Multiple Health Indicators Research Articles

G479(P) A systematic review: ‘Can postnatal women’s groups improve health outcomes for women and children in high-income countries?’

AimsParticipatory postnatal women’s groups have been shown to have significant impact on maternal and neonatal mortality in low-income countries. It is not clear however whether this approach can be used...

Correlates of Colorectal Cancer Screening Among South Asian Immigrants in the United States

South Asians are a rapidly increasing population in the United States. Little is known about influences on their cancer screening behaviors, an important prerequisite to designing culturally appropriate education. The purpose of this study was to evaluate rates and correlates of colorectal cancer (CRC) screening, knowledge, and beliefs among South Asians. A subsample of those 50 years or older (n = 275) was drawn from the South Asian Health Descriptor Study, an assessment of multiple health indicators conducted in Chicago, Illinois. Indians represented 87% of the sample; 2.2% of participants believed that they were at risk for CRC; 8% reported a past stool blood test (SBT); and 13.6% had had a sigmoidoscopy or colonoscopy. Language acculturation (adjusted odds ratio [AOR], 1.93; confidence interval [CI], 1.1-3.5) and medical mistrust (AOR, 0.243; CI, 0.091-0.650) were significantly related to SBT completion. Language acculturation (AOR, 3.30; CI, 1.8-5.5), income (AOR, 2.70; CI, 1.0-7.1), living in the United States for more than 5 years (AOR, 8.6; CI, 1.9-14.5), perception of CRC risk (AOR, 8.9; CI, 1.1-17.7), and past SBT (AOR, 5.0; CI, 1.8-14.0) were significantly related to endoscopic cancer screening. Facilitators and barriers to different CRC tests vary. Education to increase CRC screening may need to be targeted to culture and specific barriers to each screening test rather than generic messages for all screening tests. Because barriers to CRC screening may differ among people based on the specific screening test being recommended. Primary care practitioners should recognize this fact and identify different barriers to enhance adherence to screening recommendations.

What are the links between maternal social status, hippocampal function, and HPA axis function in children?

The association of parental social status with multiple health and achievement indicators in adulthood has driven researchers to attempt to identify mechanisms by which social experience in childhood could shift developmental trajectories. Some accounts for observed linkages between parental social status in childhood and health have hypothesized that early stress exposure could result in chronic disruptions in hypothalamic-pituitary-adrenal (HPA) axis activation, and that this activation could lead to long-term changes. A robust literature in adult animals has demonstrated that chronic HPA axis activation leads to changes in hippocampal structure and function. In the current study, consistent with studies in animals, we observe an association between both maternal self-rated social status and hippocampal activation in children and between maternal self-rated social status and salivary cortisol in children.

Health in older age: The German Ageing Survey (DEAS).

How healthy are people as they age, what are possible causes and consequences, and what can be derived from this with a view towards health promotion in older people? The German Ageing Survey, funded by the Federal Ministry of Family Affairs, Senior Citizens, Women and Youth (DEAS; http://www.german-ageing-survey.de) provides data to answer these questions. DEAS is an on-going population-based, representative survey of community-dwelling people living in Germany. The survey started in 1996, and the fifth wave will be conducted in 2014. It comprises cohort sequential data, i.e., both repeated cross-sectional surveys and panel data for people aged 40 and over. To date, DEAS has considered people born between 1911 and 1968, and over 14,700 participants have been interviewed face-to-face and been given written tests and questionnaires. The survey aims at knowing more about the living conditions and the quality of life of people in middle-age and later life, and at knowing more about changes over time, both on the individual and the societal level. Thus DEAS covers a large range of subject areas, including family and social networks, work and retirement, participation, economic situation, well-being, psychosocial resources, as well as health and health behaviour. The data allow both the analysis of individual health trajectories and health changes on the societal level: How healthy will older people be in the next years or decades? For this purpose, different birth cohorts can be compared that have reached the same age at different points in time. The present findings suggest that birth cohorts born later report less illnesses, lower ailments and higher physical activity, which points to better health and health behaviour of subsequent cohorts. Overall, these findings are in line with those from other surveys in Germany, though the comparison of different studies is limited. One reason for this is the use of different health indicators, which is perhaps most evident in the measurement of chronic illnesses and multi-morbidity. Additionally, other factors such as the in- or exclusion of very old or institutionalised people and the use of cross-sectional surveys versus panel data might contribute to heterogeneous findings on health trends. For the study of health trends in ageing societies, multiple health indicators are needed to allow for the fact that differences between various health components become more pronounced in later life. Aiming at harmonising concepts and instruments to assess healthy ageing, as initiated by the Robert Koch Institute, is therefore highly appreciated.

Community Risk Factors: Powerful Independent Predictors of Kidney Transplant Recipient Outcomes

Introduction: There are likely many factors which are associated with kidney transplant outcomes that are not routinely collected or are difficult to codify. We hypothesized that risk factors characterizing the communities in which transplant patients reside are significantly and independently associated with recipient outcomes. Methods: We conducted a retrospective cohort study of living and deceased donor transplant recipients in the United States between 2004-2010 (n=100,164) using a national database. We merged this database by patients’ zip codes with health indicators compiled from several other national databases and the Centers for Disease Control and Prevention including National Center for Health Statistics, Behavioral Risk Factor Surveillance System and National Center for Chronic Disease Prevention and Health Promotion. We then evaluated the association of community health indicators with transplant graft and patient survival utilizing multivariable Cox proportional hazard models. Results: Multiple health indicators from recipients’ county of residence were independently associated with transplant outcomes including low birth weights, preventable hospitalizations, inactivity rates and smoking and obesity prevalence. Recipients in highest-risk counties were more likely African American (AOR=1.59, 1.51-1.68), younger (ages 18-39; AOR=1.46,1.32-1.60), with lower educational attainment (less than high school; AOR=1.84, 1.62-2.08) and Medicare as primary insurance (AOR=1.55,1.47-1.64). The proportion of recipients from higher-risk counties varied dramatically by transplant center and state. There was an independent graded effect between the number of poor community health indicators and post-transplant mortality, including notable hazard associated with highest-risk counties (AHR=1.26, 1.13-1.40).Figure: [Relative Hazard of Community Risk Factors]Conclusions: In a national cohort of patients undergoing complex medical procedures, health indicators from patients’ communities are strong independent predictors of all-cause mortality. Findings highlight the importance of community conditions for risk stratification of patients and development of individualized treatment protocols. Findings also demonstrate that standard risk adjustment does not capture important factors contributing to patient outcomes that may impact unbiased performance evaluations of transplant centers. Further investigation of the mechanisms of this association and whether they apply in other healthcare contexts are warranted.

Housing strain, mortgage foreclosure, and health

BackgroundForeclosure rates have risen rapidly since 2005, reaching historically high levels. The purpose of this study was to examine the health implications of the current housing crisis. MethodsWe conducted a cross-sectional online consumer panel survey including residents of California, Arizona, Nevada, and Florida (n = 798) to determine the feasibility of contacting distressed homeowners via the Internet and to assess mental and physical health among respondents across the spectrum from those having no housing strain to those in loan default or home foreclosure. ResultsHomeowners in default or foreclosure exhibited poorer mental health and more physical symptoms than renters, homeowners with moderate strain, and homeowners with no strainöfollowing a gradient that was consistent across multiple health indicators. ConclusionsInternet panel sampling was an efficient method of contacting distressed homeowners. Record-high foreclosure rates may have broad implications for nursing and public health. Homeowners in default or foreclosure represent an identifiable high-risk group that may benefit from coordinated, affordable health and social services.

Cross-sectional and 35-year longitudinal assessment of salivary cortisol and cognitive functioning: The Vietnam Era Twin Study of Aging

High levels of cortisol, a sign of potential hypothalamic-pituitary-adrenal (HPA) axis dysregulation, have been associated with poor cognitive outcomes in older adults. Most cortisol research has focused on hippocampal-related abilities such as episodic memory; however, the presence of glucocorticoid receptors in the human prefrontal cortex suggests that cortisol regulation is likely to be associated with prefrontally-mediated executive function abilities. We hypothesized that elevated cortisol levels would be associated with poorer frontal-executive function in addition to episodic memory. We assessed cortisol from 15 saliva samples paralleling individual diurnal rhythms across three non-consecutive days in a group of 778 middle-aged twin men ages 51-60. Cognitive domains created from 24 standard measures included: general cognitive ability, verbal and visual-spatial ability, verbal and visual-spatial memory, short-term/immediate memory, working memory, executive function, verbal fluency, abstract reasoning, and psychomotor processing speed. Adjusting for general cognitive ability at age 20, age, race, and multiple health and lifestyle indicators, higher levels of average area-under-the-curve cortisol output across three days were significantly associated with poorer performance in three domains: executive (primarily set-shifting) measures, processing speed, and visual-spatial memory. In a 35-year longitudinal component of the study, we also found that general cognitive ability at age 20 was a significant predictor of midlife cortisol levels. These results possibly support the notion that glucocorticoid exposure is associated with cognitive functions that are mediated by frontal-striatal systems, and is not specific to hippocampal-dependent memory. The results also suggest that the direction of effect is complex.

Support vector data description for fusion of multiple health indicators for enhancing gearbox fault diagnosis and prognosis

A novel method for enhancing gearbox fault diagnosis and prognosis is developed by fusion of multiple health indicators through support vector data description. First, the Comblet transform is used to identify gear residual error signals from the raw signal. Second, based on the observation of gear residual error signals, a total of 11 gear health indicators are identified, and are categorized into two types of indicators. The first and second types of indicators are for fault diagnosis and prognosis, respectively. The first type has six indicators, which are sensitive to impulsive signals triggered by anomalous impacts. The second type has five indicators, which are suitable for tracking degradation of faults. Third, through the support vector data description, the first six health indicators are fused into type one indicators for fault diagnosis. The remaining five indicators are fused into type two indicators for fault prognosis. Finally, a Gaussian kernel is designed to enhance the performance of type one and two indicators by optimal range of width size. The effectiveness of the proposed method is validated through experiments. The new method has been proven to be superior to methods that use unfused indicators individually.

Reproductive health of young adults with physical disabilities in the U.S.

Objective Previous research shows reduced cervical and breast cancer screening among women with physical disabilities. However, other indicators of reproductive health have been largely ignored. We aimed to compare the reproductive health of young adults in the U.S. with and without physical disabilities in a nationally-representative sample. Methods Data are from 13,819 respondents aged 18–26 who participated in Waves I (1994–1995) and III (2001–2002) of the National Longitudinal Study of Adolescent Health (Add Health). Using logistic regression, we examined associations between physical disability and multiple reproductive health indicators including sexually transmitted infection (STI) testing, STI diagnosis, receipt of a gynecologic exam, and cervical cancer screening. Analyses were stratified by sex and adjusted for the complex study design. Results We identified 5.8% of respondents as having a physical disability. In multivariate analyses, females with physical disabilities had lower odds of having a Pap smear in the past 12 months than females without disabilities (OR = 0.77; 95% CI: 0.61, 0.97). Physical disability was not associated with other reproductive health indicators among females or males. Conclusion We found few differences in examined reproductive health indicators of young adults with and without physical disabilities, but findings suggest differences in some screening services that merit additional study.

Health and Treatment Implications of Food Insufficiency among People Living with HIV/AIDS, Atlanta, Georgia

HIV/AIDS is concentrated among the inner-city poor and poverty may directly interfere with HIV treatment. This study examined food insufficiency in relation to HIV-related health and treatment. A sample of 344 men and women living with HIV/AIDS in Atlanta, Georgia completed measures of food security, health, and HIV disease progression and treatment. HIV treatment adherence was monitored using unannounced pill counts. Results showed that half of people living with HIV/AIDS in this study lacked sufficient food, and food insufficiency was associated with multiple indicators of poor health, including higher HIV viral loads, lower CD4 cell counts, and poorer treatment adherence. Adjusted analyses showed that food insufficiency predicted HIV treatment non-adherence over and above years of education, employment status, income, housing, depression, social support, and non-alcohol substance use. Hunger and food insecurity are prevalent among people living with HIV/AIDS, and food insufficiency is closely related to multiple HIV-related health indicators, particularly medication adherence. Interventions that provide consistent and sustained meals to people living with HIV/AIDS are urgently needed.

Socioeconomic disparities in health in the United States: what the patterns tell us.

We aimed to describe socioeconomic disparities in the United States across multiple health indicators and socioeconomic groups. Using recent national data on 5 child (infant mortality, health status, activity limitation, healthy eating, sedentary adolescents) and 6 adult (life expectancy, health status, activity limitation, heart disease, diabetes, obesity) health indicators, we examined indicator rates across multiple income or education categories, overall and within racial/ethnic groups. Those with the lowest income and who were least educated were consistently least healthy, but for most indicators, even groups with intermediate income and education levels were less healthy than the wealthiest and most educated. Gradient patterns were seen often among non-Hispanic Blacks and Whites but less consistently among Hispanics. Health in the United States is often, though not invariably, patterned strongly along both socioeconomic and racial/ethnic lines, suggesting links between hierarchies of social advantage and health. Worse health among the most socially disadvantaged argues for policies prioritizing those groups, but pervasive gradient patterns also indicate a need to address a wider socioeconomic spectrum-which may help garner political support. Routine health reporting should examine socioeconomic and racial/ethnic disparity patterns, jointly and separately.

Does controlling for comorbidity matter? DSM‐oriented scales and violent offending in chicago youth

Mental health problems have long been linked to antisocial behaviors. Despite an impressive body of literature demonstrating this relationship and claims that comorbidity matters, few studies examine comorbidity using multiple distinct mental health indicators, with most studies instead adopting single or composite mental health measures. This study tested separate and comorbid effects of five DSM-oriented mental health issues on self-reported violence using a community-based sample of Chicago youths from the Project on Human Development in Chicago Neighborhoods. Moreover, it utilized both primary caregiver and youth self-reports of psychopathology across four developmental stages of childhood and adolescence. When examined separately, the results indicated affective/depressive, anxiety, attention deficit hyperactivity, and oppositional defiant/antisocial personality problems independently predicted violence. When considering comorbidity, however, only oppositional defiant and antisocial personality problems significantly predicted violence at any stage, regardless of informant type. Implications for future studies and policy are discussed.

An interdisciplinary, family-centered approach to treating pediatric obesity in an 11-year-old female: a case report

Pediatric obesity has become increasingly prevalent over the past 2-3 decades. Recently-published clinical practice guidelines and expert recommendations provide guidance for obesity treatment, but therapy is often complicated by a host of medical, behavioural, psychosocial, and interpersonal issues. We report the case of an 11-year-old obese girl and her family referred for weight management. Our case underscores the need for an interdisciplinary, family-centered approach to the assessment and treatment of pediatric obesity, and highlights the value of understanding familial complexities that often accompany this health issue. The importance of utilizing multiple health indicators to assess weight management ‘success’ is discussed.

Intimate Partner Violence in Latina and Non-Latina Women

No single study has delineated the prevalence of intimate partner violence (IPV) over multiple time periods for Latina versus non-Latina women and compared the health of abused Latina women to the health of abused non-Latina women using multiple health indicators. The objective of this study was to describe the prevalence of IPV over multiple time periods and the association between lifetime IPV exposure and current health in Latina and non-Latina women. A total of 3429 women (mean age=47 years) were randomly sampled from a large U.S. healthcare system; 139 (4%) were Latina. During a telephone survey, past-5-year and past-year IPV prevalence was assessed using five questions on physical and psychological abuse from the Behavioral Risk Factor Surveillance System (BRFSS), and ten questions from the Women's Experience with Battering Scale; lifetime IPV prevalence was assessed using the BRFSS questions. Current physical, social, and mental health was assessed using well-validated questionnaires. Prevalence of IPV for Latina versus non-Latina women was, respectively: 44.6% vs 44% lifetime; 20.1% vs 14.5% for the past 5 years; and 11.5% vs 7.8% for the past year. In models adjusted for age and income, women with a lifetime IPV history had significantly worse health compared to non-abused women across many health indicators; for example, Latina women with a lifetime IPV history had Short Form-36 Health Survey (SF-36) subscale scores that were 5.62 (mental health) to 7.77 (vitality) points lower than those for non-abused Latina women; depression prevalence more than two times higher; and more physical symptoms. Adverse IPV-related health was significantly worse for Latina than non-Latina women for overall mental health functioning (p<0.02), vitality (p<0.01), and emotional functioning (p<0.01) according to SF-36. This exploratory study showed that IPV is common in Latina and non-Latina women, and adverse IPV-related mental health was pronounced in Latina women.

Sex and Gender Related Health Status Differences in Ancient and Contemporary Skeletal Populations

Human skeletal and dental remains are an invaluable source of information for interpreting the way of life of past people and also provide the only direct evidence of non-living populations’ health status. This research paper discusses the sex-related health differences observed in two skeletal populations from Greece, an ancient and a modern, by employing multiple health indicators, and aims at determining the biological and possible social factors that contribute to this variation. Particular emphasis is given to the importance of hypotheses-driven, population-based studies of human remains as the most effective means of reconstructing life in the past. The results showed that fracture (<em>ancient</em>: females 0.08%, males 0.12%; <em>modern</em>: females 0.38%, males 0.19%) and osteoarthritis (<em>ancient</em>: females 0.7%, males: 3.0%; <em>modern</em>: females 4.4%, males 3.2%) frequencies were higher for male individuals than females in the ancient population, which can be explained by greater engagement in strenuous and risky activity. Dental caries (<em>ancient</em>: females 1.2%, males 1.8%; <em>modern</em>: females 23.6%, males 17.4%) and ante-mortem tooth loss (<em>ancient</em>: females 12.3%, males 7.7%; <em>modern</em>: females 69.5%, males 49.5%) rates were higher for females than males (with the exception of the almost equal caries rates for the ancient population), most likely due to hormonal fluctuations, saliva content and flow, because female teeth erupt earlier and also perhaps as a result of differences in dietary habits. Periodontitis levels were more elevated in males (<em>ancient</em>: females 9.6%, males 30.1%; <em>modern</em>: females 29.1%, males 38.3%), possibly due to poor oral hygiene practices and excessive masticatory loading. Dental enamel defects rates showed that in the ancient population, males had more chances of surviving childhood stress than females (females 19.5%, males 20.0%), whereas, in the modern population, the exact opposite was the case (females 6.1%, males 22.7%).

Modelling socioeconomic and health determinants of health‐care use: a semiparametric approach

This paper suggests bivariate semiparametric index models as a tool for modelling the interplay of socioeconomic and health characteristics in determining health-care utilisation. These models allow for a fully nonparametric relationship between socioeconomic status, health-care need and care utilisation. The only parametric restriction imposed is that multiple socioeconomic and health indicators can be aggregated into two distinct indices that measure the broader concepts of socioeconomic status and health-care need, respectively. We demonstrate the usefulness of this class of models based on an illustrative empirical example. The estimations highlight complex interactions of socioeconomic status and health-care need in determining care use, which may be difficult to grasp via standard parametric modelling approaches.

Chemical contaminants, health indicators, and reproductive biomarker responses in fish from the Colorado River and its tributaries

Common carp (Cyprinus carpio), black bass (Micropterus spp.), and channel catfish (Ictalurus punctatus) were collected from 14 sites in the Colorado River Basin (CRB) to document spatial trends in accumulative contaminants, health indicators, and reproductive biomarkers. Organochlorine residues, 2,3,7,8-tetrachlorodibenzo-p-dioxin-like activity (TCDD-EQ), and elemental contaminants were measured in composite samples of whole fish, grouped by species and gender, from each site. Selenium (Se) and mercury (Hg) concentrations in fish were elevated throughout the CRB, and pesticide concentrations were greatest in fish from agricultural areas in the Lower Colorado River and Gila River. Selenium concentrations exceeded toxicity thresholds for fish (>1.0 microg/g ww) at all CRB sites except the Gila River at Hayden, Arizona. Mercury concentrations were elevated (>0.1 microg/g ww) in fish from the Yampa River at Lay, Colorado; the Green River at Ouray National Wildlife Refuge (NWR), Utah and San Rafael, Utah; the San Juan River at Hogback Diversion, New Mexico; and the Colorado River at Gold Bar Canyon, Utah, Needles, California, and Imperial Dam, Arizona. Concentrations of p,p'-DDE were relatively high in fish from the Gila River at Arlington, Arizona (>1.0 microg/g ww) and Phoenix, Arizona (>0.5 microg/g ww). Concentrations of other formerly used pesticides including toxaphene, total chlordanes, and dieldrin were also greatest at these two sites but did not exceed toxicity thresholds. Currently used pesticides such as Dacthal, endosulfan, gamma-HCH, and methoxychlor were also greatest in fish from the Gila River downstream of Phoenix. Total polychlorinated biphenyls (PCBs; >0.11 microg/g ww) and TCDD-EQs (>5 pg/g ww) exceeded wildlife guidelines in fish from the Gila River at Phoenix. Hepatic ethoxyresorufin O-deethylase (EROD) activity was also relatively high in carp from the Gila River at Phoenix and in bass from the Green River at Ouray NWR. Fish from some sites showed evidence of contaminant exposure as indicated by fish health indicators and reproductive biomarker results. Multiple health indicators including altered body and organ weights and high health assessment index scores may be associated with elevated Se concentrations in fish from the Colorado River at Loma, Colorado and Needles. Although grossly visible external or internal lesions were found on most fish from some sites, histopathological analysis determined many of these to be inflammatory responses associated with parasites. Edema, exophthalmos, and cataracts were noted in fish from sites with elevated Se concentrations. Intersex fish were found at seven of 14 sites and included smallmouth bass (M. dolomieu), largemouth bass (M. salmoides), catfish, and carp and may indicate exposure to endocrine disrupting compounds. A high proportion of smallmouth bass from the Yampa River at Lay (70%) was intersex but the cause of this condition is unknown. Male carp, bass, and catfish with low concentrations of vitellogenin were common in the CRB. Comparatively high vitellogenin concentrations (>0.2 mg/mL) were measured in male bass from the Green River at Ouray NWR and the Colorado River at Imperial Dam and indicate exposure to estrogenic or anti-androgenic chemicals. Anomalous reproductive biomarkers including low GSI and gonadal abnormalities (calcifications, edema, and parasites) observed in fish downstream of Phoenix are likely related to the poor water-quality of the Gila River in this area.

2: Peer victimization and multiple mental and school health indicators among elementary school-aged youth

2: Peer victimization and multiple mental and school health indicators among elementary school-aged youth

Health Status of Individuals With Serious Mental Illness

We examined indices of the health of persons with serious mental illness. A sample of 100 adults with schizophrenia and 100 with major mood disorder were recruited from randomly selected outpatients who were receiving community-based psychiatric treatment. Participants were surveyed about health indicators using items from the National Health and Nutrition Examination Study III and the National Health Interview Survey. Their responses were compared with those of matched samples from the general population surveys. A total of 1% of persons with serious mental illness, compared with 10% from the general population sample, met criteria for all 5 of selected health indicators: nonsmoker, exercise that meets recommended standards, good dentition, absence of obesity, and absence of serious medical co-occurring illness. Within the mentally ill group, educational level, but not a diagnosis of schizophrenia versus mood disorder, was independently associated with a composite measure of health behaviors. We conclude that an examination of multiple health indicators may be used to measure overall health status in persons with serious mental illness.

The EUROHIS-QOL 8-item index: psychometric results of a cross-cultural field study

Survey research including multiple health indicators requires brief indices for use in cross-cultural studies, which have, however, rarely been tested in terms of their psychometric quality. Recently, the EUROHIS-QOL 8-item index was developed as an adaptation of the WHOQOL-100 and the WHOQOL-BREF. The aim of the current study was to test the psychometric properties of the EUROHIS-QOL 8-item index. In a survey on 4849 European adults, the EUROHIS-QOL 8-item index was assessed across 10 countries, with equal samples adjusted for selected sociodemographic data. Participants were also investigated with a chronic condition checklist, measures on general health perception, mental health, health-care utilization and social support. Findings indicated good internal consistencies across a range of countries, showing acceptable convergent validity with physical and mental health measures, and the measure discriminates well between individuals that report having a longstanding condition and healthy individuals across all countries. Differential item functioning was less frequently observed in those countries that were geographically and culturally closer to the UK, but acceptable across all countries. A universal one-factor structure with a good fit in structural equation modelling analyses (SEM) was identified with, however, limitations in model fit for specific countires. The short EUROHIS-QOL 8-item index showed good cross-cultural field study performance and a satisfactory convergent and discriminant validity, and can therefore be recommended for use in public health research. In future studies the measure should also be tested in multinational clinical studies, particularly in order to test its sensitivity.