Relationship between physical exercise and health of the elderly people in a rural community

The significance of life style and regular physical exercise for health of elderly people in a rural community was evaluated by questionnaires. The subjects studied were a group who had been playing gate ball (such as croquet) for more than three years (N = 86) and a group who had not (N = 255). Significantly more males in the group playing gate ball (GB group) than in the group not playing gate ball (n-GB group) reported feeling healthier than three years before. The average overall score for life style which indicates a healthier life style was analyzed. The score for life style of males was significantly lower in the GB group than in the n-GB group. Significantly more males in the GB group did not take snacks or smoke than those in the n-GB group. Regarding regular physical exercise, significantly fewer females in the GB group went for a daily walk than those in the n-GB group. The average score for integrated regular physical exercise was significantly higher in the GB group than in the n-GB group. The scores for regular physical exercise of females in the GB group, even in spite of disability or hypertension, were significantly higher than those in the n-GB group. From this survey it appears that regular physical exercise including gate ball may be beneficial for health of elderly people in a rural community.     

Community studies of the health service implications of low back pain

STUDY DESIGN: Retrospective study using primary care physician case notes and a self-report questionnaire on the same randomly selected population sample. OBJECTIVES: To assess the prevalence, management, and outcomes of low back pain in the community, comparing, in the same random sample of registered patients, self-report questionnaire data and primary care physicians' records. SUMMARY OF BACKGROUND DATA: The financial and resource implications of low back pain are extensive. Data on consultations, investigations, and the management of low back pain are fragmentary and there are no comparisons estimating prevalence from case notes and self-report. METHODS: A retrospective study of prevalence, management, referral, and outcome covering the previous 12 months was carried out in three general practices using case notes and a self-report postal questionnaire on a sample of 900 patients over 18 years. RESULTS: Lifetime prevalence of low back pain was 62%. Annual prevalence was 48%, with 16% reporting low back pain at the time of report. Twenty-four percent consulted their primary care physician for low back pain, of whom 17% were referred to a hospital specialist. The annual consultation rate of patients with low back pain was similar to the rate for patients with chronic conditions. The activities of daily living were restricted in less than half, with few taking sick leave. The general health status of those reporting recent low back pain was significantly lower than those not reporting low back pain. Most felt that low back pain was self-limiting and would not consult health professionals for future episodes. There were substantial discrepancies between case notes recorded at consultation with the primary care physician and self-report regarding consultation and investigations. CONCLUSIONS: Prevalence rates were comparable with those reported in other studies. The significant discrepancies between data sources suggest patient recall bias or underrecording in case notes. The low consultation rate, time off, and day-to-day disability indicate that most episodes are self-limiting.     

Occupational hazards, living conditions, and physical assault of sugar cane workers in KwaZulu-Natal, South Africa

OBJECTIVES: To characterise the occupational hazards and living conditions of sugar cane workers in KwaZulu-Natal. DESIGN: Based on information provided by shop stewards, a survey instrument (questionnaire) was constructed for administration to union members. SETTING: Seven sugar cane farms and estates owned by one large corporation in late 1993. SUBJECTS: Members of the South African Farm and Allied Workers Union (SAFAWU). RESULTS: Of the 632 participants, 50% were permanent workers, 22.3% were seasonal workers and 27.7% were casual workers. Mean daily pay ranged from R5 to R35 per worker. The majority of participants reported substandard housing both during the growing season and during the off-season. Percentages reporting health problems in the last 12 months believed by the respondent to be caused or made worse by work included 79% with eye problems, 78% with upper respiratory problems, 88% with lower respiratory problems, 93% with musculoskeletal problems, and 81% with an acute traumatic injury. More than half the participants reported fainting, collapsing or illness from working on hot or sunny days. Fourteen per cent reported being struck with the fist or hand, or being pushed, shoved or kicked by a farm owner, member of the owner's family, manager or supervisor; 9% reported being struck with an object, whipped, or attacked or threatened with a knife or gun by one of these same individuals. CONCLUSIONS: Sugar cane workers employed by a large corporation in KwaZulu-Natal appear to face severe threats to their physical and psychological well-being including: (i) inadequate pay to meet basic living needs; (ii) substandard living conditions; (iii) significant occupational hazards resulting in high reported levels of occupational illness and injury; and (iv) physical and psychological abuse and intimidation by farm owners and their agents.     

Community survey of factors associated with consultation for low back pain

OBJECTIVE: To investigate the psychosocial factors associated with consultation for low back pain. DESIGN: Two phase cross sectional postal survey. SETTING: Bradford Metropolitan Health District. SUBJECTS: 1813 adults responding to the phase 1 questionnaire. 540 of the 782 with an episode of low back pain in the past 12 months completed the second questionnaire. MAIN OUTCOME MEASURES: Six psychosocial constructs. RESULTS: 406 (52%) of the respondents reporting back pain in the past 12 months had not consulted a health professional. Logistic regression showed that consultation was associated with externalised beliefs regarding pain management (odds ratio 3.6; 95% confidence interval 2.1 to 6.0). Duration of pain affected the factors associated with consultation. Consultation for episodes lasting less than two weeks (n=290) was associated with greater than median pain (3.0; 1.7 to 5.5), consultation for episodes over two weeks (n=243) was associated with increased disability (3.7; 1.5 to 9.0), and consultation for episodes over three months (n=143) with increased depression (3.9; 1.3 to 11.8). CONCLUSIONS: The results support a role for psychosocial factors in consultation for low back pain and suggest that the reasons for consultation vary with duration of pain. Duration of the episode may be a useful guide to management of non-specific low back pain.     

Mental illness and substance use among sheltered homeless persons in lower-density population areas

OBJECTIVE: The prevalence of mental illness and substance abuse in homeless populations has been studied primarily in large urban areas. This study examines a sheltered homeless population in two counties of lower-density population, Dauphin and Cumberland counties in central Pennsylvania, to assess the prevalence of mental illness and substance abuse. METHODS: A total of 81 homeless adults from nine emergency shelters were interviewed using a structured questionnaire. RESULTS: The estimated lifetime prevalence rate of major depressive disorder was 26.6 percent; 6.4 percent of the sample showed evidence of psychotic thinking. Almost one-third reported previous hospitalization for emotional problems, and about one-third reported a suicide attempt. The estimated lifetime prevalence rate of alcohol or drug abuse or dependence was almost 60 percent. CONCLUSIONS: Although mental illness, especially psychosis, and substance abuse may be somewhat less prevalent among homeless persons in lower-density population areas than in large urban areas, they are nevertheless significant problems.     

Combined medical and psychological symptoms: impact on disability and health care utilization of patients with arthritis

OBJECTIVES: Many reports indicate that patients with combined chronic illness and depressive symptomatology have more disability than those with illness alone, which may influence physician visits. Studies suggest that these combined conditions are unevenly accommodated by the delivery system and nonpsychiatric physicians often fail to recognize or treat these symptoms. To address this need, this study aimed to provide further information on combined conditions and report on relations found among arthritis disease symptoms, depression, and disability. METHODS: The data was derived from a series of statewide surveys assessing the influence of psychosocial factors on disease course and treatment in a community sample of 277 patients under the care of a rheumatologist. A multivariate model was developed to assess these interrelationships, using measures of symptom severity, depression (CESD), disability (activities of daily living, days of restrictive activities, days in bed), service utilizations, and a few personal and health variables. RESULTS: Even after removing somatic items from the CESD to reduce the risk of inflation due to physical disease, evidence was found for additive impact of depression on one measure of disability, days of restrictive activities. Patients with comorbid conditions also were a high-service utilization group. Very few patients reported receiving help in dealing with emotional problems, suggesting presence of substantial unmet need. CONCLUSIONS: Nonpsychiatric physicians need to be aware of the mental health status of chronically ill patients. Although the association between medication use and depression suggests some awareness of the need to treat depression, especially in physically compromised patients, there may be some need to dispense psychological and psychosocial support to those in need.     

Social support and physical disability in older people after hospitalization: A prospective study.

This prospective study examined the effects of social support on physical disability in 269 older people (aged 65–97 yrs). Hospital monitoring identified longitudinal study participants who were admitted for hip fracture, stroke, or myocardial infarction. Interviews before the illness and at 6 wks and 6 mo after admission assessed social support and physical disability; medical records indicated illness severity and comorbidity. The number of emotional support providers and the adequacy of task support were higher after hospitalization. Medical factors and premorbid emotional support predicted disability at 6 wks; not needing support was associated with less disability than needing and receiving adequate support. Task support adequacy at 6 wks predicted less disability at 6 mo. The results reveal a dynamic relationship between social support and recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Estimates of the severity of illnesses associated with bathing in marine recreational waters contaminated with domestic sewage

BACKGROUND: During the summers of 1989-1992 we conducted four randomized intervention trials at four separate UK bathing locations judged of acceptable quality under current USEPA and EU criteria. The results showed bathers to be at increased risk of gastroenteritis, acute febrile respiratory illness (ICD-9 461-466, 480), ear and eye infections relative to non-bathers. The public health significance of these findings has been questioned based upon the unproven assumption that these illnesses are minor in nature and thus of questionable public health significance. METHODS: The severity of these illnesses or ailments in terms of duration of illness, percentage of participants seeking medical treatment, and number of days of lost normal daily activity among study participants reporting specific illnesses or ailments were assessed. In addition the attributable proportion of illness among the exposed (bathers) was calculated for each illness or ailment. RESULTS: Average duration of illness ranged from approximately 4 days to approximately 8 days depending on the specific illness reported. The percentage of study participants seeking medical treatment ranged from 4.2% to 22.2% while the percentage reporting the loss of at least one day of normal daily activity ranged from 7.0% to 25.9% depending on the illness reported. The overall percentage of each illness that can be directly attributable to exposure to marine waters contaminated with domestic sewage ranged from a low of 34.5% for gastroenteritis to a high of 65.8% for ear infections. CONCLUSIONS: To our knowledge, this is the first study to assess and report the severity of illnesses associated with bathing in recreational waters contaminated with domestic sewage. Illness associated with bathing in marine waters contaminated with domestic sewage can no longer be viewed as minor, and indeed can have a substantial impact on the public health.     

Health status of the over 60 years of age population and its relationship with sociodemographic factors (ANCO Project)

OBJECTIVE: To describe the health status of a population over 60 years and to study their relationship with several socio-demographic variables. DESIGN: A cross-sectional study, population based. SETTINGS: A community. PARTICIPANTS: A randomized sample of 1,103 non institutionalized people over 60 years living in the city of Cordoba (Spain). MEASUREMENTS AND MAIN RESULTS: By mean of a personal interview at home we used the OARS-MFAQ-VE questionnaire. Low self-rated health was associated with the age, to be female sex, a low cultural background, and a low income. Only 5.2% of the study people do not suffered any illness and 56% state that their health problems are major problems for doing their current activities. 4.9% declared to have some degree of physical incapacity. 3.7% of elderly population has an important cognitive deficit. CONCLUSIONS: The majority of elderly people has good health. Age is related with a poor health. Women have more health problems than men.     

Predictive factors of physical disability in a cohort of retired persons in Paris followed during 10 years

OBJECTIVE: The objective of the present study was to examine predictors of physical disability in a survey of retired men and women living in the Paris area followed-up longitudinally for 10 years. METHODS: Subjects were randomly selected in a supplementary retirement pension fund. In all 627 subjects took part in the first phase of the survey (1982-83) and 392 in the follow-up phase (1992-93). At the 10-year follow-up, there were 185 confirmed deaths and 50 subjects refused to participate or could not be traced. Physical disability was measured by difficulties reported by the subjects for seven basic activities of daily life. Possible predictors, socio-demographic, impairments, physical activities, working conditions during working life were explored at T1. RESULTS: The incidence of physical disability was 41.4% for men and 57.6% for women. For disability in mobility, the incidence was 37.1% for men and 54.7% for women. In multivariate analysis, predictors of physical disability were social category (clerks), no physical activities, use of medicine, mental impairment. The predictors of disability in mobility were sex (women), social category (clerks), use of medicine, cardio-respiratory and sensory impairments. On the contrary, subjects with mental impairment had a lower incidence of disability in mobility than subjects without mental impairment. CONCLUSION: The results confirm the two poles of disability: biomedical and social. Working conditions during working life do not seem to play a direct part in incidence of disability at ten years follow-up.     

Doctors and patients don't agree: cross sectional study of patients' and doctors' perceptions and assessments of disability in multiple sclerosis

OBJECTIVES: To compare the judgments of clinicians on which domains of health in the short form questionnaire (SF-36) would be most important to patients with multiple sclerosis with the opinions of patients themselves; to compare assessment of physical disability in multiple sclerosis by a clinician using Kurtzke's expanded disability status scale and a non-clinically qualified assistant using the Office of Population Census and Surveys' (OPCS) disability scale with self assessment of disability and other domains of health related quality of life by patients using the SF-36 and the EuroQol questionnaire; and to compare the scores of patients for each domain of the SF-36 with control data matched for age and sex. DESIGN: Cross sectional study. SETTING: Clinical department of neurology, Edinburgh. SUBJECTS: 42 consecutive patients with multiple sclerosis attending a neurology outpatient clinic for review or a neurology ward for rehabilitation. MAIN OUTCOME MEASURES: Scores on the SF-36; EuroQol; Kurtzke's expanded disability status scale; the OPCS disability scale. RESULTS: Patients and clinicians disagreed on which domains of health status were most important (chi 2 = 21, df = 7, P = 0.003). Patients' assessment of their physical disability using the physical functioning domain of the SF-36 was highly correlated with the clinicians' assessment (r = -0.87, P < 0.001) and the non-clinical assessment (r = -0.90, P < 0.001). However, none of the measures of physical disability correlated with overall health related quality of life measured with EuroQol, Quality of life correlated with vitality, general health, and mental health in the SF-36, each of which patients rated as more important than clinicians and for each of which patients scored lower than the controls. CONCLUSIONS: Patients with multiple sclerosis and possibly those with other chronic diseases are less concerned than their clinicians about physical disability in their illness. Clinical trials in multiple sclerosis should assess the effect of treatment on the other elements of health status that patients consider important, which are also affected by the disease process, are more closely related to overall health related quality of life, and may well be adversely affected by side effects of treatment.     

Use of traditional and orthodox health services in urban Zimbabwe

BACKGROUND: Health care in Zimbabwe is provided by both orthodox and traditional care providers. With formal medical services under economic strain it is important to understand the extent of consulting with traditional care providers and their effectiveness. METHODS: A cross-sectional community survey recorded consultations and self-treatment for episodes of illness among 1251 individuals in 222 households randomly selected in two high-density suburbs of Harare, Zimbabwe. Three dependent variables (illness experience, consultation behaviour and choice of care provider) were analysed against a range of sociodemographic, episode-related and outcome measures. RESULTS: More than one-third of the sample had experienced an illness and 83% of these had led to consultation. Medical services were consulted eight times more often than traditional ones. Non-consulting behaviour was associated with lack of money or low perceived significance of problems. Physical problems were usually taken to medical clinics where their outcome was better, but non-specific pain and other problems did no better with medical or traditional care. CONCLUSIONS: While members of the community appear to recognize physical problems and take them to medical care, traditional and orthodox medical consultations appear to be equally effective for non-specific pain or non-specific physical problems. The role of traditional medicine in relation to non-specific physical problems and psychological problems is one which deserves further examination from both clinical and administrative perspectives. Poverty appears to be associated with poorer outcomes; this is a potentially important issue in times of increasing economic hardship.     

Health-related quality of life among the least dependent institutional elderly compared with the non-institutional elderly population

The purpose of this study was to investigate health-related quality of life (HRQOL) and functional ability among the least dependent elderly in residential care, and to compare them with information on the general population. A stratified systematic sample (n = 1,587) was drawn from a one-day census of patients in all public residential homes in Finland on December 2, 1991. Sixty-nine per cent of residents in 1992 were able to participate (n = 1,097) and 86% of them returned the questionnaire (n = 948), of which n = 795 were acceptable, the response rate being 72%. A postal survey was used for data collection. The personnel of residential homes were allowed to help residents complete the questionnaire, and 90% of respondents received such help. HRQOL was measured by the Nottingham Health Profile (NHP) and functional ability by a 14-item questionnaire. Finnish studies among the general population were used for comparisons. According to the NHP, the HRQOL appeared lower in institutional care and this was associated with the dependency level. Similarly, for most ADL items the general population had less restrictions than the least dependent residential care patients. In general, women expressed more difficulties in physical mobility and lack of energy than men. The longest stay elderly expressed better HRQOL. In multivariate models adjusted for age and gender those with poor vision had worse HRQOL in almost every dimension of NHP. Difficulties in speech were connected with emotional reactions and social isolation. Chronic illness limiting normal daily life predicted more problems in energy, pain, physical mobility, and emotional reactions. The married or widowed experienced less social isolation than single elderly. Higher education was related to better HRQOL in all NHP dimensions. Poorer perceived health was associated with lack of energy, pain, and emotional reactions. We conclude from these results that there are only a few clients in residential care whose HRQOL or functional ability compare with the non-institutionalized population.     

US double-blind, controlled trials of omeprazole and amoxycillin for treatment of Helicobacter pylori

OBJECTIVE: To identify environmental and psychosocial factors associated with receiving special education services. DESIGN: The 1992 Minnesota Student Survey, an anonymous, self-report survey. SETTING: Minnesota public schools. PARTICIPANTS: A total of 121848 adolescents in the 6th, 9th, and 12th grades. MAIN OUTCOME MEASURES: Emotional status and potential environmental risk factors including family structure, family substance use problems, family violence, and sexual abuse were compared between adolescents reporting a history of having been in classes for learning problems and a grade- and race-matched comparison group of adolescents who had never been in classes for learning problems. Comparisons were conducted separately for male and female respondents. RESULTS: Compared with adolescents who had never been in classes for learning problems, a significantly greater proportion of male and female students who had been in special education classes lived in single-parent and nontraditional households, indicated that a family member had an alcohol or other drug problem, had witnessed or experienced physical abuse, and reported a history of sexual abuse and poor emotional health. Most of these associations remained significant when simultaneously controlling for the other factors in logistic regression. Significant factors showed modest odds ratios in the multivariate analyses (<1.6), except for the emotional status variable. Students with a history of receiving special education services had from 6 to 14 times the odds of reporting poor emotional health. This association was strongest among the youngest adolescents. CONCLUSION: Several environmental stressors and psychosocial factors, most notably poor emotional health, are associated with a history of special class placement for learning problems.     

Fear and Compassion: A Terror Management Analysis of Emotional Reactions to Physical Disability.

Objective: To examine whether death anxiety underlies emotional reactions toward people with disabilities (PWDs). Study Design: In Study 1, participants were primed with thoughts of death, read a vignette describing a PWD, and completed a compassion scale. Study 2 replicated the design of Study 1 and also examined the impact of target ethnicity. Studies 3 and 4 assessed the impact of physical disability on death-related cognitions and on fear of personal death. Results: Men reacted to death primes by emotionally withdrawing from a PWD and reporting less compassion, whereas women exhibited more compassionate responses. These differences in compassion were reflected in the death-related cognitions and fears sparked by physical disability. Conclusions: The human need to manage the terror of death shapes emotional reactions toward PWDs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Domestic violence and emotional distress among Nicaraguan women: Results from a population-based study.

This study aimed to measure the prevalence of emotional distress among women in León, Nicaragua, and to identify risk factors for emotional distress, with special reference to wife abuse. A survey was performed among a representative sample of women aged 15–49. Among ever-married women, 20% were classified as experiencing emotional distress at the time of the interview, and 52% reported physical partner abuse at some point in their lives. Women reporting abuse were 6 times more likely to experience emotional distress. An estimated 70% of all cases of emotional distress found among ever-married women were attributable to wife abuse. The study underscores the need to improve screening and care for battered women within mental health services in Nicaragua. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of life in relation to overweight and body fat distribution

OBJECTIVES: This study quantified the impairment of quality of life attributable to body fatness by using the standardized SF-36 Health Survey. METHODS: Tertiles of waist circumference and body mass index (BMI) in 1885 men and 2156 women aged 20 to 59 years in the Netherlands in 1995 were compared. RESULTS: The odds ratios and 95% confidence intervals of subjects with the largest waist circumferences, compared with those in the lowest tertile, were 1.8 (1.3, 2.4) in men and 2.2 (1.7, 2.9) in women with difficulties in bending, kneeling, or stooping; 2.2 (1.4, 3.7) in men and 1.7 (1.2, 2.6) in women with difficulties in walking 500 m; and 1.3 (1.0, 1.9) in men and 1.5 (1.1, 1.9) in women with difficulties in lifting or carrying groceries. Anthropometric measures were less strongly associated with social functioning, role limitations due to physical or emotional problems, mental health, vitality, pain, or health change in 1 year. The relationship between quality of life measures and BMI were similar to those between quality of life measures and waist circumference. CONCLUSIONS: Large waist circumferences and high BMIs are more likely to be associated with impaired quality of life and disability affecting basic activities of daily living.     

Neighborhood deterioration, religious coping, and changes in health during late life

Research indicates that older adults who reside in deteriorated neighborhoods experience more physical health problems than elderly people who dwell in more favorable living environments. The purpose of this study is to see whether the deleterious effects of run-down neighborhoods are reduced for older people who use religious coping responses. Data from a nationwide longitudinal survey of elderly people suggest that the noxious impact of living in a dilapidated neighborhood on changes in self-rated health over time is offset completely for older adults who rely heavily on religious coping strategies. In contrast, significant stress-buffering effects failed to emerge when functional disability served as the outcome measure.