Poor Self-reported Health Status Research Articles

The association between health insurance status and utilization of health services in rural Northern Ghana: evidence from the introduction of the National Health Insurance Scheme

BackgroundMany households in low- and middle-income countries face financial hardships due to payments for health care, while others are pushed into poverty. Risk pooling and prepayment mechanisms help to lessen the impact of the costs of care as well as assisting to achieve universal health coverage (UHC). Ghana implemented the National Health Insurance Scheme (NHIS) for the promotion of access to health services for all Ghanaians. In this paper, we examined the association between health insurance status and utilization of outpatient and inpatient health services in rural poor communities.MethodsThe study was a cross-sectional household survey conducted in the Kassena-Nankana districts of Northern Ghana. We conducted interviews in 11,175 households and collected data on 55,992 household members. Multiple logistic regression models were used to identify factors associated with the utilization of outpatient and inpatient health services. The dependent variables were the utilization of outpatient and inpatient health services. We adjusted for several potential socio-demographic factors associated with utilization and health insurance status.ResultsSignificantly, the insured had 2.51 (95% CI 2.3–2.8) and 2.78 (95% CI 2.2–3.6) increased odds of utilizing outpatient and inpatient health services respectively. Respondents with a history of recent illness or injury [32.4 (95% CI 29.4–35.8) and 5.72 (95% CI 4.6–7.1)] and poor or very poor self-reported health status [2.08 (95% CI 1.7–2.5) and 2.52 (95% CI 1.9–3.4)] and those on chronic medication [2.79 (95% CI 2.2–3.5) and 3.48 (95% CI 2.5–4.8)] also had increased odds of utilizing both outpatient and inpatient health services respectively. Among the insured, the poorest use the Community-based Health Planning and Services (CHPS) compounds, while the least poor use private clinics and public hospitals for outpatient health services. The uninsured predominately use pharmacies or licensed chemical shops (LCSs). For inpatient health services, the insured largely use public hospitals, with the uninsured using private clinics or public health centres.ConclusionThe findings suggest that being insured with the NHIS is associated with increased utilization of outpatient and inpatient health services in the study area. Overall, the NHIS can be an effective tool for achieving UHC and hence pragmatic efforts should be made to sustain it.

Regional Disparity and Factors Influencing Unmet Medical Needs: A Study Based on the Sixth Korea National Health and Nutrition Examination Survey (2015).

ObjectivesThis study aimed to determine regional differences and the factors that affect unmet medical needs.MethodsData from the 6th Korea National Health and Nutrition Examination Survey (2015) were used, and 4,946 health survey participants who provided responses on medical utilization and health behavior were included in the study.ResultsA statistically significant difference was observed in the incidence rate of unmet medical needs in terms of region. The independent variables that affected unmet medical needs were sex, age, education, region, household income, insurance type, smoking status, self-reported health status, and stress awareness. Gender (female), lower education level, rural residents, lowest household income, poor self-reported health status, and stress awareness increased the probability of unmet medical needs.ConclusionOur findings suggested that different policies and approaches should be considered for each population that is at risk to address the primary cause of the unmet medical needs. Further studies that include medical expenses and the relevant variables of an area should be conducted in the future.

The impact of malnutrition on health outcomes and healthcare cost among Chinese older adults

Objective This study used multivariate regression analysis to study the prevalence of malnutrition and the impact of malnutrition on independence in activities of daily living, health outcomes, chronic disease and healthcare cost among older Chinese adults. Methods This study was based on data from the 2013 China Health and Retirement Longitudinal Survey(CHARLS). The CHARLS data covers information on demographics, family, health status and functional limitations, health insurance, employment and earnings among mid-aged and older community-dwelling Chinese.This research focused on older Chinese adults aged 60 years and over.As a result, over 5, 900 subjects were included.This study defined malnutrition based on body mass index, weight loss and reduced handgrip strength.Functional status was assessed via adapted versions of the Katz index of independence in basic activities of daily living(ADL)and the Lawton-Brody index of independence in instrumental activities of daily living(IADL). Health outcomes included self-reported health status.Then multivariate regression analysis was used to investigate the relationship between malnutrition and various health outcomes. Results Thirty percent of older Chinese adults were malnourished.Malnutrition was associated with significantly lower IADL(OR=0.868, P<0.05), poorer health status(OR=0.675, P<0.001), as well as higher probability of having stroke(OR=1.399, P<0.05)and chronic stomach disease(OR=1.241, P<0.001). As a significant contributor of poorer self-reported health status, malnutrition, in turn, increased hospital cost by ￥214(14% increase, P<0.01)per person per year. Conclusions Malnutrition leads to functional limitations and worse health outcomes among community-dwelling older Chinese adults.These results imply that nutrition interventions such as nutrition screening and assessment, making scientific and personal nutrition support plans, and providing timely adequate nutrition support therapy can improve the health status and lower the healthcare cost of older adults living in the community. Key words: Malnutrition; Health outcomes; Activities of daily living

Factors to assess depression in homebound older adults.

Introduction:The number of homebound older adults is expected to increase as the elderly population grows. Many homebound older persons may be at high risk for depression, which has been associated with adverse health outcomes. The objective of this study was to identify selected factors that may predict depression in the homebound older population.Methods:Data from 340 homebound adults, aged 65 and older who were enrolled in Broward Meals on Wheels and who participated in a telephone survey were analyzed. Participants were asked to report demographic information, health status, medication-taking behaviors, mental health, and life satisfaction. Multiple regression analysis was used to identify predictors of depressed mood in this sample of older adults.Results:The majority of the sample (aged 65–95 years; mean, 77 years) were female (76.5%), white (77.1%), and living alone (52.6%). Multivariate modeling indicated that difficulty remembering the number of prescribed medications to be taken, feeling groggy after taking certain medications, poor self-reported health status, taking anxiety medications, and less satisfaction with life explained 34% (adjusted R2) of the variance in predicting depressed mood (F = 33.1, df = 5, P < .001).Discussion:Multiple factors related to medication use were identified that may contribute to higher levels of depressed mood in homebound older adults. These factors found in our study may be used to create a screening model to be used by pharmacists to identify homebound older adults who would benefit from further assessment for depression.

An investigation of mental health in migrant workers in an enterprise

Objective: To investigate the mental health status in migrant workers in a labor-intensive enterprise and related influencing factors. Methods: Typical sampling was used to perform an investigation in 910 migrant workers in a large foreign-funded labor-intensive enterprise in Shenzhen, China. All the respondents gave informed consent and completed the questionnaire independently and anonymously. The self-reported mental health status was evaluated using the Beck Anxiety Inventory, Beck Depression Inventory, and General Health Questionnaire. Results: Of all the migrant workers in this enterprise, 7.2% had a positive self-reported anxiety symptom, 25.4% had a moderate or severe self-reported depression symptom, and 76.4% had a poor self-reported general health status. Age had significant influence on the self-reported depression symptom (χ2=21.968, P<0.05) ; age did not have significant influence on the self-reported anxiety and general health status (χ2=6.616、12.498, both P>0.05) . The knowledge of occupational hazards had significant influence on mental health status (χ2Depression=47.289, χ2General health=21.087, both P<0.05) . The feeling of work had significant influence on self-reported depression and general health status (χ2Depression=52.406, χ2General health=17.327, both P<0.05) . Attention to self mental health had significant influence on self-reported depression (χ2=17.714, P<0.05) , and whether the person wanted to learn the knowledge of mental health had significant influence on self-reported anxiety (χ2= 6.145, P<0.05) . Conclusion: The self-reported mental health status in migrant workers is poor and is associated with age, worry about exposure to occupational hazard factors, emphasis on mental health knowledge, and a focus on personal mental health. Therefore, targeted occupational health education and occupational mental health education should be strengthened.

Self-reported health status as a predictor of functional decline in a community-dwelling elderly population: Nationwide longitudinal survey in Korea.

As the elderly population is increasing, the prediction and prevention of functional decline in older adults are of great concern. The present study aimed to evaluate whether poor self-reported health status (SRHS) could predict functional decline after 2 years in the elderly population. Data from the Korean Longitudinal Study of Aging panel, a national representative sample of aging Koreans, were used. Participants of the investigation were the elderly population aged 65 years or more without disability in carrying out activities of daily living (ADL) at baseline. The survey asked respondents about their subjective health status. Setting the respondents who stated their health status as "very good" or "good" as the reference group, multivariable logistic regression analysis was carried out to compare functional decline according to the baseline SRHS. A total of 2824 participants were included in the analysis. Among them, 138 (4.9 %) reported functional decline of at least one of the seven ADL components after 2 years. In multivariable logistic regression analysis, SRHS was significantly associated with subsequent functional decline in respondents who chose "Bad" (odds ratio 3.32, 95% confidence interval 1.71-6.44) or "Very bad" (OR 4.75, 95% CI 2.12-10.66). Furthermore, poorer SRHS was significantly associated with subsequent impairment in each ADL component. Also, SRHS predicted overall subsequent impairment in the instrumental ADL. SRHS predicted functional decline after 2 years in older adults without baseline disabilities. SRHS can be a good predictor of future functional decline in the elderly population. Geriatr Gerontol Int 2017; 17: 885-892.

Examining health and well-being outcomes associated with mining activity in rural communities of high-income countries: A systematic review.

It is recognised internationally that rural communities often experience greater barriers to accessing services and have poorer health outcomes compared to urban communities. In some settings, health disparities may be further exacerbated by mining activity, which can affect the social, physical and economic environment in which rural communities reside. Direct environmental health impacts are often associated with mining activity and are frequently investigated. However, there is evidence of broader, indirect health and well-being implications emerging in the literature. This systematic review examines these health and well-being outcomes in communities living in proximity to mining in high-income countries, and, in doing so, discusses their possible determinants. Four databases were systematically searched. Articles were selected if adult residents in mining communities were studied and outcomes were related to health or individual or community-level well-being. A narrative synthesis was conducted. Sixteen publications were included. Evidence of increased prevalence of chronic diseases and poor self-reported health status was reported in the mining communities. Relationship breakdown and poor family health, lack of social connectedness and decreased access to health services were also reported. Changes to the physical landscape; risky health behaviours; shift work of partners in the mine industry; social isolation and cyclical nature of 'boom and bust' activity contributed to poorer outcomes in the communities. This review highlights the broader health and well-being outcomes associated with mining activity that should be monitored and addressed in addition to environmental health impacts to support co-existence of mining activities and rural communities.

Analysis of hepatitis B vaccination behavior and vaccination willingness among migrant workers from rural China based on protection motivation theory

ABSTRACTIntroduction: With China's accelerating urbanization, migrant workers comprise up to 40% of the urban population of China's largest cities. More mobile than non-migrant urban dwellers, migrants are more likely to contract and spread hepatitis B (HB) than non-migrants. Due to the mandatory system of household registration (hukou), migrants are less likely to be covered by national HB immunization programs and also to have more limited access to public health services where they work than non-migrants. Migrants form a significant sub-group in all Chinese cities posing unique public policy vaccination challenges. Objective: Using protection motivation theory (PMT), we developed and measured HB cognitive variables and analyze the factors affecting HB vaccination behavior and willingness to vaccinate by migrant workers. We propose public policy interventions to increase HB vaccination rates of migrant workers. Methods: We developed a questionnaire to collect information on the HB vaccination characteristics of 1684 respondents from 6 provinces and Beijing. Exploratory factor analysis was used to create PMT variables and a binary logistic regression model was used to analyze the factors affecting migrant workers' HB vaccination behavior and willingness to vaccinate. Results: Vulnerability and response-efficacy were significant PMT cognition factors determining HB vaccination behavior. The HB vaccination rate for migrants decreased with increasing age and was smaller for the primary education than the high education group. The vaccination rate of the medical insurance group was significantly greater than the non-insured group, and the vaccination probability was significantly higher for the self-rated good health compared to the self-rated poor health group. Geographical birth location mattered: the vaccination rate for Beijing city and Ningxia province migrants were higher than for Hebei province and the vaccination rate was lower for migrants born far from health facilities compared to those located middle-near distances from health facilities. We also studied vaccination willingness for the unvaccinated group. For this group, vulnerability and self-efficacy cognition factors were significant factors determining HB vaccination willingness. The probability of willingness to vaccinate for the 46+ age group was significantly smaller than the 16–25 age group and the willingness to vaccinate was lower in Jiangsu and Hainan province than in Hebei province. Conclusion: Increased knowledge of HB cognition is an effective way for improving HB vaccination behavior and HB vaccination willingness of migrant workers. We also found that health intervention policies should focus on older migrants (age 46+), without medical insurance, with poorer self-reported health status and poor health services accessibility.

Functional status in older women diagnosed with pelvic organ prolapse

Functional status plays an important role in the comprehensive characterization of older adults. Functional limitations are associated with an increased risk of adverse treatment outcomes, but there are limited data on the prevalence of functional limitations in older women with pelvic floor disorders. The aim of the study was to describe the prevalence of functional limitations based on health status in older women with pelvic organ prolapse (POP). This pooled, cross-sectional study utilized data from the linked Health and Retirement Study and Medicare files from 1992 through 2008. The analysis included 890 women age ≥65 years with POP. We assessed self-reported functional status, categorized in strength, upper and lower body mobility, activities of daily living (ADL), and instrumental ADL (IADL) domains. Functional limitations were evaluated and stratified by respondents self-reported general health status. Descriptive statistics were used to compare categorical and continuous variables, and logistic regression was used to measure differences in the odds of functional limitation by increasing age. The prevalence of functional limitations was 76.2% in strength, 44.9% in upper and 65.8% in lower body mobility, 4.5% in ADL, and 13.6% in IADL. Limitations were more prevalent in women with poor or fair health status than in women with good health status, including 91.5% vs 69.9% in strength, 72.9% vs 33.5% in upper and 88.0% vs 56.8% in lower body mobility, 11.6% vs 0.9% in ADL, and 30.6% vs 6.7% in IADL; all P < .01. The odds of all functional limitations also increased significantly with advancing age. Functional limitations, especially in strength and body mobility domains, are highly prevalent in older women with POP, particularly in those with poor or fair self-reported health status. Future research is necessary to evaluate if functional status affects clinical outcomes in pelvic reconstructive and gynecologic surgery and whether it should be routinely assessed in clinical decision-making when treating older women with POP.

Annual Outcomes With Transcatheter Valve Therapy: From the STS/ACC TVT Registry

BackgroundThe Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry has been a joint initiative of the STS and the ACC in concert with multiple stakeholders. The TVT Registry has important information regarding patient selection, delivery of care, science, education, and research in the field of structural valvular heart disease. ObjectivesThis report provides an overview on current U.S. TVT practice and trends. The emphasis is on demographics, in-hospital procedural characteristics, and outcomes of patients having transcatheter aortic valve replacement (TAVR) performed at 348 U.S. centers. MethodsThe TVT Registry captured 26,414 TAVR procedures as of December 31, 2014. Temporal trends between 2012 and 2013 versus 2014 were compared. ResultsComparison of the 2 time periods reveals that TAVR patients remain elderly (mean age 82 years), with multiple comorbidities, reflected by a high mean STS predicted risk of mortality (STS PROM) for surgical valve replacement (8.34%), were highly symptomatic (New York Heart Association functional class III/IV in 82.5%), frail (slow 5-m walk test in 81.6%), and have poor self-reported health status (median baseline Kansas City Cardiomyopathy Questionnaire score of 39.1). Procedure performance is changing, with an increased use of moderate sedation (from 1.6% to 5.1%) and increase in femoral access using percutaneous techniques (66.8% in 2014). Vascular complication rates are decreasing (from 5.6% to 4.2%), whereas site-reported stroke rates remain stable at 2.2%. ConclusionsThe TVT Registry provides important information on characteristics and outcomes of TAVR in contemporary U.S. clinical practice. It can be used to identify trends in practice and opportunities for quality improvement.

The utilization of traditional Chinese medicine and associated factors in Taiwan in 2002.

Previous studies have noted that there is a high utilization rate of traditional Chinese medicine (TCM) services in Taiwan, China and in western countries, but few studies investigated factors associated with the utilization of TCM in Taiwan. This study analyzes the utilization rate and the factors associated with the utilization of TCM in Taiwan. Data for this study were from the 2002 HPKAP Survey that conducted the face-to-face questionnaire interviews of people aged 15 years and over from October 2002 to March 2003 in Taiwan. This study analyzed the utilization of TCM outpatient services, including admission to the hospital and clinic visits. A total of 26 755 participants completed the survey in the six-month period. The data revealed that 10.4% of participants had utilized TCM services in the past one month while 4.2% of participants utilized TCM only (without using Western medicine outpatient services (WM) or Folk therapy (FT)). The average visits of TCM services per patient was higher among people who had utilized TCM and FT services (2.68 visits) than among those who had utilized WM and FT services (2.15 visits) or TCM services alone (2.15 visits) during the previous one month. Younger people (odds ratio OR = 1.78, 95% CI = 1.47 - 2.16), women (compared with men), and people with higher education levels (OR = 1.58, 95% CI = 1.25 - 1.98) were more likely to visit TCM than compared groups. People with self-reported poor health status (OR = 2.07, 95% CI = 1.76 - 2.44) and people who exercise regularly (OR = 1.17, 95% CI = 1.07 - 1.27) had higher ORs to visit TCM service than comparison group. There is a high utilization of TCM in Taiwan. Further studies are needed to investigate the related factors and determinants between the utilization of TCM and the utilization of FT in Taiwan.

Abstract A02: Tobacco and alcohol comorbidities among young adult Pacific Islanders

Abstract Pacific Islanders (PIs) in the United States have among the highest prevalence of cigarette smoking and alcohol use both of which contribute significantly to increased risk for cancer. Across racial/ethnic groups, late adolescents and young adults between the ages of 18 and 30 years are particularly vulnerable to tobacco and alcohol use. The community-based participatory research (CBPR) program “Weaving an Islander Network for Cancer Awareness, Research, and Training (WINCART)” consisting of community researchers from five NHPI-led community-based organizations (CBOs) and academic researchers are collaborating on the development, implementation, and evaluation of a culturally attuned smoking cessation intervention for young adult PIs entitled “Motivating Pasifika against Cigarettes and Tobacco (MPACT).” Findings from MPACT baseline data provide a description of tobacco and alcohol use patterns in a community sample of young adult PI cigarette smokers in Southern California. The sample of 200 comprised 103(51.5%) males, primarily U.S. born participants 167(84.4%), and individuals self-identifying mostly as either Samoan 106(53%) or Tongan 82(41%). Education level for the majority was completion of high school or GED 89(45.4%) or some college or trade school 77(39.3%). Just over half 113(56.5%) were employed and only 113(56.5%) reported having medical insurance coverage. Regarding general health status, 84(42.6%) of participants rated their health good-excellent, while 113(57.3%) reported their health as fair-poor. Most of the sample reported light to moderate cigarette smoking, 83(43.2%) reported concurrent 30-day E-cigarette or vaping use, and 154(78.2%) smoked menthol cigarettes. Most 127(65.8%) believed that E-cigarettes or vaping were less harmful than cigarettes. The majority of the sample, 153(81%) reported past month alcohol use, 132(69.5%) reported binge drinking on a least one day during that time, and 71(37.4%) reported past month binge drinking on 3 days or more. Utilizing the Center for Epidemiologic Studies Depression (CES-D) Scale, a screening test for depression and depressive disorder, 87(47%) of the sample, reported symptoms consistent with a clinical diagnosis. These findings indicate that our study sample comprised young adult PIs smokers with a high unemployment rate, low-moderate education level, high fair to poor self-reported health status, light to moderate cigarette use with high concurrent rates of E-cigarette or vaping use, high rates of alcohol use, in particular, binge drinking, and high rates of depressive symptoms. These findings indicate the need for health education, preventive health services, and further research regarding tobacco and alcohol use health disparities that increase cancer risk in this Pacific Islander population. Citation Format: Paula Palmer, Sora Park Tanjasiri, Vanessa Tui'one May, Tupou Toilolo, Victor Kaiwi Pang, Dorothy Etimani Vaivao, Melanie Sabado, Nasya Tan, James Pike, Melevesi Fifita Talavou, Genesis Lutu, Bin Xie. Tobacco and alcohol comorbidities among young adult Pacific Islanders. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A02.

Health and human rights in eastern Myanmar after the political transition: a population-based assessment using multistaged household cluster sampling.

BackgroundMyanmar transitioned to a nominally civilian parliamentary government in March 2011. Qualitative reports suggest that exposure to violence and displacement has declined while international assistance for health services has increased. An assessment of the impact of these changes on the health and human rights situation has not been published.Methods and FindingsFive community-based organizations conducted household surveys using two-stage cluster sampling in five states in eastern Myanmar from July 2013-September 2013. Data was collected from 6, 178 households on demographics, mortality, health outcomes, water and sanitation, food security and nutrition, malaria, and human rights violations (HRV). Among children aged 6-59 months screened, the prevalence of global acute malnutrition (representing moderate or severe malnutrition) was 11.3% (8.0 – 14.7). A total of 250 deaths occurred during the year prior to the survey. Infant deaths accounted for 64 of these (IMR 94.2; 95% CI 66.5-133.5) and there were 94 child deaths (U5MR 141.9; 95% CI 94.8-189.0). 10.7% of households (95% CI 7.0-14.5) experienced at least one HRV in the past year, while four percent reported 2 or more HRVs. Household exposure to one or more HRVs was associated with moderate-severe malnutrition among children (14.9 vs. 6.8%; prevalence ratio 2.2, 95% CI 1.2-4.2). Household exposure to HRVs was associated with self-reported fair or poor health status among respondents (PR 1.3; 95% CI 1.1 – 1.5).ConclusionThis large survey of health and human rights demonstrates that two years after political transition, vulnerable populations of eastern Myanmar are less likely to experience human rights violations compared to previous surveys. However, access to health services remains constrained, and risk of disease and death remains higher than the country as a whole. Efforts to address these poor health indicators should prioritize support for populations that remain outside the scope of most formal government and donor programs.

In Brief

Functional status plays an important role in the comprehensive characterization of older adults. Functional limitations are associated with an increased risk of adverse treatment outcomes, but there are limited data on the prevalence of functional limitations in older women with pelvic floor disorders.The aim of the study was to describe the prevalence of functional limitations based on health status in older women with pelvic organ prolapse (POP).This pooled, cross-sectional study utilized data from the linked Health and Retirement Study and Medicare files from 1992 through 2008. The analysis included 890 women age ≥65 years with POP. We assessed self-reported functional status, categorized in strength, upper and lower body mobility, activities of daily living (ADL), and instrumental ADL (IADL) domains. Functional limitations were evaluated and stratified by respondents self-reported general health status. Descriptive statistics were used to compare categorical and continuous variables, and logistic regression was used to measure differences in the odds of functional limitation by increasing age.The prevalence of functional limitations was 76.2% in strength, 44.9% in upper and 65.8% in lower body mobility, 4.5% in ADL, and 13.6% in IADL. Limitations were more prevalent in women with poor or fair health status than in women with good health status, including 91.5% vs 69.9% in strength, 72.9% vs 33.5% in upper and 88.0% vs 56.8% in lower body mobility, 11.6% vs 0.9% in ADL, and 30.6% vs 6.7% in IADL; all P < .01. The odds of all functional limitations also increased significantly with advancing age.Functional limitations, especially in strength and body mobility domains, are highly prevalent in older women with POP, particularly in those with poor or fair self-reported health status. Future research is necessary to evaluate if functional status affects clinical outcomes in pelvic reconstructive and gynecologic surgery and whether it should be routinely assessed in clinical decision-making when treating older women with POP.

Associations of stigma with negative health outcomes for people living with HIV in the Gambia: implications for key populations.

The HIV epidemic in the Gambia is concentrated among stigmatized key populations. This study explores the relationship between 3 types of HIV-related stigma and 3 health outcomes among people living with HIV (PLHIV) in the Gambia. Three hundred seventeen PLHIV from PLHIV support groups in the Gambia were surveyed using the PLHIV Stigma Index. Enacted stigma in health care settings was significantly associated with avoiding or delaying seeking care [adjusted odds ratio (aOR) = 3.03, 95% confidence interval (CI) = 1.24 to 7.89]; enacted stigma in the household or community (aOR = 1.21, 95% CI = 0.98 to 1.49) and internal stigma (aOR = 1.47, 95% CI = 0.96 to 2.22) were marginally associated. Enacted stigma in health care settings was significantly associated with non-use of antiretroviral therapy (aOR = 0.52, 95% CI = 0.31 to 0.88), whereas internal stigma and enacted stigma in the household or community were not. Enacted stigma in the household or community (aOR = 0.75, 95% CI = 0.64 to 0.87) and internal stigma (aOR = 0.69, 95% CI = 0.50 to 0.93) were significantly associated with poorer self-reported health status, whereas enacted stigma in health care settings was not. PLHIV in the Gambia face stigma regardless of identity as members of key populations, who may face dual stigma. Stigma mitigation represents a potentially important component of a comprehensive package of services to improve the HIV care continuum in the Gambia. Targeted interventions that address stigma with health care workers could facilitate antiretroviral therapy use and timely care seeking for PLHIV. Interventions to address internal stigma and enacted stigma in the household and community may yield additional dividends for the overall health of PLHIV. Examining only 1 domain of stigma may not be sufficient to understand the effect of stigma on a specific health outcome.

Association of childhood physical and sexual abuse with intimate partner violence, poor general health and depressive symptoms among pregnant women.

ObjectiveWe examined associations of childhood physical and sexual abuse with risk of intimate partner violence (IPV). We also evaluated the extent to which childhood abuse was associated with self-reported general health status and symptoms of antepartum depression in a cohort of pregnant Peruvian women.MethodsIn-person interviews were conducted to collect information regarding history of childhood abuse and IPV from 1,521 women during early pregnancy. Antepartum depressive symptomatology was evaluated using the Patient Health Questionnaire-9. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI).ResultsAny childhood abuse was associated with 2.2-fold increased odds of lifetime IPV (95%CI: 1.72–2.83). Compared with women who reported no childhood abuse, those who reported both, childhood physical and sexual abuse had a 7.14-fold lifetime risk of physical and sexual IPV (95%CI: 4.15–12.26). The odds of experiencing physical and sexual abuse by an intimate partner in the past year was 3.33-fold higher among women with a history of childhood physical and sexual abuse as compared to women who were not abused as children (95%CI 1.60–6.89). Childhood abuse was associated with higher odds of self-reported poor health status during early pregnancy (aOR = 1.32, 95%CI: 1.04–1.68) and with symptoms of antepartum depression (aOR = 2.07, 95%CI: 1.58–2.71).ConclusionThese data indicate that childhood sexual and physical abuse is associated with IPV, poor general health and depressive symptoms in early pregnancy. The high prevalence of childhood trauma and its enduring effects of on women’s health warrant concerted global health efforts in preventing violence.

Frailty among Mexican community-dwelling elderly: a story told 11 years later. The Mexican Health and Aging Study.

To describe the characteristics and prognosis of subjects classified as frail in a large sample of Mexican community-dwelling elderly. An eleven-year longitudinal study of 5 644 old adults participating in the Mexican Health and Aging Study (MHAS). Frailty was defined by meeting at least three of the following criteria: weight loss, weakness, exhaustion, slow walking speed and low physical activity. The main outcomes were incident disability and death. Multiple covariates were used to test the prognostic value of frailty. Thirty-seven percent of participants (n= 2 102) met the frailty criteria. Frail participants were significantly older, female, less educated, with more chronic disease, lower income, and poorer self-reported health status, in comparison with their non-frail counterparts. Frailty was a predictor both for disability activities of daily living and for mortality. After a follow-up of more than ten years, the phenotype of frailty was a predictor for adverse health-related outcomes, including ADL disability and death.

Factors associated with poor self-reported health status after aortic valve replacement with or without concomitant bypass surgery.

Improving patients' health status is a central goal for cardiac surgery. Knowledge remains sparse on how combined CABG or other factors influence long-term, self-reported health status after aortic valve replacement (AVR). The aims of this study were (i) to identify significant factors influencing self-reported health status of patients assessed up to 13 years after AVR; and (ii) to compare their health with the age- and gender-matched general population. A survey questionnaire was sent to 1191 patients who had undergone AVR with or without concomitant CABG between 2000 and 2012. Physical and mental sum scores of Short Form 12 were used as dependent variables and 34 independent variables including the Minnesota living with Heart Failure Questionnaire (MLHFQ) were evaluated by hierarchical linear regression. A comparison was made with the Norwegian general population. Clinical data were obtained from the local cardiac surgery database. In all, 912 patients (77%) responded (mean age: 73 years; 63% men). Of these, 59% had an isolated AVR. The mean assessment interval since surgery was 6 years. Several factors significantly predicted worse physical health: low education level (b: -2.8, P = 0.005), higher preoperative EuroSCORE (b: -0.88, P = 0.007), high NYHA class (b: -4.5, P < 0.001), depression (b: -5.62, P = 0.012), worse MLHFQ physical scores (b: -0.70, P < 0.001), arthritis (b: -5.13, P = 0.003), osteoporosis (b: -6.96, P = 0.010) and cancer (b: -4.48, P = 0.047) accounting for 60% of the variation (P < 0.001). Living alone (b: -3.60, P < 0.001), anxiety (b: -12.99, P < 0.001), depression (b: -6.82, P < 0.001) and worse MLHFQ emotional score (b: -0.50, P < 0.001) predicted poor mental health status, and explained 58% of the variation among AVR patients (P < 0.001). Both genders had poorer physical and mental health than their age-matched general population peers, particularly those in older age groups. AVR patients, regardless of gender, had worse physical and mental health than the general population. Living alone, educational level, physical symptom status, anxiety and depression were the most important predictors of physical and mental health status after AVR. Implementing new screening protocols for psychosocial risk factors and individualized rehabilitation programmes may contribute to improved health in AVR patients.

Trust in physicians among U.S. chinese older adults.

Trust in physicians influences the health and well-being of older adults and is an important indicator to assess the quality of medical care. However, Asian aging populations are often underrepresented in studies of patient trust in physicians. This study aims to examine the level of trust in physicians among Chinese older adults in a community-dwelling Chinese aging population. Data were drawn from the Population Study of Chinese Elderly, a population-based survey of U.S. Chinese older adults in the Greater Chicago area. Guided by a community-based participatory research approach, a total of 3,159 Chinese older adults aged 60 and above were surveyed. An 11-item scale was used to measure participants' trust in physicians. On a scale of 11-55, the level of trust in physician among U.S. Chinese older adults was 42.0 (SD = 6.3). Items related to confidence in physicians' knowledge and skills were most commonly endorsed, including trusting physicians' judgment on medical care (84.8%), trusting physicians' advice (84.2%), and trusting physicians' words that something is so and must be true (81.2%). Younger age, male gender, higher educational level, fewer years of residing in the United States and in the community, poorer self-reported health status, and poorer quality of life were associated with lower level of trust in physicians. Trust in physician is commonly endorsed among U.S. Chinese older adults. However, future longitudinal studies are needed to improve our understanding of risk factors and outcomes associated with trust in physicians among U.S. Chinese older adults.

Factors associated with unhealthy behaviours and health outcomes: a cross-sectional study among Tuscan adolescents (Italy).

BackgroundWe aimed to determine the extent to which three core variables (school environment, peer group and family affluence) were associated with unhealthy behaviours and health outcomes among Tuscan adolescents. The unhealthy behaviours considered were smoking, alcohol consumption, sedentary lifestyle and irregular breakfast consumption; health outcomes were classified as self-reported health, multiple health complaints and life satisfaction. School environment was measured in terms of liking school, school pressure, academic achievement and classmate support; peer groups were evaluated in terms of the number of peers and frequency of peer contact. Family affluence was measured on a socioeconomic scale.MethodsData were taken from the Tuscan 2009/10 survey of “Health Behaviour in School-aged Children”, a WHO cross-national survey. A binary logistic multiple regression (95% confidence intervals) was implemented.ResultsThe total sample comprised 3291 school students: 1135 11-year-olds, 1255 13-year-olds and 901 15-year-olds. Peer group and school environment were associated with unhealthy behaviours such as smoking, alcohol consumption and sedentary lifestyle. Family affluence proved to have less impact on unhealthy behaviours, except in the case of adolescents living in low-income families. Poor health outcomes were directly related to a negative school environment. Regarding the influence of family affluence, the results showed higher odds of life dissatisfaction and poor self-reported health status in medium-income families, while low-income families had higher odds only with regard to life dissatisfaction. A consistent pattern of gender differences was found in terms of both unhealthy behaviours and health outcomes.ConclusionsUnhealthy behaviours are strongly related to the school environment and peer group. A negative school environment proved to have the strongest relation with poor health outcomes.