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The study aimed to develop and validate a tool to recognize the presence and to evaluate the level of self-neglect in community-dwelling older people. The cross-sectional study included 2,894 face-to-face interviews with randomly selected individuals from among the general population, social service users, and hospital patients. In addition, specially trained interviewers assessed the physical appearance and standards of living. Reliability, content, and construct validity were assessed. The Item Response Theory was used. The following scales were developed: the Self-Reported Self-Neglect Scale (SRSNS), the Objective Assessment of the Level of Self-Neglect–Physical Appearance (OALSN-PA) scale, concerning physical health risks based on the appearance of an individual, and the Objective Assessment of the Level of Self-Neglect–Standards of Living Arrangements (OALSN-SLA) scale, which assesses the physical and personal living conditions. The brevity of the scales makes them useful for the daily practice of health care and social care professionals.

Objectives The growing number of chronic conditions and functional limitations resulting from demographic changes and the aging of the population poses several challenges for health care and public health. Consequently, it plays a role in the assessment of the impact of diagnostic and treatment effects on patient satisfaction. The study aims to assess older patients’ overall satisfaction with the medical care and healthcare system in Poland and to verify such factors as patient-doctor interactions, access to health care and other sociodemographic characteristics as possible determinants of patient satisfaction at the later stage of life. Methods The survey data represent the polish part of the cross-sectional COURAGE in Europe study. Satisfaction with hospital care, outpatient care, and the healthcare system in Poland was assessed. The indices for the psychosocial dimension of the patient-doctor relationships and access to hospital/outpatient care were developed based on patients’ experiences as the possibility of talking about private matters, the clarity of explanations, the involvement in decision-making process, being treated respectfully, the duration of waiting and the ease of access to a preferred doctor or other healthcare professional. The ordered probit regression models were used. Results The psychosocial dimension of patient-doctor relationships was associated with the satisfaction with both hospital and outpatient care. Being treated with respect (very good experience vs. bad odds ratio [OR] = 8.1, 95% confidence interval [CI]: [1.9, 34.4]) and the possibility to talk about private matters with medical team (very good experience vs. bad OR = 3.5, 95% CI: [1.1, 10.4]) during the last stay in hospital were reflected in the higher satisfaction with the healthcare system. By contrast, the involvement of patients in the decision-making process (very good experience vs. bad OR = 3.6, 95% CI: [1.8, 6.7]) or access to outpatient health care (based on developed index OR = 1.02, 95% CI: [1.01, 1.02]) were found to be significant determinants of satisfaction with the healthcare system in Poland. Other factors associated with satisfaction with hospital stay were gender and changes in health conditions, whereas achieving the expected outcome was related to satisfaction with outpatient care, and the expenditure for medicines and medical services – to satisfaction with the heathcare system. Conclusion The investigation confirms an important role of doctor-patient communication skills in improving older patient satisfaction and highlights the need for identifying the psychosocial dimension of patient-doctor relationships as an important part of health care.

Objectives Healthy ageing (HA) is a key concept and highly desirable phenomenon in every ageing and already old societies. The aim of our study was to evaluate the influence of socio-economic conditions as well as life-style and other health-related factors on the WHO definition of HA. Design, Setting, Participants The study used cross-sectional data of the PolSenior Project — nationwide research evaluating different aspects of ageing in Poland — which included 4’653 respondents aged 65 years and over. Measurements Data were collected by trained interviewers in respondents’ homes. Three definitions of HA including or not the participants’ chronic conditions were analyzed. Results The prevalence of HA appeared as high as 17.6% if none or 1 chronic disease was present and 42.8% if no information about chronic diseases was taken into account. The association between known health predictors (age, marital status, education, income) and HA was observed. Moreover, HA appeared in relation with indicators of physical functioning and lifestyle. There was a strong concordance between HA and the fair self-rated health (OR = 1.87; 1.99, and 2.74 for the 1st, 2nd and 3rd definitions, respectively) and opposite relation with self-reported need for help (OR = 0.15; 0.15; and 0.13, respectively). Conclusions The HA definition based on no functional activity limitations, no cognitive impairment, no depressive symptoms, no more than one disease and being socially active seems to be a useful approach of HA.. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s12603-019-1243-5 and is accessible for authorized users.

We investigated the relation between alcohol drinking and healthy ageing by means of a validated health status metric, using individual data from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project. For the purposes of this study, the ATHLOS harmonised dataset, which includes information from individuals aged 65+ in 38 countries, was analysed (n = 135,440). Alcohol drinking was reflected by means of three harmonised variables: alcohol drinking frequency, current and past alcohol drinker. A set of 41 self-reported health items and measured tests were used to generate a specific health metric. In the harmonised dataset, the prevalence of current drinking was 47.5% while of past drinking was 26.5%. In the pooled sample, current alcohol drinking was positively associated with better health status among older adults ((b-coef (95% CI): 1.32(0.45 to 2.19)) and past alcohol drinking was inversely related (b-coef (95% CI): &minus, 0.83 (&minus, 1.51 to &minus, 0.16)) with health status. Often alcohol consumption appeared to be beneficial only for females in all super-regions except Africa, both age group categories (65&ndash, 80 years old and 80+), both age group categories, as well as among all the financial status categories (all p &lt, 0.05). Regional analysis pictured diverse patterns in the association for current and past alcohol drinkers. Our results report the need for specific alcohol intake recommendations among older adults that will help them maintain a better health status throughout the ageing process.

Background: Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people, and with increasing trends in general populations. Different risk factors for pain have been identified, but generally from studies with limited samples and a limited number of candidate predictors. The aim of this study is to evaluate the predictors of pain from a large set of variables and respondents. Methods: We used part of the harmonized dataset of ATHLOS project, selecting studies and waves with a longitudinal course, and in which pain was absent at baseline and with no missing at follow-up. Predictors were selected based on missing distribution and univariable association with pain, and were selected from the following domains: Socio-demographic and economic characteristics, Lifestyle and health behaviours, Health status and functional limitations, Diseases, Physical measures, Cognition, personality and other psychological measures, and Social environment. Hierarchical logistic regression models were then applied to identify significant predictors. Results: A total of 13,545 subjects were included of whom 5348 (39.5%) developed pain between baseline and the average 5.2 years' follow-up. Baseline risk factors for pain were female gender (OR 1.34), engaging in vigorous exercise (OR 2.51), being obese (OR 1.36) and suffering from the loss of a close person (OR 1.88) whereas follow-up risk factors were low energy levels/fatigue (1.93), difficulties with walking (1.69), self-rated health referred as poor (OR 2.20) or average to moderate (OR 1.57) and presence of sleep problems (1.80). Conclusions: Our results showed that 39.5% of respondents developed pain over a five-year follow-up period, that there are proximal and distal risk factors for pain, and that part of them are directly modifiable. Actions aimed at improving sleep, reducing weight among obese people and treating fatigue would positively impact on pain onset, and avoiding vigorous exercise should be advised to people aged 60 or over, in particular if female or obese., The ATHLOS project (Ageing Trajectories of Health: Longitudinal Opportunities and Synergies) has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 635316

Objectives: To report prevalence estimates of 12-month suicide ideation and attempts in young-and-middle age adults and older people, as well as their respective associated factors.Methods: A total...

Background: Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people. The aims of this study are to evaluate the temporal variations of pain rates among general populations for the period 1991-2015 and to project 10-year pain rates. Methods: We used the harmonized dataset of ATHLOS project, which included 660,028 valid observations in the period 1990-2015 and we applied Bayesian age-period-cohort modeling to perform projections up to 2025. The harmonized Pain variable covers the content "self-reported pain experienced at the time of the interview", with a dichotomous (yes or no) modality. Results: Pain rates were higher among females, older subjects, in recent periods, and among observations referred to cohorts of subjects born between the 20s and the 60s. The 10-year projections indicate a noteworthy increase in pain rates in both genders and particularly among subjects aged 66 or over, for whom a 10-20% increase in pain rate is foreseen; among females only, a 10-15% increase in pain rates is foreseen for those aged 36-50. Conclusions: Projected increase in pain rates will require specific interventions by health and welfare systems, as pain is responsible for limited quality of subjective well-being, reduced employment rates and hampered work performance. Worksite and lifestyle interventions will therefore be needed to limit the impact of projected higher pain rates., The ATHLOS project (Ageing Trajectories of Health: Longitudinal Opportunities and Synergies) has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 635316.

The aim of the study was to assess the differences between rural and urban areas as regards the role of social capital and its effect on self-rated health and subjective well-being among older people in Poland. The sample was selected on the basis of multi-stage clustered design from the non-institutionalized adult population. Analysis was based on 1,299 elderly people aged 65 and over from the general Polish population who participated in the COURAGE in Europe project. Six regions of Poland were distinguished according to first level of Nomenclature of Units for Territorial Statistics (NUTS) classification . As an indicator of social capital, the COURAGE Social Network Index, the OSLO-3 Social Support Scale, and the three item UCLA Loneliness scale were used, as well as social participation and trust was assessed. Self-rated health (SRH) was measured by WHO-Europe recommended version (ranging from 'very good' to 'very bad'). Well-being was assessed by the Day Reconstruction Method.bResults:/bThe results showed that in urban areas, social network and social participation supported positive self-rated health; in rural, older residents the number of years of education and social support played the same role, while self-rated health decreased with an increasing level of loneliness. Self-rated health decreased in both groups of older people with a growing number of diseases. The multivariate linear regression model of predictors of well-being in older age also confirmed differences between urban and rural elderly residents. In rural residents, subjective well-being significantly increased with the positive effect of the social network. In both urban and rural areas, poor assessment of subjective well-being in older age increased with a higher level of loneliness and growing number of chronic diseases.

Objectives Current demographic trends, such as society aging, the spreading of chronic diseases, as well as early retirement choices, lead to the dwindling labor market population. Taking into consideration the foregoing tendencies and their consequences, the issue of the shrinking labor force resources seems to be the most important challenge for the labor market. In response to it, this paper identifies individual and institutional causes of withdrawal from the labor market, and explores the views of Polish stakeholders on existing strategies for the occupational re-integration of persons with chronic diseases (PwCDs). Material and methods Polish results of 2 European projects: "Participation to Healthy Workplaces and Inclusive Strategies in the Work Sector" (the PATHWAYS project) and "The Collaborative Research on Aging in Europe" (COURAGE in Europe) complemented each other. The cross-sectional population data and data from stakeholders' interviews were used. Results The authors identified several causes which could encourage people to withdraw from the labor market before attaining the official retirement age at 3 different levels: individual, occupational, and institutional. Although research has shown that the macro-level situation is crucial to staying occupationally active, in Poland stakeholders have reported the lack of effective coordination in the implementation of policies for the occupational re-integration of PwCDs. Conclusions A decision to cease work prematurely reflects a combination of many different factors, such as individual determinates, work characteristics, personal convictions, and systemic solutions. The study demonstrated that, despite the awareness of the dwindling resources of labor force, the employment-related challenges faced by PwCDs as well as people who are close to the retirement age remain unaddressed. Int J Occup Med Environ Health. 2019;32(5):695-721.

Objectives The objective of this study is to present the barriers existing in Poland to professional integration and reintegration of people with chronic diseases, including mental health conditions, and discuss them on the basis of expert opinions and in comparison with the situation in other European countries. Material and methods The research methodology was based on a mixed-methods approach, including literature review, in-depth expert interviews, and a survey (based on a structured questionnaire) performed with experts. Results The mapping of policies, systems and services facilitating the integration and reintegration of people with chronic diseases in Poland, as well as expert opinions, made it possible to identify many barriers regarding access to support, such as an obligation to have a certificate of disability, and a system of certification by 2 institutions. There are also barriers regarding the support itself, including problems with subsidies and with professional (re)integration services. Conclusions Poland has a multi-level and multi-sector system of public institutions, which should provide support for people with disabilities and chronic diseases. Nevertheless, the research conducted in Poland indicates an insufficient implementation of the existing solutions. Int J Occup Med Environ Health. 2019;32(4):475–88

Background: Every research project faces challenges regarding how to achieve its goals in a timely and effective manner. The purpose of this paper is to present a project evaluation methodology gathered during the implementation of the Participation to Healthy Workplaces and Inclusive Strategies in the Work Sector (the EU PATHWAYS Project). The PATHWAYS project involved multiple countries and multi-cultural aspects of re/integrating chronically ill patients into labor markets in different countries. This paper describes key project’s evaluation issues including: (1) purposes, (2) advisability, (3) tools, (4) implementation, and (5) possible benefits and presents the advantages of a continuous monitoring. Methods: Project evaluation tool to assess structure and resources, process, management and communication, achievements, and outcomes. The project used a mixed evaluation approach and included Strengths (S), Weaknesses (W), Opportunities (O), and Threats (SWOT) analysis. Results: A methodology for longitudinal EU projects’ evaluation is described. The evaluation process allowed to highlight strengths and weaknesses and highlighted good coordination and communication between project partners as well as some key issues such as: the need for a shared glossary covering areas investigated by the project, problematic issues related to the involvement of stakeholders from outside the project, and issues with timing. Numerical SWOT analysis showed improvement in project performance over time. The proportion of participating project partners in the evaluation varied from 100% to 83.3%. Conclusions: There is a need for the implementation of a structured evaluation process in multidisciplinary projects involving different stakeholders in diverse socio-environmental and political conditions. Based on the PATHWAYS experience, a clear monitoring methodology is suggested as essential in every multidisciplinary research projects.

Background: Persons with chronic diseases (PwCDs) often experience work-related problems, and innovative actions to improve their participation in the labor market are needed. In the frame of the European (EU) Pathways Project, the aim of the study is to compare existing strategies (policies, systems, and services) for professional (re-)integration of PwCDs and mental health conditions available at both European and national level between different European welfare models: Scandinavian, Continental, Anglo-Saxon, Mediterranean, and “Post-Communist”. Method: The European strategies were identified by an overview of relevant academic and grey literature searched through Medline and internet searches, while national strategies were explored through questionnaires and in-depth interviews with national relevant stakeholders. Results: The mapping of existing strategies revealed that, both at European and national level, PwCDs are often considered as part of the group of “persons with disabilities” and only in this case they can receive employment support. European countries put in place actions to support greater labor market participation, but these differ from country to country. Conclusion: Strategies targeting “persons with disabilities” do not necessarily address all the needs of persons with chronic diseases. Countries should consider the importance of employment for all to achieve smart, sustainable, and inclusive growth.

The increasing prevalence of chronic diseases among the European working age population, as well as the implications for the individual and societal level, underline the need for policy guidelines targeting the effective inclusion of persons with chronic diseases in the workplace. The aim of the present paper was to explore the perspectives of European and National-level stakeholders on existing strategies for work re-integration of persons with chronic diseases, and to provide policy guidelines. A highly-structured interview protocol was distributed to 58 National level stakeholders (policy makers, professionals and employers) from seven European countries. Additionally, 20 European organizations concerned with health-related issues and employment completed an online survey. The findings reveal that employment-related challenges remain largely unaddressed. Both national and European stakeholders considered the existing legislative frameworks inadequate and appraised the co-ordination for the implementation of employment re-integration policies as ineffective. Policies targeting at work re-integration of persons with chronic diseases at European and national level should focus on consistent cooperation among all key stakeholders, awareness raising to staff and management, dissemination of effective strategies, developing research and evaluation standards and establishing monitoring systems on inclusive labour markets. The current study was part of the PATHWAYS project. The PATHWAYS project has received funding from the European Union’s Health Programme (2014–2020) Grant agreement n. 663474.

BACKGROUND AND AIM: Frailty is characterized by several deficits in multiple health related domains. Although cognition is among the important components of frailty, there is lack of evidence on the role of specific neuro-cognitive dimensions. The primary aim of the present work was to evaluate the multidimensional definition of frailty, and to assess whether neuro-cognitive function is a constituent of the frailty syndrome among adults aged =50?years living in three European countries. As a secondary aim, the construct validity of the created frailty index was tested (with inpatient and outpatient hospitalization), as well as its determinants. METHODS: Data were obtained from a cross-sectional, community-based, nationally-representative survey conducted in Finland, Poland and Spain (n?=?7987 individuals aged =50?years). Socio-demographic, clinical, lifestyle and social factors were assessed using validated procedures. Cognitive function was assessed with the following tests: learning and short-term memory, working memory and verbal fluency. A frailty index was constructed based on 31 frailty attributes. Principal component analysis was used to identify the components of the frailty index. Logistic and Poisson regression analysis was also conducted. RESULTS: The factor analysis on the components of the index extracted three main dimensions for frailty (disability and daily functioning, cognitive function, chronic health conditions), confirming the multiple dimensions of frailty. Various socio-demographic (e.g., financial status, education level) and lifestyle habits (alcohol consumption) were related with frailty. The presence of frailty was associated with 3.1 times higher odds for inpatient hospitalization (95%CI 2.75 to 3.51). Frailty was also related with higher frequency of outpatient visits. CONCLUSIONS: These findings suggest that frailty is a multidimensional concept with three major dimensions. Neuro-congitive function seems to be a separate dimension of the frailty syndrome. Smoking habits and alcohol intake were positively related with frailty while inpatient and outpatient hospitalization were found to be associated to the level of frailty.

Purpose The purpose of this study is to characterize health status of older cancer survivors using data from the population-based PolSenior study. Methods We compared cancer survivors and non-cancer subjects according to comorbidities, functional status, mental health, and sociodemographic factors. Results There were 286 (5.8%) cancer survivors in a population of 4943 adults aged 65 years and older. The mean age of cancer survivors was 79.4 ± 8.2 years and the median time since cancer diagnosis was 8.5 years (Q1–Q3: 4–16 years). After adjustment for age, sex, education, marital status, and number of comorbidities, compared with a non-cancer population, cancer survivors were more likely to experience falls (OR = 1.38; 95% CI: 1.04–1.83), and to report poor health (OR = 1.49; 95%CI: 1.83–2.06), but cancer survivorship was not associated with impairments in instrumental activities of daily living (IADLs). Age and university education, but neither the time from cancer diagnosis nor the number of comorbidities, were associated with impairments in cancer survivors. Three or more chronic diseases were found in over 50% of cancer survivors and in 38% of the non-cancer population (p

SAGE is supported by the United States National Institute on Aging’s Division of Behavioral and Social Research through Interagency Agreements (OGHA 04034785; YA1323-08- CN-0020; Y1-AG-1005-01) and through research grants (R01-AG034479 and R21-AG034263) and the WHO’s Department of Health Statistics and Information Systems. The research leading to these results has received funding from the European Community’s Seventh Framework Programme (FP7/2007–2013) under grant agreement number 223071 (COURAGE in Europe), from the Instituto de Salud Carlos IIIFIS research grants number PS09/00295 and PS09/01845, and from the Spanish Ministry of Science and Innovation ACI-Promociona (ACI2009-1010). Stefanos Tyrovolas received a scholarship from the Foundation for Education and European Culture (IPEP) to undertake his post-doctoral research, of which this work is a part. Ai Koyanagi’s work was supported by the Miguel Servet contract financed by the CP13/00150 project, integrated into the National R + D + I and funded by the ISCIII—General Branch Evaluation and Promotion of Health Research—and the European Regional Development Fund (ERDF-FEDER). Beatriz Olaya’s work was supported by the Sara Borrell postdoctoral programme (reference no. CD12/00429) from the Instituto de Salud Carlos III (Spain)

The aim of this study was to evaluate the factors associated with different components of arterial blood pressure in nine nationally-representative samples of people aged ≥50 years.Data were available for 53,289 people aged ≥18 years who participated in the SAGE (WHO Study on global AGEing and adult health) study conducted in China, Ghana, India, Mexico, Russia, and South Africa, and the COURAGE (Collaborative Research on Ageing in Europe) study conducted in Finland, Poland, and Spain, between 2007 and 2012. Standard procedures were used to obtain diastolic and systolic blood pressure (DBP, SBP) measurements to identify hypertensive participants, and to determine mean arterial blood pressure (MAP) and pulse pressure (PP).The analytical sample consisted of 42,116 people aged 50 years or older. South Africa had the highest prevalence of hypertension (78.3%), and the highest measurements of MAP ± SD (113.6 ± 36.4 mmHg), SBP ± SD (146.4 ± 49.5 mmHg), and DBP ± SD (97.2 ± 33.9 mmHg). In the adjusted models, dose-dependent positive associations between Body Mass Index (BMI) and MAP or PP were observed in most countries (p 0.05). Diabetes was positively associated with PP in most countries but the association between diabetes and MAP was less consistent. Stroke was associated with both higher MAP and PP in China, Ghana, and South Africa (p 0.05).Obesity and diabetes remain important modifiable risk factors for arterial peripheral resistance and stiffness as reflected by MAP and PP respectively. Controlling arterial pressure abnormalities after stroke events may be important for secondary prevention, particularly in developing countries.

Background: It is important to know whether the relationships between experienced and evaluative well-being and health are consistent across countries with different income levels. This would allow to confirm whether the evidence found in high income countries is the same as in low- and middle-income countries and to suggest policy recommendations that are generalisable across countries. We assessed the association of well-being with health status; analysed the differential relationship that positive affect, negative affect, and evaluative well-being have with health status; and examined whether these relationships are similar across countries.Methods: In this cross-sectional study, interviews were conducted amongst 53,269 adults from nine countries in Africa, Asia, Europe, and Latin America. Evaluative well-being was measured with a short version of the World Health Organization (WHO) Quality of Life instrument, and experienced well-being was measured with the Day Reconstruction Method. Decrements in health were assessed with the 12-item version of WHO Disability Assessment Schedule 2.0. Block-wise linear regression and structural equation models were employed.Results: Considering the overall sample, evaluative well-being was more strongly associated with health (β = −0.35) than experienced well-being (β = −0.14), and negative affect was more strongly associated with health (β = 0.10) than positive affect (β = −0.02). The relationship between health and well-being was similar across countries. Lower scores in evaluative well-being and a higher age were the factors more strongly related with a worse health.Conclusions: The different patterns observed across countries may be related to differences in the countries' gross domestic product, social protection system, economic situation, health care provision, lifestyle behaviours, or living conditions. The fact that evaluative well-being is more predictive of health than experienced well-being suggests that our level of satisfaction with our lives might be more important for our health than the actual emotions than we experience in our day-to-day lives and points out the need of interventions that improve the way people evaluate their lives.

Objective The care processes directed towards institutionalized older people needs to be tailored on goals and priorities that are relevant for this specific population. The aim of the present study was (a) to describe the distribution of selected health determinants in a sample of institutionalized older adults, and (b) to investigate the impact on survival of such measures. Design Multicentre longitudinal cohort-study. Setting 57 nursing homes (NH) in 7 EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non-EU country (Israel). Participants 3036 NH residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) study. Measurements We described the distribution of 8 health determinants (smoking habit, alcohol use, body mass index [BMI], physical activity, social participation, family visits, vaccination, and preventive visits) and their impact on 1-year mortality. Results During the one-year follow up, 611 (20%) participants died. Overweight (HR 0.79; 95% C.I. 0.64–0.97) and obesity (HR 0.64; 95% C.I. 0.48–0.87) resulted associated with lower mortality then normal weight. Similarly, physical activity (HR 0.67; 95% C.I. 0.54–0.83), social activities (HR 0.63; 95% C.I. 0.51–0.78), influenza vaccination (HR 0.66; 95% C.I. 0.55–0.80) and pneumococcal vaccination (HR 0.76 95% C.I. 0.63–0.93) were associated with lower mortality. Conversely, underweight (HR 1.28; 95% C.I. 1.03–1.60) and frequent family visits (HR 1.75; 95% C.I. 1.27–2.42) were associated with higher mortality. Conclusions Health determinants in older NH residents depart from those usually accounted for in younger and fitter populations. Ad hoc studies are warranted in order to describe other relevant aspects of health in frail older adults, with special attention on those institutionalized, with the ultimate goal of improving the quality of care and life.

To explore the associations between health and how people evaluate and experience their lives.We analysed data from nationally-representative household surveys originally conducted in 2011-2012 in Finland, Poland and Spain. These surveys provided information on 10 800 adults, for whom experienced well-being was measured using the Day Reconstruction Method and evaluative well-being was measured with the Cantril Self-Anchoring Striving Scale. Health status was assessed by questions in eight domains including mobility and self-care. We used multiple linear regression, structural equation models and multiple indicators/multiple causes models to explore factors associated with experienced and evaluative well-being.The multiple indicator/multiple causes model conducted over the pooled sample showed that respondents with younger age (effect size, β = 0.19), with higher levels of education (β = -0.12), a history of depression (β = -0.17), poor health status (β = 0.29) or poor cognitive functioning (β = 0.09) reported worse experienced well-being. Additional factors associated with worse evaluative well-being were male sex (β = -0.03), not living with a partner (β = 0.07), and lower occupational (β = -0.07) or income levels (β = 0.08). Health status was the factor most strongly correlated with both experienced and evaluative well-being, even after controlling for a history of depression, age, income and other sociodemographic variables.Health status is an important correlate of well-being. Therefore, strategies to improve population health would also improve people's well-being.Étudier les associations entre la santé et la manière dont les personnes évaluent et ressentent leur vie.Nous avons analysé les données tirées des enquêtes sur les ménages représentatifs à l'échelle nationale qui ont été menées en 2011–2012 en Finlande, Pologne et Espagne. Ces enquêtes ont fourni des informations sur 10 800 adultes, dont le bien-être a été mesuré en utilisant la méthode de reconstruction de la journée et le bien-être évaluatif a été quantifié avec l'échelle de Cantril (Cantril Self-Anchoring Striving Scale). L'état de santé a été évalué par des questions dans huit domaines, y compris la mobilité et le fait de prendre soin de soi-même. Nous avons utilisé des modèles d'équation structurelle à régression linéaire multiple et des modèles à indicateurs et à causes multiples pour étudier les facteurs associés au bien-être ressenti et évaluatif.Le modèle à indicateurs et à causes multiples appliqué sur l'échantillon groupé a montré que les répondants jeunes (ampleur de l'effet [L'état de santé est un facteur de corrélation important du bien-être. Par conséquent, les stratégies d'amélioration de la santé de la population devraient également améliorer le bien-être des personnes.Examinar la relación entre la salud y cómo las personas evalúan y experimentan sus vidas.Se analizaron datos de encuestas a hogares representativos a nivel nacional realizadas inicialmente entre 2011 y 2012 en Finlandia, Polonia y España. Estas encuestas proporcionaron información sobre 10 800 adultos, para quienes el bienestar experiencial se midió con el método de reconstrucción de día y el bienestar evaluativo se midió con la escala Cantril. Se evaluó el estado de salud mediante preguntas de ocho ámbitos, que incluían la movilidad y el cuidado personal. Se emplearon modelos de regresión lineal múltiple y ecuaciones estructurales, así como modelos de causas múltiples/indicadores múltiples a fin de examinar los factores asociados con el bienestar experiencial y evaluativo.El modelo de causas múltiples/indicadores múltiples realizado en la muestra combinada mostró que los encuestados de menor edad (tamaño del efecto [El estado de salud guarda una correlación importante con el bienestar. Por lo tanto, las estrategias para mejorar la salud de la población podrían asimismo mejorar el bienestar de las personas.دراسة الارتباطات بين الصحة وطريقة تقييم الأشخاص لحياتهم وخبراتهم الحياتية.قمنا بتحليل البيانات المستمدة من دراسات استقصائية ذات عينات ممثلة على الصعيد الوطني أجريت في الأصل في عامي 2011 و2012 في فنلندا وبولندا وأسبانيا. وقدمت هذه الدراسات الاستقصائية معلومات عن 10800 شخص بالغ، تم قياس مستوى الرفاهية لديهم باستخدام طريقة إعادة بناء اليوم وتم قياس مستوى الرفاهية التقييمي باستخدام مقياس كانتريل للتحديد الذاتي للازدهار. وتم تقييم الحالة الصحية عن طريق طرح أسئلة في ثمانية مجالات شملت الانتقال والرعاية الذاتية. واستخدمنا الارتداد الخطي المتعدد ونماذج المعادلة الهيكلية ونماذج المؤشرات المتعددة/ الأسباب المتعددة لاستكشاف العوامل المرتبطة بمستوى الرفاهية الفعلي والتقييمي.أظهر نموذج المؤشرات المتعددة/ الأسباب المتعددة الذي أجري على العينة المجمعة أن المشاركين صغار السن (حجم الأثر [معامل بيتا = 0.19)، الذين يتمتعون بمستويات تعليم عالية (معامل بيتا = -0.12)، أو لديهم تاريخ من الاكتئاب (معامل بيتا = -0.17) أو يعانون من سوء الحالة الصحية (معامل بيتا = 0.29) أو سوء الوظائف الإدراكية (معامل بيتا = 0.09) أبلغوا عن مستوى رفاهية أسوأ. وكانت العوامل الإضافية المرتبطة بمستوى الرفاهية التقييمي الأسوأ هي ذكورية النوع (معامل بيتا = -0.03) وعدم العيش مع شريك (معامل بيتا = 0.07) وانخفاض المستوى المهني (معامل بيتا = -0.07) أو مستوى الدخل (معامل بيتا = 0.08). وكانت الحالة الصحية العامل الأقوى ارتباطاً بكل من مستوى الرفاهية الفعلي والتقييمي، حتى بعد ضبط متغيرات تاريخ الاكتئاب والسن والدخل وغيرها من المتغيرات الاجتماعية الديمغرافية.تمثل الحالة الصحية أحد العوامل المهمة المرتبطة بمستوى الرفاهية. ومن ثم، ستؤدي الاستراتيجيات الرامية إلى تحسين صحة السكان إلى تحسين مستوى رفاهية الأشخاص كذلك.探索健康与人们如何评价和体验其生活之间的关联。我们分析了2011-2012年最初在芬兰、波兰和西班牙进行的国家横断面家庭调查的数据。这些调查提供了10800名成年人的信息，对其使用昨日重现法（Day Reconstruction Method）衡量幸福体验，并使用坎特里尔自我定位奋斗量表（Cantril Self-Anchoring Striving Scale）衡量可评价的幸福。健康状态通过包括流动性和自我保健等八个领域的问题进行评估。我们使用多元线性回归、结构方程模型和多指标/多原因模型探索与体验和可评价幸福感相关的因素。混合样本中执行的多指标/多原因模型显示，更年轻（效应量[健康状况是幸福感的重要关联因素。因此，改善人口健康的策略也将改善民生幸福度。Изучить связь между здоровьем и тем, как люди оценивают и воспринимают свою жизнь.Мы проанализировали данные национальных репрезентативных обследований домохозяйств, первоначально проведенных в 2011—2012 годах в Финляндии, Польше и Испании. Эти обследования представили информацию о 10 800 взрослых людях, степень фактического благополучия жизни которых измерялась с использованием метода реконструкции дня, а степень оценочного благополучия — на основе шкалы самооценки Кантрила. Состояние здоровья оценивалось по ответам на вопросы в восьми областях, включая мобильность и способность к самообслуживанию. Мы использовали модели множественной линейной регрессии, модели структурных уравнений и модели множественных индикаторов/множественных причин для изучения факторов, связанных с фактическим и оценочным благополучием.Применение модели множественных индикаторов/множественных причин по совокупной выборке показало, что респонденты в более молодом возрасте (величина эффекта [Состояние здоровья является важным фактором благополучия. Поэтому стратегии по улучшению здоровья населения также ведут к улучшению его благополучия.

The aim of this study was to assess the relationship of sleep duration and all-cause mortality among 2,449 Polish community-dwelling older citizens of Krakow observed during 22 years of follow-up. In particular, the role of some demographic, psychosocial and health-related conditions were investigated in terms of modification effect. In the prospective study, background information was gathered by face-to-face interview. Vital data were obtained from the population registry. Cox regression models were used to assess the role of sleep duration in mortality, in the analyses of potential effect modifiers and the shape of the relationship. Sleep duration was observed to be a significant predictor of all-cause mortality. Life-weariness, functional activity, total number of chronic diseases and age (65-79, 80+) were found to be effect modifiers for the relationship between sleep duration and mortality. Further investigation showed a U-shaped mortality risk associated with the duration of sleep among individuals with a high level of life-weariness, high functional activity and in individuals aged 80 and over. On the other hand, a linear relationship between longer sleep duration and mortality was observed among older people with no experience of life-weariness, without chronic diseases, with medium functional activity and aged 65-79, but also among those who reported three and more chronic conditions. Results of our study support available evidence showing the relationship between sleep duration and mortality among older adults and suggest that any public health intervention in this area should consider also other coexisting modifiable psychosocial and functional determinants.

The aim of the study was to create a simplified, easy implementable multidimensional instrument to assess all relevant elements of the structure and function of social network within individuals across different European countries and to provide the tool for health professionals and policy makers. The analysis was based on the sample of 10 446 non-institutionalized adult population from Finland, Poland and Spain. The Social Network Questionnaire Collaborative Research on Ageing in Europe Social Network Index (COURAGE-SNI) was part of the COURAGE questionnaire. The indicators of the functioning of social network ties (close relations), frequency of direct contact and general support were evaluated. Functions were assess within the main structural components as spouse, parents, children, grandchildren, other relatives, friends, coworkers and neighbours. The exploratory factor analysis revealed five main latent components of social network with one component composed of hierarchical part. The confirmatory factor analysis provided an acceptable fit for the model. The generalize partial credit model was used to calculate factor scores for five components of the COURAGE-SNI considering the social networks of ‘spouse/partner’, ‘parents’, ‘other family members’, ‘neighbours’ and ‘friends and co-workers’. The scores for every component were recalculated so as to provide the social network saturation ranged from 0 (the lowest) to 100% (the highest possible). Finally, the COURAGE-SNI score was obtained as the sum of weighted information calculated by the item response theory procedure for every aforementioned component. In summary, the COURAGE-SNI showed good reliability and content validity and seems to be a promising tool for the assessment of the social network phenomenon across European countries. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The Courage-SNI is a new tool to assess the construct of social network in population studies. The Courage-SNI is an instrument useful to identify high risk groups or populations whose social network is poorer.

Background: Low socio-economic status (SES) has been found to be associated with a higher prevalence of depression. However, studies that have investigated this association have been limited in their national scope, have analyzed different components of SES separately, and have not used standardized definitions or measurements across populations. The aim of the current study was to evaluate the association between SES and depression across three European countries that represent different regions across Europe, using standardized procedures and measurements and a composite score for SES.Method: Nationally-representative data on 10,800 individuals aged ≥18 from the Collaborative Research on Ageing in Europe (COURAGE) survey conducted in Finland, Poland and Spain were analyzed in this cross-sectional study. An adapted version of the Composite International Diagnostic Interview was used to identify the presence of depression, and SES was computed by using the combined scores of the total number of years educated (0–22) and the quintiles of the country-specific income level of the household (1–5). Multivariable logistic regression was used to assess the association between SES and depression.Results: Findings reveal a significant association between depression and SES across all countries (p ≤ 0.001). After adjusting for confounders, the odds of depression were significantly decreased for every unit increase in the SES index for Finland, Poland and Spain. Additionally, higher education significantly decreased the odds for depression in each country, but income did not.Conclusion: The SES index seems to predict depression symptomatology across European countries. Taking SES into account may be an important factor in the development of depression prevention strategies across Europe.

Purpose To comprehensively identify the determinants of quality of life (QoL) in a population study sample of persons aged 18–50 and 50+. Methods In this observational, cross-sectional study, QoL was measured with the WHOQOL-AGE, a brief instrument designed to measure QoL in older adults. Eight hierarchical regression models were performed to identify determinants of QoL. Variables were entered in the following order: Sociodemographic; Health Habits; Chronic Conditions; Health State description; Vision and Hearing; Social Networks; Built Environment. In the final model, significant variables were retained. The final model was re-run using data from the three countries separately. Results Complete data were available for 5639 participants, mean age 46.3 (SD 18.4). The final model accounted for 45% of QoL variation and the most relevant contribution was given by sociodemographic data (particularly age, education level and living in Finland: 17.9% explained QoL variation), chronic conditions (particularly depression: 4.6%) and a wide and rich social network (4.6%). Other determinants were presence of disabling pain, learning difficulties and visual problems, and living in usable house that is perceived as non-risky. Some variables were specifically associated to QoL in single countries: age in Poland, alcohol consumption in Spain, angina in Finland, depression in Spain, and self-reported sadness both in Finland and Poland, but not in Spain. Other were commonly associated to QoL: smoking status, bodily aches, being emotionally affected by health problems, good social network and home characteristics. Conclusions Our results highlight the importance of modifiable determinants of QoL, and provide public health indications that could support concrete actions at country level. In particular, smoking cessation, increasing the level of physical activity, improving social network ties and applying universal design approach to houses and environmental infrastructures could potentially increase QoL of ageing population.

Objectives To explore the joint association of depression and cognitive function with severe disability in nationally-representative samples of community-dwelling adults aged 50 years and older from Finland, Poland and Spain. Design Cross-sectional. Setting Community-based. Participants Population-based sample of 7987 non-institutionalized adults aged 50 and older. Measurements The outcome was severe disability, defined as ≥ 90th percentile of the 12-item version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0). Past 12-month DSM-IV major depressive disorder was assessed with the depression module of the WHO Composite International Diagnostic Interview (CIDI). A global cognitive function score was obtained through neuropsychological tests. Product terms between depression and cognition were introduced in multivariable logistic regression models to test for interaction. Results Lower cognitive function and depression were both significantly associated with severe disability in all countries. A significant interaction was only found in Finland where the ORs (95% CIs) of depression for severe disability at the 25th (worse), 50th, and 75th (better) percentiles of cognitive function were 7.26 (4.28–12.32), 11.1 (6.7–18.38), and 17.56 (9.29–33.2), respectively. Conclusion People with depression and cognitive decline are likely to benefit from the usual evidence-based treatments to reduce the burden of disability. However, in Finland, those with better cognitive function may benefit from more aggressive depression treatment. Future research is warranted to assess whether our results may be replicated.

Background. Population ageing challenges health care systems due to the high prevalence and impact of multimorbidity in older adults. However, little is known about how chronic conditions present in certain multimorbidity patterns, which could have great impact on public health at several levels. The aim of our study was to identify and describe multimorbidity patterns in low-, middle-, and high-income countries. Methods. We analyzed data from the Collaborative Research on Ageing in Europe project (Finland, Poland, and Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, and South Africa). These cross-sectional studies obtained data from 41,909 noninstitutionalized adults older than 50 years. Exploratory factor analysis was performed to detect multimorbidity patterns. Additional adjusted binary logistic regressions were performed to identify associations between sociodemographic factors and multimorbidity. Results. Overall multimorbidity prevalence was high across countries. Hypertension, cataract, and arthritis were the most prevalent comorbid conditions. Two or three multimorbidity patterns were found per country. Several patterns were identified across several countries: "cardiorespiratory" (angina, asthma, and chronic obstructive pulmonary disease), "metabolic" (diabetes, obesity, and hypertension), and "mentalarticular" (arthritis and depression). Conclusions. A high prevalence of multimorbidity occurs in older adults across countries, with low-and middle-income countries gradually approaching the figures of richer countries. Certain multimorbidity patterns are present in several countries, which suggest that common underlying etiopathogenic factors may play a role. Deeper understanding of these patterns may lead to the development of preventive actions to diminish their prevalence and also give rise to new, comprehensive approaches for the management of these co-occurring conditions.

It is widely recognized that social networks and loneliness have effects on health. The present study assesses the differential association that the components of the social network and the subjective perception of loneliness have with health, and analyzes whether this association is different across different countries. Methods: A total of 10 800 adults were interviewed in Finland, Poland and Spain. Loneliness was assessed by means of the 3-item UCLA Loneliness Scale. Individuals' social networks were measured by asking about the number of members in the network, how often they had contacts with these members, and whether they had a close relationship. The differential association of loneliness and the components of the social network with health was assessed by means of hierarchical linear regression models, controlling for relevant covariates. Results: In all three countries, loneliness was the variable most strongly correlated with health after controlling for depression, age, and other covariates. Loneliness contributed more strongly to health than any component of the social network. The relationship between loneliness and health was stronger in Finland (|β| = 0.25) than in Poland (|β| = 0.16) and Spain (|β| = 0.18). Frequency of contact was the only component of the social network that was moderately correlated with health. Conclusions: Loneliness has a stronger association with health than the components of the social network. This association is similar in three different European countries with different socioeconomic and health characteristics and welfare systems. The importance of evaluating and screening feelings of loneliness in individuals with health problems should be taken into account. Further studies are needed in order to be able to confirm the associations found in the present study and infer causality, The research leading to these results has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement number 223071 (COURAGE in Europe), from the European Commission Horizon 2020 under grant number 635316 (ATHLOS), from the Instituto de Salud Carlos III-FIS research grant numbers PS09/00295, PS09/01845, PI12/01490 and PI13/00059, and from the Spanish Ministry of Science and Innovation ACI-Promociona (ACI2009-1010). Projects PI12/01490 and PI13/00059 have been co-funded by the European Union European Regional Development Fund (ERDF) “A Way to Build Europe”. Laura Rico is supported by the programme "Contratos predoctorales para Formación de Personal Investigador, FPI-UAM", Universidad Autónoma de Madrid, Spain. Marta Miret is grateful to the Spanish Ministry of Economy and Competitiveness for the postdoctoral fellowship (FPDI-2013-15793). Beatriz Olaya is part of the Sara Borrell postdoctoral programme (reference no. CD12/00429) supported by the Instituto de Salud Carlos III, Spain

INTRODUCTION: Venom allergy in children, as a potentially life-threatening disease, may have a considerable impact on the quality of life of the parents of the affected patients. AIM: To present development of the quality of life scale for such parents. MATERIAL AND METHODS: The study sample included 70 parents of children with a history of insect sting reaction, referred for consultations to the allergy centre of the University Children's Hospital of Krakow, Krakow, Poland, in 2000-2010. An initial pool of 56 items divided into 6 domains was prepared. The items with intercorrelations higher than 0.7 were removed from each domain and principal component analysis was conducted for each domain separately to provide a one-dimensional subscale for each domain. Reliability of the subscales was assessed using the Cronbach α coefficient in terms of the Classical Test Theory and with the rho coefficient in terms of the Item Response Theory. The multidimensionality of the scale was tested using multitrait scaling. RESULTS: Two to four items from each domain were selected to constitute five subscales. Both the rho and α coefficients for all the subscales were 0.75 or higher. The multitrait method showed that almost all the items indicated stronger correlations with their own subscale than with other subscales. Correlations between subscales were lower than 0.5. CONCLUSIONS: The presented scale consists of high validity and reliability subscales measuring the quality of life of parents of Hymenoptera venom allergic children. As their quality of life is strongly related to the health of their children, such information may be helpful in everyday clinical practice. Language: en

Background The aim of this study was to evaluate the association of sarcopenia and sarcopenic obesity with disability among older adults (≥ 65 years old) in nine high-, middle- and low-income countries from Asia, Africa, Europe, and Latin America. Methods Data were available for 53,289 people aged ≥ 18 years who participated in the Collaborative Research on Ageing in Europe (COURAGE) survey conducted in Finland, Poland, and Spain, and the WHO Study on global AGEing and adult health (SAGE) survey conducted in China, Ghana, India, Mexico, Russia, and South Africa, between 2007 and 2012. Skeletal muscle mass, skeletal muscle mass index, and percent body fat were calculated with specific population formulas. Sarcopenia and sarcopenic obesity were defined by specific cut-offs used in previous studies. Disability was assessed with the WHODAS 2.0 score (range 0–100) with higher scores corresponding to higher levels of disability. Multivariable linear regression analysis was conducted with disability as the outcome. Results The analytical sample consisted of 18,363 people (males; n = 8116, females; n = 10247) aged ≥ 65 years with mean (SD) age 72.9 (11.1) years. In the fully-adjusted overall analysis, sarcopenic obesity was associated with greater levels of disability [b-coefficient 3.01 (95% CI 1.14–4.88)]. In terms of country-wise analyses, sarcopenia was associated with higher WHODAS 2.0 scores in China [b-coefficient 4.56 (95% CI: 3.25–5.87)], Poland [b-coefficient 6.66 (95% CI: 2.17–11.14)], Russia [b-coefficient 5.60 (95% CI: 2.03–9.16)], and South Africa [b-coefficient 7.75 (95% CI: 1.56–13.94)]. Conclusions Prevention of muscle mass decline may contribute to reducing the global burden of disability.

BACKGROUND: Data on the association between chronic conditions or the number of chronic conditions and sleep problems in low- or middle-income countries is scarce, and global comparisons of these associations with high-income countries have not been conducted. METHODS: Data on 42116 individuals 50 years and older from nationally-representative samples of the Collaborative Research on Ageing in Europe (Finland, Poland, Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa) conducted between 2011-2012 and 2007-2010 respectively were analyzed. RESULTS: The association between nine chronic conditions (angina, arthritis, asthma, chronic lung disease, depression, diabetes, hypertension, obesity, and stroke) and self-reported severe/extreme sleep problems in the past 30 days was estimated by logistic regression with multiple variables. The age-adjusted prevalence of sleep problems ranged from 2.8% (China) to 17.0% (Poland). After adjustment for confounders, angina (OR 1.75-2.78), arthritis (OR 1.39-2.46), and depression (OR 1.75-5.12) were significantly associated with sleep problems in the majority or all of the countries. Sleep problems were also significantly associated with: asthma in Finland, Spain, and India; chronic lung disease in Poland, Spain, Ghana, and South Africa; diabetes in India; and stroke in China, Ghana, and India. A linear dose-dependent relationship between the number of chronic conditions and sleep problems was observed in all countries. Compared to no chronic conditions, the OR (95%CI) for 1,2,3, and ≥ 4 chronic conditions was 1.41 (1.09-1.82), 2.55 (1.99-3.27), 3.22 (2.52-4.11), and 7.62 (5.88-9.87) respectively in the overall sample. CONCLUSIONS: Identifying co-existing sleep problems among patients with chronic conditions and treating them simultaneously may lead to better treatment outcome. Clinicians should be aware of the high risk for sleep problems among patients with multimorbidity. Future studies are needed to elucidate the best treatment options for comorbid sleep problems especially in developing country settings.

The aim of the study was to evaluate the association between various factors and diabetes type II (DM) with a particular emphasis on indicators of central obesity, and to compare the effect of DM on disability among elder populations (≥ 50 years old) in nine countries. Data were available for 52,946 people aged ≥ 18 years who participated in the WHO Study on global AGEing and adult health and the Collaborative Research on Ageing in Europe studies conducted between 2007 and 2012. DM was defined as self-report of physician diagnosis. Height, weight, and waist circumference were measured. Disability status was assessed with the WHODAS II questionnaire. The overall prevalence of DM was 7.9% and ranged from 3.8% (Ghana) to 17.6% (Mexico). A 10 cm increase in waist circumference and waist-to-height ratio of >0.5 were associated with a significant 1.26 (India) to 1.77 (Finland), and 1.68 (China, Spain) to 5.40 (Finland) times higher odds for DM respectively. No significant associations were observed in Mexico and South Africa. DM was associated with significantly higher disability status in all countries except Mexico in the model adjusted for demographics and smoking. The inclusion of chronic conditions associated with diabetes in the model attenuated the coefficients in varying degrees depending on the country. A considerable proportion of the studied older population had DM. Central obesity may be a key factor for the prevention of DM among older populations globally. Prevention of DM especially among the older population globally may contribute to reducing the burden of disability.

BACKGROUND: Continuous population aging has raised international policy interest in promoting active aging (AA). AA theoretical models have been defined from a biomedical or a psychosocial perspective. These models may be expanded including components suggested by lay individuals. This paper aims to study the correlates of AA in three European countries, namely, Spain, Poland, and Finland using four different definitions of AA. METHODS: The EU COURAGE in Europe project was a cross-sectional general adult population survey conducted in a representative sample of the noninstitutionalized population of Finland, Poland, and Spain. Participants (10,800) lived in the community. This analysis focuses on individuals aged 50 years old and over (7,987). Four definitions (two biomedical, one psychosocial, and a complete definition including biomedical, psychosocial, and external variables) of AA were analyzed. RESULTS: Differences in AA were found for country, age, education, and occupation. Finland scored consistently the highest in AA followed by Spain and Poland. Younger age was associated with higher AA. Higher education and occupation was associated with AA. Being married or cohabiting was associated with better AA compared to being widowed or separated in most definitions. Gender and urbanicity were not associated with AA, with few exceptions. Men scored higher in AA only in Spain, whereas there was no gender association in the other two countries. Being widowed was only associated with lower AA in Poland and not being married was associated with lower AA in Poland and Finland but not Spain./nCONCLUSIONS: Associations with education, marital status, and occupation suggest that these factors are the most important components of AA. These association patterns, however, seem to vary across the three countries. Actions to promote AA in these countries may be addressed at reducing inequalities in occupation and education or directly tackling the components of AA lacking in each country. The research leading to these results has received funding from the European Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement number 223071 (COURAGE in Europe), from the Instituto de Salud Carlos III-FIS research grant number PS09/01845 and PS09/00295 and from the Spanish Ministry of Science and Innovation ACI-Promociona (ACI2009-1010). The study was supported by the Centro de Investigación Biomédica Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III and Recercaixa 2011. J.P. is grateful to the Instituto de Salud Carlos III for a predoctoral grant (PFIS)

The aim of the study was to assess the relation between health-related beliefs concerning the importance of risk factors in stomach cancer and positive health practices in eating habits. A multicentre hospital-based incident case-control study with 431 female stomach cancer cases aged less than 75 years and an equal number of age-matched controls without cancer has been carried out in Poland. The respondents were asked about their opinions on relevance in cancer prevention of such factors as protective role of raw vegetables and fresh fruit, consumption of fats, alcohol and coffee or using table salt. The data were compared with information on eating habits and diet behaviours in the reference group. It was shown in both groups that beliefs about the importance of raw vegetables and fresh fruit were closely associated with high frequency of everyday consumption of vegetables and fruit; however, statistically significant differences were found between cases and controls as regards the frequency of eating vegetables and fresh fruit at every meal. The same relation was observed between the belief in an unhealthy role of consumption of fats and using the animal fat in cooking. Univariate and multivariate analysis showed that a relation between beliefs and behaviours existed in the cases with the same demographic and social determinants.

Background The results from previous studies have described a significant relationship between pulmonary function and all-cause mortality. It has been suggested that observed association may be explained by smoking status. In addition, the period over which pulmonary function remains a predictor of mortality is unknown. The aim of this study was to investigate the predictive value of pulmonary function during the 25-year follow-up among Krakow older citizens with the relation to the gender, smoking status and respiratory health. Methods The …

Violence against older people remains a taboo topic in Poland, and is still an under-recognized phenomenon. The aim of this study was to examine the risk of different types of domestic violence in older people in relation to their health-related quality of life as measured by chronic conditions, functional limitations, psychological well-being, depressive symptoms and feelings of social isolation. A cross-sectional study using a standardized questionnaire in a simple random sample of 518 older citizens of Krakow was carried out. A multidimensional logistic regression of data showed that such factors as poor assessment of psychological health, number of chronic conditions, suffering from emotional and social loneliness and lack of social support in everyday life significantly increased the risk of being a victim of domestic violence in older citizens of Krakow.

Health-related quality of life in cardiovascular patients - Libros de Medicina - Sistema Cardiovascular - 103,95

Background The aim of this study was to assess the change in the predictive ability of gender-related 20-year all-cause mortality in community-dwelling older people. Methods The baseline investigation was conducted in 1986–1987 and survival of 2472 subjects aged 65 years and older was followed up for 20 years. The associations of socioeconomic conditions and health measures with mortality were assessed using Cox hazard model with time-dependent covariates. Results Our study confirmed that higher education and being employed during the baseline were protective factors in males, but not among females. Healthy lifestyle was a predictive factor for all-cause mortality for both men and women and its predictive value was strong over the whole observation period. The study showed that poor self-rated health (SRH) was a valid predictor of mortality in elderly women, but not in men, and the effect of the length of follow-up on mortality was not observed. Overall, different sets of all-cause mortality predictors were found for men and women. For men the role of socioeconomic status factors was confirmed as well as healthy lifestyle and presence of chronic conditions, especially coronary heart disease (CHD) and asthma. For women the most important predictors were lifestyle factors and the feeling of life-weariness as well as SRH and diabetes mellitus present during the baseline study. Conclusions The impact of most of the examined factors on mortality was found to be stable over the twenty years of observation with the exception of the self-reported CHD, whose predictive value decreased over time.

Introduction: Venom allergy, though rare, may seriously influence health-relat - ed quality of life (HRQoL). There is a paucity of research on HRQoL of adoles - cents and young adults with Hymenoptera venom allergy. The aim was to assess the level of HRQoL and to evaluate its independent predictors in Polish ado - lescents and young adults treated with venom immunotherapy. Material and methods: A multicenter cross-sectional study based on the Vespid Allergy Quality of Life Questionnaire (VQLQ) adapted for Polish adolescents was used. The study sample included 87 patients (14-21 years) studied at different stages of venom immunotherapy (VIT). Statistical analysis was done with mul - tivariate linear regression. Results: Anxiety level was higher in patients with 4 th grade of Mueller's classi - fication (anaphylactic shock) than in those with 3 rd grade ( B = 0.84, 95% CI = 0.07-1.61, p = 0.03). Caution increased along with an increase of anxiety of ado - lescents treated with VIT ( B = 0.54, 95% CI = 0.39-0.68, p < 0.01). Level of lim - itations increased with increasing caution of adolescents ( B = 0.63, 95% CI = 0.35-0.91, p < 0.01). Discomfort increased along with a rise of caution of patients (B = 0.38, 95% CI = 0.22-0.55, p < 0.01). Similarly, it increased with an increase of their feeling of limitations ( B = 0.37, 95% CI = 0.23-0.51, p < 0.01). The level of discomfort in adolescents treated with VIT was lower in those who were treat - ed with conventional protocol in comparison to those treated with rush or ultra- rush ones ( B = -0.47, 95% CI = -0.90 - -0.03, p = 0.04). Conclusions: Severity of anaphylactic reaction is an independent determinant of anxiety level in adolescents treated with VIT. The VIT protocol affects HRQoL of treated patients.

The objective of the study undertaken among the elderly was to assess the strength and importance of health variable predictors (ventilatory lung function, blood pressure) in comparison with that of sociodemograhic variables (age, sex, education), smoking habit, obesity and health self-assessment. The study covered a sample of elderly inhabitants of Cracow (698 males and 1211 females) who attended the mass screening X-ray clinic. The sample examined did not include patients of old people's homes or geriatric wards. Statistical analysis of the relation between mortality over a 5-year period and chosen predictors was carried out with Cox proportional hazards model. It was found that besides age, forced expiratory volume in 1 s (FEV 1 ) level is the strongest survival predictor among the elderly. Subjects who had better FEV 1 by 500 ml showed significantly lower death risk, by 18% in males and 27% in females after allowing for age and height. The results obtained confirmed the expectation that ventilatory lung function is one of the strongest predictors of survival in the elderly. In the sample studied, the impact of education, smoking habit, obesity, health self-assessment on mortality was not significant. The effect of hypertension appeared to be relevant only in the female group.

Heath related quality of life has been an important object of interest in the clinical practice, focused on assessment of treatment effects from patient's point of view, with particular emphasis placed on effect of treatment on daily patient functioning. Concept of health-related quality of life needs valid and reliable instruments.The aim of the study was to present the process of validation of a new version of EORTC QLQ-CR29 module in Polish patients suffering from rectal cancer.Material and methods. EORTC QLQ-CR29 module comprises 29 questions, and was adapted to Polish cultural conditions based on EORTC procedure. Data collected from 20 patients were analyzed, their agreement with theoretical and empirical structure was assessed. Convergent and discriminant validity were analyzed with multi trait scaling.Reliability was assessed with Cronbach alpha coefficient. Known group validity was assessed in terms of differences between men and women, and between stoma and non-stoma patients. Exact Mann-Whitney test was used. P values lower than 0.05 were considered significant.Results. Scales built on bases of empirical model of module had higher validity and reliability than those based on theoretical model.There were no significant differences between men and women in health-related quality of life. Significantly higher values were observed in non-stoma patients on body image scale and for leakage of stool item. Reversed relationship was observed in case of abdominal and buttocks pain, as well as embarrassment because of bowel movements.Conclusions. Module CR29 is a valid and reliable tool, which enables standardized measurement of treatment effects, suggested for use as main tool measuring impact of disease itself and applied treatment on health-related quality of life of rectal cancer patients.

A multicentre hospital-based incident case-control study with 520 male gastric cancer cases aged < 75 years and an equal number of age- and sex-matched controls without cancer has been carried out in Poland to assess potential risks due to smoking and alcohol consumption. It was shown that after adjusting for socio-demographic and dietary confounders and vodka drinking, smoking cigarettes had no significant effect on risk. The estimated relative risk (RR) increased to 2.27 (95% confidence interval [CI] : 0.97-5.28) for intestinal cardia cancer for those who smoked cigarettes without filters. The RR for stomach cancer grew as the frequency and amount of vodka drunk increased. People drinking vodka at least once a week had about a threefold higher risk compared to non-drinkers (RR = 3.06, 95% CI : 1.90-4.95). The effect of vodka drinking on risk was particularly strong for non-cardia cancers of the intestinal type. Those who usually drank vodka before breakfast had an elevated risk (RR = 2.98, 95% CI : 1.60-5.53) which was also present in all the subgroups investigated. Cardia and non-cardia cancer showed differences with respect to the interaction between tobacco smoking and vodka drinking. For cancers of the cardia region the risk was low for non-smokers or those who drank small amounts of vodka. The risk for cardia cancer increased considerably for smokers of cigarettes without filters and vodka drinkers who consumed large amounts (RR = 3.70, 95% CI : 1.13-12.06). For the non-cardia region a uniform increase could be observed for vodka drinking regardless of cigarette smoking status.(ABSTRACT TRUNCATED AT 250 WORDS)

Introduction Venom immunotherapy (VIT) practice is the definitive treatment for patients with potentially fatal allergic reactions to Hymenoptera stings. The aim is assesing compliance of VIT practice in Poland with the current European Academy of Allergy and Clinical Immunology (EAACI) guidance. Material and methods A multicentre study was carried out using a structured questionnaire which was sent by post to all VIT practitioners in Poland. Some questionnaire items were altered, in comparison to original version by adding additional answer options or alowing multiple answer option. The response rate was 100%. The obtained results were compared with the published EAACI guidelines. Results Twenty-six Polish centres took part in the survey. SSIgE and skin prick tests (SPT) are together used as the first line of investigation, whereas confirmatory intradermal tests (IDT) are applied in half of centres. Only a few centres measure baseline serum tryptase levels. The ultra-rush protocol is preferred. Antihistamine pre-medication is routinely practiced. A target dose equal to 100 µg is used in most centres. A 6-week interval between booster doses is the most frequent. Five years is considered as an optimal VIT duration. Before the VIT completion, SSIgE is evaluated in fifty percent of centres, whereas sting challenge is considered by half of responders. Conclusions There are some differences between current practice in Poland and the EAACI recommendations, indicating areas requiring better compliance. Comparision between Poland and the United Kingdom revealed that health service organization and health care funding may play a major role in the provision of allergy services. This may affect the extent to which international guidance may be applied in individual countries. It is worth considering conducting the same survey in other European countries.

Still in its early stages, much work remains to be done in terms of the health promotion of older people in Poland. The aim of this paper is to present the current state of health promotion in older people in Poland on the basis of research conducted within the framework of the healthPROelderly project, presenting the state of health promotion in older people after 1989, and to provide practical recommendations for future interventions. (1) Content analysis of scientific and popular publications; (2) document analysis of policy papers; (3) review of existing Polish health promotion programs; (4) program case studies; (5) SWOT analysis of the state of health promotion in Poland. In the past 10 years, in terms of planning and realization, efforts aimed at health promotion in older people were only sporadically realized. There were no macrostructural programs targeting this age group nor was this an element of national health policy. Only a small number of health promotion programs targeting older people were found. There should be a renewed focus on health promotion, as opposed to preventing disease. Health promotion campaigns should target those with a decreased awareness of their health needs, with improvement in health status being based on increasing this awareness. In an effort to develop more health-conscious attitudes and behaviors in older age, health promotion initiatives should also be marketed to pre-retirement aged individuals.

SuMMAry The aim of this 17-year Cracow (Poland) study was to examine and identify the determinants most responsible for the relationship between self-rated health and mortality in non-institutionalized elderly people. Base-line data were collected in a simple random sample of 2,605 Cracow residents, aged 65 years and over. The vital status of all individuals under study was established by monitoring city records. Death certificates were obtained for the deceased and coded according to the underlying cause of death. Predictors related to self-rated health, developed using the results of principal component analysis, were modelled on three indexes: individual predisposition (to disease based on family history), caring about health in the past, and attitudes toward health. Cox multivariate analysis confirmed the significant role of self-rated health in the mortality patterns of women (HR = 1.18). Those who cared greatly about health in the past had a lower mortality risk than those who cared poorly (HR = 1.19). In men, a positive attitude towards health remained an independent predictor of mortality (HR = 1.20). Multivariate regression models found self-rated health to be a significant independent predictor of mortality only in women with a low level of individual predisposition (hazard ratio for self-rated health = 1.35) and in those with a positive attitude towards health (hazard ratio for self-rated health = 1.16).

The purpose of this study was to evaluate the functional status of the lower extremities (FSL) of elderly males from the community and to compare it with the self-assessment of health status (SHS) and ventilatory lung function based on measurement of forced expiratory vital capacity (FVC). The material covered a group of 559 males, age 65–89 years, who are residents of Krakow. The FSL was measured by the length of standing time on one leg (ST). There was a very strong declining trend in the ST with age in the elderly. The ST correlated significantly inversely with age ( r = −0.32) and positively with FVC ( r = 0.29). The FSL was also associated strongly with the SHS score, while body-mass index (BMI) and occupational category (OC) appeared to have insignificant effect. The results of the study suggest that the ST may be used as a crude indicator of the general fitness of the elderly.

Objectives: Many studies have analyzed the impact of socioeconomic factors and working conditions on health inequalities in working age adults. However, fewer reports focused on older age workers. The aim of this longitudinal study was to assess the influence of education, occupational status, and health-related behavior on mortality patterns in older age. Methods: Data for analysis derive from a study performed in 1986–1987 on a population sample of 2580 individuals (1703 women and 877 men) randomly selected from 8055 persons aged over 65 years who were residents of the Old Town area in Krakow, Poland. A face-to-face interview was conducted using a structured questionnaire regarding education, occupational status, profession, importance attached to work and other life values, early retirement/disability pension due to health condition as well as sociodemographic data and medical history. Mortality data compiled from death records for a 17-year period of time were analyzed. Cox multivariate proportional hazard models were used to analyze independent predictors and estimate mortality risk. Results: This risk tended to significantly increase with a decreasing level of education. For males with higher education, caring for one’s health in the past was the factor that significantly contributed to increased mortality risk. Conclusions: Working conditions were found to have a significant influence on mortality risk in older age. Different patterns of mortality risk were noted for men and women.

Introduction Epidemiological studies performed in the last decades confirmed the significant role of sleep as an independent predictor of survival in older age. Objective The aim of the study was to assess the role of the social position, self-reported functional status, self-rated health, and a feeling of life-weariness as risk factors of sleep duration, and to evaluate how the relationship between sleep duration and these psychosocial factors influences the risk of death. Methods Baseline study using a structured questionnaire was performed in 1986/1987 on a random sample (n=2605) of older people aged 65 years and over, community-dwelling citizens of Krakow. Vital status was monitored over 22 years. The analysis was performed using logistic regression and Cox hazard models. Results The mean observation period of the cohort was 11.5 years, for a total of 29 951 person-years. 1341 deaths in women and 771 in men were recorded. Strong feeling of life-weariness was found as predictor of short sleep in both genders. Poor self-rated health in women and both low functional activity and low level of education in men was associated with a long sleep. Analysis showed increased risk of death in men who slept Conclusions Results suggest that sleeping patterns in elders depending on several psychosocial conditions influence the mortality patterns in older age.

Longitudinal studies among elderly are concentrated on finding the predictors of mortality. Still, there is an open question if those predictors are stable over different observation periods or if they are changing. The aim of our study was to assess the change in gender-related predictors of mortality over 20 years of follow-up. Baseline data for this analysis come from epidemiological study of 2472 elderly residents of Krakow (age 65+) conducted in years 1986–1987. The multivariate Cox proportional hazard model was used to assess the changes of the role of predictors over of 20 years. In the male group, we have observed that the effect of coronary heart disease and diabetes mellitus on mortality were decreased with time. The importance of asthma as predictor of death was growing from 1.07 to 1.40 for the full follow-up. In the female group, protective effect of care about health and high functional activity were observed, however their impact decreased with increase of length of follow-up period. Poor SRH increase the mortality risk by 46% during the 5 years period and it decreased to 24% for 20 years of follow-up. Out of analysed chronic diseases the strongest predictor of mortality was diabetes mellitus with the over 60% increased mortality risk. We were able to show that the prognostic value of care about own health and healthy life-style, and high functional activity for women as well as chronic conditions present during the baseline study for men were changing with the length of observation.