Multiple Health Complaints Research Articles

Functional bowel symptoms, fibromyalgia and fatigue: A food-induced triad?

Objective. Patients with perceived food hypersensitivity typically present with multiple health complaints. We aimed to assess the severity of their intestinal and extra-intestinal symptoms. Materials and methods.In a prospective study, 84 patients referred to our outpatient clinic for investigation of perceived food hypersensitivity were enrolled consecutively. Irritable bowel syndrome (IBS) was diagnosed according to the Rome III criteria. Severity and impact of bowel symptoms, fatigue and musculoskeletal pain were evaluated by using the following questionnaires: The IBS Severity Scoring System (IBS-SSS), the Fatigue Impact Scale (FIS), the FibroFatigue Scale (FFS), and visual analogue scales (VAS) for scoring of musculoskeletal pain. Results. All but one patient were diagnosed with IBS, 58% with severe symptoms. Extra-intestinal symptoms suggestive of chronic fatigue and fibromyalgia were demonstrated in 85% and 71%, respectively. Neither IgE-mediated food allergy nor organic pathology could explain the patients' symptoms. Nevertheless, malabsorption of fat was demonstrated in 10 of 38 subjects. Conclusions.Perceived food hypersensitivity may be associated with severe, debilitating illness. The comorbid triad of IBS, chronic fatigue, and musculoskeletal pain is striking and may point to a common underlying cause.

Subjective health and mental well‐being of adolescents and the health promoting school

Purpose – The aim of this paper is to examine the impact of the health promoting school (HPS) on adolescent well‐being.Design/methodology/approach – Data from the 2006 Health Behaviour in School‐aged Children: WHO‐collaborative Study in Scotland were analysed using multilevel linear regression analyses for outcome measures: happiness, confidence, life satisfaction, feeling left out, helplessness, multiple health complaints (MHC) and self‐rated health.Findings – Particularly high proportions of both boys and girls reported high life satisfaction and no MHC. For the majority of outcomes, mean proportions of young people reporting positive well‐being were greater for schools that had or were working towards HPS status compared with those that did not. The odds of young people in a HPS never feeling left out were significantly greater than those in a school with no HPS status (OR=1.54, with 95 per cent CI (1.03, 2.29) for boys, OR=1.60 (1.03, 2.50) for girls). Similarly, among girls, the odds of never feeling...

Glasgow smiles better: An examination of adolescent mental well-being and the ‘Glasgow effect’

The existence of a negative 'Glasgow effect' on health has been much disputed. Previously, Glasgow's poor health was believed to be due to high levels of poverty. However, more recent studies investigating adult health outcomes have shown an effect over and above that of deprivation. To examine the existence of a 'Glasgow effect' on mental well-being and subjective health of an adolescent sample. Data from the 2006 Health Behaviour in School-Aged Children cross-sectional survey were analyzed. Data were modelled using multilevel logistic and linear modelling for the following outcomes: happiness, confidence, feeling left out, self-rated health, multiple health complaints (MHC), life satisfaction and health-related quality of life (KIDSCREEN-10). The models were further adjusted for family affluence and family status, as proxy measures of socio-economic status. The proportions of pupils that reported being very happy, always confident and never left out were greater among pupils in Glasgow compared with pupils in the rest of Scotland, as were mean life satisfaction and KIDSCREEN scores. Frequencies of MHC and subjective health were not significantly different in Glasgow compared with the rest of Scotland. Similar results were observed following the modelling procedures, adjusting for age, sex, grade and school type (state or independent), for all outcomes other than life satisfaction, and effect sizes increased further after adjustment for family affluence and family status. The odds of a pupil in Glasgow being very happy, for example, were 1.48 [credible interval (CI) 1.19-1.83] those of a pupil outside Glasgow. After adjustment for family affluence and family status, the odds were 1.59 (CI 1.28-1.98). An interaction term between Glasgow and grade was not significant for all mental well-being outcomes, although there was some suggestion that a negative Glasgow effect on self-rated health is emerging by Secondary 4. The Glasgow effect may not be all bad. The findings suggest that mental well-being is more prevalent in Glasgow compared with the rest of Scotland during adolescence. Further research is recommended to investigate the Glasgow effect during this life stage.

Operationalizing multimorbidity and autonomy for health services research in aging populations - the OMAHA study

BackgroundAs part of a Berlin-based research consortium on health in old age, the OMAHA (Operationalizing Multimorbidity and Autonomy for Health Services Research in Aging Populations) study aims to develop a conceptual framework and a set of standardized instruments and indicators for continuous monitoring of multimorbidity and associated health care needs in the population 65 years and older.Methods/DesignOMAHA is a longitudinal epidemiological study including a comprehensive assessment at baseline and at 12-month follow-up as well as brief intermediate telephone interviews at 6 and 18 months. In order to evaluate different sampling procedures and modes of data collection, the study is conducted in two different population-based samples of men and women aged 65 years and older. A geographically defined sample was recruited from an age and sex stratified random sample from the register of residents in Berlin-Mitte (Berlin OMAHA study cohort, n = 299) for assessment by face-to-face interview and examination. A larger nationwide sample (German OMAHA study cohort, n = 730) was recruited for assessment by telephone interview among participants in previous German Telephone Health Surveys. In both cohorts, we successfully applied a multi-dimensional set of instruments to assess multimorbidity, functional disability in daily life, autonomy, quality of life (QoL), health care services utilization, personal and social resources as well as socio-demographic and biographical context variables. Response rates considerably varied between the Berlin and German OMAHA study cohorts (22.8% vs. 59.7%), whereas completeness of follow-up at month 12 was comparably high in both cohorts (82.9% vs. 81.2%).DiscussionThe OMAHA study offers a wide spectrum of data concerning health, functioning, social involvement, psychological well-being, and cognitive capacity in community-dwelling older people in Germany. Results from the study will add to methodological and content-specific discourses on human resources for maintaining quality of life and autonomy throughout old age, even in the face of multiple health complaints.

Inequalities in Croatian pupils' unhealthy behaviours and health outcomes: role of school, peers and family affluence

To examine the influence of family affluence (measure of socioeconomic status), school environment (liking school, school pressure, academic achievement and classmates support) and peer group (size of the peer group and frequency of peer contact) on unhealthy behaviours (smoking, drunkenness, physical inactivity, irregular breakfast and soft drink consumption) and health outcomes (self-rated health, multiple health complaints and life satisfaction) in Croatian pupils. The Croatian data from Health Behaviour in School-aged Children 2005/06 (HBSC) were used (1666 11-year-olds, and 1630 15-year-olds). Binary logistic regression analysis was conducted (95% confidence intervals, P < 0.05 and P < 0.01). School environment and peer group were connected to more unhealthy behaviours along with greater differences in those behaviours than family affluence. The only exception was physical inactivity at age 11 (compared to high family affluence, low family affluence increased 80% odds for physical inactivity, whereas, compared to favourable school environment, poor school environment increased 50% odds). Compared to favourable school environment, poor school environment was the most consistent and strongest predictor of poor health outcomes (all three measures). No influence of peer group to health outcomes was found. Compared to high-affluent families, low-affluent families were associated to higher odds for poor self-rated health and life dissatisfaction, and, for 11-year-olds, medium-affluent families to lower odds for multiple health complaints. Gender differences in unhealthy behaviours and health outcomes were also found. Compared to socioeconomic inequalities, greater inequalities in unhealthy behaviours were connected to school environment and peer group, and in health outcomes to school environment.

Socio-economic inequality in multiple health complaints among adolescents: international comparative study in 37 countries

To use comparable data from many countries to examine 1) socio-economic inequality in multiple health complaints among adolescents, 2) whether the countries' absolute wealth and economic inequality was associated with symptom load among adolescents, and 3) whether the countries' absolute wealth and economic inequality explained part of the individual level socio-economic variation in health complaints. The Health Behaviour in School-aged Children (HBSC) international study from 2005/06 provided data on 204,534 11-, 13- and 15-year old students from nationally random samples of schools in 37 countries in Europe and North America. The outcome measure was prevalence of at least two daily health complaints, measured by the HBSC Symptom Check List. We included three independent variables at the individual level (sex, age group, family affluence measured by the Family Affluence Scale FAS) and two macro level measures on the country's economic situation: wealth measured by Gross National Product (GNP) and distribution of income measured by the Gini coefficient. There was a significant socio-economic variation in health complaints in 31 of the 37 countries. The overall OR (95 % CI) for 2+ daily health complaints for all countries was 1.31 (1.27-1.36) in the medium versus high FAS group and 2.07 (2.00-2.14) in the low versus high FAS group. This socio-economic gradient in health complaints attenuated somewhat in the multilevel models which included macro level data. There was no association between GNP and health complaints. The OR for high symptom load was 1.35 (1.08-1.69) per 10 % increase in Gini coefficient. The socio-economic gradient in health complaints at the individual level was somewhat attenuated in the multilevel models which included macro level data. There was a significant association between low FAS and high level of health complaints in 30 of 37 countries. Health complaints increased significantly by increasing income inequality in the country.

Subjective health, symptom load and quality of life of children and adolescents in Europe

To examine cross-cultural differences in the prevalence of school children's subjective health types and the pattern of socio-demographic and socio-economic differences. Within the cross-sectional Health Behaviour in School-aged Children 2005/2006 Survey 200,000 school children aged 11, 13 and 15 answered a general health item, the Cantrill life satisfaction ladder and a subjective health complaints checklist. ANOVA and multilevel logistic regression models were conducted. Overall, 44% of the respondents reported multiple recurrent health complaints, only poor to fair general health, low life satisfaction or a combination of these. Older adolescents (OR: 1.1-1.6) and girls (OR: 1.2-1.4) reported more health problems, the gender difference increased with age (OR: 1.3-1.6). Low socio-economic status was also associated with health problems (OR: 1.4-2.3). Sizeable cross-national variation in the prevalence of health types and the impact of the above mentioned factors were observed, yet the main pattern of impact could be confirmed cross-culturally. Increasing social and gender role pressure with growing age, as well as restricted access to material resources and psychosocial strains are discussed as potential explanations for the observed health inequalities.

Mental well-being and subjective health of 11- to 15-year-old boys and girls in Scotland, 1994-2006

Promoting young people's mental well-being and reducing socioeconomic inequalities are priority areas for WHO and the Scottish Government. This article describes changes in the subjective health and mental well-being of adolescents living in Scotland between 1994 and 2006, and investigates socioeconomic inequalities in mental well-being and subjective health over time. Data from the 1994, 1998, 2002 and 2006 Health Behaviour in School-aged Children surveys were analysed using Multilevel Binomial modelling. Boys and younger adolescents scored more favourably on measures of confidence, happiness, helplessness and feeling left out than girls and older adolescents. Multiple health complaints (MHC) were also more prevalent among girls than boys. Significant increases over time were observed for all mental well-being measures among girls and for all but confidence among boys. Similarly, there was a significant decrease in odds of MHC over time for both boys and girls. There were no socioeconomic inequalities in any of the five outcomes in 1998. However by 2006, socioeconomic inequalities in young people's happiness, confidence and MHC emerged, while inequalities in girls' helplessness also approached significance. Between 1998 and 2006 significant increases in socioeconomic inequalities in happiness and MHC were observed and increases in feeling left out also approached significance. Adolescent mental well-being and subjective health in Scotland is improving. However, gender differences persist and socioeconomic inequalities are emerging for some measures, suggesting that a longer term monitoring of mental well-being and subjective health in Scotland is required.

Adolescents with fluctuating symptoms of eating disorders: a 1‐year prospective study

This paper is a report of a study to investigate the stability of self-reported eating disorder symptoms, factors associated with them and the predictors of their recurrence. In western cultures, eating-related problems during adolescence are common but usually temporary. However, in approximately 10% of cases disordered eating is sustained, increasing the risk of a full-blown eating disorder. To distinguish adolescents with temporary eating problems from those whose problems are likely to continue, healthcare providers need to understand the progress of disordered eating and the features of high-risk adolescents. The two-stage prospective survey was conducted with a school-based sample of adolescents aged 15-17 years. At baseline, in 2003-2004, the SCOFF ('Sick', 'Control', 'One', 'Fat' and 'Food') questionnaire was administered to students in the 9th year of schooling in Finland. Follow-up assessment took place 1 year later, and 372 students provided data at both assessments. Binary logistic regression analysis was performed to investigate which factors predict the recurrence of eating disorder symptoms, defined as the occurrence of eating disorder symptoms at both assessments. Five per cent of the students reported eating disorder symptoms at both assessments. Typically, they had multiple psychological problems and health complaints. Anxiety perceived earlier in adolescence resulted in an estimated odds ratio of the logistic model of 20 for the recurrence of eating disorder symptoms. Earlier anxiety rather than dissatisfaction with appearance had a statistically significant effect on the progress of eating problems. Longitudinal research is needed to confirm the results. Until further knowledge is available, nurses should follow-up all adolescents with disordered eating to identify a possible need for intervention.

Orthosiphon versus placebo in nephrolithiasis with multiple chronic complaints: a randomized control trial.

Nephrolithiasis in the communities of Northeast Thailand frequently presents with multiple chronic health complaints, i.e. myofascial pain, back pain, dyspepsia, arthralgia, headache, fatigue, frank paresthesia, dysuria and any of these aggravated by purine-rich food (PRF). We assessed the efficacy of Orthosiphon in treating subjects with at least two active symptoms and negative for urine white blood cells. Subjects were randomly allocated to two groups. Crude extract of Orthosiphon given in a capsule (equivalent to 1.6–1.8 g of dried leaves of Orthosiphon) two times a day to Group 1 (n = 36) and a placebo to Group 2 (n = 40) for 14 days. The medication for each subject was packed and its code kept secret until the data analysis. Both groups were asked not to consume any of 25 purine-rich foods (PRFs) during treatment. The primary measure was the reduced sum of active severity symptoms as recorded using the visual analog scale before and after therapy (i.e. on day 7 and 14). The data on 76 subjects were processed. The mean of the total scores (95% CI) of the symptoms in each group were decreased significantly (P < 0.001); 185.6 (153.3, 218.0) to 94.7 (58.2, 131.2) in the Orthosiphon group and 196.1 (164.4, 227.8) to 89.6 (62.8, 116.5) in the placebo group. When comparing between groups, no statistically significant difference was found. The mean consumption in PRFs was significantly decreased (P < 0.001) in both groups; however, Orthosiphon did not have additional benefit over placebo at 7 and 14 days of treatment during which they reduced these foods.

Home care needs of extremely obese elderly European women

To examine the health and needs of extremely obese women aged over 65 years receiving home care in Europe. A cross-sectional assessment study based on the Aged in Home Care (AdHOC) project recruited 2974 women aged 65 or over who were receiving home care at 11 sites in European countries. Extreme obesity was defined as 'Obesity of such a degree as to interfere with normal activities, including respiration'. Resident Assessment Instrument for Home Care (RAI-HC version 2.0); Activity of Daily Living Scale; Instrumental Activity of Daily Living Scale; the Minimum Data Set Cognitive Performance Scale; and a health profile. One hundred and twenty women (4.0%) were extremely obese. They were younger than their thinner counterparts, with a median age of 78.3 versus 83.3 years, and they more often had multiple health complaints and needed more help with mobility outside the home. The extremely obese had received home care longer than the non-extremely obese (median 28.7 versus 36.6 months). Extremely obese women also needed more help with personal care than the other group and, due to lower age, they were less cognitively impaired. Extreme obesity is a problem that increasingly affects home care of elderly women.

Self-Reported Oral Hygiene Habits and Oral Health Problems of Kuwaiti Adults

Objective: The aims of this study were to examine self-reported oral hygiene habits and oral health problems of a sample of adult Kuwaitis. Materials and Methods: A self-administered, anonymous, structured questionnaire was distributed to 2,400 adult Kuwaiti nationals from all 6 governates of Kuwait assessing socio-demographic variables, oral hygiene habits, and oral health problems. Results: Of the 2,400 questionnaires, 1,925 (80.25%) responded. Of these, 62% reported brushing their teeth at least twice daily, while daily use of dental floss was uncommon (11.8%). Adequate toothbrushing habits were significantly associated with female gender, educational level, non-smoking status, and history of recent preventive dental visits (p = 0.001). The majority of subjects reported multiple oral health problems (64.7% with 2 or more and 41.8% with 3 or more). Factors associated with multiple oral health complaints included younger age, smoking, not having a recent preventive dental visit, and brushing the teeth less than twice daily. Conclusions: Less than two-thirds of the sampled adult Kuwaitis followed the recommended toothbrushing frequency of twice daily or more, and the majority of subjects have not had a preventive dental visit in the previous 6 months. Furthermore, most subjects reported multiple oral health problems that are mostly preventable through adequate oral hygiene habits and regular preventive dental visits.

Identifying workers at risk of sickness absence by questionnaire

Sickness absence is an important economic problem, because of high costs and lost productivity. Determining factors associated with increased risk of sickness absence may lead to the development of preventive measures. To determine whether self-report questionnaires can identify those employees at risk of sickness absence Prospective study of 238 healthy administrative workers. Participants completed a questionnaire proven to be valid and consistent. The questionnaire consisted of 116 items about health, work and working conditions. Sickness absence was followed-up for a period of 1 year. The questionnaires of 191 workers (80%) were suitable for analysis. The number of reported health complaints was significantly (P < 0.01) associated with sickness absence (OR 2.18; 95% CI 1.32-3.61). Concentration problems were correlated with more frequent absences, and both nervous complaints and coping problems with longer duration. Age (OR 0.96; 95% CI 0.93-0.99; P = 0.02) and job insecurity (OR 0.68; 95% CI 0.47-0.98; P = 0.04) were negatively associated with sickness absence. Psychosocial and physical work factors were not associated with sickness absence. Questionnaires on health and work can identify employees at future risk of sickness absence. Workers who report multiple health complaints, especially concentration problems, nervous complaints or coping problems, may be at increased risk of sickness absence.

A national survey of psychosocial job stressors and their implications for health among working people in Taiwan.

The prevalence of job stress, distributions of major job stressors, and the associations of job stress with multiple self-reported health complaints were examined in a national survey conducted in 1994 in Taiwan. A total of 9,746 men and 5,599 women who were employed at the time of the survey and aged between 25 and 65-years were studied. Information on employment status, perceived level of job stress, major job stressors, and health complaints were obtained by a self-administered questionnaire. Overall, 7.6% of men and 6.5% of women reported often or always feeling very stressed at work. Higher levels of perceived job stress were found among subjects who were younger, with higher education level, working in a larger firm, working for longer hours per week, and who were administrators or managers. Problems with individual job content were ranked as the most important job stressor in men across all employment categories and in most women. Other major job stressors included problems with monetary rewards and lack of career prospects. The patterns of major job stressors appear to vary by employment grade and by gender. After adjustment for age and education, employees who perceived higher levels of job stress had significantly increased risks of multiple health problems, including strained eyes, ringing ears, chronic cough with phlegm, chest tightness. stomach problems, headache, and musculoskeletal discomfort. These results suggest that psychosocial stress in the workplace has profound impacts on health. This study identified high-risk groups and major types of job stressors for further investigation.

Psychosocial factors predict medical outcome following a first myocardial infarction. Working Group on Cardiac Rehabilitation of the Swiss Society of Cardiology.

The aim of this study was to identify psychosocial variables that, in addition to known medical factors, predict the long-term outcome after a first myocardial infarction. The study population consisted of 222 men aged 30-60 years who entered an inpatient rehabilitation program a mean of 7 weeks after a first myocardial infarction. Medical data and completed questionnaires for psychosocial variables were obtained from the patients and their family physicians at entry to the rehabilitation center and 1 year later. Further data, including answers to a detailed questionnaire, were collected at the beginning of rehabilitation and after one year; this follow-up was 99% complete. The 1-year mortality was 2.2%, the reinfarction rate 1.8%, hospital readmissions for cardiac reasons occurred in 25%, and 13% of the patients underwent a subsequent revascularization procedure. At baseline and after 1 year, respectively, 84 and 83% of the patients were asymptomatic. A poor medical outcome, defined as death, reinfarction, severe symptoms or poor exercise capacity, was seen in 9% of the patients. The most important physiological predictors for an unfavourable medical outcome, found in bivariate and multivariate analyses, were age, severity of infarction, and major coronary risk factors. In addition, some of the psychosocial variables were significantly related to a poor medical outcome: lack of a stable partnership, high work load, poor general well-being with multiple chronic non-specific health complaints, and a low external locus of control (failure to identify disease-promoting factors within own surroundings or lifestyle). The medical course of coronary artery disease was predicted not only by medical variables but also by psychological and social variables. As well as being addressed directly, these factors may help to identify patients who need to be followed more closely, so that medical complications can be reduced by treating early signs of disease progression more aggressively.

Immunologic biomarkers associated with an acute exposure to exothermic byproducts of a ureaformaldehyde spill.

A community was exposed for several days to formaldehyde (HCHO), hexamethylenetetramine, trimethylamine, and paraformaldehyde emitted from an overheated tanker car containing ureaformaldehyde resin. Residents experienced acute HCHO symptoms at the time of the accident. Many developed chronic, multiple organ health complaints. Three years following the accident, exposed subjects were compared to residents of a nearby unexposed community for the following immunological parameters: white blood cell count, total lymphocyte count, percent and total lymphocyte subsets (CD5, CD4, CD8, CD19, CD25, and CD26 cells), prevalence of autoantibodies, and antibodies to HCHO-human serum albumin (HCHO-HSA) conjugate. The data were adjusted for gender, age, history of smoking, mobile home residency, and use of wood stoves. There was a statistically significant difference for the following: elevated percent and absolute numbers of CD26 cells (p less than 0.0001); autoantibodies (p less than 0.004), and greater titers of isotypes IgG (p less than 0.0005) and IgM (p less than 0.005) to HCHO-HSA. It is concluded that the exposed subjects had an activated immune system in addition to the elevated autoantibodies. Also, isotypes to HCHO-HSA resulted from the exposure and no other sources, such as smoking, mobile home residency, and use of wood stoves.

Immunological evaluation of four arc welders exposed to fumes from ignited polyurethane (isocyanate) foam: antibodies and immune profiles.

Four arc welders having a flu-like illness with multiple health complaints following an exposure to high concentrations of isocyanate fumes from ignited polyurethane foam underwent immunological tests as follows: ELISA antibody assays, activated lymphocyte profiles, and lymphocyte blastogenesis. ELISA procedures revealed the presence of antibodies to hexamethylene diisocyanate (HDI) and formaldehyde (F) conjugated to human serum albumin (HDI-SA and F-SA). The results from the activated lymphocyte profiles showed deviations from the norm as follows: three welders had elevated helper/suppressor (H/S) ratios; all four had elevated percentages of Tal positive cells; two had decreases in B cells; and one had low total white cell and lymphocyte counts. In contrast, the percentage and absolute numbers of ILS receptor cells were normal in the four subjects. T cell blastogenesis to PHA, Con A and PWM resulted in the following: T-cells from one subject responded normally; in another, a high response (212% of controls) to PHA occurred with normal mitogenesis to Con A and PWM. In the remaining two welders, the T cells responded abnormally low (50 to 75% of controls) to the three mitogens. In conclusion, the existence of IgG antibodies to HDI-SA and F-SA, the altered activated immune profiles, the elevated Tal cells, and the abnormal blastogenesis are interpreted as being linked with the episode of HDI and F exposure and the subsequent flu-like illness of the four welders.