Self-perceived Health Research Articles

The value of healthy ageing: Estimating the economic value of health at older ages using time use data

Abstract While health naturally has intrinsic value and maintaining health as people age seems to make good economic sense, making the case for investing in health at older ages can be challenging. Much economic growth is historically attributed to the working-age population; however, maintaining good health as people age also enables older people to contribute meaningfully to the economy. Investing in health at older ages, therefore, can be strategic economic policy. We develop a novel method to quantify the economic value of health through time use data. Using data from the United Kingdom Time Use Survey (UKTUS) 2014-15 for individuals aged 65 years-old and older, we apply survey-weighted generalized linear models to predict the time spent in non-market productive activities based on age and self-perceived health. We then quantify the monetary value of time spent engaging in these activities and simulate the monetary impact of health gains at older ages. Both age and self-perceived health status were associated with minutes spent in many non-market productive activities. Being in ‘very good’ instead of ‘very bad’ self-perceived health is associated with an additional production of 439£, 629£, and 598£ per month for an average individual aged 65 to 74 years-old, 75 to 84 years-old, and 85 years-old and older, respectively. Our simulation model indicates that improving the health of 10% of older people in ‘very bad’ health could lead to an economic increase of up to 278£ million through non-market activities. Health at older ages creates considerable economic value which is not captured using standard national accounting measures. Our work highlights the importance of health for functional capacity as people age, allowing them to engage more in non-market activities. Our method to quantify the monetary value of health can be adapted to other settings to make the economic case for investing in healthy ageing.

Sarcopenia and associated factors among older adults at high risk of dementia

Abstract Background Sarcopenia and dementia share pathophysiological pathways and risk factors, including advanced age, physical inactivity, unhealthy diet, smoking and diabetes. Older adults at high risk of dementia may face increased susceptibility to sarcopenia, which can also exacerbate cognitive decline. Thus, this study aims to estimate the frequency of sarcopenia and its associated factors within this vulnerable population. Methods This cross-sectional analysis includes data from a subset of older adults (≥65 years of age) enrolled in the MIND-Matosinhos randomized controlled trial, a community-based cognitive decline prevention program. Per the European Working Group on Sarcopenia in Older People, probable sarcopenia is defined as low muscle strength (handgrip strength <16 kg for women and <27 kg for men). Sociodemographic, lifestyle and health-related data were collected via structured questionnaires. To assess factors associated with sarcopenia, odds ratios (OR) and respective confidence intervals (95% CI) were estimated using logistic regression. Results A total of 157 participants (58.6% female), with a median age of 73 years (range: 65 to 85 years), were included. The overall prevalence of sarcopenia was 21.7% (n = 34). After adjusting for sex, age and education, inadequate adherence to Mediterranean Diet (MD) (OR = 10.90; 95% CI:1.41-84.52), current smoking status (OR = 5.06; 95% CI:1.06-24.18) and poorer self-perceived health (OR = 2.74; 95% CI:1.03-7.28) were positively associated with sarcopenia. No other statistically significant associations were found. Conclusions The observed sarcopenia frequency underscores the need for enhanced screening and management of this condition in community settings and among those at dementia risk. Inadequate adherence to MD, smoking and poor self-perceived health, seem to be associated with sarcopenia in older adults at high risk of dementia. Sarcopenia prevention should involve a holistic approach to promoting a healthy lifestyle. Key messages • Sarcopenia was observed in 21.7% of older adults at high risk of dementia, indicating a significant burden on this vulnerable population. • Inadequate adherence to the Mediterranean diet, smoking and poor self-perceived health were associated with sarcopenia.

The Health-Employment-Longevity Nexus: Implications for Retirement Age Policies in European Countries

Abstract Background Advances in medical knowledge and technology have led to increased general and healthy life expectancy in Europe. Combined with declining fertility rates, these trends have resulted in an aging population. Many European countries have been reluctant to adjust the retirement age, putting pension funds and Pay-As-You-Go social insurance systems at risk. Linking entitlement age to life expectancy could mitigate this risk and extend working life, but such policies are politically unpopular. This study investigates the empirical relationship among self-perceived health, employment, job quality, and life expectancy in the European context. Methods The study analyzes the determinants of self-rated health using the SHARE database, combined with general and healthy life-expectancy data from EUROSTAT and, where missing, the WHO, focusing on European countries. Results In Europe, both past and present employment improve self-rated health. Job quality has a detrimental effect on self-rated health for women and a positive effect on men. Life expectancy and healthy life expectancy raise self-rated health, while poverty rates negatively affect it. Job quality is widespread among European women, and its negative effect on health rises with age. For European men, job quality has a positive effect, peaking around age 56. The effects of employment and job quality on self-rated health are simultaneous. In European countries with an elasticity >1, healthy life expectancy rises faster than general life expectancy at higher ages, suggesting an improved ability to work at older ages. This finding indicates that adjusting the retirement age could be a powerful tool for improving the sustainability of social insurance systems in Europe. Conclusions For younger European women, it may be rational to set higher retirement-age increments and put them on a declining course as they age, considering the gender-specific age dynamics and job quality effects on health. Key messages • In Europe, employment and job quality significantly influence self-rated health, with gender-specific effects that vary with age and impact retirement age policies. • Adjusting retirement age in line with healthy life expectancy could improve the sustainability of European social insurance systems, considering health-employment dynamics.

Trust in sources of information about digital health technologies: The User’s Perspective

Abstract Background Trust is key to healthcare, including all types of health information. This applies not only to the process of healthcare delivery, but also to health-related behaviors and the utilization of healthcare services. Trust in health information sources has been shown to vary by social and health characteristics. Therefore, the research question is: Are there social and health-related differences in perceptions of trust in sources of information (government agencies or physicians) about digital health technologies? Methods The analysis is based on a cross-sectional online survey (STELLAR) conducted in 2022 (N = 1,200), Participants were asked whether they perceive trust (1= fully agree- 4= not at all) in information about digital health technologies provided by government agencies (institutional trust) or physicians (interpersonal trust). For the analysis, binary logistic regressions (references: traditionalists, low education level, poor self-perceived health) were used. Results Institutional Trust. Overall, 43.9% of the participants perceived trust in this information source. Baby Boomers (OR 2.022), Generation Y (OR 2.544), and Generation Z (OR 2.566), as well as medium (OR 2.526) and high (OR 3.823) educational level, increased the odds of perceived trust; the same was found for better self-perceived health (OR 1.569). Interpersonal Trust. In general, 94.8 % of the participants expressed trust physicians. Belonging to Generation Z decreased the chance (OR 0.097) and a better subjective health status increased the chance (OR 4.250) of perceiving trust. Education did not emerge as a significant determinant. Conclusions The study confirmed that interpersonal and institutional trust varies by social and health characteristics. There seems to be a need to strengthen efforts to explain the process of trust building in different population groups., e.g. to find explanations for why educational level was only relevant for institutional trust but not for interpersonal trust. Key messages • Trust in sources of information about digital health technologies differ by generation, educational level, and subjective health status. • Given the existing differences in perceptions of trust, it is worthwhile to explore the unknown mechanisms of the trust-building process among different population groups.

Diabetes mellitus EU comorbidity index: using data from EHIS 2019 and GBD disability weights

Abstract Background Individuals with diabetes mellitus (DM) exhibit several of comorbidity burdens, with lower perceived quality of life also being a factor. Literature on the impact of DM is available, including studies on the index devised by (A. Andreella et al., 2023) for the assessment of comorbidities of health conditions. This study aims to adapt and validate this index for use as a standardized DM comorbidity index within the EU. Methods A cross-sectional study was carried out using microdata from the European Health Interview Survey (EHIS) 2019. The study included adults aged 25 years or older who reported having DM (n = 20,042) from 27 EU member states. Comorbidity index was calculated to assess the comorbidity of having 9 non-communicable diseases using disability weights obtained from the Global Burden of Disease 2019 and self-perceived general health using multiplicative approach. Beta regression analysis was used to evaluate the association between comorbidity index and several demographic, socioeconomic and lifestyle variables. Comorbidity index was calculated for each nomenclature of territorial units for statistics (NUTS 2). Results The comorbidity index ranged from 0.049 to 0.993. The results indicated that having a higher education and residing in urban areas were less likely to have a high comorbidity index. Being unemployed or in other employment statuses demonstrated a significant, positive association with the index. Income exhibited a gradual, positive association with each quintile, while consuming fruits and vegetables less than once a week was found to be associated with an increased index. The highest comorbidity index was observed in Calabria (Italy), followed by Lubuskie (Poland), and the lowest was observed in Antwerp (Belgium), followed by Övre Norrland (Sweden). Conclusions By identifying comorbidity burden, targeted interventions and regional-specific strategies can be implemented to improve the quality of life for individuals with DM. Key messages • Quantifying the burden of comorbidities allows understanding of health status of DM patients. • Comorbidity index shows geographic variation in the EU which contributes to tailored policy interventions.

Defining digital health literacy profiles in Spanish adults: a latent class analysis

Abstract Background According to different reports, Spain is among the European countries that use digital health technologies the most. However, to develop inclusive and fair digital health services, there is the need to feature digital health knowledge, skills, confidence, and a positive attitude about their significance. This work aims to draw a picture of digital health literacy levels in Spain. Methods A stratified sample of the Spanish population regarding gender, age group and area of residence was used. Participants were recruited from an online panel and by direct approach to balance quotas. Between May 2021- May 2022, participants filled a self-administered online survey, including the Spanish version of the eHealth Literacy Questionnaire (eHLQ) and the eHealth Literacy Scale (eHEALS). Results Digital health literacy showed similar mean scores, between 2.6-2.7 out of 5 with similar SD on each of the 7 dimensions of the eHLQ. The highest scores were related to knowledge about filling data in digital health services and knowledge about health and how the body works, and feelings about the usefulness of digital technology for health. In contrast, lower scores were related to sharing health information by technology, thinking that using technology gives access to better health services, and the possibility to contact usual health professionals with technology. Latent profile analysis identified 5 user profiles. Significant differences were found according to age, inhabitants per municipality, technology use, self-perceived health status, educational level, socioeconomic index and eHEALS scores; not by gender. Conclusions As the scores are similar in the different subscales, competencies, attitudes and confidence in digital health that they measure are balanced. However, the main challenge appears in granting users access to digital services that work, which involves the definition and monitoring of strategies until the final implementation. Key messages • Digital Health literacy in Spain differs according to different aspects, not only age, educational or socioeconomic level. • Confidence in usefulness is a common denominator among the five digital health service user profiles identified.

Impacts of an interpretation fee on immigrants’ access to healthcare: A Danish survey study

Abstract Background In 2018, a fee for healthcare interpretation was introduced for immigrants living in Denmark for more than 3 years to incentivize learning Danish faster. The fee entails out-of-pocket costs ranging from 26-225 EUR per consultation, outpatient visit, or hospital admission. Little evidence is available on how immigrants experience impacts of the fee on their access to healthcare. The study aims to address this gap. Methods Using survey data collected among newly arrived immigrants (n = 486) at 26 cluster-randomly selected language schools in 2021, we analysed prevalence and socio-demographic background of immigrants reporting interpretation needs, and self-reports about whether the fee had caused immigrants to refrain from seeking healthcare, using ad hoc interpreters, and trying to learn Danish faster. Results In the study population, 19% (95% C.I. 14-26%, n = 95) reported interpretation needs. Refugees and their families (OR: 10.2, 95% C.I. 5.3-19.7) more often reported interpretation need compared with EU/EEA immigrants, as did immigrants with low education (OR: 1.9, C.I. 1.2-2.8), low income (OR: 2.6, C.I. 1.6-4.5) or poor self-perceived health (OR: 3.2, C.I. 1.1-9.2), adjusted for gender, age, region of residence, and length of stay. Among immigrants needing interpretation, 42% (C.I. 32-53%, n = 69) reported having refrained from seeking healthcare due to the fee, 73% (C.I. 55-86%, n = 119) using ad hoc interpreters, and 77% (C.I. 59-89%, n = 126) trying to learn Danish faster. Conclusions Findings suggest that the policy aim of incentivizing resettlement country language acquisition is partly met, but that the fee has unintended consequences in terms of hampered access to healthcare and increased use of ad hoc interpreters, raising concerns about unmet health needs and poorer quality of care, especially for vulnerable immigrants. Potential benefits of the policy should be carefully evaluated against severe negative impacts on immigrants’ access to healthcare. Key messages • Healthcare interpretation fees appear to be incentivizing acquisition of the resettlement language, but at the same time severely hamper access to care. • The fee appears to disproportionately affect vulnerable immigrants, including refugees and their families and immigrants with low education, low income, and poor health.

Inequalities in access to healthcare for older adults during COVID-19 pandemics in Lithuania

Abstract Background During COVID-19 pandemic, healthcare systems experienced unprecedented shock. Older adults were the most vulnerable group of Lithuanian society, facing distinctive health challenges and highest mortality rates. The aim of the study was to examine perceived inequalities and challenges in access to healthcare of Lithuanian population over 65 years old during COVID-19 pandemic. Methods Representative sample of Lithuanian population over 65 years old (1503 individuals) was involved in the anonymous questionnaire survey, performed in January, 2024. Results 22 % of respondents reported not using healthcare services during COVID-19 pandemics. Among them, 76% did not have any need for healthcare services, while 13.6% did not approach healthcare due to fear of getting infected by Covid-19, and the other 10.4% had various accessibility challenges. 15.8% reported frequent problems in registering with family doctors, and 20.0% - with the specialist appointment. There was a clear social gradient observed among those underserved: it was associated with educational level and place of residence. Those with lower education and living in smaller towns and rural areas reported more common healthcare accessibility problems. Higher education, income and better self-perceived health correlated with higher satisfaction with travel time reaching health care services and registering for the appointment (p < 0.05). Conclusions Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. Limited health care accessibility and clear social gradient could increase vulnerability of older adults, which resulted in exceptionally high mortality rates during COVID-19 pandemics. Results of the survey will be used for further development of transformative capabilities of healthcare system, responding to public health disasters and protection of the vulnerable groups of the society. Key messages • Limited health care accessibility and clear social gradient could increase vulnerability of older adults, which resulted in exceptionally high mortality rates during COVID-19 pandemics. • Results of the survey will be used for further development of transformative capabilities of healthcare system, responding to public health disasters.

Association of Muscle Strength With All-Cause Mortality in the Oldest Old: Prospective Cohort Study From 28 Countries.

Ageing is associated with a gradual loss of muscle strength, which in the end may have consequences for survival. Whether muscle strength and mortality risk associate in a gradual or threshold-specific manner remains unclear. This study investigates the prospective association of muscle strength with all-cause mortality in the oldest old. We included 1890 adults aged ≥ 90 years (61.6% women, mean age 91.0 ± 1.5 years) from 27 European countries and Israel participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) study. Muscle strength was assessed using handgrip dynamometry (unit: kilogram). Using time-varying Cox regression with restricted cubic splines, we determined the prospective association of muscle strength with mortality, controlling for age, sex, smoking, BMI, marital status, education, geographical region and self-perceived health. Over a mean follow-up of 4.2 ± 2.4 years, more than half of the participants died (n = 971, 51.4%). The mean handgrip strength was 20.4 ± 8.0 kg for all participants, with men (26.7 ± 7.5 kg) showing significantly higher strength than women (16.4 ± 5.4 kg) (p < 0.001). Using the median level of muscle strength as reference (18 kg), lower and higher levels were associated in a gradual and curvilinear fashion with higher and lower mortality risk, respectively. The 10th percentile of muscle strength (10 kg) showed a hazard ratio (HR) of 1.27 (95% CI 1.13-1.43, p < 0.001). The 90th percentile (31 kg) showed an HR of 0.69 (95% CI 0.58-0.82, p < 0.001). Stratified for sex, the median levels of muscle strength were 26 kg for men and 16 kg for women. The 10th percentile of muscle strength showed HRs of 1.33 (95% CI 1.10-1.61, p < 0.001) at 15 kg for men and 1.19 (95% CI 1.05-1.35, p < 0.01) at 10 kg for women. The 90th percentile of muscle strength showed HRs of 0.75 (95% CI 0.59-0.95, p < 0.01) at 35 kg for men and 0.75 (95% CI 0.62-0.90, p < 0.001) at 23 kg for women. Sensitivity analyses, which excluded individuals who died within the first 2 years of follow-up, confirmed the main findings. Rather than a specific threshold, muscle strength is gradually and inversely associated with mortality risk in the oldest old. As muscle strength at all ages is highly adaptive to resistance training, these findings highlight the importance of improving muscle strength in both men and women among the oldest old.

Relationship Between Frequency of Physical Activity, Functional Mobility, and Self-Perceived Health in People with Different Levels of Pain: A Cross-Sectional Study.

Background: Habits including regular physical activity are necessary for maintaining good health. Functional mobility, including walking and going up and down stairs, is essential for personal autonomy and well-being. Pain is a condition related to biological and psychosocial aspects that influence people's lives. Objective: The main objectives of this study were (1) to analyse the associations between physical activity frequency (PAF) and self-perceived health (SPH) and functional mobility (walking and going up and down stairs) in middle-aged and older people living in Spain with different pain levels; and (2) to analyse the risk factors for having a negative SPH and functional mobility difficulties by calculating the probabilistic risks adjusted by different variables (sex, body mass index, social class, civil status, smoking status, pain level, and PAF). Methods: A cross-sectional study based on the European Health Survey data in Spain (EHSS 2014-2020) and The Spanish National Health Survey (SNHS 2017) was carried out, with a final sample of 21,152 participants with ages between 40 and 79 years. Results: Associations between high pain levels and worse SPH and difficulties in walking and climbing stairs were found. Lower PAF levels were associated with higher-probability risks of having a negative SPH and difficulties in walking and climbing stairs. Conclusions: Physical inactivity emerged as an important risk factor for worse SPH and functional mobility. These associations underline the importance that PA programmes can play in the improvement of health and functional mobility, as well as in other aspects, in people with pain.

Work ability data management in multisectoral services for people with disabilities: a cross-sectional study

Successful collaboration between professionals working in multisectoral services for people with disabilities requires access to data on the client’s work ability. This study examines work ability data needs, availability, and acquisition in social and health care services and employment services and explores possible differences between these service sectors. A cross-sectional survey was carried out using a self-developed questionnaire based on Choo’s information management process model, the Work Ability House model and previous research on work ability data. The questionnaire was targeted at physicians, nurses, physiotherapists, psychologists, and experts who support the work ability of people with disabilities and who work in primary health care, specialised health care, social services or employment services. The findings indicate that data on clients’ self-perceived health status is more frequently available than data on self-perceived work ability. This variability in data availability exists across professional sectors, highlighting the need for enhanced data management practices related to work ability assessment and support among professionals in social and health care services and employment services. The study underscores the importance of increasing professionals’ willingness to discuss work ability issues with working-age clients, particularly in primary health care and social services. These findings are pertinent in terms of enhancing multisectoral collaboration among professionals who need to comprehensively assess and support the work ability and employment of people with disabilities. Also, the study provides a diverse list of individual pieces of data related to work ability.

Risk factors for hospitalisation in community-dwelling pre-frail and frail older people: results of a longitudinal study.

Older adults account for a large proportion of hospital admissions. In this study we aim to bridge a gap between medical and psychosocial factors in predicting hospitalisation. Demographic and social characteristics of community-dwelling pre-frail and frail older people were collected by questionnaires every six months during a two year follow-up. Hospital admission within this period was dichotomised as yes/no. To define pre-frailty and frailty the Fried frailty criteria were used. Analysis of risk factors for hospitalisation was performed using multivariable logistic regression. Hospitalised participants (n = 1803) were more often male and frail in comparison to not-hospitalised participants. They also experienced more chronic diseases (54.5% ≥ 4 chronic diseases), poorer self-perceived health (SPH) (76.4% fair to very poor) and lack of informal care (20.1%). In multivariable logistic regression male gender (Odds ratio (OR) 1.65, p < 0.001), frailty (vs. pre-frailty) (OR 1.66, p = 0.002), reporting lower SPH (OR 3.12, p < 0.001) and lacking informal care (OR 1.69, p < 0.001) showed significant associations with hospital admission. Subgroup analysis of pre-frail and frail participants, showed consistent associations between male gender (respectively OR 1.61, p < 0.001 ; OR 1.72, p = 0.085), lower SPH (OR 2.23, p = 0.001; OR 31.16, p < 0.001), lack of informal care (OR 1.64, p = 0.005; OR 2.63, p = 0.012) and hospitalisation. Frailty, male gender, lower SPH and lack of informal care are risk factors for hospitalisation within community-dwelling older people, showing the need of a holistic approach to possibly prevent hospitalisation. Further research should focus on evaluating individual factors for hospitalisation, particularly targeting pre-frail individuals.

Exploring cervical cancer mortality in Brazil: an ecological study on socioeconomic and healthcare factors

ObjectiveTo evaluate the correlation between socioeconomic and healthcare factors and cervical cancer mortality rates, as well as the accessibility to prevention and treatment across Brazilian states and macroregions. The aim...

A nomogram model for predicting frailty in middle-aged and elderly patients with colorectal cancer:A cross-sectional study

PurposeFrailty is a syndrome caused by multiple factors and can lead to serious consequences for middle-aged and elderly patients with colorectal cancer. However, few studies have comprehensively explored predictors of frailty and built predictive models. Therefore, our aim is to develop and evaluate a predictive model for frailty in middle-aged and elderly patients with colorectal cancer. MethodsFrom July 2023 to February 2024, a total of 502 middle-aged and elderly patients with colorectal cancer participated in this survey. Patients were randomly divided into training and validation groups in a 7:3 ratio. Univariate and multiple logistic regression analysis were employed to identify potential predictors of frailty in these patients. A nomogram was constructed based on the predictive factors, and the model underwent internal validation. ResultsIn the training cohort, logistic regression revealed that self-perceived health, chronic pain, loneliness, depression, and health-promoting lifestyle were independent predictors of frailty. The Areas Under the Curve (AUC) of the training and validation groups were 0.845 and 0.851, respectively. The calibration curve of the nomogram demonstrated good consistency between predicted and actual probabilities. Decision curve analysis revealed good clinical benefit. ConclusionsThis study established a predictive model with satisfactory predictive ability, providing empirical evidence for the early detection and intervention of frailty in middle-aged and elderly patients with colorectal cancer. The nomogram model has significant potential for clinical application, as it can be integrated into routine oncology practice to identify high-risk patients early, allowing for timely and individualized interventions to improve patient outcomes.

Accuracy of self-perceived cardiovascular disease risk and factors predicting risk underestimation in perimenopausal and postmenopausal women in Ismailia, Egypt.

Cardiovascular disease (CVD) is the leading cause of death globally, with women at higher risk after menopause. This increased risk is attributed to both aging and hormonal changes. Prior research has established a link between CVD risk perception and adopting healthy behaviors to prevent CVD. This study aimed to assess the accuracy of self-perceived CVD risk in perimenopausal and postmenopausal women, and to identify factors that predict CVD risk underestimation among them. A cross-sectional study was conducted in the administrative sectors of Suez Canal University campus in Ismailia, Egypt, over a period of eight months starting in July 2022. A total of 390 eligible women (employees and workers) were randomly selected. Participants were interviewed to obtain data on demographics, medical history, self-perceived risk of CVD, self-perceived general health, awareness of factors that increase the risk of developing CVD, perceived stress, health literacy, numeracy, and self-perceived 10-year risk of developing major cardiovascular events. They also underwent measurements of blood pressure, weight, and height. The updated 2019 WHO/CVD risk non-laboratory-based prediction chart for the North Africa and Middle East Region was used to predict the 10-year risk of major cardiovascular events for the study participants. Risk accuracy was measured by comparing self-perceived CVD risk with predicted CVD risk. The ratio of self-perceived to predicted moderate/high CVD risk was 27.7% to 44.3%, respectively. The accuracy of CVD risk perception was 68.2%. Kappa analysis results showed fair and significant agreement between self-perceived and predicted CVD risk (kappa ± SE = 35.9 ± 4.1%, p < 0 .001). The proportion of women who underestimated their risks was 24.1%. Of those in the high-risk group, 93.3% underestimated their CVD risk, compared to 50.6% in the moderate-risk group. Factors that significantly predicted CVD risk underestimation included being married (aOR 14.5; 95% CI 1.4-149.9), low income (aOR 2.321; 95% CI 1.09-4.909), high BMI (aOR 4.78; 95% CI 1.9-11.9), hypertension (aOR 3.5; 95% CI 2-6.2), and old age (aOR 1.46; 95% CI 1.3-1.6). Approximately one-third of our study participants misperceived their CVD risk; of those who did, 75.8% underestimated it. Marital status, old age, low income, high BMI, and hypertension strongly predicted CVD risk underestimation. These findings identified the menopausal women subgroups that could benefit from targeted health interventions designed to reduce CVD risk underestimation and improve risk accuracy.

The Impact of the COVID-19 Pandemic on Suicidal Ideation and Depression in Community-Dwelling Elderly.

This study examined the effects of the coronavirus disease 2019 (COVID-19) pandemic on depression and suicidal ideation in community-dwelling elderly in Korea. Data were employed from a survey on elderly mental health in Jeollanam-do (southwest province in Korea), conducted by the Jeollanam-do Provincial Mental Health and Welfare Center. A total of 2423 people were recruited from all 22 cities in Jeollanam-do from April to October, 2021. We used self-reported questionnaires including sociodemographic factors, COVID-19-related stress, the Geriatric Depression Scale-Short Form Korean Version, the Multidimensional Scale of Perceived Social Support, the Satisfaction With Life Scale and the Brief Resilience Scale. Logistic regression was performed to examine the factors of depression and suicidal ideation. Of the 2423 subjects, 622 (25.7%) reported depressive symptoms and 518 (21.4%) reported suicidal ideation. The multivariate logistic regression analysis revealed that living alone, poor perceived health status, worry of COVID-19 infection, and restriction of daily activities due to COVID-19 pandemic are significantly associated with depression. Female gender, poor perceived health status, inability to perform household chores, and depressive symptom are risk factors of suicidal ideation. These findings show that old age, negative perception of health, and restriction of daily activities due to COVID-19 are risk factors of depression in community-dwelling elderly in the context of the COVID-19 pandemic. Female gender, poor self-perceived health status, and depression increase the risk of suicidal ideation among the elderly. Social support and life satisfaction are protecting factors of both depression and suicidal ideation. Resilience decreased risk of depression but not in suicidal ideation.

Feeling discriminated means poor self-perceived health: a gender analysis using SHARE.

Most part of the literature has highlighted the detrimental effects of discrimination on health. However, the influence of past and perceived discrimination on older workers' self-assessed health has been understudied. Firstly, we aim at studying whether reported discrimination is associated with self-assessed health among adults of working ages (50-65 years of age). Secondly, we analyze the existence of differences by gender. Data was retrieved from the seventh wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to obtain the regular panel of questions, and the third and seventh waves of the SHARELIFE questionnaire, that includes information about discrimination (n = 30,019). We develop logistic regression models to determine the relationship of discrimination on male and female workers' self-assessed health separately. Our results show that 49.0% of our sample was composed of highly discriminated women, while the remaining percentage covered men and women (42.3% males and 8.7% females) that reported lower levels of discrimination. Our estimations reveal a significant association between discrimination and poor health status, especially in the case of men ranging from OR = 1.802 (95% CI 1.502-2.163) to OR = 1.565 (95% CI 1.282-1.910). In the case of women our results range from OR = 1.728 (95% CI 1.463-2.040) to OR = 1.196 (95% CI 0.992-1.442). These findings are essential to highlight the importance of tackling discrimination as a determinant of health that negatively affects both sexes, men and women.

Impact of self-perceived oral health and socio-economic factors on oral health-related behavior in Estonian adults.

To identify which socioeconomic factors are affecting oral health-related behavior and to provide suggestions for improving the population's oral health. Materials and methods: The survey includes population groups from age 35 and older from all 15 Estonian counties and major cities (n = 2,376). The study is based on data from a nationwide Estonian Adult Oral Health Survey questionnaire. In addition to analyzing eight aspects of oral health-related behavior and self-perceived oral health variables, the survey also includes participants' socio-economic and demographic characteristics. The study utilizes frequency tables (including cumulative distributions), means, correlations, and regression analysis as its methods. The mean number of beneficial behaviors reported by the participant was 4.2 (SD 1.6). The value of the oral health-related behavior index (OHBI, the number of reported behaviors from the eight) is initially determined by the optimal timing between meals, abstinence from smoking, and the choice of drinking water or refraining from any intake between meals. Participants with higher OHBI tended to rate their self-perceived oral health better. Adherence to beneficial dental health-related behavior in Estonian adults is primarily influenced by gender, educational level, type of settlement, and household income level. In order to significantly improve oral health and related behaviors, it is imperative to integrate dental services into universal health coverage and deliver ongoing oral health education for adults.

Individual Characteristics Associated with Fears and Prevention Behaviors Related to Respiratory Infectious Disease among South Korean Adults Using Complex Sample Design.

This study aimed to identify the relationships among individual characteristics, COVID-19-related fears, and infection-prevention behaviors using data from 228,932 adults (weighted to 43,583,798.71) aged 19 and older who participated in the 2021 Community Health Survey conducted by the Korea Disease Control and Prevention Agency. The complex sample design analysis using SPSS 20.0 revealed the following. Women had statistically significantly higher COVID-19-related fears and a higher level of preventive behaviors compared to men. During the COVID-19 pandemic, the level of physical activity among men was higher than that of women. Compared to the period before COVID-19, the frequency of smoking and drinking decreased for both men and women, with the reduction being more pronounced in men than in women. The high-exercise group had a lower level of COVID-19-related fears. Self-perceived health status was inversely and significantly related to COVID-19-related fears. The low-exercise group had a lower score for self-perceived health status than the high-exercise group. This study demonstrated that maintaining sufficient physical activity positively influences self-perceived health and reduces anxieties related to COVID-19 infection and fatalities. The results highlight the importance of physical activity and the need to identify strategies that effectively maintain regular exercise while adhering to infection-prevention measures during pandemics.

YOUNGER HYPERTENSIVE PATIENTS HAVE LOWER HEALTH-RELATED QUALITY OF LIFE AND DIFFERENT HYPERTENSION CORRELATES. EVIDENCE FROM BULGARIA

The purpose of this study was to determine hypertension correlates among the patients' survey characteristics after splitting the sample into two groups based on their age and perform this assessment separately for each of the groups. Materials and methods. A cross-sectional retrospective study among 647 patients was conducted using self-administered EQ-5D 3L, as well as demographic, economic and health questions. Results. The overall self-reported arterial hypertension (AH) prevalence was 36.9%. The sample was split into two groups: 18-54 and 55+ years, with AH prevalence of 23.5% and 51%, respectively. The differences between AH and non-AH patients in each age group were explored. Younger AH patients significantly more often reported fatigue, headache, chest pain and having at least 1 acute condition for the last year than non-hypertensive ones at the same age. Diabetes, asthma/chronic bronchitis and joint pain/arthritis were also more common among younger AH patients. The overall HRQol and self-perceived health were significantly lower among young hypertensive patients, and their median severity index was higher compared to non-hypertensive adults of the same age. They more often experienced moderate pain/discomfort and moderate anxiety/depression. Despite of this, older AH patients reported similar HRQoL compared to non-AH patients. Conclusions. Different comorbidities were found amongst younger and older hypertensive patients. Most of the already known AH correlates were confirmed only among younger adults (18-54 years old). Arterial hypertension leads to significantly lower health-related quality of life, self-perceived health and higher severity index only among the younger group, mainly due to the depression and pain they experience.