Self-reported Health Status Measures Research Articles

Preoperative Symptoms of Depression are Associated With Worse Capability 6-weeks and 6-months After Total Hip Arthroplasty for Osteoarthritis

BackgroundSymptoms of depression have been associated with greater incapability following total hip arthroplasty (THA). A brief, 2-question, measure of symptoms of depression – the Patient Health Questionnaire-2 (PHQ-2) – may be sufficient to measure associations with the magnitude of incapability during recovery from THA. This study investigated whether preoperative symptoms of depression (measured with the PHQ-2) correlated with levels of incapability 6 weeks and 6 months after THA, accounting for demographic and clinical factors. MethodsWe performed a prospective cohort study across 5 centers and recruited 101 patients undergoing THA, of whom 90 (89%) completed follow-up. Patients completed demographics, a preoperative 2-item (PHQ-2) measure of symptoms of depression, and the Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) at 6-weeks and 6-months postoperatively. Negative binomial regression models determined factors associated with HOOS JR at 6 weeks and 6 months, accounting for potential confounders. ResultsAccounting for potential confounding factors, we found that higher preoperative PHQ-2 scores (reflecting greater symptoms of depression) were associated with lower HOOS JR scores (reflecting a greater level of hip disability) at both 6 weeks (regression coefficient = −0.67, P < .001) and 6 months (regression coefficient = −1.9, P < .001) after THA. ConclusionsSymptoms of depression on a 2-question preoperative questionnaire are common, and greater symptoms of depression are associated with reduced capability within the first year following THA. These findings support the prioritization of routine mental health assessments before THA. Measuring mindset using relatively brief instruments will be important considering the current shift toward implementing self-reported measures of health status in clinical practice and incorporating them within alternative payment models.

Abstract WP280: Health and Functional Ability of Veterans and Non-Veterans With Stroke: An Analysis of the 2021 Behavioral Risk Factor Surveillance System

Introduction: Veterans represent a unique population who may be at higher risk of developing stroke. The association between Veteran status and stroke and associated outcomes have not been well described. Methods: We performed a retrospective, cross-sectional analysis of the 2021 Behavioral Risk Factor Surveillance System. Participants were stratified based on Veteran status. Demographics, social factors, and vascular risk factors were compared between the two groups. Logistical regression models were created to explore the association between Veteran status and stroke. Health and functional limitations were also compared between Veterans and Non-Veterans with stroke. Results: We identified 52,518 Veterans and 382,958 Non-Veterans. Veterans more often self-reported a history of stroke compared to non-veterans (6.2% vs. 3.6%, p&lt;0.001). Veterans more often reported a history of diabetes, tobacco use, and obesity. After adjusting for demographic, social and vascular factors, Veterans remained at a higher odds of having a history of stroke (OR 1.26 [95% CI 1.20-1.33], 1.22 weighted, Table). Veterans and Non-Veterans with a history of stroke report similar self-reported measures of health and functional status although Veterans may have more difficulty with ambulation. Conclusions: Using a sample not limited to the Veterans Health Administration, we observed higher rates of self-reported stroke among Veterans compared to Non-Veterans which is not fully explained by differences in their demographics, social factors, or vascular health history. Despite this, Veterans with stroke appear to have similar overall health and functional abilities compared to non-Veterans.

Association Between Body Mass Index and Functional Outcomes in Patients With Intracerebral Hemorrhage.

Evidence of the so-called "obesity paradox," which refers to the protective effect and survival benefit of obesity in patients with spontaneous intracerebral hemorrhage (ICH), remains controversial. This study aims to determine the association between body mass index (BMI) and functional outcomes in patients with ICH and whether it is modified by race/ethnicity. Included individuals were derived from the Ethnic/Racial Variations of Intracerebral Hemorrhage study, which prospectively recruited 1,000 non-Hispanic White, 1,000 non-Hispanic Black, and 1,000 Hispanic patients with spontaneous ICH. Only patients with available BMI were included. The primary outcome was 90-day mortality. Secondary outcomes were mortality at discharge, modified Rankin Scale (mRS), Barthel Index, and self-reported health status measures at 90 days. Associations between BMI and ICH outcomes were assessed using univariable and multivariable logistic, ordinal, and linear regression models, as appropriate. Sensitivity analyses after excluding frail patients and by patient race/ethnicity were performed. A total of 2,841 patients with ICH were included. The median age was 60 years (interquartile range 51-73). Most patients were overweight (n = 943; 33.2%) or obese (n = 1,032; 36.3%). After adjusting for covariates, 90-day mortality was significantly lower among overweight and obese patients than their normal weight counterparts (adjusted odds ratio [aOR] = 0.71 [0.52-0.98] and aOR = 0.70 [0.50-0.97], respectively). Compared with patients with BMI <25 kg/m2, those with BMI ≥25 kg/m2 had better 90-day mRS (aOR = 0.80 [CI 0.67-0.95]), EuroQoL Group 5-Dimension (EQ-5D) (aβ = 0.05 [0.01-0.08]), and EQ-5D VAS (aβ = 3.80 [0.80-6.98]) scores. These differences persisted after excluding withdrawal of care patients. There was an inverse relationship between BMI and 90-day mortality (aOR = 0.97 [0.96-0.99]). Although non-Hispanic White patients had significantly higher 90-day mortality than non-Hispanic Black and Hispanic (26.6% vs 19.5% vs 18.0%, respectively; p < 0.001), no significant interactions were found between BMI and race/ethnicity. No significant interactions between BMI and age or sex for 90-day mortality were found, whereas for 90-day mRS, there was a significant interaction with age (pinteraction = 0.004). We demonstrated that a higher BMI is associated with decreased mortality, improved functional outcomes, and better self-reported health status at 90 days, thus supporting the paradoxical role of obesity in patients with ICH. The beneficial effect of high BMI does not seem to be modified by race/ethnicity or sex, whereas age may play a significant role in patient functional outcomes.

Outcomes of a Fatigue Management Intervention for People With Post COVID-19 Condition.

Fatigue is identified as one of the most prevalent and persistent problems reported by people with post COVID-19 condition that negatively impacts on everyday living and resumption of pre-COVID-19 lifestyle. A pilot occupational therapy fatigue management intervention was designed for patients presenting with post COVID-19 condition fatigue. A retrospective analysis was carried out after the delivery of the fatigue management intervention. Self-reported measures of fatigue, well-being, and health status were taken at baseline and repeated at 2 wks after intervention. Baseline and postintervention scores were compared using nonparametric analysis. Sixty participants (73% female), median age 50.5 yrs (range, 17-74), 93% reporting symptoms persisting for 12 wks or longer, completed the fatigue management intervention. All participants reported moderate to severe fatigue impacting on everyday activity at baseline. The greatest impact of fatigue was on engagement in leisure and work activity. Statistically significant improvement in fatigue ( P < 0.001), well-being ( P < 0.001), and health status ( P < 0.001) were noted after the intervention. Findings indicate the potential of occupational therapy fatigue management interventions to enable self-management strategies and reduce the negative impact of fatigue among people with post COVID-19 condition.

Self-reported symptoms of everyday executive dysfunction, daytime sleepiness, and fatigue and health status among adults with congenital aniridia: a descriptive study

ABSTRACT Background Congenital aniridia is a rare genetic disorder of the eye characterized by visual impairment and progressive vision loss. While prior research has focused on ocular manifestations in individuals with aniridia, there is a dearth of research on impacts on cognition and mental health. The aims of this study were to describe subjective symptoms of everyday executive functioning, fatigue and sleepiness in adults with aniridia and to compare self-reported health status with that of a normative reference group. Methods Twenty-nine adults (aged 18–79 years) with congenital aniridia were included in this online survey, of whom 52% were females. Participants completed self-report measures of executive functioning (The Behavior Rating Inventory of Executive Function–Adult Version), sleepiness, fatigue, and health status (EQ-5D-5L). Results Participants reported relatively few problems in everyday executive functioning, with only 14% experiencing impaired executive functioning. Scores on the five EQ-5D-5L domains (mobility, self-care, usual activities, pain, and anxiety/depression) did not differ from those of the normative reference group. The frequencies of excessive daytime sleepiness and severe fatigue were 17% and 38%, respectively. Ocular pain was experienced by 62% of participants. Conclusions The findings show that cognitive problems are related to and reflect self-reported health status and extent of fatigue. Moreover, those who suffered from ocular pain reported more difficulties with executive functioning, sleepiness and fatigue. These findings are important for understanding this disorder and supporting patients.

Self-compassion and pain disability in adults with chronic pain: The mediating role of future self-identification and self-efficacy.

Pain disability is a primary target of treatment for chronic pain. Self-compassion shows promise as an intervention to reduce pain disability, but mechanisms linking self-compassion with less pain disability remain to be identified. This study examined two potential mechanisms, health self-efficacy and future self-identification (FSI), as parallel mediators of the relation between self-compassion and pain disability. Adults (N = 188; Mage = 40.34, SD = 11.53; 70.9% female) screened for chronic pain were recruited through online convenience sampling. Participants completed self-report measures of demographics, health status, and primary study variables. Self-compassion was positively associated with FSI and self-efficacy, but only self-efficacy was found to mediate the negative relation between self-compassion and pain disability, such that self-compassion was associated with higher self-efficacy, which was associated with less pain disability. Future experimental and longitudinal studies can establish whether the negative relation between self-compassion and pain disability is causal and mediated via health self-efficacy.

Putting “ME” into measurement: Adapting self-report health measures for use with individuals with intellectual disability

BackgroundSelf-report is important for measuring health outcomes; however, most research in intellectual disability (ID) relies on proxy report. The lack of cognitively accessible measures is one barrier to accurate self-reporting by individuals with ID. AimsThis paper describes the process of adapting self-report measures of health status, health-related quality of life, and environment for use by individuals with ID and presents evidence on their usability (accessibility), usefulness (independent self-report), and reliability (internal consistency and test-retest). Methods and proceduresWe used an inclusive research approach, in which we collaborated with adults with ID to revise, cognitively test, and pilot test cognitively accessible self-report measures. Technology supported the independent completion of measures. We assessed usability, usefulness, and reliability of these measures in 41 adults with ID. Outcomes and resultsThe resulting measures are useful (independently completed) and usable (elicit a range of responses), with modest reliability (internal consistency and test-retest). Conclusions and implicationsSelf- report by adults with ID is feasible. A key element of this measure adaptation process was engaging adults with ID. More research is needed to understand the reliability and validity of the adapted measures and the characteristics of the population for whom they are most usable.

A composite clinical motor score as a comprehensive and sensitive outcome measure for Parkinson’s disease

BackgroundAn unmet need remains for sensitive outcome measures in neuroprotective trials. The study aims to determine whether a composite clinical motor score, combining the Movement Disorders Society-Unified Parkinson’s Disease Rating...

Turning away from sound: The role of fear avoidance in noise sensitivity following mild traumatic brain injury

BackgroundNoise sensitivity (NS) following mild traumatic brain injury (mTBI) is common impacts functioning and outcomes. Recent research suggests psychological factors may have a significant role in the development of NS after mTBI. Psychological interventions have been advocated for to reduce this experience. To be effective, these interventions must aim to target the psychological processes that contribute to this relationship. Fear avoidance holds promise in this regard. The current study aimed to explore the role of fear avoidance in NS and examine its role in mediating the relationship between psychological distress and NS. MethodAdults (n = 234) diagnosed with mTBI were recruited from outpatient mTBI clinics throughout New Zealand. Participants completed self-report measures of pre-injury mental health status, as well as current post-concussion symptoms, psychological distress (anxiety, stress, depression, fear avoidance and post-traumatic stress symptoms) and functional status upon entry to an mTBI outpatient clinic (M = 8.9, SD = 9.2, post injury). ResultsA pre-injury mental health diagnosis was associated with NS after mTBI, as were symptoms of anxiety, stress, depression, and post-traumatic stress. Regression analyses revealed that fear avoidance (β = 0.45, p = .01), as well as stress (β = 0.07, p = .01) and PTSD symptoms (β = 0.02, p = .01), made a significant and unique contribution to NS. A series of mediation analyses found that fear avoidance had a significant indirect effect on the relationships between psychological distress and NS. ConclusionsFear avoidance is related to NS following mTBI. Targeting fear avoidance behaviours and beliefs may represent a treatment target for reducing NS after mTBI.

Assessment of antenatal anxiety, depression and obsessive-compulsive disorder in pregnant women in the COVID-19 era.

To assess the mental health of pregnant women, with reference to anxiety, depression and obsessive-compulsive (OC) symptoms, during the COVID-19 pandemic. A cross-sectional survey was conducted in Ireland during the third wave of the pandemic between February and March 2021. Psychiatric, social and obstetric information was collected from pregnant women in a Dublin maternity hospital, alongside self-reported measures of mental health status. Of 392 women responding, 23.7% had anxiety, scoring >9 for GAD-7 (7-item generalised anxiety disorder), 20.4% had depression, scoring >9 for PHQ-9 (9-item depression screening tool: Patient health questionnaire) and 10.3% had obsessive-compulsive disorder (OCD), scoring >13 for Yale-Brown obsessive-compulsive scale symptom checklist (Y-BOCS). Amongst self-reported OCD symptoms, there was a preponderance for obsessions rather than compulsions. Of 392 women, 36.2% described their mental health as worse during the pandemic, most frequently describing symptoms of anxiety and sleep disturbance. When analysed against test scores, self-reported worsening of mental health was significantly associated with higher scores on the GAD-7, PHQ-9 and Y-BOCS scales. The three scores were positively interrelated. Poor mental health scores were associated with self-reported strain in relationship with the baby's father, and current or previous history of mental illness. This study found high levels of depression, anxiety and OC symptoms amongst pregnant women during COVID-19. This highlights the vulnerability of this group to mental illness and the importance of enhanced screening and support during pandemics.

Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018

The elimination of racial and ethnic differences in health status and health care access is a US goal, but it is unclear whether the country has made progress over the last 2 decades. To determine 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordability among adults in the US. Serial cross-sectional study of National Health Interview Survey data, 1999-2018, that included 596 355 adults. Self-reported race, ethnicity, and income level. Rates and racial and ethnic differences in self-reported health status and health care access and affordability. The study included 596 355 adults (mean [SE] age, 46.2 [0.07] years, 51.8% [SE, 0.10] women), of whom 4.7% were Asian, 11.8% were Black, 13.8% were Latino/Hispanic, and 69.7% were White. The estimated percentages of people with low income were 28.2%, 46.1%, 51.5%, and 23.9% among Asian, Black, Latino/Hispanic, and White individuals, respectively. Black individuals with low income had the highest estimated prevalence of poor or fair health status (29.1% [95% CI, 26.5%-31.7%] in 1999 and 24.9% [95% CI, 21.8%-28.3%] in 2018), while White individuals with middle and high income had the lowest (6.4% [95% CI, 5.9%-6.8%] in 1999 and 6.3% [95% CI, 5.8%-6.7%] in 2018). Black individuals had a significantly higher estimated prevalence of poor or fair health status than White individuals in 1999, regardless of income strata (P < .001 for the overall and low-income groups; P = .03 for middle and high-income group). From 1999 to 2018, racial and ethnic gaps in poor or fair health status did not change significantly, with or without income stratification, except for a significant decrease in the difference between White and Black individuals with low income (-6.7 percentage points [95% CI, -11.3 to -2.0]; P = .005); the difference in 2018 was no longer statistically significant (P = .13). Black and White individuals had the highest levels of self-reported functional limitations, which increased significantly among all groups over time. There were significant reductions in the racial and ethnic differences in some self-reported measures of health care access, but not affordability, with and without income stratification. In a serial cross-sectional survey study of US adults from 1999 to 2018, racial and ethnic differences in self-reported health status, access, and affordability improved in some subgroups, but largely persisted.

Cannabis Use and Oral Health in a National Cohort of Adults

Cannabis use is common and increasing among adults. Evidence connects cannabis use to poor periodontal health, but few prospective studies exist of adults in the United States. This investigation examined associations between cannabis use and self-reported adverse oral health conditions among participants (N = 18,872) in the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative cohort. Survey-weighted regression modeling estimated associations between cannabis use and seven self-reported measures of oral health status, adjusted for tobacco use and other disease risk factors. Reporting past-30-days cannabis use in any of PATH Waves 1-3 was positively and statistically significantly associated at Wave 4 with multiple periodontal disease sequalae and with self-rated fair or poor overall oral health (adjusted odds ratio versus never-users: 1.75; 95% confidence interval: 1.52, 2.01). These findings provide further evidence that cannabis use is an independent risk factor for poor oral health, although study limitations (self-reported outcomes, limited information on cannabis use frequency and modality) must be considered. Dental professionals should engage patients in clear, nonjudgmental dialogue about cannabis use to address oral health risks and avoid potential patient safety issues in care delivery. General recommendations for addressing cannabis use in dental practice are presented.

Changes in Healthcare Utilization, Spending, and Perceived Health during COVID–19: A Longitudinal Study from Singapore

Importance: The outbreak of the novel coronavirus (COVID–19) has challenged the capacity of healthcare systems around the world and can potentially compromise healthcare utilization and health outcomes among non-COVID–19 patients. However, the empirical evidence regarding changes in healthcare utilization, healthcare spending, and health status among non-COVID–19 patients is limited. Objective: To examine the associations of the COVID-19 pandemic with healthcare utilization, out-of-pocket medical costs, and perceived health status in Singapore. Design: A retrospective observational study using a difference-in-differences method that examines changes in healthcare utilization, healthcare spending, and perceived health status before and during the outbreak of COVID-19 of the same individuals using monthly individual-level panel survey data. Setting: Singapore between June 2018 and June 2020. Participants: Singaporeans aged 50–70 (N=7,569; January 2020). Exposures: Outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in January 2020 in Singapore. Main Outcomes and Measures: Healthcare utilization, diagnosis of chronic health conditions, out-of-pocket medical costs (total and by medical service categories), self-reported measures of overall health status, sleep quality, and depressive symptoms. Results: Of 7,569 sample respondents in the January 2020, 53% are female, and 87% are ethnic Chinese. Their average age was 63.2. Between January and April 2020, COVID-19 was associated with a decrease in doctor visits by 9.3 percentage points (31% reduction from 29.8%; 95% Confidence Interval (CI), -11% to -8%). It was also associated with a decrease in out-of-pocket medical spending by S$46.5 (23% reduction from S$198 in January 2020; 95% CI, -S$74.3 to -S$18.7), mostly driven by reductions in inpatient and outpatient care, and a decrease in the probability of any diagnosis of chronic conditions by 2.7 percentage points (19% reduction from 13.9%; 95% CI, -4% to -2%). Although there were little changes in self-reported health status and sleep quality, COVID–19 was associated with an increase in depressive symptoms by 2.8 percentage points (4% reduction from 71%; 95% CI, 1.1% to 4%). Conclusions and Relevance: It is imperative to monitor COVID–19’s long-term health effects among non-COVID–19 patients since our findings indicated delayed healthcare and worsened mental health related to the outbreak.

Self-Reported General and Oral Health in Adults in the United States: NHANES 1999-2014.

ObjectiveTo assess self-reported general health (SRGH) and self-reported oral health (SROH), and to identify factors associated with these self-health reports among adults in the United States.MethodsData from the National Health and Nutrition Examination Survey (NHANES) for 1999 to 2014 were analyzed. Survey-weighted descriptive statistics were computed and Pearson correlations between the two self-reported health status measures were tested. Separate multivariable logistic regressions in SROH and SRGH were performed. Measures of inequality-absolute inequality (AI) and relative inequality (RI) in SRGH and SROH were investigated.ResultsThe sample consisted of 37,904 adults. Survey-weighted proportions of “excellent or very good” general health decreased from 54% in 1999–2000 to 45% in 2013–2014 and that of oral health increased from 27% in 1999–2000 to 38% in 2013–2014. Whites, participants with college degrees and those ≥400% of family poverty income ratio (PIR) had a higher probability of reporting “excellent or very good” general and oral health. Young people had a higher probability of reporting “excellent or very good” general health and the probability of reporting “excellent or very good” oral health fluctuated among the different age groups. There was a slight increase in both AI and RI by sociodemographic factors for SRGH (except for gender). For SROH, AI increased slightly, and RI decreased slightly (except for education) over the same period.ConclusionSelf-reported general health had higher ratings than self-reported oral health. Survey period, age, race/ethnicity, education and family PIR were significantly associated with SRGH and SROH, but gender was only significant in the SROH model. SRGH was significantly associated with SROH after adjusting for other sociodemographic factors.

Gender Differences in Demographic and Health Characteristics of the Million Veteran Program Cohort.

The Department of Veterans Affairs Million Veteran Program (MVP) is the largest ongoing cohort program of its kind, with 654,903 enrollees as of June 2018. The objectives of this study were to examine gender differences in the MVP cohort with respect to response and enrollment rates; demographic, health, and health care characteristics; and prevalence of self-reported health conditions. The MVP Baseline Survey was completed by 415,694 veterans (8% women), providing self-report measures of demographic characteristics, health status, and medical history. Relative to men, women demonstrated a higher positive responder rate (23.0% vs. 16.0%), slightly higher enrollment rate (13.5% vs. 12.9%), and, among enrollees, a lower survey completion rate (59.7% vs. 63.8%). Women were younger, more racially diverse, had higher educational attainment, and were less likely to be married or cohabitating with a partner than men. Women were more likely to report good to excellent health status but poorer physical fitness, and less likely to report lifetime smoking and drinking than men. Compared with men, women veterans showed an increased prevalence of musculoskeletal conditions, thyroid problems, gastrointestinal conditions, migraine headaches, and mental health disorders, as well as a decreased prevalence of gout, cardiovascular diseases, high cholesterol, diabetes, and hearing problems. These results revealed some substantial gender differences in the research participation rates, demographic profile, health characteristics, and prevalence of health conditions for veterans in the MVP cohort. Findings highlight the need for tailoring recruitment efforts to ensure representation of the increasing women veteran population receiving care through the Veterans Health Administration.

Bioaerosol exposure from composting facilities and health outcomes in workers and in the community: A systematic review update.

Rapid population growth and urbanisation around the world has led to increasing waste generation rates. Composting of organic waste in large-scale facilities is part of a growing trend in the UK, and elsewhere, to better manage and re-use the organic waste. However, composting inevitably generates bioaerosols, which have been associated with human health effects. In 2015, we reported that there was some, albeit limited, qualitative evidence linking bioaerosol emissions from composting facilities to poor respiratory health in nearby residents. However, the limited evidence precluded any quantitative assessment. Since then, the number of operational industrial-scale composting facilities in England has increased by 9% - nearly twice the growth from 2012 to 2014. At the same time, rapid urbanisation has led to expansion of city borders with more people living near large composting facilities and exposed to bioaerosol pollution. It is essential that regulatory authorities have access to the most up to date and accurate information. In this update of a systematic review published in 2015, we review and summarise the evidence from more recent studies that have assessed bioaerosol exposures within and near composting facilities and their associated health effects in both community and occupational health settings. Specifically, we wanted to find out if new evidence has emerged since the previous review to strengthen and confirm its conclusions. Two electronic databases (Medline and Embase) and bibliographies were searched for studies reporting on health outcomes and/or exposure to bioaerosols from composting facilities published between 1 January 2014 and 15 June 2018. Identification of relevant articles and data extraction was undertaken and studies were assessed for risk of bias. 23 studies met the inclusion criteria (15 exposure studies, 4 health studies, 4 health and exposure studies (one of which used an exposure proxy)). The majority of studies were conducted in occupational settings, and over short time periods. Some progress has been made in the characterisation of bioaerosol emissions from these composting facilities, with the application of molecular-based methods. Whilst the latest health studies do not rely solely on subjective self-reported measures of health status but include more objective health measures, these studies were almost exclusively carried out in compost workers and were characterised by profound methodological limitations. Only one community health study was identified and used a proxy measure of bioaerosol exposure. Although this review identified an additional 23 studies since the earlier review, the conclusions remain largely unchanged. Given the absence of any consistent evidence on the toxicity of bioaerosols from composting facilities, there is insufficient evidence to provide a quantitative comment on the risk to nearby residents from exposure to compost bioaerosols. To improve risk assessment and to best advise on risk management, it is important to ensure that the research recommendations outlined in this review are addressed.

Cigarette Smoking History and Functional Outcomes After Spontaneous Intracerebral Hemorrhage.

Background and Purpose- Although cigarette use may be a risk for intracerebral hemorrhage (ICH), animal models suggest that nicotine has a potential neuroprotective effect. The aim of this multicenter study is to determine the effect of smoking history on outcome in ICH patients. Methods- We analyzed prospectively collected data from the Ethnic/Racial Variations of Intracerebral Hemorrhage study and included patients with smoking status data in the analysis. Patients were dichotomized into nonsmokers versus ever-smokers, and the latter group was further categorized as former (>30 days before ICH) or current (≤30 days before ICH) smokers. The primary outcome was 90-day modified Rankin Scale score shift analysis. Secondary outcomes were in-hospital mortality and mortality, Barthel Index, and self-reported health status measures at 90 days. Results- The overall study cohort comprised 1509 nonsmokers and 1423 ever-smokers (841 former, 577 current, 5 unknown). No difference in primary outcome was observed between nonsmokers versus ever-smokers (adjusted odds ratio [aOR], 1.041; 95% CI, 0.904-1.199; P=0.577). No differences in primary outcome were observed between former (aOR, 0.932; 95% CI, 0.791-1.178; P=0.399) or current smokers (aOR, 1.178; 95% CI, 0.970-1.431; P=0.098) versus nonsmokers. Subgroup analyses by race/ethnicity demonstrated no differences in primary outcome when former and current smokers were compared with nonsmokers. Former, but not current, smokers had a lower in-hospital mortality rate (aOR, 0.695; 95% CI, 0.500-0.968; P=0.031), which was only observed in Hispanics (aOR, 0.533; 95% CI, 0.309-0.921; P=0.024). Differences in self-reported health status measures were only observed in whites. Conclusions- Cigarette smoking history does not seem to provide a beneficial effect on 90-day functional outcome in patients with ICH.

Abstract TP438: Cigarette Smoking History and Functional Outcomes After Spontaneous Intracerebral Hemorrhage

Objective: While cigarette use may be a risk for intracerebral hemorrhage (ICH), animal models suggest that nicotine has a potential neuroprotective effect. The aim of this multicenter study is to determine the effect of smoking on outcome in ICH patients. Methods: We analyzed prospectively collected data from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study, and included patients with smoking status data in the analysis. Patients were dichotomized into non-smokers versus ever-smokers, and the latter group was further categorized as former (&gt;30 days before ICH) or current (≤30 days before ICH) smokers. The primary outcome was 90-day modified Rankin Scale (mRS) score shift analysis. Secondary outcomes were in-hospital mortality and mortality, Barthel Index, and self-reported health status measures at 90 days. Results: The overall study cohort comprised 1,509 non-smokers and 1,423 ever-smokers (841 former, 577 current, 5 unknown). No difference in primary outcome was observed between non-smokers versus ever-smokers (aOR=1.041 [0.904-1.199], p=0.577). No differences in primary outcome were observed between former (aOR=0.932 [0.791-1.178], p=0.399) or current smokers (aOR=1.178 [0.970-1.431], p=0.098) versus non-smokers. Subgroup analyses by race/ethnicity demonstrated no differences in primary outcome when former and current smokers were compared to non-smokers. Former, but not current, smokers had a lower in-hospital mortality rate (aOR=0.695 [0.500-0.968], p=0.031), which was only observed in Hispanics (aOR=0.533 [0.309-0.921], p=0.024). Differences in self-reported health status measures were only observed in whites. Conclusion: Cigarette smoking history does not appear to provide a beneficial effect on 90-day functional outcome in patients with ICH.

Do men with more masculine voices have better immunocompetence?

Abstract The human voice is often considered to be a secondary sexual characteristic that signals underlying information about the immunocompetence of the speaker (i.e. the immunocompetence handicap hypothesis; ICHH). However, no studies have yet shown a relationship between vocal characteristics and biomarkers of immune function or self-reported health. In a sample of 108 men, we examined correlations between masculine vocal characteristics [i.e. relatively low fundamental frequency (F0), low F0 variability (F0-SD), low formant position (Pf), and high vocal tract length (VTL)] in relation to salivary immunoglobulin-A (sIgA; a marker of mucosal immunity), testosterone (T), and well-validated measures of self-reported health status. Results showed that sIgA correlated with masculinized F0, Pf, and VTL. Self-report health correlated with masculinized Pf and VTL. Anticipated future health correlated negatively with F0-SD and sick role propensity (less interference of illness in daily life) correlated positively with VTL. Perceived susceptibility to infection correlated with more feminized F0 and F0-SD. Our results demonstrated a small relationship between men's vocal characteristics and one putative indicator of mucosal immunity along with self-identified health status. We suggest that more research is warranted to determine whether the masculinity of men's voices may serve as an indicator of their phenotypic quality.

Intergenerational Health Mobility in the US

Studies of intergenerational mobility have largely ignored health despite the central importance of health to welfare. We present the first estimates of intergenerational health mobility in the US by using repeated measures of self-reported health status (SRH) during adulthood from the PSID. Our main finding is that there is substantially greater health mobility than income mobility in the US. A possible explanation is that social institutions and policies are more effective at disrupting intergenerational health transmission than income transmission. We further show that health and income each capture a distinct dimension of social mobility. We also characterize heterogeneity in health mobility by child gender, parent gender, race, education, geography and health insurance coverage in childhood. We find some important differences in the patterns of health mobility compared with income mobility and also find some evidence that there has been a notable decline in health mobility for more recent cohorts. We use a rich set of background characteristics to highlight potential mechanisms leading to intergenerational health persistence.