Prospective study of predictors of poor self-rated health in a 23-year cohort of earthquake survivors in Armenia

Long-term prospective studies exploring general health outcomes among disaster survivors are rare. Self-rated health [SRH] - a proven correlate of morbidity and mortality prognosis - was used to investigate predictors of perceived health status among a 23-year cohort of survivors of 1988 Spitak earthquake in Armenia. A geographically-stratified subsample of 725 adults from a larger initial cohort was followed during the period of 1990-2012. A logistic regression model identified predictors of SRH. Adjusted relative risks for the long-term predictors of SRH were calculated. The rate of poor SRH among the survivors was 18.8%, fair 56.5%, and good/excellent 24.7%. In the fitted model, long-term risk factors of poor SRH included baseline body mass index, baseline multi-morbidity, number of experienced stressful life events, and perceived poor living standards during the post-earthquake decade, while participation in sports in the early 1990s was a protective factor. Short-term protective factors included socio-economic status score, social support, employment and dignity, while current household size was a risk factor for poor SRH. No association was found between earthquake exposure severity and SRH after 23 years. However, the identified predictors included a number of modifiable lifestyle, material and psychological factors. Thus, interventions targeting these factors could have a long-lasting impact on disaster victims' health status

Prevention of amyloidosis in familial Mediterranean fever with colchicine: a case-control study in Armenia

To determine whether or not the use of colchicine decreases the risk of amyloidosis among Armenian patients with familial Mediterranean fever [FMF]. The study included 99 Armenian patients from the Center of Medical Genetics database with genetically ascertained FMF; 33 had renal amyloidosis and 66 were randomly selected control patients without renal amyloidosis. Self-reported colchicine use was assessed by interviewer-based questionnaire. The patients with incident amyloidosis were more likely to be older men, but younger at the time of disease onset, and more likely to have had a family history of amyloidosis and M694F mutation in the MEFV gene compared to patients without amyloidosis. The risk of amyloidosis decreased with adequate colchicine use rather than nonadequate use [adjusted odds ratio, OR, 0.48, 95% confidence interval, Cl, 0.16-1.43], continuous colchicine use rather than interrupted use [adjusted OR 0.15, 95% Cl 0.04-0.53], earlier rather than later initiation age of colchicine treatment [adjusted OR 0.95, 95% Cl 0.90-1.01], current colchicine rather than ever/never colchicine use [adjusted OR 0.20,95% Cl 0.05-0.89]. The study demonstrated that colchicine treatment is effective in preventing amyloidosis among Armenian patients with FMF and that earlier initiation and continuous therapy at an adequate dose of 1.2-1.8 mg/day may be associated with a decreased amyloidosis risk among Armenian patients with FMF

Compliance and its determinants

TWO hundred and fourteen patients were interviewed to assess the degree of their compliance to prescription instructions and to identify factors that affected that compliance. Patients instructed to take medications once per day and those given medications for nine days or less were found to comply significantly better than others, while those instructed to take medications four times daily and those given medications for ten to fourteen days had a significantly lower compliance. Patients younger than 25 years were found to have a significantly lower compliance than older patients. Sex, family size, type of drugs and number of drugs were not found to affect compliance. Where possible, it is preferrable to give the same daily requirement in less than four doses and to limit prescription to nine days or less. Otherwise the importance of taking medications according to instructions should be stressed, especially to patients where low compliance is expected

impact of family size on morbidity at a primary care health centre in Bahrain

To assess the relationship between family size and morbidity this study was carried out on 238 families in a primary care health centre in the State of Bahrain. One hundred and twenty nine families had five or more members. An inverse relationship was found between family size and the number of visits to the health centre mainly for infectious diseases of the skin, eye and upper respiratory tract, particularly in children. Crowding and low level of sanitation, education, personal hygiene and socio-economic status are the possible explanation