Multiple Dimensions Of Health Research Articles

Select dietary changes towards sustainability: Impacts on dietary profiles, environmental footprint, and cost

Healthy sustainable diets have the power to improve dietary intakes and environmental resource use. However, recommendations for improving food choices need to consider the effects of any changes across multiple dimensions of health, environmental sustainability, and dietary cost to promote long-lasting behaviour change. The aim of this study was to identify differences between original diets, and the diets that can be achieved through the implementation of select small dietary changes towards sustainability. Twelve hypothetical sustainable actions were investigated for the potential effects of these actions on dietary markers (protein, saturated fat, sugars, salt, iron, and calcium), environmental footprints (greenhouse gas emissions, freshwater withdrawals, and land use), and dietary cost. Dietary data from 1235 individuals, aged 19–94 years, participating in the UK National Diet and Nutrition Survey (2017/19) provided the original diet. Dietary changes were implemented as required by each sustainable action, and differences between the original diet and each new diet were investigated. Results revealed benefits to dietary markers and environmental characteristics from eleven sustainable actions (range: F(1,728) = 5.80, p < .001 to F(1,506) = 435.04, p < .001), but effects were stronger for some actions than for others. Greatest benefits for all three outcomes were found for actions which reduced meat consumption and/or replaced meat with pulses or eggs. The remaining sustainable actions tended to be beneficial for improving outcomes individually or to some degree. Our results demonstrate the possible impacts of a number of small sustainable dietary actions for dietary, environmental, and cost outcomes, and provide a hierarchy of actions based on benefit. Findings may facilitate dietary behaviours towards improved health, whilst also offering fruitful contributions towards environmental footprint targets in the UK.

Investigating the linkages between food insecurity, psychological distress, and poor sleep outcomes among U.S. college students.

Research overwhelmingly demonstrates that sleep is key to human health and wellbeing. Several factors likely contribute to sleep quality, including factors, such as food security and low income. In addition, exposure to structural inequalities early in life likely have downstream effects upon multiple dimensions of health. The objective of this study is to fill gaps in literature by specifically examining the associations between childhood food insecurity, current food insecurity, psychological distress, and sleep among college students. QR codes were randomly distributed to students, linking them to an online quantitative survey. The survey measured sociodemographic variables, food security (current and childhood), diet, mental distress, and sleep quality. A total of n = 134 completed the entire survey. Data were analyzed using binary and multiple linear regressions, as well as cross-tabulations. The findings revealed that psychological distress was the primary factor influencing sleep health (𝛽 = 1.51, p < .01). Students reporting higher childhood food insecurity were more likely to experience extreme psychological distress (OR = 4.61), food insecurity in college (OR = 8.41), and lack of stable housing (OR = 5.86). This study demonstrates that potential linkages exist between childhood food insecurity, poor sleep, and greater psychological distress. While acknowledging the contribution of other factors, the study highlights the importance of addressing food insecurity in relation to sleep health, considering the significant impact of sleep to overall health and wellbeing.

Assigning lifetime occupation domains for older Mexicans: MHAS-O*NET linkage protocol.

We developed a MHAS (Mexican Health and Aging Study) and O*NET (Occupational Information Network) linkage to allow global researchers using MHAS data to assign lifetime occupation domains for older Mexicans. Three bilingual raters independently matched 440 records with 132 unique occupation codes from the 2012 MHAS. We used a modified Delphi technique to reach agreements. To assess reliability, we compared the distribution of observations between the MHAS file and the MHAS-O*NET linked file across five job categories (upper white collar, lower white collar, upper blue collar, low blue collar, and agriculture/fishing/forestry). The Institutional Review Board at the University of Texas Medical Branch reviewed and approved the research (IRB # 21-0268). Using the developed 1:1 MHAS-ONET linkage, consistency between MHAS and ONET was 97.4% across the five job categories. This MHAS-O*NET linkage will allow researchers to analyze the association between lifetime occupation and multiple dimensions of health, functionality, and retirement determinants for a low-middle income country with a large proportion of workers in the informal sector.

Effects of Household Clean Fuel Combustion on the Physical and Mental Health of the Elderly in Rural China

Against the backdrop of the construction of an ecological civilization and the “Healthy China 2030” initiative, access to clean fuels is crucial for achieving optimal health and wellbeing, as well as sustainable social development. The purpose of this study is to investigate the effect of household clean fuel combustion (HCFC) on multiple dimensions of health among older adults while shedding light on the potential mechanisms. We performed a cross-sectional study of the data from the 2018 China Health and Retirement Longitudinal Survey, and we surmounted the underlying issues of endogeneity with the application of propensity score matching and the instrumental variable strategy. The results revealed that HCFC has positive effects on the health of older adults, particularly by improving their psychological wellbeing. The adoption of clean fuels among the elderly was associated with a significant increase in SRH by 3.06% to 3.42% and a decrease in CES-D by 7.96% to 8.28%. These positive environmental health effects became stronger among the elderly under the age of 75, as well as among those who were educated and had chronic diseases. Moreover, the results demonstrated that HCFC significantly alleviated chronic pain and increased social interaction among older adults, highlighting two potential pathways for promoting their wellbeing. Given that a significant number of rural households in China rely on polluting fuels, targeted strategies are crucial for promoting the use of clean fuels, particularly for vulnerable populations.

Beyond Medically Complex Pregnancy: A Scoping Review to Understand How Complexity in Pregnancy is Conceptualized.

The goal of this scoping review was to better understand how complexity in pregnancy is conceptualized. Specific objectives were to (1) identify factors that are conceptualized in the literature as complicating or impacting pregnancy; and (2) summarize tools and programs that have been implemented to support pregnant people with complex care needs. Electronic databases were searched from January 2000 to July 2020 and supplemented by bibliographic searches and citation chaining, to identify articles that described at least one nonmedical and one medical risk factor during pregnancy. We focused on complexity prior to the onset of labor and only included primary studies conducted in middle- or high-income countries. More than 6000 records were screened independently by 3 reviewers at the abstract and title level. Fourteen articles met inclusion criteria. Eight studies described antenatal risk scoring systems, including the Florida Healthy Start Prenatal Risk Screen, the Kindex risk screening tool, the prenatal event history calendar, and the Rotterdam Reproductive Risk Reduction score card. We abstracted 85 medical factors and 25 nonmedical factors from the literature. Nonmedical factors that were conceptualized as complicating pregnancy or birth could be grouped into 4 domains: characteristics of the childbearing person (7 factors), socioeconomic conditions (7 factors), family and social life (5 factors), and psychoemotional health (6 factors). We found limited scholarly research and few assessment tools that broaden the discussion of complexity in pregnancy beyond medical multimorbidity. Multiple dimensions of health should be integrated into a complexity framework for pregnancy that account for the diverse contexts and needs of pregnant people. An important part of this process is the development of a shared language to describe complexity that is strength based and acknowledges how environments, health care encounters, and the larger sociocultural context can affect pregnant people's medical status in pregnancy.

Child food insecurity in the wake of the COVID-19 pandemic: urgent need for policy evaluation and reform in Israel\u2019s school feeding programs

Even in high-income countries like Israel, children have been particularly vulnerable to the surge in food insecurity driven by quarantines, unemployment, and economic hardships of the COVID-19 pandemic. Under normal circumstances, School Feeding Programs (SFPs) can help to ensure child food security. In the wake of the pandemic, policy makers worldwide have been challenged to adapt national SFPs to provide nutritional support to children (and indirectly to their families) during extended school closures. Most national SFPs implemented contingency plans to ensure continued nutritional support for children. In Israel, where SFPs were largely suspended during long periods of mandated school closing, there was a loss of 30–50% of feeding days for the ~ 454,000 children enrolled in the program. The lack of emergency contingency planning and failure to maintain Israeli SFPs during school closures reveals longstanding structural policy flaws that hindered coordination between relevant ministries and authorities and impeded the mobilization of funds and existing programs to meet the emergent need. The school feeding law does not identify child food security as an explicit aim, there are no benchmarks for monitoring and evaluating the program to ensure that the food aid reaches the children most in need, even routinely, and the Ministry of Education had no obligation to maintain the program and to marshal data on the participants that could be acted upon in the emergency. Moreover, because Israeli SFPs are “selective”, in other words, implemented according to community risk (low-income, high poverty rate) and geographical factors, attendant stigma and financial burdens can make participation in the program less attractive to families and communities that need them the most. We argue that Israel should make urgent, long-term improvements to the SFPs as follows: First, eliminating childhood food insecurity should be made an explicit goal of legislation in the broader context of national social, health, and nutritional goals, and this includes ensuring SFPs are maintained during emergencies. Second, the government should assume responsibility for the routine assessment and data collection on food insecurity among Israeli children. Third, SFPs should be subjected to rigorous independent program evaluation. Finally, a “universal” SFP providing nutritious diets would likely improve the health of all Israeli children, across all socioeconomic backgrounds. These steps to guarantee that Israeli children have food to realize their full physical and cognitive potential would emphasize Israel’s firm commitment to support multiple dimensions of health, educational achievement, and societal values, to combat the complex and long-term consequences of the pandemic, and to prepare for the next one.

Geographic variation in gender gap among older adults in India and China: Application of a new ageing measure

A continuous rise in the life expectancy of females above that of the males among older adults in India and China may give an impression that the gender gap in health is decreasing. However, given the systemic bias against females in these countries across multiple facets, and the diversity across provinces, a fuller understanding of gender gap calls for (a) understanding the gender gap in multiple dimensions of health, and (b) understanding the variations across provinces. We estimate a multi-dimensional old-age threshold (MOAT) across provinces in India and China, that specifies different old-age thresholds for female and male populations after simultaneously accommodating for multiple dimensions related to their health. These aspects of health include remaining life expectancy, intellectual and functional health. We estimate the gender gap across provinces in these countries by differencing the MOAT of males against that of females. In addition, we also illustrate the gender gap across individual dimensions of health. Our results show that females in almost all the provinces of India and China have a lower MOAT than their male counterparts, showing an earlier advent of ‘old-age’ among females compared to males. The estimates based on remaining life expectancy shows gender gap in favor of females, but the estimates of multi-dimensional gender gap are higher and biased against females. A huge variation is seen across provinces, with Karnataka and Hubei showing lower levels of gender gap and Rajasthan and Yunnan showing higher gender gaps in India in China respectively.

Religious attendance and global cognitive function: A fixed-effects cross-lagged panel modeling study of older U.S. adults

ObjectivesEvidence linking religious attendance to better cognitive function is based on flawed study designs. No population representative longitudinal studies on the topic have taken both unobserved confounding and reverse causation into account. Recently developed fixed-effects cross-lagged panel modeling (FE-CLPM) offers simultaneous traction on these issues. It also allows parsing of long-from short-run effects. Using FE-CLPM and ten-year data from the Health and Retirement Study—a national probability sample of U.S. adults over age 50—this study began to fill the gaps above. MethodsGender-specific FE-CLPM models were used to examine bidirectional and within-person linkages of religious attendance with global cognitive function. Granger-Sims “causality” tests further examined short-run effects in both directions. Impulse response analysis was used to explore time patterns in these linkages. ResultsAt least among women, religious attendance had negative short-term prospective linkages with global cognitive function. Over successive time points, these associations increased in strength among both genders. Feedback effects—of cognitive status on religious attendance—were found in both women's and men's models, but had a gender-specific pattern. DiscussionResults contradict a large literature positing cognitive benefits of religiosity. Instead, they lend support to a recent “neural resource depletion” model—especially among women. Overall, findings illustrate the “dark side” of religious engagement, which studies increasingly present as a social determinant with “outcome wide” positive effects on multiple health dimensions.

Health risks posed by social and linguistic isolation in older Korean Americans.

Inspired by the notion of double jeopardy positing the dual disadvantage in the coexistence of different sources of vulnerability, the present study examined health risks posed by social and linguistic isolation in older Korean Americans. A cross-sectional study, using a four-cell classification to compare isolation types (no isolation, social isolation only, linguistic isolation only, and dual isolation) and to examine their impacts on physical (self-rated health), mental (mental distress), and cognitive (cognitive performance) health. Data are from the Study of Older Korean Americans survey of Korean immigrants aged 60 or older (n=2032), conducted in five states in the United States (California, New York, Texas, Hawaii, and Florida). Social isolation was indexed by the Lubben Social Network Scale-6; linguistic isolation, by a question on English-speaking ability. Physical, mental, and cognitive health were indicated by a single-item self-rating of health, the Kessler Psychological Distress Scale 6, and the Mini-Mental State Examination, respectively. The dual-isolation group exhibited notable sociodemographic and health disadvantages. The odds of having fair/poor health, mental distress, and cognitive impairment were 2.21-3.17 times higher in the dual-isolation group than in the no-isolation group. Our findings confirm that both social relationships and language proficiency are key elements for older immigrants' social connectedness and integration, the deprivation of which puts them at heightened risk in multiple dimensions of health.

219 Comparing Sleep Amount and Quality for People Working from Home with and Without Minor Dependents during the COVID-19 Pandemic

IntroductionThe global pandemic due to the novel coronavirus (COVID-19) has had unprecedented effects on society, in particular for those who are also working with children in the household. The aim of this analysis was to evaluate sleep amount and sleep quality during the COVID-19 pandemic compared to before COVID-19 for those working from home with minor household dependents.MethodsWe developed the “Anonymous Survey on Confinement during the COVID-19 Pandemic”, a national survey for individuals ≥18 years of age hosted on the Penn Medicine Clinical Research website from May 16th to November 11th, 2020. This 200 question survey captured demographics and multiple dimensions of health and well-being, including stress, sleep, eating behaviors, and coping activities. Respondents who indicated they were working from home were stratified by whether they were living with ≥1 minor dependent vs no dependents. Separate ordinal logistic regression models were used to evaluate associations between living with a minor dependent and sleep amount (less, same, more) and disturbed quality (none, less, same, more) during, compared to before, COVID-19 controlled for age, sex, ethnicity, and annual income.ResultsA total of 232 respondents (n=182 no dependents, n=50 dependents, 84.9% Caucasian) reported working from home, the majority of which had been in confinement (95.7%). Respondents with dependents were younger (mean age 38.9±13.5 vs 47.4±18.0, p=0.002) and mostly female (86% vs 76.9%, p=0.03). On average, reported days worked/week (3.5±2.4 days) and hours worked/day (5.5±4.17 hours) were similar regardless of dependents. Comparing those without to those with minor dependents, there were no significant differences in log odds of getting enough sleep (β=-0.38, p=0.25) or worse sleep quality (β=0.41, p=0.22) during the COVID-19 pandemic compared to before COVID-19. Respondents with dependents reported a higher log odds of taking longer to fall asleep during COVID-19 (β=0.71, p=0.045), and higher stress (β=-0.65, p=0.04).ConclusionIn this mostly Caucasian female sample of people working from home, having minor dependents in the household did not significantly impact sleep amount or quality compared to no minor household dependents. However, respondents with dependents reported longer time to fall asleep and were more stressed.Support (if any)MC/CJ are supported by NHLBI (T32 HL007713).

Achieving Health Equity for Older Adults Through State-of-the-Art Innovations

As health indicators such as life expectancy have improved for many older adults, some older adults experience a disproportionate amount of preventable disease, death, and disability. The causes of health disparities among older adults are multidimensional in that disparities are due to multiple, interacting factors such as socioeconomic status, disability status, geographic location, and race/ethnicity. Achieving health equity in late-life requires innovative strategies to address interconnected environmental, sociocultural, behavioral and biological factors that impede opportunities to achieve optimal health and quality of life. This symposium will present state-of-the-art innovations and strategies employed among socially disadvantaged racial, ethnic, and other population groups, and communities. We will discuss innovations in the workforce enhancements with older adult peer support specialists and community health workers, community engagement techniques in program design, and digital solutions aimed at addressing multiple dimensions of health in older adults.

Health variations among breast-cancer patients from different disease states: evidence from China

BackgroundThis study aimed to obtain health utility parameters among Chinese breast cancer patients in different disease states for subsequent health economics model. In addition, we aimed to explore the feasibility of establishing a breast cancer health utility mapping model in China.MethodsMultiple patient-reported health attributes were assessed, including quality of life, which was measured by the Functional Assessment of Cancer Therapy-Breast (FACT-B) instrument; health utility and self-rated health, which were measured by the EuroQol-5 Dimension-5 Level (EQ-5D-5L) questionnaire. Multivariate regression models, including a linear regression model, an ordinal logistic regression model and a Tobit model, were employed to analyze health differences among 446 breast cancer patients. Subgroup analyses were performed to examine differences in multiple dimensions of health derived from the FACT-B and EQ-5D-5L instruments. A mapping function was used to estimate health utility from quality of life. Rank correlation analyses were employed to examine the correlation between estimated and observed health utility values.ResultsA total of 446 breast cancer patients with different disease states were analyzed. The health utility values of breast cancer patients in the P state (without cancer recurrence and metastasis), R state (with cancer recurrence within a year), S state (with primary and recurrent breast cancer for the second year and above), and M state (metastatic cancer) were 0.81 (SD ± 0.23), 0.90 (SD ± 0.12), 0.78 (SD ± 0.31), and 0.74 (SD ± 0.27), respectively. There were positive correlations between all scores, including every domain of the FACT-B instrument (p < 0.001). Results from multivariate analysis suggested that patients in the R and M states had lower scores for overall quality of life (R, β = − 9.45, p < 0.01; M, β = − 6.72, p < 0.05). Patients in the M state had lower health utility values than patients in the P state (β = − 0.11, p < 0.05). Estimated health utility values, which were derived from quality of life by using a mapping function, were significantly correlated with directly measured health utility values (p < 0.001).ConclusionsWe obtained the health utility and health-related quality of life (HRQoL) scores of Chinese breast cancer patients in different disease states. Mapping health utility values from quality of life using four disease states could be feasible in health economic modelling, but the mapping function may need further revision.

Mobility and health: The perceived impact of frequent business trips on travelers’ health

Business travel as a form of work-related mobility has been an integrated part of working life in the global economy, generating great impact on individuals. Although prior studies address some relevant health consequences, there is a lack of research considering multiple dimensions of health or providing a deeper contextual analysis. Drawing on the multi-dimensional health concept and the framework of mobilities and health, the present study further demonstrates the complexity and dynamic of this issue. Through in-depth interviews with frequent business travellers, it was found that frequent business trips as a part of work and life bring about a range of physical, psychological and social health impacts, which shows different characteristics and interact with each other. Perceptions of these health consequences vary among respondents with different travel patterns and personal situations. Moreover, the findings indicate that there may exist a paradoxical fact: as business travellers with longer experiences of traveling work tend to become more aware of the potential health cost of highly mobile lifestyles, however, the health impairment has generated and accumulated at the later life stages and can hardly be reversed even they stop traveling. Therefore, it is significant and meaningful to raise the public concern on this issue by stressing the dark side of business travel instead of only glamorizing it. This study contributes to previous literature on mobility and health by demonstrating the characteristics of business travel as a mobile working context and how it affects travellers’ health in multi-dimensions. It also provides managerial implications for individuals and organizations.

Health profiles and socioeconomic characteristics of nonagenarians residing in Mugello, a rural area in Tuscany (Italy)

BackgroundHealth, as defined by the WHO, is a multidimensional concept that includes different aspects. Interest in the health conditions of the oldest-old has increased as a consequence of the phenomenon of population aging. This study investigates whether (1) it is possible to identify health profiles among the oldest-old, taking into account physical, emotional and psychological information about health, and (2) there are demographic and socioeconomic differences among the health profiles.MethodsLatent Class Analysis with covariates was applied to the Mugello Study data to identify health profiles among the 504 nonagenarians residing in the Mugello district (Tuscany, Italy) and to evaluate the association between socioeconomic characteristics and the health profiles resulting from the analysis.ResultsThis study highlights four groups labeled according to the posterior probability of determining a certain health characteristic: “healthy”, “physically healthy with cognitive impairment”, “unhealthy”, and “severely unhealthy”. Some demographic and socioeconomic characteristics were found to be associated with the final groups: older nonagenarians are more likely to be in worse health conditions; men are in general healthier than women; more educated individuals are less likely to be in extremely poor health conditions, while the lowest-educated are more likely to be cognitively impaired; and office or intellectual workers are less likely to be in poor health conditions than are farmers.ConclusionsConsidering multiple dimensions of health to determine health profiles among the oldest-old could help to better evaluate their care needs according to their health status.

Enriched, Task-Specific Therapy in the Chronic Phase After Stroke: An Exploratory Study.

There is a need to translate promising basic research about environmental enrichment to clinical stroke settings. The aim of this study was to assess the effectiveness of enriched, task-specific therapy in individuals with chronic stroke. This is an exploratory study with a within-subject, repeated-measures design. The intervention was preceded by a baseline period to determine the stability of the outcome measures. Forty-one participants were enrolled at a mean of 36 months poststroke. The 3-week intervention combined physical therapy with social and cognitive stimulation inherent to environmental enrichment. The primary outcome was motor recovery measured by Modified Motor Assessment Scale (M-MAS). Secondary outcomes included balance, walking, distance walked in 6 minutes, grip strength, dexterity, and multiple dimensions of health. Assessments were made at baseline, immediately before and after the intervention, and at 3 and 6 months. The baseline measures were stable. The 39 participants (95%) who completed the intervention had increases of 2.3 points in the M-MAS UAS and 5 points on the Berg Balance Scale (both P < 0.001; SRM >0.90), an improvement of comfortable and fast gait speed of 0.13 and 0.23 m/s, respectively. (P < 0.001; SRM = 0.88), an increased distance walked over 6 minutes (24.2 m; P < 0.001; SRM = 0.64), and significant improvements in multiple dimensions of health. The improvements were sustained at 6 months. Enriched, task-specific therapy may provide durable benefits across a wide spectrum of motor deficits and impairments after stroke. Although the results must be interpreted cautiously, the findings have implications for enriching strategies in stroke rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A304).

Health and wellbeing of the online lecturer: a phenomenological study

ABSTRACT There is a gap in understanding of how online lecturers experience their health during intense times of online activity such as preparing and giving online feedback/feedforward. This research is designed to explore the experience of online lecturer health and wellbeing considering multiple dimensions of health. It aims to glean rich descriptions of the lived experience of online lecturing. A phenomenological approach was taken, using emergent framework analysis. Ten experienced online lecturers within a Scottish university participated through semi-structured email interviews. Findings suggest that online lecturers’ health is enhanced by enjoyment of autonomy, freedom, ensuring quality and best practice, enabling engagement with learners and colleagues. However, health is compromised by a mismatch of time allocation and workload, long periods of sitting working intensely through a computer, and a lack of recognition by colleagues, management and faculty.

Air pollution: impact and interventions

Clean air is a fundamental requirement for the existence of life on earth. However, with the rapid rate of economic development, globalization, and increasing energy demand, large amount of emissions and waste are generated, leading to severe air pollution. This paper surveys the literature to provide an overview of the impact of air pollution on various aspects of human life. The impact is categorized broadly into health and socio-economic aspects and further subcategorized into multiple dimensions of health and socio-economic consequences. The survey reveals that the impact of air pollution is comprehensive, ranging from chronic to life-threatening diseases, and from malfunctioning of specific organ systems to subjective well-being. Additionally, evidence of the impact of air pollution on unexpected dimensions such as housing prices, larger economy, academic outcomes, and more is uncovered, leaving no doubt on the need to address this problem with the attention of the highest order. This evidence can be used to trigger more research and give policy-makers a starting point for clean-air campaigns. Merely highlighting the seriousness of the issue is not enough, and hence the paper also surveys the broader literature to identify interventions for clean air developed by public and private stakeholders across the world. While none of them may be ripe for blind duplication, this paper aims to provide decision-makers and researchers a bouquet of solutions to choose from while developing clean air programs and research agenda.

A multi-dimensional perspective on the gender gap in health among older adults in India and China: application of a new ageing measure

AbstractA continuous rise of female life expectancy above that of males among older adults in India and China may give the impression that the relative gender gap in health in these countries is decreasing. However, given the systemic gender bias against older females in these countries across multiple dimensions of health, a fuller understanding of the gender gap in health calls for a multi-dimensional perspective. We estimate a multi-dimensional old-age threshold (MOAT) that specifies different old-age thresholds for female and male populations which accommodates multiple dimensions related to physical, intellectual and general health. We use the MOAT to evaluate the multi-dimensional gender gap in India and China by differencing the MOAT for females with that of males. Females in both countries have a lower MOAT than their male counterparts, indicating an earlier advent of ‘old age’ for females. The multi-dimensional estimates of the gender gap are also higher than the estimates based on only one dimension of health. A considerable level of variation is also observed in the gender gap across provinces. The study illustrates the need to understand the gender gap in health in India and China from a multi-dimensional perspective and provides an innovative way to quantify such a gap. Province-specific as well as health dimension-specific interventions are vital in reducing the gender gap among older adults in these countries.

Design and measurement in a study of war exposure, health, and aging: protocol for the Vietnam health and aging study

BackgroundSurvivors of war throughout the world experience illnesses and injuries that are crucial to understand, given the ongoing treatment and adaptation they demand. In developing countries like Vietnam, where population aging and chronic disease burdens are rapidly rising, aging populations have seen a disproportionate share of armed conflict and related casualties. This paper describes the Vietnam Health and Aging Study (VHAS), a unique resource for investigating mechanisms of association between diverse exposures to armed conflict during the Vietnam War and multiple dimensions of older adult health among survivors of that war.MethodsThe VHAS utilizes a longitudinal design, the first wave of data collection conducted in 2018 among 2447 older adults. A second wave of follow-up data collection, scheduled to take place in 2021, will examine life course, social relational and health and mortality transitions. The VHAS was conducted in four northern Vietnamese districts purposively selected to represent a spectrum of war exposure as indicated by intensity of bombings. Additionally, VHAS uses random sampling within gender and military service subdomains to permit unique gender-specific analyses of military service, trauma exposure and health.The VHAS’ face-to-face interviews include modules detailing war and military service experiences; warzone stressors; and multiple dimensions of health such as chronic disease, functional limitation, disability, health behaviors, cognition and psychological health. Biomarker data collected for the full VHAS sample includes anthropometric and functional tests such as grip strength and blood pressure, hair samples for cortisol assay, and capillary blood samples to assay C-reactive protein, cholesterol, HbA1c, and other markers of interest for cardiovascular and other disease risks and for testing the impact of early life stressors on later life health. Blood samples will also permit epigenetic analysis of biological aging.DiscussionFuture VHAS investigations will examine dynamic linkages between war exposure, mortality and morbidity, while taking into account the selective nature of each of these processes. Longitudinal analyses will examine late-life health transitions and war-related resiliency.

The GEM model of health: a model based on generalized empirical method –Part 3 – Fleshing out the model

In this paper, I discuss Lonergan’s account of the structure of the human good and then demonstrate how it works in reference to a doctor’s description of her experience at a New Orleans’ hospital in the aftermath of Hurricane Katrina. Next, I proceed to define health and disease on the basis of Lonergan’s accounts of the human good, emergent probability and generalized empirical method. Then, I lay out the generic levels of human living in a table of terms whose interrelations embody the multiple dimensions of health and their dynamic potential for integration (and breakdown) in the GEM model of health.