Understanding the Disease Burden of Unemployed Patients with Axial Spondyloarthritis. Results of the Spanish Atlas 2017

Objective To evaluate differences in sociodemographic factors and patient-reported outcomes (PROs) between unemployed and employed axSpA patients and to explore work-related issues. Methods Data through online survey from 680 unselected patients of the Spanish Atlas of Axial Spondyloarthritis were analysed in 2017. Active workforce participants were divided into employed and unemployed according to International Labour Organization standards. Sociodemographic characteristics, PROs [BASDAI (0-10), spinal stiffness (3- 12), functional limitation (0-54), and psychological distress through General Health Questionnaire GHQ-12 (0-12)] were assessed. Logistic regression analysis was used to evaluate the association with unemployment status. Results 415 (63.6%) patients were categorised in the active population, of which 325 (78.3%) were employed and 90 (21.7%) unemployed. 62.8% (N = 54) of unemployed declared that their joblessness was due to axSpA. Of the employed, 170 (54.3%) reported work-related issues in the year prior to the survey, being the most frequent "difficulty fulfilling working hours" (44.1%), "missing work for doctor appointments" (42.9%), and "taking sick leave" (37.1%). Being unemployed was associated with lower educational level (OR= 2.92), disease activity (OR= 1.37), spinal stiffness (OR= 1.21), functional limitation (OR= 1.05), worse mental health (OR= 1.15), anxiety (OR= 2.02) and depression (OR= 2.69) in the univariable models; and only with lower educational level (OR= 2.76) and worse mental health (OR= 1.15) in the multivariable. Conclusion Results show significant differences between employed and unemployed axSpA patients. Employed axSpA patients endure many problems at work related to their condition, though unemployed patients present worse disease outcomes associated with greater psychological distress.

Prevalence, awareness, treatment, and control of hypertension in Northern China: a cross-sectional study

Background Hypertension has always been a worldwide health concern. The purpose of this study was to investigate the prevalence, awareness, treatment, and control rates of hypertension among adult residents of northern China, where people usually have a high-fat, high-salt diet and heavy alcohol consumption. Methods Through the Early Screening and Comprehensive Intervention Project for High Risk Groups of Cardiovascular Diseases in the Inner Mongolia of northern China, we collected data of 70,380 residents, from September 2015 to June 2017. We assessed the prevalence, awareness, treatment, and control of hypertension in the total population and sub-populations. Multivariable logistic regression analyses were used to identify the factors associated with the prevalence and control of hypertension. Results Among participants, only 13.4% had optimal blood pressure levels. About 55.7% (95% confidence interval (CI) = 55.3–56.1%) of the participants had hypertension. In addition, the awareness, treatment, control and control under-treatment rate of hypertension were 52.8% (95%CI = 52.3–53.3%), 43.3% (95%CI = 42.8–43.8%), 8.6% (95%CI = 8.3–8.9%) and 19.8% (95%CI = 19.2–20.4%), respectively. Multivariable logistic regression showed that older, male, Han, living in rural areas, current drinker, not married, lower educational level, lower annual income, diabetes, obesity, and dyslipidemia were more likely to be suffered from hypertension (P < 0.05). Controlled hypertension was less common in those younger, Mongol, not married, farmer, current drinker, lower educational level, obesity, diabetes, without prior CHD, and without prior CVD (P < 0.05). Conclusion Among populations aged 35–75 years in Northern China, more than half have hypertension, fewer than one-tenth have successfully controlled hypertension, and fewer than one-fifth of hypertension patients receiving treatment have controlled hypertension.

Towards an In-Depth Understanding of Physical Activity and Eating Behaviours during COVID-19 Social Confinement: A Combined Approach from a Portuguese National Survey

Rapid worldwide decreases in physical activity (PA), an increase in sedentary behaviour (SB) and poorer dietary patterns have been reported during COVID-19 confinement periods. However, as national variability has been observed, this study sought to describe PA, SB and eating patterns, and to explore their gender as well as other socio-demographic correlates and how they interrelate in a representative sample of Portuguese adults during the COVID-19 first mandatory social confinement. The survey was applied online and by telephone to 5856 adults (mean age = 45.8 years; 42.6% women). The majority reported high (46.0%) or moderate (20.5%) PA levels. Men, younger participants, those with higher education levels and a favourable perception of their financial situation reported higher PA levels, with the opposite pattern for SB. Physical fitness activities and household chores were more reported by women, with more strength training and running activities reported by men. Regarding eating behaviours, 45.1% reported changes, positive (58%) and negative (42%), with 18.2% reporting increases in consumption of fruit, vegetables, and fish and other seafood consumption, while 10.8% (most with lower educational level and less comfortable with their income) reported an increase in consumption of ready-to-eat meals, soft drinks, savoury snacks, and take-away and delivered meals. Two clusters—a health-enhancing vs. risky pattern—emerged through multiple correspondence analysis characterized by co-occurrence of high vs. low PA levels, positive vs. negative eating changes, awareness or not of the COVID-19 PA and dietary recommendations, perceived financial situation, higher vs. lower educational level and time in social confinement. In conclusion, while in social confinement, both positive and negative PA and eating behaviours and trends were displayed, highlighting the role of key sociodemographic correlates contributing to healthy vs. risky patterns. Results may inform future health interventions and policies to be more targeted to those at risk, and also advocate the promotion of PA and healthy eating in an integrated fashion.

Women’s barriers for contacting their general practitioner when bothered by urinary incontinence: a population-based cross-sectional study

Background Urinary incontinence (UI) is a frequently occurring condition among women and increases with age. Effective treatments exist but many women hesitate to contact their general practitioner (GP) regarding UI. Therefore, it is important to generate knowledge regarding barriers for healthcare-seeking. Several factors such as age, duration and number of symptoms are associated with healthcare-seeking. How socioeconomic status (SES) is associated with experiencing barriers for healthcare-seeking for UI has not been explored. The objectives of this study were to: (1) analyze frequencies of barriers for healthcare-seeking, and (2) investigate associations between SES and barriers for contacting the GP, among women reporting bothersome UI. Method A cross-sectional web-based questionnaire study of symptoms occurrence among 51,090 randomly selected women. This study investigates reported symptoms of three types of UI (stress UI, urge UI and UI without stress or urge) and reported barriers for GP contact combined with register data on SES. Results A total of 4,051 (16.4%) women reported to be bothered by either stress UI (9.1%), urge UI (4.0%) or incontinence without stress or urge (2.4%) and 76.3%, 70%, and 64% respectively, had not contacted their GP regarding the symptom(s). The most frequently reported barriers were ‘being too embarrassed’ (19.3%) and ‘being too busy’ (18.4%) for stress incontinence, and ‘being too embarrassed (19.0%) or ‘worried about wasting the doctor’s time’ (16.9%) for women with bothersome urge UI or UI without stress or urge. Younger women had higher odds of reporting barriers and the barriers embarrassment and being worried about what the doctor might find were significantly associated with lower educational level. Conclusion Women with lower educational level have an increased risk of not seeking healthcare for UI symptoms. The GP should be aware of identifying women bothered by UI for whom effective treatment options to alleviate the symptoms are available.

Socio-demographic correlates of depressive and anxiety symptoms among Jamaicans during the COVID-19 pandemic: A Rapid Online Survey

Objectives This study sought to investigate the prevalence and socio-demographic correlates of depressive and anxiety symptoms among Jamaicans during the ongoing COVID-19 pandemic. Methods This was a cross-sectional, population-based online survey. Persons 18 years and older, who reside in Jamaica were targeted via the Facebook social media platform. Those interested in participating were routed to a separate survey platform. The questionnaire captured data related to socio-demographics, knowledge of COVID-19, and beliefs and attitudes about COVID-19. Mental health issues including depressive and anxiety symptoms were assessed with questionnaire items from the Patient Health Questionnaire (PHQ-2) and the Generalized Anxiety Disorder (GAD-2). Results There were 485 participants in the study (90.8% female and 9.2% male). Almost all (97.7%) of participants felt that COVID-19 had greatly affected their lives. The prevalence of notable depressive symptoms and anxiety symptoms was 54.7% and 49.2% respectively. Binary logistic regression found significant associations between younger age, lower educational level, unemployment and significant depressive symptoms. While younger age and lower educational level were associated with significant anxiety symptoms. Conclusion The findings suggest the need for the government to develop targeted mental health initiatives for young adults, the under- or unemployed and those with lower levels of education.

Anxiety and Depression in Women Newly Diagnosed with Breast Cancer and Waiting for Surgery: Prevalence and Associations with Socio-Demographic Variables

Background and Objectives: Cancer is a threatening-life disease with a significant psychological burden. The psychological morbidity varies according to the phases of the illness and is influenced by multiple socio-demographic factors, that are useful to consider in order to identify the categories of patients most at risk of developing psychiatric disorders. The present study analyzes, in a sample of women newly diagnosed with breast cancer, the relationships between their levels of anxiety and depression and several socio-demographic characteristics. The study was cross-sectional. Materials and Methods: Four hundred and seventy eight women newly diagnosed with breast cancer completed the Hospital Anxiety and Depression Scale during the pre-surgical phase. Results: Findings show that almost 40% of the sample had clinically relevant anxious symptoms and about a quarter of the sample had significant depressive symptoms. Their prevalence was higher in widows. Moreover, depressive symptoms were higher in older women and anxious symptoms were higher in patients with a lower educational level. In the pre-surgical phase, women can suffer from clinically relevant anxiety and depression, especially the widows, older women, and women with a lower educational level. Conclusions: Identifying the most psychologically vulnerable patients, due to specific socio-demographic characteristics, is essential in order to provide adequate psycho-oncological treatments to the categories of patients, who are most at risk of developing psychopathological concerns.

Parental educational level and childhood wheezing and asthma: A prospective cohort study from the Japan Environment and Children’s Study

Background The influence of mothers’ and fathers’ educational levels in separate evaluations of asthma has not been fully investigated. This study aims to examine the associations of the mother’s and fathers’ educational levels with childhood wheeze and asthma adjusting for crude and pre-and post-natal modifiable risk factors. Methods We conducted a prospective cohort study using data from the Japan Environment and Children’s Study, which recruited pregnant women from 2011 to 2014. The mother’s and father’s educational levels were surveyed by a questionnaire during the pregnancy, and childhood wheezing and doctor-diagnosed asthma were estimated using a 3-year questionnaire. Multilevel logistic regression analysis was performed to evaluate the association between the mother’s and father’s educational levels and childhood wheezing and asthma, adjusted for pre-and post-natal factors. Results A total of 69,607 pairs of parents and their single infants were analyzed. We found 17.3% of children had wheezing and 7.7% had asthma. In crude analyses, lower educational level of parents was associated with an increased risk of childhood wheezing and asthma. After full adjustment, a lower educational level of mothers was associated with an increased risk of childhood asthma (junior high school (reference: high school); odds ratio (OR): 1.17, 95% CI, 1.01–1.36), and higher educational level, especially the mother’s, was associated with an increased risk of childhood wheezing (technical junior college, technical/vocational college, or associate degree (ECD3); OR: 1.12, 95% CI, 1.06–1.18, bachelor’s degree, or postgraduate degree; OR: 1.10, 95% CI, 1.03–1.18), and asthma (ECD3; OR: 1.13, 95% CI, 1.04–1.21). Conclusions Parents’ lower educational level was a crude risk factor for childhood wheezing and asthma. However, an increased risk of wheezing due to mothers’ higher educational level was found after adjusting for pre-and post-natal factors.

The Roots of the Obesity Boom. The Relationship Between Overweight and Educational Level Among Dutch Men, 1950–1979

While in modern, high-income populations, obesity is associated with being from a low socio-economic background, this may not have always been the case. We test the relationship between obesity and educational level (as a proxy for socio-economic status) in a historical cohort of Dutch military conscripts, from the conscription years 1950–1979. We find that in the 1950s cohort, being in tertiary education was significantly associated with an increased likelihood of being overweight. In contrast, in the 1970s cohort, being in tertiary education was significantly associated with a decreased likelihood of being overweight. We find evidence that the prevalence of obesity remained broadly similar among more highly educated men, while it increased among men of a lower educational level. This likely contributed to the overall rise in the obesity rate. Our findings echo other studies that find a crossover in education’s relationship to BMI as populations become wealthier and obesity rates rise.

Use and preferences regarding internet-based health care delivery in patients with chronic kidney disease

Background and objectives Internet-based technologies play an increasingly important role in the management and outcome of patients with chronic kidney disease (CKD). The healthcare system is currently flooded with digital innovations and internet-based technologies as a consequence of the coronavirus disease 2019 (COVID-19) pandemic. However, information about the attitude of German CKD-patients with access to online tools towards the use of remote, internet-based interactions such as video conferencing, email, electronic medical records and apps in general and for health issues in particular, are missing. Design, setting, participants, and measurements To address the use, habits and willingness of CKD patients in handling internet-based technologies we conducted a nationwide cross-sectional questionnaire survey in adults with CKD. Results We used 380 questionnaires from adult CKD patients (47.6% on dialysis, 43.7% transplanted and 8.7% CKD before renal replacement therapy) for analysis. Of these 18.9% denied using the internet at all (nonusers). Nonusers were significantly older (74.4 years, SD 11.4) than users (54.5 years, SD 14.5, p < 0.001), had a lower educational level than users (≥ 12 years: 6.9% versus 47.1%, p < 0.001) and were more often on dialysis. Within the group of internet users only a minority (2.6%) was using video conferencing with their physician, only 11.7% stated that they were using email to report symptoms and 26.6% were using the internet to schedule appointments. Slightly more than one-third of internet users (35.1%) are concerned that their personal medical data are not safe when submitted via the internet. Conclusions Within our group of German CKD-patients we found that almost one out of five patients, especially older patients and patients with a lower educational level, did not use the internet at all. The majority of internet users reported in our survey that they have not used internet-based technologies within a medical context so far, but are willing to consider it. Therefore, it seems to be important to introduce and teach motivated CKD-patients the use and benefits of simple and safe internet-based health care technologies.