Purpose The PROMIS-29 v2.0 profile assesses pain intensity using a single 0-10 numeric rating item and seven health domains (physical function, fatigue, pain interference, depressive symptoms, ...anxiety, ability to participate in social roles and activities, and sleep disturbance) using four items per domain. This paper describes the development of physical and mental health summary scores for the PROMIS-29 v2.0. Method We conducted factor analyses of PROMIS-29 scales on data collected from two internet panels (n = 3000 and 2000). Results Confirmatory factor analyses provided support for a physical health factor defined by physical function, pain (interference and intensity), and ability to participate in social roles and activities, and a mental health factor defined primarily by emotional distress (anxiety and depressive symptoms). Reliabilities for these two summary scores were 0.98 (physical health) and 0.97 (mental health). Correlations of the PROMIS-29 v2.0 physical and mental health summary scores with chronic conditions and other health-related quality of life measures were consistent with a priori hypotheses. Conclusions This study develops and provides preliminary evidence supporting the reliability and validity of PROMIS-29 v2.0 physical and mental health summary scores that can be used in future studies to assess impacts of health care interventions and track changes in health over time. Further evaluation of these and alternative summary measures is recommended.
The current study examined the links between decent work and three components of physical health (general health, health symptoms, health behaviors) with a sample of 569 employed adults. Data were ...gathered at three time points over a two-month period. Drawing from Psychology of Working Theory (PWT), survival need fulfillment and workplace fatigue (Wave 2) were positioned as mediating variables between decent work (Wave 1) and physical health outcomes (Wave 3). Hypotheses were partially supported. Decent work directly, and indirectly via workplace fatigue, predicted overall physical health; decent work predicted health symptoms indirectly via workplace fatigue; and decent work predicted heath behaviors indirectly via survival need fulfillment. Findings offer a more nuanced picture of how decent work connects to physical health. Specifically, for overall health and health symptoms, workplace fatigue appears to be the main connecting variable. Individuals working in jobs considered decent may be less likely to suffer workplace fatigue, and in turn, more generally healthy with less negative health symptoms. For healthy habits, such as diet and exercise, survival need satisfaction appears more salient. Meeting one's survival needs via work may help an individual have the time, and live in the type of environment, that more allows for access to a healthy lifestyle. Implications for research and practice are discussed.
•Three wave study examining the relation of decent work and physical health with a sample of 569 employed adults.•Decent work directly, and indirectly via workplace fatigue, predicted overall physical health.•Decent work predicted health symptoms indirectly via workplace fatigue.•Decent work predicted heath behaviors indirectly via survival need fulfillment.•For overall health and health symptoms, workplace fatigue appears to be the main connecting variable.
The negative health effects of water pollution remain a major source of morbidity and mortality in China. The Chinese government is making great efforts to strengthen water environment treatment; ...however, no studies have evaluated the effects of water treatment on human health by water pollution in China. This study evaluated the association between water pollution and health outcomes, and determined the extent to which environmental regulations on water pollution may lead to health benefits. Data were extracted from the 2011 and 2013 China Health and Retirement Longitudinal Study (CHARLS). Random effects model and random effects Logit model were applied to study the relationship between health and water pollution, while a Mediator model was used to estimate the effects of environmental water treatment on health outcomes by the intensity of water pollution. Unsurprisingly, water pollution was negatively associated with health outcomes, and the common pollutants in industrial wastewater had differential impacts on health outcomes. The effects were stronger for low-income respondents. Water environment treatment led to improved health outcomes among Chinese people. Reduced water pollution mediated the associations between water environment treatment and health outcomes. The results of this study offer compelling evidence to support treatment of water pollution in China.
•Water pollution was negatively associated with mental and physical health in China.•The common pollutants in industrial wastewater had differential impacts on mental and physical health.•Water pollution more significantly affected mental and physical health among low-income people.•Water environment treatment led to improved health outcomes among Chinese people.
Abstract
Background
Sexual and gender minority (SGM; i.e., non-heterosexual and transgender or gender-expansive, respectively) people experience physical health disparities attributed to greater ...exposure to minority stress (experiences of discrimination or victimization, anticipation of discrimination or victimization, concealment of SGM status, and internalization of stigma) and structural stigma.
Purpose
To examine which components of minority stress and structural stigma have the strongest relationships with physical health among SGM people.
Methods
Participants (5,299 SGM people, 1,902 gender minority individuals) were from The Population Research in Identity and Disparities for Equality (PRIDE) Study. Dominance analyses estimated effect sizes showing how important each component of minority stress and structural stigma was to physical health outcomes.
Results
Among cisgender sexual minority women, transmasculine individuals, American Indian or Alaskan Native SGM individuals, Asian SGM individuals, and White SGM individuals a safe current environment for SGM people had the strongest relationship with physical health. For gender-expansive individuals and Black, African American, or African SGM individuals, the safety of the environment for SGM people in which they were raised had the strongest relationship with physical health. Among transfeminine individuals, victimization experiences had the strongest relationship with physical health. Among Hispanic, Latino, or Spanish individuals, accepting current environments had the strongest relationship with physical health. Among cisgender sexual minority men prejudice/discrimination experiences had the strongest relationship with physical health.
Conclusion
Safe community environments had the strongest relationships with physical health among most groups of SGM people. Increasing safety and buffering the effects of unsafe communities are important for SGM health.
Experiencing more stigma and discrimination was related to worse physical health among LGBTQ+ people. Safe communities had the strongest relationships with physical health among most of the groups of LGBTQ+ people we studied.
This meta-analysis systematically reviewed 242 studies (1805 effect sizes) published between 1998 and 2015 and examined the correlations between racial discrimination, health (physical health, mental ...health, and substance use), and cultural outcomes (acculturation, racial identity, collective self-esteem, ethnic identity, and racial socialization) among racial-ethnic minority Americans. The relationships between several moderators were examined (e.g., gender, race) using subgroup analyses and meta-regression. The meta-analysis was conducted using Fisher’s Z with a robust variance estimation method that accounted for the dependence among correlations in the same study. Findings suggest that the direct overall relationship between racial discrimination, health, and culture was strongest for mental health (
r
= .207), then substance use (
r
= .159), culture (
r
= .101), and physical health (
r
= .067); findings were confirmed by a meta-regression that controlled for several variables. Findings also indicated that convenience samples yielded higher correlations compared to national probability samples, and Asian and Native American racial groups had stronger effects from racial discrimination than did blacks. Race, gender, and measurement characteristics are discussed, as well as research, and educational and clinical implications.
Researchers document bidirectional pathways linking peripheral inflammation and neural circuitries subserving emotion processing and regulation. To extend this work, we present results from two ...independent studies examining the relationship between inflammation and resting-state functional connectivity (rsFC), as measured by functional magnetic resonance imaging.
Study 1 involved 90 rural African American young adults, 25 years of age (52% female), and study 2 involved 82 urban African American youths, 13 to 14 years of age (66% female). Both studies measured circulating inflammatory biomarkers (C-reactive protein, interleukin 6, interleukin 10, tumor necrosis factor alpha), and the measures were averaged to form a composite. Study 2 also enumerated classical monocytes, a key leukocyte subpopulation involved in immune-to-brain signaling. All participants completed a resting-state functional magnetic resonance imaging scan.
Consistent with our prediction, higher scores on the inflammatory composite were associated with lower rsFC within an emotion regulation network in study 1, controlling for sex. Study 2 replicated study 1, showing that higher scores on the inflammatory composite were associated with lower rsFC within the emotion regulation network, controlling for sex, age, and pubertal status, and found a similar pattern for rsFC within a central executive network. Study 2 also found that higher numbers of classical monocytes were associated with lower rsFC within both the emotion regulation and central executive networks. There was no relationship between rsFC in the anterior salience or default mode networks with inflammation in either study.
With these findings, we document relationships between peripheral inflammation and rsFC within an emotion regulation and central executive network and replicate these associations with the emotion regulation network across two independent samples.
People with schizophrenia die 15‐20 years prematurely. Understanding mortality risk and aggravating/attenuating factors is essential to reduce this gap. We conducted a systematic review and ...random‐effects meta‐analysis of prospective and retrospective, nationwide and targeted cohort studies assessing mortality risk in people with schizophrenia versus the general population or groups matched for physical comorbidities or groups with different psychiatric disorders, also assessing moderators. Primary outcome was all‐cause mortality risk ratio (RR); key secondary outcomes were mortality due to suicide and natural causes. Other secondary outcomes included any other specific‐cause mortality. Publication bias, subgroup and meta‐regression analyses, and quality assessment (Newcastle‐Ottawa Scale) were conducted. Across 135 studies spanning from 1957 to 2021 (schizophrenia: N=4,536,447; general population controls: N=1,115,600,059; other psychiatric illness controls: N=3,827,955), all‐cause mortality was increased in people with schizophrenia versus any non‐schizophrenia control group (RR=2.52, 95% CI: 2.38‐2.68, n=79), with the largest risk in first‐episode (RR=7.43, 95% CI: 4.02‐13.75, n=2) and incident (i.e., earlier‐phase) schizophrenia (RR=3.52, 95% CI: 3.09‐4.00, n=7) versus the general population. Specific‐cause mortality was highest for suicide or injury‐poisoning or undetermined non‐natural cause (RR=9.76‐8.42), followed by pneumonia among natural causes (RR=7.00, 95% CI: 6.79‐7.23), decreasing through infectious or endocrine or respiratory or urogenital or diabetes causes (RR=3 to 4), to alcohol or gastrointestinal or renal or nervous system or cardio‐cerebrovascular or all natural causes (RR=2 to 3), and liver or cerebrovascular, or breast or colon or pancreas or any cancer causes (RR=1.33 to 1.96). All‐cause mortality increased slightly but significantly with median study year (beta=0.0009, 95% CI: 0.001‐0.02, p=0.02). Individuals with schizophrenia <40 years of age had increased all‐cause and suicide‐related mortality compared to those ≥40 years old, and a higher percentage of females increased suicide‐related mortality risk in incident schizophrenia samples. All‐cause mortality was higher in incident than prevalent schizophrenia (RR=3.52 vs. 2.86, p=0.009). Comorbid substance use disorder increased all‐cause mortality (RR=1.62, 95% CI: 1.47‐1.80, n=3). Antipsychotics were protective against all‐cause mortality versus no antipsychotic use (RR=0.71, 95% CI: 0.59‐0.84, n=11), with largest effects for second‐generation long‐acting injectable antipsychotics (SGA‐LAIs) (RR=0.39, 95% CI: 0.27‐0.56, n=3), clozapine (RR=0.43, 95% CI: 0.34‐0.55, n=3), any LAI (RR=0.47, 95% CI: 0.39‐0.58, n=2), and any SGA (RR=0.53, 95% CI: 0.44‐0.63, n=4). Antipsychotics were also protective against natural cause‐related mortality, yet first‐generation antipsychotics (FGAs) were associated with increased mortality due to suicide and natural cause in incident schizophrenia. Higher study quality and number of variables used to adjust the analyses moderated larger natural‐cause mortality risk, and more recent study year moderated larger protective effects of antipsychotics. These results indicate that the excess mortality in schizophrenia is associated with several modifiable factors. Targeting comorbid substance abuse, long‐term maintenance antipsychotic treatment and appropriate/earlier use of SGA‐LAIs and clozapine could reduce this mortality gap.
Attacking the problem of extreme poverty
A persistent concern about wellintentioned efforts to improve living standards for the 1.2 billion people who survive (if it can be called that) on less than ...$1.25 US per day is figuring out what works. A second concern is figuring out whether what works in one setting can be made to work in another. Banerjee
et al.
describe encouraging results from a set of pilot projects in Ethiopia, Ghana, Honduras, India, Pakistan, and Peru encompassing 11,000 households. Each project provided short-term aid and longer-term support to help participants graduate to a sustainable level of existence.
Science
, this issue
10.1126/science.1260799
Helping people in Ethiopia, Ghana, Honduras, India, Pakistan, and Peru to become self-employed enables the very poor to become less poor.
INTRODUCTION
Working in six countries with an international consortium, we investigate whether a multifaceted Graduation program can help the extreme poor establish sustainable self-employment activities and generate lasting improvements in their well-being. The program targets the poorest members in a village and provides a productive asset grant, training and support, life skills coaching, temporary cash consumption support, and typically access to savings accounts and health information or services. In each country, the program was adjusted to suit different contexts and cultures, while staying true to the same overall principles. This multipronged approach is relatively expensive, but the theory of change is that the combination of these activities is necessary and sufficient to obtain a persistent impact. We do not test whether each of the program dimensions is individually necessary. Instead, we examine the “sufficiency” claim: A year after the conclusion of the program, and 3 years after the asset transfer, are program participants earning more income and achieving stable improvements in their well-being?
RATIONALE
We conducted six randomized trials in Ethiopia, Ghana, Honduras, India, Pakistan, and Peru with a total of 10,495 participants. In each site, our implementing partners selected eligible villages based on being in geographies associated with extreme poverty, and then identified the poorest of the poor in these villages through a participatory wealth-ranking process. About half the eligible participants were assigned to treatment, and half to control. In three of the sites, to measure within village spillovers, we also randomized half of villages to treatment and half to control. We conducted a baseline survey on all eligible participants, as well as an endline at the end of the intervention (typically 24 months after the start of the intervention) and a second endline 1 year after the first endline. We measure impacts on consumption, food security, productive and household assets, financial inclusion, time use, income and revenues, physical health, mental health, political involvement, and women’s empowerment.
RESULTS
At the end of the intervention, we found statistically significant impacts on all 10 key outcomes or indices. One year after the end of the intervention, 36 months after the productive asset transfer, 8 out of 10 indices still showed statistically significant gains, and there was very little or no decline in the impact of the program on the key variables (consumption, household assets, and food security). Income and revenues were significantly higher in the treatment group in every country. Household consumption was significantly higher in every country except one (Honduras). In most countries, the (discounted) extra earnings exceeded the program cost.
CONCLUSION
The Graduation program’s primary goal, to substantially increase consumption of the very poor, is achieved by the conclusion of the program and maintained 1 year later. The estimated benefits are higher than the costs in five out of six sites. Although more can be learned about how to optimize the design and implementation of the program, we establish that a multifaceted approach to increasing income and well-being for the ultrapoor is sustainable and cost-effective.
We present results from six randomized control trials of an integrated approach to improve livelihoods among the very poor. The approach combines the transfer of a productive asset with consumption support, training, and coaching plus savings encouragement and health education and/or services. Results from the implementation of the same basic program, adapted to a wide variety of geographic and institutional contexts and with multiple implementing partners, show statistically significant cost-effective impacts on consumption (fueled mostly by increases in self-employment income) and psychosocial status of the targeted households. The impact on the poor households lasted at least a year after all implementation ended. It is possible to make sustainable improvements in the economic status of the poor with a relatively short-term intervention.
Background and purpose: Seborrheic dermatitis (SD) is a chronic skin condition that is accompanied by scaling and itching. Stress and mental rumination followed by the disease affect the quality of ...life. The aim of this study was to investigate the effect of seborrheic dermatitis on the quality of life and to compare it with the quality of life of healthy people. Materials and methods: This study was a cross-sectional study. The study sample included 60 randomly selected patients with seborrheic dermatitis who referred to Bouali and Tooba dermatology clinics in Sari during 2019-2020. Two questionnaires (DLQI and SF-36) were used to assess general quality of life in patients. Results: The relationship between the disease and occupation was statistically significant. There was a significant relationship between smoking and seborrheic dermatitis. We also found a significant relationship between the frequency of recurrences and quality of life. The mean of physical and social function in the healthy group was higher than its value for the patient group, but the difference was not significant. Conclusion: Our study showed that age, education, occupation, and smoking are factors that contribute to seborrheic dermatitis. Moreover, the findings revealed that physical and mental health as well as quality of life were less affected in the married group compared to the single group.
Stress is often invoked as a potential contributor to disparities in physical health as a function of social status. Although there is good reason to believe that stress exposure and stress responses ...may be an important pathway linking lower social status to poor health, direct evidence is lacking. We summarize the evidence for this pathway and limitations of that evidence, focusing particularly on how stress is conceptualized and measured. We argue that in addition to more direct tests of mediation, the measurement of the mediator—stress—could also be improved. We also propose that measuring theory-specific stress exposures may be more fruitful than assessing general stress exposures (e.g., life events, global perceived stress) by increasing theoretical clarity and predictive utility of stress in this context.
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