Gender differences in vulnerability to socioeconomic status on self-rated health in 15 countries

Objectives: This study compared 15 countries for multiplicative effects of gender by education and by income on self-rated health of individuals with chronic medical conditions

Methods: We analyzed data from the Research on Early Life and Aging Trends and Effects [RELATE] Study. Participants were sampled from 15 countries including Argentina, Barbados, Brazil, Chile, Cuba, Costa Rica, China, India, Ghana, Russia, Puerto Rico, South Africa, Mexico, Uruguay, and the United States. The analytical sample was limited to individuals with at least one chronic medical condition. The main outcome of interest was self-rated health [SRH]. Country-specific logistic regressions were used for data analysis. We ran separate models with gender × education and gender × income interactions

Results: In Ghana, Uruguay, and India, gender moderated the effects of socioeconomic status [SES] on SRH. In Ghana and Uruguay, education and in Mexico and India, income had a stronger effect on SRH for women than men

Conclusions: Countries vary in gender differences in vulnerability to SES indicators on SRH of patients with chronic medical conditions. Women are more vulnerable than men to the effect of low SES on SRH in Ghana, Uruguay, Mexico, and India

Veterans and risk of heart disease in the united states; a cohort with 20 years of follow up

The aim of the current study was twofold: To investigate the effect of veteran status on risk of developing heart disease over a period of 20 years in the United States and to test if socio-economic characteristics, chronic conditions, health behaviors, body mass index [BMI] and depressive symptoms explain the association between veteran status and risk of heart disease. Data came from the Health and Retirement Study, a 20 year national cohort from 1992 to 2012. The study enrolled a representative sample of Americans over the age of 50. We included 8,375 individuals who were older than 50 years at entry, did not have heart disease at baseline and provided data on heart disease over the next 20 years. Veteran status was considered to be the independent variable. Self-reported data on physician diagnosis of heart disease, which was measured on a biannual basis, was the outcome. Baseline socio-economic data [i.e. age, gender, race, marital status and education], chronic conditions [diabetes and hypertension], health behaviors [i.e. drinking, smoking, and exercise], BMI and depressive symptoms [modified Center for Epidemiologic Studies Depression Scale] were entered into logistic regressions. Logistic regression was used for data analysis. Veterans were at higher risk of having a new onset of heart disease [unadjusted relative risk [RR] = 1.996, 95% confidence interval [CI] =1.694-2.351], compared with non-veterans. Logistic regression confirmed the association between veteran status and heart disease [adjusted RR = 1.483, 95% CI = 1.176-1.871] after controlling for all covariates. Veterans may be at higher risk for heart disease over time and this link may be independent of baseline socio-economic characteristics, chronic medical conditions, health behaviors, BMI and depressive symptoms. Veterans may require more rigorous cardiovascular prevention programs

Separate and combined effects of anxiety, depression and problem drinking on subjective health among black, hispanic and non-hispanic white men

The current study examined race and ethnic differences in the separate and combined [additive] effects of anxiety, depression and problem drinking on the baseline and trajectory of subjective health among adult men in the United States. This longitudinal study used data from the Fragile Families and Child Well-being Study. We included 4,655 men, composed of 2,407 Blacks, 1,354 Hispanic Whites and 894 non-Hispanic Whites. The dependent variable was subjective health, measured four times [i.e., baseline, year 1, year 3 and year 5]. Latent growth curve modeling was used for data analysis. When controlling for socio-economics, we tested separate effects of anxiety and depression. Then we tested combined effects of anxiety, depression and problem drinking. Among all race and ethnic groups, anxiety and problem drinking were associated with baseline and trajectory of subjective health. Combined [additive] effects of anxiety and depression, however, varied based on race and ethnicity. Among Blacks, depression and anxiety were associated with a worse trajectory of subjective health. Among non-Hispanic Whites, anxiety was associated with a better baseline and worse trajectory of subjective health, while depression was associated with worse baseline subjective health. Among Hispanic Whites, anxiety was associated with a worse trajectory of subjective health, while depression was not associated with subjective health. Although separate effects of anxiety and problem drinking were similar among race and ethnic groups, race and ethnicity seemed to modify the combined effects of different mental health problems. These results warrant further exploration of these complex links

Prevention of pregnancy complications in Iran following implementing a national educational program

To determine the impact of a national intervention program on some pregnancy complications in Iran. This multicenter study was conducted in governmental sector in 14 provinces in Iran between 2003 and 2005. Intervention included education of all maternal health care providers including gynecologists, general physicians, and midwifes in the governmental sector. Time interval between the pre- [of 3,978 and 3,958 pregnancies] and post- [3,958 pregnancies] measurements were 18 months. Self reported data on pregnancy complications were registered. Interviews were conducted by trained personnel. Participants were interviewed when admitted for delivery or at the time attending for vaccination of their 2 month infants. The following pregnancy complications were reduced significantly as compared to before intervention: 1] bleeding or spotting, 2] urinary tract complications, 3] blurred vision and severe headache, 4] premature labor pain, 5] anemia, 6] severe vomiting, 7] inappropriate weight gain, 8] endometritis, 9] urinary incontinence, 10] breast abscess or mastitis, 11] wound infection, and 12] bleeding was significantly reduced after intervention, compared to before intervention. Premature rupture of membrane showed a significant increase. These complications did not show a significant change: 1] hypertension, 2] fever and chills, 3] convulsion, shock, and loss of consciousness, and 4] obstetric fistula. National programs may be proved to be largely effective by decreasing some of the pregnancy complications in developing countries

Association between sexual function and marital relationship in patients with ischemic heart disease

Patients with ischemic heart disease [IHD] may report difficulties with sexual function and marital relationship. However, there is a dearth of studies focusing on the association between these aspects in IHD patients. The present study sought to assess the association between sexual function and marital relationship among IHD patients and also test the effect modification of gender, education level, and marital distress on the above association. In this cross-sectional study, 551 patients with IHD were enrolled and their sexual function and marital relationship quality were assessed with the Relation and Sexuality Scale [RSS] and Revised Dyadic Adjustment Scale [RDAS], respectively. Association between marital relationship quality and sexual function was assessed with respect to gender, education level, and marital distress. Most participants [72%] were men at a mean age of 57 +/- 11 [range = 36-80] years. Total sexual function was significantly correlated with total marital quality [r = -0.28], marital consensus [r = -0.17], marital coherence [r = -0.19], marital affection expression [r = -0.22], and marital satisfaction [r = -0.25]. Total marital quality also showed a significant association with sexual fear [r = -0.11]. These associations were moderated by gender, education level, and marital distress level. Among the IHD patients, sexual function and marital relationship quality showed a mild to moderate association. Association between sexual function and marital relationship quality, however, may depend on gender, education level, and marital distress level

Chronic medical conditions and major depressive disorder: differential role of positive religious coping among african americans, caribbean blacks and non-hispanic whites

This study was aimed to investigate the main and buffering effects of positive religious coping on the association between the number of chronic medical conditions and major depressive disorder [MDD] among African Americans, Caribbean Blacks and Non-Hispanic Whites. This cross-sectional study used data from the National Survey of American Life, 2001 and 2003. This study enrolled 3,570 African Americans, 1,438 Caribbean Blacks and 891 Non-Hispanic Whites. Number of chronic conditions and positive religious coping were independent variables, 12-month MDD was the outcome and socio-economic characteristics were controls. We fitted the following three ethnic-specific logistic regressions for data analysis. In Model I, we included the number of chronic conditions and controls. In Model II, we added the main effect of religious coping. In Model III, we included an interaction between religious coping and number of chronic conditions. Based on Model I, number of chronic conditions was associated with higher odds of 12-month MDD among all race/ethnic groups. Model II showed a significant and negative association between religious coping and MDD among Caribbean Blacks [odds ratio [OR] =0.55, 95% confidence Interval [CI] =0.39-0.77], but not African Americans or Hispanic Whites. Model III suggested that, only among Caribbean Blacks, the effect of chronic medical conditions on MDD is smaller in the presence of high positive religious coping [OR for interaction = 0.73, 95% CI = 0.55-0.96]. Although the association between multiple chronic conditions and MDD may exist regardless of race and ethnicity, race/ethnicity may shape how positive religious coping buffers this association. This finding sheds more light onto race and ethnic differences in protective effects of religiosity on mental health of populations

Ethnicity modifies the additive effects of anxiety and drug use disorders on suicidal ideation among black adults in the United States

This study aimed to test if ethnicity moderates the additive effects of lifetime psychiatric disorders on serious suicidal thoughts among a nationally representative sample of Black adults in the United States. For this study, we used data of 5,181 Black adults [3,570 African Americans and 1,621 Caribbean Blacks] who participated in the National Survey of American Life, 2001 2003. Five lifetime psychiatric disorders [i.e., major depressive disorder, general anxiety disorder, post-traumatic stress disorder, alcohol abuse disorder, and drug abuse] were considered as the independent variables. Lifetime serious suicidal ideation was considered as the dependent variable. Logistic regressions were used to determine if ethnicity modifies the effects of each psychiatric disorder on serious suicide ideation. Ethnicity was conceptualized as the possible moderator and socio demographics [i.e., age, gender, education level, employment, marital status and country region] were control variables. Among African Americans, major depressive disorder, general anxiety disorder, post-traumatic stress disorder and alcohol abuse disorder were associated with higher odds of suicidal thoughts. Among Caribbean Blacks, major depressive disorder and drug abuse disorder were associated with higher odds of suicidal thoughts. In the pooled sample, there was a significant interaction between ethnicity and anxiety disorder and a marginally significant interaction between ethnicity and drug abuse. Based on our study, suicidality due to psychiatric disorders among Black adults in the United States may depend on ethnicity. General anxiety disorder seems to be a more important risk factor for suicidal ideation among African Americans while drug abuse may contribute more to the risk of suicidal thoughts among Caribbean Blacks.

Race and ethnicity, religion involvement, church-based social support and subjective health in United States: a case of moderated mediation

To test if social support and ethnicity mediate/moderate the association between religion involvement and subjective health in the United States. This is a secondary analysis of National Survey of American Life, 2003. Hierarchical regression was fit to a national household probability sample of adult African Americans [n = 3570], Caribbean Blacks [n = 1621], and Whites [n = 891]. Frequency of church attendance, positive/negative church-based social support, ethnicity, and subjective health [overall life satisfaction and self-rated mental health] were considered as predictor, mediator, moderator and outcome, respectively. Frequency of church attendance had a significant and positive association with mental health and life satisfaction among all ethnic groups. Frequency of church attendance was also correlated with positive and negative social support among all ethnic groups. Church-based social support fully mediated the association between frequency of church attendance and overall life satisfaction among African Americans but not among Caribbean Blacks, or Whites. Church-based social support, however, partially mediated the association between frequency of church attendance and overall mental health among African Americans but not among Caribbean Blacks or Whites. Ethnicity shapes how church-based social support mediates the association between religious involvement and subjective health. Our results showed a moderating mediation effect of ethnicity and social support on the religious involvement-subjective health linkage, in a way that it is only among African Americans that social support is a pathway for the beneficial health effect of religious involvement

Religious beliefs may reduce the negative effect of psychiatric disorders on age of onset of suicidal ideation among blacks in the United States

To evaluate the possible interaction between religious beliefs and psychiatric disorders among Black Americans. In this study, we used data of 5181 adult Black Americans who had participated in National Survey of American Life [NSAL] from February 2001 to June 2003. Variables such as socio-demographics, religious beliefs, and psychiatric disorders were entered in a Cox regression to determine the possible interaction between psychiatric disorders [0, 1, >/= 2] and the subjective religiosity on age of onset of suicidal thought among the participants. Main outcome was age of the first serious suicidal ideation. A dose-dependent effect of number of psychiatric disorders on suicidal ideation was observed. Psychiatric disorders had a higher impact on age of suicidal ideation among those with low self-reported religiosity. Religious beliefs may buffer the effect of psychiatric disorders on suicidal thought. Blacks who are less religious and suffer psychiatric disorders are at the highest risk for early suicidal ideation

Honey with coffee: a new finding in the treatment of persistent postinfectious cough

Persistent postinfectious cough [PPC] is a cough that persists longer than 3 weeks or perhaps for many months after a common cold oran upper respiratory tract infection [URTI]. PPC has poor response to routine treatment modalities, so it can be a vexing problem for the patient and the physician alike. Our hypothesis was that honey and/or coffee have some beneficial effects in the treatment of PPC. The aim of this study was to evaluate the therapeutic effects of coffee and/or honey in the treatment of patients with PPC. This was a double blind randomized clinical trial, conducted on adult patients during a 6-year period from 2003 to 2009. Included in this study were 84 adult participants that had experienced PPC longer than 3 weeks. All of them had the history of several referrals to different physicians and despite treatment, their cough had persisted. Patients with other causes of chronic cough, or systemic disease or with abnormal routine laboratory tests were excluded. All the included 84 participants were distributed into three groups. For all the participants, a jam-like paste was prepared. Each 600 grams of the product consisted of "70 grams original instant coffee" in the first regimen, "500 grams of honey" in the second regimen and "70 grams of instant coffee plus 500 grams of honey" in the third regimen. These participants were told to dissolve 25 grams of the prescribed product in about 200 [CC] of warm water [under 60° Degree[C]], and drink this solution every 8 hours for one week. All the participants were evaluated before and at the end of the first week of their treatment, to measure the frequency of their cough. In addition they were under observation for the first month. Comparing the effectiveness of all three treatment regimens, this study found "honey with coffee" as the most effective treatment modality for PPC[P< 0.001]. Combination of honey and coffee can successfully treat the PPC at a short time. Thus, it is recommended for the treatment of PPC

Hospital admission due to nephrological conditions during hajj causes, healthcare use, and short-term outcomes

In this retrospective study, records of Iranian Hajj pilgrims who were hospitalized in 2 Iranian hospitals in Mecca and Medina, Saudi Arabia, from 2005 to 2007, were reviewed of 600 patients who were hospitalized, 12 [2.0%] were admitted due to nephrological causes, which included kidney calculi [n = 7; 58.4%], acute kidney failure [n = 2; 16.7%], urinary tract infection [n = 1; 8.3%], urinary tract infection and urinary calculus [n = 1; 8.3%], and renal malignancy [n = 1; 8.3%]. None of the patients needed referral to other healthcare centers, and all of them were discharged with good condition. Length of hospital stay was 1 to 4 days. There was no association between hospitalization due to nephrological causes and sociodemographic data, healthcare use, and outcome. This inpatient epidemiological study showed 2% of total admissions were related to nephrological conditions in Iranian Hajj pilgrims, most commonly due to easily treated conditions

Costs and length of hospitalization following kidney transplantation

We assessed the costs of hospital admissions and length of hospital stay in kidney allograft recipients admitted to our center, in order to rank hospitalization causes in terms of costly and prolonged admissions, to bring to light the respective correlates of costly and prolonged admissions, and to investigate the relationship between costs and length of rehospitalizations. Among rehospitalizations, 83.3% of those due to cerebrovascular accident were costly and 51% of those with graft rejection resulted in prolonged hospital stays. Costly admissions had a high regularity in cases of patients older than 60 years, end-stage renal disease due to diabetes mellitus, graft loss, intensive care unit admission, and hospitalizations accompanied by in death. Prolonged stays were more common in those who were admitted to intensive care unit and those who ultimately died. The Costs showed a significant correlation with the length of rehospitalization [r = 0.626, P = .001]. The strong correlation between the length of hospitalization and posttransplant hospitalization costs means that the former should be curtailed by focusing on such correlates of high-cost admissions as high age and diabetes mellitus as the cause of kidney failure

Marital adjustment in patients on long-term hemodialysis. A case-control study

This study was conducted to compare marital adjustment between patients on long-term hemodialysis and healthy controls and to determine whether the psychological symptoms correlate with marital adjustment in these patients. In a case-control study, 40 patients on long-term hemodialysis and 40 healthy participants were compared for the quality of marital relationship. The Revised Dyadic Adjustment Scale was used for interviews of marital relationship, which includes total marital adjustment and its subscales of marital consensus, affection expression, marital satisfaction, and marital cohesion. Symptoms of anxiety and depression and the Ifudu comorbidity scale were also assessed in the patients group. Marital consensus, affection expression, marital satisfaction, marital cohesion, and the overall marital relationship were significantly poorer in the patients on hemodialysis than in the controls. Also, symptoms of anxiety were more severe among the patients on hemodialysis in comparison with that in the controls. However, this was not the case for symptoms of depression. In the patients on hemodialysis, the severity of anxiety slightly correlated reversely with the total marital relationship score and marital satisfaction subscale. Depression correlated reversely with total marital adjustment, affection expression, marital satisfaction, and marital cohesion. Finally, some marital relationship subscales showed poorer results in men on dialysis, younger patients, and those with higher educational levels. Marital adjustment in patients on hemodialysis, which is linked with depressive symptoms and anxiety, is poorer compared to the healthy controls. This finding shows the necessity of an appropriate family approach for patients on long-term dialysis

Urogenital history in veterans exposed to high-dose sulfur mustard a preliminary study of self-reported data

To date, little information exists regarding urogenital disease in those who have been exposed to sulfur mustard [SM]. We report the self-reported history of urologic conditions and findings on physical examination in a group of male veterans 19 to 26 years after exposed to high-dose sulfur mustard. Data on urologic health conditions of a nationwide health survey were used in this study. This survey included all 289 Iranian male veterans who had been exposed to high doses of SM between 1983 and 1989. Demographic data, exposure-related data, health status, and also self-reported lifetime history of urologic tract infections, pyelonephritis, urinary calculi, kidney failure, and urogenital neoplasms were specifically concerned. The mean age of the veterans was 45.0 +/- 7.5 years [range, 30 to 75 years]. An interval of 19 to 26 years had passed from exposure to SM. Fifty veterans [17.3%] had a positive history of urinary calculi, 25 [8.7%] had recurrent urinary tract infections, 5 [1.7%] had BPH, and 2 [0.7%] had kidney failure. None of them had experienced urogenital malignancies. Neither recurrent urinary tract infections nor urinary calculi were significantly associated with age, medications and their doses, or SM-reduced late complications in other organs. This study adds the prevalence of self-reported urologic conditions to our limited knowledge on SM-exposed veterans' health condition, without finding any link neither to demographic, nor to the severity of health complications related to SM exposure

Revised dyadic adjustment scale as a reliable tool for assessment of quality of marital relationship in patients on long-term hemodialysis

Although the revised dyadic adjustment scale [RDAS] has been widely used as an indicator of the quality of marital relationship, no report is available on the reliability of this measure in patients on hemodialysis. We examined the internal consistency of the RDAS in a group of Iranian patients undergoing maintenance hemodialysis. A translated Persian version of the RDAS was self-administered to 135 patients. The internal consistency of the RDAS was tested using the Chronbach a coefficient which was 0.898, 0.683, 0.779, 0.827, and 0.836 for the RDAS total score and the dyadic consensus, affective expression, dyadic satisfaction, and dyadic cohesion subdomains, respectively. All of the Chronbach a scores were higher in patients with higher income and education level. Using the RDAS to examine marital relationship quality in patients on hemodialysis, the total score and almost all subscores except for dyadic consensus had adequate internal consistency

Health-related quality of life in chronic obstructive pulmonary disease: are disease-specific and generic quality of life measures correlated?

Generic and disease-specific health-related quality of life [HRQoL] questionnaires are commonly used in subjects with chronic obstructive pulmonary disease [COPD]. However, it is not clear whether generic and disease-specific measures should be used in parallel, as they focus on different aspects of life. This study aimed to investigate the association between two most commonly used generic and disease specific HRQoL measures: Medical Outcomes Study Short Form 36Item [SF-36] and St George's Respiratory Questionnaire [SGRQ]. Materials and In a cross-sectional study, 58 subjects were selected through non-randomized systematic sampling from all COPD patients admitted to the "Respiratory Clinic of Baqiyatallah Hospital" during 2006. Each subject completed both SF-36 and SGRQ forms. Spirometry was also performed for each patient. The correlations between SGRQ total score and its subscores, including symptoms, activity and impacts, and SF-36 total score and its subscores, including physical functioning [PF], role-physical [RP], bodily pain [BP], general health [GH], vitality [VT], social functioning [SF], role-emotional [RE] and mental health [MH], were assessed. No significant correlation was found between the total score or subscores of SF-36 and the total score or subscales of SGRQ [p>0.05]. The generic SF-36 and the disease specific SGRQ questionnaires assess different aspects of HRQoL in COPD patients and each should be used separately. The optimal approach appears to be the application of generic and disease-specific measures together, at least in the research setting. Further studies are recommended with larger sample size