = 0.44 vs. 0.56 (F (1,3533) = 118.3, p < .001). The prevalence of SI reduced from 23.6% to 17.6% (z = 6.5, p < .001) at 3 months. Twelve-month follow-up indicated a substantial reduction in depressed mood with this reduction being more pronounced in those reporting SI (mean (baseline) = 17.7 vs. mean (12 months) = 10.3) than in other patients (mean (baseline) = 11.1 vs. mean (12 months) = 7.0). Conclusions SI is common among individuals seeking CBMPs to treat a range of chronic conditions and is associated with higher levels of depressed mood and poorer quality of life. Treatment with CBMPs reduced the prevalence and intensity of suicidal ideation.

Socioeconomic Differences in Patient Reported Outcome Measures 3 Months After Stroke: A Nationwide Swedish Register-Based Study.

There is a well-known association between low socioeconomic status (SES), poor survival, and clinician-reported outcomes after stroke. We aimed to assess socioeconomic differences in Patient Reported Outcome Measures 3 months after stroke. This nationwide cohort study included patients registered with acute stroke in the Swedish Stroke Register 2015-2017. Patient Reported Outcome Measures included activities of daily living (mobility, toileting, and dressing), and poststroke symptoms (low mood, fatigue, pain, and poor general health). Information on SES prestroke was retrieved from Statistics Sweden and defined by a composite measure based on education and income tertiles. Associations between SES and Patient Reported Outcome Measures were analyzed using logistic regression adjusting for confounders (sex and age) and additionally for potential mediators (stroke type, severity, cardiovascular disease risk factors, and living alone). Subgroup analyses were performed for stroke type, men and women, and younger and older patients. The study included 44 511 patients. Of these, 31.1% required assistance with mobility, 18% with toileting, and 22.2% with dressing 3 months after stroke. For poststroke symptoms, 12.3% reported low mood, 39.1% fatigue, and 22.7% pain often/constantly, while 21.4% rated their general health as poor/very poor. Adjusted for confounders, the odds of needing assistance with activities of daily living were highest for patients with low income and primary school education, for example, for mobility, odds ratio was 2.06 (95% CI, 1.89-2.24) compared with patients with high income and university education. For poststroke symptoms, odds of poor outcome were highest for patients with low income and university education (eg, odds ratio, 1.79 [95% CI, 1.49-2.15] for low mood). Adjustments for potential mediators attenuated but did not remove associations. The associations were similar in ischemic and hemorrhagic strokes and more pronounced in men and patients <65 years old. There are substantial SES-related differences in Patient Reported Outcome Measures poststroke. The more severe outcome associated with low SES is more pronounced in men and in patients of working age.

Long-term health outcomes by cancer diagnosed age among adolescent and young adult: multinational representative database

BackgroundThe cancer experienced in adolescent and young adult (AYA) could disturb developmental changes and long-term life. The current AYA guidelines and research for survivorship were developed and reported according to the general age range of 15–39 years; however, expected life events vary by diagnosed age. We aimed to examine the social, psychological, and physical well-being of AYA cancer survivors by age at diagnosis using a multinational representative dataset focusing on age at diagnosis.MethodsWe conducted a cross-sectional study using the US and Korean National Health and Nutrition Examination Surveys from 2007 to 2018. Participants diagnosed with any cancer aged 15–39 years and were aged > 18 years at the survey year were defined as AYA cancer survivors. AYA were classified into three groups based on their diagnosed age: adolescent survivors (diagnosed between the ages of 15 and 19, n = 45), young adult survivors (diagnosed between the ages of 20 and 29, n = 238), and late young adult survivors (diagnosed between the ages of 30 and 39, n = 539). We also selected an age-, sex-, race-, and survey year-matched general population with 1:5 ratio among participants without cancer (N = 4110).ResultsThe average age of the survey was 29.1, 43.7, and 48.7 years for AYA survivors diagnosed during adolescence, young adulthood, and late young adulthood, respectively. Adolescent survivors had more non-couple marital status (adjusted odds ratio (aOR), 1.34; 95% CI, 1.10–1.64) and unemployed (aOR, 1.30; 95% CI, 1.05–1.61) compared to late young adult survivors. Comparing with the matched general, adolescent survivors were more in poor general health (aOR, 4.65; 95% CI, 2.09–10.38) and unemployed (aOR, 2.17; 95% CI, 1.12–4.24) and late young adult survivors were more non-couple (aOR, 1.40; 95% CI, 1.05–1.86).ConclusionThis study provides evidence for future studies on long-term health, which may vary according to age at the time of diagnosis among AYA with cancer.