Objective Health Measures Research Articles

Clinical health markers in dogs fed raw meat-based or commercial extruded kibble diets.

The interest and demand for healthy and less processed foods for human consumption have been mirrored in the pet industry, with an explosion of alternative diets available. Several nontraditional feeding methodologies including raw meat-based diets (RMBDs) are believed by many dog owners to be superior to traditional extruded commercial dog foods. Despite the strong opinions, limited data are available comparing objective health measures among healthy dogs fed using different methods of diet preparation. Therefore, we compared health markers in client-owned dogs fed an RMBD to markers in dogs fed a high-quality extruded kibble. We hypothesized that healthy adult dogs fed RMBD would show differences in biochemical and hematological parameters and improved clinical health scores (e.g., dental, external ear canal, and integument scores) compared with dogs fed a kibble diet. A cross-sectional observational study was performed comparing hematology, serum biochemistry, urinalysis management history, and clinical health scores in healthy client-owned dogs reported as fed RMBD (n = 28) or kibble (n = 27) for >1 yr. Dental, external ear canal, and integument health scores were assigned by a single veterinary evaluator blinded to feed group, using a scale where 0 was normal and 3 was most severely affected. Spearman correlation coefficient (rs) was calculated to assess the strength and direction of the relationship of biochemical outcomes with age and body condition score (BCS), while analysis of variance was used to determine if biochemical analytes differed by breed or gender. Biochemical data were analyzed using multiple linear regression models, adjusting for the covariates gender, breed, age, and BCS. A composite clinical health score, (CCS) = 9 - (dental score + otitis score + integument score), was compared between feeding groups using Mann-Whitney test. Serum alkaline phosphatase activity (P < 0.001) and globulin concentration (P < 0.001) were lower, while lymphocyte count (P < 0.05) was higher in dogs fed RMBD. No differences were found in urinalysis between diet groups. Dogs fed RMBD showed a slight improvement in CCS compared with kibble-fed dogs (CCS: P = 0.03). Owner management significantly differed with a greater likelihood of management interventions including dietary supplements and sporting activities in the RMBD group. Further work is needed to specifically determine the impact of diet processing and nutrient content on canine health.

Paternal Jail Incarceration and Birth Outcomes: Evidence from New York City, 2010-2016.

To examine population-level associations between paternal jail incarceration during pregnancy and infant birth outcomes using objective measures of health and incarceration. We use multivariate logistic regression models and linked records on all births and jail incarcerations in New York City between 2010 and 2016. 0.8% of live births were exposed to paternal incarceration during pregnancy or at the time of birth. After accounting for parental sociodemographic characteristics, maternal health behaviors, and maternal health care access, paternal incarceration during pregnancy remains associated with late preterm birth (OR = 1.34, 95% CI = 1.21, 1.48), low birthweight (OR = 1.39, 95% CI = 1.27, 1.53), small sizefor gestational age (OR = 1.35, 95% CI = 1.17, 1.57), and NICU admission (OR = 1.14, 95% CI = 1.05, 1.24). We found strong positive baseline associations (p < 0.001) between paternal jail incarceration during pregnancy with probabilities of all adverse outcomes examined. These associations did not appear to be driven purely by duration or frequency of paternal incarceration. These associations were partially explained by parental characteristics, maternal health behavior, and health care. These results indicate the need to consider paternal incarceration as a potential stressor and source of trauma for pregnant women and infants.

Saving behaviour and health: A high-dimensional Bayesian analysis of British panel data

We develop a two-part high-dimensional Bayesian modelling approach to analyse the relationship between saving behaviour and health. In contrast to the existing literature, our approach allows different data-generating processes for the decision to save and the amount saved, and therefore unveils a more detailed picture of the relationship between financial behaviour and health than previous work. We explore different measures of saving, including monthly saving behaviour and the stock of financial assets held. Further, we exploit British panel data, which includes an extensive range of biomarkers. Our second contribution lies in comparing the effects of these objective measures of health with commonly used self-assessed health measures. We find that health is a significant determinant of saving behaviour and financial asset holding, and that biomarker measures have differential impacts on saving behaviour compared to self-reported health measures.

Interviewer Effects in Biosocial Survey Measurements

Increasingly surveys are using interviewers to collect objective health measures, also known as biomeasures, to replace or supplement traditional self-reported health measures. However, the extent to which interviewers affect the (im)precision of biomeasurements is largely unknown. This article investigates interviewer effects on several biomeasures collected in three waves of the National Social Life, Health, and Aging Project (NSHAP). Overall, we find low levels of interviewer effects, on average. This nevertheless hides important variation with touch sensory tests being especially high with 30% interviewer variation, and smell tests and timed balance/walk/chair stands having moderate interviewer variation of around 10%. Accounting for contextual variables that potentially interact with interviewer performance, including housing unit type and presence of a third person, failed to explain the interviewer variation. A discussion of these findings, their potential causes, and their implications for survey practice is provided.

92811 Implementation of the Fitness, Lifestyle, and Optimal Wellness (FLOW) Program and Its Associated Health Outcomes

ABSTRACT IMPACT: Through its interdisciplinary, tailored approach, the FLOW program could change the way that we approach promoting healthy lifestyle changes in the primary care field. OBJECTIVES/GOALS: The goal of this project is to assess patient outcomes associated with the implementation of the Fitness, Lifestyle, and Optimal Wellness (FLOW) Program. The ultimate aim of this program is two-fold: increasing patient-reported wellness and improving objective health measurements. METHODS/STUDY POPULATION: The FLOW program consists of a multidisciplinary team of sports medicine physicians, nutritionists, fitness trainers, and clinical psychologists. Patients who choose to participate in the program undergo a comprehensive physician-guided assessment, including lifestyle and metabolic evaluation, biomarker profile, and body composition analysis. Based on the patient’s goals and results of evaluation, he/she is then connected with other members of the FLOW team to develop a comprehensive plan and offer resources for potential improvements in physical activity, nutrition, and/or behavior. The patient will undergo follow-up assessments and questionnaires at three and six months to track their objective measurements and reported progress. RESULTS/ANTICIPATED RESULTS: The anticipated results of the FLOW program are an overall improvement in patient health and wellbeing. More specifically, we anticipate seeing increased levels of exercise from initial reported levels, as well as better nutrition habits. We expect to see improvements in follow-up body composition assessments, with gains in fat-free mass and decreased body fat, in addition to patient-reported improvements in behavioral health as measured by PHQ-9, GAD-2, and the Perceived Stress Scale. We will also assess reported sleep health with the hopes to see improvement in follow-up assessments. DISCUSSION/SIGNIFICANCE OF FINDINGS: The FLOW program is designed to address health inequities that disproportionately affect the Deep South. Through this program, we propose a new role of the primary care team in promoting healthy lifestyle habits and disease prevention through exercise, nutrition, and behavioral health services.Regulatory Science

Health measures and long-term care use in the European frail population.

This paper explores the association between health measures and long-term care (LTC) use in the 70+ old population. We examine how different measures of health-subjective versus objective-predict LTC use, provided either formally or informally. We consider an absolute measure of subjective health, the grade given by the individual to his/her health status, and additionally construct a relative measure capturing the difference between this grade and the average grade given to health by individuals sharing the same characteristics. Conceptually, this difference comes from the perception of the individual, corresponding to both the private health information and the reporting behavior affecting self-rated health. We use the baseline data from the SPRINTT study, an ongoing randomized control trial on 1519 subjects facing physical frailty and sarcopenia (PF&S) in 11 European countries. Our sample population is older than 70 (mean: 79years) and comprises a majority (71%) of women. Results show that self-rated health indicators correlate to formal care even when objective health measures are included, while it is not the case for informal care. Formal care consumption thus appears to be more sensitive to the individual's perception of health than informal care.

Association of quality of life with structural, functional and molecular brain imaging in community-dwelling older adults

BackgroundAs the population ages, maintaining mental health and well-being of older adults is a public health priority. Beyond objective measures of health, self-perceived quality of life (QoL) is a good indicator of successful aging. In older adults, it has been shown that QoL is related to structural brain changes. However, QoL is a multi-faceted concept and little is known about the specific relationship of each QoL domain to brain structure, nor about the links with other aspects of brain integrity, including white matter microstructure, brain perfusion and amyloid deposition, which are particularly relevant in aging. Therefore, we aimed to better characterize the brain biomarkers associated with each QoL domain using a comprehensive multimodal neuroimaging approach in older adults. MethodsOne hundred and thirty-five cognitively unimpaired older adults (mean age ± SD: 69.4 ± 3.8 y) underwent structural and diffusion magnetic resonance imaging, together with early and late florbetapir positron emission tomography scans. QoL was assessed using the brief version of the World Health Organization's QoL instrument, which allows measuring four distinct domains of QoL: self-perceived physical health, psychological health, social relationships and environment. Multiple regression analyses were carried out to identify the independent global neuroimaging predictor(s) of each QoL domain, and voxel-wise analyses were then conducted with the significant predictor(s) to highlight the brain regions involved. Age, sex, education and the other QoL domains were entered as covariates in these analyses. Finally, forward stepwise multiple regressions were conducted to determine the specific items of the relevant QoL domain(s) that contributed the most to these brain associations. ResultsOnly physical health QoL was associated with global neuroimaging values, specifically gray matter volume and white matter mean kurtosis, with higher physical health QoL being associated with greater brain integrity. These relationships were still significant after correction for objective physical health and physical activity measures. No association was found with global brain perfusion or global amyloid deposition. Voxel-wise analyses revealed that the relationships with physical health QoL concerned the anterior insula and ventrolateral prefrontal cortex, and the corpus callosum, corona radiata, inferior frontal white matter and cingulum. Self-perceived daily living activities and self-perceived pain and discomfort were the items that contributed the most to these associations with gray matter volume and white matter mean kurtosis, respectively. ConclusionsBetter self-perceived physical health, encompassing daily living activities and pain and discomfort, was the only QoL domain related to brain structural integrity including higher global gray matter volume and global white matter microstructural integrity in cognitively unimpaired older adults. The relationships involved brain structures belonging to the salience network, the pain pathway and the empathy network. While previous studies showed a link between objective measures of physical health, our findings specifically highlight the relevance of monitoring and promoting self-perceived physical health in the older population. Longitudinal studies are needed to assess the direction and causality of the relationships between QoL and brain integrity.

Effects of social security policy reforms on mental health and inequalities: A systematic review of observational studies in high-income countries.

Evidence increasingly shows that changes to social security policies can affect population mental health. Thus, in the context of rising burden of mental illness, it is of major importance to better understand how expansions and contractions to the social security system may impact on mental health of both adults and children. The aim of this systematic review is to provide a synthesis of observational literature on the effects on mental health and inequalities in mental health of social security reforms. We conducted a systematic review of quantitative observational studies of specific national and regional social security policy changes in high-income countries and summarised the mental health effects of these policies. We searched seven electronic databases, including Medline, PsychInfo, Embase, CINAHL, ASSIA (Proquest), Scopus and Research Papers in Economics from January 1979 to June 2020. We included both objective and subjective mental health and wellbeing measures. The study quality was assessed using the Validity Assessment tool for econometric studies. We identified 13,403 original records, thirty-eight of which were included in the final review. Twenty-one studies evaluated expansionary social security policies and seventeen studies evaluated contractionary policies. Overall, we found that policies that improve social security benefit eligibility/generosity are associated with improvements in mental health, as reported by fourteen of the included studies. Social security policies that reduce eligibility/generosity were related to worse mental health, as reported by eleven studies. Ten studies found no effect for either policies contracting or expanding welfare support. Fourteen studies also evaluated the impact on mental health inequalities and found that contractionary policies tend to increase inequalities whereas expansionary policies have the opposite effect. Changes in social security policies can have significant effects on mental health and health inequalities across different recipient groups. Such health effects should be taken into account when designing future social policy reforms.

Glycosylation Profiling as a Biomarker of Suboptimal Health Status for Chronic Disease Stratification.

WHO defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." We coined and defined suboptimal health status (SHS) as a subclinical, reversible stage of the pre-chronic disease. SHS is a physical state between health and disease, characterized by health complaints, general weakness, chronic fatigue, and low energy levels. We have developed an instrument to measure SHS, Suboptimal Health Status Questionnaire-25 (SHSQ-25), a self-reported survey assessing five health components that has been validated in various ethnical populations. Our studies suggest that SHS is associated with the major components of cardiovascular health and the early onset of metabolic diseases. Besides subjective measure of health (SHS), glycans are conceived as objective biomarkers of SHS. Glycans are complex and branching carbohydrate moieties attached to proteins, participating in inflammatory regulation and chronic disease pathogenesis. We have been investigating the role of glycans and SHS in multiple cardiometabolic diseases in different ethnical populations (African, Chinese, and Caucasian). Here we present case studies to prove that a combination of subjective health measure (SHS) with objective health measure (glycans) represents a window of opportunity to halt or reverse the progression of chronic diseases.

The effect of retirement on health biomarkers

We utilize panel data from the English Longitudinal Study of Ageing to investigate the impact of retirement on objective health measures. In contrast to many previous studies, which focus on subjective self-reported health and life satisfaction measures, we focus on objective health biomarkers, such as diabetes indicators and cholesterol. Because poor health can induce retirement, we instrument for retirement using eligibility for state and employer sponsored pensions. Overall, there are few significant impacts of retirement on health biomarkers. The direction of effects is also mixed. Some biomarkers improve upon retirement, while others deteriorate. This contrasts with the consistently positive and significant improvements that are found in self-reported measures from the same dataset.

Effect of Geriatric Assessment and Intervention on Overall Survival Among Older Adults with Hematologic Malignancies

Background: Older adults with hematologic malignancies have inferior survival outcomes due to multiple factors including under-treatment, drug toxicity, treatment discontinuation and concerns of frailty. However, aging is heterogeneous and chronological age is a poor indicator of underlying health. Standardizing the approach to identify frailty is an unmet need in malignant hematology. We have established a multi-disciplinary clinical model designed to identify frailty and develop personalized treatment based on objective measures of health. We have standardized a geriatric assessment (GA) model to identify vulnerability, frailty and geriatric syndromes. Here we report, the largest cohort to date, of older adults with hematologic malignancies (HM) depicting geriatric deficits and interventions with long-term clinical outcomes. Methods: From Feb 2016 to October 2019, 311 older adults with HM were evaluated in our multi-disciplinary Cancer and Aging Resiliency (CARE) clinic. The CARE clinic is a 7-member team prescriptively evaluating the following domains: pharmacy, audiology, psychosocial needs, nutrition, physical functioning, and cognition. Geriatric syndromes were documented by CARE physician. Referral to CARE clinic is recommended for patients 60 years of age or older but all referrals are accepted independent of age. Data was abstracted by retrospective chart review. Descriptive statistics for patient characteristics, frailty measures, and prescribed interventions in each of the GA domains were provided. Univariable and multivariable Cox models were fit to associate clinical factors with OS. OS by Rockwood Clinical Frailty Scale and deficits in activities of daily living (ADLs) was evaluated by Kaplan-Meier method. Correlation between number of geriatric syndromes, clinical frailty score, and deficits in ADLs and instrumental ADLs (IADLs) was also assessed. Results: Over the 42-month study period, 311 older adults with HM with a median age of 75.9 years were evaluated in CARE clinic. Key demographic features and the frequency of specific frailty measures are outlined in table 1.Geriatric interventions were common with 59% requiring 1-2 interventions and 34% requiring 3+ interventions. In univariable analysis, any degree of frailty by Clinical Frailty Scale (Hazard Ratio [HR]: 2.63, 95% Confidence Interval [CI]: 1.43-4.82, p &amp;lt;0.01) and increasing number of geriatric syndromes (HR:1.13, 95% CI: 1.00-1.27, p = 0.04) were associated with inferior OS. In both univariable and multivariable analyses, 10-year increase in age (multivariable HR: 2.05, 95% CI:1.44-2.91, p&amp;lt;0.01), deficit in ADL (multivariable HR: 2.60, 95% CI: 1.38-4.87, p&amp;lt;0.01), diagnosis of acute leukemia (multivariable HR: 4.53, 95% CI:1.91-10.78, p&amp;lt;0.01), and prescribed nutrition intervention (multivariable HR: 2.04, 95% CI: 1.32-3.15, p&amp;lt;0.01) were associated with inferior OS. Anemia was also associated with OS in both univariable and multivariable analysis (multivariable HR for 1 g/dL increase in hemoglobin: 0.79, 95% CI: 0.69-0.91, p&amp;lt;0.01). Additional variables for univariable and multivariable analyses are presented in table 2. There was significant correlation between the Clinical Frailty Scale and number of geriatric syndromes (Spearman correlation p &amp;lt; 0.01). The same was true of correlation between ADL or IADL deficits and Clinical Frailty Scale (p &amp;lt; 0.01 for both). OS by Clinical Frailty Scale and ADL deficit is pictured in figure 1. Discussion: The Clinical Frailty Scale is predictive of OS among older adults with HM. GA-directed intervention is warranted in the vast majority of older adults with HM. In univariable analysis, Clinical Frailty Scale, increasing age, anemia, high risk HM, and increasing geriatric syndromes are associated with inferior OS. In multivariable analysis, age, anemia, and high risk HM remain significant. Nutrition and physical function are key modifiable risk factors predictive of inferior OS. Prospective studies focusing on geriatric interventions are warranted in this population with an emphasis on modifiable risk factors. This demonstrated prognostic significance of both geriatric assessments and interventions in older adults with HM should give way to future improvements in OS, quality of life, and treatment tolerability through GA-directed intervention. Disclosures No relevant conflicts of interest to declare.

Self-reported health and the social body

Since the strong predictive power of self-reported health (SRH) for prospective health and social outcomes has been established, researchers have been in a quest to build a theoretical understanding of this widely used health measure. Current literature based predominantly in a biomedical perspective asserts a linear relationship between physical conditions and perception of health. Discrepancies from this expected relationship are considered an important weakness of SRH. Systematic discrepancies between physical conditions and reporting of SRH have been documented across different socio-economic groups. Evidence identified for educational groups shows that for the same level of health status, lower-educated groups report poorer levels of perceived health. This raised doubts whether it is useful to use SRH to measure social inequalities in health within and between countries. To date, sociologists of health have not engaged in the discussion of reporting heterogeneity in SRH. After reviewing existing evidence, we contend that the discrepancy in SRH reporting across social groups argued to be a weakness of SRH as a health measure is a strength from a sociological perspective. SRH as a social measure of health is a better predictor than objective measures of health precisely because it captures the lived experience of the embodied agent.

Cautionary tails of grip strength in health inequality studies: An analysis from the Canadian longitudinal study on aging.

Self-rated health is widely used in studies of the socioeconomic gradient of health in community-based populations. Its subjectivity may lead to under- or over-estimation of a true underlying socioeconomic gradient and has increased interest in searching for alternative, objective measures of health. Grip strength has emerged as one such alternative for community-based older populations, yet no study has directly assessed the relationship between these two measures and compared their associations with socioeconomic status and health behaviours. Using 26,754 participants aged 45-85 years in the baseline data of the Canadian Longitudinal Study on Aging Comprehensive Cohort, we estimated adjusted-grip strength through indirect standardization using age, sex, height, weight, and their square terms and used ANOVA to assess the variance of adjusted-grip strength within and between each self-rated health category. We ran four separate logistic regression models, examining unhealthy tails (those reporting poor health vs. not and those at the bottom 8th percentile of adjusted-grip strength vs. above) and healthy tails (those reporting excellent health vs. not and those at the top 20th percentile of adjusted-grip strength vs. below). Stronger adjusted-grip strength correlated with better self-rated health, but only 2% of the total variance of adjusted-grip strength was explained by variance between the self-rated health categories. While self-rated health largely showed the expected socioeconomic gradients and positive relationships with health enhancing behaviours, adjusted-grip strength showed no clear, consistent associations with either socioeconomic or health behaviour variables. The results give caution about using grip strength as an objective alternative to self-rated health in studies of social inequalities in health. Empirical approaches demand careful considerations as to which dimensions of health and corresponding measures of health are most relevant to the context being studied.

Health disparities by neighborhood socioeconomic status and the role of spatial spillovers

Abstract Background The contextual determinants of population health disparities across neighborhoods with similar socioeconomic characteristics are not well understood. We aimed to estimate subjective and objective population health measures within and between neighborhoods with similar socioeconomic status (NSES) scores, and the (in)direct potential of a spillover effect of NSES of adjacent neighborhoods. Methods Based on whole-population neighborhood data we determined the percentage of inhabitants with good/very good self-assessed health (SAH) and with at least one chronic disease (CD) in 11,521 neighborhoods with on average 1,470 inhabitants. Neighborhoods were classified by the quintile of a composite NSES score. Spatial lag of X models was applied by including neighborhood cross-sectional units on population density, the percentage of inhabitants aged 65 and over, and the NSES of adjacent neighborhoods by constructing a spatial weights matrix. Results Substantial population health disparities in SAH and CD both between neighborhoods with different and similar NSES scores were observed, with the largest SAH variance in the lowest NSES group. These differences were only partially explained by neighborhood characteristics. Neighborhoods adjacent to higher SES neighborhoods showed a higher SAH and a lower prevalence of CD, adjusted for other explanatory variables. When NSES in the first decile would be increased to the NSES of the quintile median, the direct effect on SAH would increase by 5.6% in the lowest NSES group. Spillovers would lead to an additional increase of 1.7% in all NSES groups. Conclusions Population health differs substantially among neighborhoods with similar socioeconomic characteristics, which can partially be explained by a socioeconomic spillover effect. The mechanisms behind these spillovers need further study, but may already provide interesting leads to policy design aimed at improving population health outcomes of deprived neighborhoods. Key messages Neighborhood population health is partially affected by a SES spillover effect. This study provides interesting leads to policy design aimed at improving health outcomes of deprived neighborhoods.

Health-Related Quality of Life across a Variety of Community Contexts

There is increasing interest in the socioeconomic determinants of health and well-being. Efforts to date have focused on the associations between measures of social position and objective measures of health. However, health can also be gauged using subjective measures such as health-related quality of life (HRQOL), while other social determinants, such as neighbourhood factors, appear largely neglected. The aim of this study was to estimate the relationship between HRQOL (as measured by the WHOQoL questionnaire) and both social position (as measured by the New Zealand Deprivation (NZDep) index) and participants’ perceptions about their home neighbourhood. A total of 746 participants living in areas with six different NZDep scores completed a survey probing HRQOL, problems in the neighbourhood, and perceptions of amenity. Results showed that people living in wealthier areas reported better HRQOL, and that amenity ratings mediated the relationship. The study’s findings have implications for researchers interested in the social determinants of health and the operationalisation of these social indicators and health in that health outcomes depended on perceived amenity rather than absolute wealth.

Health Related Quality of Life (HRQoL) in Hypertensive Patients

Hypertension also called as increased blood pressure (BP) is a chronic disorder in which BP is persistently elevated in the main systemic arteries. The main risk factor for cardiovascular disorder is hypertension. It is common in almost all countries. It makes a silent and gradual progress. Quality of life is a wide term which mainly affects the physical health, psychological condition, level of independence, social relationships and personal beliefs of a person. The HRQoL in people with hypertension can be mostly affected by the disease condition itself or due to the adverse effects of the treatment. Determining the quality of life of patients with hypertension has become an important issue. The HRQoL of hypertensive patients can be improved if the treatment and lifestyle modifications are done correctly. Counseling the patients with hypertension regarding risk factors, lifestyle modifications and medication adherence can also improve the HRQoL. Several questionnaires are available for assessing the HRQoL of people with different disorders. This questionnaire or instrument can be categorized into two types: the questionnaires for a specific disease and the general questionnaire. The SF instrument was introduced in the United States of America by the RANDS Corporation’s Health Insurance researches. It has now been translated to more than 120 world languages. Short form instrument is divided into different types which includes SF-36, SF-12, SF-20 and many more. EuroQol created EQ5D as a standardized method for assessing health status to provide a clear, objective health measure for medical and economic evaluation. . The EQ5D instrument comprises of three versions: EQ-5D-5L, EQ-5D-3L and EQ-5D-Y. WHOQoL- BREF, is a generic questionnaire administered on its own which contain 26 items. The MINICHAL was developed or introduced in 2001 in Spain which contains 17 questions. The word MINICHAL was obtained from “Mini Cuestionario de Calidad de Vida en Hypertensión Arterial.

The Relationship Between Subjective Well-Being and Self-Reported Health: Evidence from Ecuador

This article addresses the relationship between self-reported health and subjective well-being in two dimensions: cognitive and emotional. Using the Household Living Conditions Survey 2014, this study represents the first approach for Ecuador and Latin America to test how the two dimensions of subjective well-being explain self-reported health. The cognitive dimension is measured by a happiness question in a life-evaluative mode. Whereas the emotional dimension is proxied by an average of 16 psychosocial well-being questions that indicates how many, from the last 7 days, the person had a poor emotional state. We use descriptive statistics and a probit model with an instrumental variable approach to address the omitted variables bias and reverse causality. After controlling for socioeconomic, personal, regional, and health related variables, the results indicate that happiness or the cognitive dimension of well-being is the main predictor of self-reported health, quantitatively more important than having a recent illness (objective health measure), habits (sport) or health care (health importance). Furthermore, more days in a negative emotional state is associated with worse self-reported health.

SELF-PERCEIVED HEALTH AND PHYSICAL FUNCTION ARE ASSOCIATED WITH BODY COMPOSITION AND BLOOD LIPIDS

Clinical indicators of health status such as body composition, blood lipids, and cardiorespiratory fitness are objective; however, self-perceived health may be influenced by multiple factors. Thus, the PURPOSE of the present study was to explore associations among objective measures of health, self-perceived health, and habitual physical activity in overweight, older adults. METHODS: In 35 (27 F/8 M) overweight (body mass index, BMI≥ 27 kg/m2), older adults (>58 years) we assessed blood lipids (point-of-care analyzer); body composition (bioelectrical impedance); habitual physical activity (7-day accelerometry); cardiorespiratory fitness (VO2max); and self-perceived health (36-item short form survey, SF-36). The SF-36 includes questions that assess eight health concepts including perceptions of physical function and general health. Scores for each concept can range from 0% (poor) to 100% (excellent). Associations were assessed utilizing partial correlations (controlling for age and sex). Significance was set to p< 0.05. RESULTS: Average values for these subjects included: age: 64±5y; SF-36 (general health): 63±14%; SF-36 (physical function): 77±16%; BMI: 35±5 kg/m2; body fat percentage: 44.7±0.1%; VO2max: 16±3 ml/kg/min; moderate-to-vigorous physical activity (MVPA): 47±23 min/day, LDL cholesterol: 105±27 mg/dL, HDL cholesterol: 49±11 mg/dL, triglycerides: 113±40 mg/dL, and glucose: 100±15 mg/dL. Self-perceived physical function was significantly (p< 0.05) correlated with indices of body composition and blood lipids [body fat percentage (r= -0.39), visceral fat area (r= -0.42), and LDL cholesterol (r= -0.51)], but not habitual MVPA. Self-perceived general health was significantly correlated with LDL/HDL (r= -0.60), but not indices of body composition or physical activity level. CONCLUSIONS: These preliminary data suggest that perception of general health and physical function are more closely related to indices of body composition and blood lipids than habitual physical activity level.

Socioeconomic position and the health gradient in Cuba: dimensions and mechanisms

BackgroundTo throw light on the under-researched association between socioeconomic position (SEP) and health in Cuba, this study examined SEP gradients in health and their underlying mechanisms among urban Cuban adults aged 18–65.MethodsBy applying linear regressions to data from the 2010 National Survey on Risk Factors and Chronic Diseases, the analysis explored the SEP-health gradient along three SEP dimensions − education, occupation, and skin colour − using ten health measures: self-reported health (SRH), general and abdominal obesity, hypertension, high glucose, high cholesterol, high triglycerides, low high-density lipoprotein cholesterol, metabolic syndrome, and cumulative risk factors. Regressions also included behaviours and health-related risk perceptions (tobacco and alcohol consumption, diet, physical activity, and risk-related behaviours). It thus investigated the SEP-health gradient and its underlying mechanisms via both behaviours and health-related risk perceptions.ResultsOnce controlling for gender, age, marital status, region and provincial dummies, the analysis detected educational gradients in SRH (estimated coefficient [95% CI]: middle-level education = 3.535 [1.329, 5.741], p < 0.01; high-level education = 5.249 [3.050, 7.448], p < 0.01) that are partially explainable by both health-affecting behaviours (tobacco and alcohol consumption, diet, physical and sedentary activity) and risk perceptions. Using objective measures of health, however, it found no SEP-health gradients other than hypertension among people identified as having Black skin color (adjusted for demographic variables, 0.060 [0.018, 0.101], p < 0.01) and high cholesterol among those identified as having Mulatto or Mestizo skin color (adjusted for demographic variables, − 0.066 [− 0.098, − 0.033], p < 0.01).ConclusionsIn terms of objective health measures, the study provides minimal evidence for an SEP-health gradient in Cuba, results primarily attributable to the country’s universal healthcare system − which offers full coverage and access and affordable medications − and its highly developed education system.

Making Reasonable Adjustment to Enable and Support People With Intellectual Disability Engage in Objective Health Measures in a Research Study—The Health Fair in the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing

Abstract This observational cross-sectional study presents methods employed in designing and undertaking a suite of eight health assessments, purposely named The Health Fair, as part of Wave 2 (2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA) study. Overall, 604 persons of all levels of intellectual disability, aged 40 years and above and in different living circumstances, participated. The Health Fair process was mobile and overcame barriers such as communication challenges or access that people with intellectual disability face. This protocol could support researchers and practitioners in clinical practice to guide and improve the health assessment of people with intellectual disability to facilitate a better understanding of their health pathways and improve health care delivery and services.