Crafting policies aimed at mitigating disparities is difficult. Instituting them is complex. At every point in the process, politics can derail the plan. Reports assessing policy are often framed as ...health services research, discounting its real value as a tool. It is possible that a policy can be well crafted, initiated, and not derailed. Health services research is the way to measure disparity reduction. "The Role of the Family Health Strategy in Reducing Social Inequalities in Mortality Risk Among Older Adults in Bagé, Southern Brazil" by Kessler et al. (p. 927) is well worth a read. This article is timely because universal design is an important response to the global pandemic.1 This design hits all the marks with an added bonus: it meets the standards for the conduct of ethical research.Figure 1 succinctly illustrates the gap between output from the research community and the needs of practitioners addressing health disparities in their clinical panels.2 Family health strategy (FHS) is a Brazilian policy. It was crafted to restructure the primary health care system. That is no small undertaking. Strengthening primary care to achieve health for all was the main strategy. The sources of data shown in Figure 1-clinical trials, observational studies, qualitative interviews, expert opinion panels, case studies, and regulatory guidance-are all necessary for delivering care that diminishes health disparities. However, they are not sufficient.
Introduction
Understanding the factors that affected academic performance of students during the COVID-19 pandemic will help design effective interventions for improving students’ academic ...performance during emergency situations as well as during regular academic environment. This cross-sectional study aimed to identify the factors that explain academic performance of students in China during the pandemic.
Methods
Data on college students from the 2020 China Family Panel Studies were used, and the final sample consisted of 728 students. Ordered probit regression models were estimated to explain students’ relative performance in the semester when the in-person classes were suspended by using various student and household-related variables and characteristics. To compute missing values in selected variables, a multiple imputation technique was applied.
Results
The odds of poor academic performance declined with higher Internet use for academic purposes, but Internet use for entertainment increased the probability of being in the poor academic performance. College students who spent more time studying on college work were less likely to have poor academic performance.
Discussion
This study identified the factors (Internet use and study time) associated with academic performance among Chinese college students during the COVID-19 pandemic. These results can be used to design policies to improve educational outcomes and to address educational inequalities.
The Behavioral Risk Factor Surveillance System (BRFSS) is an annual survey designed to identify trends in the public's health. In its 2019 field survey, the U.S. state of GA tested a new 3 - item ...module to measure the numbers of bereaved, resident adults aged 18 years and older. Participants were eligible if they answered 'Yes' to the item 'Have you experienced the death of a family member or close friend in the years 2018 or 2019?'. This analysis explores two research questions. Can estimates for bereavement prevalence be derived without large sampling errors, low precision, and small subsamples? Can multiple imputation techniques be applied to overcome non-response and missing data to support multivariate modeling?
BRFSS is a non-institutionalized sample of adults aged 18 years and older living in the U.S. state of Georgia. Analyses in this study were conducted under two scenarios. Scenario 1 applies the complex sample weights created by the Centers for Disease Control and imputes values for missing responses. Scenario 2 treats the data as a panel - no weighting combined with removal of persons with missing data. Scenario 1 reflects the use of BRFSS data for public health and policy, while Scenario 2 reflects data as it is commonly used in social science research studies.
The bereavement screening item has a response rate (RR) of 69.1% (5206 of 7534 persons). Demographic subgroups and categories of health have RR of 55% or more. Under Scenario 1, the estimated prevalence of bereavement is 45.38%, meaning that 3,739,120 adults reported bereaved in 2018 or 2019. The estimated prevalence is 46.02% with Scenario 2 which removes persons with any missing data (4,289 persons). Scenario 2 overestimates the bereavement prevalence by 1.39%. An illustrative logistic model is presented to show the performance of exposure to bereavement under the two data scenarios.
Recent bereavement can be ascertained in a surveillance survey accounting for biases in response. Estimating bereavement prevalence is needed for measuring population health. This survey is limited to one US state in a single year and excludes persons aged 17 years and younger.
Objective To test the hypothesis that higher levels of resilience indicators are associated with lower overall healthcare utilization (HCU) as well as improvements in self-rated health (SRH), we ...analyzed a representative sample of 4562 adults 50—70 years old enrolled in the US 2010 health and retirement survey. Methods Multivariable logistic regression models estimated odds ratios (ORs) and 95 % confidence intervals (CIs) for high versus low resilience in relation to HCU and SRH improvements over 2 years. Resilience indicators included: cumulative lifetime adversity, social support, global mastery and domain-specific mastery. Cumulative lifetime adversity was defined as 0, 1—2, 3—4 or 5+ events. HCU included hospitalization (any vs. none) and physician visits (<20 vs. ≥20) over 2 years. Findings Hospitalization odds declined by 25 % (OR 0.75, 95 % CI 0.64—0.86), odds of ≥20 physician visits declined by 47 % (OR 0.53, 95 % CI 0.45—0.63) and the odds of SRH improvement increased by 49% (OR 1.49, 95% CI 1.17—1.88) for respondents with high versus low health mastery. Cumulative lifetime adversity manifested a dose-dependent positive relationship with HCU. Specifically, hospitalization odds was, respectively, 25, 80 and 142 % elevated for participants that reported 1—2, 3—4 and 5+ versus 0 lifetime adversities. High versus low global, financial and health mastery, respectively, predicted improved SRH, lower physician's visits and hospitalizations. Conclusion In this sample of adults near or in retirement, resilience predicted lower HCU and improved SRH. Resilience is a dynamic state that can be enhanced in adults with positive impacts on subjective well-being and HCU.
Binge drinking is a pattern of alcohol abuse. Its prevalence and associated risk factors are not well documented. Heavy drinking, on the other hand, has a well-documented association with ...bereavement. This report uses a cross-sectional, population-based survey to estimate prevalence of bingeing and its association with new bereavement. Bingeing is defined as 4 or more drinks (women) or 5 or more drinks (men) in a 2-4-h setting. For the first time in 2019, the Georgia Behavioral Risk Factor Surveillance Survey (BRFSS) included a bereavement item: 'Have you experienced the death of a family member or close friend in the years 2018 or 2019?'
Georgia BRFSS is a complex sampling survey administered annually. It is designed to represent the 8.1 million people aged 18 years and older in the U.S. state of Georgia. Alcohol consumption patterns are routinely measured in the common core. In 2019, the state added a new item probing for bereavement in the prior 24 months predating the COVID-19 pandemic. Imputation and weighting techniques were applied to yield the population prevalence rates of new bereavement, bingeing, and their co-occurrence with other high-risk health behaviors and outcomes. Multivariate models, adjusted for age, gender, and race, were used to estimate the risk for other unhealthy behaviors posed by the co-occurrence of bereavement and bingeing.
In Georgia, bereavement (45.8%), and alcohol consumption (48.8%) are common. Bereavement and alcohol use co-occurred among 1,796,817 people (45% of all drinkers) with a subset of 608,282 persons reporting bereavement combined with bingeing. The most common types of bereavement were death of a friend/neighbor (30.7%) or three plus deaths (31.8%).
While bingeing is a known risk to public health, its co-occurrence with recent bereavement is a new observation. Public health surveillance systems need to monitor this co-occurrence to protect both individual and societal health. In a time of global bereavement, documenting its influence on binge drinking can support the work towards Sustainable Development Goal #3-Good health and Well-Being.
Abstract
Objectives
We evaluated the association between cumulative stressful life events (SLE) and type of stress (lifetime vs recent) and incident diabetes (Type 2 diabetes mellitus T2DM) in ...middle-aged U.S. adults.
Methods
Data from the 2006–2014 waves of the Health and Retirement Study (HRS) were analyzed (n = 7,956). Stress-related differences in age at T2DM diagnosis were estimated using Cox proportional hazards models.
Results
The adjusted risk of T2DM significantly increased by 6% per unit increase in cumulative SLE (95% confidence interval CI = 1.03, 1.11), by 5% per unit increase in lifetime stress (95% CI = 1.00, 1.09), and by 23% per unit increase in recent stress (95% CI = 1.12, 1.36). Each level of cumulative SLE (1, 2, 3, and ≥4 events) and recent stress (1 and ≥2 events) compared to no stress was significantly associated with an increased risk of T2DM. Each level of lifetime stress compared to no stress was significantly associated with an elevated risk of T2DM except for 3 events.
Discussion
Cumulative SLE and type of stress were associated with incident T2DM in middle-aged adults. Reducing the direct effect of stress with management interventions may reduce the indirect effect of developing T2DM and warrants further investigation.
OBJECTIVES: To determine whether lower lean mass and higher fat mass have independent effects on the loss of strength and muscle quality in older adults and might explain part of the effect of age.
...DESIGN: Single‐episode, cross‐sectional analyses of a cohort of subjects in the Health, Aging and Body Composition (Health ABC) Study.
SETTING: Ambulatory clinic and research laboratory.
PARTICIPANTS: Two thousand six hundred twenty‐three men and women aged 70 to 79 from the Health ABC Study.
MEASUREMENTS: Upper and lower extremity strength was measured using isokinetic (knee extension) and isometric (grip strength) dynamometers. Body composition (lean mass and fat mass) was determined by measuring lean mass of upper and lower extremities and the total body by dual‐energy x‐ray absorptiometry. Muscle quality was ascertained by taking the ratio of strength to muscle mass for both upper and lower extremities.
RESULTS: Upper and lower extremity strength and muscle quality decreased as age increased. Most of the explained variance in strength was due to differences in muscle mass, but, in those at the extremes of body fat and lower leg muscle quality, the association with body fat was independent of the effect of age. Although blacks had greater muscle strength and mass than whites, leg muscle quality tended to be lower in blacks than in whites. Upper extremity strength adjusted for lean mass and muscle quality were also associated inversely and independently with age, body fat, and black race.
CONCLUSION: In this older cohort, lower strength with older age was predominantly due to a lower muscle mass. Age and body fat also had significant inverse associations with strength and muscle quality. Both preservation of lean mass and prevention of gain in fat may be important in maintaining strength and muscle quality in old age.
Background Despite research efforts, the causative factors that contribute to esophageal squamous cell carcinoma (ESCC) in high-risk areas have not yet been understood. In this study, we, therefore, ...aimed to describe the risk factors associated with ESCC and its precursor lesions. Methods We performed an endoscopic examination of 44,857 individuals aged 40-69 years from five high incidence regions of China in 2017-2018. Participants were classified as 4 groups of normal control, esophagitis, low-grade intraepithelial neoplasia (LGIN) and high-grade intraepithelial neoplasia/esophageal squamous cell carcinoma (HGIN/ESCC) using an unconditional logistic regression determine risk factors. Results We identified 4890 esophagitis, 1874 LGIN and 437 HGIN/ESCC cases. Crude odds ratios (ORs) and adjusted odds ratios were calculated using unconditional logistic regression. Drinking well and surface water, salty diet, and positive family history of cancer were the common risk factors for esophagitis, LGIN and HGIN/ESCC. History of chronic hepatitis/cirrhosis was the greatest risk factor of esophagitis (adjusted OR 2.96, 95%CI 2.52-3.47) and HGIN/ESCC (adjusted OR 1.91, 95%CI 1.03-3.22). Pesticide exposure (adjusted OR 1.20, 95%CI 1.05-1.37) was essential risk factor of LGIN. Conclusions Among individuals aged 40-69 years in high incidence regions of upper gastrointestinal cancer, the results provided important epidemiological evidence for the prevention of different precancerous lesions of ESCC. Keywords: Esophageal squamous cell carcinoma, Precancerous lesions, Cross-sectional study, Risk factor, Prevention
Older adults are remaining sexually active for longer periods of time, underscoring the need to assess sexual activity patterns in this group and identify differences by race/ethnicity, some of which ...may have implications for the development and implementation of sexual risk reduction interventions.
Using data from the 2010 National Social Life, Health, and Aging Project, this study examined responses from 1,429 adults aged 60 years and older. Multinomial logistic regression compared sexual behaviors, health-related indicators, interactions with healthcare professionals, and HIV-related perceptions across participants' race/ethnicity.
Approximately 81% of participants self-reported as non-Hispanic white, 10.59% as African American, and 8.05% as Hispanic. On average, participants were 69.9 years of age. In the previous year, 49.3% of participants engaged in sexual intercourse; only 3% used condoms. The majority of participants (83.1%) visited a physician at least twice in the previous year, 30.9% had discussed sex with a physician since turning 50, and 14.2% had been tested for HIV. Relative to non-Hispanic whites, African Americans were more likely to be divorced (OR=3.23, P<0.001) or widowed (OR=2.90, P<0.001); have more lifetime sexually transmitted infection (STI) diagnoses (OR=1.67, P=0.030); and have paid for sex (OR=2.83, P=0.002). Although African Americans had greater perceived risk for HIV infection (OR=1.66, P=0.046), they were less likely to have discussed sex with a physician since turning 50 (OR=0.45, P=0.009).
Contextualized interventions to improve patient-provider communication and proactive screening behaviors in sexually-active and aging African Americans are needed.
Abstract
This presentation advances studies of population health by estimating the association between new bereavement and binge drinking rates among adults aged 50 years and older. In other reports, ...bereavement is associated with significantly higher rates of binge drinking among older adults. In 2019, the state of Georgia used an optional module in the Behavioral Risk Factor Surveillance Survey (BRFSS) to measure the prevalence of new bereavement. This is the first effort to capture population-level data on bereavement in Georgia. 45% of adults (4 million persons) aged 18 and older were newly bereaved in the 24 months prior to survey. Highest bereavement rates: adults aged 55 to 64 years (51%), unemployed (49%), and Black respondents (60%). Binge drinking rate for bereaved was 31 % (versus 23.6% not bereaved). Combined bereavement and binge drinking increased risk for poor mental health (OR = 2.83) and smoking (OR = 4.54).
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