Significant Differences In Health Status Research Articles

Examining the "White Health Advantage" Effect among Latinos in the United States.

There is consensus regarding the socio-political roots of the concept of race (and ethnicity) in the United States (US). However arbitrary, the US societal constructions of race have meant racial/ethnic minorities experience disproportionate health burdens. The present study examined the so-called "white health advantage" effect in a large sample of US respondents, comparing Latinos (non-White and White) with non-Latino Whites. This cross-sectional study used deidentified data from the Dynata Global COVID Symptoms map project, collected between July 7-14, 2020 (n = 135,075). A dichotomous health status variable was created with respondents answering yes/no to any COVID-19 symptoms (difficulty breathing, coughing, fatigue, fever, and loss of taste or smell). We included relevant predisposing (age, gender, number of children, race, ethnicity, marital status, and education) and enabling factors (housing conditions, income, employment status, business ownership, and number of cars owned - a proxy measure for wealth). Multivariate logistic regression models showed significant differences in health status (as measured by COVID-19 symptoms) when comparing Latinos (non-White, White) and non-Latino Whites. For instance, higher socioeconomic status had a protective effect only among non-Latino Whites. In turn, being married/living with a partner was only associated with COVID-19 symptoms among White Latinos, indicating that the apparent benefits of this "improving" socio-political location are somewhat limited. Our study found significant differences in COVID-19 symptoms when comparing Latinos (non-White, White) and non-Latino Whites. Our findings underscore the importance of further examining health outcomes by racial identities of US Latinos, which can help inform future health equity efforts.

Patient experiences and clinical outcomes of admissions to municipal acute wards versus a hospital: a multicentre randomised controlled trial in Norway

Background In Norway, municipal acute wards (MAWs) were implemented as alternatives to hospitalisation. Evaluations of the quality of MAW services are lacking. The primary objective of this study was to compare patient experiences after admission to a MAW versus to a hospital. The secondary objective was to compare ‘readmissions’, ‘length of stay’, ‘self-assessed health-related quality of life’ as measured by the EuroQol 5 items 5 level (EQ-5D-5L) index, and ‘health status’ measured by the RAND-12, in patients admitted to a MAW versus a hospital. Methods A multicentre randomised controlled trial (RCT), randomising patients to either MAW or hospital. Results In total, 164 patients were enrolled in the study; 115 were randomised to MAW and 49 to hospital. There were no significant differences between the MAW and hospital groups regarding patient experience, which was rated positively in both groups. Patients in the MAW group reported significantly better physical health status as measured by the RAND-12 four to six weeks after admittance than those randomised to hospital (physical component summary score, 31.7 versus 27.1, p = 0.04). The change in EQ-5D index score from baseline to four to six weeks after admittance was significantly greater among patients randomised to MAWs versus hospitals (0.20 versus 0.02, p = 0.03). There were no other significant differences between the MAW and hospital groups. Conclusions In this study, patient experiences and readmissions were similar, whether patients were admitted to a MAW or a hospital. The significant differences in health status and quality of life favouring the MAWs suggest that these healthcare services may be better for elderly patients. However, unfortunately we did not reach the planned sample size due to challenges in the data collection posed by the Covid-19 pandemic.

"Heal the sick": Health status and caregiving during the 17th-18th century in Northern Italy (St. Biagio cemetery, Ravenna).

The study of health-related care provision in archeology gives important indications on the culture and community organization of past populations. This study aims to assess the health status of the skeletal assemblage recovered from the burial site of St. Biagio (Ravenna, 17th-18th Centuries); next, we identified likely instances of need for and receipt of caregiving in response to the condition, to examine evidence of community attitudes toward disease and disability. The skeletal assemblage is composed of 133 individuals in a generally good state of preservation. Sex and age-at-death were estimated through classical anthropological methods. Health status was inferred through the biological index of frailty (BIF) and paleopathological analysis was performed through macroscopic and radiographic investigations. The "bioarcheology of care" approach was applied to individuals who showed evidence of impairment and disability. The skeletal assemblage of St. Biagio was equally represented by males and females (50% males), with a higher percentage of adults (83.4%) than subadults (10.5%), and this is reflected in the high life expectancy at birth (40.3 years). No significant differences in health status emerged between age groups and sexes, with a generally high percentage of joint diseases, antemortem trauma, and infectious diseases. Evidence of care and compassion was found in some individuals with a high degree of impairment or disability, as in the case of probable Angelman syndrome. This study provided important insights into the biological and social aspects of an Early Modern population in Northern Italy, showing that people with functional and/or visible abnormalities were probably cared for in life and were presumably considered full members of the society.

The role of income in the lives of people with long-term disabilities: A multi-country analysis

Abstract Background Health is a fundamental human right. Yet, people become ill and die because they do not have enough money to access the necessary healthcare. Studies confirm that on average, more income translates to better health status. The magnitude of this relationship and its consequences beyond health like reintegration or spillovers are not widely understood but are expected to be significantly different among countries. This is especially the case in vulnerable populations like those with a spinal cord injury (SCI). This study aims to better understand the role that income plays in promoting health in people with SCI and their differences across countries. Methods The research focus on three aspects, one, the estimation of the health income gap using years after the injury and a comorbidity index, two, the decomposition of different factors of this inequality with a special interest in the unmet healthcare needs, and three, their consequences in their social participation measured by the reasons of unemployment. Results There are significant differences in health status by income and between countries. On average, the poorest income groups with SCI are up to 40 times more likely to be ill than people in the richest groups and live 4-6 years less after the injury. The working conditions and the unmet health care needs are important factors that explain that differences. In addition, the health status, the lack of sustainable employment opportunities, and workplace accessibility issues are the main issues to reintegrating into the labor market. Conclusions Health inequalities are a global problem that affects people with long-term health conditions disproportionately to others without. Even in more equal and high-income countries with a universal health system, there are different realities for the people according to their income, where the estimations and solutions for the ‘average’ individual do not target the needs of people in the extremes. Key messages • This study generates evidence about the role of income in health, lack of health services, and consequences in people with SCI across and within countries. • To achieve the goal of health equity, it is important to target the different realities focusing on the needs of people who most need which goes beyond the health system and changes by income level.

Parameters of the Infrastructure of the Residential Area and Their Relationship with Cardiovascular Risk Factors

Aim. This study determined the level of public satisfaction with neighborhood design features in Kemerovo Oblast and their connection to cardiovascular disease risk factors.Subjects and methods. The study population included 1,598 respondents aged between 35 and 70, with 491 living in rural areas and others living in Kemerovo (1,221 women and 477 men). The assessment of neighborhood environment was done according to residents' subjective opinions about infrastructural features (the Neighborhood Environmental Walkability Scale). Depending on how participants responded to the questionnaire, some of these parameters were identified as adverse.Results. The residents of Kemerovo and rural areas of Kemerovo Oblast identified the following neighborhood design features as adverse: the lack of interesting places in neighborhood environment, the remote location of parks and restaurants, the absence of pavement, busy traffic, and a long distance between home and workplace. In the city, arterial hypertension prevalence was high among men, when grocery, fruit and clothing stores were distant, and among women, when banks, public transport stops were distant and the traffic was heavy. Lipid metabolism disorders were more common among women in urban areas, when there were no interesting places around. Obesity prevalence was high among urban female population, when the following adverse factors were present: the remote location of grocery stores, fruit stores, bank, pharmacy and public transport stops and the absence of pavement. Among rural male population, this risk factor was common when there were no pavements. The highest rate of carbohydrate metabolism disorders was found among women living in villages where the traffic is heavy and public transport stops are far away.Conclusion. The impact of infrastructure on the health status of the living population is a new direction of scientific research. Epidemiological studies in different geographic areas and population groups show significant differences in health status, morbidity and mortality from chronic noncommunicable diseases. To reduce the risks of developing diseases of the cardiovascular system, the formation of a socially comfortable health-saving environment is of great importance.

Differences in characteristics, health status and fulfillment of exercise recommendations between axial spondyloarthritis patients with and without supervised group exercise

ObjectiveSince decades, supervised group exercise (SGE) is recommended for people with axial spondyloarthritis (axSpA). This study examines if weekly SGE contributes to fulfillment of exercise recommendations in axSpA patients. MethodsCross-sectional data from three studies with axSpA patients in The Netherlands, including two with outpatient populations (n = 196 and n = 153) and one with SGE participants (n = 128), were analysed. Sociodemographic and disease characteristics, SGE participation, health status (ASAS Health Index), spinal mobility and fulfillment of the recommendations for leisure-time aerobic (≥150 min/week moderate-intensity or ≥75 min/week vigorous-intensity) and strength and mobility (≥2 sessions/week) exercise (measured with SQUASH-questionnaire) were assessed. Differences between patients with and without SGE were analysed. ResultsIn the two outpatient populations (n = 349), 17 patients (5%) used SGE. The SGE participants (n = 145) were significantly older, had longer disease duration, were less frequently employed, used less medication and had worse spinal mobility than patients without SGE (n = 332). There were no significant differences in health status. Patients with SGE fulfilled the moderate-intensity aerobic (89 % vs. 69%) and strength and mobility (44 % vs. 29%) exercise recommendations more often than patients without SGE, but the aerobic exercise recommendation was less often fulfilled with vigorous-intensity exercise (5 % vs. 12%). ConclusionSGE is used by just few, especially older, axSpA patients and contributes to fulfilling recommendations for moderate-intensity, mobility and strength exercise. Both in patients with and without SGE, only a minority fulfilled the recommendations for vigorous-intensity, strength and mobility exercises. Therefore, future promotion of exercise should focus on implementing these types of exercise.

Quality of Life and Health Status of Jordanian Women Users of Various Contraceptive Methods and Associated Factors: Implications for Contraceptive Policies.

AimThe study aimed at investigating the differences in health status of women users and non-users of contraceptive methods and assess differences in contraception quality of life (CQoL) according to method used.MethodsAcross sectional study with 372 women between the ages of 18 and 49 years old were recruited. Participants completed the health status and the CQoL questionnaire, which was validated using factor analysis combining three factor loading measures with a good Cronbach's alpha reliability coefficient.ResultsResults showed that there were no significant differences in health status between users and non-users. There was a significant difference in QoL according to the method used at the p <0.05 level for the three conditions F (2193) = 6.0 and p = 0.003. Post hoc analysis indicated that the total CQoL was significantly higher in IUD users (M = 55.7, SD = 9.6) than users of natural methods (M = 50, SD = 9.0, p < 0.01). In addition, the total CQoL was significantly higher among women from the southern region (M = 56.7, SD = 9.0) than from the northern and mid-regions (M = 49.5, SD = 0.07 and M = 52, SD = 10, respectively, p < 0.01).ConclusionThe physiological changes of women’s QoL was affected by the use of the IUD method with significantly lower QoL scores than those who used oral contraceptives and non-hormonal methods. In addition, there was no significant difference in health status between users and non-users of contraceptive methods.ImplicationsThe study has implications for contraceptive counselling on quality of life of women users of IUD and women from the south region and provides opportunities for the advancement of the reproductive health services in Jordan.

基于街景测量的南昌市行道树结构特征与健康状况研究

行道树作为城市绿地系统的网络和骨架, 在城市居民生活中发挥着无可替代的作用。快速准确的掌握城市行道树的结构特征和健康状况, 有利于城市森林建设与管理, 进而提升其生态服务功能。基于百度街景平台, 通过街景测树法对南昌市的963个样方, 共计26727株行道树展开调查。测量内容包括行道树大小指标(树高、胸径、冠下高和冠幅)、健康状况(支架比例、枯稍比例、叶色不健康比例和死亡比例)和植被垂直结构配置情况; 并且探究了不同行政区和不同城市化强度(环城道路发展下的城乡梯度)下行道树的空间分布特征。结果表明: (1)南昌市行道树小树比例较高: 胸径在10-20 cm的占65%, 冠下高在1.5-2.5 m间的占76%, 树高在4-8 m间的占71%, 冠幅在2-6 m间的占76%;行道树生长整体表现为健康, 各指标所占比例较小, 但是叶片健康较差; 35%的样地无叶色不健康, 77%的样地无支架, 76%的样地无枯梢, 93%的样地无死亡; 植被垂直结构配置状况良好, 以乔-灌-草复合结构为主(比重为75%); (2)在空间分布上, 不同行政区行道树大小指标和垂直结构配置上差异显著、健康状况(支架比例和叶色不健康比例)均表现显著性差异(P < 0.05);不同环路行道树大小指标存在显著差异, 表现为1环>2环>3环, 垂直结构从内环到外环更为复杂, 配置等级为1环 < 2环 < 3环, 不同环路行道树健康状况(支架比例和叶色不健康比例)表现显著性差异(P < 0.05)。综上所述, 南昌市行道树整体健康状况良好, 行道树个体较小, 而且以复层结构为主, 本研究基于百度街景对南昌市行道树结构特征和健康状况进行比较全面的评价, 为南昌市今后城市行道树的规划和管理提供了基础数据支持。;As the network and skeleton of urban green space system, roadside trees play an irreplaceable role in urban residents' life. Rapid and accurate grasp of the structural characteristics and health status of urban roadside trees is conducive to the construction and management of urban forest, thus improving its ecological service function. Based on the Baidu Street View platform, this study investigated 963 quadrats, a total of 26, 727 roadside trees, in Nanchang by street view tree measurement method. Measures included indicators of street tree sizes (diameter at breast height (DBH), underbranch height (UBH), tree height (TH) and canopy size (CS)), health status (the proportion of Tripod-supporting, the proportion of Dieback, the proportion of Non-greenness leaf color and the proportion of Death trees), and vertical structure configuration of vegetation. Moreover, the spatial distribution characteristics of road trees under different administrative regions and different urbanization intensities (urban and rural gradient under the development of ring roads) were explored. The results showed that: (1) there was a high proportion of small trees in Nanchang: DBH of 10─20 cm accounted for 65%, UBH of 1.5─2.5 m accounted for 76%, TH of 4─8 m accounted for 71%, CS of 2─6 m accounted for 76%. The overall performance of the growth of street trees was healthy, the proportion of each index was small, but the leaf health was poor. In 35% of the plots, no leaf color was unhealthy, 77% of the plots had no Tripod-supporting, 76% of the plots had no Dieback and 93% of the plots had no death. The vertical structure of vegetation was in good condition, mainly composed of arbor-shrub-herb (75% of the sample land). (2) In terms of spatial distribution, there are significant differences in the sizes index and vertical structure configuration of road trees in different administrative areas, and significant differences in health status (proportion of Tripod-supporting and proportion of Non-greenness leaf color) (P < 0.05). There were urban-rural differences in the size index of road trees in different ring-road areas, which are manifested as 1^st ring > 2^nd ring > 3^rd ring, the vertical structure of the outer ring is more complex, configuration grade is 1^st ring < 2^nd ring < 3^rd ring. There were significant differences in the health status of different ring-road (proportion of Tripod-supporting and proportion of Non-greenness leaf color) (P < 0.05). To sum up, the overall health status of the roadside trees in Nanchang is good, the individual of the roadside trees is small, and they are mainly composed of multiple layers. Based on the Baidu Street View, this study makes a relatively comprehensive evaluation of the structural characteristics and health status of the roadside trees in Nanchang, which provides basic data support for the planning and management of the urban roadside trees in Nanchang in the future.

MO845EUROQOL EQ-5D-3L IN DIALYSIS POPULATION IN COLOMBIA

Abstract Background and Aims The EuroQol-5D (EQ-5D-3L) is a generic questionnaire to evaluate the quality of life related to health, and simultaneously facilitates the obtaining of preference values (utilities) In the economic evaluation of health interventions. Quality-adjusted life year (QALY) is a commonly used metric. Our objective is to evaluate the quality of life (QoL) and obtaining of utilities according the dialytic treatment. Method This was an observational, multicentre cross-sectional study. Prevalent patients on dialysis for at least 90 days, older than 18, at the Baxter Renal Care Services Colombia were included between August 2, 2019, to December 11, 2020. Socio-demographic and clinical characteristics of all patients were summarized descriptively, additionally, all categorical variables were compared with Pearson’s χ2 test or Fisher’s exact test and continuous variables were analysed with Student’s t-test or Mann Whitney U test. The difference in the QoL by domains will be evaluated using Pearson's χ2 test or Fisher’s exact test. The EQ VAS provides a quantitative measure of the patient’s perception of their overall health. Results A total 254 patients were evaluated, the median age was 55 years, 55% were men. At enrolment the median dialysis vintage 3.2 years, and 63% were in peritoneal dialysis treatment (Table 1). We did not find differences in the proportions by dialysis treatment when exploring each of the 5 dimensions of the QoL (Table 2). We observed that the patient´s perception of their overall health was similar median EQ VAS score 80 in HD and EQ VAS score 80 in PD (Figure 1). We did not find statistically significant differences in health status 11111, which represents not having problems in any dimension 46.8% versus 45.6%, HD and PD respectively, p-value= 0.855. Conclusion The quality of life reported by the patients and health status in haemodialysis was similar to peritoneal dialysis.

The Impact of Mandate Contract and Self-Employment on Workers' Health-Evidence from Poland.

The purpose of the study is to analyze the correlations between two clearly defined forms of non-standard employment (self-employment and mandate contract) and workers’ health. The study also addressed such variables as gender, age, length of service, and the reason for employment (voluntary vs. non-voluntary). The research was carried out in Poland in 2020 using the CATI method (a telephone interviewing technique), and it covered a sample of 200 workers (100 self-employed and 100 working under a mandate contract). Most of the respondents declared that their form of employment did not affect their health. However, the statistical analysis showed significant differences in health status between the self-employed and those working on a mandate contract. Self-employed respondents experienced mental health impacts more often, whereas those working under a mandate contract more frequently declared that their physical health was affected. The length of service was only important for mental health, having a negative impact on it. The respondents’ age and gender turned out to be statistically insignificant, which is in contradiction to many previous research findings. The inability to choose one’s form of employment resulted in worse physical health. These findings demonstrate the importance of certain variables that were not prioritized in previous studies and emphasize the need to clearly define what non-standard and precarious forms of employment are, as well as revealing new correlations between the studied categories and providing directions for further research.

A randomised controlled trial and cost-consequence analysis of traditional and digital foot orthoses supply chains in a National Health Service setting: application to feet at risk of diabetic plantar ulceration

BackgroundDiabetic foot ulceration is a considerable cost to the NHS and foot orthotic provision is a core strategy for the management of the people with diabetes and a moderate to high risk of foot ulceration. The traditional process to produce a custom-made foot orthotic device is to use manual casting of foot shape and physical moulding of orthoses materials. Parts of this process can be undertaken using digital tools rather than manual processes with potential advantages. The aim of this trial was to provide the first comparison of a traditional orthoses supply chain to a digital supply chain over a 6 month period. The trial used plantar pressure, health status, and health service time and cost data to compare the two supply chains.MethodsFifty-seven participants with diabetes were randomly allocated to each supply chain. Plantar pressure data and health status (EQ5D, ICECAP) was assessed at point of supply and at six-months. The costs for orthoses and clinical services accessed by participants were assessed over the 6 months of the trial. Primary outcomes were: reduction in peak plantar pressure at the site of highest pressure, assessed for non-inferiority to current care. Secondary outcomes were: reduction in plantar pressure at foot regions identified as at risk (> 200 kPa), cost-consequence analysis (supply chain, clinician time, service use) and health status.ResultsAt point of supply pressure reduction for the digital supply chain was non-inferior to a predefined margin and superior (p < 0.1) to the traditional supply chain, but both supply chains were inferior to the margin after 6 months. Custom-made orthoses significantly reduced pressure for at risk regions compared to a flat control (traditional − 13.85%, digital − 20.52%). The digital supply chain was more expensive (+£13.17) and required more clinician time (+ 35 min). There were no significant differences in health status or service use between supply chains.ConclusionsCustom made foot orthoses reduce pressure as expected. Given some assumptions about the cost models we used, the supply chain process adopted to produce the orthoses seems to have marginal impact on overall costs and health status.Trial registrationRetrospectively registered on ISRCTN registry (ISRCTN10978940, 04/11/2015).

Clinico-pathological profile evaluation in patients affected by chronic inflammatory bowel diseases

IntroductionInflammatory bowel diseases (IBDs) have high social impact. Aetiology is still unknown, however multifactorial genesis is surely implicated. We tried to correlate IBDs and psychological distress through evaluated psychometrical instruments and subsequently to relate subjective influences with gastroenteric clinical manifestation, defining new critical elements on which IBD are based.MethodsIn our study, we included 57 participants, selected according to their diagnosis, between those attending our gastrointestinal ambulatory: 26 had Chron's disease, while 31 had ulcerative colitis. 78 people without gastroenteric or psychiatric disorder were also included in the study as control group. Psychometric questionnaires were administered to evaluate anxiety and depressive symptoms, quality of live, self-efficacy and resilience (Fig. 1).ResultsLevels of anxiety and depression were higher in patients with IBDs than in the control group. STAI-Y highlighted higher state anxiety and trait anxiety levels in first group. HADS showed higher scores in ill patients, as well as CD-RISC showed a more impaired resilience. EQ-VAS, PGWBI and GSE revealed significant differences in health status, psychological wellness and self-efficacy between the two groups.ConclusionsIBDs seem related to psychological diseases. Affected patients have higher anxiety and depression levels than general population as well as lower self-efficacy and resilience. Those elements being strictly linked to physical discomfort contributes to develop a loop in which patients get caught. Creating a model of integrated cooperation between gastroenterologist and psychiatrist during treatment of patients with IBDs seems fundamental to grant at once all the professional figures each patient needs for better care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The health of parents with and without intellectual impairment in the UK.

Little is known about the health and well-being of the 'hidden majority' of parents with mild intellectual disability (ID), who are less likely to be in contact with disability services. We sought to add to knowledge in this area by examining the health and living conditions of parents with and without intellectual impairment in a large contemporary nationally representative sample of UK parents aged between 16 and 49 years old (n = 14 371). Our results indicated that, as expected, parents with intellectual impairment were at significantly greater risk than other parents of having poorer self-reported general, mental and physical health. They were also at significantly greater risk of experiencing higher rates of household socio-economic disadvantage and environmental adversities and lower rates of neighbourhood social capital and intergenerational support. Adjusting risk estimates to take account of between group differences in household socio-economic disadvantage eliminated statistically significant differences in health status between parents with and without intellectual impairment on all but one indicator (obesity). Further adjusting risk estimates to take account of between group differences in neighbourhood adversity, neighbourhood social capital and intergenerational support had minimal impact on the results. That controlling for between-group differences in exposure to socio-economic disadvantage largely eliminated evidence of poorer health among parents with intellectual impairment is consistent with the view that a significant proportion of the poorer health of people with IDs may be attributable to their poorer living conditions rather than biological factors associated with ID per se.

Health status of hearing‐impaired children and adolescents

This descriptive study was conducted to identify factors that affect the general health status of hearing-impaired children and adolescents aged 6-18. One hundred six hearing-impaired students were sampled from two primary schools and a high school in Izmir, Turkey. The data were collected utilizing the Child Health Questionnaire (CHQ). Children and adolescents' physical health mean score and psychological health mean score were M = 47.4 ± 10.2 and M = 49.4 ± 9.5, respectively. Statistically significant differences in health status were found between the categories of age, mother's educational level and economic status of the family. The general health status of children and adolescents was found to be positive.

Differences and Similarities in Rural Residents’ Health and Cardiac Risk Factors

Purpose: The current U.S. population exceeds three hundred million with approximately 20% living in non-urban rural areas. A higher percentage of rural residents have diagnosed heart disease and report poorer health compared to non-rural residents; however, it is not known whether risk factor modification for heart disease and health status differ based on degree of rurality. The purposes of this study were: 1) to compare differences in health status and cardiac risk factors between cardiac patients living in large and small/isolated rural areas, and 2) to compare the health status of rural cardiac patients with a national sample. Method : A secondary analysis using data from three separate studies was completed using a comparative descriptive design. The Cardiac Rehabilitation participant sample (n-191) included individuals 3 to 12 months post-cardiac event. The Arizona Heart Institute and Foundation Heart Test measured risk factors and the eight subscales of the Short-Form, Medical Outcomes study measured health status. Findings: No significant differences in health status were found; all participants rated their health moderately high. However, individuals in large rural areas reported significantly better general health than those in the normative sample. No differences in smoking, blood pressure, diabetes, or overweight/obese BMI were found between the two rural groups. Differences in exercise, and anger were present between the two groups. Significant differences were identified in waist circumference between the genders placing women at higher risk for heart disease. Conclusions: Identifying health status and cardiovascular risk factors of rural individuals informs interventions to be tested for rural residents. Key Words: Cardiac risk factors, Rural, Cardiac rehabilitation

An early intervention programme had no detectable influence on the health status of people with musculoskeletal injuries following road traffic crashes: Comparative study

ObjectiveTo compare the health status of people with minor injuries from road traffic crashes that are exposed to an early, active intervention programme (intervention group) with those receiving usual care (control group) over a 12 month period. DesignProspective comparative study using sequential cohorts. SubjectsPeople presenting to hospital emergency departments with mild to moderate musculoskeletal injuries following road traffic crashes. Main outcome measuresPhysical Component Score (PCS) and Mental Component Score (MCS) of the Short Form 36 (SF-36) health status measure; Hospital Anxiety and Depression Scale (HADS) and the Functional Rating Index (FRI) recorded immediately post-crash, at 6 months and at 12 months after injury. ResultsThere were 95 participants allocated to the control group and 98 allocated to the intervention group. Participants were enrolled at a mean of 9.3 days following the crash. There were no significant differences in baseline health measures between the groups. Apart from a small improvement in anxiety for the intervention group, there were no significant differences in health status between the groups. Twenty percent of participants in the intervention group received treatment from external healthcare providers that was inconsistent with the recommendations of the intervention programme. ConclusionsThe intervention programme failed to result in a clinically significant improvement in health outcomes compared with usual care. There is some evidence to suggest that the intervention had some psychological benefits, as evidenced by the small improvement in anxiety levels. Limited adherence, frequent use of co-interventions, or other factors (such as intervention content or intensity) may have reduced its effect.

직업 유무에 따른 노인의 건강상태, 수면 및 우울의 비교연구

본 연구의 목적은 직업유무에 따라 노인의 건강상태, 수면 및 우울을 비교하고, 건강상태와 수면이 우울과 관련이 있는지를 파악하는 것이다. 본 연구는 보건복지가족부가 실시한 "2008 노인실태조사"의 자료를 사용하였으며, 총 조사대상자 15,146명 중 직업이 있는 노인 5,204명과 직업이 없는 노인 9,942명이 최종분석에 이용되었다. 연구결과에 따르면 직업 유무에 따라 건강상태, 수면 및 우울에 유의한 차이가 있었다. 직업이 있는 노인의 경우 직업만족도가 우울에 가장 큰 영향을 미치는 요인으로 나타났으며, 주관적 건강상태, 현재 질병으로 인한 일상생활의 어려움 정도, 숙면을 취한 일수 순서로 유의한 영향을 미치는 것으로 나타났다. 이 변수들의 우울에 대한 설명력은 29%로 나타났다. 직업이 없는 노인의 경우 주관적 건강상태가 우울에 가장 큰 영향을 미치는 것으로 나타났으며, 현재 질병으로 인한 일상생활의 어려움 정도, 숙면을 취한 일수, 총 수면 시간 순으로 우울에 유의한 영향을 미치는 것으로 파악되었다. 이 변수들의 우울에 대한 설명력은 32%로 나타났다. 그러므로 노인의 건강상태, 수면, 우울을 향상시키기 위한 건강증진 중재는 직업유무에 따른 이러한 차이를 고려하여 계획되고 제공되어야 한다. The purpose of this study was to compare the health status, sleep and depression and to examine relationships between health status, sleep and depression by employment status in the elderly. This study used the data from the "2008 Korean National Survey on Older Adults" by Ministry of Health, Welfare and Family. Out of the total 15,146 Korean elderly surveyed, 5,204 subjects with job and 9,942 subjects without job at the present were used in a final analysis. There were significant differences in health status, sleep and depression by employment status. As for old adults with job, job satisfaction had the greatest effect on depression, followed by perceived health status, difficulty of daily activities by disease, and deep-sleeping days in the order. These variables accounted for 29% of depression. As for old adults without job, perceived health status had the greatest effect on depression, followed by difficulty of daily activities by disease, deep-sleeping days and total sleeping time in the order. These variables accounted for 32% of depression. Therefore, the health-promotion intervention to improve the health status, sleep and depression of the elderly should be planed and provided considering such differences by employment status.

Quality of life and health status with zoledronic acid and generic alendronate—a secondary analysis of the Rapid Onset and Sustained Efficacy (ROSE) study in postmenopausal women with low bone mass

The ROSE study compared annual infusion with zoledronic acid and weekly generic alendronate. No significant differences in quality of life or health status between treatment groups were observed. Adherence to alendronate during the study was high, with 80.9% of patients achieving adequate adherence. A secondary analysis to evaluate quality of life, health status, adherence to alendronate and therapy preference in postmenopausal women with low bone mass who received treatment with zoledronic acid or alendronate was conducted. Postmenopausal women with low bone mass were randomised 2:1 to receive an annual infusion of zoledronic acid or weekly oral generic alendronate in this open-label, multicentre study. Changes in quality of life and health status were assessed using questionnaires at baseline and month 12. Adherence to alendronate was assessed by the investigator and/or study personnel, and subjective therapy preference was assessed using a questionnaire at month 12. Patients were randomised to zoledronic acid (n = 408) and alendronate (n = 191). Overall, there were no significant differences in quality of life between zoledronic acid and alendronate. However, improvements in quality of life with zoledronic acid versus alendronate could be detected by posthoc analysis in patients with previous fractures. There were no significant differences in health status between patients receiving zoledronic acid or alendronate. Adherence to alendronate during the study was high, with 80.9% of patients achieving adequate adherence. A total of 81% of patients who had received zoledronic acid indicated that they would prefer to continue with that treatment, and 43% of the patients who received oral alendronate would like to switch to zoledronic acid. There were no significant differences in quality of life between patients receiving zoledronic acid or alendronate.

Exploring the Role of Housing Type on Physical Activity and Health Status in Community-Dwelling Older Adults

This study compared physical activity (PA) and perceived health status in older adults living in seniors' housing (SEN) versus those living in nonseniors' housing (NON). After adjusting for potential confounders, PA levels were significantly higher in the NON group. No significant differences in health status were evident between housing groups. Regression analyses showed that both physical and mental health status were associated with PA level in the NON group. In the SEN group, only physical health status was significantly associated with PA level. This supports a positive relationship between health status and physical activity levels in older adults regardless of housing arrangement.

Racial/Ethnic Disparities and Culturally Competent Health Care Among Youth and Young Men

Racial/ethnic disparities in health and health care are receiving increasing national attention from the fields of public health and medicine. Efforts to reduce disparities should adopt a life-span approach and recognize the role of gender. During adolescence, young people make increasingly independent decisions about health-related behavior and health care, while developing gender identity. Little is known about how cultural context shapes gender identity and gender identity's influence on health-related behavior and health care utilization. The authors review disparities in health status and health care among adolescents, especially young men, by reviewing health care access, clinical services, and issues related to culture, identity, and acculturation. Significant differences in health status by gender exist in adolescence, with young men faring worse on many health markers. This article discusses gaps in research and offers recommendations for improving health care quality and strengthening the research base on gender and disparities during adolescence.