Perceived health problems in elderly residents of Jordan

Jordan is typical of many developing countries in that the improving health services have significantly reduced child and infant mortality. A high fertility rate coupled with this reduction in mortality has increased the numbers of those living to adulthood and into old age. This paper identifies, in broad terms, areas where service delivery might be considered for implementation thereby improving the well-being in the elderly person. 965 residents of Jordan 55 to 95 years of age were sampled from Amman, Irbid and the surrounding suburbs. All subjects were designated, from a medical examination, as having or not having a chronic illness. Student's t-test comparing the Jordan subjects' mean scores on the six dimensions of the NHP with previously reported data suggested that although the instrument was faithfully translated there might exist significant cultural differences. Similarly, differences between males and females suggested a possible gender bias in the interpretation of the items. All chronically ill subject groupings had higher (poorer) mean scores on all dimensions. Healthy elderly males and females have a better perceived well-being than their chronically ill counterparts.     

Should the Reorganization of Addiction‐Related Research Across All the National Institutes of Health Be Structural?—The Devil Is Truly in the Details

The recent proposal to dissolve the National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse and create a new institute for substance use, abuse, and addiction will require significant effort by the staff of both institutes, the Advisory Councils, and outside experts to overcome complex challenges that could threaten its success. Although integration of the grants portfolios can be achieved, harmonization of goals and policies related to legal use of alcohol versus illegal consumption of drugs will present serious challenges. Consolidating the infrastructure of the 2 existing institutes would entail avoiding encroachment on grant funding. A new institute for substance use, abuse, and addiction would require an enormous amount of cooperation from other institutes as the portfolios of research on alcohol, tobacco, and other drug abuse should logically be transferred to the new institute. In the near term, a structural reorganization would be less efficient and more costly than the individual institutes are currently. Increasing efficiency and reducing costs over time will necessitate careful strategic planning. Success in this difficult task would be made easier and less costly by first implementing carefully placed building blocks of increasing functional reorganization. The newly created institute should increase opportunities for specialization within disorders of addiction, attract new leadership, and build a novel strategic plan that will energize scientists and staff and incorporate ideas of stakeholders to advance the public good in preventing and treating alcohol, tobacco, and all addictions. Attention must be paid to the devil in the details.     

The quality of published health economic analyses in digestive diseases: a systematic review and quantitative appraisal

BACKGROUND & AIMS: Health economic analyses are increasingly common in the digestive diseases literature and often are cited to frame practice guidelines. Although clinical trials are subjected routinely to critical appraisal, there has been no attempt to appraise the quality of health economic analyses with a validated instrument. We sought to appraise the quality of health economic analyses in digestive diseases, and to identify predictors of study quality. METHODS: We performed a systematic review to identify digestive disease health economic analyses published since 1980. We assessed these studies using the Quality of Health Economic Studies (QHES), a validated quality-scoring instrument (score range = 0-100; >75 = high quality). We conducted regression analysis to identify predictors of high quality. RESULTS: Of 186 identified analyses, 29% were high quality, 71% failed to address potential model biases, 52% failed to disclose conflicts of interest, and 74% failed to describe methods for deriving the model assumptions. Four factors predicted high quality in logistic regression: (1) one or more authors had an advanced degree in health services or a related field (odds ratio for high quality, 5.0; 95% confidence interval, 2.6-9.3); (2) the study used decision-analysis software package (odds ratio, 2.4; 95% confidence interval, 1.2-4.7); (3) the study was federally funded (odds ratio, 2.2; 95% confidence interval, 1.2-4.1); and (4) the study cited the National Panel on Cost Effectiveness guidelines (odds ratio, 2.1; 95% confidence interval, 1.1-4.2). CONCLUSIONS: Less than one third of health economic analyses in digestive diseases meet criteria for high quality. Study quality is limited by factors that potentially can be remedied. These data may be used to focus the attention of journal editors and peer reviewers to ensure the future high quality of health economic analyses in digestive diseases.     

Leveraging Clinical Digitized Data to Understand Temporal Characteristics and Outcomes of Acute Myocardial Infarctions at a Tertiary Care Medical Centre in Pakistan from 1988–2018 – Methods and Results

Background and Objective:Few data exist on trends in acute myocardial infarction (AMI) patterns spanning recent epidemiological shifts in low middle-income countries (LMICs). To understand temporal disease patterns of AMI characteristics and outcomes between 1988–2018, we used digitized legacy clinical data at a large tertiary care centre in Pakistan.Methods:We reviewed digital health information capture systems maintained across the Aga Khan University Hospital and obtained structured elements to create a master dataset. We included index admissions of patients >18 years that were discharged between January 1, 1988, and December 31, 2018, with a primary discharge diagnosis of AMI (using ICD-9 diagnoses). The outcome evaluated was in-hospital mortality.Clinical characteristics derived from the electronic database were validated against chart review in a random sample of cases (k 0.53–1.00).Results:The final population consisted of 14,601 patients of which 30.6% (n = 4,470) were female, 52.4% (n = 7,651) had ST elevation MI and 47.6% (n = 6,950) had non-ST elevation MI. The median (IQR) age at presentation was 61 (52–70) years. Overall unadjusted in-hospital mortality was 10.3%. Across the time period, increasing trends were noted for the following characteristics: age, proportion of women, prevalence of hypertension, diabetes, proportion with NSTEMI (all p_trend < 0.001). In-hospital mortality rates declined significantly between 1988–1997 and 2008–2018 (13.8% to 9.2%, p < 0.001).Conclusions:The patterns of AMI have changed over the last three decades with a concomitant decline in in-hospital mortality at a tertiary care centre in Pakistan. Clinical digitized data presents a unique opportunity for gaining insights into disease patterns in LMICs.     

长沙市城乡老年人日常生活能力调查

目的 调查长沙市城乡老年人日常生活能力损害情况,分析其影响因素.方法 采用问卷调查法,对2339名60～91岁的老年人进行日常生活能力调查,分析其性别、年龄、婚姻状况、家庭结构、教育程度、职业、常见慢性病、医疗保健意识对老年人日常生活能力的影响.结果 躯体生活自理能力中,损害率最高的是定时上厕所(18.2%),工具性日常生活能力损害率最高的是购物(26.3%).年龄、丧偶、独居、患病、医疗保健意识缺乏是影响日常生活能力的主要因素.结论 日常生活能力是反映老年人健康状况的重要指标,对高龄、丧偶、独居、患有多种慢性疾病、医疗保健意识缺乏者等老年高危人群应加强健康教育和老年保健,提高其生活质量.     

The Reationship between Engagement in Leisure Activities and Self-Rated Health in Later Life

The aim of this study was to examine leisure engagement among people in later life and the potential relationship between leisure engagement and self-rated health. A population-representative sample of 5,435 persons between 65 and 80 years of age, living in northern Sweden and Finland were included. Data were collected by a posted questionnaire survey. Results revealed that levels of leisure engagement decreased progressively between the youngest and the oldest age groups. A significant relationship was found between leisure engagement and self-rated health. The relationship between leisure engagement and health as well as implications for developing health promotion programs are discussed.     

Validity and Reliability of the Modified Manchester Health Questionnaire in Assessing Patients With Fecal Incontinence

PURPOSE To date, no measures of fecal incontinence severity or its impact on quality of life have been validated for telephone interview. This study was designed to 1) compare responses of a self-administered and a telephone-administered Fecal Incontinence Severity Index; 2) compare a self-administered Fecal Incontinence Quality of Life Scale to the Manchester Health Questionnaire after modifying the latter for telephone administration and American English (Modified Manchester Health Questionnaire); 3) assess test-retest reliability of the telephone-administered Modified Manchester Health Questionnaire; and 4) assess the internal consistency of the Modified Manchester Health Questionnaire subscales.METHODS Consecutive, English-speaking, nonpregnant females known to have fecal incontinence were invited to participate. Two validated paper questionnaires accompanied the letter informing them of the study: Fecal Incontinence Severity Index and Fecal Incontinence Quality of Life Scale. Consenting patients were contacted for the initial telephone administration of the Modified Manchester Health Questionnaire, and patients who agreed to continue the study were contacted for a repeat telephone administration of the Modified Manchester Health Questionnaire two to four weeks after completing the first interview.RESULTS Fifty-one females were invited to participate in the study; however, 13 declined or were ineligible. Thirty females, aged 49.3 ± 10.3 years, returned self-administered questionnaires and completed the first telephone interview, and 21 completed a second telephone interview after an average interval of 23 days. The telephone-administered Fecal Incontinence Severity Index scores were significantly lower than those yielded by the self-administered Fecal Incontinence Severity Index, (6.19 vs. 9.85; P < 0.001), but the telephone and written administrations were significantly correlated (r = 0.5; P < 0.02). Correlations between the Modified Manchester Health Questionnaire quality of life subscales and the paper Fecal Incontinence Quality of Life subscales ranged from 0.6 to 0.9 (median, r = 0.81). The correlation between the total score for the Fecal Incontinence Quality of Life and the total score for the Modified Manchester Health Questionnaire quality of life scales was 0.93 (P < 0.001). Test-retest reliability for the eight Modified Manchester Health Questionnaire subscales ranged from 0.55 to 0.98 (median, r = 0.83), and test-retest reliability for the two telephone administrations of the Fecal Incontinence Severity Index was r = 0.75. Cronbachs alpha for the eight Modified Manchester Health Questionnaire subscales ranged from 0.79 to 0.92 (median, alpha = 0.85).CONCLUSIONS Telephone-administered versions of the Modified Manchester Health Questionnaire showed good-to-excellent validity, internal consistency, and test-retest reliability. The telephone-administered Fecal Incontinence Severity Index yielded lower severity scores than the written Fecal Incontinence Severity Index; however, the difference (3.66 units) was not clinically significant.Supported by Pelvic Floor Disorders Network.Supported by NICHD grants U10 HD41249, U10 HD41268, U10 HD41248, U10 HD41250, U10 HD41261, U10 HD41263, U10 HD41269, U10 HD41267.Presented at the American Urogynecologic Society, Hollywood, Florida, September 11 to 13, 2003.Reprints are not available.     

Income-related inequality and its effect on depression prevalence in China: a longitudinal,population study

Background

Depression is an important mental health disorder, which is facing a serious problem of inequality. However, compared with the field of physical health, there is not as much research into the fairness of mental health. Moreover, the research mainly focuses on cross-sectional studies. Vertical comparison is missing. Therefore, we aimed to measure the income-related inequality of depressive symptoms and its trends among elderly people in China.

Quality of primary health care in China: an analysis of data from a nationwide longitudinal survey

Background

China has made remarkable efforts and achievements since its health reform in 2009, yet there are substantial knowledge gaps in the quality of primary health care (PHC) in China. We aimed to assess the quality of PHC in China by analysing hospital admission rates among diabetics, a frequently used quality indicator for PHC.

Factors associated with use of gastric cancer screening services in Korea

AIM： To identify the factors associated with participation in gastric cancer screening programs. METHODS： Using data from the Korea National Health and Nutrition Examination Survey 2005 （KNHANES Ⅲ）, a nationwide health-related survey in Korea, a cross-sectional study was performed to investigate the multiple factors associated with gastric cancer screening attendance among persons aged at least 40 years. The study population included 4593 individuals who completed a gastric cancer screening questionnaire and had no previous cancer history. Four groups of individual-level or environmental level covariates were considered as potential associated factors. RESULTS： Using KNHANES Ⅲ data, an estimated 31.71% of Korean individuals aged at least 40 years adhered to gastric cancer screening recommendations. Subjects who graduated from elementary school [adjusted odds ratio （aOR）, 1.66; 95% CI： 1.21-2.26], middle/high school （aOR, 1.38; 95% CI： 1.01-1.89）, and university or higher （aOR, 1.64; 95% CI： 1.13-2.37） were more likely to undergo gastric cancer screening than those who received no formal education at all. The population with the highest income tertile had more attendance at gastric screening compared to those with the lowest income tertile （aOR, 1.36; 95% CI： 1.06-1.73）. Gastric screening was also negatively associated with excessive alcohol consumption （aOR, 0.71; 95% CI： 0.53-0.96）. A positive attitude to preventive medical evaluation was significantly associated with better participation in gastric cancer screening programs （aOR, 5.26; 95% CI： 4.35-6.35）. CONCLUSION： Targeted interventions for vulnerable populations and public campaigns about preventive medical evaluation are needed to increase gastric cancer screening participation and reduce gastric cancer mortality.     

Delivery of care for adult patients with congenital heart disease in Europe: results from the Euro Heart Survey.

AIMS: The increasing number of adults with congenital heart disease (CHD) has prompted the development of recommendations for the management of these patients and for the organization of their healthcare. The aim of this report is to describe the delivery of care in Europe for adults with congenital cardiac anomalies. METHODS AND RESULTS: As part of the Euro Heart Survey on Adult Congenital Heart Disease, we obtained data from 71 voluntarily participating centres that detailed their care practices for these patients. Forty-eight of these centres were specialist centres and 23 were non-specialist centres. We found that only 19% of the specialist centres complied with defined standards for optimal care structure. The criteria that appeared to be most difficult for all centres to achieve were performing 50 congenital heart operations or more per year and involving nurse specialists in the care of these patients. CONCLUSION: This survey indicated that the provision of care in Europe for adults with congenital heart defects is suboptimal. To fully realize the benefits of cardiac surgery performed in infants and children, continuous effort must be applied by healthcare professionals in order to implement the recommendations on the organization of care for these patients.     

The attrition of young physician-scientists: problems and potential solutions

Physician-scientists have played a prominent role as thought leaders in American medicine over the past century. This group has produced many basic scientific advances and pioneered the translation of these advances into clinical practice. Now that we are in the post-genomic era, there is a greater need than ever for the continued participation of this group because of their unique ability to bridge the "bench to bedside." However, the number of physicians pursuing this career is static and their average age is rising. Recent data indicate that the many benefits of this career path are seen as being outweighed by so many negative factors, as to prompt the question, "Is this a career that a reasonable person should undertake in 2007 and beyond?" The following analysis suggests that the current answer is "no." We have identified the lack of professional security as a major factor that prompts young physicians to abandon the physician-scientist track. Because this problem has not been sufficiently emphasized, we believe current efforts are unlikely to reverse this disturbing trend. We propose strategies that seek to address this problem and help sustain young physician-scientists at career transition points at which they are most vulnerable to give up.     

我国棘球蚴病防治工作中健康素养提升策略之探讨

本文分析了我国棘球蚴病主要流行区健康教育与健康促进工作最新进展,指出当前流行区内人群棘球蚴病防治知识匮乏、居民健康素养水平较低、健康促进工作模式尚未完全建立、实现全民健康目标亟需努力的现状。同时,根据《“健康中国2030”规划纲要》,探讨了现阶段棘球蚴病健康促进工作需紧密结合全民健康素养提升战略要求的可行措施与策略。     

上海市闵行区不同居住环境老年人生活质量及其影响因素

目的 了解社区、敬老院、老年病房在住老年人生活质量及其影响因素,为有关部门制定提高老年人生活质量的决策提供依据. 方法 采用分层整群抽样方法抽取上海市某区9个社区居委会和3个村(统称社区)、12家敬老院、5家老年病房在住老年人,用健康状况调查简易量表(SF-36)进行调查,并对社区、敬老院、老年病房老年人生活质量及其影响因素进行分析. 结果 社区老年人生活质量情况为躯体功能(71.9±23.3)分、躯体角色(73.6±43.0)分、肌体疼痛(80.2±20.3)分、一般健康状况(53.2±19.1)分、生命力(70.4±15.6)分、社会功能(83.8±20.3)分、情感角色(81.1±37.2)分、心理健康(78.1±15.4)分、加权平均分为(74.1±17.5)分;敬老院老年人生活质量情况为躯体功能(42.1±30.7)分、躯体角色(57.9±48.1)分、肌体疼痛(78.0±23.0)分、一般健康状况(50.2±19.5)分、生命力(66.0±19.5)分、社会功能(70.8±26.3)分、情感角色(66.8±45.7)分、心理健康(73.6±19.6)分、加权平均分为(63.2±21.0)分;老年病房在住老年人生活质量情况为躯体功能(20.4±26.0)分、躯体角色(36.1±46.9)分、肌体疼痛(65.4±29.5)分、一般健康状况(43.1±17.1)分、生命力(59.0±18.0)分、社会功能(57.9±25.3)分、情感角色(49.5±48.7)分、心理健康(66.2±18.3)分、加权平均分为(49.7±18.3)分.影响社区老年人生活质量的因素为性别、文化程度、婚姻、以前从事的职业、年龄、所患疾病、对居住环境的满意度、对娱乐活动场所的满意度、体育锻炼状况;影响敬老院老年人生活质量的因素为年龄、所患疾病、对居住环境的满意度、对娱乐活动场所的满意度. 结论 社区老年人人口学因素对生活质量的影响比较明显,而敬老院、老年病房则不明显.对居住环境、娱乐活动场所、看病、交通状况满意程度不同及体育锻炼状况不同的社区、敬老院老年人生活质量明显不同.     

Health state utilities and quality of life in patients with hepatitis B

BACKGROUND:

The effect of chronic hepatitis B (CHB) infection on health-related quality of life (HRQoL) and health state utilities has not been well characterized.

OBJECTIVE:

To measure utility scores and HRQoL across disease states associated with CHB infection.

METHODS:

Patients attending four tertiary care clinics for CHB were approached between July 2007 and March 2009. Respondents completed version 2 of the Short-Form 36 Health Survey, the EQ5D, a visual analogue scale, the Health Utilities Index Mark 3, standard gamble, and demographics and risk factor surveys in English, Cantonese or Mandarin. Charts were reviewed to determine disease stage and comorbidities.

RESULTS:

A total of 433 patients were studied: 294 had no cirrhosis; 79 had compensated cirrhosis; seven had decompensated cirrhosis; 23 had hepatocellular carcinoma; and 30 had received a liver transplant. The mean standard gamble utilities for these disease states were 0.89, 0.87, 0.82, 0.84 and 0.86, respectively. HRQoL scores in noncirrhotic patients were similar to those of the general population. Scores of patients with compensated cirrhosis were not significantly lower; however, patients with decompensated cirrhosis and hepatocellular carcinoma had significantly lower HRQoL scores compared with noncirrhotic patients (P<0.05). Similar scores were observed among patients on and off oral antiviral treatment. Post-liver transplant patients had a higher HRQoL than patients with decompensated cirrhosis. Age, number of comorbidities and relationship status were significantly associated with HRQoL scores.

CONCLUSIONS:

HRQoL in CHB patients is only impaired in the later stages of liver disease. Neither CHB infection nor antiviral treatment is associated with a lower quality of life.     

高血压与老年人的生活质量

目的分析高血压对老年人生活质量的影响。方法抽样调查北京城乡社区老年人1847例,并且进行血压测量及评估躯体健康、心理健康、认知能力、生活活动能力和生活满意度。结果已患高血压的老年人生活质量显著低于血压正常者;随着高血压病程的延长,高血压相关疾病患病率增高,认知能力变差;高血压水平越高者,抑郁症状增加,生活活动能力进一步下降。结论积极防治高血压,可提高全民人口素质,提高老年人的健康相关生活质量。     

The economic cost of musculoskeletal disorders in Canada

Objective . This study estimated the total cost of musculoskeletal disorders for Canadians in 1994 and assessed the sensitivity of these cost estimates to variations in the definition of musculoskeletal disorders. Methods . Disease-related costs, from a societal perspective, were measured using a prevalencebased analysis. First, direct treatment costs, including expenditures on hospitals and other institutions, physicians and other health professionals, drugs, research, and other items were assessed. Second, indirect costs associated with lost (or foregone) productivity due to disability and premature mortality were evaluated using the human capital approach. Results . The total cost of musculoskeletal disorders in Canada was $25.6 billion (in 1994 Canadian dollars, $1.00 CDN ≈ $0.75 US) or 3.4% of the gross domestic product. Direct and indirect costs were estimated at $7.5 billion and $18.1 billion, respectively. Lower and upper bound estimates of the total cost of musculoskeletal disorders, derived from the sensitivity analysis, were $19.9 billion and $30.8 billion, respectively. Wide variations were reported in the total cost of various musculoskeletal disorder subcategories, with the highest costs reported for injuries ($10.7 billion), back and spine disorders ($8.1 billion), and arthritis and rheumatism ($5.9 billion). Conclusions . The economic cost of musculoskeletal disorders was substantial and was sensitive to the definition of musculoskeletal disorders and other underlying assumptions. The hallmark of this study was the variation between subcategories in their cost, pattern of health resource use, and sequelae. The cost estimates may provide guidance in setting priorities for research and prevention activities.     

Empowering Frontline Primary Healthcare Workers in a Global Health Partnership Training of Trainers Intervention to Strengthen the Prevention and Control of Cardiovascular Disease in Mozambique

Background:Unpreparedness of health professionals to address non-communicable diseases (NCD) at peripheral health facilities is a critical health system challenge in Mozambique. To address this weakness and decentralize NCD care, training of the primary care workforce is needed. We describe our experience in the design and implementation of a cascade training of trainers (ToT) intervention to strengthen the prevention and control of cardiovascular disease.Methods:Between October 2018 and March 2020 a multidisciplinary global technical partnership was used to train frontline primary care health professionals from a resource-poor suburban setting in Maputo, Mozambique. Following engagement with local policy makers, clinicians, and academics, core training materials were developed, and a ToT cascade was implemented, supported by an on-site pilot clinic. Knowledge and confidence acquisition by participants and new local trainers were assessed using pre- and post-training surveys, while trainees and trainers completed further evaluation surveys at the end of the program.Results:Three ToT workshops trained 60 mixed cadre healthcare workers in assessment, diagnosis and management of hypertension, diabetes, and cardiovascular risk; of these, 11 became new local trainers. Mean pre- and post-test scores improved in all three training workshops (53% to 90%, 59% to 78%, and 58% to 74% respectively). New local trainers were highly rated by their trainees and reported increased confidence as trainers (mean Likert scale 3.0/5 pre-training to 4.8/5 post-training).Conclusion:This global health partnership delivered interprofessional training with good knowledge acquisition and increased self-reported confidence. Intensive local supervision and hands-on training empowered a new cohort of trainers to strengthen the prevention and control of cardiovascular disease and is likely to improve coordination and integration at primary care level as well as support the national scale up of NCD care delivery.