Objectives: The overall aim was to investigate determinants and consequences of global non-comparative self-ratings of health (SRH). Concerning determinants, the aim was more specifically to investigate the association between age, year of investigation, stress-theory based psychobiological variables, and SRH. Materials and methods: Papers I and IV were based on eight ongoing population-based cohort studies, with sampling performed 1973-2003. The study-population consisted of 11,880 men and women, aged 25-99 years, providing 14,470 observations. Papers II and III were based on a longitudinal study of 212 adult, healthy, women and men. Results: In women, SRH declined linearly with age and year of investigation, after adjustment for influence of covariates, while in men the association was based on a third degree polynomial function. The most important covariates were complaint score, sick-leave or disability pension, and leisure time physical activity. The final model explained 76.2% of the variance in women and 74.5% in men. SRH was directly associated with psychological resources and inversely associated with psychological strain, in healthy, adult, women and men. In men with SRH which decreased to fair or poor, higher levels of prolactin and lower levels of testosterone were observed at follow-up as compared to baseline. There were no associations between endocrine variables and SRH in women. There was a significant inverse association between SRH and mortality, disability pension, and sick-leave during follow-up, in women and men, adjusted for covariates. Associations between SRH and mortality were robust during the follow-up period. Conclusions: Age and year of investigation were associated with SRH, but differently in women and men. Psychological resources and psychological strain were consistently associated with SRH, but there were no robust associations between endocrine measures and SRH. SRH was associated with mortality, disability pension, and sick-leave, during follow-up. The association between SRH and mortality was robust during the follow-up period

Thesis (M.S.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Objective: To determine ifself-rated health modifies the effect ofbaseline walking limitation on 5- and 10-year mortality in older women with early stage breast cancer Design: Secondary analysis of a multicenter 10-year prospective study of older women with early stage breast cancer Setting: Sixty-two clinical centers in four geographic areas Participants: 585 women aged 65 years or older with Stage I to IIIa breast cancer who were followed by annual telephone calls for up to 10 years. Measurements: Baseline self-rated health, ability to walk several blocks, age, race, marital status, financial status, social support, comorbid conditions, body mass index, tumor stage, estrogen receptor (ER) status, initial therapy, and emotional health. The main outcome was all-cause mortality at 5 and 10 years as determined by National Death Index and Social Security Death Index. Results: Subjects at baseline were 17% age 80+, 48% stage II-IIIa, 25% ER negative, 42% with ≤1 comorbid condition. At the time of breast cancer diagnosis, 39% of women reported low self-rated health, and 28% reported limitations in walking several blocks. Those with low self-rated health and walking limitation had higher mortality rates than those with high self-rated health and without walking limitation (28.1% vs. 12.7% at 5 years, p = 0.0002; 67.8% vs. 34.9% at 10 years, p < 0.0001). In the adjusted regression model, risk of dying from any cause by 10 years was higher for women aged 80+ (HR 3.87, 95% CI 2.45, 6.11); age 70-79 (HR 1.54, 95% CI 1.06, 2.24); with inadequate finances (HR 1.73, 95% CI 1.13, 2.65); and with the combination of low self-rated health and walking limitation at baseline (HR 1.48, 95% CI 1.02, 2.15). Conclusion: In this study of older women with breast cancer, the combination of low self-rated health and limitation in walking several blocks at diagnosis was a predictor of all-cause mortality at 10 years of follow-up; this finding was independent of age, comorbidity, tumor characteristics, and treatment. These self-report measures can be easily assessed in clinical practice and may represent an effective strategy to improve treatment decision-making in older adults with cancer.

This study was done to examine the relationship between self-rated health and social/community relations. Due to advances in modern medicine, multifactorial diseases are more prevalent than acute infectious diseases and a greater understanding of the impact sociological variables has on health is of great importance. In prior research, self-rated health has been demonstrated to be a robust predictor of mortality, even when controlling for other variables known to impact health. Presence of a strong social network and attachments to community have been shown to be protective of self-perceptions of health. The Health and Living study was conducted in the Bear River Health District located in northern Utah in 2004 utilizing a mail survey. The relationship between self-rated health and social network indicators in addition to community attachment variables was evaluated statistically. Demographic variables were also analyzed. Church attendance, number of friends, income, age, and education were found to be statistically significant.

Neighborhoods are composed of physical, social, and cultural environmental factors that influence health and health behaviors. These factors include chronic stressors that are associated with premature mortality. Determining the role of neighborhoods on health is challenging due to individual exposure to multiple types of stressors, and discerning effects of individual stressors from co-occurring neighborhood stressors. This dissertation investigates the role of neighborhood and individual stressors on physical activity, self-rated health, and depressive symptoms in the environmental justice community of Chelsea, Massachusetts. We interview 354 Chelsea residents aged 18 years and older using open- and closed-ended questions that address health-related topics and perceptions of the environment. We use GIS-based methods to map resident-defined neighborhoods and their relation to attributes of the physical environment, and regression models to quantify relationships between neighborhood factors and individual stressors with health outcomes. We also incorporate responses to open-ended interview questions to develop physical activity outcomes. We report positive associations between exposure to neighborhood factors and adverse outcomes. Noise, feeling unsafe, and low social cohesion display positive correlations with poor self-rated health and depressive symptoms. Proximity to resident-preferred parks is positively correlated with physical activity, while knowledge of rape or sexual assault is inversely associated with physical activity. Individual stressors, such as health conditions and disability, are positively associated with all adverse outcomes. Including neighborhood factors and individual stressors in the same model does not change any associations. We conclude that neighborhood factors are independent sources of chronic stress that influence health and health behaviors. In the literature, the outcomes we study are associated with premature mortality. This fact, coupled with the associations we see between our outcomes and neighborhood factors, suggest that aspects of neighborhoods can increase risk for premature mortality. Health could also be improved on an individual level by providing resources to buffer against the negative effects of disability and reported financial problems, such as a sudden loss of income or food insecurity. Environmental policies related to neighborhood conditions should consider the effects of neighborhoods factors on health as a systematic method of improving health.

No description available.

The number of persons who are not employed has increased in Sweden since the early 1990s. Unemployment has been found to influence health, especially when unemployment rates are low. The extent to which unemployment affects health when unemployment is high is less clear, and this needs to be further studied. To improve health in the population, the health care system should offer equal access to health care according to need. It is important to study whether the employment status hinders the fulfilment of this goal. This thesis is based on four papers: Paper I and II aimed at analysing self-rated health versus mortality risk in relation to employment status, during one period of low unemployment and one period of high unemployment. Paper III and IV assessed the use of medical health care services and unmet care needs among persons who were unemployed or otherwise not employed. The goal was to analyse what health problems lead people to either seek or abstain from seeking care, and what factors encumber or facilitate this process. The overall results indicate that being unemployed or outside the labour force was associated with an excess risk of poor self-rated health, symptoms of depression, mental and physical exhaustion and mortality. The differences in self-rated health between the unemployed and employed were larger when unemployment levels were high, than when they were low. More groups of the unemployed were also afflicted with poor health when unemployment was high. Thus, poor health among the unemployed seems to be a public health problem during high levels of unemployment. Lack of employment was related to abstaining from seeking care, despite perceiving a need for care, and this was related to psychological symptoms. To deal with the needs of the unemployed and others who are outside the labour force it would be useful to develop and implement interventions within the health care system. These should focus on psychological and psychosocial problems. Future research should analyse how to facilitate health-promoting interventions among persons who are not anchored in the labour market.

O envelhecimento populacional e as alterações socioestruturais recentes no contexto brasileiro tem aumentado a probabilidade de que os cuidados prestados a idosos doentes ou dependentes sejam assumidos por indivíduos também idosos. As particularidades da sobrecarga experimentada por idosos são pouco descritas pela literatura de pesquisa gerontológica, carecendo, ainda, de modelos explicativos. O presente estudo buscou testar um modelo teórico-empírico de associações explicativas de sobrecarga subjetiva de idosos cuidadores considerando sexo, idade, intensidade da ajuda prestada, comprometimento cognitivo do idoso receptor do cuidado e autoavaliação de saúde. Trata-se de um estudo de corte transversal desenvolvido a partir dos dados de um estudo maior do Programa de Pós-Graduação em Gerontologia da Faculdade de Ciências Médicas da Unicamp Bem-estar psicológico de idosos que cuidam de outros idosos no contexto da família que envolveu idosos com 60 anos ou mais, que prestam cuidados a familiares também idosos dependentes no contexto domiciliar. Foram selecionadas variáveis de caracterização sociodemográficas e econômica da amostra, da intensidade da ajuda prestada em atividades básicas e instrumentais de vida diária, do comprometimento cognitivo do idoso cuidado por meio da aplicação do Clinical Dementia Rating Scale Sum of boxes, de autoavaliação geral da saúde e da Escala de Sobrecarga de Zarit. O modelo explicativo proposto foi testado por meio da análise de equações estruturais via Path analysis com auxílio do programa estatístico SAS System for Windows (Statistical Analysis System), versão 9.2. A amostra foi composta por 138 idosos, em sua maioria mulheres (76%), cônjuges (64%), prestando cuidado, em média, há 4,4 anos (±4,1) e auxiliando em sete tarefas (±3,6). Resultados da Path analysis revelaram caminhos associativos entre o sexo e a sobrecarga mediados pelo comprometimento cognitivo do idoso receptor de cuidados e autoavaliação de saúde do cuidador. Houve associações entre sexo e intensidade da ajuda prestada mediadas pelo comprometimento cognitivo do idoso receptor de cuidados. O modelo resultante sugere que a sobrecarga de idosos cuidadores não é produto direto da intensidade da ajuda e do comprometimento cognitivo e que a autopercepção de saúde pode influenciar seus efeitos. Reproduz as concepções presentes em modelos psicológicos de adaptação ao estresse ressaltando a centralidade da saúde como recurso importante para o cuidador idoso / The ageing population and recent socio-structural changes in Brazil have increased the likelihood that the care to the elderly will be provided by another elderly individual. The burden specificities experienced by older caregivers are little described in the gerontological literature, therefore lacking explanatory models. The present study aims to test a theoretical-empirical model of explanatory associations of subjective burden of older caregivers considering variables as sex, age, aid intensity provided, cognitive impairments of the recipient of care and self-rate health. This is a cross-sectional study based on data from a larger study entitled \"Psychological well-being of the elderly who care for other elderly in the family context\", consisting of individuals aged 60 and over who provide care to family members at the home. Sociodemographic and economic variables of the sample, the intensity of the assistance given in basic and instrumental activities of daily living, were selected from the cognitive impaired of the elderly care through the application of the Clinical Dementia Rating Scale - Sum of boxes, of general health self-assessment and the Zarit Burden Scale. The proposed explanatory model was tested through the analysis of structural equations via Path analysis. The sample consisted of 138 elderly people, mostly women (76%), spouses (64%), with average time of care 4.4 years (± 4.1) and seven tasks (± 3.6). Results from Path analysis shows associative paths between sex and overload mediated by cognitive impairments of elderly care recipient and self-rated health. There were associations between sex and intensity of aid provided mediated by the cognitive impairment of the elderly care recipient. Although it explains little of the variability, the model suggests that the caregiver burden is not a direct product of the cognitive impairment of the recipient of care and that self-rated health can influence its effects. It replicates conceptions presented in different psychological models of adaptation to stress emphasizing the centrality of health as an important resource for older caregivers

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2014-10-08T19:14:45Z No. of bitstreams: 2 Dissertação - Patrícia Pereira de Vasconcelos - 2012.pdf: 1578862 bytes, checksum: 94377135b580d72c62777755a8cc3ef2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2014-10-09T11:24:30Z (GMT) No. of bitstreams: 2 Dissertação - Patrícia Pereira de Vasconcelos - 2012.pdf: 1578862 bytes, checksum: 94377135b580d72c62777755a8cc3ef2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-10-09T11:24:30Z (GMT). No. of bitstreams: 2 Dissertação - Patrícia Pereira de Vasconcelos - 2012.pdf: 1578862 bytes, checksum: 94377135b580d72c62777755a8cc3ef2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2012-05-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Chronic pain is an unpleasant experience that reaches much of the world's population; however, population studies with the elderly are rare. The aim of this study was to assess chronic pain and self-rated health among community elders. Study population-based cross-sectional, in Goiania, Goias, December/2009 between April 2010 and. For this cut, we excluded those who reached  13 on the MEEM scores, and needed help for the answers. The random sample consisted of 872 participants. Chronic pain was considered as existing for six months or more. Pain intensity was measured by using a numeric scale (0-10: zero=no pain, 1,2,3,4=mild, 5.6=moderate, and strong=7,8,9, and 10=worst pain possible) the location investigated through body diagrams, and self-rated health assessed by the scale of verbal descriptors ("very good", "good," "regular," "bad," "worst"). The project was approved by the CEP/UFG (Protocol 050/2009) and seniors signed the Informed Consent. The data were analyzed using Stata version 8.0 and operated by means of absolute and relative frequency and Confidence Interval (95%). Of the 872 elderly, 460 (52.7%: 95% CI: 49.4% -56.1%) reported chronic pain. By age, the prevalence was 52.4, 53.1 and 53.0%, respectively, among young elderly (60-69 years), elderly (70-79 years) and very elderly (80 or +). Women obtained higher prevalence of chronic pain (60.4%) than men (40.1%), prevailing among the young elderly (57.6/43.4%), elderly (62.8/38.6%) and very elderly (64.5/33.9%). The elderly with chronic pain, 49.8% were young elderly, 33.0% and 17.2% very elderly seniors. The increased representation of women was (71.3%), and 48.8% were young elderly, 32.9% and 18.3% elderly, very elderly. The marriage prevailed among young elderly (46.0%) and elderly (54.1%) and widowed (55.7%), among the very elderly. Income  minimum wage prevailed among the 3 elderly age groups (32.1; 56.4; 50.7%) and education "primary" among young elderly (48.0%), elderly (45.7%) and very elderly (53.9%). The sites of pain were prevalent: MMII (34,5%) and lumbar (29,5%) and 12.6% of seniors reported "worst possible pain," 42.0% "severe pain", 26.0% "moderate" and 19, 4%, "mild". The young elderly (45.2) and seniors (41.3%) reported more pain "strong" and the very old, "severe pain" (33.3%) and "worst pain" (20.3%). Women reported pain "strong" and "worst possible pain" (45.8; 14.1%) more often than men, who reported more pain "mild" and "moderate" (27.1; 32.2 %.) When health was perceived as "very good", "moderate pain" (41.7%) and "mild" (33.3%) prevailed. Those who perceived their health as "good" over reported "mild pain" (33.9%) and when his health was "fair", "bad" and "very bad", the highest frequency of reported pain was "strong" (46.0%), "strong" (56.5%) and "worst possible pain" (60.0%), respectively. The prevalence estimates found are similar to other national studies. Most elderly people suffer from chronic pain of high intensity, which affects the lower limbs and lower back. Population-based studies help us to identify penetration points for planning and implementing strategies that print improving health care in this population. / A dor crônica é uma experiência desagradável que atinge grande parte da população mundial, contudo, estudos populacionais com idosos são raros. O objetivo desse estudo foi analisar a dor crônica e a autopercepção de saúde entre idosos da comunidade. Estudo de base populacional, transversal, em Goiânia, Goiás, entre dezembro/2009 e abril/2010. Para este recorte, foram excluídos aqueles que alcançaram escores 13 no MEEM; e precisaram de ajuda para as respostas. A amostra probabilística constituiu-se de 872 participantes. Dor crônica foi considerada como existente há seis meses ou mais. A intensidade de dor foi medida por meio de escala numérica (0-10: zero=sem dor; 1,2,3,4=leve; 5,6=moderada e 7,8,9=forte; e 10=pior dor possível); a localização investigada por meio de diagramas corporais; e a autopercepção de saúde avaliada por escala de descritores verbais (“muito boa”, “boa”, “regular”, “ruim”, “muito ruim”). O projeto foi aprovado pelo CEP/UFG (Protocolo 050/2009) e os idosos assinaram o TCLE. Os dados foram analisados pelo programa Stata versão 8.0 e explorados por meio de frequência absoluta e relativa e Intervalo de Confiança (95%). Dos 872 idosos, 460 (52,7%: IC 95%: 49,4%-56,1%) referiram dor crônica. Por faixa etária, a prevalência foi de 52,4%; 53,1% e 53,0%, respectivamente, entre jovens idosos (60-69 anos); idosos (70-79 anos); e muito idosos (80 anos ou+). As mulheres alcançaram maior prevalência de dor crônica (60,4%) que os homens (40,1%), prevalecendo entre os jovens idosos (57,6%/43,4%); idosos (62,8%/38,6%) e muito idosos (64,5%/33,9%). Dos idosos com dor crônica, 49,8% eram jovens idosos, 33,0% idosos e 17,2% muito idosos. A maior representação foi pelas mulheres (71,3%), sendo que 48,8% eram jovens idosas, 32,9%, idosas e 18,3%, muito idosas. Os casados prevaleceram entre jovens idosos (46,0%) e idosos (54,1%); e os viúvos (55,7%), entre os muito idosos. A renda  um salário mínimo prevaleceu entre idosos das 3 faixas etárias (32,1%; 56,4%; 50,7%) e escolaridade “primário” entre jovens idosos (48,0%), idosos (45,7%) e muito idosos (53,9%). Os locais de dor prevalentes foram: MMII (34,5%) e região lombar (29,5%); e 12,6% dos idosos referiu “pior dor possível”, 42,0% “dor forte”; 26,0% “moderada” e 19,4%, “leve”. Os jovens idosos (45,2%) e idosos (41,3%) relataram mais dor “forte”; e os muito idosos, “dor forte” (33,3%) e “pior dor” (20,3%). As mulheres relataram dor “forte” e “pior dor possível” (45,8%; 14,1%) com maior frequência que os homens; que relataram mais dor “leve” e “moderada” (27,1%; 32,2%). Quando a saúde foi percebida como “muito boa”, “dor moderada” (41,7%) e “leve” (33,3%) prevaleceram. Aqueles que perceberam sua saúde como “boa” relataram mais “dor leve” (33,9%) e quando a saúde foi “regular”, “ruim” e “muito ruim”, a maior frequência de relatos foi de dor “forte” (46,0%), “forte” (56,5%) e “pior dor possível” (60,0%), respectivamente. As estimativas de prevalência encontradas são semelhantes a outros estudos nacionais. A maioria dos idosos sofre dor crônica, de elevada intensidade, que afeta os MMII e a região lombar, especialmente das mulheres. Estudos de base populacional permitem identificar pontos de penetração para planejamento e implementação de estratégias que imprimam melhoria no cuidado à saúde dessa população.

O envelhecimento populacional e as alterações socioestruturais recentes no contexto brasileiro tem aumentado a probabilidade de que os cuidados prestados a idosos doentes ou dependentes sejam assumidos por indivíduos também idosos. As particularidades da sobrecarga experimentada por idosos são pouco descritas pela literatura de pesquisa gerontológica, carecendo, ainda, de modelos explicativos. O presente estudo buscou testar um modelo teórico-empírico de associações explicativas de sobrecarga subjetiva de idosos cuidadores considerando sexo, idade, intensidade da ajuda prestada, comprometimento cognitivo do idoso receptor do cuidado e autoavaliação de saúde. Trata-se de um estudo de corte transversal desenvolvido a partir dos dados de um estudo maior do Programa de Pós-Graduação em Gerontologia da Faculdade de Ciências Médicas da Unicamp Bem-estar psicológico de idosos que cuidam de outros idosos no contexto da família que envolveu idosos com 60 anos ou mais, que prestam cuidados a familiares também idosos dependentes no contexto domiciliar. Foram selecionadas variáveis de caracterização sociodemográficas e econômica da amostra, da intensidade da ajuda prestada em atividades básicas e instrumentais de vida diária, do comprometimento cognitivo do idoso cuidado por meio da aplicação do Clinical Dementia Rating Scale Sum of boxes, de autoavaliação geral da saúde e da Escala de Sobrecarga de Zarit. O modelo explicativo proposto foi testado por meio da análise de equações estruturais via Path analysis com auxílio do programa estatístico SAS System for Windows (Statistical Analysis System), versão 9.2. A amostra foi composta por 138 idosos, em sua maioria mulheres (76%), cônjuges (64%), prestando cuidado, em média, há 4,4 anos (±4,1) e auxiliando em sete tarefas (±3,6). Resultados da Path analysis revelaram caminhos associativos entre o sexo e a sobrecarga mediados pelo comprometimento cognitivo do idoso receptor de cuidados e autoavaliação de saúde do cuidador. Houve associações entre sexo e intensidade da ajuda prestada mediadas pelo comprometimento cognitivo do idoso receptor de cuidados. O modelo resultante sugere que a sobrecarga de idosos cuidadores não é produto direto da intensidade da ajuda e do comprometimento cognitivo e que a autopercepção de saúde pode influenciar seus efeitos. Reproduz as concepções presentes em modelos psicológicos de adaptação ao estresse ressaltando a centralidade da saúde como recurso importante para o cuidador idoso / The ageing population and recent socio-structural changes in Brazil have increased the likelihood that the care to the elderly will be provided by another elderly individual. The burden specificities experienced by older caregivers are little described in the gerontological literature, therefore lacking explanatory models. The present study aims to test a theoretical-empirical model of explanatory associations of subjective burden of older caregivers considering variables as sex, age, aid intensity provided, cognitive impairments of the recipient of care and self-rate health. This is a cross-sectional study based on data from a larger study entitled \"Psychological well-being of the elderly who care for other elderly in the family context\", consisting of individuals aged 60 and over who provide care to family members at the home. Sociodemographic and economic variables of the sample, the intensity of the assistance given in basic and instrumental activities of daily living, were selected from the cognitive impaired of the elderly care through the application of the Clinical Dementia Rating Scale - Sum of boxes, of general health self-assessment and the Zarit Burden Scale. The proposed explanatory model was tested through the analysis of structural equations via Path analysis. The sample consisted of 138 elderly people, mostly women (76%), spouses (64%), with average time of care 4.4 years (± 4.1) and seven tasks (± 3.6). Results from Path analysis shows associative paths between sex and overload mediated by cognitive impairments of elderly care recipient and self-rated health. There were associations between sex and intensity of aid provided mediated by the cognitive impairment of the elderly care recipient. Although it explains little of the variability, the model suggests that the caregiver burden is not a direct product of the cognitive impairment of the recipient of care and that self-rated health can influence its effects. It replicates conceptions presented in different psychological models of adaptation to stress emphasizing the centrality of health as an important resource for older caregivers

Scholars have long theorized that religious contexts provide health-promoting social integration and regulation. A growing body of literature has documented associations between individual religiosity and health as well as macro–micro linkages between religious contexts, religious participation, and individual health. Using unique data on individuals and county contexts in the United States, this study offers new insight by using multilevel analysis to examine meso–micro relationships between religion and health. We assess whether and how the relationship between individual religiosity and health depends on communal religious contexts. In highly religious contexts, religious individuals are less likely to have poor health, while nonreligious individuals are markedly more likely to have poor health. In less religious contexts, religious and nonreligious individuals report similar levels of health. Consequently, the health gap between religious and nonreligious individuals is largest in religiously devout contexts, primarily due to the negative effects on nonreligious individuals’ health in religious contexts.