Socioeconomic Disparities in Health Risk Behavior Clusterings Among Korean Adolescents

Purpose

This study aims to investigate the socioeconomic disparities in health risk behavior clusterings among Korean adolescents and to assess the mediating role of stress on this association.

Method

We analyzed the 2015 Korean Youth Risk Behavior Survey, a nationally representative sample of Korean middle and high school students aged 12–18 years (N?=?68,043). The co-occurrence of multiple health risk behaviors (i.e., cigarette smoking, drinking, and unprotected sex) was used to operationalize health risk behavior clusterings that ranged from zero to three. Ordinal and multinomial logistic regressions were conducted to examine socioeconomic disparities in health risk behavior clusterings and mediating effect of perceived stress between socioeconomic status (SES) and health risk behaviors.

Results

When SES was grouped into five groups, adolescents in the lowest SES [adjusted odds ratio (AOR)?=?2.15, 95% confidence interval (CI)?=?1.90–2.44] and the highest SES (AOR?=?1.29, 95% CI?=?1.18–1.40) showed a higher likelihood of risk behavior clusterings than any other SES groups. Stress partially mediated the relationship between SES and co-occurrence of multiple health risk behaviors while accounting for their demographic characteristics. Adolescents in the lowest and highest SES reported higher stress than other SES groups, which, in turn, was associated with the co-occurrence of multiple health risk behaviors.

Conclusion

The results suggest that perceived stress level partly explains why affluent as well as low-SES adolescents engage in multiple risk behaviors. The findings also discourage use of a linear approach in socioeconomic disparity investigation in relation to adolescent health behaviors.

     

Work–Family Conflict and Self-Rated Health: the Role of Gender and Educational Level. Baseline Data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Purpose

This study examined gender differences in the association between work–family conflict and self-rated health and evaluated the effect of educational attainment.

Method

We used baseline data from ELSA-Brasil, a cohort study of civil servants from six Brazilian state capitals. Our samples included 12,017 active workers aged 34–72 years. Work–family conflict was measured by four indicators measuring effects of work on family, effects of family in work and lack of time for leisure and personal care.

Results

Women experienced more frequent work–family conflict, but in both genders, increased work–family conflict directly correlated with poorer self-rated health. Women’s educational level interacted with three work–family conflict indicators. For time-based effects of work on family, highly educated women had higher odds of suboptimal self-rated health (OR?=?1.54; 95 % CI?=?1.19–1.99) than less educated women (OR?=?1.14; 95 % CI?=?0.92–1.42). For strain-based effects of work on family, women with higher and lower education levels had OR?=?1.91 (95 % CI 1.48–2.47) and OR?=?1.40 (95 % CI 1.12–1.75), respectively. For lack of time for leisure and personal care, women with higher and lower education levels had OR?=?2.60 (95 % CI?=?1.95–3.47) and OR?=?1.11 (95 % CI?=?0.90–1.38), respectively.

Conclusion

Women’s education level affects the relationship between work–family conflict and self-rated health. The results may contribute to prevention activities.

     

A modified evidence-based practice- knowledge,attitudes, behaviour and decisions/outcomes questionnaire is valid across multiple professions involved in pain management

Background

A validated and reliable instrument was developed to knowledge, attitudes and behaviours with respect to evidence-based practice (EBB-KABQ) in medical trainees but requires further adaptation and validation to be applied across different health professionals.

Methods

A modified 33-item evidence-based practice scale (EBP-KABQ) was developed to evaluate EBP perceptions and behaviors in clinicians. An international sample of 673 clinicians interested in treatment of pain (mean age?=?45 years, 48% occupational therapists/physical therapists, 25% had more than 5 years of clinical training) completed an online English version of the questionnaire and demographics. Scaling properties (internal consistency, floor/ceiling effects) and construct validity (association with EBP activities, comparator constructs) were examined. A confirmatory factor analysis was used to assess the 4-domain structure EBP knowledge, attitudes, behavior, outcomes/decisions).

Results

The EBP-KABQ scale demonstrated high internal consistency (Cronbach’s alpha?=?0.85), no evident floor/ceiling effects, and support for a priori construct validation hypotheses. A 4-factor structure provided the best fit statistics (CFI =0.89, TLI =0.86, and RMSEA?=?0.06).

Conclusions

The EBP-KABQ scale demonstrates promising psychometric properties in this sample. Areas for improvement are described.

     

Headache-Specific Locus of Control and Migraine-Related Quality of Life: Understanding the Role of Anxiety

Purpose

This cross-sectional study examined the relationship between headache-specific locus of control (HSLC) and migraine-related quality of life, and anxiety as a mediator of this relationship.

Method

Two hundred and thirty-two people with migraine participated in the treatment of severe migraine trial. At baseline, participants completed self-report questionnaires of headache-specific locus of control (HSLC; subscales?=?internal, chance, and medical professionals), anxiety, and migraine-related quality of life. Correlations examined relationships between HSLC, anxiety, and migraine-related quality of life; ordinary least squares regression evaluated anxiety as a mediator of the relationship between HSLC and migraine-related quality of life.

Results

Higher internal HSLC was related to higher overall migraine-related quality of life (ps?<?.05) and emotion function impairments (p?=?.012). Anxiety mediated the relationship between internal HSLC and all measures of migraine-specific quality of life (ps?<?.05). Higher external (medical professionals and chance) HSLC was related to higher migraine-related quality of life impairments (all ps?<?.001).

Conclusion

All HSLC beliefs are associated with higher migraine-related quality of life impairments. Anxiety mediates the relationship between internal HSLC and migraine-related quality of life.

     

Through thick and thin?

Background

A good romantic relationship quality increases resilience against mental and physical health problems. Regarding correlates of relationship quality, research has focused mostly on attachment style and personality traits such as the Big Five.

Objective

The current study aims to find further predictors of a good relationship quality, such as sleep, demographics, and the boundary concept.

Materials and methods

For the study, 336 subjects were recruited, most of them women (79.76%). Only participants who were in a relationship were included in the analyses (N?=?216). The effects of sleep (Pittsburgh Sleep Quality Index, PSQI), demographics, and thin or thick boundaries (Boundary Personality Questionnaire, BPQ) on relationship quality (Partnerschaftsfragebogen—Kurzversion, PFB-K) were assessed using multiple regression.

Results

Age and thickness of boundaries were significantly connected with relationship quality. Sleep quality, gender, body mass index, and accommodation were not related to relationship quality.

Conclusion

The current study confirms the importance of age and provides new insight into the effects of boundaries in terms of relationship quality. Methodological limitations (e.g., homogenous and healthy sample) might compromise the findings regarding sleep. Future studies should include a more diverse sample and investigate further correlates of the boundary concept.

     

Workplace Stress and Working from Home Influence Depressive Symptoms Among Employed Women with Young Children

Background

Poor balance between work and family can be a major stressor for women with young children and have a negative impact on emotional well-being. Family-friendly workplace attributes may reduce stress and depressive symptoms among this population. However, few studies have analyzed the role of specific workplace attributes on mental health outcomes among women with young children because available data are limited.

Purpose

This study examines the impact of workplace attributes on changes in depressive symptoms among working women with young children between 6 and 24 months of age.

Method

This study uses data from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development (SECCYD) collected between 1991 and 1993 to examine the effects of work intensity, work schedule (night/day/variable), schedule flexibility, working from home, and work stress on changes in depressive symptoms among a national US sample of 570 women who returned to work within 6 months after childbirth. Depressive symptoms were assessed using the CES-D score. Treatment effects were estimated using fixed effects regression models.

Results

Working from home and work stress predicted within-individual changes in depressive symptoms between 6 and 24 months postchildbirth. Women who worked from home reported a statistically significant decrease in depression scores over time (β?=??1.36, SE?=?0.51, p?=?0.002). Women who reported a one-unit increase in job concerns experienced, on average, a 2-point increase in depression scores over time (β?=?1.73, SE?=?0.37, p?<?0.01). Work intensity, work schedule, and schedule flexibility were not associated with changes in depressive symptoms.

Conclusions

This study is one of the few to use longitudinal data and causal-inference techniques to examine whether specific workplace attributes influence depressive symptoms among women with young children. Reducing stress in the workplace and allowing women to work from home may improve mental health among women who transition back to work soon after childbirth.

     

Do stress coping strategies influence chronotype-related differences in sleep quality?

Background

Chronotype manifestation often has a broad influence on sleep quality. One possible explanation for daytime impairments in evening types is the concept of “social jetlag”. Social jetlag is caused by an incompatibility between circadian preference and the socially accepted rhythm. This can be declared as a social stressor.

Objective

The association between chronotype, stress coping, and sleep quality was assessed in a pilot study.

Materials and methods

A total of 75 female adults aged 20–41 years participated in the study and completely answered all questions. Various questionnaires including sociodemographic data, information about sleep quality (Pittsburgh Sleep Quality Index, PSQI), chronotype (morningness–eveningness questionnaire, MEQ), and stress coping (Stress Coping Style Questionnaire, SVF78) were applied.

Results

Heightened use of maladaptive coping strategies is associated with a reduction in sleep quality. Chronotypes did not differ in terms of sleep quality and the coping strategies used.

Conclusion

Maladaptive coping strategy use seems to have a negative influence on sleep quality. Preventive education in adaptive stress coping strategies and avoidance of maladaptive stress coping thus seems useful to reduce these adverse influences on sleep quality.

     

Medical and pharmacy student concerns about participating on international service-learning trips

Background

International Service Learning Trips (ISLT) provide health professional students the opportunity to provide healthcare, under the direction of trained faculty, to underserved populations in developing countries. Despite recent increases in international service learning trips, there is scant literature addressing concerns students have prior to attending such trips. This study focuses on identifying concerns before and after attending an ISLT and their impact on students.

Methods

A survey comprised of closed and open-ended questions was developed to elucidate student concerns prior to attending an ISLT and experiences which might influence concerns. A five-point Likert-scale (extremely concerned?=?1, minimally concerned?=?5) was used to rate apprehension and satisfaction. Paired t-test was used to compare pre- and post-trip concerns; Chi-Square test was used to compare groups.

Results

Thirty-five students (27 medical, 8 pharmacy) attended ISLTs in December 2013. All completed pre and post-trip surveys. Significant decreases were seen in concerns related to cultural barriers (4.14 vs 4.46, P?=?.047), disease/epidemics (3.34 vs 4.60, P?<?.001), natural disasters (3.94 vs 4.94, P?<?.001), terrorism (4.34 vs 4.94, P?<?.001), travel (3.86 vs 4.51, P?<?.001) monetary issues (3.80 vs 4.60, P?<?.001), hospitality (3.94 vs 4.74, P?=?.001) and food (3.83 vs 4.60, P?<?.001). Language and group dynamics remained concerns post-trip. On open-ended questions, students described benefits of attending an ISLT.

Conclusions

Students had multiple concerns prior to attending an ISLT. Most decreased upon return. Addressing concerns has the potential to decrease student apprehension. The results of this study highlight the benefits of providing ISLTs and supporting development of a curriculum incorporating trip-related concerns.

     

Negative Stress Beliefs Predict Somatic Symptoms in Students Under Academic Stress

Purpose

Medically unexplained symptoms are abundantly present in the general population. Stress may lead to increased symptom reporting because of widespread beliefs that it is dangerous for one’s health. This study aimed at clarifying the role of stress beliefs in somatic symptom reporting using a quasi-experimental study design.

Methods

Two hundred sixteen German university students (60 % of an initial sample of 363) were examined at the beginning of the term (less stressful period) and at the end of the term (stressful period due to exams). Negative beliefs about stress at baseline were expected to predict somatic symptoms at follow-up.

Results

Negative beliefs about stress at baseline significantly predicted somatic symptoms at follow-up (β?=?0.16, p?=?.012), even when controlling for general strain, physical and mental health status, neuroticism, optimism, and somatosensory amplification.

Conclusions

Being convinced that “stress is bad for you” was prospectively associated with somatic symptoms during a stressful period. Further research in patients with medically unexplained conditions is warranted to corroborate these findings.

     

Socioeconomic Status,Waist-to-Hip Ratio,and Short-Term Heart Rate Variability in Cambodians with Type 2 Diabetes

Background

Diabetes, adiposity, and socioeconomic status (SES) are all associated with decreased heart rate variability (HRV), a marker of autonomic function predictive of mortality. Cambodians have high rates of diabetes and low SES. How these factors interact to explain HRV has not been examined.

Purpose

The aims of this study were to investigate associations among waist-to-hip ratio, socioeconomic status, and HRV among Cambodians with diabetes.

Method

Sixty patients with type 2 diabetes for ≥1 year, not taking insulin, aged 35–80 years were recruited from the Cambodian Diabetes Association. The 2010 Ministry of Health survey regarding household conditions was used to measure SES. Waist-to-hip ratio was measured two times and averaged. For HRV, beat-to-beat intervals were recorded on ambulatory ECG recorders, and short-term HRV was calculated in the time domain and in the frequency domain using spectral analysis. Cross-sectional data were analyzed using a series of multiple linear regressions using SPSS v21.

Results

Participants were of mean age of 56 years old, 60 % female, with National Glycohemoglobin Standardization Program (NGSP) HbA1c mean?=?8.4. Participants were poor (e.g., 18 % did not have flush toilets), had high waist-to-hip ratios (mean?=?0.91), and had HRV values below published norms. In linear regression, there was a significant interaction between waist-to-hip ratio and SES explaining HRV in the time domain (standard deviation of the R-R interval (SDNN), beta?=?.33, t?=?2.61, p?<?.05) and the frequency domain (log transformed very low frequency (Ln VLF), LF, and total power; all p?<?.05). Among those with lower SES only, higher waist-to-hip ratio was associated with lower HRV. Findings remained significant after controlling for age, sex, and HbA1c.

Conclusion

Central adiposity shows a stronger deleterious association with autonomic tone among individuals with more adverse social conditions.

     

Examining the Associations Between Overeating,Disinhibition, and Hunger in a Nonclinical Sample of College Women

Background

Binge eating (BE) has long been identified as a correlate of overweight and obesity. However, less empirical attention has been given to overeating with and without loss of control (LOC) in nonclinical samples.

Purpose

The goal of the present study was to examine the association of (1) established correlates of BE, namely, weight and shape concerns, dietary restraint, and negative affect, and (2) three additional correlates, disinhibition, hunger, and interoceptive awareness (IA), to overeating in a nonclinical sample of college women.

Method

Female students (n?=?1,447) aged 18 to 21 years recruited from colleges in three Canadian metropolitan areas completed self-report questionnaires in class to assess sociodemographic and anthropomorphic characteristics, overeating, LOC, dietary restraint, negative affect, weight and shape concerns, IA, disinhibition, and hunger.

Results

The established correlates of BE were significant correlates of all types of overeating and explained 33 % of the variance. Disinhibition was the most strongly associated correlate of overeating.

Conclusions

Findings suggest that established correlates of BE are associated with other types of overeating such as objective overeating (OOE), as are disinhibition and hunger.

     

Risk of gestational hypertension and preeclampsia in women who discontinued or continued antidepressant medication use during pregnancy

Purpose

This study aimed to examine the association between discontinued and continued use of antidepressants and risk for gestational hypertension (GH) and preeclampsia (PE).

Methods

Data from the MotherToBaby pregnancy studies from 2004 to 2014 were analyzed to compare women who discontinued antidepressant use ?20 weeks of gestation (discontinuers) and women who continued antidepressant use ≥20 weeks of gestation (continuers) to non-users for risk of GH (blood pressure ≥140/90 mmHg on two or more occasions at ≥20 weeks of gestation) and PE (GH with proteinuria). Maternal data, including exposures and study outcomes, were collected through multiple phone interviews. Medical records were used to validate outcomes. Odds ratios (ORs) and 95 % confidence intervals were estimated using logistic regression. Risk for GH and PE were also assessed within antidepressant drug classes.

Results

Data from 3471 women were analyzed. Continuers were significantly at risk for GH (adjusted odds ratios (aOR) 1.83; 95 % CI 1.05, 3.21) after adjustment. Analyses by drug class showed that continued use of serotonin-norepinephrine reuptake inhibitors (SNRI) increased risk for GH; however, of the 21 women who continued to use SNRI, only 3 developed GH. Continuers who used two or more antidepressant drug classes had increased risk for PE. Selective serotonin reuptake inhibitors or other antidepressant use was not associated with increased risk for GH or PE. No significant associations with PE or GH were found for discontinuers.

Conclusions

Results suggest that women who continued to use antidepressants in the second half of pregnancy are at risk for GH and PE. No significant association was found among discontinuers.

     

Preliminary estimation of the prevalence of chemotherapy-induced dysgeusia in Japanese patients with cancer

Background

Although dysgeusia is a common adverse event in chemotherapy patients; it has not been evaluated using objective methods, and its prevalence and frequency have not been quantified.

Methods

Salt-impregnated taste strips were used to objectively assess dysgeusia in patients receiving chemotherapy at Akita University (n?=?38) and those off chemotherapy (n?=?9). Participant characteristics, and ongoing and previous chemotherapies were evaluated, and their associations with dysgeusia analyzed.

Results

Dysgeusia developed in 38.8% (14/38) of chemotherapy patients, and was most prevalent in patients receiving 5-fluorouracil (5-FU) or its oral analogs (48.1%, 13/27). Particularly, dysgeusia developed in 55.6% (10/18) of patients receiving oral 5-FU analogs; however, prevalence in patients receiving and off chemotherapy was not significantly different. Patients aged ≥70 years also tended to experience dysgeusia (75.0%, 6/8).

Conclusions

Association with dysgeusia may be higher for some chemotherapeutic drugs. Dysgeusia should be routinely assessed in chemotherapy patients with objective methods such as paper strips; interventions for its prevention may be required.

     

Music Listening and Stress in Daily Life—a Matter of Timing

Purpose

Despite increasing evidence suggesting that music listening in daily life has stress-reducing effects, studies mostly rely on subjective, retrospective data on music listening. Thus, the temporal dynamics underlying the stress-reducing effect of music listening remain unclear. Therefore, we aimed to examine the temporal dynamics of the associations between stress and music listening by assessing subjective and objective data on music in daily life.

Design

An exploratory Ambulatory Assessment study examining a total of 60 participants (37 women), aged 18 to 34 years (M = 22.4 years, SD = 3.5) was conducted.

Methods

For 1 week, participants answered questions on music listening and stress six times per day via an electronic diary device, which additionally objectively sampled the exact time point of music listening and its duration.

Results

Self-reports on mere music listening were associated with lower stress reports, whereas objectively assessed data was not. However, concerning duration of music listening, both subjective and objective data on music listening showed associations between a minimum of 20 min of music listening and lower stress reports. Concerning the latency, objective data on music listening revealed that the association between stress reports and music listening occurs in a time-delayed manner.

Conclusions

Although the study design does not allow for causal inferences, substantial associations among subjectively and objectively assessed data on music listening were found to differentially affect the experience of stress after music listening. In particular, when focusing on the temporal dynamics, objectively assessed data allowed for a more fine-grained analysis. In consequence, subjectively and objectively reported data on music listening should be assessed jointly when investigating effects of music listening on health. Experimental research with rigorous methodological control is required in order to corroborate our findings in a laboratory setting.

     

Acupuncture decreased the risk of coronary heart disease in patients with rheumatoid arthritis in Taiwan: a Nationwide propensity score-matched study

Background

Patients with rheumatoid arthritis (RA) have a higher risk of coronary heart disease (CHD). Acupuncture, a commonly used treatment for patients with RA, has not been reported to prevent CHD in patients with RA. We aimed to assess the risk of developing CHD in acupuncture users and non-users of patients with RA.

Methods

We identified 29,741 patients with newly diagnosed RA from January 1997 to December 2010 from the Registry of Catastrophic Illness Patients Database from the Taiwanese National Health Insurance Research Database. Among them, 10,199 patients received acupuncture (acupuncture users), and 19,542 patients did not receive acupuncture (no-acupuncture users). After performing 1:1 propensity score matching by sex, age, baseline comorbidity, conventional treatment, initial diagnostic year, and index year, there were 9932 patients in both the acupuncture and no-acupuncture cohorts. The main outcome was the diagnosis of CHD in patients with RA in the acupuncture and no-acupuncture cohorts.

Results

Acupuncture users had a lower incidence of CHD than non-users (adjusted HR?=?0.60, 95% CI?=?0.55–0.65). The estimated cumulative incidence of CHD was significantly lower in the acupuncture cohort (log-rank test, p?<?.001). Subgroup analysis showed that patients receiving manual acupuncture of traditional Chinese medicine style, electroacupuncture, or combination of both all had a lower incidence of CHD than patients never receiving acupuncture treatment. The beneficial effect of acupuncture on preventing CHD was independent of age, sex, diabetes mellitus, hypertension, hyperlipidemia, and statins use.

Conclusions

This is the first large-scale study to reveal that acupuncture might have beneficial effect on reducing the risk of CHD in patients with RA. This study may provide useful information for clinical utilization and future studies.

     

Lack of MMP-9 expression is a marker for poor prognosis in Dukes’ B colorectal cancer

Background

Matrix metalloproteinases (MMPs) play a role in cancer progression by degrading extracellular matrix and basement membranes, assisting in tumour neovascularization and in supporting immune response in cancer.

Methods

We studied the prognostic value of immunohistochemical expression of MMP-2, MMP-8, and MMP-9 in a series of 619 colorectal cancer patients using tissue microarray specimens.

Results

Of the samples, 56% were positive for MMP-2, 78% for MMP-8, and 60% for MMP-9. MMP-9 associated with low WHO grade (p?<?0.001). In univariate analysis of Dukes’ B tumours, MMP-9 negativity associated with poor survival (p?=?0.018), and MMP-9 positivity was an independent prognostic marker in multivariate analysis of these tumours (p?=?0.034).

Conclusion

Negative MMP-9 expression can predict poor prognosis in Dukes’ B colorectal tumours and may prove useful for identifying patients, who should be offered adjuvant treatment.

     

Larger and More Prominent Graphic Health Warnings on Plain-Packaged Tobacco Products and Avoidant Responses in Current Smokers: a Qualitative Study

Background

The introduction of tobacco plain packaging legislation in Australia meant that all tobacco products were to be sold in plain dark-brown packaging with 75 % front-of-pack graphic health warnings and standardised font type and size for brand name and product variant. The change in the size and prominence of the warnings has been proposed as a reason for behaviour change in smokers in terms of increased intentions to quit and quit attempts.

Purpose

The current research examined attitudes and beliefs of cigarette smokers toward the increased size and prominence of the warnings and effects on their behaviour.

Method

Participants (N?=?160) completed open-ended responses to questions on beliefs, attitudes and responses to plain packaging. Responses were subjected to inductive thematic content analysis for key themes.

Results

Four themes emerged from the analysis: emotional response to packaging, scepticism of health warnings, warnings and cessation behaviour, and avoidant coping behaviours. Participants reported increased negative emotional responses to the packaging and made specific reference to the graphic health warnings. Some participants attempted to discredit the messages. Others reported increased intentions to quit or quitting attempts. There were pervasive reports of avoidant responses including covering or hiding the warnings.

Conclusion

Consistent with theories of illness perceptions and coping, current findings indicate that the larger, prominent graphic health warnings on plain-packaged tobacco products had pervasive effects on threat perceptions and subsequent behavioural responses. While some of the reported responses were adaptive (e.g. attempts to quit), others were maladaptive (e.g. avoiding the warnings).

     

Effects of different natural extracts in an experimental model of benign prostatic hyperplasia (BPH)

Objective and design

To characterize the impact of inflammatory process and oxidative stress in the degree of benign prostatic hyperplasia (BPH), a common condition in which chronic inflammation plays a crucial role, we investigated the effect of different plant extract preparations in an in vivo model of BPH as new therapeutic target.

Material

BPH was made in rats with daily administration of testosterone propionate (3 mg/kg) for 14 days.

Treatment

Rats were randomized into different groups to receive oral administration of plant extract preparations: Serenoa repens with selenium (SeR 28.5 mg/kg associated with Se 0.005 mg/kg), Teoside (2 mg/kg), and Puryprost (14 mg/kg containing Teoside 50% 2 mg/kg and Epilobium 12 mg/kg).

Methods

After 14 days, rats were killed and histological changes, prostate weight and apoptotic pathways were assayed.

Results

The results obtained demonstrated that the association of treatments reduced prostate weight and hyperplasia, while treatment with Puryprost demonstrated a greater trend of protection compared to the other treatments.

Conclusion

Thus, our results indicate that plant extract could be considered as new useful therapy in the treatment of BPH with particular attention on Puryprost that represents a rational approach to reduce BPH through modulation of inflammatory process and anti-oxidant process.