Seasonal Specificity of Seasonal Allergens and Validation of the ARIA Classification in Korea

Purpose

In Korea, tree pollens are known to be prevalent in spring, grass pollens in summer and weed pollens in autumn. However, few studies have revealed their seasonal specificity for allergic rhinitis symptoms. An ARIA (Allergic Rhinitis and its Impact on Asthma) classification of allergic rhinitis was recently introduced and its clinical validation has not been well proved. The aim of this study was to evaluate the seasonal specificity of seasonal allergens and to validate the ARIA classification with the conventional seasonal and perennial allergic rhinitis (SAR/PAR) classification.

Methods

Two hundred twenty six patients with allergic rhinitis were included in this study. The patients were classified according to the sensitized allergens and the ARIA classifications. A questionnaire survey was performed and the data on the seasonal symptom score, the severity of symptoms and the SNOT (sinonasal outcome test)-20 score was obtained and the data was analyzed and compared between the conventional SAR/PAR classification and the ARIA classification.

Results

Seasonal pollens (tree, grass, weed) were not specific to the pollen peak season and the patients'' symptoms were severe during spring and autumn regardless of the offending pollens. More than 60% of the patients with SAR showed persistent symptoms and 33% of the patients with perennial allergic rhinitis (PAR) had intermittent symptoms, showing the lack of association between the SAR/PAR/PAR+SAR classification and the ARIA classification. The ARIA classification showed better association not only with the symptomatic score, but also with the SNOT-20 score, which showed better validity than the conventional SAR/PAR classifications.

Conclusions

Seasonal pollens were not specific to their season of prevalence in terms of the severity of symptoms, and the ARIA classification showed better representation of allergic symptoms and quality of life (SNOT-20 score) than did the SAR/PAR classification.     

Health related quality of life in common variable immunodeficiency

Purpose

To quantify the health related quality of life in primary immunodeficiency patients.

Materials and Methods

We used generic health status and general psychological health questionnaires to determine the range of issues that needed to be considered in examining the burden of common variable immunodeficiency (CVID).

Results

The health status of patients with CVID was lower than that observed in normal subjects. Overall, Role-Physical and General Health scales correlated with a poorer clinical status. Surprisingly, the duration of disease did not influence health status. Being female, older, General Health Questionnaire-positive and alexithymic proved to be major risk factors associated with a poor health status. Patients with chronic lung disease and chronic diarrhea had the lowest values on the Medical Outcome Study, Short Form SF-36 (SF-36) scales. Disease severity perception was associated with the General Health Questionnaire and alexithymia status. Limitations in daily activities as a result of lower physical health were the major problems facing common variable immunodeficiency patients.

Conclusion

Our data underlined the importance of conducting a periodical health related quality of life assessment on patients with primary antibody deficiencies and, moreover, stressed the necessity of providing psychological support to at risk patients.     

Interactions Between Innate Immunity Genes and Early-Life Risk Factors in Allergic Rhinitis

Purpose

Allergic rhinitis (AR) is a common chronic disease. Many factors could affect the development of AR. We investigated early-life factors, such as delivery mode, feeding method, and use of antibiotics during infancy, which could affect the development of AR. In addition, how interactions between these factors and innate gene polymorphisms influence the development of AR was investigated.

Methods

A cross-sectional study of 1,828 children aged 9-12 years was conducted. Three early-life factors and AR were assessed by a questionnaire. Skin prick tests were done. Polymorphisms of TLR4 (rs1927911) and CD14 (rs2569190) were genotyped.

Results

Use of antibiotics during infancy increased the risk of AR (aOR [95% CI] 1.511 [1.222-2.037]) and atopic AR (aOR [95% CI], 1.565 [1.078-2.272]). There were synergistic interactions between caesarean delivery, formula feeding, and use of antibiotics in the rate of atopic AR (aOR [95% CI], 3.038 [1.256-7.347]). Additional analyses revealed that the risk for the development of AR or atopic AR subjects with the TLR4 CC genotype were highest when all the 3 early-life factors were present (aOR [95% CI], 5.127 [1.265-20.780] for AR; 6.078 [1.499-24.649] for atopic AR). In addition, the risk for the development of AR or atopic AR in subjects with the CD14 TT genotype were highest when all the 3 early-life factors were present (aOR [95% CI], 5.960 [1.421-15.002] for AR; 6.714 [1.440-31.312] for atopic AR).

Conclusions

Delivery mode, feeding method, and use of antibiotics during infancy appeared to have synergistic interactions in the development of AR. Gene-environment interactions between polymorphism of innate genes and early- life risk factors might affect the development of AR.     

Association of Antioxidants With Allergic Rhinitis in Children From Seoul

Purpose

The prevalence of allergic diseases has risen over the last few decades. Many factors, including environmental factors such as those related to diet, have been considered. Among dietary factors, intake of antioxidant-related nutrients has been associated with the risk of allergic disease. We investigated the association of antioxidant nutritional status with allergic rhinitis (AR) in Korean schoolchildren aged 6-12 years.

Methods

Subjects were 4,554 children in Seoul, Korea. The risk of allergic disease was measured using the Korean version of the International Study of Asthma and Allergies in Childhood, and dietary intake was measured by a semi-quantitative food frequency questionnaire. Intake of vitamins A (including retinol and β-carotene), C, and E was used in the analysis.

Results

Vitamin C intake was negatively associated with an increased risk of current symptoms (adjusted odds ratio, 0.886; 95% confidence interval, 0.806-0.973). There was no association between AR and intake of vitamin A, retinol, β-carotene, or vitamin E. Total serum IgE level and sensitization to allergen did not differ according to nutrient intake.

Conclusions

The group of children with increased vitamin C consumption had fewer AR symptoms, despite the lack of a difference in total serum IgE level or allergen sensitization. These findings suggest that nutrient intake, especially that of vitamin C, influences AR symptoms.     

Association between Serum 25-Hydroxyvitamin D Level and Insulin Resistance in a Rural Population

Purpose

A low serum 25-hydroxyvitamin D [25(OH)D] level in the blood has been correlated with an increased risk of diabetes mellitus; however, the association between serum 25(OH)D level and insulin resistance has not been established in a Korean rural population. The aim of this study was to investigate the independent association between serum 25(OH)D level and insulin resistance in rural Korean adults.

Materials and Methods

This study used data from the Korean Genome Epidemiology Study-Kangwha Study. In the 2011 study, 1200 adults completed health examinations. In an ancillary study, serum 25(OH)D level was measured in a subsample (n=813). After excluding those taking vitamin D supplements, a cross-sectional analysis was carried out on 807 participants (324 men and 483 women) aged 40 to 89 years old. Measured from overnight fasting blood samples, glucose and insulin levels were used to calculate the homeostasis model assessment for insulin resistance (HOMA-IR). Measures of glucose, insulin, and HOMA-IR were log-transformed for parametric tests.

Results

Serum 25(OH)D level was inversely associated with HOMA-IR (β=-0.003, p=0.039) in a univariate analysis. However, the association was not significant after adjustment for sex and age (β=-0.002, p=0.123) or after adjustment for sex, age, body mass index, smoking status, alcohol intake, and regular exercise (β=-0.003, p=0.247).

Conclusion

Our findings suggest that vitamin D is not independently associated with insulin resistance in Korean men and women.     

Anxiety and depression among North Korean young defectors in South Korea and their association with health-related quality of life

Purpose

This study examined anxiety and depression among 108 North Korean adolescent and young adult (age, 12-29 years) defectors who settled in South Korea, and evaluated the relationship between their mental health and health-related quality of life (HRQoL).

Materials and Methods

Subjects completed a questionnaire that included the Hospital Anxiety and Depression Scale (HADS), the Short Form with 36 questions (SF-36; consists of mental and physical health components) for measuring HRQoL, and items related to the period of time since defection and settlement and socio-demographic variables.

Results

Among the participants, 53.7% scored≥8 on the anxiety measure questionnaire, and 22.2% scored≥11; 36.1% of the participants scored≥8 on the depression measure questionnaire and 14.8% scored≥11. Both anxiety and depression subscales were associated with lower scores of total SF-36, physical component and mental component score. Depressive symptom appeared more frequently among the subjects who had lived in South Korea for <1 year than among the subjects who had lived in South Korea for 2 year or longer (odds ratio=3.77, 95% confidence intervals=1.12 to 12.70).

Conclusion

Among North Korean adolescent and young adult defectors, anxiety and depression were associated with lower HRQoL. Therefore, it is needed to develop strategies to screen for mental health and intervene to reduce anxiety and depression during their early resettlement stage.     

Sociodemographic Status and Self-Reported BMI-related Morbidity in Koreans

Purpose

This study examined whether the relationship between body mass index (BMI) and the morbidity of chronic diseases differs by marital status, education, and income level.

Materials and Methods

From a nationally representative sample of 5,526 adults from the third Korean National Health and Nutrition Examination Survey (2005), data regarding measured height and weight to classify BMI category (< 23, 23-24.9, ≥ 25), self-reported sociodemographics (marital status, education, income, age, sex, and residence area), health behaviors (smoking, alcohol use, exercise, sleep, stress perception, and depression), and morbidity from at least one chronic disease were collected.

Results

Education, income, and marital status were significantly associated with morbidity regardless of adjustment for BMI and health behaviors. After adjusting for BMI, other sociodemographic factors, and health behaviors, the odds ratio (95% confidence interval) of morbidity was 2.9 (2.4-3.7) for those in the married group and 2.9 (2.1-4.0) for those in the separated/divorced/widowed group, 2.0 (1.6-2.5) for those in the lowest education group, and 1.3 (1.2-1.6) for those in the lowest income group. When the BMI category and sociodemographic factors were combined, the odds ratios were elevated for those in the combination group with higher BMI and lower sociodemographic position.

Conclusion

Korean subjects who were married, in the lowest education group, or in the lowest income level had a higher risk of morbidity in relation to BMI.     

Novel Risk Factors for Allergic Rhinitis in Korean Elementary School Children: ARCO-kids Phase II in a Community

Purpose

Allergic rhinitis (AR) is a multifactorial disease whose genetic and environmental risk factors have been studied for decades. Many pediatric studies have pointed out the familial history of allergy, hygiene hypothesis, breast-feeding, pet ownership, and diets as risk factors of AR. However, most of factors are still up for debate. This preliminary report aimed to confirm the known risk factors and find the novel risk factors for AR in the Korean pediatric population.

Methods

A bi-seasonal, winter and summer, study in 2 elementary schools included all students whose parents completed the questionnaire of medical and social histories, quality of life, infant and early-childhood history, and the living styles. Skin prick tests and endoscopic examinations were conducted on all participants.

Results

Among total 1,020 children, 338 participants had AR. The multivariate logistic regression analysis highlighted 6 factors: male gender (OR, 2.10; 95% CI, 1.32-3.33), older age (1.65; 1.03-2.65), previous history of allergic conjunctivitis (14.25; 4.99-40.74), asthma (2.73; 0.96-7.76) and pneumonia (0.39; 0.19-0.82), and an hour increase in daily playing time (0.90; 0.80-1.00).

Conclusions

Lack of pneumonia in early childhood and short playing time are newly found risk factors for Korean pediatric AR in this study confirming male gender, older age and previous history of allergic conjunctivitis and asthma as the risk factors.     

Application of a new spirometric reference equation and its impact on the staging of Korean chronic obstructive pulmonary disease patients

Purpose

A new spirometric reference equation was recently developed from the first national chronic obstructive pulmonary disease (COPD) survey in Korea. However, Morris'' equation has been preferred for evaluating spirometric values instead. The objective of this study was to evaluate changes in severity staging in Korean COPD patients by adopting the newly developed Korean equation.

Materials and Methods

We evaluated the spirometric data of 441 COPD patients. The presence of airflow limitation was defined as an observed post-bronchodilator forced expiratory volume in one second/forced vital capacity (FEV1/FVC) less than 0.7, and the severity of airflow limitation was assessed according to GOLD stages. Spirometric values were reassessed using the new Korean equation, Morris'' equation and other reference equations.

Results

The severity of airflow limitation was differently graded in 143 (32.4%) patients after application of the new Korean equation when compared with Morris'' equation. All 143 patients were reallocated into more severe stages (49 at mild stage, 65 at moderate stage, and 29 at severe stage were changed to moderate, severe and very severe stages, respectively). Stages according to other reference equations were changed in 18.6-49.4% of the patients.

Conclusion

These results indicate that equations from different ethnic groups do not sufficiently reflect the airflow limitation of Korean COPD patients. The Korean reference equation should be used for Korean COPD patients in order to administer proper treatment.     

Does Narcolepsy Symptom Severity Vary According to HLA-DQB1*0602 Allele Status?

Study Objectives:

To investigate associations between HLA-DQB1*0602 allele status and measures of narcolepsy symptom severity.

Design:

Cross-sectional study of population-based narcolepsy patients.

Setting:

King County, Washington.

Participants:

All prevalent cases (n = 279) of physician-diagnosed narcolepsy ascertained from 2001-2005.

Interventions:

N/A

Measurements:

Narcolepsy diagnosis was based on cataplexy status, diagnostic sleep study results, and chart review. The number of HLA-DQB1 alleles was determined from buccal genomic DNA. Symptom severity instruments included the Epworth Sleepiness Scale (ESS), the Ullanlinna Narcolepsy Scale (UNS), age of symptom onset, subjective sleep latency and duration, and various clinical sleep parameters. We used linear regression adjusted for African American race and an extended chi-square test of trend to assess relationships across ordered groups defined by allele number (0, 1, or 2).

Results:

Narcolepsy patients were 63% female and 82% Caucasian, with a mean age of 47.6 years (SD = 17.1). One hundred forty-one (51%) patients had no DQB1*0602 alleles; 117 (42%) had one; and 21 (7%) had two. In the complete narcolepsy sample after adjustment for African American race, we observed a linear relationship between HLA-DQB1*0602 frequency and sleepiness as defined by the ESS (P < 0.01), narcolepsy severity as defined by UNS (P < 0.001), age of symptom onset (P < 0.05), and sleep latency (P < 0.001). In univariate analyses, HLA-DQB1*0602 frequency was also associated with napping (P < 0.05) and increased car and work accidents or near accidents (both P < 0.01). Habitual sleep duration was not associated with HLA status. These race-adjusted associations remained for the ESS (P < 0.05), UNS (P < 0.01), and sleep latency (P < 0.001) when restricting to narcolepsy with cataplexy.

Conclusions:

Narcolepsy symptom severity varies in a linear manner according to HLA-DQB1*0602 allele status. These findings support the notion that HLA-DQ is a disease-modifying gene.

Citation:

Watson NF; Ton TGN; Koepsell TD; Gersuk VH; Longstreth WT. Does narcolepsy symptom severity vary according to HLA-DQB1*0602 allele status? SLEEP 2010;33(1):29-35.     

Social capital and its relationship to self-perceived health: National health survey in Colombia 2007

Objective:

To analyze the self-reported perceived health related to socio-demographic characteristics, social health inequalities and social capital in Colombia.

Methods:

This study is a cross-sectional design; data was obtained from the National Health Survey of Colombia 2007. Independent variables: socio-demographic characteristics; component variables: social health inequality and social capital. Dependent variable: self-reported health. Analysis of the relationship used logistic regression through OR and its confidence interval.

Results:

The determinant factors for a negative health perceptions are related to being a female (OR: 0.49 [0.47 to 0.52]), and in both genders being older than 37 years of age (OR: 0.72 [0.61 to 0.85]), living without a partner, black ethnicity, indigenous women (0.80 [0.69 to 0.94] and low economic incomes.

Discussion:

The relationship between social determinants and social capital in the perception of health shows inequities and indirectly reflects the level of health. Given the policies and the model of health, requires a rational adjustment of the goals, programs, and national and regional strategies with the object of improving the demand and quality of services.     

Predicting biopsychosocial outcomes for heroin users in primary care treatment: a prospective longitudinal cohort study

Background

Opiate substitution treatment for heroin users reduces mortality, illicit drug use, crime, and risk-taking behaviour, and improves physical, mental and social functioning. Few extended studies have been carried out in UK primary care to study factors predicting recovery.

Aim

To establish whether primary care opiate substitution treatment is associated with improvements in outcomes over 11 years, in delivering recovery, and to identify predictive factors.

Design and setting

A prospective longitudinal cohort study, with repeated measures in the Primary Care Addiction Service, Sheffield, 1999–2011.

Method

A total of 123 eligible patients were assessed using the Opiate Treatment Index at entry to treatment and at 1, 5, and 11 years. Clinical records were used to assess factors including employment and discharge status.

Results

At 11 years, there was a high rate of drug-free discharge (22.0%) and medically-assisted recovery (30.9%), and low mortality (6.5%). Continuous treatment was associated with being discharged drug free (P = 0.005). For those still in treatment, there were highly significant reductions in heroin use and injecting, and significantly improved psychosocial functioning. There were strong positive correlations between mental health, physical health, and social functioning. Patients in employment had significantly better psychological and social functioning (P = 0.017, P = 0.007, respectively).

Conclusion

Opiate substitution treatment is associated over 11 years with full recovery, drug-free discharge and medically-assisted recovery. There is a strong association between the psychosocial variables, suggesting that intervention in any one of these areas may have extended benefits, by impacting on related variables and employment. The best predictor of a drug-free discharge was continuous uninterrupted treatment.     

Burnout and psychological distress among nurses in a Nigerian tertiary health institution

Background

The role of nurses in the health care delivery system cannot be overemphasized. Nurses are needed at all levels of healthcare and the profession requires a lot of dedication, time and energy with regards to patient management and service delivery. This time investment and dedication to duty is likely to lead to burnout and psychological distress among the nurses.

Objective

This study assesses the prevalence of burnout and psychological distress among nurses working in Nigerian tertiary health institution.

Method

The Maslach Burnout Inventory (MBI) and the General Health Questionnaire (GHQ-12) were used to assess 210 nurses working in this health institution for symptoms of burnout and psychological distress.

Results

High levels of burnout were identified in 42.9% of the respondents in the area of emotional exhaustion, 47.6% in the area of depersonalization and 53.8% in the area of reduced personal accomplishment, while 44.1% scored positive in the GHQ-12 indicating presence of psychological distress.

Conclusion

Prevalence of burnout and psychological distress is high among nurses.     

Decisions about referrals for psychological therapies: a matched-patient qualitative study

Background

Psychological therapies are effective treatments for common mental health problems, but access is limited. GPs face difficult decisions as to whom to refer, but little is known about this decision-making process.

Aim

To explore GPs'' accounts of decisions to refer, or not refer, patients for psychological therapy.

Design of study

A qualitative study, using a matched-patient procedure.

Setting

General practices in two inner London boroughs.

Method

In semi-structured interviews, GPs were asked to compare and contrast five matched-patient pairs, consisting of patients who had been referred for psychological therapy paired with patients not referred. The interviews were analysed using a general thematic analysis.

Results

Fourteen GPs discussed 130 matched patients (65 patient pairs). Three main factors distinguished GPs'' accounts of the patients they referred compared with the matched patients they did not refer. These factors were: patient initiative in requesting or showing interest in referral; estimated capacity of the patient to benefit from psychological therapy; and the GP''s own capacity to help the patient in terms of skills, expertise, and time.

Conclusion

GPs gave accounts of themselves acting as rational decision makers, judging how effective they thought a referral would be based on a patient''s clinical presentation and motivation, compared with the GPs'' own ability to help.     

GPs' role in the detection of psychological problems of young people: a population-based study

Background

Among young people, about one in three females and one in five males report experiencing emotional distress but 65–95% of them do not receive help from health professionals.

Aim

To assess the differences among young people who seek help and those who do not seek help for their psychological problems, considering the frequency of consultations to their GP and their social resources.

Design of study

School survey.

Setting

Post-mandatory school.

Method

Among a Swiss national representative sample of 7429 students and apprentices (45.6% females) aged 16–20 years, 1931 young people reported needing help for a problem of depression/sadness (26%) and were included in the study. They were divided into those who sought help (n = 256) and those who did not (n = 1675), and differences between them were assessed.

Results

Only 13% of young people needing help for psychological problems consulted for that reason and this rate was positively associated with the frequency of consultations to the GP. However, 80% of young people who did not consult for psychological problems visited their GP at least once during the previous year. Being older or a student, having a higher depression score, or a history of suicide attempt were linked with a higher rate of help seeking. Moreover, confiding in adults positively influenced the rate of help seeking.

Conclusion

The large majority of young people reporting psychological problems do not seek help, although they regularly consult their GP. While young people have difficulties in tackling issues about mental health, GPs could improve the situation by systematically inquiring about this issue.     

Impact of the QOF and the NICE guideline in the diagnosis andmanagement of depression: a qualitative study

Background

The National Institute for Health and clinical Excellence (NICE) depression guideline (2004) and the updated Quality and Outcomes Framework (QOF) ( 2006) in general practice have introduced the concepts of screening severity assessment, for example using the Patient Health Questionnaire 9 (PHQ-9), and ‘stepped care’ for depression.

Aim

To explore primary care practitioner perspectives on the clinical utility of the NICE guideline and the impact of the QOF on diagnosis and management of depression in routine practice.

Design and setting

Qualitative study using focus groups from four multidisciplinary practice teams with diverse populations in south Yorkshire.

Method

Four focus groups were conducted, using a topic guide and audiotaping. There were 38 participants: GPs, nurses, doctors in training, mental health workers, and a manager. Data analysis was iterative and thematic.

Results

The NICE guideline, with its embedded principles of holism and evidence-based practice, was viewed positively but its impact was compromised by resource and practitioner barriers to implementation. The perceived imposition of the screening questions and severity assessments (PHQ-9) with no responsive training had required practitioners to work hard to minimise negative impacts on their work, for example: constantly adapting consultations to tick boxes; avoiding triggering open displays of distress without the time to offer appropriate care; positively managing how their patients were labelled. Further confusion was experienced around the evolving content of psychological interventions for depression.

Conclusion

Organisational barriers to the implementation of the NICE guideline and the limited scope of the QOF highlight the need for policy makers to work more effectively with the complex realities of general practice in order to systematically improve the quality and delivery of ‘managed’ care for depression.     

Short Sleep Duration in Prevalent and Persistent Psychological Distress in Young Adults: The DRIVE Study

Objectives:

Young people are sleeping less. Short sleep duration has a range of negative consequences including a hypothesized link with psychological distress, which has yet to be studied

Design:

Prospective cohort study

Setting:

Community-based sample from Australia

Participants:

Twenty thousand (20,822) young adults (aged 17-24) identified through the state vehicle licensing authority. A random sample (n = 5000) was approached for follow-up 12-18 months later, with 2937 providing full data.

Main Outcome Measure:

Psychological distress, determined by a Kessler 10 score > 21, at baseline; and as both onset and persistence of distress at follow-up.

Results:

Shorter sleep duration was linearly associated with prevalent psychological distress: relative risk (RR) 1.14 (95%CI 1.12 to 1.15). Only the very short (< 5 h) sleepers among those not distressed at baseline had an increased risk for onset of psychological distress (RR 3.25 [95% CI 1.84, 5.75]). Of 945 cohort participants reporting psychological distress at baseline, 419 (44%) were distressed at follow-up. Each hour less of sleep increased the risk of psychological distress persisting after adjustment for potential confounding variables: RR 1.05 (95%CI 1.01 to 1.10). Long sleep duration showed no association with distress at any time point.

Conclusions:

Self-reported shorter sleep duration is linearly associated with prevalent and persistent psychological distress in young adults. In contrast, only the very short sleepers had a raised risk of new onset of distress. Different approaches to sleep duration measurement yield different results and should guide any interventions to improve subjective sleep duration in young adults.

Citation:

Glozier N; Martiniuk A; Patton G; Ivers R; Li Q; Hickie I; Senserrick T; Woodward M; Norton R; Stevenson M. Short sleep duration in prevalent and persistent psychological distress in young adults: the DRIVE study. SLEEP 2010;33(9):1139-1145.     

Prevalence of poor self-rated health and associated risk factors among older adults in Cali,Colombia

Introduction:

Self-rated health (SRH) has beeen considered an important marker of quality of life and an independent predictor of mortality in older adults.

Objective:

To determine the prevalence of poor SRH and identify risk factors associated with poor SRH among older adults residing in the Commune 18 of the city of Cali, Colombia, in 2009.

Methods:

A population-based cross-sectional study with a single-stage cluster sampling design. Sample included 314 persons aged 60 and older. The dependent variable, SRH was dichotomized into good (excellent, very good, good) and poor (fair, poor). Independent variables were sociodemographic, biological, mental, functional and geriatric syndromes. Logistic regression was used for multivariate statistical modeling.

Results:

Overall, 40.1% reported poor SRH (women 42.9%, men 35.0%). Factors independently associated with poor SRH were diabetes mellitus, depression, fear of falling and frailty syndrome (frail and pre-frail vs. non-frail). Widowed men reported poorer health than married men while other marital status (single/separated/divorced) was associated with better self-rated health in women.

Conclusion:

Potential modifiable factors such as depression and frailty syndrome are important determinants for poor SRH in Colombian older adults.