The association of self-rated health with mortality is well established but poorly understood. This paper provides new insights into self-rated health that help integrate information from different ...disciplines, both social and biological, into one unified conceptual framework. It proposes, first, a model describing the health assessment process to show how self-rated health can reflect the states of the human body and mind. Here, an analytic distinction is made between the different types of information on which people base their health assessments and the contextual frameworks in which this information is evaluated and summarized. The model helps us understand why self-ratings of health may be modified by age or culture, but still be a valid measure of health status. Second, based on the proposed model, the paper examines the association of self-rated health with mortality. The key question is, what do people know and how do they know what they know that makes self-rated health such an inclusive and universal predictor of the most absolute biological event, death. The focus is on the social and biological pathways that mediate information from the human organism to individual consciousness, thus incorporating that information into self-ratings of health. A unique source of information is provided by the bodily sensations that are directly available only to the individual him- or herself. According to recent findings in human biology, these sensations may reflect important physiological dysregulations, such as inflammatory processes. Third, the paper discusses the advantages and limitations of self-rated health as a measure of health in research and clinical practice. Future research should investigate both the logics that govern people's reasoning about their health and the physiological processes that underlie bodily feelings and sensations. Self-rated health lies at the cross-roads of culture and biology, therefore a collaborative effort between different disciplines can only improve our understanding of this key measure of health status.
Background
The broad concept of health as “the ability to adapt and self‐manage in the face of social, physical and emotional challenges” has been operationalized by “Positive Health,” a framework ...increasingly used in the Netherlands. We explored to what degree the impact of the COVID‐19 pandemic and preventive measures on Positive Health differed between community‐dwelling older adults without, with mild and with complex health problems, as well as differences flowing from their use of preventive measures.
Methods
During the second wave in the Netherlands (November 2020–February 2021), a convenience sample of adults aged ≥65 years completed an online questionnaire. Positive Health impact was measured based on self‐reported change of current health status, across six dimensions, compared to before the pandemic (decreased/unchanged/increased). The complexity of health problems (past month) was assessed using the validated ISCOPE tool, comparing subgroups without, with mild or with complex health problems. High use of preventive measures was defined as ≥9 of 13 measures and compared to low use (<9 measures).
Results
Of the 2397 participants (median age 71 years, 60% female, and 4% previous COVID‐19 infection), 31% experienced no health problems, 55% mild health problems, and 15% complex health problems. Overall, participants reported a median decrease in one Positive Health dimension (IQR 1–3), most commonly in social participation (68%). With an increasing complexity of health problems, subjective Positive Health declined more often across all six dimensions, ranging from 3.3% to 57% in those without, from 22% to 72% in those with mild, and from 47% to 75% in those with complex health problems (p‐values for trend <0.001; independent of age and sex). High users of preventive measures more often experienced declined social participation (72% vs. 62%, p < 0.001) and a declined quality of life (36% vs. 30%, p = 0.007) than low users, especially those with complex health problems.
Conclusion
As the complexity of health problems increased, the adverse impact of the COVID‐19 pandemic and related preventive measures was experienced more frequently across all dimensions of Positive Health. Acknowledging this heterogeneity is pivotal to the effective targeting of prevention and healthcare to those most in need.
Self-rated health is widely considered a good indicator of morbidity and mortality but its validity for health equity analysis and public health policies in Italy is often disregarded by ...policy-makers. This study had three objectives. O1: To explore response distribution across dimensions of age, chronic health conditions, functional limitations and SRH in Italy. O2: To explore associations between SRH and healthcare demand in Italy. O3: To explore the association between SRH and household income.
Cross-sectional data were obtained from the 2015 Health Interview Survey (HIS) conducted in Italy. Italian respondents (n = 20,814) were included in logistic regression analyses. O1: associations of chronic health conditions (CHC), functional limitations (FL), and age with self-rated health (SRH) were tested. O2: associations of CHC, FL, and SRH with hospitalisation (H), medical specialist consultations (MSC), and medicine use (MU) were tested. O3: associations of SRH and CHC with household income (PEI) were tested.
O1: CHC, FL, and age had an independent summative effect on respondents' SRH. O2: SRH predicted H and MSC more than CHC; age and MU were more strongly correlated than SRH and MU. O3: SRH and PEI were significantly correlated, while we found no correlation between CHC and PEI.
Drawing from our results and the relevant literature, we suggest that policy-makers in Italy could use SRH measures to: 1) predict healthcare demand for effective allocation of resources; 2) assess subjective effectiveness of treatments; and 3) understand geosocial pockets of health inequity that require special attention.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
OBJECTIVES
To explore how different frameworks and categories of chronic conditions impact multimorbidity (defined as two or more chronic conditions) prevalence estimates and associations with ...patient‐important functional outcomes.
DESIGN
Baseline data from a population‐based cohort study.
SETTING
National sample of Canadians.
PARTICIPANTS
A total of 51 338 community‐living adults, aged 45 to 85 years.
MAIN OUTCOME MEASURES
Chronic conditions from three commonly recognized frameworks were categorized as: (1) diseases, (2) risk factors, or (3) symptoms. Estimates of multimorbidity prevalence were compared among frameworks by age and sex. Separate weighted logistic regression models were used to explore the impact of the different frameworks and categories of chronic conditions on odds ratios (ORs) for multimorbidity for four patient‐important functional outcomes: disability, social participation restriction, and self‐rated physical and mental health.
RESULTS
One framework included diseases and risk factors, and two frameworks included diseases, risk factors, and symptoms. The prevalence of multimorbidity differed among the frameworks, ranging from 33.5% to 60.6% having two or more chronic conditions. Including risk factors in frameworks increased prevalence estimates, while including symptoms increased prevalence estimates and associations with most patient‐important outcomes. The two frameworks that included symptoms had the largest ORs for associations with disability, social participation restriction, and self‐rated physical health but not self‐rated mental health. Similar results were found when we compared ORs for patient‐important outcome for multimorbidity based on three subframeworks: one including diseases only, one including diseases and risk factors, and one including diseases, risk factors, and symptoms.
CONCLUSIONS
Including risk factors appeared to increase only the prevalence of multimorbidity without significantly altering relationships to outcomes. The inclusion of symptoms increased prevalence and associations with patient‐important outcomes. These findings underscore the importance of considering not only the number, but also the category, of conditions included in multimorbidity frameworks, as simply counting the number of diagnoses may reduce sensitivity to outcomes that are important to individuals. J Am Geriatr Soc 67:1632–1640, 2019
Background
The population health impact of loneliness remains unknown. We quantified the impact of loneliness on total life expectancy (TLE) and health expectancy (the duration of remaining life ...lived in different health states) among older adults, aged ≥60 years.
Design
Multistate life table analysis of a nationally representative longitudinal survey.
Setting
Singapore.
Participants
Survey participants (n = 3449) interviewed in 2009, 2011–12, and 2015.
Measurements
Health states were defined using self‐rated health (SRH) status and activity of daily living (ADL)/instrumental ADL (IADL) status. Participants with somewhat or very unhealthy SRH were considered as unhealthy. Those reporting health‐related difficulty with any ADL/IADL were considered to have limitation in ADLs/IADLs. TLE and health expectancy (healthy and unhealthy life expectancy (HLE and UHLE) in the context of SRH, and active and inactive life expectancy (ALE and IALE) in the context of ADLs/IADLs) were estimated using the multistate life table method with a microsimulation approach, considering loneliness as time varying.
Results
At age 60, 70, and 80, those sometimes lonely or mostly lonely generally had shorter TLE, HLE and ALE, similar UHLE and IALE, and a higher proportion of remaining life with unhealthy SRH or with ADL/IADL limitations versus those never lonely. For example, at the age of 60, those sometimes lonely versus never lonely had shorter TLE (by 5.4 95% Confidence Interval: 3.4–7.9 years), shorter HLE (by 5.9 4.1–8.6 years), similar UHLE (difference: 0.6 −0.7–1.7 years), and higher proportion of remaining life with unhealthy SRH (by 6.2 1.2–10.8 percentage points). For those mostly lonely versus never lonely, TLE was shorter by 3.6 (0.7–6.6) years, HLE was shorter by 4.8 (2.3–8.2) years, UHLE was similar (difference: 1.2 −0.1–4.0 years), and proportion of remaining life with unhealthy SRH was higher by 7.2 (2.1–18.1) percentage points.
Conclusion
Identification and management of loneliness may increase years of life with healthy SRH and without limitation in ADLs/IADLs among older adults.
•The study surveyed participants during and after the first COVID-19 peak in the UK.•Perceived access to public and private green space are linked to better health and wellbeing.•Private gardens can ...compensate for a lack of perceived access to public green spaces.•Public green spaces are more protective for those without a private garden.•Public and private green space are an essential health resource in times of crisis.
Research has consistently shown that access to parks and gardens is beneficial to people’s health and wellbeing. In this paper, we explore the role of both public and private green space in subjective health and wellbeing during and after the first peak of the COVID-19 outbreak that took place in the UK in the first half of 2020. It makes use of the longitudinal COVID-19 Public Experiences (COPE) study, with baseline data collected in March/April 2020 (during the first peak) and follow-up data collected in June/July 2020 (after the first peak) which included an optional module that asked respondents about their home and neighbourhood (n = 5,566). Regression analyses revealed that both perceived access to public green space (e.g. a park or woodland) and reported access to a private green space (a private garden) were associated with better subjective wellbeing and self-rated health. In line with the health compensation hypothesis for green space, private gardens had a greater protective effect where the nearest green space was perceived to be more than a 10-minute walk away. This interaction was however only present during the first COVID-19 peak when severe lockdown restrictions came into place, but not in the post-peak period when restrictions were being eased. The study found few differences across demographic groups. A private garden was relatively more beneficial for men than for women during but not after the first peak. The results suggest that both public and private green space are an important resource for health and wellbeing in times of crisis.
In this paper, we briefly review theories and findings on migration and health from the health equity perspective, and then analyse migration-related health inequalities taking into account gender, ...social class and migration characteristics in the adult population aged 25–64 living in Catalonia, Spain. On the basis of the characterisation of migration types derived from the review, we distinguished between immigrants from other regions of Spain and those from other countries, and within each group, those from richer or poorer areas; foreign immigrants from low-income countries were also distinguished according to duration of residence. Further stratification by sex and social class was applied. Groups were compared in relation to self-assessed health in two cross-sectional population-based surveys, and in relation to indicators of socio-economic conditions (individual income, an index of material and financial assets, and an index of employment precariousness) in one survey. Social class and gender inequalities were evident in both health and socio-economic conditions, and within both the native and immigrant subgroups. Migration-related health inequalities affected both internal and international immigrants, but were mainly limited to those from poor areas, were generally consistent with their socio-economic deprivation, and apparently more pronounced in manual social classes and especially for women. Foreign immigrants from poor countries had the poorest socio-economic situation but relatively better health (especially men with shorter length of residence). Our findings on immigrants from Spain highlight the transitory nature of the ‘healthy immigrant effect’, and that action on inequality in socio-economic determinants affecting migrant groups should not be deferred.
Aim
Investigate potential long‐term cohort influences on health‐related quality of life (HRQoL) in adults born extremely preterm (EP) during the 1980–90s, in view of advancements in neonatal care ...within that timeframe.
Methods
Two cohorts of EP‐born adults (82–85 cohort and 91–92 cohort) enrolling matched term controls, were compared. Participants were assessed at 18 years and again in their mid‐twenties using the Child Health Questionnaire Children Form‐87 (CHQ‐CF87) and the Short Form Health Survey (SF‐36).
Results
At 18 years, 77 (90%) EP‐born and 75 (93%) term controls had data, followed by 67 (78%) EP‐born and 66 (82%) term controls in their mid‐twenties. At 18 years, there were no differences across the birth decades, and EP‐born and term‐born reported relatively similar HRQoL scores. In the mid‐twenties, birth decade did also not significantly impact HRQoL scores, although the EP‐born 82–85 cohort scored numerically poorer than the 91–92 cohort in three domains. Term controls scored similarly across birth decade in all domains. Regarding influence from neonatal factors, postnatal corticosteroids had a negative impact in some domains.
Conclusion
No significant differences in HRQoL were observed between EP‐born adults from the 82–85 cohort versus the 91–92 cohort, although the EP‐born 82–85 cohort tended to score poorer in their mid‐twenties.
Zung's Self-rating Anxiety Scale (SAS) is a norm-referenced scale which enjoys widespread use a screener for anxiety disorders. However, recent research (Dunstan DA and Scott N, Depress Res Treat ...2018:9250972, 2018) has questioned whether the existing cut-off for identifying the presence of a disorder might be lower than ideal.
The current study explored this issue by examining sensitivity and specificity figures against diagnoses made on the basis of the Patient Health Questionnaire (PHQ) in clinical and community samples. The community sample consisted of 210 participants recruited to be representative of the Australian adult population. The clinical sample consisted of a further 141 adults receiving treatment from a mental health professional for some form of anxiety disorder.
Mathematical formulas, including Youden's Index and the Receiver Operating Characteristics Curve, applied to positive PHQ diagnoses (presence of a disorder) from the clinical sample and negative PHQ diagnoses (absence of a disorder) from the community sample suggested that the ideal cut-off point lies between the current and original points recommended by Zung.
Consideration of prevalence rates and of the potential costs of false negative and false positive diagnoses, suggests that, while the current cut-off of 36 might be appropriate in the context of clinical screening, the original raw score cut-off of 40 would be most appropriate when the SAS is used in research.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Previous studies have demonstrated cross‐cultural differences in the levels of self‐rated health (SRH), an individual's overall perception of their health, and that Korea and Japan tend to show ...relatively poor SRH despite higher life expectancy compared to countries like the United States. While it has been suggested that response styles and macro‐level cultural values contribute to such differences, there is limited research on what other factors might be. The present study focused on influence and adjustment strategies as a potential cultural factor that could partly explain the cultural differences in SRH. Results from structural equation modeling have shown that Americans reported greater influence and positive reappraisal, plus a lower adjustment of goals than Japanese individuals, which partially explained the higher SRH among Americans than in the Japanese. These patterns were found even when a more objective measure of health (i.e., chronic conditions) was controlled for. Together, the findings highlight the role of influence and adjustment in understanding cultural differences in SRH.
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