Poor Self-rated Health Status Research Articles

The association between certain chronic diseases and health status with depression

Depression is more likely in patients with certain chronic diseases, and it is associated with increased rates of disability and mortality. The goal of this study was to determine the relationship between certain chronic diseases; hypertension, diabetes, asthma, low hemoglobin level and health status, with the presence of depression among general population. Cross-sectional study was conducted from 787 subjects in different age groups, who had participated in a major campaign in Riyadh, Saudi Arabia during March 2012. Blood pressure (BP), random blood glucose (RBG), Serum hemoglobin (Hb), Beck Depression Inventory Scale (BDI) had been measured. Covariates included age, sex, and presence of hypertension, diabetes, or asthma. Of the 787 subjects participated in the study, 50.5% were females, 12.7% of study subjects were less than 25 years and 4.2% were 55 or more years of age. Measuring the Hb level was surprising, (14%) were having Hb level below 11 g/dl. BDI scale was used to screen for depression. The prevalence of depression among “medically free” population was (29.9%). The overall prevalence of chronic diseases among the study subjects including asthma, hypertension, and diabetes or combination of two diseases or more were 18.2%. Surprisingly, there was no significant relation between depression and chronic diseases with p-value 0.092. The presence of chronic diseases such as hypertension, diabetes, and low hemoglobin level are not risk factors for having depressive symptoms among general population. Poor self-rated health status appears to be more strongly associated with depression than the presence of chronic disease.

Binge eating in adults: prevalence and association with obesity, poor self-rated health status and body dissatisfaction.

To estimate the prevalence of episodes of binge eating and to assess potential associations with nutritional status, satisfaction with current body weight, self-rated health status and self-rated body weight. A cross-sectional population-based study. Binge eating was assessed using adapted questions from the Brazilian Portuguese version of the Questionnaire on Eating and Weight Patterns and was defined as binging one or more times over the last 3 months before the interview. City of Pelotas, southern Brazil. Individuals (n 2097) aged 20-59 years. The prevalence of binge eating and recurrent binge eating was 7.9% and 2.7%, respectively. In the adjusted analysis, obesity, fair/poor self-rated health status and body dissatisfaction remained strongly associated with binge eating. The study showed a high prevalence of binge eating among adults in Pelotas, being higher among younger women, the obese and those who desired to weigh less. The current results are informative, but longitudinal studies would be needed to demonstrate the causal relationship between these events.

Joint predictability of health related quality of life and leisure time physical activity on mortality risk in people with diabetes

BackgroundReduced health related quality of life (HRQOL) has been associated with increased mortality in individuals with diabetes. In contrast, increased leisure time physical activity (LTPA) has been associated with reduced mortality. The aim of this study was to investigate the combined relationship of HRQOL and LTPA on mortality and whether high levels of LTPA are associated with reduced risk of mortality in adults with diabetes and inferior HRQOL.MethodsWe analyzed data from a national sample of adults (18 years or older) with self-reported physician-diagnosed diabetes, who participated in the 2001 National Health Interview Survey in Taiwan (N = 797). A total of 701 participants had complete Short Form 36 (SF-36) and LTPA data and were followed from 2002 to 2008. Participants were divided into 3 groups based on their LTPA: (1) a regularly active group who reported 150 or more min/week of moderate-intensity activity; (2) an intermediately active group who reported engaging in LTPA but did not meet the criterion for the “regular” category; and (3) an inactive group who reported no LTPA. The physical component summary (PCS) and mental component summary (MCS) scores were dichotomised at the median (high vs. low) (PCS = 45.11; MCS = 47.91). Cox proportional-hazards models were used to investigate associations between baseline characteristics and mortality.ResultsAfter 4,570 person-years of follow-up, 121 deaths were recorded and the crude mortality rate was 26.5 per 1,000 person-years. Both PCS scores and LTPA were significant predictors of mortality, whereas no significant relationship was observed between MCS and mortality. After adjustment for other factors, participants with low PCS who reported no LTPA had a hazard ratio (HR) for mortality of 4.49 (95% CI = [2.15-9.36]). However, participants with low PCS who were active (including intermediate and regular LTPA) had a HR for mortality of 1.36 (95% CI = [0.64-2.92]).ConclusionsOur results show a significantly increased mortality risk of diabetes associated with reduced HRQOL in individuals who report no LTPA. Engaging in LTPA may be associated with improved survival in participants with diabetes with poor self-rated physical health status.

Abstract ED04-03: Health literacy and health information technology: Promises and pitfalls.

Abstract Studies of cancer disparities would benefit from attention to health literacy limitations. Both inadequate (i.e., very low) and marginal health literacy (HL) appear to be important factors in the causal pathway to health disparities, especially in low income patients with chronic diseases. Patients with poorer health literacy skills are at greater risk for increased HgA1c & retinopathy, late stage presentation of cancer, depression/anxiety, poor self-rated health status, hospitalization, and mortality. Given the high prevalence (46% of the US population) of inadequate (i.e., very low) plus marginal HL, often described as limited HL and limited literacy's association with poor health outcomes, there has been great interest in including HL assessments in epidemiologic and clinical research. There are several standard health literacy measures including REALM TOFHLA, Newest Vital Sign, and sTOFHLA. Chew and colleagues developed three self-reported HL screening questions and found that a single item (“How confident are you filling out medical forms by yourself?”) may be sufficient to detect patients. As health information technology is burgeoning it is important to consider health literacy implications. A study by Sarkar et al. found that across each function of a patient portal, those reporting limited health literacy were consistently less likely to complete each function. Ensuring universal internet and computer access will become more important than ever. As services migrate to the internet, those most at risk for poor health outcomes are at risk of falling further behind as health systems increasingly rely on patient portal health service functions and limit the alternative modes of access and communication. Additionally, improving the usability of internet-based patient portals, such that those with limited health literacy can navigate them effectively, is critical to realizing health benefits. The internet has potential, via use of audio, graphic, video, and multiple languages, to greatly expand the capacity and reach of health care systems (Institute of Medicine, 2009). However, in the real world, that potential has yet to be realized. Barriers to internet-based health care services require improved technology access as well as tailoring of design and services to reach those with limited health literacy. In summary, interventions to address disparities in cancer screening and treatment should attend to the health literacy limitations of populations in order to improve their reach and effectiveness. Citation Format: Urmimala Sarkar. Health literacy and health information technology: Promises and pitfalls. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr ED04-03.

Natural course of depressive symptoms in late life. An 8-year population-based prospective study

The aim of the study was to follow the natural course of late-life depressive symptoms within a German population-based study. Within the Leipzig Longitudinal Study of the Aged (LEILA 75+), a representative sample of 1265 individuals aged 75 years and older were interviewed every 1.5 years over 8 years. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D, German-specific cut-off score ≥23). The incidence of depressive symptoms was 34 per 1000 person-years (95% confidence interval 31-37). In a multivariate regression model, female gender, poor self-rated health status, stroke, risky alcohol consumption, a poor social network, higher number of specialist visits, functional impairment, and CES-D score at baseline were significant risk factors of future depressive symptoms. We observed remission in 60%, an intermittent course in 17% and a chronic course in 23% of the participants. No baseline characteristic distinguished the remission group from the persistently depressed. Depressive symptoms in late life are common and highly persistent. In the present study encountered risk factors entailed potentialities for secondary prevention.

Effect of unequal employment status on workers’ health: Results from a Japanese national survey

This study assesses the possibility of a period effect on Japanese workers’ health and its association with historical changes in the work environment. We used multi-year national cross-sectional surveys, the Comprehensive Survey of Living Conditions for 2001, 2004, and 2007, and estimated the period effect on the health of employed workers aged 18–65 years. The prevalence of ill-health indicators (poor self-rated health status, subjective symptoms, and the number of respondents receiving consultations from medical doctors and other health professionals) significantly increased during this period. Deteriorating trends in these health indicators persisted after adjusting for age and cohort effects and for individual factors such as employment, marital, and child-rearing status. Furthermore, after adjusting for income level as an individual factor, deteriorating trends remained for the poor self-rated health status of male employees, subjective symptoms of female employees, and receiving medical consultations for both genders. The health status of employed workers in Japan deteriorated, especially from 2004 to 2007, regardless of age and cohort effects. After taking individual socio-economic factors and the effects of the recession on society into consideration, we hypothesized a posteriori that the increase in precarious non-regular work may be the main factor underlying this period effect and may be the cause of the deterioration in workers’ health.

Burden of Morbidity in 10+ Year Survivors of Hematopoietic Cell Transplantation (HCT): A Report From the Bone Marrow Transplant Survivor Study (BMTSS)

Abstract 841▪FN2▪This icon denotes a clinically relevant abstract Background:High-intensity therapeutic exposures and prolonged immunosuppression increase the risk of long-term complications after HCT, with an attendant increase in the healthcare needs of these long-term survivors. We have previously demonstrated that morbidity increases with increasing time after HCT (Sun CL, Blood, 2010;116:3129–39). However, the burden of morbidity in patients who survive extended lengths of time after HCT and the consequent healthcare needs of these survivors are unknown. Methods:Utilizing resources offered by the BMTSS, we evaluated the risk of chronic health conditions and psychological health of 366 10+ year HCT survivors and their siblings (n=309). A severity score (grade 1 [mild]; grade 2 [moderate], grade 3[severe], grade 4 [life-threatening], and grade 5 [death due to chronic health condition]) was assigned to each health condition using the CTCAE, v3.0. Cumulative incidence of chronic health conditions was evaluated, using competing risks method. Brief Symptom Inventory (BSI) was used to describe adverse psychological health. Multivariate regression analysis allowed identification of vulnerable subgroups. The current status of healthcare utilization by the HCT survivors was also evaluated. Results:The mean age at HCT was 22 years (range: 0.4–59.8) and at study participation was 37 years (range: 11–72); mean length of follow-up was 15 years (range: 10–28). Primary diagnoses included AML (28%), ALL (17%), CML (17%), NHL (11%), aplastic anemia (11%), HL (7%), and other diagnoses (9%). Stem cell graft was autologous (27%); allogeneic related (65%) and unrelated donor (8%); 72% of the patients received TBI-based conditioning. At least one chronic health condition was reported by 74% of the HCT survivors, compared with 29% of siblings (p<0.001); 25% of the survivors reported severe/life-threatening conditions compared to only 8% of the siblings (p<0.001). Commonly reported severe/life-threatening chronic health conditions included myocardial infarction, stroke, blindness, diabetes, musculoskeletal problems, and subsequent malignancies. As shown in Figure 1A, the 15-year cumulative incidence of any chronic health condition (grades 1–5) was 71% (95% CI, 67–75%), and of severe-life-threatening conditions or death was 40% (95% CI, 33–47%). HCT survivors were 5.6 times as likely to develop a severe/life-threatening condition (95% CI, 3.7–8.6), compared with age- and sex-matched siblings. The cumulative incidence of severe/life-threatening conditions did not differ by type of HCT (p=0.79, Figure 1B). Using BSI, we evaluated somatic distress, anxiety, and depression among HCT survivors and their siblings. While the prevalence of anxiety and depression were comparable between survivors and siblings, HCT survivors were 2.7 times more likely to report somatic distress (p<0.001). Among survivors, female gender (OR=3.6, 95% CI, 1.4–9.0), low household income (<$20,000 OR=4.4, 95% CI, 1.1–17.2), and poor self-rated health status (OR=10.6, 95% CI, 4.0–27.9) were associated with increased risk for somatic distress. Fortunately, 90% of HCT survivors carried health insurance coverage, because a high proportion needed ongoing specialized medical care; 69% of the HCT survivors reported cancer/HCT-related visits at an average of 15 years after HCT. Conclusions:The burden of long-term physical and emotional morbidity borne by 10+ year HCT survivors is substantial, resulting in a high utilization of specialized healthcare. Patients, families and healthcare providers need to be made aware of the high burden, such that they can plan for post-HCT care, even many years after HCT. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Identifying target groups for the prevention of depression among caregivers of dementia patients

Depression in informal caregivers of persons with dementia is a major, costly and growing problem. However, it is not yet clear which caregivers are at increased risk of developing depression. With this knowledge preventive strategies could focus on these groups to maximize health gain and minimize effort. The onset of clinically relevant depression was measured with the Center for Epidemiologic Studies - Depression Scale in 725 caregivers who were not depressed at baseline and who were providing care for a relative with dementia. Caregivers were followed over 18 months. The indices calculated to identify the most important risk indicators were: odds ratio, attributable fraction, exposure rate and number needing to be treated. The following significant indicators of depression onset were identified: increased initial depressive symptoms, poor self-rated health status and white or Hispanic race/ethnicity. The incidence of depression would decrease by 72.3% (attributive fraction) if these risk indicators together are targeted by a completely effective intervention. Race/ethnicity was not a significant predictor if caregivers of patients who died or were institutionalized were left out of the analyses. Detection of only a few characteristics makes it possible to identify high-risk groups in an efficient way. Focusing on these easy-to-assess characteristics might contribute to a cost-effective prevention of depression in caregivers.

P1-221 Epidemiology of depression in old age: results of the Leipzig longitudinal study of the aged (LEILA 75+)

BackgroundDepression is one of the most common mental disorders in old age. In order to assess future needs of the healthcare system for prevention and treatment, information on epidemiology of...

Prevalence and risk factors of depressive symptoms in latest life—results of the Leipzig Longitudinal Study of the Aged (LEILA 75+)

Because the oldest old will be the fastest-growing age group in the future and information about epidemiology of depressive symptoms in latest life is scarce, the present study aims at determining the age-specific and gender-specific prevalence rates and risk factors of depressive symptoms in latest life. As part of the Leipzig Longitudinal Study of the Aged (LEILA 75+), a population-based sample of 1,006 individuals aged 75 years and older were interviewed on socio-demographic, clinical and psychometric variables. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (cut-off score ≥16); mild cognitive impairment (MCI) was diagnosed according to criteria of the International Working Group on MCI. Factors associated with depressive symptoms were determined with multiple logistic regression models. Of the overall sample, 38.2% (95% confidence interval, CI 35.2-41.2) were classified as depressed. In the full multivariate model, the following variables were significantly associated with depressive symptoms: divorced or widowed marital status, low educational level, poor self-rated health status, functional impairment, multi-domain MCI, stressful life events and poor social network. All variables but MCI remained significant correlates of depressive symptoms in the parsimonious model. Because depressive symptoms are common in oldest age and associated with broad categories of risk factors, latest-life depression represents an important public health issue. Employment of comprehensive geriatric assessment to ascertain depressive symptoms and its concomitants could help to improve treatment success.

Geschlechtsspezifische Prädiktoren von Institutionalisierung im Alter – Ergebnisse der Leipziger Längsschnittstudie in der Altenbevölkerung (LEILA 75+)

Especially given the different socialization and life conditions of men and women, it could not be assumed that factors leading to nursing home admission (NHA) can be equally applied to both genders. We aimed to determine gender-specific predictors of NHA. Data were derived from the Leipzig Longitudinal Study of the Aged, a population-based study of individuals aged 75 years and older. 1,058 older adults were interviewed six times on average every 1.4 years. Sociodemographic, clinical, and psychometric variables were obtained. Cox proportional hazards regression was used to determine predictors of NHA. 10.3 % of men and 19.5 % of women (p < 0.001) were admitted to nursing home during the study period. The mean time to nursing home was 7.2 years for men and 6.8 years for women. Characteristics associated with a shorter time to NHA were increased age for men and women; cognitive impairment, poor self-rated health status, and less than two specialist's visits in the preceding 12 months for women, and being unmarried, moderate educational status, and hospitalization in the preceding 12 months were predictors of NHA for men. Gender differences in prediction of NHA do actually exist. The inclusion of gender-specific factors in design and application of interventions to support individuals at home and delay or prevent NHA appears to be warranted.

Self-rated health of population in southern China: association with socio-demographic characteristics measured with multiple-item self-rated health measurement scale

BackgroundSelf-rated health (SRH) status has been increasingly acknowledged as a valid and appropriate indicator of public health and chronic morbidity. However, limited research was conducted in China due to the different culture and socioeconomic situations. The aim of this study is to assess the SRH status of the population in Southern China using multiple-item SRH measurement scale (SRHMS). Socio-demographic characteristics including sex, age, marital status, education, and income are considered variable in this survey.MethodsA cross-sectional survey was conducted in a total of 8400 community residents of 14 years old and over in Southern China. SRH status was measured using SRHMS with a stratified sampling approach, and compared between different subgroups with t-test and one-way analysis of variance (ANOVA).ResultsTotally 8400 subjects were recruited in this study and 80.96% (6801) responded to the survey. The mean score for SRHMS dimensions ranged from 66.16 ± 20.65 (mean ± sd) for positive emotion (M2) to 92.14 ± 14.06 for daily physical activities (B2). Results showed that SRHMS scores for women, elderly men, low education level, low income, divorced, separated or widowed and suburban residents in Southern China were significantly lower than other subgroups (P < 0.05).ConclusionsIn this study, using SRHMS we assessed the association of SRH with socio-demographic characteristics including sex, age, marital status, education, and income in Southern China. The performance of the questionnaire in the large scale survey is satisfactory and provides a large picture of SRH status in Southern China. Our results indicate that women, elderly men, low education level, low income, divorced, separated or widowed and suburban residents in Southern China suffer from relatively poor SRH status.

Psychiatric Morbidity in HIV-infected Male Prisoners

The seroincidence of human immunodeficiency virus (HIV) in Taiwan has drastically increased since 2004, particularly among injection drug users and prisoners. The major purpose of this study was to explore the prevalence and correlates of psychiatric morbidity among HIV-infected male prisoners. In 2006, data were collected from all of HIV-infected male prisoners (n = 535) in seven prisons in Taiwan. This collection was performed using a self-administered, anonymous questionnaire in group settings directed by our interviewers. Psychiatric morbidity was measured using the five-item Brief Symptom Rating Scale in 535 participants, which represented an 85% response rate. After excluding incomplete data, 479 participants were included in the analysis. Psychiatric morbidity was present in 46% of participants. Multivariate logistic regression revealed that correlates of the five-item Brief Symptom Rating Scale defined cases included the following: being a recidivist, having poor self-rated health status, and having experienced psychiatric symptoms in one's lifetime (e.g. significant physical pain or discomfort, depression for 2 weeks or longer, serious anxiety or tension, trouble understanding, concentrating, or remembering, and serious thoughts of suicide), with a Nagelkerke R(2) equal to 0.365. Psychiatric morbidity is prevalent among HIV-infected male prisoners. Tailored HIV/AIDS education related to mental health is therefore suggested for inclusion as part of a comprehensive HIV/AIDS training program among incarcerated populations.

Health status and risk for depression among the elderly: a meta-analysis of published literature

the goal of this study was to determine the relationship between health status, including self-rated health status and chronic disease, and risk for depression among the elderly. MEDLINE, EMBASE and The Cochrane Library Database were used to identify potential studies. The studies were classified into cross-sectional and longitudinal subsets. For each study, the numbers of the total participants, cases (for cross-sectional study) or incident cases (for longitudinal study) of depression in each health status group were extracted and entered into Review Manager 4.2. The quantitative meta-analysis of cross-sectional studies and that of longitudinal studies were performed, respectively. For prevalence and incidence rates of depression, odds risk and relative risk (RR) were calculated, respectively. the quantitative meta-analysis showed that, compared with the elderly without chronic disease, those with chronic disease had higher risk for depression (RR: 1.53, 95% confidence intervals (CI): 1.20-1.97). Compared with the elderly with good self-rated health, those with poor self-rated health had higher risk for depression (RR: 2.40, 95% CI: 1.94-2.97). despite the methodological limitations of this meta-analysis, both poor self-rated health status and the presence of chronic disease are risk factors for depression among the elderly. In the elderly, poor self-reported health status appears to be more strongly associated with depression than the presence of chronic disease.

Impact of HIV infection on self-rated health in a high-prevalence popolation with low awareness of own HIV status

Background: Self-rated global health status has been found to be a sensitive marker of declining health and to operate as an independent predictor of survival. This study examines the effect of HIV infection on self-rated health in a population with high prevalence of HIV infection and low awareness of own status of HIV infection. Methods: The data stem from a comprehensive population-based HIV survey conducted in selected urban and rural populations in Zambia in 1996. A total of 1951 males and 2158 females of age more than 14 years were interviewed of which 6% refused to be tested for HIV infection. A logistic regression model was used assuming socio-demographic factors, mental distress and health care use to be associated both with HIV infection and self-rated health. Results: The proportion of persons judging their health status as poor was higher in the rural than in the urban population. Generally no major difference in the proportions of persons rating their health status as poor was observed between sexes. The proportion of poor self-rated health status increased linearly with age. Use of health care services, mental distress and self-perceived risk of HIV infection were negatively associated with self-rated health. Both males and females living in an urban area and males living in a rural area of age more than 24 years who were infected with HIV were about twice as likely to rate their health status as poor compared to respondents who were not infected with HIV. Conclusion: HIV infection had a strong independent negative effect on self-rated health in persons of age greater than 24 years. This measure of people’s subjective health may be used as a valuable “diagnostic” tool in HIV-related care and support programmes, and should be evaluated for use in such services.

Serious psychological distress and health outcomes for persons with epilepsy in poverty

Epidemiology literature demonstrates socioeconomic status as an important variable for outcomes in persons with epilepsy. However, no previous studies have analyzed the association between poverty and epilepsy in the United States. Forty-one percent (246/604) of persons with a history of epilepsy (PWHE) in the 2005 California Health Interview Survey ( n = 43,020) had an annual income <200% Federal Poverty Level (FPL), adjusted lifetime prevalence rate 0.5% [98.33% CI 0.4–0.7]. Four groups are presented in the analyses: (1) those with a history of epilepsy <200% FPL, (2) those with a history of epilepsy ≥200% FPL, (3) those not reporting a history of epilepsy <200% FPL and (4) those not reporting a history of epilepsy ≥200% FPL. PWHE in poverty reported significantly higher amounts of serious psychological distress, based on the validated Kessler 6 (K6) scale, than both non-epilepsy populations. After adjusting for demographics and other comorbid conditions, logistic regression analyses show PWHE in poverty are significantly more likely to report fair or poor self-rated health status when compared to the PWHE not in poverty and both non-epilepsy populations. PWHE in poverty are also more likely to report ≥14 generally unhealthy days and ≥14 physically unhealthy days in the past 30 days compared to the PWHE not in poverty and both non-epilepsy populations. Psychological well-being needs to be incorporated into any comprehensive treatment strategy for managing epilepsy.

The impact of follicular (FL) and other indolent non‐Hodgkin's lymphomas (NHL) on work productivity–a preliminary analysis

Although much is known about the efficacy, toxicity, and direct costs of treatment for follicular lymphoma (FL), there is no data assessing the impact of this diagnosis on the work productivity of affected individuals. We conducted a cross-sectional survey study of consecutive patients attending a malignant haematology clinic at a large multi-disciplinary cancer centre. Patients with a diagnosis of FL or other indolent non-Hodgkin's lymphoma completed questionnaires assessing health status, work productivity, and activity impairment. Eighty-four patients completed the survey study (95% response). Patients who continued to work reported a minimal impact on their work productivity (10%+/-standard deviation SD 20; 0%=no effect and 100%=complete impairment of activity) and on their daily activities (13%+/-SD 25) attributable to their cancer. Prior to lymphoma diagnosis, over 71% of patients were working while 14% were retired. At the time of survey administration, only 41% of patients were still able to work with a significant proportion of patients having transitioned to retirement (36%), sick leave (10%), or unemployment (4%). On multivariate analysis, significant activity impairment (daily activity impairment>50%) was predicted by poor self-rated health status (OR 32.1; 95% CI: 5.9-174.2; p<0.0001) and active chemotherapy treatment (OR 14.5; 95% CI: 0.91-230.9; p=0.059). Although few patients with indolent lymphoma identified significant impairment in productivity, many were unable to continue employment following diagnosis, needed to miss days from work, or imposed a significant burden on caregivers. The greatest impact on activity is apparent in patients who rate their health status as poor and in those who are currently receiving systemic therapy.

Socio-Demographic Characteristics and Health Perceptions among Male and Female Visitors to CAM Practitioners in a Total Population Study

Background: The aim was to explore the prevalence of visitors to CAM practitioners in a total population with reference to sex, self-rated health status and socio-demographic characteristics. Methods: The paper reports findings from the Nord-Trøndelag Health Study (HUNT 2), a total population-based health survey of 42,277 respondents conducted in central Norway who answered questions on visits to a CAM practitioner. Variables included were age, marital status, education, receiving social welfare benefits, lifestyle (daily smoker), Hospital Anxiety and Depression Scale (HADS-T), self-rated health status, and having a limiting chronic complaint. Results: Some 12.8% (95% CI 12.5–13.1) of the population had visited a CAM practitioner in the last 12 months, with females visiting almost twice as often as males. Multivariate analysis showed that consulting a CAM practitioner was significantly associated in both sexes with being middle-aged (male age 40–49 OR 1.6 (1.2–2.0), female age 30–39 OR 1.4 (1.1–1.6)); poor self-rated health status (male OR 5.1 (3.1–8.5), female 3.9 (2.2–6.8 )); and reporting a chronic complaint (male OR 1.5 (1.3–1.8), female OR 1.4 (1.2–1.6)). Daily smoking of cigarettes was associated with a decreased likelihood for visiting a CAM practitioner (male OR 0.7 (0.6–0.9), female OR 0.8 (0.7–0.9)). In females, both a higher total HADS-T score (score >20 OR 1.5 (1.2–2.0)) and middle-level education (OR 1.2 (1.1–1.4)) were associated with visiting a CAM practitioner. Conclusions: Visitors to CAM practitioners had lower self-reported health than non-users, but socio-demographic variables did not discriminate between users and non-users.

Food insufficiency in rural Kilimanjaro, Tanzania

To estimate the prevalence of reported food insufficiency associated socio-demographic factors and health indicators in rural Tanzania. A cross-sectional study. A rural community in Kilimanjaro, Tanzania. Eight hundred and ninety nine individuals aged 15-36 years. A structured questionnaire was administered to collect information on socio-demographic factors, health indicators and food insufficiency. Participants were tested for HIV-1 using saliva samples. The prevalence of food insufficiency was 25.3% with no sex difference. After controlling for potential confounders age (Adjusted Odds Ratio [AOR] = 1.05; 95% Confidence Interval [CI]: 1.02-1.08), low education level (AOR = 4.73; CI: 1.30-17.11), being a peasant (AOR = 2.29; CI: 1.04-5.04), poor self-rated health status (AOR = 4.35; CI: 1.71-11.00) and having health problems (AOR = 2.23; CI: 1.21-4.08) were associated with food insufficiency among women but not men. In unadjusted analysis, women with food insufficiency had over twice the odds of testing HIV positive although the association did not reach statistical significance (AOR = 2.12; CI: 0.87-5.19) in adjusted analysis. Food insufficiency was prevalent in rural Tanzania. It was associated with sociodemographic factors and health indicators among women but not men. Our findings suggest that food insufficiency may play a role in increasing vulnerability to HIV infection particularly among women however; more research is needed to explore further this relationship.

The Potential for Lost Productivity and Daily Activity Impairment in Patients with Follicular (FL) and Other Indolent Non-Hodgkin's Lymphoma (NHL).

Introduction: Nearly one in five cancer survivors report limitations in ability to work following diagnosis, with poor work-related outcomes particularly noted in the hematologic cancers. Although much is known about the efficacy, toxicity and direct costs of treatment for follicular lymphoma, there is no data assessing the impact of this diagnosis on productivity of affected individuals.Methods: We conducted a consecutive cross-sectional study of patients attending a malignant hematology clinic at a large multi-disciplinary cancer centre. Patients with a diagnosis of FL or other indolent NHL were asked to complete questionnaires assessing demographics, health status (EQ-5D), and work productivity and activity impairment (WPAI questionnaire).Results: Eighty-four patients completed the survey study (>95% response rate). Mean age was 58.7 (+/−13.8 SD) and 55% were male. Diagnoses included FL (55%), CLL (25%), and other indolent NHL (20%). The majority of patients presented in advanced stage (stage III–IV; 65%) and had received some therapy, although 29% were still being observed without having received therapy by the time of survey administration. The median disclosed income was $40,000–$59,000; 76% had pursued post-secondary education. Over 61% were working full-time prior to diagnosis while 14% were retired. Patients reported a minimal impact on their work productivity (1.9+/−3.2 on a scale of 0 to 10; 0=no effect and 10=complete impairment of activity) and on their daily activities (2.4+/−3.1) attributable to their cancer diagnosis. However, following diagnosis of NHL (and at the time of survey completion), only 33% were able to continue full-time work, 7% were working part-time, 10% required disability, and 37% were retired. Of those still working, a mean of 2.1 days (+/−6.9) were missed due to illness in the preceding 4 weeks, with a mean of 16 days (+/−8.7) worked in that period. Only 6% received paid assistance, while 17% required unpaid care from a partner/spouse, relative, or friend. Unpaid caregivers missed a mean of 11.3 days (+/−16.2) of work and provided a mean of 9.8 days (+/−13.4) of care. There was a significant inverse correlation between daily activity scores (high values=complete impairment) and health status ratings (high values=excellent health status/utilities) ascertained by the EQ-5D instrument (Spearman correlation coefficient −0.69; p<0.0001). After controlling for age, stage, and remission status, significant activity impairment (score >5) was predicted by poor self-rated health status (OR 32.1; 95% CI 5.9–174.2; p<0.0001) and also trended to be worse in patients receiving active treatment (OR 14.5; 95% CI 0.91–230.9; p=0.059).Conclusion: Although few patients with indolent lymphoma identified significant impairment in daily activity or work productivity, many were unable to continue full time employment following diagnosis, needed to miss days from work due to illness, or imposed a significant burden on caregivers. The greatest impact on activity and productivity is apparent in patients who rate their health status as poor and in those who are currently receiving systemic therapy.