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INTRODUCTION: This study investigated the effects of falls on self-rated health and anxiety symptoms and the moderating role of psychological resilience in Chinese older persons with chronic multimorbidity. METHODS: Data were taken from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used a linear regression model to evaluate the associations among falls and self-rated health and anxiety symptoms, the moderating role of psychological resilience was verified by moderation analysis, and we also used a replacement model to test robustness. Finally, the results of the study were further verified via heterogeneity analysis through subgroup regression. RESULTS: A total of 2933 people aged 60 years or older with chronic multimorbidity were included in our study. The linear regression results revealed that falls were significantly negatively correlated with the self-rated health symptoms of older Chinese people with chronic multimorbidity (ß = -0.1703, p < 0.01) and significantly positively correlated with anxiety symptoms (ß = 0.5590, p < 0.01). Among the moderating effects, we found that psychological resilience played a moderating role between falls and anxiety symptoms (ß = - 0.151 [-0.217, -0.084], p < 0.01). Finally, we found heterogeneity in the study results by sex, residence and number of chronic diseases. CONCLUSION: Falls are associated with poorer self-rated health and higher anxiety levels among older persons with chronic multimorbidity in China. High levels of psychological resilience have a moderating effect on the development of anxiety symptoms.
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Accidentes por Caídas , Ansiedad , Multimorbilidad , Resiliencia Psicológica , Humanos , Masculino , Femenino , Anciano , China/epidemiología , Ansiedad/psicología , Ansiedad/epidemiología , Persona de Mediana Edad , Anciano de 80 o más Años , Enfermedad Crónica/psicología , Enfermedad Crónica/epidemiología , Estudios Longitudinales , Autoinforme , Estado de Salud , Autoevaluación Diagnóstica , Pueblos del Este de AsiaRESUMEN
BACKGROUND: Recent studies have attempted to analyze the changes in self-rated health (SRH) during the coronavirus disease 2019 (COVID-19) pandemic. However, the results have been inconsistent. Notably, SRH is subjective, and responses may vary across and within countries because of sociocultural differences. Thus, we aimed to examine whether the interaction effects between the COVID-19 pandemic and regional deprivation influenced SRH in South Korea. METHODS: The study population comprised 877,778 participants from the Korea Community Health Survey. The data were collected from 2018 to 2021. Multiple regression analysis was employed to determine the relationship between SRH and the interaction between the COVID-19 pandemic status and the socioeconomic level of residential areas. RESULTS: The post-pandemic groups (odds ratio [OR] = 2.25, P < .0001; OR = 2.29, P < .0001) had significantly higher odds of reporting favorable SRH than the pre-pandemic groups (OR = 0.96, P < .0001). However, the difference in ORs based on regional socioeconomic status was small. CONCLUSIONS: SRH showed an overall increase in the post-pandemic groups relative to that in the disadvantaged pre-pandemic group. Possible reasons include changes in individuals' health perceptions through social comparison and the effective implementation of COVID-19 containment measures in South Korea. This paradoxical phenomenon has been named the "Eye of the Hurricane," as the vast majority of people who had not been infected by the virus may have viewed their health situation more favorably than they ordinarily would.
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COVID-19 , Humanos , COVID-19/epidemiología , COVID-19/psicología , República de Corea/epidemiología , Estudios Transversales , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Adulto Joven , Pandemias , Encuestas Epidemiológicas , Estado de Salud , Autoevaluación Diagnóstica , Factores Socioeconómicos , Adolescente , AutoinformeRESUMEN
BACKGROUND: Subjective cognitive decline (SCD) is prevalent in community-dwelling (pre)frail older adults. This study aimed to investigate whether baseline subjective cognitive decline (SCD) and mild cognitive impairment (MCI) impacted the effectiveness of an exercise intervention among (pre)frail older adults. METHODS: This is a post hoc analysis of a stepped-wedge cluster randomized trial among (pre)frail older adults across six communities. The intervention effectiveness was examined among (pre)frail older people among subgroups with normal cognition (n = 44), SCD (n = 58), or MCI (n = 30). RESULTS: The normal cognition group had both immediate and persistent treatment responses to most outcomes. The SCD group showed positive responses to frailty (0-, 12-, 24 week), ambulation and dynamic balance (0-week), and depressive symptoms (12-week). The MCI group exhibited immediate improvement in frailty, cognition, depressive symptoms, social support and QoL, which persisted only in frailty status, social support and mental QoL at follow-ups. The MCI group showed superior immediate responses to cognitive function and depressive symptoms compared to another two subgroups. No differences were found between the normal cognition and SCD groups except for cognitive status (12-week). CONCLUSIONS: (Pre)frail people with SCD or MCI had fewer improved outcomes compared to those with normal cognition regardless of immediate or persistent improvements. The incorporation of cognitive strategies with exercise interventions are recommended among (pre)frail older adults with SCD or MCI.
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Disfunción Cognitiva , Terapia por Ejercicio , Vida Independiente , Humanos , Masculino , Disfunción Cognitiva/terapia , Disfunción Cognitiva/rehabilitación , Disfunción Cognitiva/etiología , Femenino , Anciano , Terapia por Ejercicio/métodos , Anciano de 80 o más Años , Depresión/terapia , Calidad de Vida , Anciano Frágil , Autoevaluación Diagnóstica , Evaluación de Resultado en la Atención de SaludRESUMEN
The aim of this study was to investigate how self-rated health (SRH) reflects ongoing ill-health and how SRH is associated with previous ill-health and/or predicts future ill-health such as burnout, disturbed sleep, and somatic symptoms. The study used two waves from the population-based Västerbotten Environmental and Health Study in which 2 336 adult persons participated by answering a questionnaire at two time points three years apart. Hierarchical and logistic regression analyses were conducted, thus treating all variables both continuously (degree) and categorically (case). The analyses were performed both cross-sectionally and longitudinally. The results showed bidirectionality between suboptimal SRH and burnout, disturbed sleep and somatic severity caseness. Moreover, degree of poor SRH was more likely to occur simultaneously to high degrees of burnout and somatic severity than to degree of poor sleep quality. Also, caseness of burnout, disturbed sleep and somatic severity increased the risk of simultaneous suboptimal SRH. Finally, the results showed that degree of burnout three years earlier, predicted degree of poor SRH, and that degree of poor SRH predicted degree of sleep three years later. In conclusion, in a population-based, normal adult sample there is a bidirectional relationship between suboptimal SRH and caseness of burnout, disturbed sleep quality and somatic symptoms, but not between degree of these symptoms. The results can have implications for health care meeting patients complaining about poor general health.
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Estado de Salud , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Estudios Transversales , Calidad del Sueño , Estudios Longitudinales , Encuestas y Cuestionarios , Síntomas sin Explicación Médica , Suecia/epidemiología , Agotamiento Psicológico/psicología , Agotamiento Psicológico/epidemiología , Anciano , Autoevaluación Diagnóstica , Autoinforme , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/psicología , Adulto JovenRESUMEN
Purpose: This study aimed to reveal the association between the osteoporosis self-assessment tool for Asians (OSTA) and airflow limitation (AL) in post-menopausal Japanese women. Participants and Methods: This cross-sectional study included 1580 participants undergoing a comprehensive health examination using spirometry and dual-energy X-ray absorptiometry. The OSTA was calculated by subtracting the age in years from the body weight (BW) in kilograms, and the result was multiplied by 0.2. The OSTA risk level was defined as low (>-1), moderate (-4 to -1), or high (<-4). AL was defined as forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) <0.7. The association between the OSTA and AL was assessed using logistic regression analysis. Results: The prevalence of AL was significantly higher in the high OSTA group (15.3%) than in the low OSTA group (3.1%) (p<0.001). In multiple linear regression analysis, the OSTA was independently associated with FEV1/FVC. In logistic regression models adjusted for smoking status, alcohol consumption, current use of medication for diabetes, hyperglycemia, rheumatoid arthritis, second-hand smoke, and ovary removal showed a significantly higher risk of AL (odds ratio: 5.48; 95% confidence interval: 2.90-10.37; p<0.001) in participants with OSTA high risk than in those with OSTA low risk. Conclusion: These results suggest that the OSTA high risk indicates reduced BMD at the femoral neck and presence of AL in Japanese post-menopausal women aged ≥45 years.
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Absorciometría de Fotón , Pueblo Asiatico , Pulmón , Posmenopausia , Espirometría , Humanos , Femenino , Estudios Transversales , Persona de Mediana Edad , Japón/epidemiología , Anciano , Volumen Espiratorio Forzado , Factores de Riesgo , Capacidad Vital , Prevalencia , Pulmón/fisiopatología , Osteoporosis Posmenopáusica/fisiopatología , Osteoporosis Posmenopáusica/etnología , Osteoporosis Posmenopáusica/diagnóstico , Osteoporosis Posmenopáusica/epidemiología , Valor Predictivo de las Pruebas , Modelos Logísticos , Medición de Riesgo , Densidad Ósea , Modelos Lineales , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/etnología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Autoevaluación Diagnóstica , Oportunidad Relativa , Pueblos del Este de AsiaRESUMEN
As a potential preclinical stage of Alzheimer's dementia, subjective cognitive decline (SCD) reveals a higher risk of future cognitive decline and conversion to dementia. However, it has not been clear whether SCD status increases the clinical progression of older adults in the context of amyloid deposition, cerebrovascular disease (CeVD), and psychiatric symptoms. We identified 99 normal controls (NC), 15 SCD individuals who developed mild cognitive impairment in the next 2 years (P-SCD), and 54 SCD individuals who did not (S-SCD) from ADNI database with both baseline and 2-year follow-up data. Total white matter hyperintensity (WMH), WMH in deep (DWMH) and periventricular (PWMH) regions, and voxel-wise grey matter volumes were compared among groups. Furthermore, using structural equation modelling method, we constructed path models to explore SCD-related brain changes longitudinally and to determine whether baseline SCD status, age, and depressive symptoms affect participants' clinical outcomes. Both SCD groups showed higher baseline amyloid PET SUVR, baseline PWMH volumes, and larger increase of PWMH volumes over time than NC. In contrast, only P-SCD had higher baseline DWMH volumes and larger increase of DWMH volumes over time than NC. No longitudinal differences in grey matter volume and amyloid was observed among NC, S-SCD, and P-SCD. Our path models demonstrated that SCD status contributed to future WMH progression. Further, baseline SCD status increases the risk of future cognitive decline, mediated by PWMH; baseline depressive symptoms directly contribute to clinical outcomes. In conclusion, both S-SCD and P-SCD exhibited more severe CeVD than NC. The CeVD burden increase was more pronounced in P-SCD. In contrast with the direct association of depressive symptoms with dementia severity progression, the effects of SCD status on future cognitive decline may manifest via CeVD pathologies. Our work highlights the importance of multi-modal longitudinal designs in understanding the SCD trajectory heterogeneity, paving the way for stratification and early intervention in the preclinical stage. PRACTITIONER POINTS: Both S-SCD and P-SCD exhibited more severe CeVD at baseline and a larger increase of CeVD burden compared to NC, while the burden was more pronounced in P-SCD. Baseline SCD status increases the risk of future PWMH and DWMH volume accumulation, mediated by baseline PWMH and DWMH volumes, respectively. Baseline SCD status increases the risk of future cognitive decline, mediated by baseline PWMH, while baseline depression status directly contributes to clinical outcome.
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Disfunción Cognitiva , Progresión de la Enfermedad , Imagen por Resonancia Magnética , Tomografía de Emisión de Positrones , Humanos , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/patología , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/etiología , Femenino , Masculino , Anciano , Sustancia Gris/diagnóstico por imagen , Sustancia Gris/patología , Anciano de 80 o más Años , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/patología , Estudios Longitudinales , Autoevaluación Diagnóstica , Depresión/diagnóstico por imagen , Depresión/patologíaRESUMEN
BACKGROUND: Increasingly, evidence has shown that different aspects of neighborhood context play a significant role in self-rated health, one of the key health indicators in advanced age. Nevertheless, very old adults are often under represented or excluded from such research. Therefore, the first aim of this study was to examine whether social, socioeconomic, and physical neighborhood context is associated with self-rated health in the very old population of Germany. The second objective was to explore whether the link of socioeconomic and physical neighborhood context with self-rated health is moderated by availability of social resources in neighborhoods. METHODS: Data from the representative survey, "Old Age in Germany" (D80+) were employed. In total, the study sample of D80+ included 10,578 individuals aged 80 years and over. Additionally, the D80+ data were matched with the freely accessible regional dataset of the Federal Institute for Research on Building, Urban Affairs, and Spatial Development. Two self-rated items (place attachment and social cohesion) were used to assess social neighborhood context. Socioeconomic context of neighborhoods was operationalized by German index of socioeconomic deprivation. To evaluate physical context, perceived measures of building conditions and walkability were included. Using the maximum likelihood estimator with robust standard errors, logistic regression models were estimated to analyze the relationship between neighborhood context (social, socioeconomic, and physical context, as well as their interactions) and self-rated health. RESULTS: Including 8,066 participants in the analysis, the findings showed that better condition of residential building, higher walkability, being closely attached to outdoor places, and higher social cohesion were associated with higher chance to report good self-rated health of very old adults. In the adjusted models, the German socioeconomic deprivation index was not related to self-rated health. The effect of socioeconomic and physical neighborhood context on self-rated health did not differ according available neighborhood social resources. CONCLUSIONS: The results indicate that especially more favorable conditions in social and physical neighborhood context are associated with good self-rated health in the very old population of Germany. Further studies should consider multiple aspects of neighborhood context as well as their interplay when examining the neighborhood impact on self-rated health in older populations.
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Estado de Salud , Características de la Residencia , Humanos , Alemania/epidemiología , Masculino , Femenino , Anciano de 80 o más Años , Estudios Transversales , Características del Vecindario , Factores Socioeconómicos , Autoevaluación Diagnóstica , AutoinformeRESUMEN
OBJECTIVE: The objective of this study is to explore potential differences in brain functional networks at baseline between individuals with progressive subjective cognitive decline (P-SCD) and stable subjective cognitive decline (S-SCD), as well as to identify potential indicators that can effectively distinguish between P-SCD and S-SCD. METHODS: Alzheimer's Disease Neuroimaging Initiative (ADNI) database was utilized to enroll SCD individuals with a follow-up period of over 3 years. This study included 39 individuals with S-SCD, 15 individuals with P-SCD, and 45 cognitively normal (CN) individuals. Brain functional networks were constructed based on the AAL template, and graph theory analysis was performed to determine the topological properties. RESULTS: For global metric, the S-SCD group exhibited stronger small-worldness with reduced connectivity among nearby nodes and accelerated compensatory information transfer capacity. For nodal efficiency, the S-SCD group showed increased connectivity in bilateral posterior cingulate gyri (PCG). However, for nodal local efficiency, the P-SCD group exhibited significantly reduced connectivity in the right cerebellar Crus I compared with the S-SCD group. CONCLUSION: There are differences in brain functional networks at baseline between P-SCD and S-SCD groups. Furthermore, the right cerebellar Crus I region may be a potentially useful brain area to distinguish between P-SCD and S-SCD.
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Encéfalo , Disfunción Cognitiva , Progresión de la Enfermedad , Imagen por Resonancia Magnética , Red Nerviosa , Humanos , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/diagnóstico , Femenino , Masculino , Anciano , Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Imagen por Resonancia Magnética/métodos , Red Nerviosa/diagnóstico por imagen , Red Nerviosa/fisiopatología , Anciano de 80 o más Años , Autoevaluación Diagnóstica , Persona de Mediana EdadRESUMEN
BACKGROUND: Health-related quality of life (HRQOL) in cancer patients has attracted increasing attention, which may be associated with self-rated health (SRH), anxiety, and depression. However, limited studies have focused on the mediating role of anxiety and depression in the relationship between SRH and HRQOL among cancer patients. Therefore, this study aims to explore the serial multiple mediating effects of anxiety and depression between SRH and HRQOL in cancer patients. METHODS: This cross-sectional study investigated a total of 565 hospitalized cancer patients in Anhui province in China from November 2020 to October 2021. SRH was assessed using a single-item measure, anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) and HRQOL was assessed using the EuroQol-5 Dimension (EQ-5D, three-level version). Socio-demographic and clinical characteristics were analyzed using descriptive statistics. The relationships between SRH, anxiety, depression, and HRQOL were evaluated by Pearson correlation analysis. The serial multiple mediation of anxiety and depression was assessed by SPSS PROCESS macro. RESULTS: SRH, anxiety, depression and HRQOL were significantly correlated(P < 0.001). In comparison to the fair SRH, the good SRH exhibited a significantly positive direct effect (Effect = 0.2366, Bootstrap 95%CI: 0.0642 ~ 0.4090) and total effect on HRQOL (Effect = 0.4761, Bootstrap 95%CI: 0.2975 ~ 0.6546). Conversely, the poor SRH demonstrated a significantly negative total effect on HRQOL (Effect= -0.4321, Bootstrap 95%CI: -0.7544~ -0.1099). When considering the fair SRH as the reference group, the poor SRH displayed a negative indirect effect on HRQOL through the single mediation of anxiety (Effect= -0.1058, Bootstrap 95%CI: -0.2217~ -0.0107) and the serial mediation of anxiety and depression (Effect= -0.0528, Bootstrap 95%CI: -0.1233~ -0.0035). Conversely, the good SRH had a positive indirect impact on HRQOL through the single mediation of anxiety (Effect = 0.1153, Bootstrap 95%CI: 0.0583 ~ 0.1900) and depression (Effect = 0.0667, Bootstrap 95%CI: 0.0206 ~ 0.1234), as well as the serial mediation of anxiety and depression (Effect = 0.0575, Bootstrap 95%CI: 0.0192 ~ 0.1030). CONCLUSION: SRH can improve HRQOL through the decrease of anxiety and depression in cancer patients. Focusing on SRH would be beneficial for their mental health and HRQOL in cancer patients.
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Ansiedad , Depresión , Neoplasias , Calidad de Vida , Humanos , Calidad de Vida/psicología , Masculino , Femenino , Persona de Mediana Edad , Neoplasias/psicología , Estudios Transversales , Ansiedad/psicología , Depresión/psicología , Adulto , China , Anciano , Estado de Salud , Autoevaluación Diagnóstica , AutoinformeRESUMEN
High risk perception (HRP) is fundamental for adequate health behavior. However, its impact on rapid access to cardiac care after the onset of acute myocardial infarction (AMI) is not known. Conflicting evidence exists about sources that promote HRP. Data on sociodemographic and clinical characteristics of 588 AMI patients who participated in the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study were collected at the bedside. Adjusted multivariate logistic regression models identified factors associated with HRP. Only 13.4% (nâ¯= 79) of patients had a favorable HRP level. The HRP patients did not differ from those with low risk perception (LRP) in terms of sex, age, other sociodemographic features, and somatic risk factors. Among the univariate contributors to HRP were prodromal chest pain (pâ¯= 0.0004), symptom mismatch during AMI (pâ¯< 0.0001), depression (pâ¯= 0.01), and anxiety (pâ¯= 0.005). However, family history of AMI, a previous AMI, and knowledge of AMI remained significant in the multivariate regression model. Median delay time to reach a hospital-based emergency facility after the onset of AMI was 127â¯min (interquartile range [IQR]: 83-43, pâ¯= 0.02) in HRP patients and 216â¯min (IQR: 106-721) in LRP patients. An increasing risk perception score was associated with a corresponding stepwise decline in median delay time (pâ¯> 0.004). Self-perceived AMI risk is associated in a dose-response relationship with the time needed to reach coronary care emergency facilities. Recurrent AMI, family history of AMI, and sufficient knowledge of MI contribute to risk perception, whereas somatic risk factors do not.
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Servicios Médicos de Urgencia , Infarto del Miocardio con Elevación del ST , Humanos , Masculino , Femenino , Persona de Mediana Edad , Infarto del Miocardio con Elevación del ST/terapia , Alemania , Medición de Riesgo , Tiempo de Tratamiento/estadística & datos numéricos , Anciano , Factores de Riesgo , Autoevaluación Diagnóstica , PrevalenciaRESUMEN
PURPOSE: To determine whether individuals with subjective cognitive decline (SCD) have changes in whole-brain network characteristics and intracerebral node characteristics in the structural network, and whether there is a difference between SCD with and without Apolipoprotein E4 (APOEε4). METHODS: This cross-sectional study included 36 individuals without SCD without APOEε4 (healthy control, HC group), 21 individuals with SCD with APOEε4 (APOEε4+ group), and 33 individuals with SCD without APOEε4 (APOEε4- group). The white matter structural network was constructed using the fractional anisotropy (FA) based deterministic fiber tracking method. Graph theory was used to analyze the whole-brain network characteristics and intracerebral node characteristics of the three groups. RESULTS: Regarding the whole-brain network characteristics, all three groups exhibited small-worldness in their structural networks. The clustering coefficient (Cp) and local efficiency (Eloc) in the APOEε4+ and APOEε4- groups were significantly lower than in the HC group (p < 0.05), but no significant difference in Cp or Eloc was observed between the APOEε4+ and APOEε4- groups. Regarding intracerebral node characteristics, there were significant differences in some brain regions, mainly the default mode network (DMN), the occipital lobe, the temporal lobe, and subcortical regions. The change in intracerebral node characteristics was different between the APOEε4+ group and the APOEε4- group. CONCLUSIONS: Individuals with SCD demonstrate changes in whole-brain network characteristics and intracerebral node characteristics in the structural network. Moreover, differences exist between APOEε4+ and APOEε4- individuals.
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Apolipoproteína E4 , Disfunción Cognitiva , Red Nerviosa , Sustancia Blanca , Humanos , Apolipoproteína E4/genética , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/patología , Masculino , Femenino , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/patología , Estudios Transversales , Anciano , Persona de Mediana Edad , Red Nerviosa/diagnóstico por imagen , Red Nerviosa/patología , Red Nerviosa/fisiopatología , Imagen de Difusión Tensora , Autoevaluación DiagnósticaRESUMEN
Background: Social transition is one of the multi-level mechanisms that influence health disparities. However, it has received less attention as one of the non-traditional social determinants of health. A few studies have examined China's social transition and its impact on health inequality in self-rated health (SRH). Therefore, this study explores the impact of China's market-oriented reforms-social transition and socioeconomic status (SES)-on residents' SRH. Methods: Using the cross-sectional data from the Chinese General Social Survey (CGSS) in 2017, we analyzed the effects of social transition and SES on the SRH of Chinese residents using the RIF (Recentered influence function) method. The RIF decomposition method investigated health differences among different populations and their determinants. Results: Social transition and SES have significant positive effects on the SRH of Chinese residents. The correlation between SES and the SRH of Chinese residents is moderated by social transition, implying that social transition can weaken the correlation between SES and the SRH of Chinese residents. The impacts of SES and social transition on SRH vary across populations. Conclusion: Promoting social transition and favoring disadvantaged groups with more resources are urgently needed to promote equitable health outcomes.
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Clase Social , Humanos , China , Estudios Transversales , Masculino , Femenino , Persona de Mediana Edad , Adulto , Cambio Social , Disparidades en el Estado de Salud , Anciano , Adolescente , Encuestas y Cuestionarios , Adulto Joven , Determinantes Sociales de la Salud/estadística & datos numéricos , Autoevaluación Diagnóstica , Estado de SaludRESUMEN
Self-rated health is an indicator that can be easily identified in health surveys, widely used to measure physical, social, mental, and health aspects of the population, and predict premature mortality. In Venezuela, this information only began to be collected recently, in the National Survey of Living Conditions (ENCOVI). In this context, our study aims to analyze the demographic and socioeconomic factors associated with non-positive self-rated health among Venezuelan adults. The ENCOVI 2021 (n = 16,803) was used as a data source, assessing a probability stratified sample with questions about health, education, emigration, and other social and economic aspects. Crude and adjusted prevalence ratio analyses were performed using Poisson regression models with robust variance. The prevalence of fair/bad self-rated health among Venezuelans was 17.8%. The results indicated a strong association between outcome prevalence and age group, 3.81 times higher (95%CI: 3.29-4.41) among individuals aged 60 or more when compared to individuals aged 18 to 29 years. Also, participants experiencing severe food insecurity had a prevalence 2 times higher (95%CI: 1.61-2.47) than those who did not have any level of food insecurity. Factors such as poverty, education, recent emigration of family members, and sex also showed a significant influence, also when analyzed independently. The results show that special attention should be dedicated to the health of individuals facing hunger and of the older people.
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Encuestas Epidemiológicas , Factores Sociodemográficos , Factores Socioeconómicos , Humanos , Venezuela , Adulto , Masculino , Femenino , Persona de Mediana Edad , Adulto Joven , Adolescente , Anciano , Prevalencia , Disparidades en el Estado de Salud , Estado de Salud , Autoinforme , Factores de Edad , Autoevaluación Diagnóstica , Estudios TransversalesRESUMEN
BACKGROUND: Subjective hearing loss (SHL) refers to an individual's self-assessment of their hearing loss. The association and underlying mechanisms between SHL and cognitive impairment still necessitate elucidation. OBJECTIVES: To validate potential mechanisms between SHL and cognitive impairment. DESIGN: Cross-section. SETTING: Shanghai, China. PARTICIPANTS: A total of 2369 individuals from communities and the cognitive disorder clinic. MEASUREMENTS: All participants were subjected to a comprehensive neuropsychological assessment, encompassing the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S). The participants' brain ß-amyloid (Aß) deposition status, plasma biomarkers associated with Alzheimer's disease (AD), and cardiovascular risk factors were also collected. RESULTS: In individuals with a heightened SHL, elevated HHIE-S score was linked to diminished cognitive and daily functioning as well as heightened levels of depressed mood. This correlation was observed in auditory memory performance but not in visual memory. The influence of SHL on cognitive function was mediated by depressed mood. SHL was associated with diabetes and smoking, whereas cognitive function was associated with hyperlipidemia and alcohol consumption. In individuals with positive brain Aß deposition, SHL demonstrated associations with cognitive function independent of plasma Aß42/40 ratio, P-tau181, neurofilament light chain, and APOE allele status. CONCLUSION: SHL has an independent effect on cognitive impairment. The findings do no provide evidence for the common cause mechanism. Instead, the findings support the presence of a cognitive resource mechanism and an impoverished environment mechanism, along with the potential for a pathological interaction mechanism.
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Péptidos beta-Amiloides , Disfunción Cognitiva , Pérdida Auditiva , Humanos , Masculino , Femenino , Pérdida Auditiva/psicología , Anciano , Péptidos beta-Amiloides/metabolismo , Péptidos beta-Amiloides/sangre , Estudios Transversales , China , Pruebas Neuropsicológicas , Persona de Mediana Edad , Biomarcadores/sangre , Factores de Riesgo , Autoevaluación Diagnóstica , Encéfalo/metabolismo , DepresiónRESUMEN
BACKGROUND: The anal symptoms occurring during pregnancy and post-partum, mainly related to Haemorrhoidal Disease (HD), have been reported with in a wide range of incidence in the literature. Although in many cases the course of the disease is mild and self-limiting, sometimes it is severe enough to affect quality of life. METHODS: Our study has been conducted through a questionnaire administered via social media with the aim of obtaining epidemiologic data on the incidence of the symptoms of HD in an unselected population of pregnant women. In addition, we looked for the presence of those factors notoriously predisposing or associated to HD (constipation, straining on the toilet, low dietary fibres and fluid intake). RESULTS: Out of 133 patients 51% reported symptoms of HD during pregnancy, mainly in the second and third trimester. Constipation, straining on the toilet, low dietary fibres and fluid intake were not significantly related to incidence of HD. Only a previous history of HD was correlated to onset of symptoms of HD in pregnancy and reached a statistical significance (odds ratio = 5.2, p < 0.001). CONCLUSION: Although with the limitations posed by the nature of our retrospective study via a self-assessment interview, our results suggest that the occurrence of HD in pregnancy seems not sustained by the classical risk factors observed in the general population. At the moment, specific therapeutic measures are lacking and treatment relies on empiric suggestions concerning diet, fluid intake, bowel care, local ointment. Further studies are needed in order to identify a targeted etiologic treatment.
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Hemorroides , Complicaciones del Embarazo , Humanos , Femenino , Embarazo , Hemorroides/epidemiología , Adulto , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/psicología , Encuestas y Cuestionarios , Estudios Retrospectivos , Factores de Riesgo , Incidencia , Fibras de la Dieta/administración & dosificación , Adulto Joven , Medios de Comunicación Sociales/estadística & datos numéricos , Estreñimiento/epidemiología , Autoevaluación DiagnósticaRESUMEN
OBJECTIVES: As populations age globally, understanding the dynamics that influence the well-being of older individuals become increasingly crucial. The research employs a comprehensive approach to unravel the multifaceted interplay between social engagements and subjective health perceptions of older Indians, with a special focus on gender differences. SUBJECTS AND METHODS: This study used data from the Longitudinal Aging Study in India (LASI) wave 1, 2017-18 with a total sample of 30,533 older adults aged 60 years and above. Bivariate analysis, chi-square tests and unadjusted and adjusted average marginal effects from logistic regression models were used to assess the relationship between social engagements and subjective health among older adults, stratified by gender. RESULTS: The prevalence of poor health status decreased with higher frequency of social networks among both men (pp. (percentage point) = 6.1; CI (Confidence Interval): 10.6, 1.6) and women (pp. = 9.2; CI: 14.9, 3.4). The adjusted average marginal effects demonstrate that with an increase in the overall score of social engagement, the likelihood of poor health is almost reduced by half. For men, the prevalence of poor health was 9.8 pp. (95 % CI: 13.7, 5.8), while for women, it was 9.3 pp. (95 % CI: 15.2, 3.1). CONCLUSION: Gendered perspectives unveil unique patterns, highlighting how societal expectations and roles assigned to each gender may influence the subjective health perceptions of older individuals. This study adds to the expanding knowledge base to enhance the well-being and fulfillment of aging populations, considering the complex interplay of social dynamics and gendered perspectives.
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Envejecimiento , Estado de Salud , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Estudios Longitudinales , India/epidemiología , Factores Sexuales , Envejecimiento/psicología , Envejecimiento/fisiología , Anciano de 80 o más Años , Participación Social , Autoevaluación Diagnóstica , Apoyo SocialRESUMEN
OBJECTIVES: We sought to (1) characterize the process of diagnosing pneumonia in an emergency department (ED) and (2) examine clinician reactions to a clinician-facing diagnostic discordance feedback tool. MATERIALS AND METHODS: We designed a diagnostic feedback tool, using electronic health record data from ED clinicians' patients to establish concordance or discordance between ED diagnosis, radiology reports, and hospital discharge diagnosis for pneumonia. We conducted semistructured interviews with 11 ED clinicians about pneumonia diagnosis and reactions to the feedback tool. We administered surveys measuring individual differences in mindset beliefs, comfort with feedback, and feedback tool usability. We qualitatively analyzed interview transcripts and descriptively analyzed survey data. RESULTS: Thematic results revealed: (1) the diagnostic process for pneumonia in the ED is characterized by diagnostic uncertainty and may be secondary to goals to treat and dispose the patient; (2) clinician diagnostic self-evaluation is a fragmented, inconsistent process of case review and follow-up that a feedback tool could fill; (3) the feedback tool was described favorably, with task and normative feedback harnessing clinician values of high-quality patient care and personal excellence; and (4) strong reactions to diagnostic feedback varied from implicit trust to profound skepticism about the validity of the concordance metric. Survey results suggested a relationship between clinicians' individual differences in learning and failure beliefs, feedback experience, and usability ratings. DISCUSSION AND CONCLUSION: Clinicians value feedback on pneumonia diagnoses. Our results highlight the importance of feedback about diagnostic performance and suggest directions for considering individual differences in feedback tool design and implementation.
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Registros Electrónicos de Salud , Servicio de Urgencia en Hospital , Neumonía , Humanos , Neumonía/diagnóstico , Retroalimentación , Actitud del Personal de Salud , Masculino , Femenino , Entrevistas como Asunto , Autoevaluación Diagnóstica , Retroalimentación Formativa , Encuestas y CuestionariosRESUMEN
BACKGROUND: In the early stages of the COVID-19 pandemic in 2020, daily life was significantly restricted due to the containment measures of the initial lockdown while SARS-CoV2 incidences remained relatively low. This study analyses socio-demographic and socio-economic groups in terms of changes in their subjective health during this phase. METHODS: Data from the Socio-Economic Panel (nâ¯= 14,856, March-July 2020) were used to estimate the relative frequency of self-reported good health, great worries about one's own health, and high life satisfaction of men and women stratified by age, education, income, migration history, pre-existing medical conditions, and high-risk occupation. The results were mutually adjusted using logistic regression, displayed on a monthly basis, and compared with the pre-pandemic period. RESULTS: Individuals of higher age, with lower education or income, and with pre-existing medical conditions reported positive health outcomes less frequently and worries more often. The differences between the subgroups remained largely stable compared to the pre-pandemic period. During the period of strongest restrictions due to infection-control measures, good health was reported less frequently by individuals with lower education or income compared to individuals with higher education or income. DISCUSSION: The impact of the early phase of the pandemic on subjective health and life satisfaction was low for the majority of the examined groups. Relative impairments were only identified for women in low socio-economic positions.
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COVID-19 , Pandemias , Factores Socioeconómicos , Humanos , COVID-19/epidemiología , Femenino , Masculino , Alemania/epidemiología , Persona de Mediana Edad , Adulto , Factores de Riesgo , Anciano , Adulto Joven , SARS-CoV-2 , Adolescente , Estado de Salud , Autoevaluación DiagnósticaRESUMEN
INTRODUCTION: Subjective cognitive decline (SCD) is characterized by subjective cognitive concerns without objective cognitive impairment and is considered a risk factor for cognitive decline and dementia. However, most SCD patients will not develop neurodegenerative disorders, yet they may suffer from minor psychiatric, neurological, or somatic comorbidities. The aim of the present study was to provide a taxonomy of the heterogeneous SCD entity and to conduct a preliminary validation using data from a memory clinic sample. METHODS: Participants were fifty-five SCD individuals consecutively recruited at the Geneva Memory Center. Based on clinical reports, they were classified into three clinically pre-defined subgroups: (i) those with psychological or psychiatric comorbidities (Psy), (ii) those with somatic comorbidities (SomCom), (iii) and those with no apparent cause (NAC). Baseline demographics, clinical, cognitive, and biomarker differences among the SCD subgroups were assessed. Longitudinal cognitive changes (average 3 years follow-up) were modeled using a linear mixed model. RESULTS: Out of the 55 SCD cases, 16 were SomCom, 18 Psy, and 21 NAC. 47% were female, mean age was 71 years. We observed higher frequency of APOE ε4 carriers in NAC (53%) compared to SomCom (14%) and Psy (0%, p = 0.023) and lower level of plasma Aß42 in NAC (6.8 ± 1.0) compared to SomCom (8.4 ± 1.1; p = 0.031). SomCom subjects were older (74 years) than Psy (67 years, p = 0.011), and had greater medial temporal lobe atrophy (1.0 ± 1.0) than Psy (0.2 ± 0.6) and NAC (0.4 ± 0.5, p = 0.005). SomCom has worse episodic memory performances (14.5 ± 3.5) than Psy (15.8 ± 0.4) and NAC (15.8 ± 0.7, p = 0.032). We observed a slightly steeper, yet not statistically significant, cognitive decline in NAC (ß = -0.48) compared to Psy (ß = -0.28) and SomCom (ß = -0.24). CONCLUSIONS: NAC features a higher proportion of APOE ε4 carriers, lower plasma Aß42 and a trend towards steeper cognitive decline than SomCom and Psy. Taken together, these findings suggest that NACs are at higher risk of cognitive decline due to AD. The proposed clinical taxonomy might be implemented in clinical practice to identify SCD at higher risk. However, such taxonomy should be tested on an independent cohort with a larger sample size.
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Disfunción Cognitiva , Humanos , Femenino , Masculino , Anciano , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/sangre , Persona de Mediana Edad , Estudios de Cohortes , Pruebas Neuropsicológicas/estadística & datos numéricos , Anciano de 80 o más Años , Péptidos beta-Amiloides/sangre , Apolipoproteína E4/genética , Autoevaluación DiagnósticaRESUMEN
BACKGROUND: Subjective cognitive decline (SCD) is an early stage of dementia linked to Alzheimer's disease pathology. White matter changes were found in SCD using diffusion tensor imaging, but there are known limitations in voxel-wise tensor-based methods. Fixel-based analysis (FBA) can help understand changes in white matter fibers and how they relate to neurodegenerative proteins and multidomain behavior data in individuals with SCD. METHODS: Healthy adults with normal cognition were recruited in the Northeastern Taiwan Community Medicine Research Cohort in 2018-2022 and divided into SCD and normal control (NC). Participants underwent evaluations to assess cognitive abilities, mental states, physical activity levels, and susceptibility to fatigue. Neurodegenerative proteins were measured using an immunomagnetic reduction technique. Multi-shell diffusion MRI data were collected and analyzed using whole-brain FBA, comparing results between groups and correlating them with multidomain assessments. RESULTS: The final enrollment included 33 SCD and 46 NC participants, with no significant differences in age, sex, or education between the groups. SCD had a greater fiber-bundle cross-section than NC (pFWE < 0.05) at bilateral frontal superior longitudinal fasciculus II (SLFII). These white matter changes correlate negatively with plasma Aß42 level (r = -0.38, p = 0.01) and positively with the AD8 score for subjective cognitive complaints (r = 0.42, p = 0.004) and the Hamilton Anxiety Rating Scale score for the degree of anxiety (Ham-A, r = 0.35, p = 0.019). The dimensional analysis of FBA metrics and blood biomarkers found positive correlations of plasma neurofilament light chain with fiber density at the splenium of corpus callosum (pFWE < 0.05) and with fiber-bundle cross-section at the right thalamus (pFWE < 0.05). Further examination of how SCD grouping interacts between the correlations of FBA metrics and multidomain assessments showed interactions between the fiber density at the corpus callosum with letter-number sequencing cognitive score (pFWE < 0.01) and with fatigue to leisure activities (pFWE < 0.05). CONCLUSION: Based on FBA, our investigation suggests white matter structural alterations in SCD. The enlargement of SLFII's fiber cross-section is linked to plasma Aß42 and neuropsychiatric symptoms, which suggests potential early axonal dystrophy associated with Alzheimer's pathology in SCD. The splenium of the corpus callosum is also a critical region of axonal degeneration and cognitive alteration for SCD.