Self-reported Chronic Conditions Research Articles

Development and validation of multimorbidity index predicting mortality among Chinese older adults

This study aimed to construct a multimorbidity index among Chinese older adults. Participants aged 65-84 years (n=11,757) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Fourteen self-reported chronic conditions were assessed at baseline. Outcome was all-cause mortality within five-year follow-up. We used restrictive association rules mining to identify the patterns of multiple chronic conditions associated with mortality. The weights of conditions and disease combinations were assigned using logistic regression adjusted by age and sex in training set. Multimorbidity index (MI) with individual diseases and multimorbidity index incorporating disease combinations (MIDC) were developed. We compared the performance of MI and MIDC with condition count and XGBoost algorithm in the validation set. There were no significant differences of c-statistics between condition count (0.687) and MI (0.692) or MIDC (0.689). The c-statistic of XGBoost algorithm (0.675) was the lowest among all models. The Integrated Discrimination Improvement (IDI) and categorical Net Reclassification Index (NRI) for MI (IDI: 0.01, P < 0.001; NRI: 0.01, P = 0.127), MIDC (IDI: 0.004, p = 0.002; NRI: 0.02, P = 0.033), and XGBoost model (IDI: 0.02, P < 0.001; NRI: 0.03, P = 0.004) were significantly positive compared with condition count. However, no significant differences for IDI and NRI were observed between MI and MIDC. Among Chinese older adults, weighted multimorbidity index with individual disease can better predict five-year mortality risk over condition count. There was little improvement in the predictive performance of the index after considering the joint effects of disease combinations.

Depressive and subthreshold depressive symptomatology among older adults in a socioeconomically deprived area in Brazil.

This study aimed to assess rates of depressive and subthreshold depressive symptomatology, and the characteristics associated, among older adults living in a socioeconomically deprived area of Brazil. This study is part of the PROACTIVE cluster randomised controlled trial. 3356 adults aged 60+ years and registered in 20 primary health clinics were screened for depressive symptomatology with the Patient Health Questionnaire-9 (PHQ-9). Depressive status was classified according to the total PHQ-9 score and the presence of core depressive symptoms (depressed mood and anhedonia) as follows: no depressive symptomatology (PHQ-9 score 0-4, or 5-9 but with no core depressive symptom); subthreshold depressive symptomatology (PHQ-9 score 5-9 and at least one core depressive symptom); and depressive symptomatology (PHQ-9 score≥10). Sociodemographic information and self-reported chronic conditions were collected. Relative risk ratios and 95% CIs were obtained using a multinomial regression model. Depressive and subthreshold depressive symptomatology were present in 30% and 14% of the screened sample. Depressive symptomatology was associated with female gender, low socioeconomic conditions and presence of chronic conditions, whereas subthreshold depressive symptomatology was only associated with female gender and having hypertension. Depressive and subthreshold depressive symptomatology is highly prevalent in this population registered with primary care clinics. Strategies managed by primary care non-mental health specialists can be a first step for improving this alarming and neglected situation among older adults.

Pre-race self-reported medical conditions and allergies in 133 641 Comrades ultramarathon (90km) runners - SAFER XXIII

ABSTRACT Objectives To determine the prevalence of self-reported pre-race chronic medical conditions and allergies in ultramarathon race entrants and to explore if these are associated with an increased risk of race-day medical encounters (MEs). Methods Data from two voluntary open-ended pre-race medical screening questions (Q1 – history of allergies; Q2 – history of chronic medical conditions/prescription medication use) were collected in 133641 Comrades Marathon race entrants (2014–2019). Race-day ME data collected prospectively over 6 years are reported as incidence (per 1000 starters) and incidence ratios (IR: 95%CI’s). Results Pre-race medical screening questions identified race entrants with a history of chronic medical conditions and/or prescription medication use (6.9%) and allergies (7.4%). The % entrants with risk factors for cardiovascular disease (CVD) was 30% and being older (>45 years) or male (27.5%) were the most frequent CVD risk factors. 0.3% of entrants reported existing CVD. The overall incidence of MEs was 20/1000 race starters. MEs were significantly higher in race entrants reporting a ‘yes’ to Q1 (allergies) (IR = 1.3; 1.1–1.5) (p = 0.014) or Q2 (chronic medical conditions and/or prescription medication use) (IR = 1.3; 1.1–1.5) (p = 0.0006). Conclusions Voluntary completion of two open-ended questions identified chronic medical conditions and/or prescription medication use in 6.9% and allergies in 7.4% of ultramarathon race entrants. This is lower than that reported for other races that implemented compulsory completion of a more comprehensive pre-screening questionnaire. Despite potential under-reporting, a pre-race self-reported history of chronic medical conditions and allergies was associated with a higher risk of race-day MEs.

Association between Neighborhood Disadvantage and Health Status/Healthcare Utilization in Survivors of Blood or Marrow Transplantation (BMT) - a BMTSS Report

Background: Living in a disadvantaged neighborhood (reflecting neighborhood-level social determinants of health) is associated with poor health outcomes. BMT survivors remain at a high risk of long-term and late-occurring chronic health conditions that require anticipatory management. We hypothesized that neighborhood disadvantage would be associated with poor health status as reported by the BMT survivors, as well as poor utilization of the healthcare system.Methods: We leveraged data from BMTSS - a retrospective cohort study examining long-term outcomes among individuals who survived ≥2y following BMT performed at three institutions between 1974 and 2014. Participants in this analysis underwent a single BMT and completed the BMTSS survey, which captures sociodemographic characteristics and chronic health conditions. We graded chronic health conditions using CTCAE v5.0, and calculated a summative index that takes into account the number and grades of the conditions, where a higher score indicates more/worse conditions. The survey also captured self-reported health status (“In general would you say your health is: excellent, very good, good, fair or poor?”) and healthcare utilization (“When was your most recent routine check-up? <1y ago, 1-2y ago, 2-5y ago, ≥5y ago, never”). Neighborhood disadvantage was measured using the Area Deprivation Index (ADI), a validated composite indicator based on 17 US Census measures and percentiled as 0 (least deprived) to 100 (most deprived). BMT survivors were linked to ADI via census block group using home address at survey completion. Using multivariable ordered logit regression, we modeled the association between ADI and the odds of worse self-reported health or a longer time since a routine healthcare visit. Models were adjusted for available clinical factors (primary cancer diagnosis, donor source, conditioning intensity, chronic health conditions, chronic graft vs. host disease (GvHD), time from BMT) and individual-level sociodemographic characteristics (age at survey, sex, payor, race/ethnicity, education, income, marital status).Results: The cohort included 2,893 BMT survivors; median age at BMT was 47y (IQR: 30-58); median follow-up time was 9y (IQR: 5-16). Table 1 summarizes patient characteristics. Median ADI ranged from 14.0 in patients rating their health as excellent to 28.5 in those rating their health as poor, and from 21.0 in patients with visits <1y ago to 34.0 in patients reporting no visits [Fig 1]. In multivariable analyses, the odds of reporting worse health were higher for patients residing in more disadvantaged neighborhoods (OR per_unit_higher_ADI=1.005, p=0.003). Thus, for our cohort, a patient living in the most disadvantaged neighborhood (ADI=100) had 1.65 times the odds of reporting poor health compared to a patient living in the least disadvantaged neighborhood (ADI=1). Further, the odds of a longer time since the last routine physician visit were higher for patients living in more disadvantaged neighborhoods (OR per_unit_higher_ADI=1.007, p<0.001). Thus, a patient living in the most disadvantaged neighborhood had twice the odds (OR=2.06) of reporting no visits compared to a patient living in the least disadvantaged neighborhood.Conclusions: Conditional on surviving 2 or more years after BMT, living in a disadvantaged neighborhood was associated with poorer self-reported health and a longer time interval since a routine healthcare visit, after adjusting for self-reported individual socioeconomic indicators and chronic health conditions. The significant association between area deprivation and poorer self-reported health persisted after controlling for prior health care utilization. Our findings suggest that health status and access to healthcare are associated with characteristics of the built and social environment and deserve detailed examination in order to inform multi-level interventions that include policy. [Display omitted] DisclosuresArora: Syndax: Research Funding; Kadmom: Research Funding; Pharmacyclics: Research Funding.

Multimorbidity and health literacy: A population-based survey among 28,627 Danish adults.

Individuals with multimorbidity often have complex healthcare needs challenging their health literacy skills. This study aimed to investigate the association between the number of physical conditions and health literacy and to examine the difference in health literacy levels between individuals with multimorbidity based on physical conditions and individuals with additional mental disorders. Respondents aged 25 years or older from a Danish population-based survey were included (N = 28,627). Multimorbidity was assessed based on 18 self-reported chronic conditions; health literacy was measured using two scales from the Health Literacy Questionnaire focusing on understanding health information and engaging with healthcare providers. Associations were examined using multiple logistic regression analysis. We found a positive association between number of physical conditions and the odds of having difficulties in understanding health information and engaging with healthcare providers. For example, the adjusted odds ratio (OR) of having difficulties in understanding health information was 1.45 (95% confidence interval (CI): 1.09-1.94) for individuals with two physical conditions compared with individuals without multimorbidity. The associations formed a positive exposure-response pattern. Furthermore, respondents with both mental and physical conditions had more than twice the odds of having health literacy difficulties compared to respondents with only physical conditions (adjusted OR 2.53 (95% CI 2.02-3.18) and 2.28 (95% CI 1.92-2.72) for the scales, respectively). Our results suggest that responding to patients' health literacy needs is crucial for individuals with multimorbidity - especially those with combined mental and physical conditions.

Bidirectional association between physical multimorbidity and subclinical depression in Chinese older adults: Findings from a prospective cohort study

BackgroundBoth physical multimorbidity and subclinical depression pose a significant threat to aging population worldwide. The association between these conditions appeared to be in a bidirectional way, however the joint causal relationship yet to be fully understood in elderly Chinese population. MethodsA total of 4605 Chinese elders from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2015) were included for the present study. Physical multimorbidity was defined as having two or more self-reported chronic physical conditions. Subclinical depression was defined by ≥ 12 scores assessed using the 10-item Centre for Epidemiological Studies Depression Scale. The bidirectional association between physical multimorbidity and subclinical depression was examined using multivariable logistic regression models, adjusting for covariates. ResultsDuring study period, 23.99% of participant reported incident episode of subclinical depression and 21.36% reported physical multimorbidity. In fully adjusted model, those with physical multimorbidity were two times more likely to have subclinical depression (OR = 2.05, 95% CI: 1.71–2.46). Besides that, subclinical depression was associated with physical multimorbidity (OR = 1.84, 95% CI: 1.50–2.46), but in slightly less magnitude. Furthermore, the bidirectional association remains statistically significant across different subgroups. LimitationsChronic conditions were all self-reported and we couldn't adjust for all confounders, which may be subject to measurement error. ConclusionsPhysical multimorbidity and subclinical depression was associated in a bidirectional way in elderly Chinese population, which highlights the necessary of covering a broad spectrum of aspects of clinical management among adults with physical multimorbidity or subclinical depression.

Impacts of Incarceration on Health Focusing on Minority Males: Considerations for COVID-19 and Future Pandemics

Long-standing health and social inequalities associated with minorities have increased their risk for infection, hospitalization, and death related to COVID-19. This disparity is further exacerbated with incarcerated individuals, yet little attention, both prepandemic and presently, has been devoted to collecting up-to-date data. This study uses the 2004 Survey of Inmates in State Correctional Facilities (SISCF), the most recent data, to explore the general offender population and self-reported chronic and medical health conditions to highlight how COVID-19 will impact marginalized populations. Results from the four binary regression models found that minority males are more likely to have chronic illnesses which increase in probability with longer sentences, number of incarcerations, and advancement in age. Our findings advocate for the development of recent data sets on inmate health, particularly minority individuals, as well as the construction of more precise health measures to address these health disparities, including COVID-19.

Association between joint diseases and common mental disorders in women at ages related to menopause: Data from the São Paulo City Health Survey, SP, Brazil.

To investigate the association between joint diseases (JD) and common mental disorders (CMD) in women at ages related to menopause. Cross-sectional, population-based study (São Paulo City Health Survey, SP, Brazil). The sample was composed of 1191 women, 40years and older. Dependent variable (outcome): Presence of CMD, investigated by the Self Reporting Questionnaire-20 (SRQ-20). Presence of JD; other self-reported chronic conditions different from JD (OCC); age categories (40-45, 46-50, 51-55, 56-60, 61+ years old); Adjusting variables: years of formal education and ethnicity (skin color), used as proxies of socioeconomic status. The associations were investigated using simple and multiple logistic regression models. The prevalence of CMD was 30.4%, and JD was 21.4%. Considering only the women presenting CMD, the prevalence of JD was 31.6%. The final regression model showed an independent association between JD and CMD (OR=1.998; p<0.001), age between 56 and 60years (OR=0.542; p=0.018), and having three OCC (OR=2.696; p=0.027). Our data showed that JD in women of the ages related to menopause was significantly and independently associated with CMD. Interestingly, the 56 to 60years' age interval showed a very particular feature, with opposite association's direction, which demands further investigations.

Dental care use and other population characteristics of older Americans with self-reported chronic conditions in the health and retirement study.

To analyze relative differences in oral health care utilization, oral health, and other population characteristics of older Americans with respect to self-reported chronic conditions in the health and retirement study. Differences in estimated percentages of those with specific chronic conditions by selected attributes were tested for statistical significance with standardized normal Z tests and logistic regressions. All estimates were based on weighted data from 1992 to 2016 Early Release RAND HRS Longitudinal file. SE estimates for the percentages accounted for the complex sample design of the survey. We establish that the strength of the associations between regular use of dental care and the absence of a chronic condition is similar in magnitude to having a college education, living in a high-income family, never smoking, not having certain functional limitations, and being under 65 years of age. These cross-sectional findings establish the relative strength of relationships between dental care use, oral health status, and other population characteristics and eight diagnosed conditions. Further work beyond the scope of this paper is needed to confirm these results as either attributes of those with the disease or causal risk factors for the onset of the condition.

The impact of multimorbidity patterns on health-related quality of life in the general population: results of the Belgian Health Interview Survey

BackgroundChronic diseases and multimorbidity are a major cause of disease burden—for patients, caregivers, and society. Little is known however about potential interaction effects between specific disease combinations. Besides an additive effect, the presence of multiple conditions could also act synergistically or antagonistically regarding the impact on patients’ health-related quality of life (HRQoL). The aim was to estimate the impact of coexisting chronic diseases on HRQoL of the adult general Belgian population.MethodsThe Belgian Health Interview Survey 2018 provided data on self-reported chronic conditions and HRQoL (EQ-5D-5L) for a nationally representative sample. Linear mixed models were used to analyze two-way and three-way interactions of disease combinations on HRQoL.ResultsMultimorbidity had a prevalence of 46.7% (≥ 2 conditions) and 29.7% (≥ 3 conditions). HRQoL decreased considerably with the presence of multiple chronic diseases. 14 out of 41 dyad combinations and 5 out of 13 triad combinations showed significant interactions, with a dominant presence of negative/synergistic effects. Positive/antagonistic effects were found in more subjective chronic diseases such as depression and chronic fatigue. Conditions appearing the most frequently in significant disease pair interactions were dorsopathies, respiratory diseases, and arthropathies.ConclusionsDiverse multimorbidity patterns, both dyads and triads, were synergistically or antagonistically associated with lower HRQoL. Tackling the burden of multimorbidity is needed, especially because most disease combinations affect each other synergistically, resulting in a greater reduction in HRQoL. Further knowledge about those multimorbidity patterns with a greater impact on HRQoL is needed to better understand disease burden beyond mortality and morbidity data.

Perception and awareness of COVID-19 among health science students and staff of Kuwait University: An online cross-sectional study.

Background: Coronavirus disease 2019 (COVID-19) pandemic is unprecedented. Health science students are the future frontliners to fight pandemics. Awareness and perception toward COVID-19 among health science students and staff at Kuwait University was assessed. Methods: Between June and July 2020, an online questionnaire was distributed to all students and staff at HCS. The questionnaire was divided into six sections: socio-demography, risk and awareness, preparedness and prevention, source of information, policies, and social stigma. Results: A total of 592 students and 162 staff completed the questionnaire. The prevalence of self-reported chronic condition among students and staff was 14.0% and 19.1%, respectively. Moreover, self-reported COVID-19 prevalence among students and staff was 2.7% and 1.2%, respectively. Interestingly, 54% of students and 38.3% of staff reported that they knew someone within their immediate social environment who have been/are infected with SARS-CoV-2. Among students, 92.4% wore face mask in indoor places (outside of their home) 'often/all the time' compared to wearing it outdoors (69.3%); whereas, for staff, it was more common to wear it outdoor than in indoor places (75.9% vs. 81.5%). Willingness to take COVID-19 vaccine was indicated by 50% of students 'strongly agreed' and an additional 25.8% agreed to taking it. Interest vaccine uptake was lower among staff (28.4% and 34.6% strongly agreed or agreed, respectively). Participants strongly agreed or agreed (72.5% and 19.6% of students as well as 68.5% and 22.2% of staff ) that wearing face mask in public should be obligatory. More than 18% of students and staff indicated that they would avoid contact with COVID-19 infected people. Conclusions: Responses of students and staff were mostly similar and showed that they follow precautionary measures to control spread of COVID-19, understand the viral transmission risk, and willing to raise awareness to reduce social stigma.

Frailty differences across population characteristics associated with health inequality: a cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging (CLSA)

ObjectiveTo evaluate the pattern of frailty across several of social stratifiers associated with health inequalities.Design, setting and participantsCross-sectional baseline data on 51 338 community-living women and men aged 45–85 years...

A national survey on COVID-19\xa0second-wave lockdowns on older adults\u2019 mental wellbeing, health-seeking behaviours and social outcomes across Australia

BackgroundThe impact of severe second lockdown measures on older adults’ wellbeing is unknown. We aimed to (i) identify the impact of the second lockdown that resulted from the second wave of COVID-19 cases on older Australians’ quality of life; (ii) compare the impact of second wave lockdowns in Victoria, Australia’s second most populous State, to those in other States and Territories not in lockdown.MethodsA national cross-sectional study of community-dwelling older adults completed online questionnaires for quality of life, social networks, healthcare access, and perceived impact of COVID-19 between July to September 2020. Tobit regression was used to measure the relationships of healthcare service access and social networks with quality of life of older adults in Victoria compared to those in the rest of Australia.ResultsA total of 2,990 respondents (mean [SD] age, 67.3 [7.0]; 66.8 % female) participated. At time of data collection, Victoria’s second COVID-19 lockdown had been in force for an average 51.7 days. Median quality of life scores were significantly higher in Victoria compared to the rest of Australia (t2,827=2.25 p = 0.025). Being female (95 % CI, -0.051–0.020), having lower educational attainment (95 % CI, -0.089–-0.018), receiving government benefits (95 % CI, -0.054–-0.024), having small social networks (95 % CI, 0.006–0.009) and self-reported physical chronic health conditions were all independent predictors of lower quality of life.ConclusionsLonger-term studies are required to provide more robust evidence of the impact as restrictions lift and normal social conventions return.

Functional status and its associated factors among community-dwelling older adults in rural Nepal: findings from a cross-sectional study

BackgroundThe high burden of chronic conditions, coupled with various physical, mental, and psychosocial changes that accompany the phenomenon of aging, may limit the functional ability of older adults. This study aims to assess the prevalence of poor functional status and investigate factors associated with poor functional status among community-dwelling older adults in rural communities of eastern Nepal.MethodsData on 794 older adults aged ≥ 60 years from a previous community-based cross-sectional study was used. Participants were recruited from rural municipalities of Morang and Sunsari districts of eastern Nepal using multi-stage cluster sampling. Functional status was assessed in terms of participants’ ability to perform activities of daily living using the Barthel Index. Covariates included sociodemographic characteristics, lifestyle factors, and self-reported chronic conditions. A binary logistic regression model was used to investigate factors associated with poor functional status.ResultsThe overall prevalence of poor functional status was 8.3 % (male: 7.0 % and female: 9.6 %), with most dependence noted for using stairs (17.3 %), followed by dressing (21.9 %) on Barthel Index. In the adjusted model, oldest age group (odds ratio [OR] = 2.83, 95 %CI: 1.46, 5.50), those unemployed (OR = 2.41, 95 %CI: 1.26, 4.65), having memory/concentration problems (OR = 2.32, 95 %CI: 1.30, 4.13), depressive symptoms (OR = 2.52, 95 %CI: 1.28, 4.95), and hypertension (OR = 1.78, 95 %CI: 1.03, 3.06) had almost or more than two times poor functioning.ConclusionsOne in 12 older adults had poor functional status as indicated by their dependency on the items of the Barthel Index; those in the oldest age bracket were more likely to exhibit poor functional status. We suggest future studies from other geographies of the country to supplement our study from the rural setting for comprehensive identification of the problem, which could guide the development of prevention strategies and comprehensive interventions for addressing the unmet needs of the older adults for improving functional status.

‘Gentrification is not improving my health’: a mixed-method investigation of chronic health conditions in rapidly changing urban neighborhoods in Austin, Texas

Though there are extensive studies on neighborhood effects on health, this relationship remains elusive and requires continuous empirical evidence to support existing findings. Gentrification is a process of neighborhood change that affects most longtime residents. This study examined the health impact of the rapidly changing physical and cultural environment using oral history interviews, electronic interviews, and a quantitative structured survey. The study draws on the social determinants of health framework to explain the self-reported chronic health conditions (SR-CHCs) among 331 residents in Austin, Texas. The study employed non-linear techniques suitable for Poisson distribution to estimate the association between gentrification and SR-CHCs and complemented by direct quotes from in-depth interviews (IDIs). Perceived gentrification score significantly vary by marital status (p < 0.001), educational attainment (p < 0.001), and gender (p < 0.01), while SR-CHCs only significantly varies by educational attainment, p = 0.015). Multivariate results show that gentrification was positively associated with SR-CHCs, after adjusting for socioeconomic variables. Compared to the Hispanics, blacks were 97% more likely to report multiple counts of SR-CHCs (IRR = 1.969, 95% CI 1.074–3.608), and participants with high household income were 8% less likely to report multiple CHCs (IRR = 0.920, 95% CI 0.870–0.973). Drawing from the empirical findings, this study recommends both area-based and individual-level policies to mitigate neighborhood change's impact on residents' health. Finally, this study further adds to the understanding of social determinants of health in understanding chronic health within the changing urban physical and socio-ecology systems.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10901-021-09847-8.

Self-Perceived Health and Chronic Conditions Among Users of Supplements With and Without Botanical Ingredients: Findings from the 2009–2014 National Health and Nutrition Examination Survey

The objective of this research was to investigate associations among self-reported health status, chronic conditions, and use of dietary supplements containing botanicals and describe reasons for use among U.S. adult supplement users. This was a cross-sectional analysis using data from the 2009–2014 National Health and Nutrition Examination Survey (NHANES). Supplement information was collected with a 30-day recall interview. Self-reported general health status and doctor-informed diagnoses of chronic conditions were assessed using a health status questionnaire. We used weighted multivariate logistic regressions to assess associations between supplement use and perceived health and number of chronic conditions. Participants were 16,958 non-institutionalized U.S. adults aged 20 years and older. Adults with excellent or very good self-perceived health were more likely to use botanical supplements than adults with good perceived health (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.28–1.74). Adults with three or more chronic conditions were more likely to report using botanical supplements than adults with no chronic conditions (aOR, 1.49; 95% CI, 1.13–1.69). The most frequently reported reasons for both non-botanical and botanical supplements use were “personal choice or influenced by advertisements or word of mouth,” “improve health,” and “specific health conditions” (93.3%, 84.2%, and 64.7%, respectively). While perceptions of health are more positive among adults using botanical supplements, chronic conditions and reasons for botanical supplements use related to personal choice, improving health, or addressing specific conditions were more likely. Differentiating botanical supplements from other complementary and integrative therapies may be useful for facilitating a deeper understanding of the reasons.

Multimorbidity patterns and their related characteristics in European older adults: A longitudinal perspective

BackgroundThe concurrence of several chronic conditions is a rising concern that poses a serious burden on ageing populations. Analysing how these conditions appear together and how they change through time may provide useful information to design successful multimorbidity-management programs. ObjectiveTo identify multimorbidity patterns and their related characteristics from a longitudinal perspective. Subjects25,931 older adults aged 50+ drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE), a population-based longitudinal European study. MethodsA sex-stratified Latent Transition Analysis was conducted to fit latent classes based on 15 self-reported chronic conditions across three time points. Health-related and socioeconomic variables were assessed as covariates of those patterns. ResultsWe identified 4 time-constant latent classes for each sex. A “severely impaired” class (with a weighted prevalence percentage of 7.24% for females and 3.30% for males at the first time point), a “metabolic” class (26.15% and 23.82%) and a “healthy” class (50.92% and 54.32%). The fourth class was named “osteoarticular” for females (15.70%) and “articular-COPD-ulcer” for males (18.56%). Age, smoke, material deprivation and a high body mass index were associated with worse health patterns, whereas education, being employed and physical activity were related to less multimorbid classes. Few class changes were detected when modelling transitions. ConclusionsWe reported information of multimorbidity classes and their characteristics that may help to develop targeted health strategies. Within a time window of four years, the identified latent classes were consistent between time points.

Rapid assessment of mental health of Detroit-area health care workers during the COVID-19 pandemic.

The COVID-19 pandemic may adversely impact the mental health of health care workers (HCWs). To address this issue, it is essential to determine levels of anxiety, depression, and traumatic stress, and sources of stress, and to identify subgroups of HCWs at a higher risk of adverse mental health outcomes during the COVID-19 pandemic. We conducted a cross-sectional study of symptoms of mental illness in HCWs in the area surrounding Detroit, Michigan. The online survey included questions about demographics, health and clinical factors, and sources of stress. Several tools were used to assess psychiatric symptoms among HCWs, including the Perceived Stress Scale, the Patient Health Questionnaire depression scale, the Generalized Anxiety Disorder 7-item assessment, and the Posttraumatic Stress Disorder Checklist for DSM-5. The adequacy of personal protective equipment, patient resources, and training for highly contagious diseases were rated. The sample (N = 129) was predominantly female (51.2%) and White (65.9%), with 30.2% screening positive for clinical follow-up to assess anxiety, 20.9% for moderate to severe depression, and 16.3% for elevated traumatic stress. Differences were found by self-reported psychiatric diagnosis and chronic conditions, and role on treatment teams. Frontline HCWs demonstrate high levels of stress and trauma symptoms. Timely screening and accommodations may be needed during health care crises, such as the COVID-19 pandemic.

Maintaining sense of purpose in midlife predicts better physical health

ObjectiveHaving a sense of purpose in life is fundamental to psychological and physical well-being. Despite the benefits of purpose, it may be difficult to hold onto purpose as people age. The present research addressed four aims: (1) to estimate average change in sense of purpose during midlife; (2) to test associations between purpose levels and later physical health; (3) to test associations between purpose change and later physical health; (4) to examine the cross-cultural generalizability of findings. MethodsWe used reliable change indices to estimate change in sense of purpose during midlife in three prospective cohorts: one comprised predominately of White participants in the U.S. (N = 2692), a second predominately of African American participants in the U.S. (N = 248), and a third of Japanese participants in Tokyo (N = 644). Next, we used linear regression to examine associations between purpose levels and purpose change and later self-reported general health and chronic health conditions. ResultsAt the group level, purpose declined slightly across time (Cohen's ds = −0.08 to −0.17). At the individual level, 10–14% of participants reliably decreased in purpose, whereas only 6–8% of participants reliably increased in purpose. Consistent with our preregistered hypotheses, higher purpose levels predicted better health in the two larger samples (βs = 0.10–0.18, small effects) and more positive purpose change predicted better health in all three samples (βs = 0.08‐–0.22., small to medium effects). ConclusionTogether, these findings suggest that both having a sense of purpose and holding onto it may be important for physical health in middle to older adulthood.

Educating Patients on Nutrition Using a Short Computer-Based Video

Purpose: The purpose of this study is to determine if computer-based videos can successfully educate patients about the health benefits of a whole-food, plant-based diet (WFPBD) during the clinic wait time. As physicians, we recognize the importance of nutrition in disease prevention and treatment. Therefore, we investigated the effectiveness of a video-based educational model in increasing patient knowledge and confidence regarding diet.&#x0D; Methods: Subjects (n = 77) were recruited from an outpatient clinic. An electronic survey was developed and administered to patients before and after watching a 5-minute educational computer-based video about the beneficial health effects of WFPBD. Responses to the survey’s 10 knowledge-based (KB) questions were scoredon a dichotomous incorrect/correct scale, and the survey’s 9 confidence-based (CB) questions were scored on a likert scale from 1 (strongly disagree) to 5 (strongly agree). Paired pre- to post-video intervention difference scores (knowledge and confidence) were calculated for each patient and independently analyzed using a related-samples Wilcoxon signed rank test. one-way ANoVA tests were used to investigate survey questions demonstrating the greatest improvement post-video intervention.&#x0D; Results: Statistically significant improvements in patient knowledge and confidence in their knowledge of nutrition after watching the brief educational video on nutrition were found. Patients scored significantly higher post-video intervention than pre-video intervention on KB survey questions (z = 5.748; P&lt; .001) and CB survey questions (z= 6.605; P&lt; .001). Statistical significance remained across all self-reported chronic condition groups, except for obesity (oB) and atherosclerosis (AS) groups for total knowledge and AS group for total confidence. one-way ANoVA tests confirmed that self-reported chronic conditions did not significantly predict baseline (pre-intervention) total KB or CB scores. The exploratory question-specific analysis demonstrated that the survey questions regarding average daily fiber consumption (P&lt; 0.001) and the association of saturated fats with chronic disease (P= 0.001) were the most significant predictors of the increase in patient knowledge post-intervention.&#x0D; Conclusion: our findings indicate that providing patients with a short computerbased educational video during clinic wait time can significantly increase patient knowledge on the health benefits of a WFPBD. Future studies can test the model on a larger, more varied sample of patients and gauge the longevity of the knowledge gained from this educational model.