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Poorer Health (poorer + health)
Terms modified by Poorer Health Selected AbstractsAlcohol consumption patterns and risk factors among childhood cancer survivors compared to siblings and general population peersADDICTION, Issue 7 2008E. Anne Lown ABSTRACT Aims This study describes alcohol consumption among adult survivors of pediatric cancer compared to sibling controls and a national sample of healthy peers. Risk factors for heavy drinking among survivors are described. Design, setting and participants Cross-sectional data were utilized from the Childhood Cancer Survivor Study including adult survivors of pediatric cancer (n = 10 398) and a sibling cohort (n = 3034). Comparison data were drawn from the National Alcohol Survey (n = 4774). Measurement Alcohol consumption, demographic, cancer diagnosis, treatment and psychosocial factors were measured. Findings Compared to peers, survivors were slightly less likely to be risky [adjusted odds ratio (ORadj) = 0.9; confidence interval (CI) 0.8,1.0] and heavy drinkers (ORadj = 0.8; CI 0.7,0.9) and more likely to be current drinkers. Compared to siblings, survivors were less likely to be current, risky and heavy drinkers. Risk factors for survivors' heavy drinking included being age 18,21 years (ORadj = 2.0; 95% CI 1.5,2.6), male (ORadj = 2.1; 95% CI 1.8,2.6), having high school education or less (ORadj = 3.4; 95% CI 2.7,4.4) and drinking initiation before age 14 (ORadj = 6.9; 95% CI 4.4,10.8). Among survivors, symptoms of depression, anxiety or somatization, fair or poor self-assessed health, activity limitations and anxiety about cancer were associated with heavy drinking. Cognitively compromising treatment, brain tumors and older age at diagnosis were protective. Conclusions Adult survivors of childhood cancer show only a modest reduction in alcohol consumption compared to peers despite their more vulnerable health status. Distress and poorer health are associated with survivor heavy drinking. Screening for alcohol consumption should be instituted in long-term follow-up care and interventions among survivors and siblings should be established to reduce risk for early drinking. [source] Health status and heterogeneity of cost-sharing responsiveness: how do sick people respond to cost-sharing?HEALTH ECONOMICS, Issue 4 2003Dahlia K. Remler Abstract This paper examines whether the responsiveness of health care utilization to cost-sharing varies by health status and the implications of such heterogeneity. First, we show theoretically that if health care utilization of those in poor health is less responsive to cost sharing, this, combined with the skewness of health expenditures in health status, leads to overestimates of the effect of cost sharing. This bias is exacerbated when elasticities are generalized to populations with greater expenditure skewness. Second, we show empirically that cost-sharing responsiveness does differ by health status using data from the Medicare Current Beneficiary Survey. Medicare beneficiaries are stratified into health status groups based on activity of daily living (ADL) impairments and self-reported health status. Separately, for each of the health status groups, we estimate the effect of Medigap insurance on Part B utilization using a two-part expenditure model. We find that the change in expenditures associated with Medigap is smaller for those in poorer health. For example, when stratified using ADLs, Medigap insurance increases expenditures for ,healthy' groups by 36.4%, while the increase for the ,sick' group is 12.7%. Results are qualitatively the same for different forms of supplemental insurance and different methods of health status stratification. We develop a test to demonstrate that adjusting our results for selection bias would result in estimates of greater heterogeneity. Our results imply that a lowerbound estimate of the bias from neglecting heterogeneity is about 2,7%. Copyright © 2002 John Wiley & Sons, Ltd. [source] Comparing United States versus International Medical School Graduate Physicians Who Serve African- American and White ElderlyHEALTH SERVICES RESEARCH, Issue 6 2006Daniel L. Howard Objective. To examine the relationship that international medical school graduates (IMGs) in comparison with United States medical school graduates (USMGs) have on health care-seeking behavior and satisfaction with medical care among African-American and white elderly. Data Sources. Secondary data analysis of the 1986,1998 Piedmont Health Survey of the Elderly, Established Populations for the Epidemiological Study of the Elderly, a racially oversampled urban and rural cohort of elders in five North Carolina counties. Study Design. Primary focus of analyses examined the impact of the combination of elder race and physician graduate status across time using a linear model for repeated measures analyses and ,2 tests. Separate analyses using generalized estimating equations were conducted for each measure of elder characteristic and health behavior. The analytic cohort included 341 physicians and 3,250 elders (65 years old and older) in 1986; by 1998, 211 physicians and 1,222 elders. Data Collection/Extraction Methods. Trained personnel collected baseline measures on 4,162 elders (about 80 percent responses) through 90-minute in-home interviews. Principal Findings. Over time, IMGs treated more African-American elders, and those who had less education, lower incomes, less insurance, were in poorer health, and who lived in rural areas. White elders with IMGs delayed care more than those with USMGs. Both races indicated being unsure about where to go for medical care. White elders with IMGs were less satisfied than those with USMGs. Both races had perceptions of IMGs that relate to issues of communication, cultural competency, ageism, and unnecessary expenses. Conclusion. IMGs do provide necessary and needed access to medical care for underserved African Americans and rural populations. However, it is unclear whether concerns regarding cultural competency, communication and the quality of care undermine the contribution IMGs make to these populations. [source] Selective non-response to clinical assessment in the longitudinal study of aging: implications for estimating population levels of cognitive function and dementiaINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2002Kaarin J. Anstey Abstract Objective To identify the cognitive outcome of interviewed participants who did not progress to partake in clinical assessments in a longitudinal aging study. Design A retrospective study was conducted on participants who were interviewed but who did not complete the clinical assessment (including an extended cognitive assessment) at either Wave 1 or both Wave 1 and Wave 3 of the Australian Longitudinal Study of Ageing. A total of 1947 participants aged 70 and older commenced the study, 246 participants without clinical data at either or both Waves 1 and 3 were identified for the sub-sample followed-up retrospectively. The Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) was administered to informants and medical records were reviewed. Results Participants who did not complete the clinical assessment at Wave 3 reported poorer health and had poorer cognitive function at Wave 1 independent of age and gender. Rates of possible dementia or cognitive decline were higher in the group who did not undertake the clinical assessment compared with both those who did the clinical assessment and with population data. Conclusion Selective non-response to clinical assessment in a longitudinal aging study is associated with higher risk of cognitive decline and probable dementia. Longitudinal aging studies may underestimate rates of dementia and population levels of cognitive decline. Copyright © 2002 John Wiley & Sons, Ltd. [source] Personal and social determinants of health services utilization by Mexican older peopleINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 3 2010Maria Isabel Peñarrieta De Córdova PhD de córdova m.i.p., mier n., curi e.j.m., gómez t.g., quirarte n.h.g. & barrios f.f. (2009) Personal and social determinants of health services utilization by Mexican older people. International Journal of Older People Nursing 5, 193,201 doi: 10.1111/j.1748-3743.2009.00193.x Background., Increased healthcare needs among older individuals around the world demands a better understanding of factors influencing healthcare service utilization patterns. Objective., To examine personal and social correlates to health services utilization among Mexican older persons. Design and methods., This was a cross-sectional study conducted between 2004 and 2006 with 2030 Mexican adults 60 years and older and based on a health services utilization framework. A two-stage cluster sampling with probability proportionate to size was used. Participants were randomly selected and recruited in four metropolitan areas in Northeastern Mexico. Chi-square and Pearson's chi-squared tests and logistic regression were used for data analyses. Results., Significantly more women than men had lost a spouse and were illiterate. Also, females reported significantly poorer health, higher nutritional risk and lower ability to perform activities of daily and instrumental living than males. Predictors of healthcare utilization were: Having a caregiver during an illness; perceiving to have a health problem; being able to afford food, and having children. Conclusions., Predisposing, enabling and need factors are strong predictors of health services utilization among Mexican older persons. In addition, gender differences exist among this population in relation to health status, but not to health services demands. [source] Health Insurance Literacy of Older AdultsJOURNAL OF CONSUMER AFFAIRS, Issue 2 2009LAUREN McCORMACK We developed an instrument to measure dimensions of health insurance literacy reflecting familiarity with health insurance terminology and proficiency with the Medicare program. The instrument's items were based on a conceptual framework integrating the financial and health insurance literacy fields and were fielded in a national survey of older adults. We found that overall levels of health insurance literacy were low to moderate. The oldest adults, those with lower education and income, and those with poorer health had lower levels of health insurance literacy. The items demonstrated good psychometric properties and construct validity. They are a promising way to measure selected aspects of health insurance literacy. [source] Poverty, socio-economic position, social capital and the health of children and adolescents with intellectual disabilities in Britain: a replicationJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 11 2007E. Emerson Abstract Background When compared with their nonintellectually disabled peers, people with intellectual disabilities (IDs) have poorer health and are more likely to be exposed to poverty during childhood. Given that exposure to child poverty has been linked to poorer health outcomes, we attempted to estimate the extent to which the health inequalities faced by children and adolescents with IDs may be accounted for by their more disadvantaged socio-economic position. Methods Secondary analysis of data on a nationally representative sample of 12 160 British children aged under 17 years extracted from the Department of Work and Pensions' Families and Children Study. Results After controlling for age and sex, children with IDs were significantly more likely (corrected odds ratio = 2.49) to be reported to have less than good health than their nonintellectually disabled peers. However, 31% of the elevated risk for poorer health was accounted for by between-group differences in socio-economic position and social capital. Conclusions A socially and statistically significant proportion of the increased risk of poorer health among children and adolescents with IDs may be attributed to their increased risk of socio-economic disadvantage. [source] The Effects of Marital and Nonmarital Union Transition on HealthJOURNAL OF MARRIAGE AND FAMILY, Issue 2 2002Zheng Wu This study examines the effects of marital and nonmarital union transition on health. Utilizing Canadian longitudinal data, we find that exiting both marriage and cohabitation seems to have similar effects: Dissolving either union tends to be associated with a decrease in physical health, mental health, or both. With possible selection effects eliminated and protection effects held constant, we find that remaining in either type of union generally is associated with poorer health. We speculate that decreased union quality may account for this inverse relationship, and that protection effects may explain much of the reported health gains associated with union life. [source] Physical and psychological health of first and second generation Turkish immigrants in Germany,AMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 4 2010Ashwin A. Kotwal Recent studies in Germany suggest that first generation Turkish immigrants have lower mortality rates compared to native Germans. Conversely, studies examining morbidity, though not national in scope, have demonstrated that first generation Turks may have poorer health than native Germans. Additionally, little is known about the health of the emerging second generation Turkish population in Germany. To evaluate the discrepancy between mortality and morbidity trends and contribute to a better understanding of second generation Turkish immigrant health, this paper uses a nationally-representative dataset, including the 2005 German Gender and Generations Study (GGS) (n = 10,017) and the 2006 GGS Turkish supplement (n = 4,045), to assess three health outcomes: chronic illness, self-assessed health, and feelings of emptiness. The paper investigates whether sex, age, socioeconomic status, emotional support, or duration of residence in Germany predict these dimensions of health. Results establish clear health status differences between Turks and native Germans. Surprisingly, both first and second generation Turks tend to have lower chronic illness rates and rate their health as better than Germans at younger ages, but the advantage diminishes among higher age strata for the first generation. Feelings of emptiness results generally indicate an increased susceptibility to psychological problems for both generations of Turks. Controlling for socioeconomic status and age reduces these health differences modestly, pointing to their likely role as mediators. The relatively higher risks for all three health outcomes among Turkish females of both generations compared to their German counterparts suggest that female Turkish immigrants and their female offspring may be particularly vulnerable. Am. J. Hum. Biol. 2010. © 2010 Wiley-Liss, Inc. [source] The health of Arctic populations: Does cold matter?AMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 1 2010T. Kue Young The objective of the study was to examine whether cold climate is associated with poorer health in diverse Arctic populations. With climate change increasingly affecting the Arctic, the association between climate and population health status is of public health significance. The mean January and July temperatures were determined for 27 Arctic regions based on weather station data for the period 1961,1990 and their association with a variety of health outcomes assessed by correlation and multiple linear regression analyses. Mean January temperature was inversely associated with infant and perinatal mortality rate, age-standardized mortality rate from respiratory diseases, and age-specific fertility rate for teens and directly associated with life expectancy at birth in both males and females, independent of a variety of socioeconomic, demographic, and health care factors. Mean July temperature was also associated with infant mortality and mortality from respiratory diseases, and with total fertility rate. For every 10°C increase in mean January temperature, the life expectancy at birth among males increased by about 6 years and infant mortality rate decreased by about 4 deaths/1,000 livebirths. Cold climate is significantly associated with higher mortality and fertility in Arctic populations and should be recognized in public health planning. Am. J. Hum. Biol., 2010. © 2009 Wiley-Liss, Inc. [source] Health Care in Rural TexasPOLICY STUDIES JOURNAL, Issue 1 2001William DeSoto The purpose of this article is to assess the quality of health and health care services available to rural Texans. Specifically, we seek to answer two related questions. First, do people living in rural areas of Texas generally suffer from poorer health than people living in urban Texas? One undoubtedly would think so, given frequent references to the low quality of personal services in general for rural America. Moreover, the persistence of the congressional Rural Health Care Caucus over the past two decades points to a rural health care crisis. Second, to what extent are these differences in health conditions explained by differences in access to health care enjoyed by people living in the two different regions? Access certainly appears to be the problem alluded to above. Rural people apparently lack physician care. In addition to providing answers to these questions, we also examine the difference in the health conditions and access to care enjoyed by minority and non-minority rural Texans. Is this a part of the rural health care problem given the high incidence of non-whites in rural Texas? If so this may be minority rather than rural neglect. We briefly conclude the article with some recommendations for improving the problems we identify. [source] Immature Defense Mechanisms Are Associated with Lesser Vaginal Orgasm Consistency and Greater Alcohol Consumption before SexTHE JOURNAL OF SEXUAL MEDICINE, Issue 2pt1 2010Rui Miguel Costa MA ABSTRACT Introduction., Disturbances of emotional and physical awareness can impair female sexual function. Previous research revealed that immature psychological defense mechanisms (impairing emotional awareness) are associated specifically with impaired vaginal orgasm (orgasm triggered solely by penile,vaginal stimulation). Alcohol consumed before sex (ACBS) might impair vaginal orgasm or lead to avoiding the opportunity for it, but research examining immature defenses, ACBS, and specific sexual behaviors has been lacking. Aim., To test the hypothesis that greater use of immature defenses and greater ACBS are inversely associated with vaginal orgasm consistency, but unrelated or positively correlated with greater frequency of other sexual behaviors. Methods., Three hundred twenty-three coitally experienced women (predominantly Scottish) responded to an online survey reporting their frequency of various sexual activities (and corresponding orgasms) and their ACBS, and completed the Defense Style Questionnaire DSQ-40. Main Outcome Measures., Univariate and multivariate correlations of immature defenses, ACBS, and various sexual behaviors. Results., Both immature defenses and ACBS were associated with less vaginal orgasm consistency, but unrelated or positively correlated with frequency of other sexual behaviors (including clitoral masturbation during penile,vaginal intercourse). Immature defenses were associated with more ACBS. Immature defenses explained the association between ACBS and both lack of vaginal orgasm and greater frequency of other sexual behaviors. Conclusions., The results provide further evidence that difficulty in having a vaginal orgasm is associated with immature defenses (and associated disturbances of sensibility), among other indicators of poorer health and relatedness. ACBS might impair vaginal orgasm or increase the likelihood of choosing other sexual activities, but this effect might be somewhat contingent on immature defenses. Based on various empirical studies, we call for examination of the possibility that lack of vaginal orgasm (given an adequate man) should qualify as a female sexual dysfunction. Costa RM, and Brody S. Immature defense mechanisms are associated with lesser vaginal orgasm consistency and greater alcohol consumption before sex. J Sex Med 2010;7:775,786. [source] Psychological distress is associated with a range of high-priority health conditions affecting working AustraliansAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010Libby Holden Abstract Background: Psychological distress is growing in prevalence in Australia. Comorbid psychological distress and/or depressive symptoms are often associated with poorer health, higher healthcare utilisation and decreased adherence to medical treatments. Methods: The Australian Work Outcomes Research Cost-benefit (WORC) study cross-sectional screening dataset was used to explore the association between psychological distress and a range of health conditions in a sample of approximately 78,000 working Australians. The study uses the World Health Organization Health and Productivity Questionnaire (HPQ), to identify self-reported health status. Within the HPQ is the Kessler 6 (K6), a six-item scale of psychological distress which strongly discriminates between those with and without a mental disorder. Potential confounders of age, sex, marital status, number of children, education level and annual income were included in multivariate logistic regression models. Results: Psychological distress was significantly associated with all investigated health conditions in both crude and adjusted estimates. The conditions with the strongest adjusted association were, in order from highest: drug and alcohol problems, fatigue, migraine, CVD, COPD, injury and obesity. Conclusions: Psychological distress is strongly associated with all 14 health conditions or risk factors investigated in this study. Comorbid psychological distress is a growing public health issue affecting Australian workers. [source] Sources of stress in impoverished neighbourhoods: insights into links between neighbourhood environments and healthAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2009Deborah Warr Abstract Objective:This paper explores associations between residents' perceptions of social incivilities and physical disorders in local environments and self-reported health status. Method: Surveys were conducted with 4,029 residents from 13 Neighbourhood Renewal sites and 1,857 residents of corresponding Local Government Areas in Victoria. An open-ended question asked respondents to nominate the worst things about living in their neighbourhood and this qualitative data was analysed for the range of perceptions of incivilities. Quantitative data analysis considered associations between incivilities in neighbourhood environments and self-reported health status. Results: Issues conceptualised as social incivilities (drug and alcohol use, dangerous driving, the behaviour of other people, feeling unsafe, noise, racism) accounted for 58% of issues nominated. Quantitative analyses suggested that increased exposure to issues related to aspects of neighbourhood safety were associated with living in a disadvantaged neighbourhood. Perceptions of lower levels of neighbourhood safety were, in turn, associated with poorer health. Conclusions: Cumulative and compounding aspects of local environments that heighten feelings of insecurity and anxiety may be mechanisms through which places affect health. Implications: While the characteristics of populations are important determinants of health outcomes, the findings endorse the value of incorporating complementary place-based approaches for addressing mechanisms that contribute to health inequalities in local environments. [source] Is the health of young unemployed Australians worse in times of low unemployment?AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2009Justin Newton Scanlan Abstract Objective: To compare the health of young unemployed Australians during a period of low unemployment (April 2007: rate 4.4%) against published Australian norms for 18,24 year olds and unemployed people during a time of higher unemployment (February 1995 to January 1996: rate 8.1% to 8.9%). Methods: Two hundred and fifty-one unemployed 18,25 year olds residing in New South Wales completed the SF36 Health Survey version 2 (SF36v2) during a time of low unemployment. SF36v2 subscale and component summary scores were compared with published norms for 18,24 year olds and for unemployed persons during a time of higher unemployment. Results: Young unemployed people during a period of low unemployment reported poorer health in all areas when compared with age-matched norms and poorer psychological health when compared with the published norms for unemployed people from a time when unemployment rates were higher. Conclusions: The health of young unemployed individuals during a time of low unemployment was poor when compared to both the general population and to unemployed people during a time of higher unemployment. Implications: Public health interventions must focus on improving the health of young unemployed people to support their engagement with and contribution to Australian society. [source] Attrition in longitudinal studies: who do you lose?AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2006Anne F. Young Objective: To describe the risk factors for various types of attrition in three age cohorts of women in a longitudinal study and to discuss strategies to minimise attrition. Methods: Analysis of survey data from the Australian Longitudinal Study on Women's Health, collected by mailed questionnaire. In 1996, the study recruited and surveyed a national random sample of ,younger' (18,23 years, n=14,247), ,mid-age' (45,50 years, n=13,716), and ,older' women (70,75 years, n=12,432), and began a staggered cycle of mailed follow-up questionnaires: 1998 (mid-age), 1999 (older), 2000 (younger) and so on. Demographic, health and social risk factors for attrition were examined using multivariate analysis. Results: Attrition at survey 2 was highest among younger women (32%), mainly because of participants not being contactable (21%), and lower among the older (16%) and mid-age women (10%). At survey 1, the survey 2 non-respondents were more likely to report having less education, being born in a non-English-speaking country and being a current smoker, in all cohorts, and had poorer health (mid-age and older cohort) and more diffculty managing on their income (younger and mid-age). Conclusion: Although the magnitude of different types of attrition was found to differ by age, there were several risk factors for attrition that remained consistent. These fndings are important to inform future studies on ways to lessen or prevent systematic loss of participants. Implications: Recruitment and follow-up methods in longitudinal studies should be tailored to maximise retention of participants at higher risk of dropout. [source] Social Inequality: Utilisation of general practitioner services by socio-economic disadvantage and geographic remotenessAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2004Gavin Turrell Objective: To examine the association between socio-economic status (SES) and GP utilisation across Statistical Local Areas (SLAs) that differed in their geographic remoteness, and to assess whether Indigenous status and GP availability modified the association. Design: Retrospective analysis of Medicare data for all unreferred GP consultations (1996/97) for 952 SLAs comprising the six Australian States. Geographic remoteness was ascertained using the Area Remoteness Index of Australia (ARIA), and SES was measured by grouping SLAs into tertiles based on their Index of Relative Socioeconomic Disadvantage score. Main outcome measure: Age/sex standardised rates of GP utilisation for each SLA. Main results: In SLAs classified as ,highly accessible', rates of GP use were 10.8% higher (95% CI 5.7,16.0) in the most socio-economically disadvantaged tertile after adjustment for Indigenous status and GP availability. A very different pattern of GP utilsation was found in ,remote/very remote' SLAs. After adjustment, rates of GP use in the most socio-economically disadvantaged tertile were 25.3% lower (95% CI 5.9,40.7) than in the most advantaged tertile. Conclusions: People in socio-economically disadvantaged metropolitan SLAs have higher rates of GP utilisation, as would be expected due to their poorer health. This is not true for people living in disadvantaged remote/very remote SLAs: in these areas, those most in need of GP services are least likely to receive them. Australia may lay claim to having a primary health care system that provides universal coverage, but we are still some way from having a system that is economically and geographically accessible to all. [source] Marital quality and survivorshipCANCER, Issue 1 2009Slowed recovery for breast cancer patients in distressed relationships Abstract BACKGROUD: Although marital distress has been implicated in difficulties with adjustment to a breast cancer diagnosis, its long-term effects, especially on physical recovery, are unknown. METHODS: Longitudinal data from newly diagnosed breast cancer patients (N = 100) who were married or cohabiting were used. Patients were assessed after diagnosis and surgery (baseline) and then reassessed every 4 or 6 months for the next 5 years. Women in stable, distressed relationships (n = 28) were compared with those in stable, nondistressed relationships (n = 72). Stress, health behavior, and health outcomes were examined using mixed-effects modeling. RESULTS: Overall, marital distress was associated with slowed recovery trajectories and poor outcomes. At baseline, both groups had equivalent, high levels of stress, but diverged thereafter. Stress declined more slowly for the Distressed group, and by 5 years it remained significantly higher. Differential reductions in physical activity were also observed. With regard to health, the Distressed group was found to have a slower recovery in performance status and more symptoms/signs of illness and treatment side effects through 3 years. Finally, all the effects were observed above and beyond reductions occurring with depressive symptomatology, which was significantly higher in the Distressed group. CONCLUSIONS: Marital distress is not only associated with worse psychologic outcomes for breast cancer survivors, but poorer health and a steeper decline in physical activity. These novel data demonstrate recovery trajectories for breast cancer survivors to be constrained for those also coping with ongoing difficulties in their marriage. Cancer 2009. © 2008 American Cancer Society. [source] | |||||||||||||