Levels Of Self-rated Health Research Articles

Portrait of a Caregiver: Ethnodrama Development and Its Influence on Caregiver Well-Being.

The majority of long-term care needs are placed upon family members who often receive minimal support. In this study, we collaborate with family caregivers to create an ethnodrama about their experience and assess outcomes of participation, including caregiver well-being. Participants met over 4 months to discuss their roles as informal caregivers. Discussions were analyzed in a two-phase process and themes were developed into a script. Member checks included script review and revisions, culminating in viewing a professional performance of the play followed by a post-performance discussion and reflection. Data were gathered at six timepoints to assess caregiver well-being and longitudinal analysis was used to assess change during the course of the intervention. Twenty-two caregivers completed intervention activities. Participant reactions to the process evolved overtime, from an initial hesitance about what individuals had to offer leading to an acknowledgement of feeling heard and a desire to help others. Caregivers had high levels of burden and positive perceptions towards caregiving. Those with high levels of self-rated health had the lowest levels of burden and the most positive perceptions of caregiving. Developing an ethnodrama in partnership with caregivers is a unique and feasible method of caregiver support, mentoring, reflexivity, and meaning making. Promoting caregiver health early in the caregiving trajectory has the potential of reducing burden and elevating positivity towards caregiving.

Survey on the self-rated health of doctors and nurses at China′s 144 tertiary public hospitals

Objective To establish comprehensive understanding of the self-rated health of the Chinese doctors and nurses and probe into their influencing factors. Methods Data were drawn from a hospital performance survey, which was conducted by the Peking Union School of Public Health from March 18th to April 9th, 2019, among the 144 tertiary public hospitals in 31 provinces, autonomous regions, and municipalities. The survey included a cell-phone based questionnaire filled out by the sampled doctors and nurses, in which they were asked to rate their health using a 5-level Likert scale(from very poor to very good ). Mann-Whitney U test was used to analyze the differences in self-rated health between doctors and nurses. Chi-square test and two-class multivariate logistic regression were performed to analyze factors affecting self-rated health of the providers. Results Among the 144 sample hospitals, the proportion of doctors, who rated their health as healthy , was 20.30%(4 979/24 529), that of nurses was 28.92%(8 361/28 910). It was worse than that in some developed countries and lower than the general population in China. Multi-variate analysis showed that adequate sleeping time, satisfaction with the work and with the doctor-patient relationship, were positively associated with the level of self-rated health of the sampled doctors and nurses(P<0.05). It was also found that the longer the average weekly working time, the higher the recognition of the work load is too heavy , the lower the proportion of doctors and nurses who rated their health as healthy (P<0.05). Conclusions Sleep time, job satisfaction, workload and doctor-patient relationship are important factors affecting self-rated health of the Chinese doctors and nurses. Key words: Health status; Self-related; Medical staff; Influencing factors; Third party evaluation

Till Death Do Us Part: Intersecting Health and Spousal Dementia Caregiving on Caregiver Mortality.

We consider whether it is the healthiest dementia caregivers who experience a mortality benefit and whether a protective association is consistent for leading causes of mortality. Using the Health and Retirement study (2000-2012), Cox survival models predict time to death for dementia caregivers, including an interaction between dementia caregiver status and self-rated health. The nationally representative sample consisted of 10,650 married adults aged 51 or older (917 dementia caregivers). A significant interaction between dementia caregiver status and self-rated health suggested that relative to noncaregivers, dementia caregivers had reduced mortality, with this effect particularly strong at lower levels of self-rated health. The protective effect of dementia caregiver status was consistent across death by heart disease, cancer, and cerebrovascular disease. These findings add to a growing body of literature suggesting that caregiving may provide a mortality benefit and a reason to maintain health.

Development of perceived job insecurity among young workers: a latent class growth analysis.

Individual differences in the development of perceived job insecurity among young workers may be influenced by characteristics of the first job (contract type and sector) and individual background (education and previous unemployment), and can have implications for subsequent health and well-being. The aim of this study was to investigate the development of perceived job insecurity during the early career, as well as associations between different patterns of development (i.e., trajectories), predictors and outcomes. We conducted a latent class growth analysis to identify trajectories of perceived job insecurity and investigated their respective associations with predictors and outcomes across 6 years in a sample of 1711 German labor market entrants. Six trajectories were identified: three showed stable job insecurity perceptions (stable moderate, 36%; stable low, 32%; stable high, 5%), two showed decrease (moderate to low, 12%; high to moderate, 3%), and one showed increasing job insecurity perceptions (low to moderate, 13%). Temporary contracts and previous unemployment predicted trajectories characterized by increasing, higher initial or higher overall levels of perceived job insecurity. In contrast, public sector employees and university graduates were less likely to experience persisting or increasing job insecurity. The trajectories differed in their overall levels of self-rated health and job satisfaction, but not with respect to change in these outcomes. Instead, increasing perceived job insecurity was associated with decreasing life satisfaction. The findings suggest that an insecure career start and individual risk factors may predispose young workers to anunfavorable development of both job insecurity perceptions and levels of well-being.

Impacts of income growth on air pollution-related health risk: Exploiting objective and subjective measures

China’s remarkable economic growth during the past four decades has resulted in a number of environmental problems. However, very few studies have addressed the interactive impact of both income and air pollution on public health. Thus, an innovative contribution of this paper is to test whether household income growth (HIG) can mitigate the health risks resulting from air pollution in China. More specifically, using pooled data from the China Health and Retirement Longitudinal Study and official statistical data, we try to estimate the interactive impact of HIG and air pollution-related health risks by employing an ordered logistic regression model, and compare these effects across different levels of pollution and education attainment. Our results indicate that HIG can significantly reduce the health risks of air pollution, especially those health risks caused by gaseous pollutants (SO2 and NOx). However, HIG fails to offset the adverse health effect induced by particulate matter (PM). Further, heterogeneity analysis shows that the health benefits from incomes vary greatly among different regions. HIG can mitigate the health risks of NOx to people in heavily polluted regions. In terms of education level, HIG can significantly raise the self-rated health level for groups with different educational backgrounds, but HIG of the highly educated group can significantly offset the health losses due to air pollution.

Employment Status and Work Ability in Long-Term Young Adult Cancer Survivors.

Purpose: In young adult cancer survivors (YACSs) to explore the rate of being nonemployed and having low work ability, and to identify factors associated with these two outcomes. Methods: All Norwegian YACSs (N = 3558) diagnosed at ages 19-39 years and treated between 1985 and 2009 for breast or colorectal cancer, leukemia, non-Hodgkin lymphoma, or melanoma, and alive in 2015, were mailed a questionnaire. The response rate was 42%. For treatment, a minimal surgery-only group (N = 198) was defined as reference group, and 1000 YACSs represented the local, systemic, and systemic plus other treatment groups. Work status was compared with normative data. Results: The sample included 63% females. Median age at survey was 49 years (range 27-65), and median time since first cancer diagnosis was 16 years (range 6-31). At survey, 25% (95% confidence interval [CI]: 22-27) of YACSs were nonemployed, and 38% (95% CI: 35-41) reported low work ability. The rate of being nonemployed was similar to normative data. More female YACSs held disability pension compared with normative data. In multivariable analyses, an increasing number of adverse effects (AEs), cardiovascular diseases, lower basic education, reduced level of self-rated health, and increased level of depression were significantly associated with both being nonemployed and having low work ability. Conclusions: In YACSs surveyed at median 49 years of age, 25% were nonemployed and 38% had low current work ability. An increased mean number of long-term AEs and several other health-related factors were significantly associated with both these outcomes. Health care providers responsible for YACSs should be attentive to such factors and work ability.

Associations of demographic, socioeconomic, self-rated health, and metastasis in colorectal cancer in Iran.

Background: Metastasis in Colorectal Cancer (CRC) is important because of the costs imposed on the individual. Self-Rated Health (SRH) can be useful for preventing cancer. Considering the role of Socio-Economic Status (SES) in CRC, our study was conducted to evaluate the relationship between demographic, SES, SRH, and metastasis of this type of cancer in Markazi province, Iran. Methods: This cross-sectional, descriptive study (April to July 2018) was conducted on 411 patients suffering from CRC. These patients were hospitalized in one of the medical centers affiliated to Arak University of Medical Sciences (Arak, Iran), and with non-random sampling (available sampling) they were imported to the study. A reliable and valid questionnaire about levels of SES and SRH was filled by patients. For analyzing the data, Binomial logistic regression and chi-square tests were executed using Stata 11 software. Results: The mean age was 60.01 years. According to the results of this study, as compared with poorest SES patients, the OR estimate of metastasis was 0.80 (95% CI: 0.36, 1.78) among the richest SES patients, in patients with age of >60 years was 9.92 (95% CI: 1.53, 64.39) in comparison with patients with age of <40 years, in male patients was 3.26 (95% CI: 1.76, 6.04) compared with female ones; in divorced/widowed patients was 0.52 (95% CI: 0.11, 2.51) in comparison with single ones; among those with academic level of education was 4.28 (95% CI: 1.49, 12.26) compared with illiterate patients; and compared with poor SRH-age of patients, was 3.78 (95% CI: 2.09, 6.85) among those with good SRH-age. Conclusion: Patient's education and SES are important variables in metastasis and SRH of CRC in Iranian patients. All diagnostic tests and medical possibilities should be available for all individuals with adequate interventions. Patient’s education and awareness should also be increased.

Socioeconomic inequalities in self-rated health: role of work-to-family conflict in married Korean working women

ABSTRACTLittle evidence exists on the role of work-to-family conflict (WFC) in explaining socioeconomic inequality in self-rated health (SRH). We examined the association between socioeconomic status (SES) and SRH and tested the mediating effect of WFC in the association between SES and SRH among married Korean working women. A cross-sectional study was conducted using data from the 2014 Korean Longitudinal Survey of Women and Family. Participants were 3,226 women. Three SES indicators were used: income as measured by income-to-needs ratio; education categorized into college vs. noncollege education levels; and occupation classified by white vs. pink/blue-collar occupations. Lower levels of all the SES indicators were significantly associated with poor SRH and higher levels of WFC. The higher levels of WFC were also significantly associated with poor SRH. In the relation between SES and SRH, WFC showed a partial mediating effect for income (z = −4.13, p < .001) and full mediating effects for education (z = −3.79, p < .001) and occupation (z = −4.59, p < .001). WFC played a mediating role in explaining socioeconomic health inequality among married Korean working women. Workplace strategies focused on alleviating the WFC levels of socioeconomically disadvantaged married women may be crucial for improving their health status.

Social Network Types and Health among Older Adults in Rural China: The Mediating Role of Social Support.

This study aimed to identify social network types among older adults in rural China, to explore the relationship between social network types and the health of the older adults, and further, to examine the mediating role of social support in this relationship. A cross-sectional survey method was employed to investigate the health of adults aged 60 or older in rural areas of Hubei Province from 5 September 2018 to 15 October 2018; 405 samples were obtained. First, using k-means clustering analysis, we found five robust network types: diverse, restricted, family, friends and a specific type—family-restricted. Second, the results of multiple linear regression analysis showed that social network types were significantly associated with depressive symptoms and self-rated health in older adults. Older people with diverse friend networks were significantly associated with lower levels of depressive symptoms, whereas those with restricted and family-restricted networks were significantly associated with higher levels of depressive symptoms and lower levels of self-rated health. Finally, the results of multiple linear regression analysis confirmed that social support partially mediated the association of the identified social network types with depressive symptoms and self-rated health. Enriching the social network relationships of older adults and providing them with more social support should be conducive to promoting their mental and physical health.

Self-rated health (SRH) in young people and causes of death and mortality in young adulthood. A prospective registry-based Norwegian HUNT-study

BackgroundSelf-rated health (SRH), which is frequently used in epidemiological research, has consistently been shown to be a strong predictor of morbidity and mortality, even after controlling for demographic, social and medical risk factors. However, less is known about the relationship between SRH and all-cause and cause-specific mortality in young adulthood. ObjectiveTo investigate SRH in young people (13–35 years-old) as a predictor of all-cause mortality in young adulthood (deaths before age 54) and examine the associated causes of death. MethodsWe used data from two large population-based cohort studies (N = 23,679): Young-HUNT1 (1995–1997, persons 13 to 20 years old, participation rate = 90%) and HUNT2 (1995–1997, persons 20 to 35 years old, participation rate = 70%). These data were linked to the Norwegian Cause of Death Registry up to 2014, and 247 deaths were identified. Other predictors we examined included age, gender, baseline smoking, physical activity and physical and mental disability. ResultsParticipants reporting ‘not so good’/‘poor’ SRH had approximately twice the risk of death compared to those reporting ‘good’ or ‘very good’ SRH at baseline. The association between low SRH and risk of death was attenuated when the models were adjusted for other predictors, but remained statistically significant. The causes of death differed somewhat between SRH levels. Most of the deaths for people reporting ‘very good’ SRH at baseline were mostly due to neoplasms (34%) and other external causes (30%). The causes of death were more varied for people reporting ‘not so good’/‘poor’ SRH, with suicide (23%), other external causes (21%) and other/unknown causes of death (17%) being the most frequent causes. ConclusionSRH predicts all-cause mortality in young adulthood, with poor SRH being associated with death in young adulthood. The findings also indicate different causes of death for different SRH. This knowledge is important for identifying groups at risk for later disease, which can potentially be used to prevent morbidity in the adult population.

근로자의 주관적 사회계층인식 및 사회계층 이동성과 주관적 건강 및 우울상태와의 관계 : 정규직과 비정규직 근로자 집단의 비교

Objectives: This study aims to identify employees’ subjective social class and social class mobility and the associations with their self-rated health and depression focusing on the differences between standard workers and nonstandard workers. Methods: 3,117 samples were selected from a secondary data regarding social and psychological factors of anxiety and mental health in Korea. Multiple regression analyses were used to test the associations of subjective social class and social class mobility with self-rated health and depression. This study also examined the relationships between subjective social class, social class mobility and health outcomes by employment types. Results: Nonstandard workers perceived their subjective social class and social class mobility lower than did standard workers. Results from multiple regression showed that social class mobility significantly predicted levels of self-rated health and depression. Finally, the types of employment had significant moderating effects which indicates nonstandard workers were more likely to have worse self-rated health and be more depressed compared to standard workers when they perceived subjective social class and social class mobility lower. Conclusions: It is necessary to consider how to reduce health disparities between standard workers and nonstandard workers through narrowing down gaps in subjective social class and social class mobility.

Midlife predictors of active and healthy aging (AHA) among older businessmen

BackgroundActive and healthy aging (AHA) is an important phenomenon in aging societies.AimsOur aim was to investigate midlife predictors of AHA in a socioeconomically homogenous male cohort.MethodsIn 2010, AHA was defined in the Helsinki Businessmen Study (men born in 1919–1934) with six criteria: (1) being alive, (2) responding to the mailed survey, (3) no reported cognitive problems, (4) feeling of happiness, (5) no difficulties in activities of daily living (ADL), and (6) no significant chronic diseases. Midlife factors were assessed in 1974 (n = 1759, mean age 47 years). Of the survivors in 2010 (n = 839), 10.0% (n = 84) fulfilled all AHA criteria, whilst 13.7% (n = 115) had chronic diseases but fulfilled other five criteria. Midlife predictors of AHA were analyzed with logistic models.ResultsOf the midlife factors, smoking [Odds ratio (OR) 0.44, 95% confidence interval (CI) 0.25–0.77], higher body mass index (BMI) (OR 0.75, 0.59–0.96), and higher total cholesterol (OR 0.76, 0.60–0.97) prevented significantly full AHA criteria, whereas higher self-rated health (SRH) (OR 1.73, 1.07–2.80) predicted significantly of fulfilling all AHA criteria. Midlife smoking (OR 0.87, 0.84–0.91), higher BMI (OR 0.73, 0.61–0.86), and higher alcohol consumption (OR 0.73, 0.60–0.90) prevented significantly of fulfilling the five AHA criteria with chronic diseases, and higher SRH (OR 1.90, 1.37–2.63) predicted significantly the five AHA criteria (chronic diseases present).DiscussionOur study suggests that midlife factors, especially good SRH and low levels of cardiovascular risk factors, are associated with AHA.ConclusionsThe study emphasizes the importance of life-course predictors of healthy aging.

The relationship between self-rated health and local government spending on parks and recreation in the United States from 1997 to 2012.

The purpose of this study was to analyze the relationship between local government spending on parks and recreation and self-rated health in the United States. Using four publicly available datasets from the U.S. Census Bureau, the Current Population Survey, the Decennial Census, the American Community Survey, and the State and Local Government Finance Survey for the years 1997–2012 (n = 303,203), we estimated a multinomial and a binary logit model predicting self-rated health with county area percentage of expenditures contributed to parks and recreation operations as the independent variable of interest. A one-percent increase in the portion of county area expenditures contributed to parks and recreation operations was associated with decreased relative risk of very good (RRR = 0.95; 95% CI = 0.93, 0.96), good (RRR = 0.95; 95% CI = 0.93, 0.97), or fair (RRR = 0.89; 95% CI = 0.87, 0.92) health relative to excellent health. The effect held in the binary logit model for adult men and women, but not youth. Higher levels of parks and recreation spending were associated with higher levels of self-rated health for adults across the United States from 1997 to 2012. Investing greater portions of local government budgets in parks and recreation operations may have the potential to improve self-rated health among residents.

The association between self-rated health and high-sensitivity C-reactive protein level: a cross-sectional and 5-year longitudinal study

BackgroundAlthough self-rated health (SRH) independently predicts mortality, the biological background of this association remains unexplained. This study aimed to examine the association between SRH and serum high-sensitivity C-reactive protein (hsCRP) level.MethodsSubjects were 899 participants aged 35–69 years (237 men and 662 women) in the Daiko Study, part of the Japan Multi-Institutional Collaborative Cohort Study. They were enrolled from 2008 to 2010. Of the subjects, 666 participated in a second survey 5 years later. Lifestyle factors and SRH were assessed using a self-administered questionnaire. Serum hsCRP level was measured using a latex-enhanced immunonephelometric assay. The association between SRH and serum hsCRP level was evaluated using a general linear model with covariates. We further longitudinally investigated whether higher serum hsCRP level at baseline predicts poor SRH after 5 years using an unconditional logistic regression model.ResultsA higher serum hsCRP level was significantly associated with poor SRH at baseline after adjusting for covariates (p for trend = 0.023). The age- and sex-adjusted odds ratio and 95% confidence interval (CI) for poor SRH after 5 years was 1.45 (95% CI: 0.76–2.78) for the highest tertile compared with the lowest tertile of serum hsCRP level at baseline with a significant linear trend (p for trend = 0.033), although the risk increase disappeared after adjustment for other covariates.ConclusionsThe present study demonstrated that poor SRH is cross-sectionally associated with higher serum hsCRP level. However, the longitudinal data did not support the relationship between serum hsCRP level at baseline and future SRH. Further longitudinal studies that include data on mortality and multiple inflammatory markers are warranted to elucidate the possible role of low-grade inflammation in the association between SRH and mortality risk.

Decreased Skeletal Health Negatively Impacts Quality of Life of People with Hemophilia

Introduction: People with Hemophilia (PwH) have decreased bone mineral density (BMD) and increased risk of fracture. Children as well as adults have demonstrably lower BMD than age-matched control populations. Additionally, PwH have increased rates of bone resorption and decreased rates of bone mineralization. This study aims to characterize the impact of factor VIII (FVIII) replacement on biomarkers of bone metabolism in PwH as well as correlate those biomarkers with physical characteristics and Quality of Life.Methods: Twelve participants with severe FVIII-deficiency were screened and enrolled in the single site IRB-approved study. After a 72-hour washout, plasma samples were obtained at 8 time points over the course of five days following FVIII infusions on Day 1 (50 units/Kg) and Day 3 (20 units/Kg). All participants had a physical examination and completed quality of life, activity, pain and factor compliance questionnaires on Day 1. Visual Analog Scale (VAS) via the EQ-5D-5L was utilized to report participants' self-rated health. BMD was measured as Z-scores via Dual-Energy X-ray Absorptiometry (DEXA) Scanning. Joint assessment was performed using the Hemophilia Joint Health Score (HJHS). Plasma cytokine levels were measured using ELISA and magnetic bead multiplex kits. Samples were evaluated for 42 cytokines (Table 1).Results: VAS score increased with Spine L1-L4 Z (SZ)-score (p=0.023, R2=0.42) and Hip Total Z (HTZ)-score (p=0.006, R2=0.54). VAS was lower in PwH with higher HJHS (p=0.006, R2=0.55). HJHS was higher in PwH with lower SZ-scores (p=0.004, R2=0.62). The average ratio of OPG to RANKL increased from 0.9 to 6.2 during the study period (p=0.006, R2=0.75). Plasma vascular endothelial growth factor (VEGF), an angiogenic cytokine that has been implicated in bone development and repair, and IL-8, a chemokine that stimulates osteolysis, inversely correlated with SZ-score. Carboxy-terminal collagen crosslinks (CTX-1), a breakdown product of bone, is elevated in samples from subjects with higher Hip Neck Z (HTZ)-scores. Eotaxin, an eosinophil chemoattractant, and VEGF levels were decreased in samples from subjects with lower HTZ-scores. CTX-1 levels were elevated in subjects with higher HNZ-scores. Parathyroid hormone (PTH), a hormone that stimulates osteolysis, eotaxin, VEGF, and IL-4, a potential osteoblast activity mediator, levels were lower in plasma samples from subjects with higher HNZ-scores. Average plasma eotaxin, VEGF, and IL-12p70, a T-cell stimulating factor, levels were positively correlated with HJHS score. Correlation coefficients, p-values and R2 values for average cytokine values and skeletal health measures are listed in Table 1.Conclusions: PwH with decreased BMD report a lower level of self-rated health. This is evidenced by correlations between VAS, HJHS, and BMD. Plasma CTX-1 is elevated in PwH with higher BMD, suggesting that PwH with improved skeletal health experience higher rates of bone turnover as measured by osteoclast activity. The average OPG/RANKL ratio increased during the study period suggesting that FVIII infusion may have a direct effect on the RANKL-OPG pathway. PTH, eotaxin, and VEGF are inversely correlated with BMD and positively correlated with HJHS. Lower levels of these cytokines appear to be associated with poor skeletal health in PwH. Increased levels of PTH are associated with osteoporosis and VEGF has been implicated in bone development and repair. These data suggest an intricate association between skeletal health, factor administration, and cytokine levels. Continued analysis of these data is ongoing and additional findings will be discussed. [Display omitted] DisclosuresLattimore:UniQure BV: Research Funding. Taylor:Bioverativ: Membership on an entity's Board of Directors or advisory committees; Shire: Research Funding; Alnylam: Research Funding; CSL: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.

The Health Effects of Combining Work and Family Demands: An International Comparison of 31 Countries

Abstract This article aims to analyze the relationship between work-family conflict (wfc) and self-rated health in 31 countries. It argues that wfc, in line with the Sociological Stress Model (Pearlin 1987), is a major role stressor, associated with health problems of workers. The results show that wfc influences the level of self-rated health in the expected direction, when controlling for sociodemographic, family and working characteristics. Country differences exist regarding the moderating role of a country’s degree of individualism. In countries which show higher degrees of individualism, the negative health effects of wfc are stronger. The analysis uses data from the ISSP in 2012 (N=29.857) and multilevel regression models are calculated in order to analyze country differences.

Development of the Taiwanese version of the Health Enhancement Lifestyle Profile (HELP-T).

ObjectivesTo develop and validate a Taiwanese version of the Health Enhancement Lifestyle Profile (HELP-T) for community-dwelling older Taiwanese adults (≥ 55 years).MethodsThe original Health Enhancement Lifestyle Profile (HELP) is a 56-item self-report questionnaire measuring various aspects of health-related lifestyles in older adults. The standard cultural-adaptation procedure was used for questionnaire translation and modification. A field test was conducted for culturally specific item selection, rating-scale analysis, and psychometric validation of the HELP-T in a sample of 274 community-dwelling older adults via classical test theory.ResultsThe 59-item HELP-T is culturally adapted from the original 56-item HELP. The original 6-point rating scale was modified to a 3-point scale for easy use by Taiwanese older adults. The HELP-T had good internal consistency (Cronbach’s alpha = 0.82). The test-retest reliability for the total score was high (0.92), and moderate to high (range: 0.57–0.92) for subscales. The construct validity was supported by the significant correlations between each subscale and the total score (Spearman’s rho = 0.41–0.67, p < 0.0001) and by the ability of the scores to significantly discriminate between participants with different levels of self-rated health (p = 0.0001).ConclusionsThe HELP-T is a suitable clinical tool for assessing and monitoring lifestyle risk factors, establishing client-centered lifestyle intervention goals, and determining the outcomes of lifestyle interventions.

Intersections of Home, Health, and Social Engagement in Old Age: Formal Volunteering as a Protective Factor to Health After Relocation.

This study aims to further our understanding of formal volunteering as a protective mechanism for health in the context of housing relocation and to explore race, gender, and education as moderators. A quasi-experimental design evaluated the effects of volunteering on older adults' health (self-report health, number of instrumental activities of daily living [IADLs], and depressive symptoms) among individuals who relocated but did not volunteer at Time 1 ( N = 682) in the Health and Retirement Study (2008-2010). Propensity score weighting examined health differences at Time 2 between 166 volunteers (treated) and 516 nonvolunteers (controlled). Interaction terms tested moderation. Individuals who moved and engaged in volunteering reported higher levels of self-rated health and fewer IADL difficulties compared to the control group. Race moderated the relationship between volunteering and depressive symptoms, while gender moderated the relationship between volunteering and self-assessed health. Formal volunteering protects different dimensions of health after relocation. Volunteering was particularly beneficial for females and older Whites.

Increasing educational inequalities in self-rated health in Brazil, 1998-2013.

The objectives of this study are to analyze the associations between educational levels and poor self-rated health (SRH) among adults in Brazil and to assess trends in the prevalence of poor self-rated health across educational groups between 1998 and 2013. Individual-level data came from the 1998, 2003 and 2008 Brazilian National Household Survey and the 2013 National Health Survey. We estimate prevalence rates of poor SRH by education. Using multivariable regressions, we assess the associations between educational levels and poor self-rated health. We use these regressions to predict the estimated ratios between the prevalence rates of those in low vs. high education in order to assess if relative changes in poor SRH have narrowed over time. Finally, we tested for statistically significant time trends in adult chronic disease inequalities by education. Results indicate a clear educational gradient in poor SRH. Prevalence ratios show that Brazilian adults with no education have levels of poor SRH that are 7 to 9 times higher than those with some college or more. The difference between those with lowest and highest education increased from 1998 to 2013. Compared to those with no education, there were increases in the prevalence of poor SRH among those with primary and secondary incomplete as well as among those with secondary complete in 2008 and 2013. In conclusion, there is a positive association between poor SRH and low education. Brazil has many social and geographic inequalities in health. Even though educational levels are increasing, there is no improvement in the general subjective health of Brazilians. Health inequalities by race and region highlight the need to improve the health of socially disadvantaged groups in Brazil. Addressing chronic conditions and mental health is needed to improve self-perceptions of health in Brazil as well.

A self-management support program for older Australians with multiple chronic conditions: a randomised controlled trial.

To determine whether a clinician-led chronic disease self-management support (CDSMS) program improves the overall self-rated health level of older Australians with multiple chronic health conditions. Randomised controlled trial: participants were allocated to a clinician-led CDSMS group (including client-centred goal setting and the development of individualised care plans) or to a control group in which they received positive attention only. Patients aged 60 years or more with at least two chronic conditions, recruited between September 2009 and June 2010 from five general practices in Adelaide. The primary outcome was self-rated health. Secondary outcome measures related to health status (fatigue, pain, health distress, energy, depression, illness intrusiveness), health behaviour (exercise, medication adherence), and health service utilisation. 254 participants were randomised to the CDSMS and control groups, of whom 231 (117 control and 114 CDSMS participants) completed the 6-month programs and provided complete outcomes data (91%). An intention-to-treat analysis found that CDSMS participants were more likely than control participants to report improved self-rated health at 6 months (odds ratio, 2.50; 95% confidence interval, 1.13-5.50; P = 0.023). Between-group differences for secondary outcomes were not statistically significant. CDSMS may benefit some older people with multiple chronic conditions to a greater extent than positive attention and health education. Australian New Zealand Clinical Trials Registry ACTRN12609000726257.