Self-reported Chronic Illness Research Articles

Inflammatory, Hematological, and Biochemical Biomarkers in COVID-19 Patients.

There are few accurate prognostic indications of the illness's development and severity for COVID-19, despite certain biomarkers having been investigated. The unexpected nature of COVID-19's course, which can quickly progress from asymptomatic to life-threatening symptoms, lies at the heart of the disease's intricacy. Predicting SARS-CoV-2 pathogenicity through laboratory biomarkers and as such, identifying the patients' illness severity at the time of their initial admission would be crucial in improving patient care. In this study, we sought to evaluate the potential of hematological, biochemical, and inflammatory biomarkers in predicting the course of COVID-19 at a tertiary hospital in western Kenya. This cross-sectional study involved 48 COVID-19 patients (16 asymptomatic; 16 moderate symptomatic; and 16 severe symptomatic) and 48 age-sex-matched COVID-19-negative clients attending the Moi Teaching and Referral Hospital, Kenya. Demographic information, self-reported chronic illnesses, symptoms, and laboratory results were collected at recruitment. Significantly, the severity of COVID-19 was associated with; hemoglobin (p < 0.0001), white blood cells (p = 0.0022), hematocrit (p < 0.0001), blood urea nitrogen (p = 0.01), blood sodium (p = 0.0002), potassium (p = 0.0483), C-reactive protein (p = 0.0002), and Lactate Dehydrogenase (p < 0.0001). Regression analysis of CRP revealed a strong positive correlation (p = 0.0006) whereas LDH revealed a weak positive correlation (p < 0.0001) with COVID-19 disease severity. Discriminative accuracy was highest when asymptomatic was compared to severe COVID-19 for CRP and LDH (AUC: 0.8867, 95% CI: 0.7532-1.000) and (AUC: 1.000, 95% CI: 1.000-1.000) respectively. The hematological indices, inflammatory and biochemical biomarkers studied have the potential to predict the course of COVID-19. These parameters may be useful in helping design appropriate care for COVID-19 patients.

State affect and body image effects of body positive social media content within a female chronic illness sample

Body positivity refers to a movement, popularized on social media, that encourages the normalization and acceptance of bodies diverging from sociocultural ideals, specifically within marginalized communities. Previous studies suggest that briefly viewing body positive social media content may lead to increased body satisfaction and positive affect in young women relative to thin-ideal and appearance-neutral content. Diminished body functionality and appearance change due to chronic illness poses a unique challenge to positive body image in young adults living with chronic illness. Typical body positive social media content may not be useful for this community since chronic illnesses are often not outwardly depicted, so the current study aimed to examine the state effects before and after viewing body positive social media content in a sample of young women (N=201) with at least one self-reported chronic illness. Participants (Mage = 29.4, SD = 6.74; 79.2 % white) were randomly assigned to view one of two sets of 10 images: chronic illness body positive and typical body positive. Participants completed a Visual Analogue Scale (VAS) pre- and post-stimuli exposure. Findings from repeated measures ANOVA revealed significant interaction between time and group for negative affect (F(1198) = 4.402, p =.037) and broad conceptualization of beauty (F(1199) = 4.288, p =.040), such that those exposed to the chronic illness stimuli reported a larger reduction in negative affect and an increase in conceptualization of beauty beyond the non-chronically ill ideal post-exposure. Thus, exposure to body positive social media content inclusive of chronic illness may be more useful in stabilizing affect and promoting greater positive body image within the community. These findings highlight the importance of inclusive body positive portrayals in terms of dimensions beyond weight and shape to account for the effects of diminished body functionality.

Determinants of self-reported chronic disease diagnoses among older persons in South Africa.

Chronic diseases tend to affect the quality of life for older persons worldwide, especially in resource-constrained developing countries. Chronic diseases contribute to a large number of deaths among the population of South Africa. This study examines the determinants of self-reported chronic disease diagnoses among older persons in South Africa. The study setting was South Africa. Cross-sectional data from the 2019 South Africa General Household Survey were analysed (n[weighted] = 4 887 334). We fitted a binary logistic regression model to determine the relationship between socio-demographic factors and being diagnosed with self-reported chronic diseases. We found that at least 5 in 10 older persons were diagnosed with self-reported chronic disease. The bivariate findings showed that age, population group, sex, marital status, level of education, disability status, household composition and province were significantly associated with self-reported chronic disease diagnoses. At the multivariate level, we found that age, sex, population group, marital status, educational level, disability status, household wealth status, household composition and province were key predictors of self-reported chronic disease diagnoses. We found that various factors were key determinants of being diagnosed with self-reported chronic diseases. This study offers important insights into the main correlations between older adults and self-reported chronic illness diagnoses. More study is required on the health of the elderly as it will help direct policy discussions and improve the development of health policies about the elderly.Contribution:This study highlights the need for a better understanding of, and continued research into, the determinants health among older populations to guide future healthcare strategies.

Physical illness and multimorbidities in patients diagnosed with personality disorder

IntroductionPeople with personality disorder (PD) often experience suffering, suboptimal psychiatric treatment outcomes, and early mortality due to chronic physical illness (CPI) and multimorbidity (≥2 CPI) (CPM). Increasing research underscores the elevated prevalence of CPI and CPM in those with PD.ObjectivesTo compare the prevalence of CPI/CPM between the general population and those with PD and to explore the relationship between CPI/CPM and various aspects of PD.MethodsThis cross-sectional study enrolled 126 PD patients (70.6% female, mean age 41.22 years) based on the ICD-10 criteria, and 126 socio-demographically matched individuals from the general population. The participants completed the following instruments: the ICD-11 Personality Disorder Severity Scale (PDS-ICD-11), the Personality Assessment Questionnaire for ICD-11 (PAQ-11), Subjective Emptiness Scale (SES), the Reflective Functioning Questionnaire-Revised-7 (RFQ-R-7), and self-reported chronic physical illnesses questionnaire.ResultsThe mean number of CPI in patients with PD and matched controls was 2.69 (SD=2.371) and 1.02 (SD=1.702), respectively, and this difference was statistically significant. Patients with PD also suffered more often from CPM than none or one CPI, compared to matched controls. In the multivariate logistic regression analyses among the patients with PD, higher personality disorder severity, increased trait Negative Affectivity and poorer reflective functioning/mentalizing were predictive of having CPM. These relationships were independent of age, gender, education status, income level, length of psychiatric treatment, and smoking status. Subjective emptiness was not significantly predictive of having CPM.ConclusionsThis study highlights a higher prevalence of CPI and CPM in individuals with PD compared to the general population. Factors such as higher PD severity, increased Negative Affectivity, and poorer reflective functioning were identified as predictors of CPM. These findings underscore the necessity for integrated healthcare approaches to address the multifaceted needs of PD patients, emphasizing the importance of considering both mental and physical health in treatment strategies.Disclosure of InterestNone Declared

What makes a ‘good doctor’? A critical discourse analysis of perspectives from medical students with lived experience as patients

What constitutes a ‘good doctor’ varies widely across groups and contexts. While patients prioritise communication and empathy, physicians emphasise medical expertise, and medical students describe a combination of the two...

Cognitive Performance Deficits Are Associated with Clinically Significant Depression Symptoms in Older US Adults

Accumulating research has described cognitive impairment in adults with depression, however, few studies have focused on this relationship during older adulthood. Our cross-sectional study investigated the association between cognitive function performance and clinically significant depression symptoms in older adults. We analysed the data from the 2011 to 2014 National Health and Nutrition Examination Survey on older (aged 60 years and above) US adults. Cognitive function was assessed as a composite score and on a test-by-test basis based on the Consortium to Establish a Registry for Alzheimer's Disease Word List Learning Test, the Word List Recall Test, and Intrusion Word Count Test, the Animal Fluency Test, and the Digit Symbol Substitution Test (DSST). Depression was defined as clinically significant depression symptoms based on the standard cut-off point of the Patient Health Questionnaire-9 (PHQ-9) score of 10 or greater. Adjusted-logistic regression analysis was employed using survey weights to examine the former relationships. Sociodemographic factors, in addition to medical history and status in terms of self-reported chronic illness and the incidence of stroke or memory-cognitive function loss, were considered as covariates. Among 1622 participants of a survey-weighted 860,400 US older adults, cognitive performance was associated with clinically significant depression symptoms (p = 0.003) after adjustment. Most prominently, older adults with significant cognitive deficits had approximately two and a half times (OR: 2.457 [1.219-4.953]) higher odds for a PHQ-9 score above threshold compared to those with the highest performance. Particularly, those with lowest DSST score had increased odds of almost four times (OR: 3.824 [1.069-13.678]). Efforts to decipher the underlying aetiology of these negative disparities may help create opportunities and interventions that could alleviate the risks from depression, cognitive impairment, and associated consequences in older adults at a population level.

PS-C26-9: A URINARY PEPTIDOMICS APPROACH FOR EARLY STAGES OF CARDIOVASCULAR DISEASE RISK: THE AFRICAN-PREDICT STUDY

Objective: Cardiovascular disease (CVD) affects individuals across the lifespan with multiple cardiovascular (CV) risk factors increasingly present in young populations. The underlying mechanisms in early cardiovascular disease development are complex and still poorly understood. We therefore employed urinary proteomics as a novel approach to gain better insight into the early CVD-related molecular pathways based on a CVD-risk stratified approach. Design and Methods: This study included 964 apparently healthy (no self-reported chronic illnesses and free from clinical symptoms of CVD) black and white men and women (aged 20–30 years old) from the African-PREDICT study. Cardiovascular risk factors used for stratification included obesity, physical inactivity, tobacco use, high alcohol intake, hyperglycemia, dyslipidemia and hypertension. Participants were divided into low (0 risk factors), medium (1–2 risk factors) and high (3 or more risk factors) CV risk groups. We analyzed urinary peptidomics profiles by capillary electrophoresis time-of-flight mass spectrometry. Results: Upon adjusting for ethnicity, we identified 293 sequenced urinary peptides that were differentially expressed between the CV risk groups (all q-value smaller or equal to 0.01). These peptides included a lower abundance of collagen type I and a higher abundance of collagen type III derived peptides in the high compared to the low CV risk group. We also found a lower abundance of fibrinogen alpha and alpha antitrypsin 1 and a higher abundance of uromodulin derived peptides in the high compared to the low CV risk group (all q-value smaller or equal to 0.007). Conclusion: Our findings point out different abundances in collagen I and III between the high compared to low CV risk group, suggesting potential early alterations in the CV extracellular matrix.

INVESTIGATING LINKS BETWEEN CHILDHOOD HEALTH AND FAMILY LIFE AND ACCELERATED BIOLOGICAL AGING

Abstract An epigenetic clock measure, DNA methylation (DNAm) PhenoAge, differentiates individual aging trajectories and has been shown to predict mortality and morbidities. Despite suggestions that early-life experiences may shape epigenetic aging, little is known to date about specific risk and protective factors. We use data from Health and Retirement Study (HRS) to investigate the role of childhood factors, including health and family financial situation, in epigenetic age acceleration. The sample (N = 3952, M age = 64, range 50-100) included participants from the HRS 2016 Venous Blood Study and those, who reported about their childhood health and family. Using logistic regression, we predicted DNAm PhenoAge acceleration, calculated as the residuals resulting from regressing DNAm PhenoAge on chronological age and coded as 0 or 1 (1 = positive values, faster epigenetic aging rate). Participants with more years of education were less likely to have accelerated epigenetic aging (OR: 0.963, 95%CI[0.941-0.985], p &amp;lt; .001). However, self-reported chronic illnesses before age 16 (15 possible conditions), self-rated childhood health, and family financial situation before age 16 were not associated with accelerated aging. In addition, men had higher likelihood of accelerated aging than women (OR: 1.145, 95%CI[1.007-1.301], p &amp;lt; .05). Race/ethnicity and age cohort (e.g., being younger or older age 65) were not significant predictors. Our results highlight that investigation of relation between childhood disadvantages and DNAm PhenoAge acceleration might need to include other indicators (e.g., residential history). Future work is needed also to identify life course moderators of the clock efficacy.

Childhood adversity and adult health: A dyadic analysis of Black American couples.

The association between childhood adversity and adulthood health is well established, but few studies have examined potential effects of childhood adversity on partner health in couples. This study examined the long-term health impact of childhood adversity on individuals as well as their significant others. The participants were 163 distinguishable dyads from the Family and Community Health Study. Health outcomes included both self-reported chronic illness and a messenger RNA index of accelerated aging. The actor-partner interdependence model with structural equation methods was used to test the hypothesis. Replicating prior research, childhood adversity was associated with more chronic illness and an accelerated speed of aging. Further, participants' health in adulthood was affected by both own and partner experiences of childhood adversity. There were no gender differences. Our findings replicate and extend prior research on the long-term impact of exposure to childhood adversity, suggesting that adverse childhood experiences are also harmful to romantic partners. Further studies are required to examine potential mechanisms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A urinary peptidomics approach for early stages of cardiovascular disease risk: The African-PREDICT study.

Cardiovascular disease (CVD) affects individuals across the lifespan, with multiple cardiovascular (CV) risk factors increasingly present in young populations. The underlying mechanisms in early cardiovascular disease development are complex and still poorly understood. We therefore employed urinary proteomics as a novel approach to gain better insight into early CVD-related molecular pathways based on a CVD risk stratification approach. This study included 964 apparently healthy (no self-reported chronic illnesses, free from clinical symptoms of CVD) black and white men and women (aged 20-30 years old) from the African Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT) study. Cardiovascular risk factors used for stratification included obesity, physical inactivity, tobacco use, high alcohol intake, hyperglycemia, dyslipidemia and hypertension. Participants were divided into low (0 risk factors), medium (1-2 risk factors) and high (≥3 risk factors) CV risk groups. We analyzed urinary peptidomics by capillary electrophoresis time-of-flight mass spectrometry. After adjusting for ethnicity, sex and age, 65 sequenced urinary peptides were differentially expressed between the CV risk groups (all q-values ≤ 0.01). These peptides included a lower abundance of collagen type I- and III-derived peptides in the high compared to the low CV risk group. With regard to noncollagen peptides, we found a lower abundance of alpha-1-antitrypsin fragments in the high compared to the low CV risk group (all q-values ≤ 0.01). Our findings indicate lower abundances of collagen types I and III in the high compared to the low CV risk group, suggesting potential early alterations in the CV extracellular matrix.

The impact of smoking status on anticipated stigma and experience of care among smokers and ex-smokers with chronic illness in general practice.

To compare self-reported levels of 'anticipated' stigma and experience of care in general practice between current and ex-smokers living with COPD, other chronic illnesses, or those with no chronic conditions. Participants completed an online survey, advertised through social media, about their experience of care from general practitioners (GPs) in the past 12 months. Respondents self-reported doctor-diagnosed chronic illnesses. Experience of care and anticipated stigma was assessed using validated questions. Multi-nominal regressions were used to determine independent effect of smoking status on anticipated stigma and other indicators of patient experience in primary care. Patients with COPD (n = 161) reported significantly higher anticipated stigma scores compared to those with other chronic conditions (n = 225) and this was strongly related to delayed or avoidance in seeking help from a GP when needed. This relationship remained irrespective of current smoking status. There was no difference between groups for relational components of experience of care. Primary care patients living with COPD reported worse experience of care across several domains and were more likely to anticipate experiencing stigma in the GP setting irrespective of their current smoking status compared to those with other chronic illnesses or no chronic illnesses.

Outcomes of SARS-CoV-2–Positive Youths Tested in Emergency Departments

Severe outcomes among youths with SARS-CoV-2 infections are poorly characterized. To estimate the proportion of children with severe outcomes within 14 days of testing positive for SARS-CoV-2 in an emergency department (ED). This prospective cohort study with 14-day follow-up enrolled participants between March 2020 and June 2021. Participants were youths aged younger than 18 years who were tested for SARS-CoV-2 infection at one of 41 EDs across 10 countries including Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States. Statistical analysis was performed from September to October 2021. Acute SARS-CoV-2 infection was determined by nucleic acid (eg, polymerase chain reaction) testing. Severe outcomes, a composite measure defined as intensive interventions during hospitalization (eg, inotropic support, positive pressure ventilation), diagnoses indicating severe organ impairment, or death. Among 3222 enrolled youths who tested positive for SARS-CoV-2 infection, 3221 (>99.9%) had index visit outcome data available, 2007 (62.3%) were from the United States, 1694 (52.6%) were male, and 484 (15.0%) had a self-reported chronic illness; the median (IQR) age was 3 (0-10) years. After 14 days of follow-up, 735 children (22.8% [95% CI, 21.4%-24.3%]) were hospitalized, 107 (3.3% [95% CI, 2.7%-4.0%]) had severe outcomes, and 4 children (0.12% [95% CI, 0.03%-0.32%]) died. Characteristics associated with severe outcomes included being aged 5 to 18 years (age 5 to <10 years vs <1 year: odds ratio [OR], 1.60 [95% CI, 1.09-2.34]; age 10 to <18 years vs <1 year: OR, 2.39 [95% CI 1.38-4.14]), having a self-reported chronic illness (OR, 2.34 [95% CI, 1.59-3.44]), prior episode of pneumonia (OR, 3.15 [95% CI, 1.83-5.42]), symptoms starting 4 to 7 days prior to seeking ED care (vs starting 0-3 days before seeking care: OR, 2.22 [95% CI, 1.29-3.82]), and country (eg, Canada vs US: OR, 0.11 [95% CI, 0.05-0.23]; Costa Rica vs US: OR, 1.76 [95% CI, 1.05-2.96]; Spain vs US: OR, 0.51 [95% CI, 0.27-0.98]). Among a subgroup of 2510 participants discharged home from the ED after initial testing and who had complete follow-up, 50 (2.0%; 95% CI, 1.5%-2.6%) were eventually hospitalized and 12 (0.5%; 95% CI, 0.3%-0.8%) had severe outcomes. Compared with hospitalized SARS-CoV-2-negative youths, the risk of severe outcomes was higher among hospitalized SARS-CoV-2-positive youths (risk difference, 3.9%; 95% CI, 1.1%-6.9%). In this study, approximately 3% of SARS-CoV-2-positive youths tested in EDs experienced severe outcomes within 2 weeks of their ED visit. Among children discharged home from the ED, the risk was much lower. Risk factors such as age, underlying chronic illness, and symptom duration may be useful to consider when making clinical care decisions.

Do preterm-born adolescents have a poorer oral health-related quality of life?

BackgroundTo evaluate oral health-related quality of life (OHRQoL) over a period of five years using the Oral Health Impact Profile (OHIP-14) questionnaire in a population of Swedish adolescents born preterm and full term.MethodsIn a longitudinal study of adolescents aged 12–14 and 17–19, changes over time in OHRQoL were measured by using OHIP-14. The OHIP-14 score, self-reported chronic illness, temporomandibular disorder (TMD pain) and subjective orthodontic treatment need were compared between 98 extremely and very preterm born (< 32 gestational week) and 93 full-term controls (≥ 37 gestational week) at two ages. The chi-square test was used for comparisons within the extremely-, very-, and full-term control groups, and to contrast the differences of mean scores of OHIP-14, the ANOVA test was used for comparisons within the study groups of extremely preterm, very preterm and full term-born adolescents.ResultsAll adolescents reported a good self-perceived OHRQoL. No significant differences in the comparisons of the total mean scores were revealed between the groups, between gender or in domain-specific scores over the 5-year period. Very preterm adolescents with reported chronic illness at 12–14 years of age showed significantly higher mean scores of OHIP-14 compared with those without chronic illness (p = 0.015). At age 17–19, significantly higher mean scores of OHIP-14 were reported by very preterm adolescents with TMD pain compared to those without TMD pain (p = 0.024). Significantly higher mean scores of OHIP-14 were found among the extremely preterm (p = 0.011) and very preterm born adolescents (p = 0.031) with a subjective need of orthodontic treatment compared with those without orthodontic treatment need.ConclusionsPoor OHRQoL measured with OHIP-14 in very preterm adolescents aged 12–14 was related to chronic illness and aged 17–19 to TMD pain. In addition, extremely and very preterm-born adolescents with subjective orthodontic treatment need at 17–19 years of age also reported poor OHRQoL. To improve the dentist–patient relationship and achieve more successful treatment results, it is important for dental clinicians to understand the impact that chronic illness, TMD pain and orthodontic treatment need has on OHRQoL in preterm-born adolescents.

Quality of life and its determinants among sewage workers: A cross-sectional study in Puducherry, South India.

There is a paucity of information on sewage worker's quality of life (QoL). Hence, we aimed to assess the QoL and its associated factors among sewage workers in Puducherry, coastal south India. A total of 210 sewage workers were included in the study. QoL was assessed using a validated Tamil version of WHO QoL-BREF. The association of QoL with age, educational status, residence area, self-reported chronic illness, use of protective measures, tobacco and alcohol use was assessed by univariate analysis. Multiple linear regression analysis was used to assess the independent factors associated with QoL. Overall mean (standard deviation) score of QoL was 56.9 (9); mean score of social relationship domain was comparatively lower than physical, psychological and environmental domains. Current tobacco and alcohol uses were 17% and 67%, respectively, while alcohol use during work (entering sump) was 5%. At least one morbidity was present among 94 (45%) subjects. About half (47%) used at least one protective measure while entering the drainage sump. Age group above 50 years, below primary level education, presence of chronic illness, smokers and alcohol users had significantly lower QoL score. Social relationships' domain of QoL was very low among sewage workers. The majority of them do not use any personal protective devices and almost half had chronic illnesses.

Work-family spillover stress predicts health outcomes across two decades.

Work is a common source of stress for many adults, arising from situations that occur at work (e.g., job demands) as well as the worries and responsibilities that people take home with them (negative work-family spillover). Over time, work-related stress may impact physical health. The current study prospectively examined the effects of job demands and negative work-family spillover (NWFS) on three self-reported physical health measures. Participants in the Midlife in the United States (MIDUS) survey (N=4200) reported their job demands and negative work-family spillover at wave 1. They also reported on their health across three waves of data collection. Higher levels of NWFS at baseline were related to a higher number of self-reported chronic illnesses, greater functional limitation, and poorer self-rated health approximately 10 and 20 years later. In contrast, job demands were unrelated to any health indices at baseline or at the approximately 10- and 20-year follow-ups. Findings suggest that NWFS is a unique form of stress with long-lasting and detrimental effects on physical health.

Health, Sexual Activity, and Sexual Satisfaction.

Physical and mental health disorders can markedly affect sexual activity and sexual satisfaction. Until now, there has been a lack of representative data from the German population that could serve as a basis for demonstrating specific links between sexuality and health. In the German Health and Sexuality Survey (GeSiD), 4955 men and women in a two-step stratified random sample drawn from local resident registration offices across Germany were surveyed by questionnaire. The response rate was 30.2%. The questions involved, among other things, the respondents' selfassessment of sexual activity and sexual satisfaction, general health status, and any chronic illnesses or disabilities. The percentage of respondents who reported having been sexually active with one partner in the past four weeks was highest among men aged 36 to 45 and women aged 26 to 35. In male respondents, the likelyhood of having been sexually active in the past four weeks decreased from 79.1% to 59.0% and 30.1%, respec - tively, if they described their own health status as fair or bad compared with those in very good health. In female respondents the decrease was from 72.5 % to 48.0 % and 32.4%, respectively. A comparable association was found with self-reported chronic illnesses and disabilities that were perceived as impairing sexuality. Sexual satisfaction was present to a similar extent in all age groups. Self-reported physical and mental illnesses are often associated with marked impairment of sexuality. Even illnesses without any immediately evident relation to sexuality often affect aspects of sexual health. It is, therefore, advisable for physicians to address their patients' sexuality routinely in everyday clinical practice.

Healthcare seeking for chronic illness among adult slum dwellers in Bangladesh: A descriptive cross-sectional study in two urban settings.

IntroductionAccompanying rapid urbanization in Bangladesh are inequities in health and healthcare which are most visibly manifested in slums or low-income settlements. This study examines socioeconomic, demographic and geographic patterns of self-reported chronic illness and healthcare seeking among adult slum dwellers in Bangladesh. Understanding these patterns is critical in designing more equitable urban health systems and in enabling the country’s goal of Universal Health Coverage by 2030.MethodsThis descriptive cross-sectional study compares survey data from slum settlements located in two urban sites in Bangladesh, Tongi and Sylhet. Reported chronic illness symptoms and associated healthcare-seeking strategies are compared, and the catastrophic impact of household healthcare expenditures are assessed.ResultsSignificant differences in healthcare-seeking for chronic illness were apparent both within and between slum settlements related to sex, wealth score (PPI), and location. Women were more likely to use private clinics than men. Compared to poorer residents, those from wealthier households sought care to a greater extent in private clinics, while poorer households relied more on drug shops and public hospitals. Chronic symptoms also differed. A greater prevalence of musculoskeletal, respiratory, digestive and neurological symptoms was reported among those with lower PPIs. In both slum sites, reliance on the private healthcare market was widespread, but greater in industrialized Tongi. Tongi also experienced a higher probability of catastrophic expenditure than Sylhet.ConclusionsStudy results point to the value of understanding context-specific health-seeking patterns for chronic illness when designing delivery strategies to address the growing burden of NCDs in slum environments. Slums are complex social and geographic entities and cannot be generalized. Priority attention should be focused on developing chronic care services that meet the needs of the working poor in terms of proximity, opening hours, quality, and cost.

Quality of life and psychological functioning of pediatric and young adult patients with Gaucher disease, type 1

This study examined the health-related quality of life (HRQoL) and psychological functioning of children and young adults with Gaucher disease, type 1 (GD1). Thirty-two (17 pediatric, 15 young adult) patients with GD1 and one parent completed age-appropriate assessments of HRQoL, emotional, and behavioral health. The HRQoL of children with GD1 was compared with a healthy sample and to children diagnosed with Fabry disease (FD; another lysosomal storage disease), while young adults were compared to a healthy sample and to patients with self-reported chronic illnesses. Children with GD1 reported significantly lower HRQoL across all domains relative to healthy counterparts yet comparable HRQoL compared to children with FD. Young adults reported mildly lower physical functioning than healthy peers, but no differences in HRQoL relative to the chronic illness sample. Parent-reported symptom severity was associated with poorer HRQOL in children but not young adults. Few group differences in psychological functioning were observed, except young children showed more school problems than the normative average and there was a trend toward internalizing symptoms. Overall, results consistently identified younger patients with GD1 as more affected than older patients in HRQoL and psychological domains. Implementation of psychosocial interventions may be particularly beneficial during early childhood.

Explaining Health Outcomes of Asian Immigrants: Does Ethnicity Matter?

The present study intended to evaluate whether 4 discrete ethnic groups of Asian immigrants could, for empirical reasons, be assigned a set of unique operating factors explaining health outcomes of members. The set comprised several acculturation, social structure, lifestyle, and health-related factors. Our study asked if these factors uniformly explained health outcomes across the 4 groups. We pooled National Health Interview Survey (NHIS) data dating 1999-2015 and developed 2 outcomes: self-rated health and self-reported chronic illness (specifically, diagnosis of cardiovascular disease, prediabetes/diabetes, hypertension, cancer, or stroke). Since data for smaller Asian ethnic groups are not readily available, we confined our analyses to respondents of Chinese, Filipino, Asian Indian, and "other Asian" ethnicity. Descriptive statistics suggested that Asian Indian respondents were least likely to report having 1 of the 5 specified serious illnesses and self-rated their health higher than the other 3 respondent groups. Additionally, while some factors (e.g., body mass index, depression) proved related to the health outcomes across the 4 ethnic groups, we did observe for each group a unique pattern of factors associated with the outcomes. Our results confirmed, furthermore, a moderating role for ethnicity in associations between the outcomes and those operating factors in the set we evaluated. The study results should be of use in tailoring preventive and intervention programs to various ethnic groups of Asian immigrants; clearly, in promoting health, one approach will not fit all.

Fertility histories and chronic conditions later in life in Europe

Understanding the association between fertility histories and health later in life is necessary in the context of ageing societies. Past literature has generally found a U-shaped relationship between parity, age at first birth, and several health-related outcomes. However, these findings differed to some extent depending on the country under analysis and on the measures of health considered. As such, using wave 3 (2008–2009) and 5 (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE), this work aimed to answer the question: “Are fertility histories associated with the presence of chronic conditions later in life in Europe?” The analysis included 11 European countries and compared results using two different measures of chronic conditions: self-reported chronic or long-term illness and chronic diseases diagnosed by a doctor. Results showed that age at first birth is more relevant than parity for health outcomes at older ages. Moreover, in socio-democratic and continental countries, the association between fertility and chronic conditions—in particular between age at first birth and long-term illnesses—is statistically significant among women, but not among men. Finally, the association between fertility history and health was similar when using self-reported measures and chronic diseases diagnosed by a doctor.