Levels Of Self-reported Health Research Articles

Validation of the Italian version of carers' quality-of-life questionnaire for parkinsonism (PQoL Carer) in progressive supranuclear palsy.

Progressive supranuclear palsy (PSP) is a rare, rapidly progressive, neurodegenerative disease characterized by falls and ocular movement disturbances. Caring for a partner or relative who suffers from PSP entails a strenuous and demanding task, usually lasting for years that affects carers' everyday life routines and emotional and social well-being. The 26-item Parkinsonism Carers QoL (PQoL Carer) is a self-administered, concise instrument evaluating the quality of life of caregivers of patients with atypical parkinsonism (both PSP and multiple system atrophy). Here, the PQoL Carer was translated into Italian and validated in 162 carers of PSP patients (54.3% women; mean age (standard deviation), 62.4 (15.4)) diagnosed according to the Movement Disorder Society criteria and recruited in 16 third-level movement disorders centers participating in the Neurecanet project. The mean PQoL total score was 40.66 ± 19.46. The internal consistency was excellent (Cronbach's alpha = 0.941); corrected item-total correlation was > 0.40 for all the items. A correlation with other health-related quality of life measures as well as with behavioral assessments was shown suggesting adequate convergent validity of the scale. PQoL also correlated with patients' severity of disease. The discriminant validity of the scale was evidenced by its capacity to differentiate between carers with varying levels of self-reported health (p < 0.001). In conclusion, the Italian version of the PQoL Carer is an easy, consistent, and valid tool for the assessment of the quality of life in carers of PSP patients.

EQ-5D-5L population norms and health inequalities for Trinidad and Tobago.

The EQ-5D instrument is now used in many health systems as a health outcomes measure. Recently an EQ-5D valuation study was conducted for Trinidad and Tobago, but thus far there have been no population norms published for Trinidad and Tobago or for any Caribbean country. The objective of this study is to provide a set of population norms, and to investigate inequalities in health in Trinidad and Tobago. The EQ-5D-5L questionnaire was included in the 2012/2013 Adult Population Survey of the Global Entrepreneurship Monitor for Trinidad and Tobago. This survey covered a representative sample of 2,036 adults aged 18 and over. Demographic data and self-reported health using EQ-5D-5L were collected. The Trinidad and Tobago value set was used to obtain EQ-5D index values. The Kakwani index and logistic regression models were used to evaluate inequalities in health. Mean EQ-5D index values and EQ-VAS values were calculated by age group, ethnicity, gender, income, educational attainment, employment status and place of residence. The 10 most commonly observed EQ-5D-5L states accounted for 90% of the respondents. The mean VAS value for the sample was 83.6 and the mean EQ-5D-5L index value was 0.95. Pain/discomfort was found to be the EQ-5D dimension with the highest prevalence of reported problems with 22% of the population reporting pain at any level. Self-care was the dimension with the lowest prevalence of problems reported at any level (3%). Health declines with increasing age, and men reported fewer problems and higher levels of self-reported health than women. Age, gender and education level were found to be important drivers of health status as measured by the EQ-5D instrument. Being in a very low income group was also observed to affect EQ-VAS values among younger respondents. The population norms provided in this study can be used by clinicians, academics and policy makers in several ways. They can be used in comparing different demographic groups or patient groups, or as a basis for tracking the progress of patients through a treatment regimen. They can also provide a baseline for cost utility analysis of health interventions for Trinidad and Tobago.

Shared decision-making about cardiovascular disease medication in older people: a qualitative study of patient experiences in general practice

ObjectivesTo explore older people’s perspectives and experiences with shared decision-making (SDM) about medication for cardiovascular disease (CVD) prevention.Design, setting and participantsSemi-structured interviews with 30 general practice patients aged 75 years...

School starting age and long-run health in the United States.

School starting age has been shown to have long-run effects that persist throughout adolescence and into adulthood. Using variation from state-level school starting age laws in the United States, we find that males who are older when they enter school are more likely to have higher levels of self-reported health later in life. We are largely able to rule out education and labor market outcomes as significant channels for this finding. Building from the previous studies that have found conflicting evidence on the effect of school starting age on educational attainment and labor market outcomes in the United States, we find that school starting age decreases the likelihood of high school completion among males but has no significant effect for females. We do not find that labor market outcomes are affected by school starting age.

Quantifying the Gap in Self-Rated Health for Transition Countries Over 1989–2014

Previous literature has shown substantially lower levels of self-reported health in transition countries. The current paper provides the most recent estimates of the size of the transition gap in self-rated health by using up to 241,698 observations from the World Values Survey and the European Values Study collected between 1989 and 2014. The estimated gap is in the range of 12.7–23.7 percentage points lower probability of reporting ‘Very Good’ or ‘Good’ self-rated health which indicates that the process of transition is far from completion at least based on a subjective evaluation of health.

What is the impact of underweight on self-reported health trajectories and mortality rates: a cohort study

BackgroundUtilizing a cohort study design combining a survey approach with repeated physical examinations, we examined the independent effects of BMI on mortality and self-reported health (SRH) and whether these independent effects change as people grow older.MethodsThe Tromsø Study consists of six surveys conducted in the municipality of Tromsø, Norway, with large representative samples of a general population. In total, 31,985 subjects participated in at least one of the four surveys administered between 1986 and 2008. Outcomes of interest were SRH and all-cause mortality.ResultsOverweight and underweight subjects reported significantly lower levels of SRH, but age affected the thinnest subjects more than all others. The SRH trajectory of underweight subjects at age 25 was slightly above the other categories (0.08), but it fell to −.30 below the reference category at age 90. For obese subjects, the difference was −0.15 below the reference category at age 25 and −0.18 below at age 90. This implies that even though a low BMI was slightly beneficial at a young age, it represented an increasing risk with age that crossed the reference curve at age 38 and even crossed the obese trajectory at age 67 in the full fitted model. The proportional hazard ratio for those who were underweight was 1.69 (95% CI: 1.38-2.06) for all-cause death as compared to 1.12 (95% CI: 1.02-1.23) for obese subjects.ConclusionBMI affected SRH and all-cause mortality independently from comorbidity, mental health, health-related behaviors and other biological risk factors. Being underweight was associated with excess mortality as compared to all others, and age affected the thinnest subjects more than all others. Weight increase was beneficial for mortality but not for SRH among the underweight. The rapid decline of SRH with increasing age suggests that particular attention should be paid to underweight after 38 years of age.

Relations between longitudinal trajectories of subjective financial wellbeing with self-rated health among elderly

Background and objectiveThe relationship between income and health in late life is well established, but the link between subjective financial wellbeing (SFW) and self-rated health (SRH) has been relatively ignored, especially among elderly in Europe. Adopting a longitudinal person-oriented analytical approach this study investigates the relationship between SFW and SRH in late life in Italy. Materials and methodsAnalysis of the European Statistics on Income and Living Conditions survey (EU-SILC) for the period 2010–2013 in Italy examined these relationships at ages 65–78 (N=1268). Latent class growth analysis and growth mixture modeling were used to identify latent trajectories of SFW. Post hoc analysis of variance examined how SFW latent groups differed in terms of SRH across time. ResultsA three-group latent trajectory model fitted the data best. The three SFW groups were named average-decreasing (n=238), low-stable (n=216), and high-stable (n=814). Repeated measures analysis of variance indicated a significant multivariate effect of SFW latent trajectory class on SRH, controlling for age, gender, and presence of chronic diseases. Post hoc analyses revealed that levels of SRH in the high-stable SFW group remained the highest compared to the other two groups and did not decrease over time, while the average-decreasing group showed a decrease in SRH levels. ConclusionsResults suggest that in late life longitudinal negative changes in perceptions of financial wellbeing may occur together with decreases levels of self-reported health. Future research on health inequalities in elderly should pay specific attention to the link between financial wellbeing and health from a self-reported perspective.

Psychological characteristics of emotion control in physicians and teachers

IntroductionEmotional control can play positive role in professional growth. Are there any negative effects of emotional control on the professional activity of physicians and teachers?Objectives and aimsTo reveal the specifics of emotional control in groups of physicians and teachers with different self-reported health levels.MethodsThe study involved 160 physicians and 179 school teachers. Gender ratio and mean age in both groups were similar. The instruments used: SF-36 health survey and Ban on the emotional expression questionnaire.ResultsIn general, physicians, and teachers more often than control group controlled the expression of their emotions. Physicians in comparison with teachers were more likely to restrict both positive (joy) and negative emotions (sadness, anger). Teachers with a high level of health by SF-36 had a minimal ban on the expression of sadness (P &lt; 0.01). The maximum level of the ban on the expression of anger (P &lt; 0.001) and fear (P &lt; 0.05) and an aggregated ban of emotional expression was revealed in teachers with average level of health by SF-36 (P &lt; 0.001). Expression of joy in teachers was not directly related to the self-reported health level (P &gt; 0.05). Physicians who showed the maximum ban on the emotion expressions reported only the low health level by SF-36 (P &lt; 0.05). It was more related to the ban on joy, and less to the ban on anger.ConclusionsThe revealed models of emotional expression control can strengthen both professional and everyday stresses in physicians and teachers. Different prevention programs are needed for these groups of professionals.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Economic Freedom, Race, and Health Disparities

The social determinants of health include the communities in which people reside. Associated with geographic areas are public policies that influence a variety of economic and social outcomes. The group of public policies associated with economic freedom have been found to be positively related to a number of economic and social outcomes. In this article, we investigate the impact of economic freedom on self-reported health and racial health disparities. We use propensity score matching to construct a control group of whites who can be compared to blacks in the 2007, 2009, and 2011 Behavioral Risk Factor Surveillance System. After accounting for confounding variables and possible selection, we find evidence that economic freedom is associated with lower levels of self-reported health for the population overall. After allowing for the effects of economic freedom to differ by race, we find that higher levels of economic freedom mitigate the observed gap in health status.

Where's WALY? : A proof of concept study of the 'wellbeing adjusted life year' using secondary analysis of cross-sectional survey data.

BackgroundThe Quality-Adjusted Life Year (QALY) is a measure that combines life extension and health improvement in a single score, reflecting preferences around different types of health gain. It can therefore be used to inform decision-making around allocation of health care resources to mutually exclusive options that would produce qualitatively different health benefits. A number of quality-of-life instruments can be used to calculate QALYs. The EQ-5D is one of the most commonly used, and is the preferred option for submissions to NICE (https://www.nice.org.uk/process/pmg9/). However, it has limitations that might make it unsuitable for use in areas such as public and mental health where interventions may aim to improve well-being. One alternative to the QALY is a Wellbeing-Adjusted Life Year. In this study we explore the need for a Wellbeing-Adjusted Life Year measure by examining the extent to which a measure of wellbeing (the Warwick-Edinburgh Mental Well-being Scale) maps onto the EQ-5D-3L.MethodsSecondary analyses were conducted on data from the Coventry Household Survey in which 7469 participants completed the EQ-5D-3L, Warwick-Edinburgh Mental Well-being Scale, and a measure of self-rated health. Data were analysed using descriptive statistics, Pearson’s and Spearman’s correlations, linear regression, and receiver operating characteristic curves.ResultsApproximately 75 % of participants scored the maximum on the EQ-5D-3L. Those with maximum EQ-5D-3L scores reported a wide range of levels of mental wellbeing. Both the Warwick-Edinburgh Mental Well-being Scale and the EQ-5D-3L were able to detect differences between those with higher and lower levels of self-reported health. Linear regression indicated that scores on the Warwick-Edinburgh Mental Well-being Scale and the EQ-5D-3L were weakly, positively correlated (with R2 being 0.104 for the index and 0.141 for the visual analogue scale).ConclusionThe Warwick-Edinburgh Mental Well-being Scale maps onto the EQ-5D-3L to only a limited extent. Levels of mental wellbeing varied greatly amongst participants who had the maximum score on the EQ-5D-3L. To evaluate the relative effectiveness of interventions that impact on mental wellbeing, a new measure – a Wellbeing Adjusted Life Year – is needed.

Health Impact Index. Development and Validation of a Method for Classifying Comorbid Disease Measured against Self-Reported Health.

The objective of this study was to develop a method of classifying comorbid conditions that accounts for both the severity and joint effects of the diseases. The Tromsø Study is a cohort study with a longitudinal design utilizing a survey approach with physical examinations in the Tromsø municipality from 1974 to 2008, where in total 40051 subjects participated. We used Tromsø 4 as reference population and the Norwegian Institute of Public Health (FHI) panel as validation population. Ordinal regression was used to assess the effect of comorbid disease on Self-Reported Health (SRH). The model is controlled for interaction between diseases, mental health, age, and gender. The health impact index estimated levels of SRH. The comparison of predicted and observed SRH showed no significant differences. Spearman’s correlation showed that increasing levels of comorbidity were related to lower levels of SRH (RS = -0.36, p <.001). The Charlson Comorbidity Index(CCI) was also associated with SRH (r = -.25, p <.001). When focusing on only individuals with a comorbid disease, the relation between SRH and the Health Impact Index (HII) was strengthened (r = -.42, p <.001), while the association between SRH and CCI was attenuated (r = -.14, p <.001). CCI was designed to control for comorbid conditions when survival/mortality is the outcome of interest but is inaccurate when the outcome is SRH. We conclude that HII should be used when SRH is not available, and well-being or quality of survival/life is the outcome of interest.

Characteristics of Patients Who Report Confusion After Reading Their Primary Care Clinic Notes Online

ABSTRACTPatient access to online electronic medical records (EMRs) is increasing and may offer benefits to patients. However, the inherent complexity of medicine may cause confusion. We elucidate characteristics and health behaviors of patients who report confusion after reading their doctors’ notes online. We analyzed data from 4,528 patients in Boston, MA, central Pennsylvania, and Seattle, WA, who were granted online access to their primary care doctors’ clinic notes and who viewed at least one note during the 1-year intervention. Three percent of patients reported confusion after reading their visit notes. These patients were more likely to be at least 70 years of age (p < .0001), have fewer years of education (p < .0017), be unemployed (p < .0001), have lower levels of self-reported health (p < .0043), and worry more after reading visit notes (relative risk [RR] 4.83; confidence interval [CI] 3.17, 7.36) compared to patients who were not confused. In adjusted analyses, they were less likely to report feeling more in control of their health (RR 0.42; CI 0.25, 0.71), remembering their care plan (RR 0.26; CI 0.17, 0.42), and understanding their medical conditions (RR 0.32; CI 0.19, 0.54) as a result of reading their doctors’ notes compared to patients who were not confused. Patients who were confused by reading their doctors’ notes were less likely to report benefits in health behaviors. Understanding this small subset of patients is a critical step in reducing gaps in provider–patient communication and in efforts to tailor educational approaches for patients.

Is Healthier Nutrition Behaviour Associated with Better Self-Reported Health and Less Health Complaints? Evidence from Turku, Finland.

We examined nutrition behaviour, self-reported health and 20 health complaints of undergraduates in Finland. Students at the University of Turku in Finland participated in a cross-sectional online survey (N = 1189). For nutrition behaviour, we computed two composite food intake pattern scores (sweets, cakes and snacks; and fruits and vegetables), a dietary guideline adherence index and the subjective importance of healthy eating. Multinomial logistic regression assessed the association of students’ nutrition behaviour with three levels of self-reported health, controlling for many potential confounders (age, sex, living with partner, economic situation, moderate physical activity, Faculty and BMI). Factor analysis of the 20 health complaints revealed three components (psychological, pains/aches and circulatory/breathing symptoms). Multiple linear regression tested the association of students’ eating habits with the three components of health complaints, controlling for the same confounders. Fruits and raw and cooked vegetable consumption, dietary guideline adherence index and subjective importance of healthy eating were highest among students with excellent/very good self-reported health, exhibiting a decreasing trend for those individuals with poor/fair self-reported health. High levels of psychological symptoms were associated with decreased consumption of fruits and vegetables, less dietary guideline adherence and less subjective importance of healthy eating. Pain/aches symptoms were associated with a higher consumption of sweets, cookies and snacks and a lower adherence to dietary guidelines. More healthy nutrition behaviour was consistently associated with better self-reported health and less health complaints. Of the four nutrition behaviour indicators we employed, the dietary guideline adherence index was the best indicator and exhibited the most consistent associations with self-reported health and health complaints.

Development and validation of a carers quality-of-life questionnaire for parkinsonism (PQoL Carers).

Atypical parkinsonism (AP) has a considerable impact on the lives not only of patients but also of their carers. The aim of this study was to develop an instrument for assessing the quality of life (QoL) of carers of patients with AP. A 40-item pool was generated from in-depth interviews with carers of patients with AP, a thorough review of the existing literature and consultation with movement disorder experts. Item refinement and reduction was performed using the results of pilot testing and a survey in 282 carers of multiple system atrophy (MSA) patients and 226 carers of progressive supranuclear palsy (PSP) patients. A validation study, with responses of 243 carers of MSA and 187 carers of PSP patients, was undertaken to evaluate the psychometric properties of the final 26-item scale. The validation study results suggest that the scale is unidimensional and has high internal consistency (Cronbach's α=0.96). The correlations of scale scores with patients' health status and QoL measures, such as PDQ-39 summary score and EQ-5D index (Spearman's ρ=0.56 and -0.31, respectively, P<0.001), as well as carers' measures, such as Caregiver Burden Inventory (CBI) total and EQ-5D index (Spearman's ρ=0.85 and -0.39, respectively, P<0.001), document the convergent and concurrent validity of the scale. ANOVA results support the discriminant validity of the scale, as evidenced by its capacity to differentiate between carers with varying levels of self-reported health. The 26-item Parkinsonism Carers QoL (PQoL Carer) is a concise instrument with adequate psychometric qualities that can be used for clinical and research purposes.

Autopercepção de saúde de idosos usuários de um serviço de oncologia

We aimed at describing health self-perception of older adults receiving chemotherapy in an oncology service, according to sociodemographic, morbidity and social support variables. A quantitative descriptive study conducted by applying pre-coded questionnaires with close-ended questions, which were given to 108 older adults receiving chemotherapy. The data were organized in a bank and analyzed through frequency distribution. Results displayed that male participants who lived with a partner and had some type of occupation had higher self-reported health levels. The poorest results were obtained in the 60-74 age group, among residents of rural areas, with one to two minimum monthly wages and systemic arterial hypertension. The results suggest intervention possibilities for health professionals, which can lead to improving self-perceived health status, such as stimulating family support and maintaining occupational activities.doi: 10.5216/ree.v16i3.21482.

Accelerometer-determined physical activity and self-reported health in a population of older adults (65–85 years): a cross-sectional study

BackgroundThe link between physical activity (PA) and prevention of disease, maintenance of independence, and improved quality of life in older adults is supported by strong evidence. However, there is a lack of data on population levels in this regard, where PA level has been measured objectively. The main aims were therefore to assess the level of accelerometer-determined PA and to examine its associations with self-reported health in a population of Norwegian older adults (65–85 years).MethodsThis was a part of a national multicenter study. Participants for the initial study were randomly selected from the national population registry, and the current study included those of the initial sample aged 65–85 years. The ActiGraph GT1M accelerometer was used to measure PA for seven consecutive days. A questionnaire was used to register self-reported health. Univariate analysis of variance with Bonferroni adjustments were used for comparisons between multiple groups.ResultsA total of 560 participants had valid activity registrations. Mean age (SD) was 71.8 (5.6) years for women (n = 282) and 71.7 (5.2) years for men (n = 278). Overall PA level (cpm) differed considerably between the age groups where the oldest (80–85 y) displayed a 50% lower activity level compared to the youngest (65–70 y). No sex differences were observed in overall PA within each age group. Significantly more men spent time being sedentary (65–69 and 70–74 years) and achieved more minutes of moderate to vigorous PA (MVPA) (75–79 years) compared to women. Significantly more women (except for the oldest), spent more minutes of low-intensity PA compared to men. PA differed across levels of self-reported health and a 51% higher overall PA level was registered in those, with “very good health” compared to those with “poor/very poor health”.ConclusionNorwegian older adults PA levels differed by age. Overall, the elderly spent 66% of their time being sedentary and only 3% in MVPA. Twenty one percent of the participants fulfilled the current Norwegian PA recommendations. Overall PA levels were associated with self-reported health.

Predictors of the Decision to Retire among Nurses in Spain

Background: Nurses typically retire in their late 50s and since nursing shortages exist in most countries understanding nursing staff decisions to retire might open up possibilities of encouraging and supporting them to remain in the workforce longer. Objective: This study examines potential predictors of retirement intentions amongst nurses working in Spain. Population: All registered nurses in Spain with 50 years old or more. Methods: Survey. Data were collected with the collaboration of the regional nursing associations in Spain using anonymous online questionnaires employed to nursing staff (n=497) for those who are 50 years or older. Results: Nurses indicated their interest in retiring, their planning for retirement, and their expectations for retiring. Results show that retirement intentions were higher in nursing staff that were older, experienced higher levels of burnout, indicated poorer levels of self-reported health, and reported greater job demands and more negative work attitudes (less affective commitment, job involvement, work engagement). The majority of these were push factors which are related to dissatisfaction in the workplace. Conclusion: Organizations can and should create age-friendly workplaces enabling them to cope with the nursing shortage and workplaces can be changed to better accommodate the needs and expectations of older employees.

Development of a PROMIS item bank to measure pain interference

This paper describes the psychometric properties of the PROMIS-pain interference (PROMIS-PI) bank. An initial candidate item pool ( n = 644) was developed and evaluated based on the review of existing instruments, interviews with patients, and consultation with pain experts. From this pool, a candidate item bank of 56 items was selected and responses to the items were collected from large community and clinical samples. A total of 14,848 participants responded to all or a subset of candidate items. The responses were calibrated using an item response theory (IRT) model. A final 41-item bank was evaluated with respect to IRT assumptions, model fit, differential item function (DIF), precision, and construct and concurrent validity. Items of the revised bank had good fit to the IRT model (CFI and NNFI/TLI ranged from 0.974 to 0.997), and the data were strongly unidimensional (e.g., ratio of first and second eigenvalue = 35). Nine items exhibited statistically significant DIF. However, adjusting for DIF had little practical impact on score estimates and the items were retained without modifying scoring. Scores provided substantial information across levels of pain; for scores in the T-score range 50–80, the reliability was equivalent to 0.96–0.99. Patterns of correlations with other health outcomes supported the construct validity of the item bank. The scores discriminated among persons with different numbers of chronic conditions, disabling conditions, levels of self-reported health, and pain intensity ( p < 0.0001). The results indicated that the PROMIS-PI items constitute a psychometrically sound bank. Computerized adaptive testing and short forms are available.

Social participation and healthy ageing: An international comparison using SHARE data

Using the Survey of Health, Ageing & retirement in Europe (SHARE) data for respondents aged 50 years and over in 2004, this study evaluates the potential contribution of increased social participation to self-reported health (SRH) in 11 European countries. The probability to report good or very good health is calculated for the whole sample (after controlling for age, education, income and household composition) using regression coefficients estimated for individuals who do and for those who do not take part in social activities (with correction for selection bias in these two cases). Counterfactual national levels of SRH are derived from integral computation of cumulative distribution functions of the predicted probability thus obtained. The analysis reveals that social participation contributes by three percentage points to the increase in the share of individuals reporting good or very good health on average. Higher rates of social participation could improve health status within the whole sample and within most countries. Context and institutional arrangements (such as income inequality) may explain differences in social participation health efficiency.

Examining the influences of gender, race, ethnicity, and social capital on the subjective health of adolescents

We investigate the factors that influence adolescent self-assessed health, based upon surveys conducted between 2000 and 2004 of high-school seniors in Washington State ( N=6853). A large proportion of the sample (30%) was first and second generation immigrants from Asia, Latin America, and Eastern Europe. Findings include a robust negative effect of female gender on self-reported health that is largely unmodified by demographic, developmental, social capital, and parental support variables, gender differences in the covariates of self-reported health, and the tendency of male adolescents of Cambodian and Vietnamese origin to report lower levels of self-reported health despite controls for other health-related individual characteristics. Social capital dimensions such as positive school affiliation, social network cohesion, and a safe learning environment were found to covary with the self-reported health of adolescent females.