Gender differences in processing information for making self-assessments of health

Sex and age differences in self-reported immune fitness

Studies have reported sex and age differences in self-rated health. On average, women rate their health as being poorer compared to men, and older individuals report poorer health than younger individuals. The current study evaluated sex and age differences for self-reported immune fitness, i.e. the capacity of the body to respond to health challenges (such as infections) by activating an appropriate immune response in order to promote health and prevent and resolve disease. Data from different survey studies (N = 8586) were combined for the current analyses. N = 8064 participants (93.3%) completed the single-item scale to assess momentary immune fitness (mean (Standard deviation, SD) age of 32.4 (16.7) years old, range: 18 to 103, 68.0% women) and N = 4263 participants (49.7%) completed the Immune Status Questionnaire (ISQ) to assess past year's immune fitness (mean (SD) age of 40.9 (17.1) years old, range: 18 to 103, 61.1% women). The analyses revealed that women rated their momentary and past year's immune fitness significantly lower than men (p < 0.001). A small but significant decline in momentary immune fitness when aging was found (r = -0.073, p < 0.001). In contrast, past year's immune fitness steadily improved with progressing age (r = 0.295, p < 0.001), and for each age group the difference from the 18-24 years old group was statistically significant (p < 0.001). When using age as covariate, the sex differences in immune fitness remained significant for both momentary immune fitness (p < 0.001) and past year's immune fitness (p < 0.001). In conclusion, women report a poorer momentary and past year's immune fitness than men. The sex effects in immune fitness are robust and seen across all age groups except the elderly. A relative stable momentary immune fitness was found across the age groups. However, past year's immune fitness (assessments with the ISQ) improved with age. This observation may be related to the fact that the studies comprised convenience samples. Therefore, the observed age effects should be interpreted with caution and require further investigation in nationally representative samples.

Research on the health status and influencing factors of the older adult floating population in Shanghai

Introduction

Over the past decade, against the dual background of population aging and mobility, the older adult/adults floating population has become a new type of mobile group in China, continually congregating in large cities, posing significant challenges to the socio-economic development, eldercare services, and public management of these metropolises. Shanghai, as a mega-city and the economic center of the China, is typically representative of the national population.

Methods

Based on the dynamic monitoring data of Shanghai's floating population in 2018, this research uses mathematical statistics and binary Logistic regression models.

Objective

This research analyzes the demographic characteristics and health status of the older adult/adults floating population in Shanghai in the new era and reveals its primary influencing factors.

Results and discussion

(1) A prominent contradiction in the scale and structure of the older adult/adults floating population, with widowed and low-educated mobile older adult/adults requiring attention. (2) There is a lack of health knowledge, and the proportion of local reimbursement is low. Over 90% of migrant older adult/adults self-assessed their health (with a very few unable to care for themselves), far higher than the proportion of older adult/adults who are not sick (injured) or uncomfortable (actually healthy), which exceeds 70%. The health status of migrant older adult/adults deteriorates with age, and those who have never attended school and live alone have the worst health status. (3) Older adult/adults people with advanced age and low educational levels are at risk of health issues, while a better living environment can reduce the risk of illness in the older adult/adults floating population. Low family income, poor housing affordability, and the medical burden brought about by illness can easily lead to older adult/adults floating populations falling into the trap of older adult/adults poverty, and older adult/adults people from central regions and those who migrate along have difficulty adapting to city life, leading to poor self-assessed health. Meanwhile, community/enterprise health education helps to enhance the health protection awareness of the older adult/adults floating population. Finally, based on the governance concept of "mobility publicness," several public management and service optimization strategies for social support for the older adult/adults floating population in Shanghai are proposed.

Patient global assessment and inflammatory markers in patients with idiopathic inflammatory myopathies - A longitudinal study

AIM

To explore if patient global assessment (PGA) is associated with inflammation over time and if associations are explained by other measures of disease activity and function in patients with idiopathic inflammatory myopathies (IIM).

METHODS

PGA and systemic inflammatory markers prospectively collected over five years were retrieved from the International MyoNet registry for 1200 patients with IIM. Associations between PGA, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and creatine kinase (CK) were analyzed using mixed models. Mediation analysis was used to test if the association between PGA and inflammatory markers during the first year of observation could be explained by measures of disease activity and function.

RESULTS

PGA improved, and inflammatory markers decreased during the first year of observation. In the mixed models, high levels of inflammatory markers were associated with worse PGA in both men and women across time points during five years of observation. In men, but not in women, the association between elevated ESR, CRP and poorer PGA was explained by measures of function and disease activity. With a few exceptions, the association between improved PGA and reduced inflammatory markers was partially mediated by improvements in all measures of function and disease activity.

CONCLUSION

Increased levels of systemic inflammation are associated with poorer PGA in patients with IIM. In addition to known benefits of lowered inflammation, these findings emphasize the need to reduce systemic inflammation to improve subjective health in patients with IIM. Furthermore, the results demonstrate the importance of incorporating PGA as an outcome measure in clinical practice and clinical trials.

Design, Development, and Validation of the Self-Perceived Health Scale (SPHS)

Health is a multidimensional concept with notable psychological factors, such as self-perceived health (SPH). SPH is defined as the subjective assessment of individual health status, and it integrates information related to both physical and psychological aspects, such as lifestyle. This study describes the development of the Self-Perceived Health Scale (SPHS), and its validation in a Mexican sample (n = 600). Exploratory factor analysis (n = 303) and confirmatory factor analysis (n = 293) were carried out, and they supported the three-dimensionality of the SPH construct: physical health, psychological health, and healthy lifestyle. A final 12-item scale was obtained, and the scale showed adequate validity and reliability, as well as measurement invariance between sexes, indicating its robustness.

Non-linear relationship between body mass index and self-rated health in older Korean adults: body image and sex considerations

OBJECTIVES

The purpose of this study was to investigate the association between body mass index (BMI) and self-rated health (SRH) in older adults aged over 65 years while examining the influence of self-perceived body image (SBI) and sex.

METHODS

Raw data were obtained from the Korea Community Health Survey, which included BMI measurements of Koreans aged over 65 years (n=59,628). Non-linear relationships between BMI and SRH were analyzed separately for each sex using restricted cubic splines while controlling for SBI and other confounding variables.

RESULTS

Men showed a reverse J-shaped association, while women showed a J-shaped association between BMI and poor SRH. However, including SBI in the model changed this association for men to an inverted U-shape showing a negative direction, with the highest risk of poor SRH observed in the underweight to overweight range. For women, a nearly linear positive relationship was observed. Regardless of BMI, those who perceived their weight as not "exactly the right weight" had a higher risk of poor SRH than those who perceived their weight as "exactly the right weight" in both men and women. Older men who thought they were much too fat or too thin had similar highest risks of poor SRH, whereas older women who thought they were too thin had the highest risk of poor SRH.

CONCLUSIONS

The findings of this study emphasize the importance of considering sex and body image perceptions when assessing the relationship between BMI and SRH in older adults, especially in men.

Sex differences in hardiness, coping, and health in new West Point cadets

The U.S. Military Academy at West Point places young men and women in a highly demanding world of extreme mental and physical challenges. As such, it provides an excellent natural laboratory in which to study how people respond and adapt to highly stressful conditions. The present study explores the role of personality hardiness and coping as stress resilience resources in new (freshmen) cadets at West Point, while also considering sex differences. Using survey methods, N = 234 cadets were assessed during their first year at West Point. Measures included personality hardiness, coping strategies, health symptoms, and number of hospitalizations for all causes. Results show that female cadets are higher in hardiness and emotion-focused coping, as well as somewhat higher in symptoms reports. For the total group, hardiness is linked to better health, both in terms of symptoms reports and hospitalizations. Multiple regression results indicate symptoms are predicted by lower hardiness, higher avoidance coping, and female sex. Conditional process path analysis reveals that the effect of hardiness on symptoms is mediated by emotion-focused coping, and that emotion-focused coping can have both positive and negative effects. This study confirms hardiness is an important stress resilience resource for both men and women in the highly stressful first year at West Point. These findings lend further support to a growing body of evidence that hardiness influences health in part via the coping strategies that people choose to apply in dealing with stressful situations.

Preoperative incongruent subtalar joint predicts less favorable clinical outcome in total ankle arthroplasty

BACKGROUND

This study aimed to determine the clinical effect of incongruent subtalar joint space on total ankle arthroplasty (TAA).

METHODS

Thirty-four consecutive patients who underwent TAA were grouped according to the status of subtalar joint incongruency. A comparison of clinical and radiographic parameters between groups as well as multiple regression analysis was performed to identify contributing factors to the final functional outcome.

RESULTS

The final American Orthopaedic Foot and Ankle Society (AOFAS) score was significantly higher in the congruent group compared to that of the incongruent group (p = 0.007). There were no significant differences between the two groups in measured radiographic angles. In multiple regression analysis, the female sex (p = 0.006) and incongruency of the subtalar joint (p = 0.013) were found to be significant contributing factors to the final AOFAS score.

CONCLUSIONS

A thorough preoperative investigation should be taken into the state of the subtalar joint for TAA.

Polypharmacy and the Change of Self-Rated Health in Community-Dwelling Older Adults

Polypharmacy is associated with poorer self-rated health (SRH). However, whether polypharmacy has an impact on the SRH progression is unknown. This study investigates the association of polypharmacy with SRH change in 1428 participants of the Berlin Initiative Study aged 70 years and older over four years. Polypharmacy was defined as the intake of ≥5 medications. Descriptive statistics of SRH-change categories stratified by polypharmacy status were reported. The association of polypharmacy with being in SRH change categories was assessed using multinomial regression analysis. At baseline, mean age was 79.1 (6.1) years, 54.0% were females, and prevalence of polypharmacy was 47.1%. Participants with polypharmacy were older and had more comorbidities compared to those without polypharmacy. Over four years, five SRH-change categories were identified. After covariate adjustment, individuals with polypharmacy had higher odds of being in the stable moderate category (OR 3.55; 95% CI [2.43-5.20]), stable low category (OR 3.32; 95% CI [1.65-6.70]), decline category (OR 1.87; 95% CI [1.34-2.62]), and improvement category (OR 2.01; [1.33-3.05]) compared to being in the stable high category independent of the number of comorbidities. Reducing polypharmacy could be an impactful strategy to foster favorable SRH progression in old age.

Determinants of Self-Perceived Health: The Importance of Physical Well-Being but Also of Mental Health and Cognitive Functioning

With life expectancy increasing for the general population, public health promotion activities should be a priority to aim at a reduction of the burden and costs of hospitalization, disability, and lifelong treatment. This study aimed to explore the influence of parameters pertaining to different aspects of well-being, including physical and mental health and cognitive functioning, on self-perceived health, a predictor of chronic disease prevalence and mortality. We used data from the Survey of Health, Aging and Retirement in Europe (SHARE) project gathered between 2013 and 2017, obtaining a sample of 96,902 participants (63.23 ± 6.77 years). We found a strong association between the self-perceived health rating and not only physical health aspects but also mental health and cognitive functioning. In particular, BMI, chronic diseases and medications, muscle strength, and mobility issues had a strong effect on self-perceived health, as also did the quality of life, depression, and verbal fluency, while other aspects, such as individual characteristics, limitations in daily activities, and pain, among others only had a small effect. These results show that public health and prevention interventions should prioritize the targeting of all aspects of well-being and not only of physical health, acknowledging self-perceived health rating as a simple tool that could help provide a complete overview of psycho-physical well-being and functional status.

Does Physical Activity Reduce the Risk of Perceived Negative Health in the Smoking Population?

BACKGROUND

Smoking is associated with poor health status. Increased prevalence of multiple diseases has been found in populations of smokers and ex-smokers. Physical activity (PA) could reduce the negative effects of smoking.

AIMS

To analyze the relationships between smoking and self-perceived health and between PA level and self-perceived health, according to the relationship with smoking in the Spanish population. To calculate the risks of perceiving negative health in relation to smoking, according to the PA level of the population.

HYPOTHESIS

A higher level of PA reduces the risk of perceiving negative health in the Spanish smoking population.

DESIGN AND METHODOLOGY

Cross-sectional study with data from 17,708 participants, 15-69 years old, interviewed in the Spanish National Health Survey 2017. Intergroup differences were studied. Odds ratios (OR) and relative risks (RR) and their confidence intervals (95% CI) were calculated for negative self-perceived health. A Spearman's rho correlation study was performed between the variables of interest.

RESULTS

Dependency relationships were found between self-perceived health and PA levels, in both genders and in different relationships with smoking (x2 < 0.001). Inactivity was related to higher prevalences of negative health perception (p < 0.05) in all groups analyzed. Inactive smokers (OR: 6.02. 95% CI: 3.99-9.07. RR: 5.24. 95% CI: 3.56-7.73) presented increased risks of negative health perception compared to people with low/medium PA levels, similarly found in other relationships with tobacco.

CONCLUSIONS

Increasing the PA level of the smoking population could reduce the negative effects on their perceived health. Medium and high PA levels reduce the risk of negative health perception in the Spanish population, both in smokers, ex-smokers, and non-smokers.

Aging and self-reported health in 114 Latin American cities: gender and socio-economic inequalities

Background

Understanding how urban environments influence people’s health, especially as individuals age, can help identify ways to improve health in the rapidly urbanizing and rapidly aging populations.

Objectives

To investigate the association between age and self-reported health (SRH) in adults living in Latin-American cities and whether gender and city-level socioeconomic characteristics modify this association.

Methods

Cross-sectional analyses of 71,541 adults aged 25–97 years, from 114 cities in 6 countries (Argentina, Brazil, Colombia, Chile, El Salvador, and Guatemala), as part of the Salud Urbana en America Latina (SALURBAL) Project. We used individual-level age, gender, education, and self-reported health (SRH) data from harmonized health surveys. As proxies for socioeconomic environment we used a city-level socioeconomic index (SEI) calculated from census data, and gross domestic product (GDP) per-capita. Multilevel Poisson models with a robust variance were used to estimate relative risks (RR), with individuals nested in cities and binary SRH (poor SHR vs. good SRH) as the outcome. We examined effect modification by gender and city-level socioeconomic indicators.

Results

Overall, 31.4% of the sample reported poor SRH. After adjusting for individual-level education, men had a lower risk of poor SRH (RR = 0.76; CI 0.73–0.78) compared to women, and gender modified the association between age and poor SRH (p-value of interaction < 0.001). In gender stratified models, the association between older age and poor SRH was more pronounced in men than in women, and in those aged 25–65 than among those 65+ (RR/10 years = 1.38 vs. 1.10 for men, and RR/10 years = 1.29 vs. 1.02 for women). Living in cities with higher SEI or higher GDP per-capita was associated with a lower risk of poor SRH. GDP per-capita modified the association between age (25–65) and SRH in men and women, with SEI the interaction was less clear.

Conclusions

Across cities in Latin America, aging impact on health is significant among middle-aged adults, and among men. In both genders, cities with lower SEI or lower GDP per-capita were associated with poor SRH. More research is needed to better understand gender inequalities and how city socioeconomic environments, represented by different indicators, modify exposures and vulnerabilities associated with aging.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13752-2.

The association between self-rated health and all-cause mortality and explanatory factors in China's oldest-old population

Background

Self-rated health (SRH) is considered a condensed summary of information about bodily conditions that involves people’s biological, cognitive, and cultural status, but has been under-studied in the oldest old population. This study aimed to investigate the association between SRH and all-cause mortality among the oldest-old population in China and to explore potential explanatory factors in this association.

Methods

The study was based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018 and included 30 222 participants aged 80 years or older (ie, the oldest old) in the analysis. We used Cox models to assess the association between SRH and mortality in this population and its subgroups, and used the Percentage Excess Risk Mediated approach to identify potential contributing factors.

Results

After adjustment of confounders, people with “good” “neutral”, and “bad/very bad” SRH were significantly associated with 8% (95% confidence interval (CI) = 3%-13%), 23% (95% CI = 18%-29%), and 52% (95% CI = 44%-61%) higher hazard of mortality respectively, compared with those with “very good” SRH. The significant SRH-mortality associations were exclusive to men and those with at least primary education. The adjustment of “regular physical activity”, “leisure activity”, “activities of daily living (ADL)”, and “cognitive function” all led to noticeable attenuation to the SRH-mortality association, with “leisure activity” causing the most attenuation (64.9%) in the “Good SRH” group.

Conclusions

Self-rated health is significantly associated with all-cause mortality among the oldest old population in China, particularly among men and the educated, and is considerably explained by regular physical activity, leisure activity, ADL, and cognitive function. We advocate the use of SRH as a simple and efficient tool in research and (potentially) health care practices.

Gender differences of health literacy in persons with a migration background: a systematic review and meta-analysis

OBJECTIVE

To investigate gender differences of health literacy in individuals with a migration background.

DESIGN

Systematic review and meta-analysis. OVID/MEDLINE, PsycINFO and CINAHL were searched in March 2018 and July 2020.

SETTING

Studies had to provide health literacy data for adult women and men with a migration background, collected with a standardised instrument, or report results that demonstrated the collection of such data. Health literacy data were extracted from eligible studies or requested from the respective authors. Using a random-effects model, a meta-analysis was conducted to assess standardised mean differences (SMDs) of health literacy in men and women. Two researchers independently assessed risk of bias for each included study using the Appraisal Tool for Cross-Sectional Studies.

RESULTS

Twenty-four studies were included in this systematic review. Thereof, 22 studies (8012 female and 5380 male participants) were included in the meta-analyses. In six studies, gender-specific health literacy scores were reported. The authors of additional 15 studies provided their data upon request and for one further study data were available online. Women achieved higher health literacy scores than men: SMD=0.08, 95% CI 0.002 to 0.159, p=0.04, I2=65%. Another 27 studies reported data on female participants only and could not be included due to a lack of comparable studies with male participants only. Authors of 56 other eligible studies were asked for data, but without success.

CONCLUSION

Men with a migration background-while being much less frequently examined-may have lower health literacy than women. As heterogeneity between studies was high and the difference became statistically insignificant when excluding studies with a high risk of bias, this result must be interpreted with caution. There is a paucity of research on the social and relational aspects of gender in relation to health literacy among people with a migration background, especially for men.

PROSPERO REGISTRATION NUMBER

CRD42018085555.

Gender Differences in Knowledge and Perception of Cardiovascular Disease among Italian Thalassemia Major Patients

We evaluated gender differences in knowledge and perception of cardiovascular disease (CVD) among Italian thalassemia major (TM) patients. An anonymous questionnaire was completed by 139 β-TM patients (87 (62.7%) females, 40.90 ± 8.03 years). Compared to females, males showed a significantly higher frequency of CVDs, and they less frequently selected tumors in general as the greatest health problem for people of the same age and gender (48.1% vs. 66.7%; p = 0.031) and as the greatest danger to their future health (26.9% vs. 43.7%; p = 0.048). CVDs were designated as the greatest danger to their future health by a significantly higher percentage of males than females (53.8% vs. 36.8%; p = 0.048). Both males and females showed a good knowledge of cardiovascular risk factors and preventive measures for CVDs. No gender differences were detected in the subjective well-being and the perceived cardiovascular risk. The perceived risk was not influenced by age, presence of cardiovascular risk factors, or disease, but no patient with a low perceived CVD risk had myocardial iron overload. Our findings highlight the need to implement future educational programs aimed at increasing the awareness of CVD as the greatest health issue, especially among the female TM population, and at informing TM patients of the different actors, besides iron, that play a role in the development of cardiovascular complications.

Weight Cycling and Dieting Behavior in Fitness Club Members

Background

Along with the rising prevalence of high body-mass index (BMI), there is also increased emphasis on leanness and fitness. Both these trends suggest that many individuals are concerned about weight management and may try to lose weight. Using data from the research project "Fitness clubs - a venue for public health?", we aimed to describe weight cycling and energy-restricted dieting in men and women at start-up of fitness club membership, and to investigate influencing factors [age, BMI, educational level, self-classified overweight/obesity, compliance with nutritional guidelines, unhealthy weight control strategies and self-perceived health (SPH)].

Methods

In a cross-sectional online survey, 250 men and women from 25 fitness clubs in Oslo, reported anthropometrics, self-classified weight group, weight cycling, weight loss/gain, eating habits/dieting, and background/health information. Enrollment was limited to adult (≥18 years) novice exercisers (exercising <60 min/week at a moderate or vigorous intensity or brisk walking <150 min/week, the past six months) with less than four weeks of membership. Factors associated with weight cycling were examined using simple and multiple logistic regression, separated for men and women.

Results

In both sexes (mean age: 36.4 ± 11.3, range 18-71 years), a high number reported substantial weight fluctuation (+/-5 kg) the past 12 months (men: 50% and women: 62%, mean difference 12%, 95% CI -0.3 to 23.8, p=0.056) and unhealthy weight control strategies (men: 24.8% and women: 47.2%, mean difference 22.4%, 95% CI 10.5 to 33.4, p<0.001). Weight cyclers had a higher mean BMI compared with non-cyclers (mean difference -1.5, 95% CI -2.6 to - 0.4, p= 0.003). Further, the difference in body weight was 6.7 kg (95% CI 2.2 to 10.8, p=0.004) and 10.8 kg (95% CI 5.8 to 15.8, <0.001) in men and women, respectively. Besides BMI status, self-classified overweight/obesity was the strongest predictor of reporting weight cycling (men: OR 5.54, 95% CI 2.03 to 15.12, p<0.01 and women: OR 7.17, 95% CI 2.48 to 20.68, p<0.001).

Conclusion

In novice exercisers, a large proportion reported weight cycling and unhealthy weight control strategies, and both were more prevalent in women than in men. Self-classified overweight was found to be the most important factor influencing weight cycling.

Do individuals' attitudes toward immigrants affect their own health? Analysis of 15 European countries

BACKGROUND

Hostility toward others is related to negative emotions, which is hypothesized to have negative health consequences. In this article, we sought to test the relationship between individuals' attitudes toward immigrants and their self-rated health (SRH) across time in large dataset of 15 European countries.

METHODS

We used the 2010, 2012, 2014 and 2016 waves of the European Social Survey, which include information about attitudes toward immigrants and individuals' SRH.

RESULTS

Combining all countries and survey years, we found an association between negative attitudes toward immigrants and fair/poor SRH. However, when analyzing the relationship within each country, we found variations (depending on the year of the survey) in some countries, such as Hungary, Poland, Portugal, Sweden and Slovenia. Additionally, we found that there are more middle class individuals who hold unfavorable attitudes toward immigrants over time.

CONCLUSIONS

In general, poor attitudes toward immigrants are associated with higher odds of reporting fair/poor health, although the 'health advantage' of those with favorable attitudes is diminishing over time. However, in some countries, this relationship is contingent on when the survey was conducted, possibly reflecting the changing composition of individuals who hold unfavorable attitudes toward immigrants.

An objective metric of individual health and aging for population surveys

BACKGROUND

We have previously developed and validated a biomarker-based metric of overall health status using Mahalanobis distance (DM) to measure how far from the norm of a reference population (RP) an individual's biomarker profile is. DM is not particularly sensitive to the choice of biomarkers; however, this makes comparison across studies difficult. Here we aimed to identify and validate a standard, optimized version of DM that would be highly stable across populations, while using fewer and more commonly measured biomarkers.

METHODS

Using three datasets (the Baltimore Longitudinal Study of Aging, Invecchiare in Chianti and the National Health and Nutrition Examination Survey), we selected the most stable sets of biomarkers in all three populations, notably when interchanging RPs across populations. We performed regression models, using a fourth dataset (the Women's Health and Aging Study), to compare the new DM sets to other well-known metrics [allostatic load (AL) and self-assessed health (SAH)] in their association with diverse health outcomes: mortality, frailty, cardiovascular disease (CVD), diabetes, and comorbidity number.

RESULTS

A nine- (DM9) and a seventeen-biomarker set (DM17) were identified as highly stable regardless of the chosen RP (e.g.: mean correlation among versions generated by interchanging RPs across dataset of r = 0.94 for both DM9 and DM17). In general, DM17 and DM9 were both competitive compared with AL and SAH in predicting aging correlates, with some exceptions for DM9. For example, DM9, DM17, AL, and SAH all predicted mortality to a similar extent (ranges of hazard ratios of 1.15-1.30, 1.21-1.36, 1.17-1.38, and 1.17-1.49, respectively). On the other hand, DM9 predicted CVD less well than DM17 (ranges of odds ratios of 0.97-1.08, 1.07-1.85, respectively).

CONCLUSIONS

The metrics we propose here are easy to measure with data that are already available in a wide array of panel, cohort, and clinical studies. The standardized versions here lose a small amount of predictive power compared to more complete versions, but are nonetheless competitive with existing metrics of overall health. DM17 performs slightly better than DM9 and should be preferred in most cases, but DM9 may still be used when a more limited number of biomarkers is available.

Autoavaliação ruim do estado de saúde: prevalência e fatores associados em mulheres privadas de liberdade

Resumo Objetivo Verificar a prevalência da autoavaliação ruim do estado de saúde em mulheres encarceradas e analisar os fatores associados. Método Trata-se de estudo transversal, realizado entre os anos de 2019 e 2020, por meio de censo, com participação de 99 mulheres. A análise dos fatores associados ao desfecho foi conduzida a partir de um modelo teórico de determinação com três blocos hierarquizados de variáveis. As variáveis foram ajustadas entre si dentro de cada bloco. Aquelas com nível de significância ≤ 0,20 foram incluídas no modelo de regressão de Poisson e ajustadas ao nível superior ao seu, considerando o nível de 5% de significância. Resultados A prevalência da autoavaliação ruim da saúde foi de 31,3% (IC95% = 22,8%–40,9%). Morbidade referida, presença de sintomas de ansiedade e a pior perspectiva em relação às condições de saúde pós-encarceramento foram as variáveis associadas com o desfecho. Considerações finais e implicações para a prática Os fatores associados à ocorrência do evento investigado poderão direcionar medidas que visem à redução dos impactos à saúde durante o período de encarceramento.

Are lifestyle factors significantly associated with self-rated health among Japanese female healthcare students?

Background

Self-rated health (SRH), a subjective perception of an individual’s overall health, is widely used in public health assessment. The transition from adolescence to young adulthood is a critical period involving substantial changes in lifestyle and dietary habits. Therefore, it is important to understand SRH among young Japanese females. The present study aimed to investigate the relationships between SRH among female healthcare students and their lifestyle factors, such as living status (living with others or living alone), smoking habit, alcohol consumption, frequency of breakfast consumption (FBC), physical activity, insomnia, and physique recognition.

Methods

A cross-sectional survey was conducted on 1101 female healthcare students in Japan. The body mass index was calculated from the body height and weight using data from periodic health examinations. Self-reported sociodemographic, lifestyle or dietary habits, physical activity, and SRH were used through a self-administered questionnaire. Participants were classified as having either good SRH (excellent, very good, or good) or impaired SRH (fair or poor). Multivariate logistic regression analysis was performed to investigate the independent relationships between SRH and lifestyle factors.

Results

A total of 11.4% participants demonstrated impaired SRH. Multivariate logistic regression analysis showed that the University of California Los Angeles activity score, Athens Insomnia Scale, and physique recognition were associated with SRH.

Conclusions

It was suggested that public health activities that consider physical activity, sleep, and physique recognition may help maintain and improve SRH in female university students in Japan.

Health expectancies in the European Union: same concept, different methods, different results

BACKGROUND

Healthy life expectancy (HLE) is a population health measure that combines mortality and morbidity, which can be calculated using different methods. In this study, we aimed to assess the correlation, reliability and (dis)agreement between two estimates monitored in the European Union (EU), that is, the European Commission's HLE based on self-perceived health (SPH-HLE) and the Institute for Health Metrics and Evaluation's HLE based on disability weight (DW-HLE), by sex, and comparing these results with LE and proportion of life spent in good health (%GH).

METHODS

We performed a retrospective study in the EU28 countries, between 2010 and 2017. The HLE methods differ in definition, measurement and valuation of health states. While SPH-HLE relies directly on one question, DW-HLE relies on epidemiological data adjusted for DW. Spearman's r, intraclass correlation coefficient, information-based measure of disagreement and Bland-Altman plots were used to assess reliability, correlation and disagreement in HLE resulting from both methods and in LE or %GH measured by both institutions.

RESULTS

Correlation and reliability between SPH-HLE and DW-HLE were good (better for males), with low disagreement, and were even better for LE between both institutions. The HLE Bland-Altman plots suggest a variability range of approximately 6 years for both sexes, higher for females. There was also an increasing HLE difference between methods with higher average HLE for both sexes.

CONCLUSION

We showed wide variations between both methods with a clear and different high impact on female and male HLE, showing a tendency for countries with higher health expectancies to yield larger gaps between SPH-HLE and DW-HLE.

To what extent do socioeconomic inequalities in SRH reflect inequalities in burden of disease? The HELIUS study

BACKGROUND

Self-rated health (SRH), an attractive measure for health monitoring, shows persistent inequalities with regard to socioeconomic status (SES). However, knowledge on the extent to which inequalities in SRH reflect inequalities in disease burden is lacking.

METHODS

Data come from the multi-ethnic HEalthy LIfe in an Urban Setting study (Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish or Moroccan origin, N = 19 379, aged 18-70). SES was defined by educational and occupational level. Disease burden was operationalized as chronic diseases, physical and mental functioning (measured with SF-12) and depressive symptoms (measured with PHQ-9). We applied logistic regression analyses and reported average marginal effects (AME).

RESULTS

Dutch origin participants with low educational or low occupational level had higher probabilities of reporting fair/poor SRH, compared to the highest levels (AME = 0.20 95% CI: 0.13;0.27; and 0.12 (0.09;0.15), respectively). Associations were attenuated after adjusting for all disease burden indicators, to AME = 0.03 (0.01;0.04) and AME = 0.02 (-0.00;0.04). In all the non-Dutch origin groups, a larger part of the inequalities remained after adjustment.

CONCLUSION

Socioeconomic inequalities in SRH are for a large part explained by higher disease burden in lower socioeconomic groups, but less so in those with non-Dutch origin. Future research should examine if our conclusions also hold for trend data on inequalities in SRH.

Sex differences in the association between self-rated health and high-sensitivity C-reactive protein levels in Koreans: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey

BACKGROUND

No studies have investigated the association between self-rated health (SRH) and high-sensitivity C-reactive protein (hs-CRP) levels in South Koreans. We explored this association and analyzed differences between sexes.

METHODS

Using cross-sectional data from the 2015-2017 Korea National Health and Nutrition Examination Survey, we analyzed the association between SRH and high hs-CRP levels (> 1.0 mg/L) in 14,544 Koreans aged ≥ 19 years who responded to the SRH survey and had available hs-CRP test results. Differences in sociodemographic factors were analyzed using the Pearson's chi-square test for categorical variables or the Mann-Whitney U test for continuous variables. Multiple logistic regression analysis was used to measure the association between hs-CRP levels and SRH according to sex while adjusting for other possible confounders.

RESULTS

The percentage of very poor to poor SRH was higher in the high hs-CRP group (22.4%) than in the low hs-CRP group (17.66%). Among men, the risk of a high hs-CRP level increased with worse SRH (adjusted for confounders; P for trend < 0.001). After adjusting for all confounders, including chronic diseases, men with very poor SRH showed a higher odds ratio (OR) for high hs-CRP levels than those with very good SRH (fully adjusted OR, 1.74; 95% CI, 1.04-2.90). Significant correlations were absent among women.

CONCLUSIONS

Poor SRH was correlated with low-grade inflammation (high hs-CRP levels) among Korean male adults. These findings could be useful for developing health improvement programs and in goal setting at a national scale.

The role of individual, household, and area of residence factors on self-rated health in Colombian adults: A multilevel study

Introduction:

Self-rated health is strongly associated with morbidity and mortality. It is largely influenced by individual factors but also by individuals’ social surroundings and environment.

Objective:

To investigate individual, household, and locality factors associated with self- rated health in Colombian adults.

Materials and methods:

We conducted a cross-sectional multilevel study using data from national databases on 19 urban localities and 37,352 individuals nested within 15,788 households using a population-based survey. Given the natural hierarchical structure of the data, the estimates of self-rated health related to individual, household, and locality characteristics were obtained by fitting a three-level logistic regression.

Results:

The adjusted multilevel logistic models showed that at individual level, higher odds of poor self-rated health were found among older adults, persons from low socio-economic status, those living without a partner, with no regular physical activity, and reporting morbidities. At the household level, poor self-rated health was associated with households of low socioeconomic status located near noise sources and factories and in polluted and insecure areas. At the locality level, only poverty was associated with poor self-rated health after adjusting for individual and household variables.

Conclusions:

These results highlight the need for a more integrated framework when designing and implementing strategies and programs that aim to improve health conditions in urban populations in Latin America.

Does gender influence the outcomes of total ankle arthroplasty in patients with ankle osteoarthritis?

Background

Total ankle arthroplasty has progressed as a treatment option for patients with ankle osteoarthritis. However, no studies have been conducted to evaluate the effect of gender on the outcome. The purpose of the present study was to evaluate outcomes, survivorship, and complications rates of total ankle arthroplasty, according to gender differences.

Methods

This study included 187 patients (195 ankles) that underwent mobile-bearing HINTEGRA prosthesis at a mean follow-up of 7.5 years (range, 4 to 14). The two groups consisted of a men’s group (106 patients, 109 ankles) and a women’s group (81 patients, 86 ankles). Average age was 64.4 years (range, 45 to 83).

Results

Clinical scores on the Ankle Osteoarthritis Scale for pain and disability, and American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved and the difference was not statistically significant between the two groups at the final follow-up. There were no significant differences in complication rates and implant survivorship between the two groups. The overall survival rate was 96.4% in men and 93.4% in women at a mean follow-up of 7.5 years (p = 0.621).

Conclusions

Clinical outcomes, complication rates, and survivorship of total ankle arthroplasty were comparable between men and women. These results suggest that gender did not seem to affect outcomes of total ankle arthroplasty in patients with ankle osteoarthritis.

Level of evidence

Therapeutic level III

Does the single-item self-rated health measure the same thing across different wordings? Construct validity study

Purpose

The self-rated health (SRH) item is frequently used in health surveys but variations of its form (wording, response options) may hinder comparisons between versions over time or across surveys. The objectives were to determine (a) whether three SRH forms are equivalent, (b) the form with the best construct validity and (c) the best coding scheme to maximize equivalence across forms.

Methods

We used data from 58,023 respondents of the Swiss Health Survey. Three SRH forms were used. Response options varied across forms and we explored four coding schemes (two considering SRH as continuous, two as dichotomous). Construct validity of the SRH was assessed using 34 health predictors to estimate the explained variance.

Results

Distributions of response options were similar across SRH forms, except for the “good” and “very good” options (“good” in form 1: 58.6%, form 2: 65.0% and form 3: 44.1%). Explained variances differed across SRH forms, with form 3 providing the best overall explained variance, regardless of coding schemes. The linear coding scheme maximised the equivalence across SRH forms.

Conclusion

The three SRH forms were not equivalent in terms of construct validity. Studies examining the evolution of SRH over time with surveys using different forms should use the linear coding scheme to maximise equivalence between SRH forms.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02533-2) contains supplementary material, which is available to authorized users.

Men with impaired glucose tolerance have lower self-rated health than men with impaired fasting glucose

AIM

Previous studies have shown that individuals with impaired glucose tolerance (IGT) have lower self-rated health than normoglycaemic individuals. The aim of this study was to examine differences in self-rated health between individuals with IGT and those with impaired fasting glucose (IFG) and to consider the potentially mediating effect of physical activity.

METHODS

In 2002-2005, a total of 2816 individuals were randomly selected for a population-based study in Sweden. All participants performed an oral glucose tolerance test (OGTT). Fasting venous blood samples were drawn, and questionnaires concerning lifestyles were completed. Self-rated health (SRH) and leisure time physical activity (LTPA) were reported on a five-graded and four-graded scale, respectively. A total of 213 individuals with IGT and 129 with IFG were detected.

RESULTS

IGT, but not IFG, was associated with low self-rated health. The difference in self-rated health was seen particularly in men when adjusted for age and BMI (OR = 2.13, CI: 1.13-4.02, p = 0.020). The results became insignificant when including physical activity in the model (OR = 1.8, CI: 0.91-3.58, p = 0.094).

CONCLUSION

The low self-rated health adds further weight to the risk profile in men with IGT and stresses the importance of early detection and lifestyle interventions.

Gender differences in the effect of self-rated health (SRH) on all-cause mortality and specific causes of mortality among individuals aged 50 years and older

Although different gender associations between self-rated health (SRH) and mortality have been reported, the results of the respective studies have been inconsistent and little is known about the cause-specific relation of mortality with SRH by gender. Therefore, to evaluate the gender differences in all-cause or specific causes of mortality by SRH, this retrospective cohort study was conducted using the data of 19,770 Korean adults aged 50 years and over who underwent health screening at Seoul National University Hospital between March 1995 and December 2008. SRH was surveyed using a simple questionnaire, and the all-cause mortality and cause-specific mortality were followed up from baseline screening until December 31, 2016. Results showed that the relationship between SRH and all-cause mortality differed by gender, and the differences also varied depending on the cause of death. In men, the adjusted hazard ratio (aHR) of all-cause mortality was higher in the poor SRH group than the very good SRH groups even after adjustment for socio-demographic, clinical, and behavioral risk factors (aHR:1.97, 95% CI 1.51-2.56), and these results were similar to those for cancer, cardiovascular, and respiratory disease mortalities (aHR:1.52, 95% CI 0.93-2.50; aHR: 2.11, 95% CI 1.19-3.74; aHR:10.30, 95% CI 2.39-44.44, respectively). However, in women, the association between SRH and all-cause mortality was insignificant, and inverse relationships were found for cardiovascular and respiratory disease mortalities in the poor and very good SRH groups. Cancer mortality had a positive relation with SRH (aHR: 1.14, 95% CI 0.75-1.72; aHR: 2.58, 95% CI 1.03-6.48; aHR: 0.49, 95% CI 0.24-0.98; aHR: 0.15, 95% CI 0.04-0.57: all-cause, cancer, cardiovascular, and respiratory disease mortalities, respectively). Clinicians need to take these gender differences by SRH into account when evaluating the health status of over-middle aged adults.

The role of education in the association between self-rated health and levels of C-reactive protein: a cross-sectional study in rural areas of China

OBJECTIVES

This study aims to examine the association between self-rated health (SRH) and levels of C-reactive protein (CRP) among adults aged 45 to 101 years old in rural areas of China, and to explore the role of education in the association.

DESIGN

Cross-sectional study.

SETTING

The study population was derived from two databases in China: Nanping project (NP) and the China Health and Retirement Longitudinal Study (CHARLS).

PARTICIPANTS

There were 646 participants from a rural area of Nanping (NP) and 8555 rural participants from a national representative sample of China (CHARLS).

METHODS

CRP was measured using a high sensitivity sandwich enzyme immunoassay in the NP and immunoturbidimetric assay in the CHARLS. SRH was assessed by SRH questionnaires and categorised into good and poor. Education was measured by the maximum years of schooling and dichotomised into illiterate and literate. Multivariate linear regression models were used to study the associations.

RESULTS

Compared to people with good SRH, those with poor SRH had higher levels of CRP in NP (β=0.16, 95% CI -0.02 to 0.34) and in CHARLS (β=0.07, 95% CI 0.02 to 0.11) after adjusting for potential confounders. Similar findings were observed in the pooled population (β=0.08, 95% CI 0.03 to 0.12), especially in men (β=0.13, 95% CI 0.06 to 0.20) and in literate people (β=0.12, 95% CI 0.06 to 0.18).

CONCLUSION

Poor SRH may be a predicator of elevated levels of CRP among middle-aged and older people in rural areas, especially in men and literate people.

Gender, Depressive Symptoms, Chronic Medical Conditions, and Time to First Psychiatric Diagnosis among American Older Adults

Background:

To test whether gender moderates the effects of baseline depressive symptoms and chronic medical conditions (CMCs) on risk of receiving subsequent psychiatric diagnosis among older adults.

Methods:

Data came from ten waves of the Health and Retirement Study, a nationally representative longitudinal study. We followed 9794 individuals older than 52 years without any diagnosed psychiatric disorder at baseline for up to 18 years. Baseline depressive symptoms and CMC were the predictors, time to receiving an emotional diagnosis was the outcome, baseline demographics and socioeconomics were controls, and gender was the moderator. We used Cox proportional hazards models for data analysis.

Results:

In the pooled sample, female gender increased the effect of baseline depressive symptoms (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.26–2.00) and reduced the effect of baseline CMC (HR, 0.78; 95% CI, 0.63–0.97) on time to receiving a psychiatric diagnosis. Among men, baseline depressive symptoms (HR, 2.36; 95% CI, 1.87–2.97) increased and baseline CMC (HR, 0.81; 95% CI, 0.69–0.95) decreased time to receiving a psychiatric diagnosis. Among women, depressive symptoms (HR, 1.49; 95% CI, 1.21–1.83) but not CMC (HR, 1.06; 95% CI, 0.91–1.23) were associated with time to receiving a psychiatric diagnosis over time.

Conclusions:

Men and women differ in how depressive symptoms and CMC influence their risk of receiving a psychiatric diagnosis over time. Depressive symptoms are more salient promotor for men than women while CMC is only a barrier for men.

Reporting biases in self-assessed physical and cognitive health status of older Europeans

This paper explores which demographic characteristics substantially bias self-reported physical and cognitive health status of older Europeans. The analysis utilises micro-data for 19 European countries from the Survey of Health, Ageing and Retirement in Europe to compare performance-tested outcomes of mobility and memory with their self-reported equivalents. Relative importance analysis based on multinomial logistic regressions shows that the bias in self-reported health is mostly due to reporting heterogeneities between countries and age groups, whereas gender contributes little to the discrepancy. Concordance of mobility and cognition measures is highly related; however, differences in reporting behaviour due to education and cultural background have a larger impact on self-assessed memory than on self-assessed mobility. Southern as well as Central and Eastern Europeans are much more likely to misreport their physical and cognitive abilities than Northern and Western Europeans. Overall, our results suggest that comparisons of self-reported health between countries and age groups are prone to significant biases, whereas comparisons between genders are credible for most European countries. These findings are crucial given that self-assessed data are often the only information available to researchers and policymakers when asking health-related questions.

Gender differences in psychosocial determinants of self-perceived health among Portuguese older adults in nursing homes

Objectives: Self-perceived health declines with age, varies by gender and is a predictor of mortality, morbidity, physical and psychological functioning. However, gender differences in health and illness perception are complex and not yet fully understood. This study aimed to explore gender-related differences in psychosocial determinants of self-perceived health among older adults living in nursing homes. Method: Nationwide face-to-face survey of the Portuguese population aged 65 and over. A representative sample of nursing homes residents was obtained through a multistage cluster random sampling of nursing homes, stratified by main Portuguese administrative regions (NUTS II). Results: Overall, 1186 nursing homes residents voluntarily enrolled in this study (participation rate, 93%) and a total of 515 participants (70.1% women) were considered to have adequate cognitive functioning to answer all questionnaires. A significant association between self-rated health and gender was found: 90.6% of all women (95% CI: 85.7-93.9) and 82.3% of all men (95% CI: 72.9-88.9) rated their health as less than good (p = 0.023). Gender-stratified analyses showed differences in psychosocial determinants of self-perceived health. While symptoms of depression and loneliness feelings were the major psychosocial determinants of poor self-perceived health among women, age and subjective financial well-being were the only determinants among men. Conclusion: Factors associated with perceived health, as representative of healthy ageing, were identified by gender, leading to future avenues for fruitful investigation. The acknowledgement of interpersonal and socioeconomic factors that determine the experience of ageing at a national level is crucial to improve the health of elders.

Health-related behaviours and their relationship with self-rated health among Canadian adults

BACKGROUND

Self-rated health (SRH) is a commonly used survey measure as a substitute for a clinical measure of health, which has demonstrated validity and reliability in a variety of populations. The referents that individuals incorporate into their self-evaluations have been shown to include health-related behaviours, though these relationships are not static. Our purpose was to describe and test for relationships between health-related behaviours and SRH among Canadian adults.

METHODS

We used pooled data from the Canadian Health Measures Surveys Cycles 3 (2012-13) and 4 (2014-15). All men and non-pregnant women aged 18 years and older were included (n = 6,789). We used binary logistic regression to test for relationships between health-related behaviours and SRH, including smoking status, adequate fruit and vegetable intake, inadequate sleep, alcohol use, and adequate physical activity.

RESULTS

The majority of respondents rated their health as good, very good, or excellent, though differences in SRH were found according to age group, highest level of household education, and income adequacy. Inadequate sleep was most strongly associated with poorer SRH among men and women combined, as compared to other health-related behaviours. Among women only, those who report heavy episodic drinking (OR, 2.64) or daily drinking (OR, 3.51) rated their health better, as compared to women who report low-risk alcohol use.

CONCLUSIONS

Sleep quality is an important predictor of SRH for both men and women. Second, sex/gender differences must be considered in strategies to address alcohol use, as we may not be fully appreciating potentially health-affirming qualities associated with alcohol use among women.

Health self-perception and its association with physical activity and nutritional status in adolescents

OBJECTIVE

To evaluate the association between total physical activities, physical activity in free time and nutritional status with self-perceived health in adolescents of both genders.

METHODS

This is a quantitative study that integrates the school-based, cross-sectional epidemiological survey with statewide coverage, whose sample consisted of 6261 adolescents (14-19 years old) selected by random conglomerate sampling. Data were collected using the Global School-based Student Health Survey. The chi-squared test (χ²) and the Poisson regression model with robust variance were used in the data analyses.

RESULTS

It was observed that 27.3% of the adolescents had a negative health self-perception, which was higher among girls (33.0% vs. 19.0%, p<0.001). After adjusting for potential confounding factors, it was observed that boys who did not practice physical activity during free time (PR=1.44, 95% CI: 1.15-1.81) and were classified as insufficiently active (PR=1.27, 95% CI: 1.04-1.56), as well as girls who did not practice physical activity during free time (PR=1.15, 95% CI: 1.02-1.29) and were classified as overweight (PR=1.27, 95% CI: 1.01-1.29) had a greater chance of negative health self-perception.

CONCLUSION

Behavioral issues may have different effects on health self-perception when comparing boys with girls. Negative health self-perception was associated with nutritional status in girls and a lower level of physical activity in boys, and the practice of physical activity in the free time was considered a protective factor against a negative health self-perception for adolescents of both genders.

The association between self-rated health and underlying biomarker levels is modified by age, gender, and household income: Evidence from Understanding Society - The UK Household Longitudinal Study

The goal of this study was to evaluate how self-rated health (SRH) and objective measures of health (biomarkers) are associated, and if this association varies by gender, age, and socioeconomic position (measured by household income). Data come from the UK Household Longitudinal Study nurse visit (2010–2012), including a representative sample of adults in Great Britain (N = 15 687 maximum sample). SRH was assessed by the question “In general, would you say your health is excellent, very good, good, fair, or poor?” and dichotomized into good or poor. Indices were created for four biomarker categories based on the aspects of health they are likely to reflect, including visible weigh-related, fitness, fatigue, and disease risk biomarkers. Logistic regression models were run with SRH as the outcome and each biomarker index as a predictor, adjusting by gender, age, and income. Further, interaction terms between each biomarker index and gender, age, and income (independently) were added to test for effect modification. All biomarker indices were associated with SRH in expected directions, with the fitness index most strongly predicting SRH. Gender, age, or income modified the associations between SRH and all biomarker indices to different extents. The association between the visible weight-related biomarker index (including body mass/fat variables) and SRH was stronger for women than men and for those in higher income groups than lower income groups. Income also modified the association between SRH and the fitness biomarker index, whereas age modified the association between SRH and the fatigue biomarker index. When using SRH to investigate health inequalities, researchers and policy makers should be clear that different social groups may systematically consider different dimensions of health when reporting their SRH.

•

The association between self-rated global health and underlying objective health as measured by biomarkers varies by type of biomarker, age, sex and socioeconomic status.

•

Biomarkers that measure different aspects of fitness most strongly predicting self-rated health.

•

The association between the visible biomarkers (including body mass/fat variables) and self-rated health was stronger for women than men and for those in higher income groups than lower income groups.

•

Income also modified the association between self-rated health and biomarkers of disease, with a stronger association for higher income groups.

•

When rating own health individuals from different social groups may systematically consider different dimensions of health.

Serum Oxidative-Antioxidative Status in Patients With Alkaptonuria

Background

Alkaptonuria (AKU) is a rare genetic disease associated with the deposition of melanin-like pigments (ochronosis) in connective tissues. However, data regarding the effect of oxidative stress products on disease pathogenesis are limited. The purpose of this study was to investigate oxidative stress and related factors in patients with alkaptonuria and compare the findings with those in healthy control subjects.

Methods

The study sample comprised of 21 AKU patients and 19 age- and sex-matched healthy controls. Serum samples were obtained to detect the total antioxidative capacity (TAC), and oxidation degradation products of thiobarbituric acid-reactive substances, protein carbonyls, advanced oxidation protein products, and homogentisic acid levels in urine were determined.

Results

Serum TAC, oxidation degradation products of thiobarbituric acid-reactive substances, and protein carbonyl levels in the AKU group were higher than those measured for the control subjects, and the difference was statistically significant (P < 0.05). Moreover, a positive correlation was found between the patient's serum protein carbonyl, patient's age and AKU severity score (r = 0.492 and 0.746, respectively; P < 0.05). Furthermore, the protein carbonyl serum levels can be used to predict the disease severity score in alkaptonuria patients (P < 0.05).

Conclusions

In sum, the study results provide further support for the role of oxidation in the pathogenesis of alkaptonuria, suggesting presence of a more complex relationship than what has been previously assumed. Thus, further studies are needed to clarify these conflicting results.

Is the story about sensitive women and stoical men true? Gender differences in health after adjustment for reporting behavior

Research indicates that women have higher levels of physical disability and depression and lower scores on physical performance tests compared to men, while the evidence for gender differences in self-rated health is equivocal. Scholars note that these patterns may be related to women over-reporting and men under-reporting health problems, but gender differences in reporting behaviors have not been rigorously tested. Using Wave 1 of the Survey of Health, Ageing and Retirement in Europe (SHARE), the present study investigates the extent to which adjusting for differences in reporting behavior modifies gender differences in general health. We also examine whether men and women's reporting behaviors are consistent across different levels of education. After adjusting for reporting heterogeneity, gender differences in both poor and good health widened. However, we found no clear gender-specific patterns in reporting either poor or good health. Our findings also do not provide convincing evidence that education is an important determinant of general health reporting, although the female disadvantage in poor health and the male advantage in good health were more apparent in lower than higher education groups at all ages. The results challenge prevailing stereotypes that women over-report and men under-report health problems and highlight the importance of attending to health problems reported by women and men with equal care.

Dark and sick, light and healthy: black women's complexion-based health disparities

Objective: Although research on skin tone inequalities suggest that darker-skinned Black women should experience worse health outcomes than lighter-skinned women, findings have been mixed. The present study investigates the possibility that the manner that stress and health are measured (i.e. global versus count measures) may explain the conflicting findings. Design: Black American women of different skin tones were investigated in two cross-sectional samples: the National Longitudinal Study of Adolescent to Adult Health (N = 571) and the Detroit Area Study (N = 290). Women's skin tone health disparities were examined using both objective (i.e. directly measured) or count measures (i.e. number of diagnosed chronic health conditions) as well as a global measure of health (i.e. self-rated health - SRH). Additionally, in the Detroit Area Study (DAS), disparities in stress exposure were examined using count and global measures. Results: Skin tone did not predict global measures of health (i.e. SRH) in both samples. In contrast, skin tone predicted objective and count measures of health in both samples, and the disparities between dark- and light-skinned women were starker among higher SES populations. Furthermore, DAS analyses of stress measures indicated that skin tone did not predict a global measure of stress but significantly predicted a count measure of stress (i.e. life events) since dark-skinned women reported worse outcomes. Conclusions: Health disparities research will benefit from accounting for Black women's skin tones as an important social determinant of health. Additionally, use of subjective measurements of health (e.g. SRH) may conceal within-race health disparities across complexions as well as obscure the magnitude of disparities across race.

Prediction of unplanned hospital admissions in older community dwellers using the 6-item Brief Geriatric Assessment: Results from REPERAGE, an observational prospective population-based cohort study

BACKGROUND

The 6-item Brief Geriatric Assessment (BGA) provides a priori risk stratification of incident hospital health adverse events, but it has not been used yet to assess the risk of unplanned hospital admission for older patients in primary care. This study aims to examine the association between the a priori risk stratification levels of the 6-item BGA performed by general practitioners (GPs) and incident unplanned hospital admissions in older community patients.

METHODS

Based on an observational prospective cohort design, 668 participants (mean age 84.7 ± 3.9 years; 64.7% female) were recruited by their GPs during an index primary care visit. The 6-item BGA was completed at baseline and provided an a priori risk stratification in three levels (low, moderate, high). Incident unplanned hospital admissions were recorded during a 6-month follow-up.

RESULTS

The incidence of unplanned hospital admissions increased with the risk level of the 6-item BGA stratification, the highest prevalence (35.3%) being reported with the high-risk level (P = 0.001). The risk of unplanned hospital admission at the high-risk level was significant (crude odds ratio (OR) = 5.48, P = 0.001 and fully adjusted OR = 3.71, P = 0.032, crude hazard ratio (HR) = 4.20; P = 0.002 and fully adjusted HR = 2.81; P = 0.035). The Kaplan-Meier's distributions of incident unplanned hospital admissions differed significantly between the three risk levels (P-value = 0.002). Participants with a high-risk level were more frequently admitted to hospital than those at a low-risk level (P = 0.001). Criteria performances of all risk levels were poor, except the specificity of the high-risk level, which was 98.2%.

CONCLUSIONS

The a priori 6-item BGA risk stratification was significantly associated with incident unplanned hospital admissions in primary care older patients. However, except for the specificity of the high-risk level, its criteria performances were poor, suggesting that this tool is unsuitable for screening older patients in primary care settings at risk of unplanned hospital admission.

Characterizing Alcohol Use Behaviors among Homeless Men and Women

Objectives: In this study, we characterized alcohol use behaviors by sex among sheltered homeless adults and explored associations with health and readiness to change drinking behaviors. Methods: Participants (N = 581; 63.7% men; Mage = 43.6, 29.4% white) self-reported alcohol use and readiness to change drinking behaviors. Sex differences were analyzed via Wilcoxon ranksum, chi-square tests, logistic regression, and ANCOVAs. Results: Overall, 38.5% of the sample met criteria for current at-risk drinking, 39.7% self-reported a history of alcohol problems, and 22.9% reported having a formal alcohol use disorder (AUD) diagnosis. Among current alcohol users, 83.8% reported at-risk drinking. Men had more drinks per drinking day, more drinks per week, and more drinking days per week when compared to women. No sex differences were found for at-risk drinking, self-reported alcohol problems, probable alcohol abuse/dependence, AUD diagnosis, readiness to change drinking, or recent alcohol/substance abuse counseling. Conclusions: High rates of at-risk drinking were found among alcohol users. Homeless men and women did not exhibit differences in several manifestations of problematic alcohol use. Alcohol use interventions might be equally appealing to both sexes given equivalent readiness to change drinking; however, rates of recent treatment receipt were low.

Is the single self-rated health item reliable in India? A construct validity study

Introduction

In high-income countries, the self-rated health (SRH) item is used in health surveys to capture the population’s general health because of its simplicity and satisfactory validity and reliability. Despite scepticism about its use in low-income and middle-income countries, India implemented the SRH item in many of its demographic and population health surveys, but evidence of its validity is lacking. The objective was to assess the construct validity of the SRH item in India.

Methods

Data for 4492 men and 4736 women from the Indian sample of the World Health Survey (2003) were used. Overall, 43 health status indicators were grouped into health dimensions (physical, mental and functional health, chronic diseases, health behaviours) and the SRH item was regressed on these indicators by using sex-stratified multivariable linear regressions, adjusted with demographic and socioeconomic variables.

Results

Respondents (participation rate 95.6%; mean age 38.9 years) rated their health as very good (21.8%), good (36.4%), moderate (26.6%), bad (13.2%) or very bad (2.0%). Among men, the adjusted explained SRH variance by health dimensions ranged between 18% and 41% (physical 33%, mental 32%, functional health 41%, chronic diseases 23%, health behaviours 18%). In multivariable models, the overall explained variance increased to 45%. The 43 health status indicators were associated with SRH and their effect sizes were in the expected direction. Among women, results were similar (overall explained variance 48%).

Conclusion

The SRH item has satisfactory construct validity and may be used to monitor health status in demographic and population health surveys of India.

The case of the middle class: Social determinants of health in Mumbai

In India, a growing middle class and rising lifestyle diseases put prevention in the spotlight. This study assesses the impact of health behaviors (tobacco use and exercise) as well as psychological states (positive emotional style, hope, and perceived stress) on the health of 314 middle class participants from Mumbai. Logistic regression predicting objective health revealed that positive emotional style was a protective factor. Linear regression predicting perceived health indicated perceived stress and positive emotional style as the significant factors. An intersectional approach focusing on psychological factors and health behaviors, nested within class and gender, will lead to effective preventive strategies.

Health-related quality of life after adverse bleeding events associated with antithrombotic drug therapy - A systematic review

Little is known about the health-related quality of life (HRQOL) following adverse bleeding events associated with antithrombotic drug therapy. This systematic review assesses the HRQOL of patients who suffered a bleeding event related to antithrombotic drug use. A literature search was performed using PubMed, EMBASE, and the Cochrane Library from inception through June 16, 2017. Studies measuring HRQOL after a bleeding event related to antithrombotic drug therapy for primary or secondary prevention of a thromboembolic event were included. Four studies with a total of 13,209 patients met the inclusion criteria, and of them, 3,649 patients developed a bleeding event. Patients who were included received antithrombotic drugs because of acute myocardial infarction or atrial fibrillation. EQ-5D, SF-36, and GHP MOS-13 were used to measure HRQOL. The follow-up time ranged from 6 to 29 months. Patients who suffered a bleeding event reported worse HRQOL compared to those who did not (EQ-5D - average increase on all domains of 0.09, p-values ranging from <0.001 to 0.003; SF-36 - average decrease on all domains of 21.4, p < 0.001; and GHP MOS-13 score - decrease of 11.9 points, p < 0.05) and an increased health concern (13.4-point increase; p < 0.05). In conclusion, adverse bleeding events occurring because of the use of antithrombotic agents are associated with a clinically relevant lower HRQOL and hence deserve more attention as part of the shared decision-making process between patients and providers. These data should be valuable for facilitating more substantive care and risk discussions regarding potential changes in outcome and rehabilitation.

Adolescent self-rated health predicts general practice attendance in adulthood: Results from the Young-HUNT1 survey

AIMS

Self-rated health (SRH) is a predictor of future health. However, the association between SRH in adolescence and health problems and health care utilization in adulthood has rarely been investigated. The aim of this study was to examine adolescent SRH as a predictor of general practitioner consultations in adulthood.

METHODS

SRH was registered in the Young-HUNT1 survey in 1995-1997 ( N=8828, mean age 16 years, 88% participation rate). General practitioner consultations during 2006-2014 were obtained from a national claims database. The predictive value of adolescent SRH on general practitioner consultations in adulthood was analysed by regression models estimating the relative risks (RR) for the total number of consultations and consultations for psychological, gastrointestinal, musculoskeletal or respiratory problems. Age, sex and baseline measures of chronic disease and health care attendance were used as the adjusting variables.

RESULTS

SRH was reported as 'very good' by 28.4%, 'good' by 60.6% and 'not good' by 11.0% of the respondents. The increases in consultation rates were 21% (RR 1.21, 95% CI 1.15-1.27) and 52% (RR 1.52, 95% CI 1.40-1.64) when comparing respondents with 'very good' SRH to those with 'good' and 'not good' SRH, respectively. We also demonstrated a dose-response association between adolescent SRH and general practitioner consultations for psychological, gastrointestinal, musculoskeletal or respiratory problems.

CONCLUSIONS

SRH in adolescence is a predictor for general practitioner consultations in adult life. Previous research shows that SRH is influenced by factors such as well-being, health behaviour, functional status and body satisfaction. Intervention studies are needed to evaluate whether population-based and clinical interventions can improve SRH by improving these factors among adolescents.

Is self-rated health in adolescence a predictor of prescribed medication in adulthood? Findings from the Nord Trøndelag Health Study and the Norwegian Prescription Database

Self-rated health (SRH) is a commonly used health indicator predicting morbidity and mortality in a range of populations. However, the relationship between SRH and medication is not well established. The aim of this study was to examine adolescent SRH as a predictor for prescribed medication later in young adulthood. Eighteen years' prospective data from the Nord-Trøndelag Health Study (HUNT) and the Norwegian Prescription Database (NorPD) were analyzed. Baseline data, gathered from 8982 adolescents (mean age 16.0 years) in the Young-HUNT I survey (1995-1997), were linked to individual data from NorPD, including information on all medications prescribed in 2013-2014. Gender-stratified negative binomial regression models were used to investigate the association between SRH and medication, also adjusted for age, baseline self-reported medicine use, physical and mental disability, smoking, and physical activity. Based on the Anatomical Therapeutic Chemical (ATC) Classification System, total consumption and consumption related to various ATC groups were examined. The adjusted analyses showed a dose-response relationship for females, with poorer SRH predicting higher average medication for both total consumption and for the ATC groups "Musculoskeletal system" (M), "Nervous system" (N; Analgesics (N02), Opioids (N02A)) and "Respiratiory system" (R). The predictive power of SRH, as well as the role of the adjustment factors, varies by gender and drug groups. This knowledge is important in order to identify risks for later disease and to capture pathological changes before and beyond the disease diagnosis, potentially preventing morbidity in the adult population.

Self-rated health is associated with subsequent functional decline among older adults in Japan

BACKGROUND

Previous studies have reported that self-rated health (SRH) predicts subsequent mortality. However, less is known about the association between SRH and functional ability. The aim of this study was to examine whether SRH predicts decline in basic activities of daily living (ADL), even after adjustment for depression, among community-dwelling older adults in Japan.

METHODS

A three-year prospective cohort study was conducted among 654 residents aged 65 years and older without disability in performing basic ADL at baseline. SRH was assessed using a visual analogue scale (range; 0-100), and dichotomized into low and high groups. Information on functional ability, sociodemographic factors, depressive symptoms, and medical conditions were obtained using a self-administered questionnaire. Logistic regression analysis was used to examine the association between baseline SRH and functional decline three years later.

RESULTS

One hundred and eight (16.5%) participants reported a decline in basic ADL at the three-year follow-up. Multiple logistic regression analysis showed that the low SRH group had a higher risk for functional decline compared to the high SRH group, even after controlling for potential confounding factors (odds ratio (OR) = 2.4; 95% confidence interval (CI) = 1.3-4.4). Furthermore, a 10-point difference in SRH score was associated with subsequent functional decline (OR = 1.37; 95% CI = 1.16-1.61).

CONCLUSIONS

SRH was an independent predictor of functional decline. SRH could be a simple assessment tool for predicting the loss or maintenance of functional ability in community-dwelling older adults. Positive self-evaluation might be useful to maintain an active lifestyle and stay healthy.

Gender and validity of self-rated health in nineteen European countries

AIMS

The aims of this study were to: (1) examine the concurrent validity of self-rated health for mental and physical health in Europe; and (2) evaluate whether self-rated health predicts health problems differentially by gender.

METHODS

Data are from 19 European countries surveyed in the 2014 European Social Survey. We applied ordinary least squares regression to examine the association between self-rated health and summary indicators of physical and mental health problems.

RESULTS

We observed an association between self-rated health and both physical and mental health problems in all countries. Gender differences in the concurrent validity of self-rated health were documented in eleven out of 19 countries.

CONCLUSIONS

Self-rated health is a valid and efficient measure of physical and mental health across the European continent, with significantly greater concurrent validity among women.