Reliability and validity of interview data on chronic diseases. The Mini-Finland Health Survey

Children who run away from home: risks for suicidal behavior and substance misuse

PURPOSE

The primary aim of this study is to examine the extent to which running away from home as a child is associated with behavioral problems and victimization during childhood and with suicidal behavior and substance abuse during early adulthood.

METHODS

A random probability sample comprising 7,461 respondents was interviewed for the 2007 survey of psychiatric morbidity of adults in England. A subsample of 16- to 34-year-old individuals was selected for secondary analysis (N = 2,247). All survey respondents were asked whether they had run away from home and asked specific questions on being physically, emotionally and sexually abused as children. They were also asked about suicidal behavior and alcohol and drug dependence in early adulthood.

RESULTS

Approximately 7% of 16- to 34-year-old individuals reported running away from home before the age of 16 years, with higher rates in women than in men (9.8% compared with 5.3%). Overall, 45.3% reported being bullied, 25.3% experienced violence at home, and 8.8% reported unwanted sexual intercourse. Runaways were far more likely than other children to have suffered victimization and family difficulties and to exhibit behavioral problems. Adults who reported running away from home were three times more likely than other adults to have thought about or attempted suicide, but the relationship with substance abuse was far less pronounced.

CONCLUSIONS

Sexual, physical, and emotional abuse, along with family difficulties, can all impact children who run away from home. Running away from home was strongly associated with suicidal behavior in adulthood, regardless of other childhood adversities.

Physical ill health, disability, dependence and depression: results from the 2007 national survey of psychiatric morbidity among adults in England

BACKGROUND

The relationship between physical ill health, disability, and depression is not straightforward. Both cross-sectional and longitudinal studies have clearly shown that medical illness and physical disability are strongly associated with depression.

OBJECTIVE

To test the hypothesis that disability is associated with an increased prevalence of depression irrespective of physical health problems and that this is proportionate to the severity of disability (measured in terms of the number of difficulties in daily activities and the degree of dependence on others).

METHODS

Using a random probability sample design, 7460 respondents were interviewed for the third national survey of psychiatric morbidity of adults in the private household population in England. Fieldwork was carried out throughout 2007. The prevalence of depression was established by the administration of the revised Clinical Interview Schedule (CIS-R), while disability was measured by reported difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL).

RESULTS

Disability was associated with depression even after adjustment for physical ill health. The number of ADL/IADL difficulties was directly related to the likelihood of respondents having depression. Dependence on others was not associated with depression once severity of disability had been accounted for.

CONCLUSION

All ADL/IADL limitations are significantly associated with depression and there seems to be a cumulative effect irrespective of whether the limitation is in personal care or in instrumental activities such as mobility problems.

[Impact of chronic diseases on life expectancy in the population of Catalonia, Spain, in 1994 and 2006]

This paper analyzes the changes in the prevalence of selected chronic conditions and their impact on the life expectancy in the population of Catalonia. The chronic conditions selected are: hypertension, diabetes, stroke, heart diseases, chronic bronchitis, asthma, chronic allergies, musculoskeletal system diseases, and anxiety/depression. The prevalence of these diseases is estimated from data collected by the Health Survey of Catalonia in 1994 and 2006. The most frequently chronic conditions among the Catalan population are the musculoskeletal disorders, the high blood pressure and the depression and/or anxiety. By the analysis of the changes in the life expectancy free of chronic disorders, this study shows the impact of these disorders in the life expectancy. The burden of the chronic morbidity in our community, and its impact on the health systems, requires further studies to increase the knowledge of this phenomenon.

Moderating effect of Islamic religiosity on the relationship between chronic medical conditions and psychological well-being among elderly Malays

BACKGROUND

Research has found that physical health decline in later life is associated with poor psychological well-being. This study aimed to examine the possible moderating effect of Islamic religiosity on the relationship between chronic medical conditions and psychological well-being.

METHODS

The sample for this study consisted of 1415 elderly Malay Muslims. It was obtained from a cross-sectional survey entitled 'Patterns of Social Relationship and Psychological Well-Being among Older Persons in Peninsular Malaysia', which conducted from 2007 to 2009, using a multistage stratified sampling procedure. Data collection was performed through face-to-face interviews. A four-step moderated hierarchical regression analysis using SPSS software for Windows and the 'ModGraph-2' software program was used to test the hypothesis.

RESULTS

Results of bivariate analysis showed, at certain levels of chronic medical conditions, older persons with a high level of religiosity reported significantly higher levels of psychological well-being compared to their counterparts with a low level of religiosity. Four-step moderated hierarchical regression analysis revealed that the negative effect of chronic medical conditions on psychological well-being is reduced by both personal and social religiosity (β = 0.07, P ≤ 0.01), after controlling for selected sociodemographic factors.

CONCLUSION

Taken together, these findings indicate that the depressogenic effect of physical illness is decreased by religiosity in chronically ill elderly people. The implications and limitations of the current study are discussed and recommendations for future research are proposed.

Health indicators in Europe: availability and data needs

BACKGROUND

The European Union (EU) lacks adequate capacity for public health monitoring. The creation of a stable European Health Information System would help Member States to carry out evidence-based health policy. Such a system would also benefit EU health priorities by providing European wide comparable information. This study is the first comprehensive assessment of the availability of general health data in Europe.

METHODS

The main aim was to assess the availability of the European Community Health Indicators (ECHI) in each EU Member State. This was done by means of a review of international health databases, an online survey and face-to-face discussions with experts in 31 European countries.

RESULTS

The European average availability score for all ECHI indicators was 74% ranging from 56% to 84%. In most countries, about half of the ECHI indicators can be derived from routinely collected health information. This is true for demographic information, mortality and hospital discharge-based morbidity. However, many important ECHI indicators are lacking in most European countries. These include population representative data for health determinants, the provision and use of health care services, injuries, the quality of health care and health promotion.

CONCLUSION

Valid health information is essential for improving people's health across Europe. There is an urgent need to develop harmonized methods for gathering and disseminating representative health data. These methods should be developed jointly by DG Health and Consumers, Eurostat and EU Member States.

Changes over time in the health of caregivers of children with health problems: growth-curve findings from a 10-year Canadian population-based study

OBJECTIVES

We used Canadian population-based data to examine changes in the health of caregivers of children with complex health problems compared with caregivers of healthy children over a 10-year time period.

METHODS

The National Longitudinal Survey of Children and Youth collected data biennially from 9401 children and their caregivers in 6 waves from 1994-1995 to 2004-2005. We conducted growth-curve analyses of these data to model self-reported general health and depressive symptoms for 4 groups of caregivers: caregivers of healthy children, and caregivers of children with 1, 2, or at least 3 of 4 conceptually distinct indicators of child health problems. We modeled covariates for children (age, gender, only-child status) and caregivers (age, gender, education, income, marital status).

RESULTS

After we controlled for covariates, caregiver health outcomes worsened incrementally with increasing complexity of child health problems. Change in self-reported general health and depressive symptoms over the 10-year period was consistent across all groups of caregivers.

CONCLUSIONS

Poorer health among caregivers of children with health problems can persist for many years and is associated with complexity of child health problems. Attention to parental health should form a component of health care services for children with health problems.

Parity and risk of hip fracture in postmenopausal women

Hip fracture risk was assessed according to parity among postmenopausal women. Compared with nulliparous women, the fracture risk was lower in women with three or more births.

INTRODUCTION

Parity was assessed for long-term prediction of hip fracture in postmenopausal women.

METHODS

Postmenopausal women (n= 2,028) aged 45 or over with no history of hip fracture were studied. From 1978 to 1980, all of them had participated in a comprehensive health survey based on a nationally representative population sample. Emerging cases of hip fracture were identified from the National Hospital Discharge Register during a follow-up period extending up to 17 years.

RESULTS

The risk of hip fracture was lower among parous women compared with nulliparous women. The model adjusted for age showed a significant inverse association between parity as a continuous variable and the risk of hip fracture [RR = 0.74; 95% confidence interval (CI), 0.61-0.90] per an increment of one standard deviation (2.4 births). Adjusted for age, menopausal age, level of education, body mass index, vitamin D status, alcohol consumption, smoking history, leisure time physical activity, and self-rated health, the relative risk was 0.50 (95% CI, 0.32-0.79) for women with three or more births and 0.85 (95% CI, 0.55-1.32) for women with one to two births as compared with nulliparous women.

CONCLUSION

Parity, three or more births in particular, predicts a lowered risk of hip fracture in the long run.

Musculoskeletal comorbidities in cardiovascular disease, diabetes and respiratory disease: the impact on activity limitations; a representative population-based study

Background

The purpose of this study was to quantify the contribution of comorbidity to activity limitations in populations with chronic cardiovascular disease, diabetes or respiratory disease (index conditions), with emphasis on musculoskeletal comorbidity (arthritis or back problems).

Methods

Analysis of the 2005 Canadian Community Health Survey 3.1 (age 20+ years, n = 115,915). Prevalence ratios for activity limitations in people with the index conditions and co-occurring musculoskeletal disease, adjusted for age, gender, and socioeconomic factors, were used to estimate population associated fractions (PAF).

Results

Comorbid arthritis and back problems significantly increased the risk of activity limitations across all index conditions with prevalence ratios of 1.60 and 1.46 for cardiovascular disease, 1.51 and 1.36 for diabetes, and 1.38 and 1.44 for respiratory disease for arthritis and back problems respectively. Arthritis and back problems accounted for at least 13% and 9% of activity limitations in the index populations.

Conclusions

While chronic musculoskeletal conditions are not always considered priorities in chronic disease prevention, they account for a substantial proportion of activity restrictions seen in people with cardiovascular disease, diabetes and respiratory disease, with implications for prevention and control strategies.

Work-related injury in the nursing profession: an investigation of modifiable factors

AIM

This paper is a report of a correlational study of the relationships between work-related injury-risk events and modifiable risk factors in a nursing population after controlling for socioeconomic factors.

BACKGROUND

Nurses are at high risk for work-related injury. Work-related injury is strongly influenced by psychosocial factors and physical job-related exposures, but the magnitude of effect from modifiable factors remains unclear.

METHOD

Data were based on the Work Outcomes Research Cost-benefit survey conducted in Australia during 2005 and 2006. The study sample of 5724 represented ~14% of nurses in Queensland, Australia. Logistic regression was used to determine the magnitude of association of psychological distress (represented by the Kessler 6 score: six-item scale of psychological distress), the number of health conditions and various socioeconomic factors with work place injury.

RESULTS

High psychological distress was associated with a 5% probability of injury. As the number of health conditions increased, the probability of injury increased; 3 and ≥ 6 health conditions increased the chance of injury by 5% and 15% compared with no health conditions. Compared with the total sample, nurses who reported high levels of psychological distress demonstrated greater sensitivity to the number of health conditions. Computation of the marginal effects showed little difference in the likelihood of injury when the total sample was compared with nurses with < 5 years of work experience.

CONCLUSION

Effective occupational health and safety workplace programmes that target modifiable factors such as psychological distress and physical health conditions may improve the health capital of nurses and productivity levels within the profession.

"I know I have arthritis but I don't know what type". Understanding and knowledge of this chronic condition

Background

"Arthritis" is a common musculoskeletal condition but the knowledge of what type of arthritis people have, may be limited but may have changed over time in response to campaigns, increased awareness and improved health literacy. This paper describes people who did not know what type of arthritis they had, by a range of relevant demographic and socioeconomic variables, and assesses changes over time in the proportion of people who report having arthritis but do not know what type, using representative population surveillance data.

Methods

Data were collected using the South Australian Monitoring and Surveillance System (SAMSS), a risk factor surveillance system where each month, a representative random sample of South Australians is selected from the Electronic White Pages, with interviews conducted using computer assisted telephone interviewing (CATI). Data were used for the period January 2006 to December 2008 (n = 16465) for respondents aged 18 years and over.

Results

Overall, the proportion of respondents who did not know what type of arthritis they had, among people aged 18 years and over, for 2006 to 2008 was 6.5% (95% CI 6.1-6.9). When considering only those respondents reporting that they had been told by a doctor that they had arthritis, 30.1% did not know what type of arthritis they had. Multivariate analysis indicated that males, those with have a trade, certificate or diploma or secondary level of education, who spoke a language other than English at home, were widowed and earned $20,001 to $60,000, more than $80,000 or did not state their income were more likely to maintain that they did not know what type of arthritis they had.

Conclusions

Population ageing and an increase in arthritis prevalence in the future will further increase the burden of arthritis. These increases in prevalence are not inevitable, especially if investments are made in public health prevention programs, particularly those addressing cultural and linguistic diversity and differences in socio-economic status and health literacy.

Socioeconomic variation in the magnitude of the association between self-rated health and mortality

PURPOSE

To assess socioeconomic variation in the association between self-rated health (SRH) and mortality and to determine whether socioeconomic inequalities in SRH and socioeconomic inequalities in mortality differ in magnitude.

METHODS

We used data from a cohort of Spanish people 60 years of age and older with an 8-year follow-up of mortality. The association between SRH at baseline and mortality was estimated by the age-adjusted relative risk of mortality in people with low, medium, and high education. The measures of health inequalities were the prevalence ratio of poor SRH and the age-adjusted relative risk of mortality according to educational level. The validity of SRH to reflect life-threatening and non-life-threatening health conditions was summarized with the likelihood ratio for poor SRH in each educational category.

RESULTS

The relative risk of mortality according to SRH in subjects with high and low education was 3.24 and 1.62 in men and 2.25 and 1.50 in women, respectively. Inequalities in poor self-rated health were larger than inequalities in mortality: -1.63 versus 1.07 in men and 1.45 versus 1.30 in women. The highest likelihood ratio for SRH was seen in persons with high education in the case of life-threatening conditions, and for those with low education, in the case of non-life-threatening conditions.

CONCLUSIONS

Socioeconomic variation in the validity of SRH to reflect life-threatening and non-life-threatening conditions could explain the greater ability of SRH to predict mortality in persons with high education and why inequalities in poor SRH are larger than inequalities in mortality.

Associations between psychological distress, workplace accidents, workplace failures and workplace successes

PURPOSE

This study investigates associations between psychological distress and workplace accidents, workplace failures and workplace successes.

METHODS

The Health and Work Performance Questionnaire (HPQ) was distributed to employees of 58 large employers. A total of 60,556 full-time employees were eligible for analysis. The HPQ probed whether the respondent had, in the past 30-days, a workplace accident, success or failure ("yes" or "no"). Psychological distress was quantified using the Kessler 6 (K6) scale and categorised into low, moderate and high psychological distress. Three binomial logistic regressions were performed with the dependent variables being workplace accident, success or failure. Covariates in the models were K6 category, gender, age, marital status, education level, job category, physical health and employment sector.

RESULTS

Accounting for all other variables, moderate and high psychological distress significantly (P < 0.0001) increased the odds ratio (OR) for a workplace accident to 1.4 for both levels of distress. Moderate and high psychological distress significantly (P < 0.0001) increased the OR (OR = 2.3 and 2.6, respectively) for a workplace failure and significantly (P < 0.0001) decreased the OR for a workplace success (OR = 0.8 and 0.7, respectively).

CONCLUSIONS

Moderate and high psychological distress increase the OR's for workplace accidents work failures and decrease the OR of workplace successes at similar levels. As the prevalence of moderate psychological distress is approximately double that of high psychological distress moderate distress consequentially has a greater workplace impact.

Awareness, treatment, and control of vascular risk factors among stroke survivors

INTRODUCTION

Stroke survivors should recognize and control vascular risk factors to prevent recurrent strokes. We therefore assessed the prevalence, treatment, and control of hypertension, diabetes, and dyslipidemia among stroke survivors versus stroke-free control subjects.

METHODS

We conducted cross-sectional analysis from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study cohort, which includes oversampling from the Stroke Belt and African Americans. Patients were interviewed by telephone then visited for blood pressure, glucose, and lipid measurements. There were 2830 participants reporting a past stroke or transient ischemic attack (TIA) (stroke survivors) and 24,886 participants without past stroke or TIA (control subjects). Outcome measures included the recognition, treatment, and control of hypertension, diabetes, and dyslipidemia.

RESULTS

Stroke survivors were more likely to have unrecognized hypertension (18.7% v 13.5%, P < .0003), unrecognized stage 2 hypertension (4.4% v 2.2%, P < .0006), and unrecognized diabetes (4.2% v 3.2%, P < .026) versus control subjects. Stroke survivors were more likely to be treated for hypertension (92.4% v 89.0%, P < .0001), diabetes (88.3% v 81.4%, P < .0001), and dyslipidemia (76.3% v 61.9%, P < .0001). However, despite treatment, stroke survivors were more likely to have hypertension (33.3% v 30.4%, P=.0074) and stage 2 hypertension (9.1% v 7.6%, P=.017). Predictors of unrecognized and undertreated risk factors in stroke survivors include increasing body mass index, black race, and lower education.

CONCLUSION

Despite having a past stroke or TIA, stroke survivors had higher rates of unrecognized hypertension, unrecognized diabetes, and undertreated hypertension. Better efforts are needed to help stroke survivors recognize and control vascular risk factors to prevent recurrent stroke.

Risks associated with tendinitis: effects from demographic, socioeconomic, and psychological status among Brazilian workers

BACKGROUND

Self-reported tendinitis/tenosynovitis was evaluated by gender, age group, skin color, family income, and educational and psychological status.

METHODS

!The study was carried out in a representative sample of formally contracted Brazilian workers from a household survey. A total of 54,660 participants were included. Occupations were stratified according to estimated prevalences of self-reported injuries. Non-conditional logistic regression was performed, and all variables were analyzed in two occupational groups.

RESULTS

The overall prevalence rate of tendinitis/tenosynovitis was 3.1%: 5.5% in high-prevalence occupations (n = 10,726); and 2.5% in low-prevalence occupations (n = 43,934). White female workers between the ages of 45 and 64 years and at a higher socioeconomic level were more likely to report tendinitis/tenosynovitis regardless of their occupational category. An adjusted OR = 3.59 [95% CI: 3.15--4.09] was found between tendinitis/tenosynovitis and psychological status.

CONCLUSION

Among formally contracted Brazilian workers, higher income can imply greater physical and psychological demands that, regardless of occupational stratum, increase the risk of tendinitis/tenosynovitis.

Discordance Between Self-report of Physician Diagnosis and Administrative Database Diagnosis of Arthritis and Its Predictors

Objective.

To study predictors of discordance between self-reported physician diagnosis and administrative database diagnosis of arthritis.

Methods.

A cohort of all veterans who utilized Veterans Integrated Service Network (VISN)-13 medical facilities were mailed a questionnaire that included patient self-report of physician diagnosis of arthritis and questions regarding demographics, functional limitation, and SF-36V (a validated version of the Medical Outcomes Study Short-Form 36). Kappa coefficient was used to assess the extent of agreement between self-report of physician diagnosis and administrative database definitions that incorporated International Classification of Diseases (ICD) codes and use of medications for arthritis. We identified predictors of overall discordance between self-report and administrative database diagnosis using multivariable logistic regression analyses.

Results.

Among 70,334 eligible veterans surveyed, 19,749 subjects had an ICD diagnosis of arthritis in the administrative database in the year prior to the survey; 34,440 answered the arthritis question and 18,464 self-reported a physician diagnosis of arthritis. Kappa coefficient showed slight to fair agreement of 0.19–0.32 between self-report and administrative database definitions of arthritis. We found significantly higher overall discordance among veterans with more comorbidities, greater age, worse functional status, lower use of outpatient and inpatient services, lower education level, and among single medical-site users.

Conclusion.

Low level of agreement between self-report and database diagnosis of arthritis and its significant association with patient demographic, clinical, and functional characteristics highlights the limitation of use of these strategies for identification of patients with arthritis in epidemiological studies.

Accuracy of self-reported diabetes, hypertension and hyperlipidemia in the adult Spanish population. DINO study findings

INTRODUCTION AND OBJECTIVES

The aim of this study was to determine the accuracy of self-reported diabetes, hypertension and hyperlipidemia in a representative sample of adults (719 men and 837 women) from the south of Spain.

METHODS

Self-reported data were gathered using a structured questionnaire. Biometric data recorded included blood glucose, total cholesterol and triglyceride concentrations and arterial systolic and diastolic blood pressures. The sensitivity, specificity, and positive and negative predictive values of self-reported diagnoses were calculated using the biometric data as the reference standard. The degree of overall agreement was determined using Cohen's kappa coefficient.

RESULTS

The kappa values obtained indicated good agreement for self-reported diabetes (kappa=0.78), moderate agreement for hypertension (kappa=0.51), and minimal agreement for hyperlipidemia (kappa=0.27). Using the information reported, around 70% of diabetic cases were detected, along with half of hypertensive cases and 35% of hyperlipidemic cases. The specificity was high overall (>96%). The factors associated with an accurate self-reported diagnosis in subjects with disease included female sex and obesity (for hypertension), older age (for hyperlipidemia), a family history of disease (for diabetes) and having undergone blood pressure measurement (for all three conditions) or blood lipid measurement (for hypertension and hyperlipidemia) in the past year.

CONCLUSIONS

The accuracy of self-reported diabetes was high, whereas that of self-reported hypertension or hyperlipidemia was lower. Further efforts are needed to increase awareness of these conditions among the population.

Health among caregivers of children with health problems: findings from a Canadian population-based study

OBJECTIVES

We used population-based data to evaluate whether caring for a child with health problems had implications for caregiver health after we controlled for relevant covariates.

METHODS

We used data on 9401 children and their caregivers from a population-based Canadian study. We performed analyses to compare 3633 healthy children with 2485 children with health problems. Caregiver health outcomes included chronic conditions, activity limitations, self-reported general health, depressive symptoms, social support, family functioning, and marital satisfaction. Covariates included family (single-parent status, number of children, income adequacy), caregiver (gender, age, education, smoking status, biological relationship to child), and child (age, gender) characteristics.

RESULTS

Logistic regression showed that caregivers of children with health problems had more than twice the odds of reporting chronic conditions, activity limitations, and elevated depressive symptoms, and had greater odds of reporting poorer general health than did caregivers of healthy children.

CONCLUSIONS

Caregivers of children with health problems had substantially greater odds of health problems than did caregivers of healthy children. The findings are consistent with the movement toward family-centered services recognizing the link between caregivers' health and health of the children for whom they care.

Accuracy of death certification and hospital record linkage for identification of incident stroke

BACKGROUND

There is little information on the validity of using record linkage with routinely collected data for case ascertainment of stroke in large population-based studies in the UK. We examined the accuracy of these routine record linkage approaches for identifying incident stroke cases in a large UK population-based study, the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort.

METHODS

We examined a sample of hospital records of incident stroke cases identified by linkage with two routine data sources, death certificates and a national hospital record linkage system (ENCORE), using predefined study criteria. Two senior Specialist Registrars with clinical experience in stroke medicine examined the hospital records and searched for the evidence of stroke recorded in these records between 1993/97-2003.

RESULTS

Of 520 incident strokes identified between 1993/1997-2003 using record linkage systems in the EPIC-Norfolk, a sample of 250 medical case notes were examined between March and July 2004. Using the predefined study criteria, there were 191 definite strokes (76%), 20 probable strokes (8%), 11 possible strokes and 11 cases of transient ischaemic attacks (4% each) i.e. 233/250 (93%) with possible or definite stroke or transient ischaemic attacks. Stroke could not be verified using hospital records in 13 cases (5%) and 4 cases (2%) had other diagnoses: 3 cases of vascular dementia and 1 case of benign intracranial hypertension. The diagnosis of stroke in 185 out of 250 cases identified in the EPIC-Norfolk (74.0%) was supported by radiological evidence using WHO criteria.

CONCLUSION

Death certificates and hospital record linkage in this British prospective study have a high accuracy or positive predictive value in correctly identifying incident stroke cases.

Self-reported medical history was generally accurate among Japanese workplace population

OBJECTIVE

To assess the validity of self-reported medical history of several diseases among the Japanese population, and to clarify to what extent the self-reported year of diagnosis for chronic diseases is different from the physician's reports.

STUDY DESIGN AND SETTING

Subjects were 8,947 persons who responded to questions about medical history in a self-administered questionnaire. Of them, 854 subjects reported one or more medical histories and gave permission to contact their physician. The physicians were then requested to provide information on 809 subjects. Valid responses of 714 subjects were collected. We compared the self-reported medical histories with those reported by the physician.

RESULTS

Of 15 persons who reported myocardial infarction, 13 (87%) were confirmed. Angina pectoris was verified in eight out of the 11 (73%). The confirmation proportions of hypertension, diabetes, hyperlipidemia, and hyperuricemia were 97%, 96%, 95%, and 95%, respectively. The self-reported year of diagnosis was 1.70-2.49 years earlier than the physician-reported year for chronic diseases. Agreement between the self-reported and the physician-reported years was higher, the more recent the self-reported year was.

CONCLUSION

Self-reported medical histories were generally accurate, especially for diseases with clear diagnostic criteria. However, investigators should be aware of the errors in reporting the year of diagnosis.

The relative impact of 13 chronic conditions across three different outcomes

STUDY OBJECTIVE

Previous estimates of individual and population attributable risks for adverse outcomes due to chronic conditions have considered only a limited number of conditions and outcomes, with some studies using inappropriate formulae or methods of estimation. This study re-examines the magnitude of individual and population attributable risks for a wide range of conditions and various health outcomes.

DESIGN

Log-Poisson regression was used to calculate prevalence ratios as an indicator of individual risk and population-associated fractions of 13 chronic conditions, examining activity limitations, self-rated health and physician visits. The effect of multimorbidity on prevalence ratios was examined.

SETTING

Canada, 2000-01.

PARTICIPANTS

Nationally representative sample of Canadians aged 12+ years (n _ 130 880).

MAIN RESULTS

At the individual level, fibromyalgia/chronic fatigue syndrome and cancer, and to a lesser extent stroke and heart disease, were associated with an increased risk of both activity limitations and a self-rated health status of fair or poor; high blood pressure was associated with four or more physician visits in the previous 12 months. In contrast, population attributable fractions were substantial for arthritis/rheumatism, heart disease, back problems and high blood pressure across all outcomes. Adjustment for multimorbidity resulted in a marked decreases in prevalence ratios.

CONCLUSIONS

Differences in the ranking of individual risks and population attributable fractions for different diseases and outcomes are substantial. This needs to be taken into account when setting priorities, as interventions may need to be targeted to different conditions depending on which aspects of health are being considered, and whether the focus is on individuals, such as in clinical care, or improving the health of the population.

Major depression and disability in older primary care patients with heart failure

The purpose of this study was to examine the association between dependence in activities of daily living (ADL) and instrumental ADL (IADL) and major depression among 415 community-dwelling primary care patients age 65+ with heart failure and significant ADL or IADL dependence. Main findings include (1) a progressive increase in depression prevalence from 0% for no IADL dependence to about 40% for 6 IADL dependencies (P < .001), (2) a steady rise in depression prevalence to 40% for 6 ADL dependencies following a "floor effect" at about 10% for 0 to 2 ADL dependencies (P < .001), and (3) the association in a logistic regression model of major depression with number of IADL dependencies (P = .016) but not with number of ADL dependencies (P = .602). Our principal conclusion is that the progressively greater likelihood of major depression as the number of IADL dependencies increases has important clinical, personal, social, and public health relevance.

Exhaustion measured by the SF-36 vitality scale is associated with a flattened diurnal cortisol profile

The possible association between stress-related exhaustion and reduced activity in the hypothalamo-pituitary-adrenal (HPA) axis is increasingly in focus. The aim of the present study was to examine whether exhaustion measured in a non-patient population is associated with alterations in diurnal cortisol profile. The study population included 78 working individuals. The study group was dichotomised into exhausted and non-exhausted groups by means of the SF-36 vitality scale. Salivary cortisol was measured at three times during 1 workday: at awakening, 30min after awakening, and in the evening. The results showed that diurnal cortisol variation was significantly reduced in exhausted individuals. The difference in cortisol variation was mainly due to lowered morning cortisol in the exhausted group. Differences in cortisol levels at each sampling time or in mean diurnal output of cortisol were not statistically significant. The results would support the notion that exhaustion is associated with HPA axis hypoactivity as assessed by salivary cortisol. Furthermore, the SF-36 vitality provides a measure of exhaustion that may be useful in epidemiological studies in order to explore long-term health effects of stress-related exhaustion.

A comparison of baseline sociodemographic and clinical characteristics between major depressive disorder patients with and without diabetes: a STAR*D report

BACKGROUND

Patients with major depressive disorder (MDD) have high rates of medical comorbidities which can impair MDD treatment. Yet little is known regarding associations between the presence of a serious comorbidity and MDD treatment. The purpose of this study was to examine the baseline sociodemographic and clinical characteristics of MDD outpatients with and without diabetes mellitus to evaluate possible associations between these characteristics and the presence of comorbid diabetes.

METHODS

We gathered baseline sociodemographic and clinical data for 4041 participants with non-psychotic MDD who enrolled in the STAR*D, a large-scale depression treatment protocol, and made comparisons between participants with and without diabetes.

RESULTS

Participants with diabetes were more likely to be male, older, black, Hispanic, unemployed, and have less education, a lower income, higher mental functioning, lower physical functioning, atypical features, increased appetite, psychomotor slowing and leaden paralysis, and were less likely to have concurrent alcohol abuse/dependence, mood reactivity or problems with concentration. We found no significant differences between groups regarding depression severity.

LIMITATIONS

The primary limitation is the lack of a clinical diagnosis of diabetes.

CONCLUSIONS

We found no difference in depression severity between participants with and without diabetes. Diabetes was associated with physical symptoms of depression. Thus treatments for these participants should be directed toward these symptoms.

Accuracy of patients' reports of comorbid disease and their association with mortality in ESRD

BACKGROUND

Patient awareness of chronic diseases is low. Unawareness may represent poor understanding of chronic illness and may be associated with poor outcomes in patients with end-stage renal disease (ESRD).

STUDY DESIGN

Concurrent prospective national cohort study.

SETTING & PARTICIPANTS

Incident hemodialysis and peritoneal dialysis patients enrolled in the Choices for Healthy Outcomes in Caring for ESRD Study and followed up until 2004.

PREDICTOR

Inaccurate patient self-report of 8 comorbid diseases compared with the medical record.

OUTCOMES & MEASUREMENTS

All-cause mortality was the primary outcome. Cox proportional hazard models were used to assess the contribution of demographics and clinical measures in the relation of inaccurate self-report to mortality.

RESULTS

In 965 patients, the proportion of inaccurate self-reporters ranged from 3% for diabetes mellitus to 35% for congestive heart failure. Generally, inaccurate self-reporters were older and had more chronic diseases. Greater risk of death was found for inaccurate self-reporters of ischemic heart disease (hazard ratio [HR], 1.34; 95% confidence interval, 1.12 to 1.59; P = 0.001), coronary intervention (HR, 1.46; 95% confidence interval, 1.08 to 1.97; P = 0.01), and chronic obstructive pulmonary disease (HR, 1.40; 95% confidence interval, 1.14 to 1.70; P = 0.001). The greater risk of death remained significant for chronic obstructive pulmonary disease (HR, 1.36; 95% confidence interval, 1.11 to 1.66; P = 0.003) after adjustment for age, sex, and race. In patients receiving peritoneal dialysis, greater risk of death (HR, 2.06; 95% confidence interval, 1.34 to 3.15; P = 0.001) was found for inaccurate self-reporters of ischemic heart disease.

LIMITATIONS

Includes potential for residual confounding, medical record error, misclassification of patient accuracy of self-report, and low inaccurate self-report of some chronic diseases, reducing the power to measure associations.

CONCLUSIONS

Accuracy of self-report depends on the specific comorbid disease. Patients with ESRD, especially those receiving peritoneal dialysis, who inaccurately report heart disease may be less aware of their chronic comorbid disease and may be at greater risk of mortality compared with those who accurately report their comorbid disease.

Health Observation Compared to Health Reporting: Findings from a Pilot Study in Florence

PURPOSE

Both health interview surveys (HISs) and health examination surveys (HESs) are used to describe the health status of populations. In Italy, to determine the feasibility of conducting a national-level HES, a pilot HES was conducted in the city of Florence among participants of a previous national-level HIS. The aim of the present analysis was to compare the results of the two surveys.

METHODS

The study population consisted of the 343 Florence residents 35 to 74 years of age who participated in both surveys (sample drawn with probabilistic criteria). We compared the self-reported HIS data to the HES health measurements for diabetes, hypertension, osteoporosis, smoking, height, weight, and body mass index. For categorical variables, contingency tables were used, calculating symmetric and asymmetric indices. For the continuous variables, Student's t test for matched samples was used.

RESULTS

The prevalence of the most important pathologic conditions and risk factors determined with HES measurements was significantly higher than that based on self-reported HIS data.

CONCLUSIONS

The results stress that individuals have poor knowledge of their own health; therefore health measurements need to be taken.

Societal costs and quality of life of children suffering from attention deficient hyperactivity disorder (ADHD)

BACKGROUND

The impact of attention deficit hyperactive disorder (ADHD) in the Netherlands on health care utilisation, costs and quality of life of these children, as well as of their parents is unknown.

OBJECTIVE

The aim of this study was to assess the direct medical costs of patients suffering from ADHD and their quality of life as well as the direct medical costs of their mothers.

STUDY DESIGN

We selected a group of 70 children who were being treated by a paediatrician for ADHD based on the DSM-IV diagnostic criteria for ADHD. For comparison's sake, we also included a non-matched group of 35 children with behaviour problems and 60 children with no behaviour problem from a large school population-based study on the detection of ADHD. We collected information on the health care utilisation of the children applying the Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness' (TiC-P). Their health related quality of life was collected by using the Dutch 50-item parent version of the Child Health Questionnaire (CHQ PF-50). Measurements were at baseline and at 6 months. Subsequently, we collected data on the health utilisation of the mothers and their production losses due to absence from work and reduced efficiency.

RESULTS

The mean direct medical costs per ADHD patient per year were euro 2040 or euro 1173 when leaving out one patient with a long-term hospital admission, compared to euro 288 for the group of children with behaviour problems and euro 177 for the group of children with no behaviour problems. The direct medical costs for children who had psychiatric co-morbidities were significantly higher compared to children with ADHD alone. The mean medical costs per year for the mothers of the ADHD patients were significantly higher than for the mothers of the children with behaviour problems and the mothers of children with no behaviour problems respectively euro 728, euro 202 and euro 154. The physical summary score showed no significant differences between the groups. However, the score on the Psychosocial Summary Score dimension was significantly lower for ADHD patients compared to the scores of the children in the two other samples. The mean annual indirect costs due to absence from work and reduced efficiency at work were euro 2243 for the mothers of the ADHD patients compared to euro 408 for the mothers of children with behaviour problems and euro 674 for the mothers of children with no behaviour problems.

CONCLUSION

Our study showed that the direct medical costs of ADHD patients were relatively high. Additionally, our study indicated that ADHD appears to be accompanied by higher (mental) health care costs for the mothers of ADHD patients and by increased indirect costs for this group.

No evidence for marked ethnic differences in accuracy of self-reported diabetes, hypertension, and hypercholesterolemia

OBJECTIVE

To assess whether the accuracy of self-reported diabetes, hypertension, and hypercholesterolemia in high-risk groups differs according to ethnicity.

STUDY DESIGN AND SETTING

We analyzed data of 430 patients at high risk of cardiovascular disease from different ethnic origin, including Turkish, Surinamese, and Dutch. Risk factors based on self-reports were compared with data from medical records and with a gold standard based on clinical measurements. Proportions of concordance between self-reports and other methods and kappa statistics (kappa) were determined by ethnicity.

RESULTS

Concordance between self-reports and other data sources was highest in diabetes and lowest for hypercholesterolemia. Agreement of self-reports was substantial to almost perfect for diabetes (kappa: 0.84-0.76), substantial to moderate for hypertension (kappa: 0.63-0.51), and moderate for hypercholesterolemia (kappa: 0.55-0.48). There was no statistically significant association between ethnicity and concordance, except for self-reporting of diabetes among Surinamese vs. Dutch indigenous patients (odds ratio=0.37; 95% confidence interval: 0.14-0.97).

CONCLUSION

There are no marked ethnic differences in the accuracy of self-reports of diabetes, hypertension, and hypercholesterolemia in high-risk populations. Larger studies including multiple ethnic groups are needed to confirm these findings.

Educational differences in mobility: the contribution of physical workload, obesity, smoking and chronic conditions

BACKGROUND

In earlier studies, determinants of socioeconomic gradient in mobility have not been measured comprehensively.

AIM

To assess the contribution of chronic morbidity, obesity, smoking and physical workload to inequalities in mobility.

METHODS

This was a cross-sectional study on 2572 persons (76% of a nationally representative sample of the Finnish population aged > or = 55 years). Mobility limitations were measured by self-reports and performance rates.

RESULTS

According to a wide array of self-reported and test-based indicators, persons with a lower level of education showed more mobility limitations than those with a higher level. The age-adjusted ORs for limitations in stair climbing were threefold in the lowest-educational category compared with the highest one (OR 3.3 in men and 2.9 in women for self-reported limitations, and 3.5 in men and 2.2 in women for test-based limitations). When obesity, smoking, work-related physical loading and clinically diagnosed chronic diseases were simultaneously accounted for, the educational differences in stair-climbing limitations vanished or were greatly diminished. In women, obesity contributed most to the differences, followed by a history of physically strenuous work, knee and hip osteoarthritis and cardiovascular diseases. In men, diabetes, work-related physical loading, musculoskeletal diseases, obesity and smoking contributed substantially to the inequalities.

CONCLUSIONS

Great educational inequalities exist in various measures of mobility. Common chronic diseases, obesity, smoking and workload appeared to be the main pathways from low education to mobility limitations. General health promotion using methods that also yield good results in the lowest-educational groups is thus a good strategy to reduce the disparities in mobility.

Self-reported glaucoma in Canada: findings from population-based surveys, 1994-2003

BACKGROUND

To provide population estimates and 10-year trends in the self-reported prevalence of glaucoma in Canada, including age and sex profiles, frequency of contact with eye specialists, and associated chronic medical conditions.

METHODS

Analyses were based on cross-sectional, self-reported data for ages >or=20 years from 5 national surveys: the 1994-95, 1996-97, and 1998-99 National Population Health Survey (minimum sample size [n] = 33 153) and the 2000-01 and 2002-03 Canadian Community Health Survey (min n = 113 212). Prevalence estimates were derived from descriptive analyses; multivariate logistic regression analyses examined the association of income, education, and chronic medical conditions with the likelihood of reporting glaucoma.

RESULTS

In 2002-03, an estimated 409,000 Canadians had glaucoma, including 2.7% of those >or=40 years and 11% of those >or=80 years. Overall, the prevalence of self-reported glaucoma increased from 1.1% in 1994-95 to 1.8% in 2002-03 (p < 0.01). Significant increases in age-specific prevalences over time were also observed in 4 of 6 age groups. In total, 14% of respondents with glaucoma reported no recent contact with an eye specialist. Arthritis (and other rheumatic conditions), high blood pressure, migraines, and diabetes were associated with glaucoma.

INTERPRETATION

Our review suggests glaucoma is at least as prevalent in Canada as in other Western nations. It is most common in the over-80 age group and appears to be associated with other medical conditions.

Prevalence and impact of osteoarthritis and osteoporosis on health-related quality of life among active subjects

BACKGROUND AND AIMS

To assess the prevalence and impact of osteoarthritis (OA) and osteoporosis (OP) on health-related quality of life (HRQOL) among active subjects employed in the public workforce in Belgium.

METHODS

A cohort of 3440 subjects employed by the Liège City Council was prospectively followed for 6 months. The employees were asked to fill in a monthly log in a health record book, of data regarding their healthcare consumption due to OA and OP. HRQOL was assessed using the Medical Outcomes Study Short Form-36 (SF-36).

RESULTS

1811 subjects (52.6%) filled in at least one questionnaire. The mean duration of follow-up was 3.46 months. The self-reported prevalence of OA and OP at entry to the study were respectively 34.1% and 5.3%. 3.6% of subjects reported suffering from both OA and OP. Subjects with OA and both OA and OP had significantly lower scores on all SF-36 dimensions compared with normal subjects, reflecting a worse HRQOL. The OP group had significantly lower mean scores for physical functioning and pain compared with controls. Subjects with both OA and OP had significantly lower values for physical functioning, physical role and pain when compared with the OA and OP groups.

CONCLUSIONS

The results of this survey of a large sample of active subjects show that self-reported osteoarthritis and osteoporosis are common in the workplace. Both diseases have a major impact on health-related quality of life compared with that of people without self-reported musculoskeletal diseases.

Fatigue, emotional exhaustion and perceived health complaints associated with work-related characteristics in employees with and without chronic diseases

OBJECTIVES

Ageing of the Dutch working force and increasingly more stringent restrictions regarding early retirement and disability benefits are leading to higher numbers of workers with ill health. Until now, only a few studies have explored how employees with ill health perceive their work. This study investigated possible differences in scores on fatigue, emotional exhaustion, perceived health complaints and various work-related characteristics between chronically ill (CIWs) and non-chronically ill workers (NCIWs), as well as differences in associations between work- and health-related characteristics.

METHODS

A questionnaire was sent to all employees of a Dutch university to collect data on perceived work-related and health-related characteristics (response 49.1%). Differences in various scores were analysed using chi (2)-tests and the general linear model. Associations between the work- and the health-related characteristics were determined by multiple linear regression analyses in the CIWs (n = 444) and NCIWs (n = 1,347) separately. Interaction terms were included to detect differences between the two groups.

RESULTS

The results indicated that the CIWs had less favourable scores on the three health-related characteristics. Also, the CIWs scored less favourably than the NCIWs on almost all the work-related characteristics. In the two groups, negative work-related aspects, such as higher work pressure, contributed most to explaining the variance in the health-related characteristics. However, in the CIWs, fatigue was not explained by the work-related aspects as much as in the NCIWs. In the CIWs, the association between unpleasant treatment and the health-related characteristics was stronger than in the NCIWs, but there were indications that autonomy, possibilities for learning and social support from superiors also played an important role.

CONCLUSIONS

CIWs perceived more fatigue, emotional exhaustion and health complaints than NCIWs. There were different patterns of associations between work- and health-related characteristics in the NCIWs and CIWs. Future studies on associations between work-related characteristics and health should take the presence of chronic disease into account.

Impacts of diabetes and hypertension on the risk of hospitalization among less educated people

Coexisting hypertension increases the morbidity and mortality associated with diabetes, and may be more so in less educated people. We analysed data from 49 904 Canadians 40-64 years of age who participated in the Canadian Community Health Survey, 2000-2001. Multiple classification analysis was used to adjust for covariates. Population weight and design effect of the survey were taken into account in the analysis. The association between hypertension and hospitalization varied according to diabetes and education. The adjusted difference in hospitalization incidence attributable to hypertension was significantly higher for the lower education group than the higher education group, and such a pattern tended to be more pronounced among diabetic people. The adjusted incidence difference attributable to hypertension was higher in the diabetic group (8.8, 95% confidence interval (CI): 4.6, 13.0%) than in the non-diabetic group (4.6, 95% CI: 3.6, 5.6%) for people with low education, but was similar for those with well-educated people. Possible reasons for the modifying effect of education on the relationship among hypertension, diabetes and hospitalization were discussed.

Agreement of self-reported comorbid conditions with medical and physician reports varied by disease among end-stage renal disease patients

OBJECTIVE

To compare self-report of eight diseases with review of medical records and physician reports.

STUDY DESIGN AND SETTING

In a cohort of 965 incident end-stage renal disease (ESRD) patients (Choices for Healthy Outcomes in Caring for End-stage renal disease study), data on existing medical conditions were obtained from medical record abstraction, physician report (CMS Form 2728), and self-report in a baseline questionnaire. We evaluated agreement with kappa statistics (k) and sensitivity of self-report. Regression models were used to examine characteristics associated with agreement.

RESULTS

The results showed excellent or substantial agreement between self-report and the medical record for diabetes (k=0.93) and coronary artery intervention (k=0.79), and poor agreement for chronic obstructive pulmonary disease (k=0.20). Physician-reported prevalence for all diseases was equal or lower than that by self-report. Male patients were more likely to inaccurately report hypertension. Compared to white patients, African American patients were more likely to inaccurately report cardiovascular diseases.

CONCLUSION

In ESRD patients, self-report agreement with the medical record varies with the specific disease. Awareness of diseases of the cardiovascular system appears to be low. African American and male ESRD patients are at risk of low awareness of disease and educational interventions are needed in this high-risk population.

Gender differences in health-related quality of life among the elderly: the role of objective functional capacity and chronic conditions

Although worse Health-Related Quality of Life (HRQL) among women has been widely described, it remains unclear whether this is due to differential reporting patterns, or whether there is a real difference in health status. The objective of this study was to evaluate to what extent gender differences in HRQL among the elderly might be explained by differences in performance-based functional capacity and chronic conditions, using the conceptual model of health outcomes as proposed by Wilson and Cleary. Data are from a cross-sectional home survey of 872 surviving individuals from an elderly cohort representative of Barcelona's general population. Complete valid data for these analyses were obtained from 62% of the subjects (n = 544). The evaluation included the Nottingham Health Profile (NHP), a generic measure of HRQL; three performance-based functional capacity tests (balance, chair-stand, and walking tests); and a standardized list of self-reported chronic conditions. A series of multiple linear regression models were built with the total NHP score as the dependent variable, with gender, socio-demographic information, performance-based functional capacity and chronic conditions included sequentially, as independent variables. Women (65.4%) showed worse results than men on HRQL (mean of NHP total score 28.3 vs 16.7, p < 0.001) and functional capacity (mean of summary score 7.1 vs 8.3, p < 0.001). Functional capacity, arthritis, back pain, diabetes, and depression were significantly associated to the NHP total score in the final regression model, which explained 42% of the variance. Raw differences by gender in the total NHP score were 11.5 points (p < 0.001), but decreased to a non-significant 3.2 points (p = 0.18) after adjusting for all the other variables. In conclusion, our data suggest that worse reported HRQL in elderly women is mainly due to a higher prevalence of disability and chronic conditions.

Association between parental histories of hypertension, diabetes and dyslipidemia and the clustering of these disorders in offspring

BACKGROUND

Familial aggregation of hypertension, diabetes and dyslipidemia has been well reported. However, only a few studies have assessed to what extent parental histories were involved in the clustering of these diseases.

METHOD

In 2002, associations between parental histories of hypertension, diabetes and dyslipidemia and the clustering of high blood pressure, hyperglycemia and dyslipidemia in individuals were assessed on the basis of 5010 Japanese men and women aged 33-66 years. Risk factor clusters were defined as those having at least two of the three clinical disorders.

RESULTS

Compared with persons with no parental history of the three diseases, those who had 1, 2 and 3 or more parental histories had risk factor clusters, 1.25 (95% CI: 1.07, 1.47), 1.46 (95% CI: 1.16, 1.84) and 1.41 (95% CI: 0.95, 2.11) times higher, respectively, after adjusting for confounding factors. ORs by 1, 2 and 3 of maternal history were 1.33 (95% CI: 1.12, 1.58), 1.65 (95% CI: 1.16, 2.35) and 1.69 (95% CI: 0.64, 4.42), respectively (trend P < 0.001). However, the number of paternal history was not associated with risk factor clusters.

CONCLUSION

We conclude that familial history, particularly maternal history, is an important aid to prevention strategy and public health practice for metabolic disorders.

Diabetes mellitus and cancer risk in a population-based case-control study among men from Montreal, Canada

Diabetics may have a higher risk of cancer, notably liver and pancreatic cancers. Evidence about other cancer types remains sparse. The authors examined potential associations between diabetes and several types of cancer in a large multicancer case-control project carried out in Montreal, Canada, in the 1980s. This report, based on 3,107 male cancer cases and 509 population controls, uses information on diabetes and several covariates collected by interview. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) were estimated for the associations between diabetes and each of 12 cancer types. Risks of pancreatic and liver cancers were increased among diabetics: adjusted ORs were 2.1 (95% CI: 1.0, 4.3) for pancreatic and 3.1 (95% CI: 1.1, 8.8) for liver cancer. The increased risk of pancreatic cancer was completely restricted to those with recent onset of diabetes; this was likely a manifestation of reverse causality. Conversely, the increased risk of liver cancer was independent of the interval between diabetes and cancer diagnoses. No associations were observed with melanoma, non-Hodgkin's lymphoma, cancers of the esophagus, stomach, colon, rectum, lung, prostate, bladder and kidney. In conclusion, diabetes was associated with an increased risk of liver cancer among men, but with no other cancer type including pancreatic cancer.

Interviews or medical records, which type of data yields the best information on elderly people's health status?

BACKGROUND AND AIMS

Self-reported data and/or medical records are often used to assess the prevalence of illness and impairment in epidemiological studies. However, these two data sources do not always provide the same information. The aim was to compare data from interviews and medical records regarding illness, symptoms and impairment in the elderly, and to analyze the agreement between a consensus from both data sources and data from interviews and medical records, respectively.

METHODS

We interviewed 130 persons (age range 67-99) regarding socio-demographic background data and physical and mental health. Medical records were reviewed. Illness burden was rated according to the Cumulative Illness Rating Scale for Geriatrics, and was rated in three ways based on: (1) interview data; (2) medical records; (3) information from both interviews and medical records considered to be consensus. Agreement was measured by the Kappa coefficient and the Svensson Paired Rank Measurement. A permutation test tested whether the ratings from interviews and medical records had the same agreement when compared with consensus.

RESULTS

Statistically significant differences in agreement were found between interview versus consensus and medical records versus consensus for the vascular system (medical records best), eyes/ears/nose/throat/larynx and musculoskeletal/integument (interview best). Medical records gave better in formation concerning specific diseases and diagnoses, whereas interview data provided a better measure of illness, functional impairment and health in a broader sense.

CONCLUSIONS

Both medical records and interviews yield good information of elderly people's health status, but they focus on different aspects of health.

The direct and indirect costs of the chronic management of osteoporosis: a prospective follow-up of 3440 active subjects

INTRODUCTION

The objective of this study was to estimate the direct and indirect costs attributable to osteoporosis (OP) from a societal and a payer's perspective among active subjects living in Belgium and employed in the public workforce.

MATERIALS AND METHODS

A cohort of 3440 subjects employed by the Liege City Council was followed for 6 months. The City Council employees were invited to fill a monthly log of the data related to their utilization of health resources (contacts with health professionals, medical examinations, drug use,...) due to OP. Information on work disability (number of days of sick leave) and on informal care (number of days off work incurred by active subjects in helping relatives or friends suffering from OP) was also collected.

RESULTS

Of those asked to participate in the study, 1,811 subjects filled in at least one questionnaire. The mean duration of follow-up was 3.46 months. Self-reported prevalence of OP at inclusion was 5.3%. OP subjects were significantly older (52.7+/-6.1 years) than normal subjects (45.5+/-9.8 years) (p<0.05) and included more women (85.3 vs. 55.9%). Direct costs came to 44.6 euros per OP patient-month: 10.9 euros was spent on contact with health professionals, 19.0 euros on medical examinations, 12.1 euros on drugs and 2.6 euros on hospitalizations. During this 6-month study, a total of 140 days of sick leave was recorded (mean: 0.4 per OP patient-month). From a payer's perspective, this loss in productivity yielded a mean cost of 34.05 euros per OP patient-month. A mean number of days off work of 0.018 per active subject-month, attributable to informal care, was recorded. These days of inactivity represented, for the employer, a mean cost of 1.8 euros per active subject-month.

CONCLUSION

The results of this survey of a large sample of active subjects confirm that OP-related expenditures, both for medical care and for loss of productivity, are significant.

Interleukin-6 modulates plasma cholesterol and C-reactive protein concentrations in nonagenarians

OBJECTIVES

To establish whether the relationship between interleukin-6 (IL-6) and plasma lipid and C-reactive protein (CRP) concentrations is different in Finnish nonagenarians than in middle-aged subjects with lower inflammatory status.

DESIGN

Cross-sectional.

SETTING

Observational cohort study concentrating on the oldest old.

PARTICIPANTS

Nonagenarians (n=291, mean age+/-standard deviation 90+/-1; 68 men, 223 women) who lived in the Tampere municipality in southern Finland and a middle-aged control population from the same area (n=227, aged 44+/-8).

MEASUREMENTS

Plasma high sensitive CRP and lipid concentrations were analyzed using an automatic analyzer and IL-6 levels using enzyme-linked immunosorbent assay.

RESULTS

Plasma concentrations of IL-6 (4.39+/-5.25 vs 1.88+/-1.98 pg/mL) and CRP (3.54+/-4.98 vs 1.53+/-1.91 mg/L) were significantly higher in nonagenarians than in middle-aged subjects (P<.001). In nonagenarians, plasma CRP levels increased (P<.001) and plasma total cholesterol (P=.006), low-density lipoprotein cholesterol (P=.02), and high-density lipoprotein cholesterol (P=.002) levels decreased according to IL-6 quartiles. In middle-aged subjects, similar associations were not found.

CONCLUSION

The relationship between IL-6 and plasma CRP and cholesterol levels in nonagenarians with enhanced systemic inflammation differs from that of middle-aged subjects.

The prevalence of hypertension and its association with other cardiovascular disease risk factors in a representative sample of the Lebanese population

Hypertension is a well-known major risk factor for cardiovascular diseases. This study has been designed to assess the prevalence of hypertension, its co-occurrence with other cardiovascular risk factors and its association with cardiovascular diseases in a representative sample of Lebanese population. A pretested questionnaire was administered to 2125 adults aged equal or above 30 years old from all regions in Lebanon and proportionate with the respective population density. Data revealed that 23.1% of the respondents admitted being hypertensive, with no statistically significant difference between male and female patients. Prevalence of hypertension increased with age (P < 0.01) and hypertension tended to occur more in the less educated and the unemployed (P < 0.01). Only 45.7% of hypertensive patients followed a low fat diet while 14.7% exercised daily. The prevalence of hypertension increased significantly with an increase in body mass index particularly in female patients. Among the hypertensive respondents, 23.9% were diabetic, 38.1% were hyperlipidaemic and 9.1% were both diabetic and hyperlipidaemic. Co-occurrence of hypertension with diabetes, hyperlipidaemia or both was more common in female patients compared to male patients. In addition, stroke, myocardial infarction (MI) and atherothrombosis occurred in hypertensive respondents at rates of 2.4, 4.3 and 9.5%, respectively. Hypertensive female patients reported more stroke and atherothrombotic episodes compared to male patients, whereas hypertensive male patients had more MIs. Based on these results it is very important to address the issue of lifestyle modification for the prevention and treatment of hypertension and awareness campaigns should stress the fact that cardiovascular diseases are not only restricted to men.

Are there socioeconomic differences in responses to a commonly used self report measure of chronic illness?

BACKGROUND

Single questions on self-reported morbidity are commonly used in social or health surveys. It has been suggested that these may underestimate socioeconomic gradients in health because more disadvantaged social groups may have higher thresholds for defining illness. Method Face-to-face interviews by research nurses with community-based respondents in the West of Scotland, using a specially designed suite of prompts following up on responses to the UK General Household Survey (GHS) long-standing illness question. Participants were 858 respondents born in the early 1930s and 852 respondents born in the early 1950s (mean age at interview 59 and 40, respectively) classified by occupational social class and area deprivation.

RESULTS

Adjusted for age and sex, the Relative Index of Inequality (RII) for reporting any condition in response to the GHS question was 2.14 (95% CIs 1.49-3.08) for social class and 2.01 (1.41-2.87) for Depcat. Among those not reporting any conditions to the GHS question, the RII for reporting conditions to any further prompts was 1.54 (0.87-2.70) for social class and 0.86 (0.50-1.46) for Depcat. The RIIs for reporting any condition after the initial question and all prompts were 2.16 (1.40-3.33) for social class and 1.50 (0.98-2.29) for Depcat. Across a range of conditions defined as more serious, and conditions classified by different ICD categories, socioeconomic status (SES) gradients after the initial question and all prompts were similar to, or less steep than, those produced by the GHS question alone.

CONCLUSIONS

These data do not support the hypothesis that poorer social groups are more stoical and more likely to need detailed prompting in order to elicit morbidity. Nor do they support the hypothesis that SES gradients in morbidity are underestimated by using the GHS question rather than more detailed questioning. This suggests that responses to this type of question can be used in epidemiology and health needs assessment without major socioeconomic bias.

The EUROHIS-QOL 8-item index: psychometric results of a cross-cultural field study

BACKGROUND

Survey research including multiple health indicators requires brief indices for use in cross-cultural studies, which have, however, rarely been tested in terms of their psychometric quality. Recently, the EUROHIS-QOL 8-item index was developed as an adaptation of the WHOQOL-100 and the WHOQOL-BREF. The aim of the current study was to test the psychometric properties of the EUROHIS-QOL 8-item index.

METHODS

In a survey on 4849 European adults, the EUROHIS-QOL 8-item index was assessed across 10 countries, with equal samples adjusted for selected sociodemographic data. Participants were also investigated with a chronic condition checklist, measures on general health perception, mental health, health-care utilization and social support.

RESULTS

Findings indicated good internal consistencies across a range of countries, showing acceptable convergent validity with physical and mental health measures, and the measure discriminates well between individuals that report having a longstanding condition and healthy individuals across all countries. Differential item functioning was less frequently observed in those countries that were geographically and culturally closer to the UK, but acceptable across all countries. A universal one-factor structure with a good fit in structural equation modelling analyses (SEM) was identified with, however, limitations in model fit for specific countires.

CONCLUSIONS

The short EUROHIS-QOL 8-item index showed good cross-cultural field study performance and a satisfactory convergent and discriminant validity, and can therefore be recommended for use in public health research. In future studies the measure should also be tested in multinational clinical studies, particularly in order to test its sensitivity.

Determinants of health in early adulthood: what is the role of parental education, childhood adversities and own education?

BACKGROUND

Of the many studies assessing the impact of childhood living conditions on health and health inequalities in adulthood, only few have combined information on current determinants of health with detailed individual level data on different aspects of childhood living conditions and adversities. This study aims (i) to assess the role of parental education, self-reported childhood adversities and family structure as determinants of different dimensions of health in early adulthood, and (ii) to identify the role of the respondent's own education as a modifier of the association between childhood living conditions and health.

METHODS

The study is based on a representative sample (n = 3669; participation rate 83%) of young adults aged 18-39 years in 2000 in Finland. The main outcome measures were poor self-rated health (SRH), psychological distress (by GHQ12) and somatic morbidity.

RESULTS

Parental education, problems in childhood and the respondent's own education were independently related to SRH and psychological distress. The impact of childhood living conditions on health varied by gender and according to the measure of health. Childhood conditions were strongly associated with poor SRH and psychological distress, whereas the connection with somatic morbidity was weaker. The associations remained relatively unchanged after controlling for the respondent's own education.

CONCLUSIONS

Childhood living conditions and adversities are strongly associated with poor SRH and psychological distress in early adulthood. Early recognition of childhood adversities followed by relevant support measures may play an important role in preventing health problems in adulthood.