Productivity Loss at Work; Health-Related and Work-Related Factors

Introduction Productivity loss is an increasing problem in an aging working population that is decreasing in numbers. The aim of this study is to identify work-related and health-related characteristics associated with productivity loss, due to either sickness absence or reduced performance at work. Methods In this cross-sectional study, data of the Netherlands Working Conditions Survey of 2007 were used, which includes a national representative sample of 22,759 employees aged 15 to 64 years. Demographic characteristics, health-related and work-related factors were assessed with a questionnaire. Logistic regression analyses were carried out to study the relationship of work-related and health-related factors with low performance at work and sickness absence in the past 12 months. Results Poor general health, the number of longstanding health conditions, and most types of longstanding health conditions were associated with productivity loss. Health-related factors were in general stronger associated with sickness absence than with low performance at work. Performance: poor health OR 1.54 CI 1.38–1.71, >1 health conditions OR 1.21 CI 1.09–1.35; sickness absence: poor health OR 2.62 CI 2.33–2.93, >1 health conditions OR 2.47 CI 2.21–2.75. Of the different types of longstanding health conditions, only psychological complaints and to a small extent musculoskeletal symptoms, were associated with low performance (respectively OR 1.54 CI 1.27–1.87; OR 1.09 CI 1.00–1.18). Low performance at work was less likely among employees with high physically demanding work (shift work OR 0.70 CI 0.63–0.76, using force OR 0.78 CI 0.72–0.84, and repetitive movements OR 0.74 CI 0.70–0.79). Psychosocial factors were stronger associated with low performance at work than with sickness absence (performance: job autonomy OR 1.28 CI 1.21–1.37, job demands OR 1.23 CI 1.16–1.31, emotionally demanding work OR 1.73 CI 1.62–1.85; sickness absence: job autonomy ns, job demands OR 1.09 CI 1.03–1.17, emotionally demanding work OR 1.09 CI 1.02–1.16). Conclusion Except for psychological complaints, workers with a longstanding health condition generally perform well while being at work. Nevertheless, the likelihood of taking sick leave is increased. Among work-related factors, psychosocial work characteristics have the strongest relation with productivity loss, mostly with performance while at work.     

Mental Health Screening of Adolescents in Pediatric Practice

This study examines routine computerized mental health screening for adolescents scheduled for a routine physical examination in a group pediatric practice. Medical records of adolescents aged 13 to 17 who were offered screening (n = 483) were reviewed. Approximately 44.7% (95% confidence interval (CI) 40.3–49.2) were screened, and 13.9% (95% CI 9.3–18.5) were identified as being at risk. Screening was associated with significantly increased odds of receiving either pediatric mental health care or a referral for specialty mental health care (adjusted odds ratio (AOR): 2.6 95% CI 1.2–5.6). Among patients who received either mental health intervention, those who were screened were significantly more likely to be referred to specialty care (AOR: 15.9 95% CI 2.5–100.4), though they were less likely to receive pediatric mental health care (AOR: 0.10 95% CI 0.02–0.54). The findings support the feasibility of routine mental health screening in pediatric practice. Screening is acceptable to many parents and adolescents, and it is associated with referral for specialized mental health care rather than care from the pediatrician.     

Stress-Associated Poor Health Among Adult Immigrants with a Language Barrier in the United States

The healthy migrant hypothesis supported by the ‘Hispanic paradox’ suggests that immigrants are healthier than non-immigrants. To test the generalizability of this hypothesis, we studied the stress-associated health status of adult immigrants with a language barrier in the USA. Three stress-related conditions (Unhappiness, Depression, and Anxiety) and self-reported health status were ascertained from participants of the Community Tracking Study Health Survey conducted in 2003. The associations between these conditions as well as the immigrants’ length of time living in the USA and health were assessed. Our results demonstrated that the three stress-related conditions were significantly associated with a dramatically elevated poor health status (Unhappiness: OR = 5.22, 95% CI: 4.43–6.14; Depression: OR = 3.03, 95% CI: 2.31–3.98; Anxiety: OR = 5.12, 95% CI: 3.53–7.41). Compared to US citizens without a language barrier, immigrants with a language barrier were more likely to report poor health (OR = 2.15, 95% CI: 1.66–2.78). After adjustment for stressors, the likelihood of reporting poor health among immigrants with a language barrier decreased significantly (OR = 1.75, 95% CI: 1.05–2.91). In addition, these immigrants were more likely to report poor health within the first 10 years of their living in the USA (≤5 years: OR = 2.79, 95% CI: 1.94–4.02; 6–10 years: OR = 2.68, 95% CI: 1.86–3.86). In summary, immigrants who have a language barrier were generally more stressed, especially at the beginning of their lives as immigrants. The combined effect of stress and a language barrier led to poorer health in these immigrants. Thus, the healthy migrant hypothesis may not be generalizable to this population.     

A new measurement for optimal antenatal care: determinants and outcomes in Cameroon

A combined measure of optimal antenatal care can provide more information on the role it plays in maternal health. Our objectives were to investigate the determinants of a measure of optimal antenatal care and the associated pregnancy outcomes. Data on 7,557 women taken from the 2004 Demographic and Health Survey in Cameroon were used to develop a new measurement of optimal antenatal care based on four indicators: at least four visits, first visit in first trimester, last visit in third trimester and a professional provider of antenatal care. We studied the relationship of this new variable with other related variables in a multivariate analysis, taking into account the complex study design. Almost sixty six percent of the women had optimal antenatal care. Secondary or higher education (OR 1.74; 95% CI 1.28–2.36), greater wealth (OR 2.31; 95% CI 1.73–3.1), urban residence (OR 1.42; 95% CI 1.12–1.82) and parity of 3–4 (OR 0.79; 95% CI 0.62–0.99) were independently associated with optimal antenatal care. Women with optimal antenatal care were more likely to deliver in a health unit (OR 2.91; 95% CI 2.42–3.49), to be assisted by a skilled health worker during delivery (OR 1.88; 95% CI 1.49–2.37) and to have a baby with a normal birthweight (OR 1.62; 95% CI 1.11–2.38). Obtaining and using a new measure for ANC is feasible. The association of optimal antenatal care to education, wealth and residence in this study, consistent with others, highlights the role of the country’s development in maternal health.     

Discriminatory Mass De-housing and Low-Weight Births: Scales of Geography,Time, and Level

Struening et al.1 demonstrated a widening disparity of low birthweight (LOB) rates among New York City health areas from 1980–1986, clearly a dynamic process. In contrast, the New York City Department of Health reported static citywide LOB rate in 1988–2008.2 Struening et al.1 is extended here at the health district level with mapping and regression analyses. Additionally, birthweight data are reported for babies born in 1998–2001 to a group of African-American and Dominican women in Upper Manhattan. The data reported in this paper indicate that both fetal programming of the mother herself (life course model) and stress during or shortly before pregnancy may play a role in LOB. Current stress may arise from past events. Intergenerational effects, thus, could arise from stresses on the grandmother and their residual impacts on the mother as well as new stresses on the mother as an adult. The average weight of babies born to the Upper Manhattan mothers who were born in 1970–1974 was 3,466 g, with 1.6% below 2,500 g; that of babies of mothers born in 1975–1979, 3,320 g, with 6% below 2,500 g. The latter group was born during the 1975–1979 housing destruction. Intergenerational impacts of that event may be reflected in this elevated rate of LOB. Health district maps of LOB incidence ranges show improvement from 1990–2000 and then deterioration in 2005 and 2008. Bivariate regressions of socioeconomic (SE) factors and LOB incidence showed many strong associations in 1990; but by 2000, the number and strength of these associations declined. In 1990, 2000, and 2008, black segregation was the SE factor most strongly associated with LOB. Black segregation and murder rate explained about 85% of the pattern of 1990 LOB. Regressing the 1970–1980 percent population change against the SE factors showed effects even in 2000. The 1990 murder rate and 1989 percentage of public assistance explained over half the 2008 LOB incidence pattern. The housing destruction of the 1970s continued to influence LOB incidence indirectly in 2008. The ability of community and individual to cope with current stressors may hinge on resilience status, which is shaped by past events and circumstances. The present interacts with the past in many ways. Serial displacement exemplifies this interaction of immense importance to public health.     

Changes in Maternal and Child Health Outcomes After Introduction of a Helicopter into Perinatal Transportation in Japan

To examine the effect of perinatal helicopter transportation on maternal and child health. Helicopter transportation for the sparsely populated southern areas of Wakayama and Mie prefectures was introduced in June 2003. Maternal and child health statistics for 2000–2002 and 2004–2006 were compared between the south and north regions of the prefectures. There were 9 maternal transports from south Wakayama, 2 from north Wakayama, and 5 from south Mie in 2004–2006; and 13 neonatal transports from south Wakayama and 7 from north Wakayama during the same period. Decreases in neonatal and perinatal mortalities in 2004–2006 compared to 2000–2002 were greater in south Wakayama than in north Wakayama (−0.31 vs. −0.28, and −0.57 vs. −0.18, respectively); and greater in south Mie than in north Mie (−0.90 vs. −0.49, and −2.49 vs. −1.48, respectively). The changes in the number of maternal deaths between 2000–2002 and 2004–2006 were 0 in south Wakayama, 1 in north Wakayama, −2 in south Mie, and −1 in north Mie, with the greatest change occurring in south Mie. Use of a helicopter for perinatal transportation can possibly improve maternal and child health in sparsely populated areas far away from urban areas.     

Health care expenditure inertia in the OECD countries: A heterogeneous analysis

Health care expenditure studies of the Organization for Economic Cooperation and Development (OECD) countries remain important because their findings often suggest cost containment and other policy initiatives. This paper focuses on the compatibility of OECD health data with the “expenditure inertia” (or lagged adjustments) hypothesis, by modeling individual country time‐series data of 21 nations for the 1960–1993 period. Maximum likelihood estimates of the Box–Cox transformation regression models reveal that: (a) the hypothesized impact of health “expenditure inertia” is both pervasive and strong, averaging 0.64 across the countries; (b) the real GDP elasticities of health care expenditures vary widely among the countries and average 0.34 in the short run – implying that health care is a necessity; (c) the long run GDP elasticities are less than 1 in 8 countries, unitary elastic in 8 countries and elastic in 5 countries – suggesting that health care is not universally a necessity or a luxury commodity for the OECD countries; (d) physician‐inducement effects (dis‐inducement in a few countries) are weak, with a mean elasticity estimate of 0.17; and (e) no unique functional form approximation model is globally compatible with the data across the countries. Health care cost containment policy implications of these findings are explored. This revised version was published online in July 2006 with corrections to the Cover Date.     

Associations of self-rated health with different forms of leisure activities among ageing people

Summary Objectives:  This study examined associations between self-rated health and specific forms of leisure activities – i. e. singing in a choir, art painting, playing music; art exhibitions, theatre, movies, concerts; religious events; studying and self-development; voluntary work – and investigated how confounding factors contribute to these associations among ageing people in Finland. Methods:  A postal survey was conducted in 2002 among men and women born in 1926–30, 1936–40 and 1946–50. The final 2,815 participants represented 66% of the original sample drawn, stratified by age, gender, and municipality. Logistic regression analyses were used to investigate associations between specific forms of leisure activities and self-rated health. Results:  Going to art exhibitions, theatre, movies, and concerts among women and studying and self-development among men were significantly positively related to self-rated health, even after adjusting for socioeconomic status (SES), other sociodemographic variables, obesity, and health behaviours. Among women, active participation in religious events and voluntary work were negatively associated with self-rated health. Conclusions:  The association of leisure activities and good self-rated health may differ for genders due to their nature or meaning. Partial support was found for the assumption that leisure activities go together with better self-rated health among ageing people. Submitted: 14 December 2006; Revised: 04 July 2007; Accepted: 02 April 2008     

Is Health Insurance Enough? A Usual Source of Care may be More Important to Ensure a Child Receives Preventive Health Counseling

Despite the promise of expanded health insurance coverage for children in the United States, a usual source of care (USC) may have a bigger impact on a child’s receipt of preventive health counseling. We examined the effects of insurance versus USC on receipt of education and counseling regarding prevention of childhood injuries and disease. We conducted secondary analyses of 2002–2006 data from a nationally-representative sample of child participants (≤17 years) in the Medical Expenditure Panel Survey (n = 49,947). Children with both insurance and a USC had the lowest rates of missed counseling, and children with neither one had the highest rates. Children with only insurance were more likely than those with only a USC to have never received preventive health counseling from a health care provider regarding healthy eating (aRR 1.21, 95% CI 1.12–1.31); regular exercise (aRR 1.06, 95% CI 1.01–1.12), use of car safety devices (aRR 1.10, 95% CI 1.03–1.17), use of bicycle helmets (aRR 1.11, 95% CI 1.05–1.18), and risks of second hand smoke exposure (aRR 1.12, 95% CI 1.04–1.20). A USC may play an equally or more important role than insurance in improving access to health education and counseling for children. To better meet preventive counseling needs of children, a robust primary care workforce and improved delivery of care in medical homes must accompany expansions in insurance coverage.     

Gradients in the Health Status and Developmental Risks of Young Children: The Combined Influences of Multiple Social Risk Factors

Objectives: To analyze child vulnerability as a profile of multiple risk factors for poorer health based on race/ethnicity, social class (maternal education and family poverty status), child health insurance coverage, and maternal mental health. Profiles are examined in relation to disparities in the health status and developmental risks of young children. Data Sources: Cross-sectional data on 2,068 children ages 4–35 months from the 2000 National Survey of Early Childhood Health. Study Design: Multiple logistic regression models are used to examine risk profiles in relation to child health status and developmental risk (based on parent concerns about development). The profiles are also examined in relation to three measures of basic access to health care: telephone contact with a physician, well-child visit in the past year, and missed or delayed needed care. Principal Findings: About one-third of (or 3.1 million) young children in the United States have two or more risk factors (RF) for poor health. Controlling for other family factors, having more RFs is associated with poorer health status (i.e., percent reported “good/fair/poor” vs. “excellent/very good”) and being higher risk for developmental delays. For example, the likelihood of having either poorer health or higher developmental risk increases with each RF (vs. zero): 1 RF (OR = 1.70, CI: 1.20–2.38), 2 RFs (OR = 3.28, CI: 2.27–4.73), 3 RFs (OR = 4.69, CI: 2.84–7.73), 4 RFs (OR = 14.58, CI: 4.98–42.64). Higher RFs were also associated with poorer health care access. Conclusions: This study demonstrates a dose–response relationship of higher risk profiles with poorer child health status and higher developmental risk. Because children with higher profiles of risk are also more likely to lack access to care, this suggests that children who most need care have the greatest difficulty obtaining it. Addressing health gradients for vulnerable children will require explicit attention to these multiple, overlapping risk factors.     

Untreated Reproductive Morbidities among Ever Married Women of Slums of Rajkot City,Gujarat: The Role of Class,Distance, Provider Attitudes,and Perceived Quality of Care

It is a common problem in India for women in the reproductive age group to suffer from reproductive illnesses and not seek care. This paper is an attempt to assess untreated reproductive morbidities and to study factors affecting treatment-seeking behavior among ever married women of urban slums. We selected 1,046 women of the reproductive age group (15–49 years) using two-stage cluster sampling for a community-based, cross-sectional study. From this sample, 593 responses reporting reproductive morbidity were analyzed for treatment-seeking behavior and its correlates. Information was collected on demographics, socioeconomic status, self-reported reproductive morbidity, and treatment-seeking patterns, along with reasons for not utilizing available health services, all using a pretested, structured interview schedule. Univariate and multivariate analyses were done in SPSS 15.0. In our sample, 57% of women had at least one reproductive morbidity; of these, only one third sought health care. Women belonging to the Scheduled Castes/Scheduled Tribes caste group (OR = 3.92, 95% CI 1.44–10.64), at a distance of more than 2 km from a health facility (OR = 2.67, 95% CI 1.28–5.58), and whose duration of illness was more than 1 year (OR = 14.44, 95% CI 3.66–56.87) accessed fewer reproductive health services compared to their counterparts. The present study found that a lower sense of need, the cost of care, and societal barriers were the reasons for not seeking care. Providers’ poor attitudes, poor quality of services, and long waiting times were found to be the reasons for not utilizing health facilities. The determinants for accessing reproductive health care were resources available at the household level, social factors, the availability of services, and behaviors related to health. Government facilities remained underutilized.     

Multi-person Sex among a Sample of Adolescent Female Urban Health Clinic Patients

Adolescent sexual activity involving three or more people is an emerging public health concern. The goal of this exploratory, cross-sectional study was to describe the prevalence, correlates, and context of multiple-person sex among a sample of adolescent females seeking health care from an urban clinic. Because sex involving multiple people may either be consensual (i.e., “three-ways” or “group sex”) or forced (i.e., “gang rape”), we use the term “multi-person sex” (MPS) to encompass these experiences. Subjects were 328 females, ages 14–20 years old, who utilized a Boston-area community- or school-based health clinic between April and December of 2006, and completed an anonymous survey using computer-assisted self-interview software. Overall, 7.3% reported ever having had a MPS experience. Of these, 52% reported ever being pressured to engage in MPS and 43% reported ever being threatened or forced. Condom nonuse by at least one male participant in the most recent MPS was reported by 45%. Controlling for potential demographic confounders, MPS was associated with cigarette smoking (adjusted prevalence ratio [APR], 3.83; 95% confidence interval [CI], 1.56–9.44), sexual initiation prior to age 15 (APR, 2.50; 95% CI, 1.04–5.98), ever being diagnosed with an STI (APR, 2.55; 95% CI, 1.08–6.03), dating violence victimization (APR, 4.43; 95% CI, 1.68–11.69), childhood sexual abuse victimization (APR, 4.30; 95% CI, 1.83–10.07) and past-month pornography exposure (APR, 4.79; 95% CI, 1.91–11.98). Additional study of the perpetration and prevention of adolescent MPS is urgently needed.     

Do physicians accept quality of life and utility measurement?

This study investigates to what extent physicians accept quality of life (QoL) and economic utility measures as endpoints in clinical studies. It also explores who physicians think should value health states. As part of a European study three different physician groups were surveyed using a standardized mail questionnaire. These surveys were carried out by national random sample in Finland (rendering n=367) and by nonrandom samples in Austria (n=33), and Germany (n=41). Acceptance of utility measurement was classified by a four-level hierarchy. Knowledge of the QoL concept ranged between 30% and 54% in the three samples. QoL was accepted by 72–90% of physicians, a summary index of QoL by 62–80%, its combination with duration by 51–68%, and quality-adjusted life years by 44–61%. Most physicians felt that health care professionals should value health states, and 92–94% considered common effect measures in clinical and economic studies to be desirable or necessary. Most physicians surveyed accepted QoL as a study endpoint, a significant share accepted utility measurement. Evaluating health effects by common measures is considered an important challenge.     

A Prospective Study of Return to Work Across Health Conditions: Perceived Work Attitude,Self-efficacy and Perceived Social Support

Background The aim of the present study was to conduct subgroup-analyses in a prospective cohort of workers on long-term sickness absence to investigate whether associations between perceived work attitude, self-efficacy and perceived social support and time to RTW differ across different health conditions. Methods The study was based on a sample of 926 workers on sickness absence (6–12 weeks). The participants filled out a baseline questionnaire and were subsequently followed until the tenth month after listing sick. Perceived work attitude was measured with a Dutch language version of the Work Involvement Scale. Perceived social support was measured with a self-constructed standardized scale reflecting a person’s perception of social support regarding RTW. Self-efficacy was measured with the standardised Dutch version of the General self-efficacy scale, assessing the subjects’ expectations of their general capacities. The sample was divided into three subgroups: musculoskeletal health conditions, other physical health conditions and mental health conditions. Anova analyses and Cox proportional hazards regression analyses were used to identify differences in association between the three factors and the time to RTW between different subgroups. Results The associations between the perceived work attitude, self-efficacy and perceived social support and the time to RTW vary across different health condition subgroups, not only with regard to the strength of the association but also for the type of factor. In the multivariate model, hazard ratios (HRs) of 1.33 (95% CI 1.01–1.75) in the musculoskeletal subgroup, and 1.26 (95% CI 0.89–1.78) in the other physical subgroup were found in perceived work attitude. With regard to perceived social support HRs of 1.39 (95% CI 1.12–1.99) respectively 1.51 (1.05–2.17) in the same subgroups were found. Only self-efficacy remained in the multivariate model in all subgroups with HRs of 1.49 (95% CI 1.12–1.99) in the musculoskeletal subgroup, 1.53 (95% CI 1.07–2.18) in the other physical subgroup and 1.60 (1.07–2.40) in the mental subgroup. Conclusions The results of this study show that perceived work attitude, self-efficacy and perceived social support are relevant predictors with regard to the time to RTW in all types of health conditions, but that important differences are observed in type of factor and strengths of the relationships between physical and mental health conditions.     

High Prevalence of Affective Disorders among Adolescents Living in Rural Zimbabwe

Poor mental health accounts for considerable disease burden among young people globally. We investigated the prevalence and determinants of affective disorders among rural Zimbabwean youth in 2006. We undertook a cross-sectional survey among 1495 Zimbabwean youth aged 15–23 (median 18) from 12 rural communities in three provinces in south-eastern Zimbabwe. Mental health was assessed using the Shona Symptom Questionnaire (SSQ), a locally validated 14-item indigenous screening tool for affective disorders, notably depression and anxiety disorders. Participants scoring ≥8/14 were considered at risk of being affected and ≥11 as at risk of being severely affected. Most participants (93.1%) completed the SSQ. Of these, 51.7% (95%CI:49.0–54.3%) scored ≥8/14 and 23.8% (95%CI:21.5–26.0%) scored ≥11. Affective disorders were independently associated with household poverty (adjusted odds ratio (AOR) 1.9, 95%CI:1.4–2.7), living in a female-headed household (AOR 1.3, 95%CI:1.0–1.7), having moved home within last 5 years (AOR 1.4, 95%CI:1.0–1.9) and feeling stigmatized (AOR being shunned by others 3.7, 95%CI:2.5–5.7). There was a strong linear association between risk of affective disorders and sexual risk taking (ever sex AOR 1.5, 95%CI:1.0–2.4, and 2.8, 95%CI:1.9–4.2 for affected and severely affected, respectively, test for trend P < 0.001; ≥2 lifetime partners AOR 2.3, 95%CI:1.1–4.8 and 5.4, 95%CI:2.7–10.7, test for trend P < 0.001). This study indicates high levels of psychological morbidity among rural Zimbabwean youth which was associated with sexual risk taking. Interventions to prevent, identify and treat mental health disorders in this vulnerable population are urgently required. In HIV-endemic countries, such interventions may also help reduce HIV transmission.     

Global patterns of healthy life expectancy in the year 2002

Background  

Healthy life expectancy – sometimes called health-adjusted life expectancy (HALE) – is a form of health expectancy indicator that extends measures of life expectancy to account for the distribution of health states in the population. The World Health Organization reports on healthy life expectancy for 192 WHO Member States. This paper describes variation in average levels of population health across these countries and by sex for the year 2002.     

Quality of Life (QoL) in severely disabled multiple sclerosis patients: Comparison of three QoL measures using multidimensional scaling

This study reports a comparison of three quality of life (QoL) measures completed by patients with advanced multiple sclerosis. Multidimensional scaling analysis explored the structure of relationships amongst a general health measure (the Short Form 36 – SF 36) and two person-centred measures (the Patient Generated Index – PGI; and the Schedule for the Evaluation of Individual Quality of Life – Direct Weighting version – SEIQoL-DW). Results showed distinct differences both between the two person-centred measures, and when compared against the general health measure, reflecting the different conceptual bases of these measures. The findings suggest that PGI scores closely relate to measures of physical functioning, whereas SEIQoL-DW scores relate more closely to feelings of health and vitality. The implications of these results for selection and development of appropriate QoL scales for the target population are discussed. This revised version was published online in June 2006 with corrections to the Cover Date.     

The HBSC study in Scotland: can the study influence policy and practice in schools?

This paper reviews the role of the HBSC study in Scotland and suggests that the HBSC study has growing status and relevance in Scotland for a number of reasons as it continues to provide insights for politicians, policy makers, education professionals and health promotion practitioners. The paper will set out the historical background to the HBSC study and the associated research and health promoting school developments in Scotland. It will explore the factors that have been important in its influential role in contributing to health promotion policy developments in the education and health sectors in Scotland. It is suggested that this role has been shaped by:

Hurricane Katrina-Related Maternal Stress,Maternal Mental Health,and Early Infant Temperament

To investigate temperament in infants whose mothers were exposed to Hurricane Katrina and its aftermath, and to determine if high hurricane exposure is associated with difficult infant temperament. A prospective cohort study of women giving birth in New Orleans and Baton Rouge, LA (n = 288) in 2006–2007 was conducted. Questionnaires and interviews assessed the mother’s experiences during the hurricane, living conditions, and psychological symptoms, 2 months and 12 months postpartum. Infant temperament characteristics were reported by the mother using the activity, adaptability, approach, intensity, and mood scales of the Early Infant and Toddler Temperament Questionnaires, and “difficult temperament” was defined as scoring in the top quartile for three or more of the scales. Logistic regression was used to examine the association between hurricane experience, mental health, and infant temperament. Serious experiences of the hurricane did not strongly increase the risk of difficult infant temperament (association with three or more serious experiences of the hurricane: adjusted odds ratio (aOR) 1.50, 95% confidence interval (CI) 0.63–3.58 at 2 months; 0.58, 0.15–2.28 at 12 months). Maternal mental health was associated with report of difficult infant temperament, with women more likely to report having a difficult infant temperament at 1 year if they had screened positive for PTSD (aOR 1.82, 95% confidence interval (CI) 0.61–5.41), depression, (aOR 3.16, 95% CI 1.22–8.20) or hostility (aOR 2.17, 95% CI 0.81–5.82) at 2 months. Large associations between maternal stress due to a natural disaster and infant temperament were not seen, but maternal mental health was associated with reporting difficult temperament. Further research is needed to determine the effects of maternal exposure to disasters on child temperament, but in order to help babies born in the aftermath of disaster, the focus may need to be on the mother’s mental health.     

Factors associated with short-term recovery of health status among emergency department patients with acute exacerbations of chronic obstructive pulmonary disease

Objective  To determine the factors associated with short-term recovery of health status following chronic obstructive pulmonary disease (COPD) exacerbation. Methods  In a prospective multicenter cohort study, consecutive emergency department (ED) patients with COPD exacerbation were enrolled. Patients were interviewed and instructed to complete the validated Short Form Chronic Respiratory disease Questionnaire. Follow-up data were collected 2 weeks later, and included the global transition question. The primary outcome was recovery of health status, which was assigned to patients who stated that their COPD was “a little better” or “much better” than at the time of their ED presentation. Results  Of the 330 patients, 270 [82%; 95% confidence interval (CI), 77–86%] reported recovery of health status following acute exacerbations. Multivariable analysis showed that recovery of health status was associated with having a primary care provider (PCP) [odds ratio (OR), 3.1; 95% CI, 1.5–6.4] and a co-diagnosis of asthma (OR, 2.2; 95% CI, 1.2–3.8). By contrast, frequent exacerbations (two or more exacerbations in the past year) (OR, 0.4; 95% CI, 0.2–0.7) was inversely associated with recovery. Conclusions  Reducing exacerbation frequency and provision of adequate PCP follow-up after ED visit may help improve the recovery of health status following acute exacerbations of COPD.