Modern Health Worries, Somatosensory Amplification and Subjective Symptoms: A Longitudinal Study

Background

Modern health worries (MHWs; i.e., concerns about possibly harmful features of modern life) have been associated with somatic symptoms and somatosensory amplification in previous cross-sectional studies. Causal relationship among these variables is yet to be discovered.

Purpose

The study investigates the temporal association among subjective symptoms, somatosensory amplification (SSA), and modern health worries (MHWs).

Method

Baseline and follow-up questionnaires (somatic symptoms—PHQ-15, somatosensory amplification scale—SSAS, modern health worries scale—MHW, PANAS negative affect scale—NA) were completed by 366 undergraduate students in a 2-month longitudinal study.

Results

MHWs were predicted by baseline MHWs (β?=?0.721, p?<?0.001) and by somatic symptoms (β?=?0.084, p?<?0.05). Somatic symptoms were predicted by baseline symptoms (β?=?0.610, p?<?0.001), NA (β?=?0.104, p?<?0.05), and SSAS scores (β?=?0.089, p?<?0.05). The only predictor of SSA was baseline SSAS score (β?=?0.628, p?<?0.001).

Conclusion

Based on the results, a linear model (proneness to somatosensory amplification leads to subjective symptoms which lead to MHWs) was proposed, where MHWs serve as explanations of physical symptoms or as possible environmental threats to avoid.     

Modern Health Worries, Subjective Health Complaints, Health Care Utilization, and Sick Leave in the Norwegian Working Population

Background

Modern health worries (concerns about aspects of modern life affecting health) heve been associated with subjective health complaints and health care utilization.

Purpose

The aim of this study was to investigate the association between modern health worries (MHW) and subjective health complaints (SHC), health care utilization, and sick leave related to such complaints in the Norwegian working population.

Methods

A sample of the Norwegian working population (N?=?569) answered a questionnaire which included the Subjective Health Complaints Inventory and a Norwegian version of the Modern Health Worries Scale.

Results

Ninety-one percent of the participants reported at least one complaint in the past 30 days, and 96 % of the participants reported concerns for at least one of the items in the MHW scale. Women reported significantly more and more severe complaints compared to men and significantly more concern about aspects of modern life affecting health. Participants who reported a high level of MHW showed nearly twice the risk of reporting a high level of SHC (odds ratio (OR)?=?1.83; 95 % confidence interval (CI)?=?1.30–2.71; p?=?0.001), and they showed twice the risk for self-certified sick leave related to SHC (OR?=?2.04; 95 % CI?=?1.01–3.92; p?=?0.048). High levels of MHW showed no significant association with health care utilization or doctor-certified sick leave.

Conclusions

Subjective health complaints and concerns about aspects of modern life affecting health are very common, even among healthy workers. Women have more complaints and more concerns compared to men. Within the health care system, it may be advantageous to pay close attention to the association between high levels of MHW and high levels of SHC.     

Jewish Spirituality, Depression, and Health: an Empirical Test of a Conceptual Framework

Background

Little is known about the links between spirituality and mental health among Jews.

Purpose

This study assessed trust/mistrust in God and religious coping and examined their relationships to depressive symptoms and physical health. Religious affiliation and intrinsic religiousness were examined as moderating variables and religious coping was examined as a mediator.

Method

Anonymous internet surveys were completed by 208 Jewish women and men of diverse denominations who resided primarily in the USA.

Results

Trust in God and positive religious coping were associated with lower levels of depressive symptoms and mistrust in God and negative religious coping were associated with greater depressive symptoms. Intrinsic religiosity showed a small moderation effect for mistrust in God and negative religious coping in relation to depressive symptoms and for trust in God in relation to physical health. Further, positive religious coping fully mediated the link between trust in God and less depressive symptoms and negative religious coping fully mediated the relationship between mistrust in God and greater depressive symptoms.

Conclusion

The data lend themselves to a possible integrative cognitive-coping model, in which latent core beliefs about the Divine activate coping strategies during times of distress, which in turn impact psychological health. The findings highlight the potential clinical significance of spirituality to mental health among Jews and provide a basis for future longitudinal, experimental, and treatment outcome research.     

The Relationship Between Maternal Fear of Hypoglycaemia and Adherence in Children with Type-1 Diabetes

Background

Regular blood glucose monitoring is important for children with type-1 diabetes; however, the relationship between maternal fear of hypoglycaemia and glycaemic control is not well understood.

Purpose

The relationship between maternal beliefs about diabetes, concerns about glycaemic control and adherence to recommended blood glucose levels in young children with type-1 diabetes were examined in this study.

Method

Seventy-one mothers with children under 13 were recruited, and a prospective design was used. Demographics, maternal self-reported hypoglycaemic fear and illness perceptions were measured at baseline. Self-report daily blood sugar levels were recorded over 1 week, and glycosylated haemoglobin (HbA_1c) blood glucose levels were collected at baseline and 3 months later.

Results

High maternal fears of hypoglycaemia were predictive of suboptimal daily glycaemic control (elevated blood glucose levels), irrespective of illness duration or age at diagnosis.

Conclusion

The results suggest that mothers who worry most about hypoglycaemia compensate by maintaining their child’s blood glucose levels above recommended levels. Elevated blood glucose levels have important consequences for long-term health, and further research could explore ways to target maternal fear of hypoglycaemia.     

Associations Between Supportive Leadership and Employees Self-Rated Health in an Occupational Sample

Background

Protecting the health of the work force has become an important issue in public health research.

Purpose

This study aims to explore potential associations between supportive leadership style (SLS), an aspect of leadership behavior, and self-rated health (SRH) among employees.

Method

We drew on cross-sectional data from a cohort of industrial workers (n?=?3,331), collected in 2009. We assessed employees' ratings of supportive, employee-oriented leadership behavior at their job, their SRH, and work stress as measured by the effort–reward model and scales measuring demands, control, and social support. Logistic regression estimated odds ratios (ORs) and corresponding 95 % confidence intervals (CIs) for the association between the perception of poor SLS and poor SRH controlling for work-related stress and other confounders. Sensitivity analyses stratified models by sex, age, and managerial position to test the robustness of associations.

Results

Perception of poor SLS was associated with poor SRH [OR 2.39 (95 % CI 1.95–2.92)]. Although attenuated following adjustment for measures of work-related stress and other confounders [OR 1.60 (95 % CI 1.26–2.04)], the magnitude, direction, and significance of this association remained robust in stratified models in most subgroups.

Conclusion

SLS appears to be relevant to health in the workplace. Leadership behavior may represent a promising area for future research with potential for promoting better health in a large segment of the adult population.     

Beliefs About Expectations Moderate the Influence of Expectations on Pain Perception

Background

Expectations congruently influence, or bias, pain perception. Recent social psychological research reveals that individuals differ in the extent to which they believe in expectation biases and that individuals who believe in expectation biases may adjust for this bias in their perceptions and reactions. That is, idiosyncratic beliefs about expectations can moderate the influence of expectations on experience.

Purpose

Prior research has not examined whether idiosyncratic beliefs about expectations can alter the degree to which one's expectations influence pain perception. Using a laboratory pain stimulus, we examined the possibility that beliefs about expectation biases alter pain responses following both pain- and placebo-analgesic expectations.

Methods

Participants' beliefs about expectation biases were measured. Next, participants were randomly assigned to receive either a pain expectation or a placebo-analgesia expectation prior to a cold-pressor task. After the task, participants rated their pain.

Results

Beliefs about expectation biases significantly influenced pain reports. Specifically, pain reports were more influenced by provided expectations the less participants believed in expectation biases (i.e., pain expectations resulted in more pain than analgesia expectations).

Conclusions

Beliefs about the expectation bias are an important and under-examined predictor of pain and placebo analgesia.     

Acute resistance exercise increases the expression of chemotactic factors within skeletal muscle

Introduction

Intense resistance exercise causes mechanical loading of skeletal muscle, followed by muscle adaptation. Chemotactic factors likely play an important role in these processes.

Purpose

We investigated the time course of changes in the expression and tissue localization of several key chemotactic factors in skeletal muscle during the early phase of recovery following resistance exercise.

Methods

Muscle biopsy samples were obtained from vastus lateralis of eight untrained men (22 ± 0.5 years) before and 2, 4 and 24 h after three sets of leg press, squat and leg extension at 80 % 1-RM.

Results

Monocyte chemotactic protein-1 (95×), interleukin-8 (2,300×), IL-6 (317×), urokinase-type plasminogen activator (15×), vascular endothelial growth factor (2×) and fractalkine (2.5×) mRNA was significantly elevated 2 h post-exercise. Interleukin-8 (38×) and interleukin-6 (58×) protein was also significantly elevated 2 h post-exercise, while monocyte chemotactic protein-1 protein was significantly elevated at 2 h (22×) and 4 h (21×) post-exercise. Monocyte chemotactic protein-1 and interleukin-8 were expressed by cells residing in the interstitial space between muscle fibers and, in some cases, were co-localized with CD68 + macrophages, PAX7 + satellite cells and blood vessels. However, the patterns of staining were inconclusive and not consistent.

Conclusion

In conclusion, resistance exercise stimulated a marked increase in the mRNA and protein expression of various chemotactic factors in skeletal muscle. Myofibers were not the dominant source of these factors. These findings suggest that chemotactic factors regulate remodeling/adaptation of skeletal muscle during the early phase of recovery following resistance exercise.     

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.

     

Cardiovascular Risk Factor Assessments and Health Behaviours in Patients Using Statins Compared to a Non-Treated Population

Background

The perception of cardiovascular risk factors is believed to be associated with a person's willingness to carry out lifestyle changes as well as their willingness to adhere to prescribed preventive medications. Little is known about whether these perceptions differ between statin users and those not using statins, including how these factors relate to health behaviours.

Purpose

The objective was to investigate and compare the perceptions of known modifiable risk factors for cardiovascular disease in patients using statins with those of a non-treated population. One further objective was to investigate if statin use was associated with favourable health behaviours.

Method

Data about health, perception of the importance of cardiovascular risk factors and health behaviours were collected through questionnaires from 829 statin users and 629 non-statin users. Beliefs about risk factors were compared in univariate analyses, and four health behaviours were compared in multivariate regression models.

Results

Statin users had better health behaviours in univariate analyses compared to non-statin users. Statin users rated lifestyle-related risk factors as more important contributors for the development of cardiovascular disease than non-statin users. In a multivariate model, statin use was associated with having better eating habits.

Conclusion

People using statins are more concerned about cardiovascular risk factors compared to non-statin users. The behaviour of taking statins seems to be associated with favourable eating habits.     

Prevalence and Morbidity of Primary Immunodeficiency Diseases,United States 2001–2007

Purpose

Few studies have estimated population prevalence and morbidity of primary immunodeficiency diseases (PIDD). We used administrative healthcare databases to estimate the prevalence of PIDD diagnoses in the United States from 2001 to 2007.

Methods

MarketScan databases compile claims from commercial health insurance plans and Medicaid, recording individual diagnoses for outpatient encounters and hospital stays. We used a cross sectional survey to estimate prevalence of PIDD using related ICD-9 codes (279.0, 279.1, 279.2, 279.8, 279.9, 288.1 and 288.2). Persons with secondary immunodeficiency diagnoses were excluded from analysis.

Results

Between 2001 and 2007, prevalence of any PIDD diagnosis increased from 38.9 to 50.5 per 100,000 among privately insured and from 29.1 to 41.1 per 100,000 among publicly insured persons. B cell defects predominated. Prevalence was more than twice as high among Whites as among Blacks or Hispanics.

Conclusion

In this large database, we found a higher prevalence of diagnosed PIDD than has been reported previously from registries. Increased awareness may have contributed to the increasing prevalence.     

Sorcin antibody as a possible predictive factor in conversion from radiologically isolated syndrome to multiple sclerosis: a preliminary study

Objective

To identify an antibody biomarker for prediction of conversion from radiologically isolated syndrome (RIS) to relapsing remitting multiple sclerosis (RRMS).

Methods

Sera of 13 RIS patients were screened by a protein macroarray derived from human fetal brain cDNA library.

Results

Sequencing of a clone with the highest signal intensity revealed sorcin as a potential target autoantigen in RIS patients. ELISA studies showed high-titer sorcin-antibodies in 3 of 4 RIS patients who converted to RRMS in a 5-year follow-up period and 13 of 23 control RRMS patients.

Conclusion

The value of sorcin antibody as a predictor of conversion from RIS to RRMS requires to be tested in larger prospective studies.     

NLRP3 inflammasome activation and interleukin-1β release in macrophages require calcium but are independent of calcium-activated NADPH oxidases

Objective and design

We studied the involvement of calcium and calcium-activated NADPH oxidases in NLRP3 inflammasome activation and IL-1β release to better understand inflammasome signaling in macrophages.

Material or subjects

Human volunteer blood donors were recruited to isolate monocytes to differentiate them into macrophages. Wild-type or DUOX1-deficient C57/B6 mice were used to prepare bone marrow-derived macrophages.

Treatment

Murine or human macrophages were treated in vitro with NLRP3 inflammasome agonists (ATP, silica crystals) or calcium agonists (thapsigargin, ionomycin) in calcium-containing or calcium-free medium.

Methods

Intracellular calcium changes were followed by measuring FURA2-based fluorescence. Gene expression changes were measured by quantitative real-time PCR. Protein expression was assessed by western blotting. Enzymatic activity was measured by fluorescence caspase-1 activity assay. IL-1β release was determined by ELISA. ELISA data were analyzed by ANOVA and Tukey’s post hoc test.

Results

Our data show that calcium is essential for IL-1β release in human macrophages. Increases in cytosolic calcium alone lead to IL-1β secretion. Calcium removal blocks caspase-1 activation. Human macrophages express Duox1, a calcium-regulated NADPH oxidase that produces reactive oxygen species. However, Duox1-deficient murine macrophages show normal IL-1β release.

Conclusions

Human macrophage inflammasome activation and IL-1β secretion requires calcium but does not involve NADPH oxidases.     

Relationship Between Cognitive Factors and Anxiety in Individuals with Irritable Bowel Syndrome

Background

Individuals with irritable bowel syndrome (IBS) have high anxiety. There is insufficient information about the relationships between concrete cognitive contents and anxiety in IBS.

Purpose

The present study investigated the relationship between cognitive factors and anxiety in individuals with IBS.

Method

The participants were 1,087 college students (male, 506; female, 576; unidentified, 5; age, 19.72?±?1.76?years) who completed a set of questionnaires that included the Rome II Modular Questionnaire (based on diagnostic criteria for IBS), Anxiety Sensitivity Index (ASI), Cognitive Appraisal Rating Scale (CARS; subscales: commitment, appraisal of effect, appraisal of threat, and controllability) for measuring symptom-related cognition, an item about attention to abdominal symptoms, the Hospital Anxiety and Depression Scale-Anxiety Scale (HADS-A), and an item regarding the presence of avoidant behavior due to anxiety of IBS symptoms.

Results

The participants included 881 individuals without IBS and 206 individuals with IBS. Individuals with IBS had higher ASI and HADS-A scores than those of the individuals belonging to the control group (p?p?p?Conclusion Severe anxiety sensitivity in individuals with IBS related to their symptom-related cognition, and the altered cognition increases anxiety, leading to the possible development of a disabling condition.     

An Exploratory Analysis of Fear of Recurrence among African-American Breast Cancer Survivors

Background

Fear of recurrence (FOR) is a psychological concern that has been studied extensively in cancer survivors but has not been adequately examined in African-American breast cancer survivors.

Purpose

This exploratory study describes the extent and nature of FOR in African-American breast cancer survivors. FOR is examined in relation to socio-demographic characteristics, treatment-related characteristics, psychological distress, and quality of life (QOL).

Methods

Participants completed questionnaires assessing FOR, psychological distress, QOL, and demographic and treatment characteristics. Pearson r correlations, t tests, and ANOVAs were used to determine the association between FOR and demographic and treatment-related characteristics. Hierarchical multiple regression models were performed to investigate the degree to which FOR dimensions account for the variance in QOL and psychological distress.

Results

Fifty-one African-American breast cancer survivors participated in this study. The mean age of participants was 64.24 (SD?=?12.3). Overall fears as well as concerns about death and health were rated as low to moderate. Role worries and womanhood worries were very low. Inverse relationships were observed between age and FOR dimensions. FOR was positively correlated with measures of psychological distress and negatively correlated with QOL. FOR significantly accounted for a portion of the variance in QOL and distress after controlling for other variables.

Conclusions

This study suggests that African-American women in this sample demonstrated some degree of FOR. Results indicate that FOR among African-American breast cancer survivors decreases with age and time since diagnosis and co-occurs with psychological distress as well as diminished quality of life.     

Are modern health worries,environmental concerns,or paranormal beliefs associated with perceptions of the effectiveness of complementary and alternative medicine?

Objective. To investigate to what extent paranormal beliefs, modern health worries (MHWs), and environmental concerns were related to beliefs about, and behaviour associated with complementary and alternative medicine (CAM). Methods. Of the participants, 150 completed a four‐part questionnaire measuring use and perception of CAM, MHWs, paranormal beliefs, and environmental concerns. Results. A factor analysis on the CAM questions revealed three clear components, labelled efficacy of CAM, attitudes to CAM, and safety of CAM. Age, total MHWs, paranormal beliefs, and environmental concerns were used as predictor variables in regression analyses with efficacy as criterion variable. Age was found to be a significantly related to efficacy of CAM. When total MHW score, paranormal belief score, and environmental concern score were added to the model, the r² increased by 29%. Environmental concern did not significantly relate to efficacy but spiritualism beliefs did. A factor analysis of the MHW scale items revealed nine factors. Out of these, radiation, doctors playing God, disasters, and epidemics, as well as harmful rays and air contaminants significantly predict belief in the efficacy of CAM. Conclusion. Overall, older people, with more MHWs, and who believe in the paranormal are more likely to believe that CAM works, possibly because of a more intuitive, ‘holistic’, thinking style. Limitations of the study are considered.     

Modifying the Implicit Illness-Related Self-Concept in Patients with Somatoform Disorders May Reduce Somatic Symptoms

Background

According to dual process theories, not only do explicit but also implicit cognitive processes play a major role in the development and maintenance of somatoform disorders (SFDs). Recent evidence [1] suggests that patients with SFDs have a stronger implicit illness-related self-concept, which is related to the experience of medically unexplained symptoms.

Purpose

The current study was designed to investigate a possible causal link between biased implicit associations and symptoms in SFD patients by experimentally modifying the implicit illness-related self-concept.

Methods

Twenty-nine patients with SFDs (according to the DSM-IV) initially completed an Implicit Association Test (IAT) for assessing the implicit illness-related self-concept. Two weeks later, they underwent an evaluative conditioning task to modify the implicit self-concept.

Results

After this procedure, a change toward a healthier implicit self-concept was apparent in the follow-up IAT. A reduction in symptom severity and changes in health- and body-related cognitions were observed 13 days after the training in the follow-up questionnaires.

Conclusions

The findings suggest that a biased implicit self-concept may be causally relevant for symptom experiences in patients with SFDs. Existing cognitive behavioral treatments for SFDs might benefit from targeting implicit cognitive processes more directly.     

The First US Domestic Report of Disseminated Mycobacterium avium Complex and Anti-Interferon-γ Autoantibodies

Introduction

Anti-interferon-γ (IFNγ) autoantibodies have been associated with disseminated mycobacterial infections, mostly in patients from Southeast Asia.

Purpose

We studied an American-born, Caucasian female with M. avium complex infection of the subglottic mucosa and brain for underlying etiologies of infection.

Methods

Plasma was screened for anticytokine autoantibodies using a Luminex-based approach. The ability of patient plasma to block IFNγ-induced STAT1 phosphorylation in normal blood cells was evaluated by flow cytometry with intracellular staining. Plasma inhibition of IFNγ production and IFNγ-induced cytokines in normal and patient blood cells washed of autologous plasma was also evaluated.

Results

Patient plasma contained high-titer IgG anti-IFNγ autoantibodies, primarily of the IgG₁ subclass. Patient but not control plasma prevented IFNγ-induced STAT1 phosphorylation and expression of the IFNγ-inducible cytokines tumor necrosis factor (TNF) α and interleukin (IL)-12 in normal blood cells. Patient blood cells washed free of autologous plasma demonstrated normal IFNγ production and response.

Conclusions

Disseminated nontuberculous mycobacterial infections should always prompt immune evaluation. This first case of disseminated nontuberculous mycobacterial infection and anti-IFNγ autoantibodies in an American-born Caucasian suggests that anti-cytokine autoantibodies are not racially or regionally restricted.     

Spirituality,Religiosity, and Health: a Comparison of Physicians’ Attitudes in Brazil,India, and Indonesia

Background

One of the biggest challenges in the spirituality, religiosity, and health field is to understand how patients and physicians from different cultures deal with spiritual and religious issues in clinical practice.

Purpose

The present study aims to compare physicians’ perspectives on the influence of spirituality and religion (S/R) on health between Brazil, India, and Indonesia.

Method

This is a cross-sectional, cross-cultural, multi-center study carried out from 2010 to 2012, examining physicians’ attitudes from two continents. Participants completed a self-rated questionnaire that collected information on sociodemographic characteristics, S/R involvement, and perspectives concerning religion, spirituality, and health. Differences between physicians’ responses in each country were examined using chi-squared, ANOVA, and MANCOVA.

Results

A total of 611 physicians (194 from Brazil, 295 from India, and 122 from Indonesia) completed the survey. Indonesian physicians were more religious and more likely to address S/R when caring for patients. Brazilian physicians were more likely to believe that S/R influenced patients’ health. Brazilian and Indonesians were as likely as to believe that it is appropriate to talk and discuss S/R with patients, and more likely than Indians. No differences were found concerning attitudes toward spiritual issues.

Conclusion

Physicians from these different three countries had very different attitudes on spirituality, religiosity, and health. Ethnicity and culture can have an important influence on how spirituality is approached in medical practice. S/R curricula that train physicians how to address spirituality in clinical practice must take these differences into account.

     

A scoping review of research on complementary and alternative medicine (CAM) and the mass media: Looking back, moving forward

Background

With the increased usage of CAM worldwide comes the demand for its integration into health professional education. However, the incorporation of CAM into health professional curricula is handled quite differently by different institutions and countries. Furthermore, the evaluation of CAM curricula is complicated because students' ability to learn about CAM may be influenced by factors such as student's prior knowledge and motivation, together with the perceptions and attitudes of clinical preceptors. The study aimed to describe the attitudes, perceptions and beliefs of second, third and fourth year pharmacy students towards complementary and alternative medicine (CAM) and to explore factors that might affect attitudes such as learning, preceptors and placements.

Methods

Pharmacy students from a University in South East Queensland, Australia participated in the study. The study consisted of a cross-sectional survey (n = 110) and semi-structured interviews (n = 9).

Results

The overall response rate for the survey was 75%, namely 50% (36/72) for second year, 77.3% (34/44) for third year and 97.6% (40/41) for fourth year students. Overall, 95.5% of pharmacy students believe that pharmacists should be able to advise patients about CAM and most (93.7%) have used CAM prior to course enrolment. Students' attitudes to CAM are influenced by the use of CAM by family, friends and self, CAM training, lecturers and to a lesser degree by preceptors. The majority of pharmacy students (89.2%) perceive education about CAM as a core and integral part of their professional degree and favour it over an additional postgraduate degree. However, they see a greater need for education in complementary medicines (such as herbal medicines, vitamins and minerals) than for education in complementary therapies (such as acupuncture, meditation and bio-magnetism). Knowledge and educational input rationalised rather than marginalised students' attitudes towards CAM.

Conclusion

Pharmacy students perceive education about CAM as a core and integral part of their professional degree. Students' attitudes towards CAM can be influenced by learning, lecturers, preceptors and practice experience. The content and focus of CAM education has to be further investigated and tailored to meet the professional needs of our future health professionals.     

Benefits of ICU admission in critically ill patients: Whether instrumental variable methods or propensity scores should be used

Background

The term 'inequities' refers to avoidable differences rooted in injustice. This review examined whether or not, and how, quantitative studies identifying inequalities in risk factors and health service utilization for asthma explicitly addressed underlying inequities. Asthma was chosen because recent decades have seen strong increases in asthma prevalence in many international settings, and inequalities in risk factors and related outcomes.

Methods

A review was conducted of studies that identified social inequalities in asthma-related outcomes or health service use in adult populations. Data were extracted on use of equity terms (objective evidence), and discussion of equity issues without using the exact terms (subjective evidence).

Results

Of the 219 unique articles retrieved, 21 were eligible for inclusion. None used the terms equity/inequity. While all but one article traced at least partial pathways to inequity, only 52% proposed any intervention and 55% of these interventions focused exclusively on the more proximal, clinical level.

Conclusions

Without more in-depth and systematic examination of inequities underlying asthma prevalence, quantitative studies may fail to provide the evidence required to inform equity-oriented interventions to address underlying circumstances restricting opportunities for health.