Associations of the COVID-19 pandemic with older individuals’ healthcare utilization and self-reported health status: a longitudinal analysis from Singapore

Background The COVID–19 pandemic has challenged the capacity of healthcare systems around the world and can potentially compromise healthcare utilization and health outcomes among non-COVID–19 patients. Objectives To examine the associations of the COVID-19 pandemic with healthcare utilization, out-of-pocket medical costs, and perceived health among middle-aged and older individuals in Singapore. Method Utilizing data collected from a monthly panel survey, a difference-in-differences approach was used to characterize monthly changes of healthcare use and spending and estimate the probability of being diagnosed with a chronic condition and self-reported health status before and during the COVID-19 outbreak in 2020. Subjects Data were analyzed from 7569 nationally representative individuals from 2019 January and 2020 December. Measures Healthcare utilization and healthcare spending by medical service categories as well as self-reported health status. Results Between January and April 2020 (the first peak period of COVID-19 in Singapore), doctor visits decreased by 30%, and out-of-pocket medical spending decreased by 23%, mostly driven by reductions in inpatient and outpatient care. As a result, the probability of any diagnosis of chronic conditions decreased by 19% in April 2020. The decreased healthcare utilization and spending recovered after lifting the national lockdown in June, 2020 and remained similar to the pre-pandemic level through the rest of 2020. Conclusions Middle-aged and older Singaporeans’ healthcare utilization and the diagnosis of chronic conditions substantially decreased during the first peak period of the COVID-19 outbreak. Further studies to track the longer-term health effect of the pandemic among non-COVID-19 patients are warranted.

Perceptions of Live Donor Kidney Transplantation Using Segmentation Analysis and Perceptual Mapping to Understand Differences by Self-Reported Health Status in People on Dialysis

Living donor kidney transplantation is a superior treatment option for those with end stage kidney disease, but most transplants are from deceased donors. Securing a living donor for living donor kidney transplantation requires effective, well-timed communication which many may find difficult or intimidating. This study uses segmentation analysis and an innovative marketing technique called perceptual mapping to create three dimensional models to compare living donor kidney transplant perceptions by self-reported health status in 160 end-stage kidney disease dialysis patients of two hospital-based dialysis units and an online forum through cross-sectional surveys. Findings indicate patients with poor self-reported health status are more concerned with not knowing what to say or being afraid a person would say no to living donor kidney transplantation. They are also concerned about the donor’s ability to care for family or donate in the future. They are, however, more likely to see benefits of living donor kidney transplantation, including the kidney lasting longer and having a greater quality of life. Findings reveal messages that could be emphasized in interventions to enhance the ability to ask for living donor kidney transplantation, especially in those assessed as having poor health status. Segmentation analysis and perceptual mapping methods can provide a more nuanced look at how best to develop intervention content to increase living donor kidney transplant.

Association of Regular Leisure-Time Physical Activity with Self-Reported Body Mass Index and Obesity Risk among Middle-Aged and Older Adults in Taiwan

Through this study, we aimed to determine the association of regular leisure-time physical activity (LTPA) with self-reported body mass index (BMI) and obesity risk among middle-aged and older adults in Taiwan. We conducted a cross-sectional study and reviewed the data derived from the Taiwan National Physical Activity Survey (TNPAS). Responses from 12,687 participants aged 45–108 years from the database were collected in this study. All the participants completed a standardized structured questionnaire that solicitated information regarding their demographic characteristics (age, gender, education, occupation, and self-reported health status), physical activity behaviors (regular/nonregular LTPA), and self-reported anthropometrics (height, weight, and BMI). Multiple linear and logistic regressions were used to examine the association between regular LTPA and BMI, and between regular LTPA and obesity status, respectively. Regular LTPA was associated with male gender, normal weight, excellent or good self-reported health status, and a lower rate of being underweight compared with nonregular LTPA. Regular LTPA was significant negatively associated with being underweight (OR = 0.71, p < 0.05), whereas it had no significant relationship with BMI and obesity (p > 0.05). Regular LTPA was associated with a reduced risk of being underweight among middle-aged and elderly adults in Taiwan. Further research on the relevant mechanism underlying this phenomenon is warranted.

The Association Between Veteran Status and Obesity Differs Across Race/Ethnicity

Purpose This study aims to evaluate the interaction between veteran status and race/ethnicity on obesity status. Design Cross-sectional survey Setting The 2013–2017 National Health Interview Survey Sample A total of 151,765 adults (8.62% veterans and 91.38 nonveterans) with 69.30% identifying as White, 13.05% identifying as Hispanic, 12.57% identifying as Black, and 5.08% identifying as Asian Measures Obesity status (measured using self-reported body mass index), race/ethnicity, survey year, age, marital status, educational attainment, federal poverty level, health insurance, type of insurance, self-reported health status, and whether participant had a usual care source. Analysis Weighted logistic regression analysis Results In a fully adjusted model, there was no evidence that veterans overall had higher odds of obesity compared to nonveterans (adjusted odd ratio (aOR): 1.05, 95% CI: .99, 1.11). White veterans had lower odds of obesity compared to White nonveterans (OR: .93, 95% CI: .87, .98). Hispanic veterans had higher odds of obesity compared to Hispanic nonveterans (aOR: 1.53, 95% CI: 1.23, 1.90). There was no evidence of an association between veteran status and obesity status for Black and Asian adults. Conclusions Effectual prevention strategies are needed to decrease obesity risks among active and retired Hispanic veterans.

After Over a Year of Pandemic: Mental Well-being and Life Satisfaction of Filipino College Students

The COVID-19 pandemic has been there for over a year and may substantially negatively impact student’s mental well-being. This study aimed to assess the subjective mental well-being and satisfaction with life of Filipino college students. This cross-sectional study involved the analysis of 1,141 college students in the Philippines. The data were collected using the Short Warwick-Edinburgh Mental Wellbeing Scale and the Satisfaction with Life Scale. Results indicated that while 52.8% reported high satisfaction with life, 40.2% had poor mental well-being. Self-reported health status (β=1.899, p=.000), age (β=0.179, p=.000), and year level (β=0.306, p=.000) predicted mental well-being. On the other hand, subjective mental well-being (β=0.736, p=.000), self-reported health status (β=0.967, p=.000), and age (β=0.691, p=.025) predicted life satisfaction. The COVID-19 pandemic has likely affected students’ mental health and well-being. Interventions should be initiated to address the mental health needs of the students during this pandemic and even beyond the health crisis.

Comparisons of factors associated with suicidal ideation of older individuals by health status

This study examined the factors associated with suicidal ideation among older individuals and compared those factors by their objective and subjective health status. Data were obtained from the 13th wave of the Korean Health Panel Survey in 2018. The sample of 6,283 older individuals, who are 55 years and older, was classified into four groups by their objective and subjective health status. Objective health status was measured by the number of chronic health conditions, and subjective health status was defined by an individual’s self-reported health status. To examine the factors associated with suicidal ideation among four groups of older individuals, logistic regression analyses were conducted after controlling for socio-demographic characteristics, physical health and mental health characteristics. The results show that depression and anxiety were found as common factors associated with suicidal ideation for all four groups. As for the group of older individuals who reported bad objective health and bad subjective health, younger age, being male, and low educational attainment were found to be associated suicidal ideation. For those with bad objective health regardless of their subjective health status, the level of stress was found to be related to suicidal ideation among older individuals. Based upon those results, the present study discussed practical and policy implications for suicide prevention among older individuals by reflecting their objective health and subjective health status.

Long-term recovery of upper limb motor function and self-reported health: results from a multicenter observational study 1 year after discharge from rehabilitation

Background Impaired motor functions after stroke are common and negatively affect patients' activities of daily living and quality of life. In particular, hand motor function is essential for daily activities, but often returns slowly and incompletely after stroke. However, few data are available on the long-term dynamics of motor recovery and self-reported health status after stroke. The Interdisciplinary Platform for Rehabilitation Research and Innovative Care of Stroke Patients (IMPROVE) project aims to address this knowledge gap by studying the clinical course of recovery after inpatient rehabilitation. Methods In this prospective observational longitudinal multicenter study, patients were included towards the end of inpatient rehabilitation after ischemic or hemorrhagic stroke. Follow-up examination was performed at three, six, and twelve months after enrollment. Motor function was assessed by the Upper Extremity Fugl-Meyer Assessment (FMA), grip and pinch strength, and the nine-hole peg test. In addition, Patient-Reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10) was included. Linear mixed effect models were fitted to analyze change over time. To study determinants of hand motor function, patients with impaired hand function at baseline were grouped into improvers and non-improvers according to hand motor function after twelve months. Results A total of 176 patients were included in the analysis. Improvement in all motor function scores and PROMIS-10 was shown up to 1 year after inpatient rehabilitation. FMA scores improved by an estimate of 5.0 (3.7–6.4) points per year. In addition, patient-reported outcome measures increased by 2.5 (1.4–3.6) and 2.4 (1.4–3.4) per year in the physical and mental domain of PROMIS-10. In the subgroup analysis non-improvers showed to be more often female (15% vs. 55%, p = 0.0155) and scored lower in the Montreal Cognitive Assessment (25 [23–27] vs. 22 [20.5–24], p = 0.0252). Conclusions Continuous improvement in motor function and self-reported health status is observed up to 1 year after inpatient stroke rehabilitation. Demographic and clinical parameters associated with these improvements need further investigation. These results may contribute to the further development of the post-inpatient phase of stroke rehabilitation. Trial registration: The trial is registered at ClinicalTrials.gov (NCT04119479).

Will Africans take COVID-19 vaccination?

The economic and humanistic impact of COVID-19 pandemic is enormous globally. No definitive treatment exists, hence accelerated development and approval of COVID-19 vaccines, offers a unique opportunity for COVID-19 prevention and control. Vaccine hesitancy may limit the success of vaccine distribution in Africa, therefore we assessed the potentials for coronavirus vaccine hesitancy and its determinants among Africans. An online cross-sectional African-wide survey was administered in Arabic, English, and French languages. Questions on demographics, self-reported health status, vaccine literacy, knowledge and perception on vaccines, past experience, behavior, infection risk, willingness to receive and affordability of the SARS-COV-2 vaccine were asked. Data were subjected to descriptive and inferential statistics. A total of 5,416 individuals completed the survey. Approximately, 94% were residents of 34 African countries while the other Africans live in the Diaspora. Only 63% of all participants surveyed were willing to receive the COVID-19 vaccination as soon as possible and 79% were worried about its side effects. Thirty-nine percent expressed concerns of vaccine-associated infection. The odds of vaccine hesitancy was 0.28 (95% CI: 0.22, 0.30) among those who believed their risk of infection was very high, compared to those who believed otherwise. The odds of vaccine hesitancy was one-fifth (OR = 0.21, 95% CI: 0.16, 0.28) among those who believed their risk of falling sick was very high, compared to those who believed their risk of falling very sick was very low. The OR of vaccine hesitancy was 2.72 (95% CI: 2.24, 3.31) among those who have previously refused a vaccine for themselves or their child compared to counterparts with no self-reported history of vaccine hesitancy. Participants want the vaccines to be mandatory (40%), provided free of charge (78%) and distributed in homes and offices (44%). COVID-19 vaccine hesitancy is substantial among Africans based on perceived risk of coronavirus infection and past experiences.

Relationship Between Personality Measures and Perceived Mental Fatigability

Objective Examine the association between personality measures and perceived mental fatigability. Methods We performed a cross-sectional analysis in N=1670 men, age 84.3±4.1 years. Multivariable linear regression models were used to examine the covariate adjusted association between personality measures (conscientiousness, optimism, goal reengagement, and goal disengagement) and perceived mental fatigability (measured with the validated 10-item Pittsburgh Fatigability Scale, PFS). Results One standard deviation lower conscientiousness (β=−0.91, p<.0001) and optimism (β=−0.63, p<.0001), and higher goal reengagement (β=0.51, p=.01) scores were independently associated with higher PFS Mental scores adjusted for age, cognitive function, self-reported health status, depressive symptoms, sleep disturbance, physical activity, and goal disengagement. Discussion Lower conscientiousness, optimism, and higher goal reengagement were linked with more severe perceived mental fatigability in older men. Personality traits may potentially contribute to early risk assessment for fatigability in later life. Future work should be longitudinal in nature and include personality assessments to confirm the temporality of the relationships observed.

Clustering repeated ordinal data: Model based approaches using finite mixtures

<p>Model based approaches to cluster continuous and cross-sectional data are abundant and well established. In contrast to that, equivalent approaches for repeated ordinal data are less common and an active area of research. In this dissertation, we propose several models to cluster repeated ordinal data using finite mixtures. In doing so, we explore several ways of incorporating the correlation due to the repeated measurements while taking into account the ordinal nature of the data. In particular, we extend the Proportional Odds model to incorporate latent random effects and latent transitional terms. These two ways of incorporating the correlation are also known as parameter and data dependent models in the time-series literature. In contrast to most of the existing literature, our aim is classification and not parameter estimation. This is, to provide flexible and parsimonious ways to estimate latent populations and classification probabilities for repeated ordinal data. We estimate the models using Frequentist (Expectation-Maximization algorithm) and Bayesian (Markov Chain Monte Carlo) inference methods and compare advantages and disadvantages of both approaches with simulated and real datasets. In order to compare models, we use several information criteria: AIC, BIC, DIC and WAIC, as well as a Bayesian Non-Parametric approach (Dirichlet Process Mixtures). With regards to the applications, we illustrate the models using self-reported health status in Australia (poor to excellent), life satisfaction in New Zealand (completely agree to completely disagree) and agreement with a reference genome of infant gut bacteria (equal, segregating and variant) from baby stool samples.</p>