Pharmacological treatment and perceived health status during 1-year follow up in patients diagnosed with coronary artery disease, but ineligible for revascularization. Results from the Euro Heart Survey on Coronary Revascularization

Background It has been recognized that a clinically significant portion of patients with coronary artery disease (CAD) continue to experience anginal and other related symptoms that are refractory to the combination of medical therapy and revascularization. The Euro Heart Survey on Revascularization (EHSCR) provided an opportunity to assess pharmacological treatment and outcome in patients with proven CAD who were ineligible for revascularization. Methods We performed a secondary analysis of EHS-CR data. After excluding patients with ST-elevation myocardial infarction and those in whom revascularization was not indicated, 4409 patients remained in the analyses. We selected two groups: (1) patients in whom revascularization was the preferred treatment option (n = 3777, 86%), and (2) patients who were considered ineligible for revascularization (n = 632, 14%). Results Patient ineligible for revascularization had a worse risk profile, more often had a total occlusion (59% vs. 37%, p < 0.001), were treated more often with ACE-inhibitors (65% vs. 55%, p < 0.001) but less likely with aspirin (83% vs. 88%, p < 0.001). Overall, they had higher case-fatality at 1-year (7.0% vs. 3.7%, p < 0.001). Regarding self-perceived health status, measured via the EuroQol 5D (EQ-5D) questionnaire, these same patients reported more problems on all dimensions of the EQ-5D. Furthermore, in the revascularization group we observed an increase between discharge and 1-year follow up (utility score from 0.85 to 1.00) whereas patients ineligible for revascularization did not improve over time (utility score remained 0.80) Conclusion In this large cohort of European patients with CAD, those considered ineligible for revascularization had more co-morbidities and risk factors, and scored worse on self-perceived health status as compared to revascularized patients in the revascularization group. With the exception of ACE-inhibitors and aspirin, there were no major differences regarding drug treatment between the two groups. Given these clinically significant observations, there appears to be a role for nurse-led, multidisciplinary, rehabilitation teams that target clinically vulnerable patients whose symptoms remain refractory to standard medical care.

Adolescent-parent disagreement on health-related quality of life of food-allergic adolescents:who makes the difference?

Background: Food-allergic adolescents are at highest risk for food allergy fatalities, which may be partly due to compromised self-management behavior. Such behavior may be negatively influenced by conflictual situations caused by adolescent–parent disagreement on the adolescent’s health-related quality of life (HRQL). Comparisons of adolescent-self-reported and parent-proxy-reported HRQL of food-allergic adolescents have never extensively been studied. The aims of this study were to investigate disagreement in adolescent-self-reports and parent-proxy-reports on the HRQL of food-allergic adolescents and to investigate the factors influencing adolescent–parent disagreement. Methods: Teenager Form (TF) and Parent Form (PFA) of the Food Allergy Quality of Life Questionnaire (FAQLQ), Food Allergy Independent Measure (FAIM), and Brief-Illness Perception Questionnaire (Brief-IPQ) were sent to food-allergic Dutch adolescents (13–17 years) and their parents. ICCs, t-tests, and Bland–Altman plots were used to investigate adolescent–parent disagreement. Participant characteristics, illness expectations, and illness perceptions influencing adolescent–parent disagreement were studied using regression analysis. Results: Seventy adolescent–parent pairs were included. There were a moderate correlation (ICC = 0.61, P < 0.001) and no significant difference (3.78 vs 3.56, P = 0.103) between adolescent-self-reported and parent-proxy-reported HRQL at group level. However, Bland–Altman plots showed relevant differences (exceeding the minimal important difference) for 63% of all adolescent–parent pairs. Adolescent’s age (>15 years), poorer adolescent-reported illness comprehension (Brief-IPQ-TF, coherence), and higher adolescent-reported perceived disease severity (Food Allergy Independent Measure-Teenager Form & -Parent Form) were associated with adolescent–parent disagreement. Conclusions: Adolescent–parent disagreement on the adolescent’s HRQL was mainly associated with adolescents’ rather than parents’ perceptions and characteristics. Illness comprehension of the adolescent may be an important target for intervention aimed at reducing adolescent–parent disagreement.

An intervention encouraging planned self-regulation and goal setting in drivers across the lifespan:testing an extended theory of planned behaviour

Previous work has demonstrated that planning behaviours may be more adaptive than avoidance strategies in driving self-regulation, but ways of encouraging planning have not been investigated. The efficacy of an extended theory of planned behaviour (TPB) plus implementation intention based intervention to promote planning self-regulation in drivers across the lifespan was tested. An age stratified group of participants (N=81, aged 18-83 years) was randomly assigned to an experimental or control condition. The intervention prompted specific goal setting with action planning and barrier identification. Goal setting was carried out using an agreed behavioural contract. Baseline and follow-up measures of TPB variables, self-reported, driving self-regulation behaviours (avoidance and planning) and mobility goal achievements were collected using postal questionnaires. Like many previous efforts to change planned behaviour by changing its predictors using models of planned behaviour such as the TPB, results showed that the intervention did not significantly change any of the model components. However, more than 90% of participants achieved their primary driving goal, and self-regulation planning as measured on a self-regulation inventory was marginally improved. The study demonstrates the role of pre-decisional, or motivational components as contrasted with post-decisional goal enactment, and offers promise for the role of self-regulation planning and implementation intentions in assisting drivers in achieving their mobility goals and promoting safer driving across the lifespan, even in the context of unchanging beliefs such as perceived risk or driver anxiety.

Food customs of rural and urban Inupiaq elders and their relationships to select nutrition parameters, food insecurity, health, and physical and mental functioning

The Inupiaq Tribe resides north of the Arctic Circle in northwestern Alaska. The people are characterized by their continued dependence on harvested fish, game and plants, known as a subsistence lifestyle (Lee 2000:35-45). Many are suggesting that they leave their historical home and move to urban communities, places believed to be more comfortable as they age. Tribal Elders disagree and have stated, "Elders need to be near the river where they were raised" (Branch 2005:1). The research questions focused on differences that location had on four groups of variables: nutrition parameters, community support, physical functioning and health. A total of 101 Inupiaq Elders ≥ 50 years were surveyed: 52 from two rural villages, and 49 in Anchorage. Location did not influence energy intake or intake of protein; levels of nutrition risk and food insecurity; all had similar rates between the two groups. Both rural and urban Elders reported few limitations of ADLs and IADLs. Self-reported general health scores (SF-12.v2 GH) were also similar by location. Differences were found with rural Elders reporting higher physical functioning summary scores (SF-12.v2 PCS), higher mental health scores (SF-12.v2 MH), higher vitality and less pain even though the rural mean ages were five years older than the urban Elders. Traditional food customs appear to support the overall health and well being of the rural Inupiaq Elders as demonstrated by higher intakes of Native foods, stronger food sharing networks and higher family activity scores than did urban Elders. The rural community appeared to foster continued physical activity. It has been said that when Elders are in the rural setting they are near "people they know" and it is a place "where they can get their Native food" (NRC 2005). These factors appear to be important as Inupiaq Elders age, as rural Inupiaq Elders fared as well or better than Inupiaq Elders in terms of diet, mental and physical health.

The effectiveness of a conceptually-based health and wellness course in developing health related factors, exercise self-efficacy and knowledge of health issues and exercise performance among diverse college students

The purpose of the study was to investigate the physiological and psychological benefits provided by a self-selected health and wellness course on a racially and ethnically diverse student population. It was designed to determine if students from a 2-year Hispanic serving institution (HIS) from a large metropolitan area would enhance their capacity to perform physical activities, increase their knowledge of health topics and raise their exercise self-efficacy after completing a course that included educational and activity components for a period of 16 weeks. A total of 185 students voluntarily agreed to participate in the study. An experimental group was selected from six sections of a health and wellness course, and a comparison group from students in a student life skills course. All participants were given anthropometric tests of physical fitness, a knowledge test, and an exercise self-efficacy scale was given at the beginning and at the conclusion of the semester. An ANCOVA analyses with the pretest scores being the covariate and the dependent variable being the difference score, indicated a significant improvement of the experimental group in five of the seven anthropometric tests over the comparison group. In addition, the experimental group increased in two of the three sections of the exercise self-efficacy scale indicating greater confidence to participate in physical activities in spite of barriers over the comparison group. The experimental group also increased in knowledge of health related topics over the comparison group at the .05 significance level. Results indicated beneficial outcomes gained by students enrolled in a 16-week health and wellness course. The study has several implications for practitioners, faculty members, educational policy makers and researchers in terms of implementation of strategies to promote healthy behaviors in college students and, to encourage them to engage in regular physical activities throughout their college years.

Health changes in Hispanic older adults in a Spanish arthritis self -management education program

Arthritis is the most common chronic condition affecting older people and is a major cause of limited activity. Arthritis education programs in English have demonstrated a positive impact on health but these programs have not reached the Hispanic communities where arthritis is the leading cause of disability. Minorities, such as Hispanics, have traditionally been reluctant to pursue self-help programs, and have been identified as an under-served population in terms of medical care. This study examined the effectiveness of one community health adult education program targeting Hispanic older adults with arthritis, the Spanish Arthritis Self Management Education Program (SASMEP), by evaluating changes in the participants' general health, pain, disability, self-efficacy, health perceptions, frequency of physician visits, and exercise. A pre and post control group experimental design and analyses of covariance were used to determine the pre and post differences in health status and health behaviors for a group participating in the SASMEP and a group who did not using gender and age as covariates. A repeated measures design was also used, and repeated measures analyses of variance and post hoc tests were done on health status and health behavior data collected pre, post and one-year post education to determine long-term differences. ^ Results indicated the participants' health status significantly improved in general health, significantly decreased in pain, and significantly decreased in arthritic disability immediately following the education. Self-efficacy and health perceptions increased for both groups but not significantly. The participants' health behaviors showed significantly fewer physician visits and significantly increased time spent performing stretching and strengthening exercise and time spent performing aerobic exercise. No group differences were found in the frequency of arthritis physician visits. ^ The improvements seen immediately after the SASMEP participation were not reflected in the post one-year scores. No significant differences were found for the participants' health status or health behaviors one year following the education. Health status and health behaviors did not return below baseline scores after one year suggesting the participants' health, although not improved, did not deteriorate. Therefore, the SASMEP education provided short-term health benefits for older Hispanic adults with arthritis, but not long-term health benefits. ^

The effects of health education on student health -related behaviors

During their transitional period from childhood to adulthood, adolescents engage in risk-taking behaviors that become public health concerns. It is important for school health education professionals to design instructional programs that focus on adolescents' developmental needs and foster healthier lifestyles. The goal of health education is to help students acquire health skills that are necessary to succeed in school and in life. This is especially important because the increase in teenagers' risky behaviors can affect their health, well being, and eventually the course of their lives. ^ This study examined the effects of health education on health-related behaviors of public high school students. A multivariate analysis of variance was conducted to determine whether the comprehensive approach based on The Jessors' Problem Behavior Theory (PBT) had a greater impact on adolescents' risk-taking behaviors than the traditional approach. After 18 weeks of health instruction using one of these approaches, the Youth Risk Behavior Survey (YRBS) was administered to measure the level of subjects' self-reported behaviors in six categories of adolescent risky behaviors: the use of tobacco; the use of alcohol and other drugs; engagement in injurious activities; consumption of unhealthy diet; an inadequate level of participation in physical activities; and engagement in risky sexual activities. ^ The results of this study did not support the hypothesis that using the comprehensive health education approach was more influential than the traditional health education approach in improving students' health-risk behaviors. Further research studies based on bio-psychosocial theories are needed to develop and evaluate methods of instruction and delivery of health skills. ^

Tradução e adaptação transcultural do domínio função física do Patient-Reported Outcomes Measurement Information System – PROMIS® - versão para a língua portuguesa

In 2004, the National Institutes of Health made available the Patient-Reported Outcomes Measurement Information System – PROMIS®, which is constituted of innovative item banks for health assessment. It is based on classical, reliable Patient-Reported Outcomes (PROs) and includes advanced statistical methods, such as Item Response Theory and Computerized Adaptive Test. One of PROMIS® Domain Frameworks is the Physical Function, whose item bank need to be translated and culturally adapted so it can be used in Portuguese speaking countries. This work aimed to translate and culturally adapt the PROMIS® Physical Function item bank into Portuguese. FACIT (Functional Assessment of Chronic Illness Therapy) translation methodology, which is constituted of eight stages for translation and cultural adaptation, was used. Fifty subjects above the age of 18 years participated in the pre-test (seventh stage). The questionnaire was answered by the participants (self-reported questionnaires) by using think aloud protocol, and cognitive and retrospective interviews. In FACIT methodology, adaptations can be done since the beginning of the translation and cultural adaption process, ensuring semantic, conceptual, cultural, and operational equivalences of the Physical Function Domain. During the pre-test, 24% of the subjects had difficulties understanding the items, 22% of the subjects suggested changes to improve understanding. The terms and concepts of the items were totally understood (100%) in 87% of the items. Only four items had less than 80% of understanding; for this reason, it was necessary to chance them so they could have correspondence with the original item and be understood by the subjects, after retesting. The process of translation and cultural adaptation of the PROMIS® Physical Function item bank into Portuguese was successful. This version of the assessment tool must have its psychometric properties validated before being made available for clinical use.

Migration and Perception of Health Status: a Qualitative Study in Kazakh Chinese

This qualitative study explored the rural to urban migration’s effect and its related factors on later life health status and health perception among Kazakh Chinese. The participants were same sex sibling pairs, of which one moved from rural to urban areas in early life and the other stayed in rural areas. Rural participants tend to have more selected chronic diseases conditions and other self-reported conditions than urban participants but less physical limitations in older age. There is no clear difference on the health perceptions between rural and urban participants. Health care access and environmental factors are the major differences that may affect health in later life for rural participants.

Alcoholic Beverage Preference and Dietary Habits in Elderly across Europe: Analyses within the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES) Project

INTRODUCTION: The differential associations of beer, wine, and spirit consumption on cardiovascular risk found in observational studies may be confounded by diet. We described and compared dietary intake and diet quality according to alcoholic beverage preference in European elderly.

METHODS: From the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES), seven European cohorts were included, i.e. four sub-cohorts from EPIC-Elderly, the SENECA Study, the Zutphen Elderly Study, and the Rotterdam Study. Harmonized data of 29,423 elderly participants from 14 European countries were analyzed. Baseline data on consumption of beer, wine, and spirits, and dietary intake were collected with questionnaires. Diet quality was assessed using the Healthy Diet Indicator (HDI). Intakes and scores across categories of alcoholic beverage preference (beer, wine, spirit, no preference, non-consumers) were adjusted for age, sex, socio-economic status, self-reported prevalent diseases, and lifestyle factors. Cohort-specific mean intakes and scores were calculated as well as weighted means combining all cohorts.

RESULTS: In 5 of 7 cohorts, persons with a wine preference formed the largest group. After multivariate adjustment, persons with a wine preference tended to have a higher HDI score and intake of healthy foods in most cohorts, but differences were small. The weighted estimates of all cohorts combined revealed that non-consumers had the highest fruit and vegetable intake, followed by wine consumers. Non-consumers and persons with no specific preference had a higher HDI score, spirit consumers the lowest. However, overall diet quality as measured by HDI did not differ greatly across alcoholic beverage preference categories.

DISCUSSION: This study using harmonized data from ~30,000 elderly from 14 European countries showed that, after multivariate adjustment, dietary habits and diet quality did not differ greatly according to alcoholic beverage preference.

Mental Health and Morbidity of Caregivers and Co-Residents of individuals with Dementia: A Quasi-Experimental Design

Objectives: To determine if providing informal care to a co-resident with dementia symptoms places an additional risk on the likelihood of poor mental health or mortality compared to co-resident non-caregivers.
Design: A quasi-experimental design of caregiving and non-caregiving co-residents of individuals with dementia symptoms, providing a natural comparator for the additive effects of caregiving on top of living with an individual with dementia symptoms. 
Methods: Census records, providing information on household structure, intensity of caregiving, presence of dementia symptoms and self-reported mental health, were linked to mortality records over the following 33 months. Multi-level regression models were constructed to determine the risk of poor mental health and death in co-resident caregivers of individuals with dementia symptoms compared to co-resident non-caregivers, adjusting for the clustering of individuals within households.
Results: The cohort consisted of 10,982 co-residents (55.1% caregivers), with 12.1% of non-caregivers reporting poor mental health compared to 8.4% of intense caregivers (>20 hours of care per week). During follow-up the cohort experienced 560 deaths (245 to caregivers). Overall, caregiving co-residents were at no greater risk of poor mental health but had lower mortality risk than non-caregiving co-residents (ORadj=0.93, 95% CI 0.79, 1.10 and ORadj=0.67, 95% CI 0.56, 0.81, respectively); this lower mortality risk was also seen amongst the most intensive caregivers (ORadj=0.65, 95% CI 0.53, 0.79).
Conclusion: Caregiving poses no additional risk to mental health over and above the risk associated with merely living with someone with dementia, and is associated with a lower mortality risk compared to non-caregiving co-residents.

The impact of childhood residential mobility on mental health outcomes in adolescence and early adulthood: a record linkage study.

Background Understanding the causes of poor mental health in early childhood and adolescence is important as this can be a significant determinant of mental well-being in later years. One potential and relatively unexplored factor is residential mobility in formative years. Previous studies have been relatively small and potentially limited due to methodological issues. The main aim of this study was to investigate the relationship between early residential instability and poor mental health among adolescents and young adults in Northern Ireland.

Methods A Census-based record linkage study of 28% of children aged 0–8 years in 2001 in Northern Ireland (n=49 762) was conducted, with six monthly address change assessments from health registration data and self-reported mental health status from the 2011 Census. Logistic regression models were built adjusting for socioeconomic status (SES), household composition and marital dissolution.

Results There was a graded relationship between the number of address changes and mental ill-health (adjusted OR 3.67, 95% CIs 2.11 to 6.39 for 5 or more moves). This relationship was not modified by SES or household composition. Marital dissolution was associated with poor mental health but did not modify the relationship between address change and mental health (p=0.206). There was some indication that movement after the age of five was associated with an increased likelihood of poor mental health.

Conclusions This large study clearly confirms the close relationship between address change in early years and later poor mental health. Residential mobility may be a useful marker for children at risk of poorer mental health in adolescence and early adulthood

Falls and the Social Isolation of Older Adults in the National Health and Aging Trends Study

Thesis (Ph.D.)--University of Washington, 2016-08

Unmet health needs in patients with coronary heart disease: implications and potential for improvement in caring services

BACKGROUND: Improving the quality of health care services requires tailoring facilities to fulfil patients' needs. Satisfying patients' healthcare needs, listening to patients' opinions and building a closer provider-user partnership are central to the NHS. Few published studies have discussed cardiovascular patients' health needs, but they are not comprehensive and fail to explore the contribution of outcome to needs assessment. METHOD: A comprehensive self-administered health needs assessment (HNA) questionnaire was developed for concomitant use with generic (Short Form-12 and EuroQOL) and specific (Seattle Angina Questionnaire) health-related quality of life (HRQL) instruments on 242 patients admitted to the Acute Cardiac Unit, Nottingham. RESULTS: 38% reported difficulty accessing health facilities, 56% due to transport and 32% required a travelling companion. Mean HRQOL scores were lower in those living alone (P < 0.05) or who reported unsatisfactory accommodation. Dissatisfaction with transport affected patients' ease of access to healthcare facilities (P < 0.001). Younger patients (<65 y) were more likely to be socially isolated (P = 0.01). Women and patients with chronic disease were more likely to be concerned about housework (P < 0.05). Over 65 s (p < 0.05) of higher social classes (p < 0.01) and greater physical needs (p < 0.001) had more social needs, correlating moderately (0.32 < r < 0.63) with all HRQL domains except SAQ-AS. Several HRQL components were highly correlated with the HNA physical score (p < 0.001). CONCLUSIONS: Patients wanted more social (suitable accommodation, companionship, social visits) and physical (help aids, access to healthcare services, house work) support. The construct validity and intra-class reliability of the HNA tool were confirmed. Our results indicate a gap between patients' health needs and available services, highlighting potential areas for improvement in the quality of services

The interpersonal and mental health implications of the coherence of coming out narratives for a sample of gay men in committed romantic relationships

The coming out process has been conceptualized as a developmental imperative for those who will eventually accept their same-sex attractions. It is widely accepted that homophobia, heterosexism, and homonegativity are cultural realities that may complicate this developmental process for gay men. The current study views coming out as an extra-developmental life task that is at best a stressful event, and at worst traumatic when coming out results in the rupture of salient relationships with parents, siblings, and/or close friends. To date, the minority stress model (Meyer, 1995; 2003) has been utilized as an organizing framework for how to empirically examine external stressors and mental health disparities for lesbians, gay men, and bisexual individuals in the United States. The current study builds on this literature by focusing on the influence of how gay men make sense of and represent the coming out process in a semi-structured interview, more specifically, by examining the legacy of the coming out process on indicators of wellness. In a two-part process, this study first employs the framework well articulated in the adult attachment literature of coherence of narratives to explore both variation and implications of the coming out experience for a sample of gay men (n = 60) in romantic relationships (n = 30). In particular, this study employed constructs identified in the adult attachment literature, namely Preoccupied and Dismissing current state of mind, to code a Coming Out Interview (COI). In the present study current state of mind refers to the degree of coherent discourse produced about coming out experiences as relayed during the COI. Multilevel analyses tested the extent to which these COI dimensions, as revealed through an analysis of coming out narratives in the COI, were associated with relationship quality, including self-reported satisfaction and observed emotional tone in a standard laboratory interaction task and self-reported symptoms of psychopathology. In addition, multilevel analyses also assessed the Acceptance by primary relationship figures at the time of disclosure, as well as the degree of Outness at the time of the study. Results revealed that participant’s narratives on the COI varied with regard to Preoccupied and Dismissing current state of mind, suggesting that the AAI coding system provides a viable organizing framework for extracting meaning from coming out narratives as related to attachment relevant constructs. Multilevel modeling revealed construct validity of the attachment dimensions assessed via the COI; attachment (i.e., Preoccupied and Dismissing current state of mind) as assessed via the Adult Attachment Interview (AAI) was significantly correlated with the corresponding COI variables. These finding suggest both methodological and conceptual convergence between these two measures. However, with one exception, COI Preoccupied and Dismissing current state of mind did not predict relationship outcomes or self-reported internalizing and externalizing symptoms. However, further analyses revealed that the degree to which one is out to others moderated the relationship between COI Preoccupied and internalizing. Specifically, for those who were less out to others, there was a significant and positive relationship between Preoccupied current state of mind towards coming out and internalizing symptoms. In addition, the degree of perceived acceptance of sexual orientation by salient relationship figures at the time of disclosure emerged as a predictor of mental health. In particular, Acceptance was significantly negatively related to internalizing symptoms. Overall, the results offer preliminary support that gay men’s narratives do reflect variation as assessed by attachment dimensions and highlights the role of Acceptance by salient relationship figures at the time of disclosure. Still, for the most part, current state of mind towards coming out in this study was not associated with relationship quality and self-reported indicators of mental health. This finding may be a function of low statistical power given the modest sample size. However, the relationship between Preoccupied current state of mind and mental health (i.e., internalizing) appears to depend on degree of Outness. In addition, the response of primary relationships figures to coming out may be a relevant factor in shaping mental health outcomes for gay men. Limitations and suggestions for future research and clinical intervention are offered.