Worse Self-reported Health Status Research Articles

Financial toxicity of patients with lung cancer in China: Results from a National Survey Study.

To develop a comprehensive understanding of financial toxicity (FT) among patients with lung cancer in China and the major factors affecting FT. Drawing from a national cross-sectional survey, which used the validated comprehensive score for financial toxicity (COST) questionnaire, we estimated the prevalence and degree of FT. Patient coping actions were investigated. Pearson's chi tests and multinomial logistic regression were used to evaluate the predictors of FT in patients with lung cancer. The median score of FT was 20 (scored on a range of 0-44, with lower scores indicating more severe toxicity). Altogether, 77% of the sample patients had FT (COST <26), 54.5% had mild FT (COST 14-25), and 22.5% had moderate and severe FT (COST 0-13). Living in the less-developed western region of China, being male, having a lower educational level, lower annual family income, and advanced stage or worse self-reported health status were significantly related to higher FT than their counterparts (p< 0.05). Patients with higher FT tended to have a lower level of medical compliance, a higher risk of incurring debts, and reduced living expenditures relative to those with lower FT. Despite China's remarkable progress in the past two decades with regard to Universal Healthcare Coverage, FT still presents a serious challenge for patients with lung cancer. Keen attention must be paid to reducing the disproportionate high financial risks of patients with low socioeconomic status.

Trajectories of physical functioning and its predictors in older adults: A 12-year longitudinal study in China.

ObjectiveMaintaining and delaying a decline in physical function in older adults is critical for healthy aging. This study aimed to explore trajectories, critical points of the trajectory changes, and predictors among older people in the Chinese community.DesignThis study was one with a longitudinal design performed in China.Setting and participantsThe target population was community-dwelling older adults aged over 65 years. A total of 2,503 older adults from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included in this study.MethodsPhysical functioning was measured by instrumental activities of daily living (IADL). Population-based trajectory models were used to identify potential heterogeneity in longitudinal changes over 12 years and to investigate associations between baseline predictors and different trajectories for different cohort members using LASSO regression and logistic regression.ResultsFour trajectories of physical function were identified: slow decline (33.0%), poor function and moderate decline (8.1%), rapid decline (23.5%), and stable function (35.4%). Older age, male sex, worse self-reported health status, worse vision status, more chronic diseases, worse cognitive function, and a decreased frequency of leisure activity influenced changes in the trajectory of physical function. Having fewer teeth, stronger depressive symptoms, a lack of exercise, and reduced hearing may increase the rate of decline.Conclusion and implicationsFour trajectories of physical function were identified in the Chinese elderly population. Early prevention or intervention of the determinants of these trajectories can maintain or delay the rate of decline in physical function and improve healthy aging.

Types of usual sources of care and their association with healthcare outcomes among cancer survivors: a Medical Expenditure Panel Survey (MEPS) study

Purpose To assess associations between usual source of care (USC) type and health status, healthcare access, utilization, and expenses among adult cancer survivors.MethodsThis retrospective cross-sectional analysis using 2013–2018 Medical Expenditure Panel Survey included 2690 observations representing 31,953,477 adult cancer survivors who were currently experiencing cancer and reporting one of five USC types: solo practicing physician (SPP), a specific person in a non-hospital facility, a specific person in a hospital-based facility, a non-hospital facility, and a hospital-based facility. We used logistic regressions and generalized linear models to determine associations of USC type with health status, healthcare access, utilization, and expenses, adjusting for patient demographic and clinical characteristics.ResultsAll non-SPP USC types were associated with reporting more difficulties contacting USC by telephone during business hours (p < 0.05). Compared to SPP, non-hospital facility was associated with more difficulty getting needed prescriptions (OR: 1.81, p = 0.036) and higher annual expenses ($5225, p = 0.028), and hospital-based facility was associated with longer travel time (OR: 1.61, p = 048), more ED visits (0.13, p = 0.049), higher expenses ($6028, p = 0.014), and worse self-reported health status (OR: 1.93, p = 0.001), although both were more likely to open on nights/weekends (p < 0.05). Cancer survivors with a specific person in a hospital-based facility (vs. SPP) as USC were > twofold as likely (p < 0.05) to report difficulty getting needed prescriptions and contacting USC afterhours.ConclusionsAmong adult cancer survivors who were currently experiencing cancer, having a non-SPP type of UCS was associated with reporting more difficulties accessing care, worse health, more ED visits, and higher total expenses.Implications for Cancer SurvivorsTransitioning to SPP type of USC may result in better healthcare outcomes.

Frequency and factors associated with foregone and delayed medical care due to COVID-19 among nonelderly US adults from August to December 2020.

To estimate the frequency and factors associated with foregone and delayed medical care attributed to the COVID-19 pandemic among nonelderly adults from August to December 2020 in the United States. We used three survey waves from the Urban Institute's Household Pulse Survey (HPS) collected between August 19-31, October 14-26and December 9-21. The final sample included 155,825 nonelderly (18-64) respondents representing 135,835,598 million individuals in the United States. We used two multivariable logistic regressions to estimate the association between respondents' characteristics and foregone and delayed care. The frequency of foregone and delayed medical care was 26.9% and 35.9%, respectively. Around 60% of respondents reported difficulties in paying for usual household expenses in the last 7 days. More than half reported several days of mental health issues. The regression results indicated that foregone or delayed care were significantly associated with difficulties in paying usual household expenses (p < 0.001), worse self-reported health status (p < 0.001), increased mental health problems (p < 0.001), Veterans Affairs (p <0.001) or Medicaid (p = 0.003) coverage compared to private healthcare coverage, and older age groups. Individuals who participated in the latter two waves of the survey (October, December) were less likely to report foregone and delayed care compared to those who participated in Wave 1 (August). Overall, the frequency of foregone and delayed medical care remained high from August to December 2020 among nonelderly US adults. Our findings highlight that pandemic-induced access barriers are major drivers of reduced healthcare provision during the second half of the pandemic and highlight the need for policies to support patients in seeking timely care.

The Influence of Patient and Hospital Characteristics on Inpatient Satisfaction at Beijing District-Level Hospitals

PurposePatient satisfaction is a key indicator of healthcare quality and hospital performance. This study aims to assess inpatient satisfaction at district-level hospitals and explore the determinants of inpatient satisfaction.Patients and MethodsA total of 1458 adults from inpatient departments of 47 district-level hospitals in 16 districts across Beijing were recruited with a multi-stage stratified sample at Beijing in 2019. Univariate analysis and multivariate logistic regression were used to identify the influence of patient and institutional characteristics on inpatient satisfaction in four domains – administrative process, hospital environment, medical care, hospitalization expenses, and overall satisfaction.ResultsOf the 1458 participants, 577 (39.6%) were men, 581 (39.8%) were over 60 years of age. The average value of satisfaction score measured by a 5-point Likert scale were 4.37, 4.00, 4.44, 3.89, and 4.33 for the four domains and overall satisfaction. Patient and institutional characteristics were strongly associated with inpatient satisfaction. Patients with higher educational level were more satisfied with administrative process (P<0.05). Elder patients and patients with worse self-reported health status were less satisfied with hospital environment (P<0.05). Female, higher monthly family income and Urban Employees Basic Medical Insurance were positively associated with patient satisfaction in hospitalization expenses (P<0.05). And patients receiving care in suburban hospitals were less satisfied with administrative process, hospital environment and overall satisfaction (P<0.05). Patients receiving care in Traditional Chinese Medicine hospitals were more satisfied with medical care and expenses but less satisfied with environment (P<0.05). Chronic disease and hospital grade were not significantly associated with satisfaction in all domains.ConclusionPatient satisfaction was influenced by demographic characteristics and hospital features. These determinants should be considered in hospital evaluation.

Reasons Older Veterans Use the Veterans Health Administration and Non-VHA Care in an Urban Environment.

Older veterans in urban settings rely less on the Veterans Health Administration (VHA) health care, suggesting deficits of access and services for aging veterans. We aimed to identify reasons for VHA and non-VHA use across the health status of older, urban-dwelling veterans. We examined open-ended responses from 177 veterans who were enrolled in primary care at the Bronx VA Medical Center, used non-VHA care in prior 2 years, and completed baseline interviews in a care coordination trial from March 2016 to August 2017. Using content analysis, we coded and categorized key terms and concepts into an established access framework. This framework included 5 categories: acceptability (relationship, second opinion), accessibility (distance, travel); affordability; availability (supply, specialty care); and accommodation (organization, wait-time). Self-reported health status was stratified by excellent/very good, good, and fair/poor. We were able to categorize the responses of 166 veterans, who were older (≥75 years, 61%), minority race and ethnicity (77%), and low income (<$25,000/y, 51%). Veterans mentioned acceptability (42%) and accessibility (37%) the most, followed by affordability (33%), availability (25%), and accommodation (11%). With worse self-reported health status, accessibility intensified (excellent/very good, 24%; fair/poor, 46%; P = .031) particularly among minority veterans, while acceptability remained prominent (excellent/very good, 49%; fair/poor, 37%; P = .25). Other categories were mentioned less with no significant difference across health status. Even in an urban environment, proximity was a leading issue with worse health. Addressing urban accessibility and coordination for older, sicker veterans may enhance care for a growing vulnerable VHA population.

COVID-19 psychological impact, knowledge and perceptions of healthcare professionals in Greece: Α nationwide cross-sectional study.

The impact of the COVID-19 pandemic on the mental health of healthcare professionals is currently under research and prevalence of mental health symptoms across the world vary a lot. Moreover, knowledge and perceptions of healthcare professionals towards the new coronavirus is yet to be explored since very few data have been published to date. Thus, we decided to conduct a cross-sectional, web-based survey to measure the levels of depressive, anxiety and stress symptoms using the Depression, Anxiety and Stress Scale-21. The knowledge and perceptions of healthcare professionals towards the new coronavirus were also examined with a self-constructed questionnaire. Data were collected between April 19th and May 31st 2020. In total, 1484 professionals participated in the survey and 1064 completed it in full; 60.8% were females, 66.5% were physicians and 24.3% were first-line healthcare workers. The prevalence of at least moderate symptoms was 13% for depression, 11.9% for anxiety, and 11.3% for stress. Women, younger participants, residents in urban areas, having lower income and worse self-reported health status had higher scores in all outcomes. First-line healthcare workers also indicated higher anxiety scores compared to those who were not first responders. Regarding knowledge and perceptions, most participants agreed with the asymptomatic nature of the virus and its heightened danger for older individuals and those with underlying health conditions. Different views were expressed regarding the possibility of airborne transmission, its similarity to common flu, and the statements that the new coronavirus is manufactured and serves a specific purpose and that it is out of control. In conclusion, the results of our study suggest that the prevalence of depressive, anxiety and stress symptoms in Greek healthcare professionals is placed in the lower end of the range reported from various recent studies across the world. Nevertheless, professionals at risk should be monitored closely and supported when needed.airborne transmission, its similarity to common flu, and the statements that the new coronavirus is manufactured and serves a specific purpose and that it is out of control. In conclusion, the results of our study suggest that the prevalence of depressive, anxiety and stress symptoms in Greek healthcare professionals is placed in the lower end of the range reported from various recent studies across the world. Nevertheless, professionals at risk should be monitored closely and supported when needed.

Associations of Sleep Quality and Frailty among the Older Adults with Chronic Disease in China: The Mediation Effect of Psychological Distress.

Frailty affects the elderly and leads to adverse health outcomes. Preliminary evaluations have suggested that sleep quality and psychological distress are predictors of frailty among older adults. However, the mechanisms by which sleep quality affect frailty had not been fully addressed in the previous research. This study aimed to explore the mediation effect of psychological distress on the association between sleep quality and frailty among the elderly with chronic diseases in rural China. A total of 2346 old adults were included in the analysis. Frailty status was measured by Fried Phenotype criteria. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), and psychological distress was examined by Kessler Psychological Distress Scale (K10). Ordinal logistic regressions were performed to assess the relationships between sleep quality and frailty. Mediation test was also conducted by bootstrap method. The prevalence rate of frailty among the elderly with chronic diseases was 21% in rural China. Compared with the elder of robust status, respondents identified as having frailty have lower SES, less vigorous physical activity, and worse self-reported health status. Poor sleep quality was a significant predictor of frailty with mediators (OR = 1.44, 95% CI = 1.19–1.76). Mediation analysis suggested that psychological distress mediated 41.81% of total effect between sleep quality and frailty. This study indicated that poor sleep quality was significantly related to frailty, and psychological was a mediator of this association. However, we could not investigate causal relationships between variables since this was one cross-sectional study. These findings suggested that an early detection of sleep problems and also psychological disorders should be taken to prevent frailty among the rural older adults in China.

Association of sleep duration and self-reported health status among us adults with osteoarthritis

Purpose: : Among persons with arthritis, sleep disturbances such as insufficient sleep and issues with feeling unrested and/or fatigued after sleep are common. Sleep disorders may impact on quality of life, pain perception, and functional abilities. The aim of this study was to examine the extent to which sleep duration is associated with self-reported health status and reported days with activities affected by pain in a nationally representative sample of persons with osteoarthritis. Methods: Using cross-sectional data from the 2007-2012 National Health and Nutrition Examination Survey (NHANES), we identified 1,559 adults (weighted N= 20,866,345) with self-reported osteoarthritis. Sleep duration was assessed using the question that asked: “How much sleep do you usually get at night on weekdays or workdays?” Total hours of sleep were classified as three levels ≤6 hours, 7-8 hours, and ≥9 hours. Current health status was evaluated using two questions: 1) how many days in the past 30 days did pain make it hard for you to do the usual activities, such as self-care, work, or recreation (range: 0-30); and 2) self-reported general health status such as excellent, very good, good, fair, or poor and collapsed into fair/poor versus excellent/very good/good. According to levels of sleep duration, socio-demographic and clinical characteristics were calculated. Multivariable logistic and Poisson models were used to examine the relationship between sleep duration and self-reported health status adjusting for socio-demographic and health factors. Adjusted rate ratios (aRR) and odds ratios (aOR) with 95% confidence intervals (CI) were estimated and compared with a common reference group (sleep duration of 7-8 hours). Results: Among persons with osteoarthritis, most were aged over 50 years, women, non-Hispanic white, overweight or obese, and had at least some college education. Approximately 2 in 5 participants had sleep duration less or equal to 6 hours (40.4%, 95% CI: 37.6%-43.2%). While the average disease duration was 12.7 years in those reporting sleep duration ≤6 hours, the average disease duration was 15.3 years among those reporting sleep duration ≥9 hours. In persons with osteoarthritis, sleep duration (≤6 hours) was associated with more days with difficulty for usual activities due to pain (aRR ≤6 hours versus 7-8 hours: 1.30, 95% CI: 1.06 to 1.59). Compared with sleep duration for 7-8 hours, those with fewer sleep hours were more likely to be associated with poor/fair self-reported health status (e.g., aOR ≤6 hours versus 7-8 hours: 2.05, 95% CI: 1.38-3.04). Conclusions: In US adults with osteoarthritis, short sleep duration is common. More importantly, short sleep duration is associated with worse self-reported health status in persons with osteoarthritis. These findings may indicate that individuals with osteoarthritis may be at a higher risk for sleep disturbances. Future studies using longitudinal analysis to evaluate other factors such as sleep habits and clinical outcomes in persons with arthritis maybe needed.

Medical Care Avoidance Among Older Adults.

Objective: To examine factors and reasons associated with medical care avoidance among older adults in the United States. Method: Analysis of data on 2,155 adults aged 65 and older, who completed the 2008 Health Information National Trends Survey. Results: Nearly one fourth of older adults reported medical care avoidance (n = 449; weighted % = 22.5%). Of these, more than one third reported doing so because of feeling uncomfortable when their body is examined (34.5%) or fearing a serious illness (35.9%) and with fewer reporting avoiding care because it made them think of dying (14.3%). Likelihood of avoidance was higher among those with worse self-reported health status, severe psychological distress, lower health self-efficacy, lower confidence in obtaining health information, lower trust in doctors, less patient-centered communication, lower perceived health care quality, and those who were current smokers. Qualitative reasons for avoidance corroborated quantitative results. Conclusion: Avoidance by older adults appears to be largely associated with evaluations of the quality of care and provider communication.

What is the impact of a clinically related readmission measure on the assessment of hospital performance?

BackgroundThe Hospital Readmission Reduction Program (HRRP) penalizes hospitals for high all-cause unplanned readmission rates. Many have expressed concern that hospitals serving patient populations with more comorbidities, lower incomes, and worse self-reported health status may be disproportionately penalized by readmissions that are not clinically related to the index admission. The impact of including clinically unrelated readmissions on hospital performance is largely unknown. We sought to determine if a clinically related readmission measure would significantly alter the assessment of hospital performance.MethodsWe analyzed Medicare claims for beneficiaries in Michigan admitted for pneumonia and joint replacement from 2011 to 2013. We compared each hospital’s 30-day readmission rate using specifications from the HRRP’s all-cause unplanned readmission measure to values calculated using a clinically related readmission measure.ResultsWe found that the mean 30-day readmission rates were lower when calculated using the clinically related readmission measure (joint replacement: all-cause 5.8%, clinically related 4.9%, p < 0.001; pneumonia: all cause 12.5%, clinically related 11.3%, p < 0.001)). The correlation of hospital ranks using both methods was strong (joint replacement: 0.95 (p < 0.001), pneumonia: 0.90 (p < 0.001)).ConclusionsOur findings suggest that, while greater specificity may be achieved with a clinically related measure, clinically unrelated readmissions may not impact hospital performance in the HRRP.

Identifying patient and practice characteristics associated with patient-reported experiences of safety problems and harm: a cross-sectional study using a multilevel modelling approach

ObjectiveTo identify patient and family practice characteristics associated with patient-reported experiences of safety problems and harm.DesignCross-sectional study combining data from the individual postal administration of the validated Patient Reported Experiences...

Longitudinal evaluation of medication underuse in older outpatients and its association with quality of life.

We investigated the factors promoting prescribing omissions (medication underuse) in long-term medical care and the impact of withholding indicated medications on quality of life. In a population-based cohort study of older ambulatory patients (ESTHER), we collected data with sequential questionnaires from participants and from their GPs. Concurrently, in two consecutive home visits, trained study physicians performed comprehensive geriatric assessments and recorded all medicines currently taken. Each patient's medication was screened for underuse using the START-2 criteria. Medication underuse (absence of ≥1 indicated medication) was present in 70.3 and 73.2% of 989 participants at two consecutive home visit assessments, respectively. Following variable selection accounting for subject-specific heterogeneity over time, multivariate results revealed that more drugs (odds ratio with 95% confidence intervals: 0.83 [0.78;0.87] per drug) and better cognitive status (0.93 [0.87;0.99] per point on the MMSE scale) were preventive factors, while worse self-reported health status (1.33 [1.05;1.67] per point on an 5-point scale) and increasing frequency of GP consultations (1.07 [1.00;1.15] per visit within the preceding 3months) were positively associated with medication underuse. An increase in omitted medications over time was associated with worse quality of life as determined on the EuroQuol EQ-Vas and EQ-5D scales. In addition to general and physician-related factors, also patient-related aspects, such as individual health appraisal, were associated with medication underuse. Because withholding indicated drugs was associated with substantially reduced quality of life, controlled intervention studies are necessary to confirm the notion that pharmacological appropriateness improves personal wellbeing.

Associations between multimorbidity, healthcare utilisation and health status: evidence from 16 European countries.

with ageing populations and increasing exposure to risk factors for chronic diseases, the prevalence of chronic disease multimorbidity is rising globally. There is little evidence on the determinants of multimorbidity and its impact on healthcare utilisation and health status in Europe. we used cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2011-12, which included nationally representative samples of persons aged 50 and older from 16 European nations. Negative binomial and logistic regression models were used to assess the association between number of chronic diseases and healthcare utilisation, self-perceived health, depression and reduction of functional capacity. overall, 37.3% of participants reported multimorbidity; the lowest prevalence was in Switzerland (24.7%), the highest in Hungary (51.0%). The likelihood of having multimorbidity increased substantially with age. Number of chronic conditions was associated with greater healthcare utilisation in both primary (regression coefficient for medical doctor visits = 0.29, 95% CI = 0.27-0.30) and secondary setting (adjusted odds ratio (AOR) for having any hospitalisation in the last year = 1.49, 95% CI = 1.42-1.55) in all countries analysed. Number of chronic diseases was associated with fair/poor health status (AOR 2.13, 95% CI = 2.03-2.24), being depressed (AOR 1.48, 95% CI = 1.42-1.54) and reduced functional capacity (AOR 2.12, 95% CI = 2.02-2.22). multimorbidity is associated with greater healthcare utilisation, worse self-reported health status, depression and reduced functional capacity in European countries. European health systems should prioritise improving the management of patients with multimorbidity to improve their health status and increase healthcare efficiency.

Pediatric Leukemia/Lymphoma Patients Have Worse Patient-Reported Health Status Than Pediatric Solid Tumor and CNS Tumor Patients during Intensive Treatment

Introduction: Children receiving treatment for cancer experience impaired health status. Health status during treatment can be systematically quantified using patient-reported outcome measures (PROs). PROs are any report of a patient's health status that comes directly from the patient and provide composite scores from a series of questions around a central concept to quantify the level of distress or impairment caused by a patient's symptoms, disease, or treatment. Previous work in pediatric leukemia patients and brain tumor patients measuring PROs over time demonstrated no change in patient-reported health status late in therapy compared to the end of therapy. Changes in patient function over the early, intensive phases of treatment have not been studied. Additionally, the impact of cancer disease type (Leukemia/Lymphoma, CNS Tumor, Solid Tumor) on patient-reported health status during intensive cancer therapy is not known.The objective of this study was to characterize the impact of disease type on patient function related to mobility, fatigue, pain, anxiety, depression, and peer relationships over the initial six months of therapy. We hypothesized that CNS/Solid Tumor patients have worse self-reported health status than Leukemia/Lymphoma patients and that patient function worsened over time for all domains measured.Methods: We conducted a prospective cohort study of children ages 5-21 yearsold with a new diagnosis of cancer. Patients were enrolled in the study for six months or until their treatment completed, whichever time period was shorter. Our primary outcome was patient function as measured using the Patient-Reported Outcome Measurement Information System (PROMIS) for impaired mobility, pain, fatigue, anxiety, depressive symptoms, and peer relationships. PROMIS is a validated PRO that provides separate scores for each domain measured (reported as T score) with a mean score of 50. Self-report participant assessments were obtained twice monthly on electronic tablets, at the beginning of a treatment cycle and approximately 1 week later. Intensity of therapy was determined using the Intensity of Treatment Rating (ITR-3) scale and classified as moderate, very, and most intensive treatments.Patient demographics were analyzed using simple statistics. Analysis of changes in patient function used a generalized linear mixed model (GLMM) using predictors of type of cancer and time from diagnosis.Results: Forty patients completed the study and had a mean age of 11.7 years (SD 4.7). Fifty-eight percent of the patients were male and 60% of patients had Leukemia/Lymphoma. Forty percent of patients received moderate intensity treatment, 47.5% received very intensive, and 12.5% received most intensive treatment. The intensity of treatments was similar in the Leukemia/Lymphoma group and the CNS/Solid Tumor group (p=0.21).Disease Group: CNS/Solid Tumor patients have better self-reported health status for all domains measured compared to Leukemia/Lymphoma patients. CNS/Solid Tumor patients report better mobility (higher T scores) compared to Leukemia/Lymphoma patients by a factor of 1.1 (p<0.001), less fatigue (lower T scores) by a factor of 0.83 (p<0.001), less pain (lower T scores) by a factor of 0.83 (p<0.001), less anxiety (lower T scores) by a factor of 0.83 (p<0.001), less depressive symptoms (lower T scores) by a factor of 0.85 (p<0.001), and better peer relationships (higher T scores) by a factor of 1.11 (p=0.0036).Time from diagnosis: Time from diagnosis has a significant effect on patient-report of pain for both Leukemia/Lymphoma and CNS/Solid Tumor patients, with improved pain over time. At 100 days from diagnosis, pain scores decrease by a factor of 0.91 (p=0.008). Time from diagnosis did not have a significant effect on patient function in any other domain measured.Conclusion: Leukemia/Lymphoma patients experience significantly worse patient functioning compared to patients with CNS/Solid Tumors over the first six months of cancer treatment.In addition, as time from diagnosis increases patient function related to pain improves. The significant burden of disease for Leukemia/Lymphoma patients demonstrated in this study is a surprising finding and perhaps reflects an underestimation of the burden of Leukemia/Lymphoma treatment because of the overall favorable prognosis for most of the children with these diagnoses. DisclosuresPanepinto:HRSA, NIH: Research Funding; NKT Therapeutics, Inc: Consultancy.

An explorative cross-sectional study examining self-reported health and nutritional status of disadvantaged people using food banks in Germany.

BackgroundEven in high-income countries some population groups depend on food banks to support their food intake. We aimed to explore and compare health and nutritional status of food bank clients (Tafel e.V.) in different cities in Germany.MethodsIn a cross-sectional study, self-reported health and nutritional status of food bank clients living in three cities (Berlin - capital, Ludwigsburg- affluent city, Fulda - small town) which differ in size, available income and poverty rate, were assessed and compared to survey variables of the low socioeconomic status population of national surveys (DEGS and GEDA).ResultsAcross cities, food bank clients (N = 276, response rate of 21.5 %) did not differ in main socio-demographic characteristics (age, nationality, education, professional qualification, household income). Smoking, having at least one chronic illness, estimating their own health status as moderate to poor and low consumption of fruits and vegetables were common characteristics. Comparing selected variables with the low socioeconomic status population of DEGS and GEDA, differences were found for a higher prevalence of diabetes among food bank clients and a worse self-reported health status. Considerably lower fruit consumption and lower hypertension prevalence among female and lower overweight rates among male food bank clients were found.ConclusionsAlthough people using food banks vary in socio-demographic background, no differences for main demographics across the cities were found. In addition, the study suggests that for some health- and nutrition-related variables, national surveys in Germany might underestimate socioeconomic differences.

Characteristics of Indigenous adults with poorly controlled diabetes in north Queensland: implications for services.

BackgroundIndigenous Australian adults with diabetes continue to have suboptimal clinical control and poorer outcomes compared with non-Indigenous people although there is a paucity of data documenting the detailed health status of Indigenous people in Australia. To further investigate the characteristics of Indigenous Australian adults with poorly controlled diabetes we analysed baseline data from a cluster randomized trial aiming to deliver a program of integrated community-based intensive chronic disease management for Indigenous people in remote communities in far north Queensland, Australia.MethodsIndigenous adults aged 18 to 65 years from 12 clinics in rural north Queensland with established type 2 diabetes and with HbA1c ≥8.5% were invited to participate. The primary outcome variable measured at baseline was HbA1c. Other variables measured included socio-demographic indicators, health literacy, BMI, blood pressure, lipids, renal function, smoking status and quality of life measures. Data were collected between December 2010 and July 2011. Analysis was performed by ethnicity – Aboriginal or Torres Strait Islander.ResultsOne hundred and ninety three participants were included in the analysis. Very high rates of albuminuria, high rates of smoking, dyslipidaemia, hypertension and elevated BMI were recorded. Aboriginal participants reported higher levels of socio-economic disadvantage, higher smoking rates, lower BMI and worse self-reported health status than Torres Strait Islander participants.ConclusionThese results demonstrate a high potential for improved culturally sound community-based management of diabetes and other comorbid conditions in this very high risk population. They also provide further evidence for including albuminuria in cardiovascular risk calculation.

Has the Prevalence of Migraine Changed over the Last Decade (2003–2012)? A Spanish Population-Based Survey

IntroductionInformation on temporal trends can identify groups of people at risk for any particular condition; however information on temporal trends on migraine headache at population levels is scarce. Our aim was to estimate the time trends in the prevalence of migraine from 2003 to 2012 in Spain.MethodsA population-based national study was conducted. We analyzed data using individualized information taken from national surveys conducted in 2003/4, 2006/7, 2009/10 and 2011/12. A total of 94,158 Spanish adults participated. We considered the presence of self-rated and diagnosed migraine, and we analyzed socio-demographic features, lifestyle habits, self-rated health status, and comorbid diseases using logistic regressions.ResultsThe prevalence of migraine increased from 6.54% in 2003 to 9.69% in 2012 with significant time trends (adj. OR 1.65; 95%CI 1.50–1.81). The probability of women of suffering migraine was 3 times higher than for men (adj.OR 3.08; 2.82–3.37). There was a declining trend in migraine prevalence as age increased (adj.OR 0.42; 0.35–0.51). Demographic variables associated with migraine were lower educational level (adj.OR 1.32; 1.13–1.54) and not being an immigrant (adj.OR 1.37; 1.15–1.64). A worse self-reported health status was related to higher prevalence of migraine (adj.OR 2.83; 2.59–3.09). The prevalence of migraine also increased as the number of comorbid conditions increased (adj.OR 2.42; 2.05–2.86).ConclusionThe prevalence of migraine has increased in the first decade of the 21st century in Spain. Migraine was associated with being female, mid-age, low educational level, not being an immigrant, worse self-rated health status and presence of comorbid conditions.

Chapter 1 posttraumatic stress disorder: a view from the operating theater.

Posttraumatic stress disorder (PTSD) is an anxiety disorder that develops following exposure to a traumatic event. The prevalence and symptom severity of PTSD is greater in military combat Veterans than the civilian population. Although PTSD is a psychiatric disorder, in Veterans, it is associated with several physical comorbidities, chronic pain, substance abuse, and worse self-reported health status which may predispose them to greater perioperative morbidity and mortality. At present, the effect of surgery on the severity of PTSD is largely unknown. However, the perioperative clinician should consider PTSD a chronic illness associated with the accumulation of risk factors across the life span.

Smoking is associated with a worse self-reported health status in patients with psoriatic arthritis: data from a Swedish population-based cohort.

The aim was to study possible associations between smoking habits and self-reported clinical features in a large population-based cohort of patients with psoriatic arthritis (PsA). All subjects with PsA who had sought health care in the period 2003-2007 were identified using a regional health-care register. In 2009, all those identified who were 18 years of age or more (n = 2,003) were sent a questionnaire with questions on smoking, health-related quality of life [EuroQol five-dimension (EQ-5D)questionnaire], function [Health Assessment Questionnaire (HAQ)], pain, fatigue, and global health. We performed age- and sex-adjusted regression analysis to compare health status outcomes in never and ever smokers. Altogether, 1,185 subjects (59%) returned the questionnaire. Mean age was 57 years (SD 13.5), and 58% were women; 38% were never smokers and 62% were ever smokers. Mean age at disease onset was 38.2 years (SD 13.2) and 41.2 years (SD 13.6), respectively (p = 0.001). In age- and sex-adjusted data, ever smokers reported worse EQ-5D (p = 0.009); worse reports of global health (p = 0.01), pain (p = 0.01), and fatigue (p = 0.04); and a higher number of painful body regions (p = 0.04) compared to never smokers. In this population-based PsA cohort, patients who were ever smokers reported worse health status than never smokers. Besides being a possible result of a worse PsA in ever smokers, impaired health status could also be an effect of unstudied comorbidities. Further longitudinal studies are needed to gain a better understanding of cause and effect. However, smoking cessation should be recommended because of general health considerations as well as disease-specific issues.