Temporal dynamics, patterns and correlates of single and multimorbidity in India, 1994–2018

Objective As a consequence of the epidemiological transition, multimorbidity has been identified as a critical public health challenge in India. The majority of the studies in the domain are grounded on hospital-based data or are based on small sample size, findings from which can only be generalized to a specific sub-group. These studies recommend exploring multimorbidity holistically at a national level to ensure adequate healthcare management in the country. Therefore, the present study examines the pattern and correlates of single and multimorbidity over the past two decades in India. Methods The study utilized data on 397901, 257519, and 399705 individuals from 52nd (1994–1995), 60th (2004–2005), and 75th (2018) rounds of cross-sectional data from the National Sample Survey (NSS). Univariate, bivariate, and multivariable statistical methods were applied to draw inferences from the data. The findings depict an increase in single and multimorbidity burden over individuals’ age and NSS rounds. Results Hypertension and diabetes were the fastest-growing morbidities over time. Higher education, urban residence, and belonging to an affluent class were significantly associated with both single and multimorbidity occurrence over time. Conclusion The burden of single and multimorbidity increases over time among India’s older adults. Therefore, there is an urgent need to recuperate chronic disease management strategies for older adults in the Indian healthcare infrastructure.

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Disaggregating between- and within-person relations for depression and burnout symptoms with cumulative hair cortisol and endocannabinoid concentrations: A multilevel analysis of four annual assessment waves

10.31234/osf.io/y8vuf ◽

2021 ◽

Author(s):

Andreas Walther ◽

Clemens Kirschbaum ◽

Susanne Wehrli ◽

Nicole Rothe ◽

Magdalena Wekenborg ◽

...

Keyword(s):

Multilevel Analysis ◽

Small Sample Size ◽

Regulatory System ◽

Endocannabinoid System ◽

Small Sample ◽

Depression Symptoms ◽

Hair Cortisol ◽

Cross Sectional ◽

Dependent Relation ◽

Over Time

Background: The endocannabinoid system (ECS) is increasingly being recognized as key regulatory system coupled with the glucocorticoid system implicated in the pathophysiology of stress-related mental disorders. However, prior studies examining the ECS in depression or burnout have been inconclusive, of small sample size or of cross-sectional nature limiting interpretations of causal inferences or time-dependent effects.Methods: In a prospective community based cohort study including 128 individuals (women: 108), depression (PHQ-9) and burnout symptoms (MBI-GS) as well as hair cortisol and endocannabinoids were measured annually over four years. Cortisol, arachidonylethanolamide (AEA) and 2-arachidonyl-sn-glycerol/1-arachidonyl-sn-glycerol (2-AG/1-AG) were extracted from 3 cm hair segments reflecting cumulative concentrations of the last 3 months prior hair sampling.Results: Cross sectional group comparisons at baseline revealed reduced cortisol and AEA levels in the group with a positive major depressive disorder screening compared to individuals with low depression symptomatology (both p < .05). Cortisol was also reduced in the group with a positive burnout screening compared to individuals with a negative screening at baseline (p < .05). Longitudinal multilevel analysis, showed for the total sample that a within-person increase in burnout symptoms was associated with a decrease in cortisol levels over time (p < .05). In the male subsample, a between-person increase in AEA levels across time was associated with a decrease in depression symptoms and vice versa. However, a within-person increase of AEA levels across time was associated with an increase in depression symptoms and vice versa (both p < .05). Further, a within-person increase in burnout symptoms lead to a significant increase in AEA levels in the male subsample (p < .05).Conclusions: While cross-sectional analyses suggest higher depression or burnout symptomatology to be associated with reduced cortisol and AEA release, longitudinal analyses disaggregating between- and within-person effects reveal a complex pattern. A within-person increase in burnout symptoms precedes a decrease in cortisol secretion suggesting an exhaustion of the HPA axis. Between-person analysis show only for men a negative association between depression symptoms and AEA levels over time. However, within-person effects, indicate an increase in depression symptoms to preced and to follow an increase in AEA levels, suggesting a dynamic counterregulatory mechanism between the EC and depression in men differing on the between- and within-person levels. These longitudinal associations further elucidate the time and sex dependent relation between depression, burnout, glucocorticoid and endocannabinoid secretion.

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Validating the Factor Structure of the Stigma of Suicide Scale–Short Form Spanish Version Among Healthcare Students

Crisis ◽

10.1027/0227-5910/a000728 ◽

2020 ◽

pp. 1-5

Author(s):

Ruthmarie Hernández-Torres ◽

Paola Carminelli-Corretjer ◽

Nelmit Tollinchi-Natali ◽

Ernesto Rosario-Hernández ◽

Yovanska Duarté-Vélez ◽

...

Keyword(s):

Factor Structure ◽

Structural Equation ◽

Short Form ◽

Small Sample Size ◽

Small Sample ◽

Spanish Version ◽

Equation Modeling ◽

Cross Sectional ◽

Healthcare Students ◽

Spanish Speaking

Abstract. Background: Suicide is a leading cause of death among Spanish-speaking individuals. Suicide stigma can be a risk factor for suicide. A widely used measure is the Stigma of Suicide Scale-Short Form (SOSS-SF; Batterham, Calear, & Christensen, 2013 ). Although the SOSS-SF has established psychometric properties and factor structure in other languages and cultural contexts, no evidence is available from Spanish-speaking populations. Aim: This study aims to validate a Spanish translation of the SOSS-SF among a sample of Spanish-speaking healthcare students ( N = 277). Method: We implemented a cross-sectional design with quantitative techniques. Results: Following a structural equation modeling approach, a confirmatory factor analysis (CFA) supported the three-factor model proposed by Batterham and colleagues (2013) . Limitations: The study was limited by the small sample size and recruitment by availability. Conclusion: Findings suggest that the Spanish version of the SOSS-SF is a valid and reliable tool with which to examine suicide stigma among Spanish-speaking populations.

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Augmenting the Clinical Data Sources for Enigmatic Diseases: A Cross-Sectional Study of Self-Tracking Data and Clinical Documentation in Endometriosis

Applied Clinical Informatics ◽

10.1055/s-0040-1718755 ◽

2020 ◽

Vol 11 (05) ◽

pp. 769-784

Author(s):

Ipek Ensari ◽

Adrienne Pichon ◽

Sharon Lipsky-Gorman ◽

Suzanne Bakken ◽

Noémie Elhadad

Keyword(s):

Additional Data ◽

Intraclass Correlation ◽

Management Strategies ◽

The Self ◽

Self Management ◽

Cross Sectional ◽

Two Samples ◽

Data Source ◽

Daily Function ◽

Over Time

Abstract Background Self-tracking through mobile health technology can augment the electronic health record (EHR) as an additional data source by providing direct patient input. This can be particularly useful in the context of enigmatic diseases and further promote patient engagement. Objectives This study aimed to investigate the additional information that can be gained through direct patient input on poorly understood diseases, beyond what is already documented in the EHR. Methods This was an observational study including two samples with a clinically confirmed endometriosis diagnosis. We analyzed data from 6,925 women with endometriosis using a research app for tracking endometriosis to assess prevalence of self-reported pain problems, between- and within-person variability in pain over time, endometriosis-affected tasks of daily function, and self-management strategies. We analyzed data from 4,389 patients identified through a large metropolitan hospital EHR to compare pain problems with the self-tracking app and to identify unique data elements that can be contributed via patient self-tracking. Results Pelvic pain was the most prevalent problem in the self-tracking sample (57.3%), followed by gastrointestinal-related (55.9%) and lower back (49.2%) pain. Unique problems that were captured by self-tracking included pain in ovaries (43.7%) and uterus (37.2%). Pain experience was highly variable both across and within participants over time. Within-person variation accounted for 58% of the total variance in pain scores, and was large in magnitude, based on the ratio of within- to between-person variability (0.92) and the intraclass correlation (0.42). Work was the most affected daily function task (49%), and there was significant within- and between-person variability in self-management effectiveness. Prevalence rates in the EHR were significantly lower, with abdominal pain being the most prevalent (36.5%). Conclusion For enigmatic diseases, patient self-tracking as an additional data source complementary to EHR can enable learning from the patient to more accurately and comprehensively evaluate patient health history and status.

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A Cross-Sectional Study to Evaluate the Effects of Age and Duration of HIV Infection on Anxiety and Depression in Cisgender Men

AIDS and Behavior ◽

10.1007/s10461-021-03373-y ◽

2021 ◽

Author(s):

Sara Gianella ◽

Rowan Saloner ◽

Genevieve Curtin ◽

Susan J. Little ◽

Anne Heaton ◽

...

Keyword(s):

Hiv Infection ◽

Small Sample Size ◽

Cross Sectional Study ◽

Small Sample ◽

Self Report ◽

Anxiety And Depression ◽

Depression And Anxiety ◽

Sectional Study ◽

Cross Sectional ◽

Study Results

AbstractThis observational cross-sectional study of 152 people with HIV (PWH) examined the effects of age and estimated duration of HIV infection (EDI) on depressive and anxiety symptoms. All participants were cisgender men and completed the Profile of Moods State (POMS), a self-report inventory of current (i.e., past week) mood states. Overall, study results confirmed higher levels of anxiety and depression in PWH compared to individuals without HIV. Age group (< 50 or ≥ 50 years) moderated the effect of EDI (< 3 or ≥ 3 years) on mood disturbance. Specifically, younger PWH with early diagnosed infection exhibited the highest levels of depression and anxiety, whereas depression and anxiety were attenuated in older PWH with early infection such that their POMS scores did not significantly differ from the HIV-negative and chronically HIV-infected groups. Despite the small sample size and other important limitations in our study design, our preliminary findings confirm previous observations that older people may have some adaptive ability to better handle the acute psychological stressors associated with recent HIV infection.

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Perceptions and Understanding of Diabetes Mellitus Technology in Adults with Type 1 or Type 2 DM: A Pilot Survey from Pakistan

Journal of Diabetes Science and Technology ◽

10.1177/19322968211011199 ◽

2021 ◽

pp. 193229682110111

Author(s):

Sarah Nadeem ◽

Uswah Siddiqi ◽

Russell Seth Martins ◽

Kaleemullah Badini

Keyword(s):

Diabetes Mellitus ◽

Pilot Study ◽

Diabetes Care ◽

Online Survey ◽

Small Sample Size ◽

Developed Countries ◽

Small Sample ◽

Cost Of Care ◽

Cross Sectional ◽

Specific Patient

Introduction: Diabetes mellitus technology (DMT) is increasingly used for routine management in developed countries, yet its uptake in developing countries is not as consistent. Multiple factors may influence this, including country specific patient perception regarding DMT. We conducted a pilot study in Pakistan to understand this important question which has not been studied yet. Methods: A cross-sectional pilot study was conducted in Pakistan. An anonymous survey exploring perceptions of diabetes technology was circulated on social media platforms, collecting responses over 2 weeks. Target population included adults (≥18 years) living in Pakistan, with DM1 or 2. Results: A total of 40 responses were received. The majority (36/40) reported using conventional glucometers. Nine used continuous glucose monitoring (CGM). Thirty-two of 40 patients believed DMT improved diabetes care, 22 felt it helped decreased risk of Diabetes-related complications. 15/40 stated that DMT results in increased cost of care. Sixteen reported their diabetes care teams had never discussed wearable DMT options whereas 11 disliked them because they did not want a device on their self. Conclusion: In our pilot study we have identified broad themes of opportunity and challenges to DMT use in Pakistan. Patients’ perceptions regarding DMT were generally positive but significant barriers to its acceptance included high cost, lack of discussion between doctor and patient about available technology and personal hesitation. Limitations of our study include sampling bias (online survey) and small sample size, but this data can help inform larger studies, to look at this important topic in greater detail.

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Abstract 88: Increasing False Positive Diagnoses May Lead to Overestimation of Stroke Incidence, Particularly in the Young

Stroke ◽

10.1161/str.51.suppl_1.88 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Abhinav J Appukutty ◽

Lesli E Skolarus ◽

Mellanie V Springer ◽

William J Meurer ◽

James F Burke

Keyword(s):

Older Adults ◽

False Positive ◽

Age Groups ◽

Vascular Risk Factor ◽

The United States ◽

Cross Sectional ◽

Stroke Incidence ◽

Ed Visits ◽

Over Time

Introduction: Stroke incidence is reportedly increasing in younger adults. While increasing vascular risk factor prevalence has been suggested as a cause, the reasons for rising stroke incidence in the young are not clear. We explored several alternate explanations: trends in neurologically-focused emergency department (ED) visits, differential diagnostic classification of stroke and TIA over time, and changes in the use of advanced imaging in young and older adults. Methods: We performed a retrospective, serial, cross-sectional study on a nationally representative sample of all ED visits in the United States to quantify changes in patterns of neurologically-focused ED visits, stroke and TIA diagnoses, and rates of MRI utilization for young (18 – 44 years) and older (65+ years) adults over a 17-year period (1995 – 2000; 2005 – 2015) using National Hospital Ambulatory Medical Care Survey (NHAMCS) data. Results: In young adults, 0.4% (95% CI 0.3% – 0.5%) of neurologically-focused ED visits resulted in a primary diagnosis of stroke vs. 6.8% (95% CI 6.2% – 7.5%) for older adults. In both populations, the incidence of neurologically-focused ED visits has increased over time (+111/100,000 population/year, 95% CI +94 – +130 in the young vs. +70/100,000 population/year, 95% CI +34 – +108 in older adults). There was no evidence of differential classification of TIA to stroke over time (OR 1.001 per year, 95% CI 0.926 – 1.083 in the young; OR 1.003 per year, 95% CI 0.982 – 1.026 in older adults) and no evidence of disproportionate rise in MRI utilization for neurologically-focused ED visits in the young (OR 1.057 per year, 95% CI 1.028 – 1.086 in the young; OR 1.095 per year, 95% CI 1.066 – 1.125 in older adults). Conclusions: If the specificity of stroke diagnosis amongst ED visits is similar amongst young and older populations, then the combination of data observed here, including (1) a lower prior probability of stroke diagnoses in the young and (2) an increasing trend in neurologically-focused ED visits in both age groups, suggests that false positive diagnoses will increase over time, with a faster rise in the young compared to older adults. These data suggest a potential explanation that may contribute to higher stroke incidence in the young and merits further scrutiny.

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Intensity of perceived stress and control of anger, anxiety and depression of people staying in Polish penitentiary institutions

International Journal of Prisoner Health ◽

10.1108/ijph-12-2020-0103 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Kinga Kołodziej ◽

Anna Kurowska ◽

Anna Majda

Keyword(s):

Perceived Stress ◽

Small Sample Size ◽

Prison Population ◽

Research Area ◽

Cross Sectional Study ◽

Small Sample ◽

Emotional Control ◽

Coping With Stress ◽

Cross Sectional ◽

Content Type

Purpose The purpose of this study is to assess the intensity of perceived stress and measure the subjective control of anxiety, anger and depression in a group of women and men staying in Polish penitentiary institutions. Design/methodology/approach The research was carried out in two penitentiary institutions located in the Lesser Poland Voivodeship at the turn of 2019/2020. The study group consisted of 152 prisoners. In the cross-sectional study, two standardised research tools – the Perceived Stress Scale and the Emotional Control Scale – were used. Findings Over half of the prisoners (57.24%) presented a high level of stress. The intensity of the perceived stress did not depend on the gender and age of the convicted persons. The general indicator of emotional control among the respondents averaged 51.82 points (standard deviation = 14.52) and ranged from 22 to 83 points, which means that people detained in penitentiary institutions suppressed their negative emotions at an average level. The prisoners had the best control over fear (M = 18.68), less over anger (M = 16.86) and the least over depression (M = 16.27). Statistical analysis showed a correlation between the level of emotional control and the intensity of perceived stress. Research limitations/implications The small sample size of the group participating in the study and narrowing of the research area means that results can not be generalised across all isolated prison population. Practical implications The results obtained from the study can be used by a multidisciplinary team to develop therapeutic programmes for convicted persons, the aim of which is to evaluate strategies for coping with stress and controlling emotions. Social implications Popularising reliable information related to the issue of experiencing stress and varied emotions in those staying in penitentiary institutions may lead to the elimination of harmful stereotypes functioning in society, as well as reduce the phenomenon of marginalisation of prisoners, and thus contribute to the success of the social rehabilitation process. Originality/value Research on the level of stress intensity in prisoners is important because the rates of mental health disorders among prisoners consistently exceed the rates of such disorders in the general population.

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Italian Children’s Well-Being after Lockdown: Predictors of Psychopathological Symptoms in Times of COVID-19

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182111429 ◽

2021 ◽

Vol 18 (21) ◽

pp. 11429

Author(s):

Marcella Caputi ◽

Barbara Forresi ◽

Ludovica Giani ◽

Giovanni Michelini ◽

Simona Scaini

Keyword(s):

Small Sample Size ◽

Well Being ◽

Small Sample ◽

Novelty Seeking ◽

Cross Sectional ◽

Convenience Sample ◽

Childhood Experiences ◽

Adverse Experiences ◽

Adverse Childhood ◽

Cross Sectional Design

The first Italian lockdown imposed to fight the spread of COVID-19 caused important disruptions in families’ everyday lives. The main aim of this research was to investigate the predictors of psychopathology in children aged 5–10 years, immediately after the national 2-month lockdown. A total of 158 Italian parents (148 mothers, 10 fathers, mean age = 41 years) were recruited and asked to complete an online research concerning their 158 children (76 boys, mean age = 7.4 years). Parents completed questionnaires on parent–child conflict, resilience, temperament, behavior, and previous adverse childhood experiences. Hierarchical regressions showed that children’s psychopathology was predicted by low child resilience, high novelty seeking and harm avoidance, adverse experiences, and high flooding levels. Moreover, girls exposed to adverse experiences appeared more vulnerable to psychopathology. The recruitment of a convenience sample, the small sample size, and the cross-sectional design of our study limit the generalizability and interpretation of the present findings. Nonetheless, this research extends our knowledge of children’s functioning in such an exceptional period. Shedding light on predictors of children’s psychopathology following prolonged quarantine can indeed guide effective psychological interventions now and in future similar situations.

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Risk factors in adolescents’ involvement in violent behaviours

Journal of Aggression Conflict and Peace Research ◽

10.1108/jacpr-09-2013-0025 ◽

2015 ◽

Vol 7 (1) ◽

pp. 2-18 ◽

Cited By ~ 7

Author(s):

Sarah Baxendale ◽

Leanne Lester ◽

Robyn Johnston ◽

Donna Cross

Keyword(s):

Risk Factors ◽

Physical Violence ◽

Small Sample Size ◽

Small Sample ◽

Future Research ◽

School Students ◽

Cross Sectional ◽

Violent Media ◽

Content Type ◽

Factors Associated

Purpose – The purpose of this paper is to examine risk factors associated with Western Australian secondary school students’ involvement in violence-related behaviours. Design/methodology/approach – This cross-sectional study examined data collected using an anonymous self-completion questionnaire from 542 school students aged 13-17 years. The questionnaire measured risk factors associated with being a perpetrator and/or victim of violence-related behaviours. Findings – Gender was significantly associated with being a victim and perpetrator of violence-related behaviours. Males were significantly more likely than females to be a victim of threatening and physical violence at school, and to be a perpetrator of physical violence at school and in the community. Males were significantly more likely than females to watch violent media, with exposure to violent media associated with physically hurting someone at school. Students involved in greater acts of animal cruelty had increased odds of being involved in all forms of the violence measured. Research limitations/implications – Limitations such as the cross-sectional nature of the study and the small sample size are noted, along with suggestions for future research. Practical implications – Implications of the research for practitioners working with adolescents, with a particular focus on the school setting, are discussed. Originality/value – Most previously published research on adolescent involvement in violence has been conducted outside Australia, and as such, may not be directly applicable to the experiences of young people in Western Australia.

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Association between obesity-related anthropometric indices and multimorbidity among older adults in Shandong, China: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-036664 ◽

2020 ◽

Vol 10 (5) ◽

pp. e036664

Author(s):

Jiao Zhang ◽

Lingzhong Xu ◽

Jiajia Li ◽

Long Sun ◽

Wenzhe Qin

Keyword(s):

Older Adults ◽

Normal Population ◽

Management Strategies ◽

Normal Weight ◽

Eastern Coast ◽

Anthropometric Indices ◽

Cross Sectional ◽

Weight Category ◽

Old Adults ◽

Young Old

ObjectivesWhether the association between obesity-related anthropometric indices and multimorbidity differs by age among Chinese older adults (aged 65+) is unclear. We aimed to investigate the association between body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) with multimorbidity among the young-old (aged 65–79) and old-old (aged 80+) adults.DesignCross-sectional population-based study.SettingShandong province on the eastern coast of China.Participants5493 subjects aged 65 years or above.MeasurementsDetails on sociodemographics, lifestyle characteristics and chronic conditions were collected using a structured questionnaire. The respondents were assessed with anthropometric measurements including height, weight, WC, hip circumference.ResultsThe overall prevalence of multimorbidity in older adults (aged 65+) was 35.2%. The BMI-obesity, WC-obesity and WHR-obesity rates were 7.4%, 57.5% and 80.4%, respectively. In the young-old adults (aged 65–79), the likelihood of multimorbidity was more than two times higher among the BMI-obese than the BMI-normal population (OR 2.08, 95% CI 1.66 to 2.60). Similar but less strong associations were found for the WC-obese and WHR-obese young-old population (OR 1.60, 95% CI 1.42 to 1.81; OR 1.31, 95% CI 1.10 to 1.56, respectively). For the old-old group (aged 80+), the BMI-obese, WC-obese and WHR-obese had a higher likelihood of having multimorbidity compared with the normal weight category (OR 2.10, 95% CI 0.96 to 4.57; OR 1.75, 95% CI 1.21 to 2.54; OR 2.15, 95% CI 1.18 to 3.93, respectively).ConclusionBMI-obesity, WC-obesity and WHR-obesity were associated with a greater risk of multimorbidity, and the associations were different between the young-old and the old-old adults. These age differences need to be considered in assessing healthy body weight in old age. These findings may be vital for public health surveillance, prevention and management strategies for multimorbidity in older adults.

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