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Socioeconomic status (SES) relates to life satisfaction in old age, although the underlying mechanisms remain unclear. Health and subjective social status have shown to be related to both SES and life satisfaction. This study aims to test the mediating role of health and subjective social status in old age, and to analyze if these potential mediations vary among three European countries with different socioeconomic characteristics and welfare regimes. The sample comprised 7,272 participants aged 50+ from COURAGE in Europe study, a household survey carried out in 2011–2012 on nationally representative samples from Finland, Poland, and Spain. A Multiple Indicators, Multiple Causes approach based on multi-group Structural Equation Modeling was implemented to test mediating effects. The structural invariance model showed an adequate fit (CFI = 0.971, RMSEA = 0.061). Health and subjective social status invariantly mediated the relationship between SES and life satisfaction across countries with different socioeconomic characteristics and welfare regimes. SES direct effects explained 0.83–0.85% of life satisfaction variance, whilst indirect effects explained 2.29–2.36% of life satisfaction variance via health, 3.30–3.42% via subjective social status, and 0.06% via both mediating variables. Policies aimed at increasing the SES of the older adults may entail multiple benefits, resulting in better subjective social status, health, and life satisfaction outcomes, thus fostering healthy aging of the population. [ABSTRACT FROM AUTHOR]

Background: There is a global demand for rehabilitation services but to date little attention has been paid to rehabilitation as part of the health agenda, especially in low- and middle-income countries. The objective of the scoping review was to get an overview of the needs and unmet needs for rehabilitation services described in the literature. Materials and methods: Electronic search was performed in PubMed and REHABDATA for studies published between 2000 and 2017. Results: Eighty-six articles met the inclusion criteria. Results revealed a profound need for rehabilitation among different user groups with non-communicable diseases and injuries across countries. However, this need considerably outstripped the provision of services, which left many people with substantial unmet needs for rehabilitation. The main reasons for the unmet needs for rehabilitation were the absence of or unequal geographical distribution of services within a country, lack of transportation, and unaffordability of the services. Conclusions: There are substantial unmet needs for rehabilitation and numerous barriers to accessing services. Efforts need to focus on building the capacity for rehabilitation research predominantly in low- and middle-income countries. The comprehensive data that this review provides is useful for raising awareness for the need of rehabilitation at policy level. There is a profound need for rehabilitation services due to the ageing population and growing prevalence of non-communicable diseases. This scoping review shows that the need for rehabilitation considerably outstrips the provision of services. There are substantial unmet needs for rehabilitation and numerous barriers to accessing services. Concerted global action to scale up quality rehabilitation services is needed, especially in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Purpose: Developing valid and reliable instruments that can be used across countries is necessary. The present study aimed to test the comparability of quality of life scores across three European countries (Finland, Poland, and Spain).Method: Data from 9987 participants interviewed between 2011 and 2012 were employed, using nationally representative samples from the Collaborative Research on Ageing in Europe project. The WHOQOL-AGE questionnaire is a 13-item test and was employed to assess the quality of life in the three considered countries. First of all, two models (a bifactor model and a two-correlated factor model) were proposed and tested in each country by means of confirmatory factor models. Second, measurement invariance across the three countries was tested using multi-group confirmatory factor analysis for that model which showed the best fit. Finally, differences in latent mean scores across countries were analyzed.Results: The results indicated that the bifactor model showed more satisfactory goodness-of-fit indices than the two-correlated factor model and that the WHOQOL-AGE questionnaire is a partially scalar invariant instrument (only two items do not meet scalar invariance). Quality of life scores were higher in Finland (considered as the reference category: mean = 0, SD = 1) than in Spain (mean = - 0.547, SD = 1.22) and Poland (mean = - 0.927, SD = 1.26).Conclusions: Respondents from Finland, Poland, and Spain attribute the same meaning to the latent construct studied, and differences across countries can be due to actual differences in quality of life. According to the results, the comparability across the different considered samples is supported and the WHOQOL-AGE showed an adequate validity in terms of cross-country validation. Caution should be exercised with the two items which did not meet scalar invariance, as potential indicator of differential item functioning. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: Gender-related differences in life expectancy, prevalence of chronic conditions and level of disability in the process of ageing have been broadly described. Less is known about social determinants, which may have different impacts on quality of life in men and women. The investigation aims to reveal gender-related differences in social determinants on quality of life assessed by a multi-pathway model including health, social, demographic and living place characteristics.Methods: The study group consisted of 5099 participants aged 50+ representing general populations of three different European regions (Finland, Poland, Spain) who participated in COURAGE in EUROPE Project. Standardized tools were used to measure quality of life (WHOQOL-AGE) and social determinants (COURAGE Social Network Index, OSLO-3 Social Support Scale, UCLA Loneliness Scale, participation scale and trust). A multipath model considering exogenous predictors (demographic, economic), mediators (social) and endogenous outcome (QOL) was created to reveal the role of determinants. Gender-related differences were investigated across three age categories: 50-64; 65-79 and 80+.Results: The model (RMSEA = 0.058; CFI = 0.939) showed the effects of all of the investigated determinants. Gender-related differences in the association between social constructs and QOL were observed for social networks in the group of 80+, for social support in the group of 50-64 and 65-79 years, and for social participation in the group of 65-79 years. Males benefited more (in QOL) from social networks and social support, and women from social participation.Conclusions: The research provides valuable knowledge about the role of social determinants in QOL considering complex relations between different social constructs. Additionally, the results showed gender-related differences in the associations between social networks, social support, social participation and QOL, suggesting that men might benefit more from the interventions in the first two. Although our research did not investigate the effects of interventions, the results show directions for future investigations, how to shape social interventions at the population level to improve quality of life of older adults, and thus help achieve successful ageing. [ABSTRACT FROM AUTHOR]

Given the growing interest in the study of subjective well-being as a measure of social progress, instruments that produce valid and reliable scores and that can be used within and across countries are needed. The aim of the present study was to analyze the measurement equivalence of the Day Reconstruction Method in its brief version, using nationally representative samples from Finland, Poland, and Spain obtained within the COURAGE in Europe project. The goodness-of-fit of a two-correlated-factors model and the reliability of the scores obtained were assessed. Cross-country invariance was tested employing a multiple group confirmatory factor analysis, through sequential constraint imposition. In each country, measurement invariance was tested across time frames (morning, afternoon and evening) and days of the week (weekday and weekend). The results found support for the hypothesis of a two-correlated-factors (positive and negative affect) structure; the reliability of the positive, the negative and the net affect scores showed appropriate values. A high equivalence across the three national samples was found: all items except one showed strong measurement invariance indicating that respondents from Finland, Poland, and Spain attribute the same meaning to the latent construct under study, and the levels of the underlying items are equal in all three countries. Similar results were found for the measurement equivalence across time frames and days of the week. Our findings support the assumption of comparability across the different samples considered; in general, higher positive affect and lower negative affect were found in Finland, in the evening and at the weekend. [ABSTRACT FROM AUTHOR]

COURAGE in Europe was a 3-year project involving 12 partners from four European countries and the World Health Organization. It was inspired by the pressing need to integrate international studies on disability and ageing in light of an innovative perspective based on a validated data-collection protocol. COURAGE in Europe Project collected data on the determinants of health and disability in an ageing population, with specific tools for the evaluation of the role of the built environment and social networks on health, disability, quality of life and well-being. The main survey was conducted by partners in Finland, Poland and Spain where the survey has been administered to a sample of 10 800 persons, which was completed in March 2012. The newly developed and validated COURAGE Protocol for Ageing Studies has proven to be a valid tool for collecting comparable data in ageing population, and the COURAGE in Europe Project has created valid and reliable scientific evidence, demonstrating cross-country comparability, for disability and ageing research and policy development. It is therefore recommended that future studies exploring determinants of health and disability in ageing use the COURAGE-derived methodology. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message COURAGE in Europe Project collected data on the determinants of health and disability in an ageing population, with specific tools for the evaluation of the role of built environment and social networks on health, disability quality of life and well-being., The COURAGE Protocol for Ageing Studies has proven to be a valid tool for collecting comparable data in the ageing population., The COURAGE in Europe Consortium recommends that future studies exploring determinants of health and disability in ageing use COURAGE-derived methodology. [ABSTRACT FROM AUTHOR]

We use the method of deficit accumulation to describe prevalent and incident levels of frailty in community-dwelling older persons and compare prevalence rates in higher income countries in Europe, to prevalence rates in six lower income countries. Two multi-country data collection efforts, SHARE and SAGE, provide nationally representative samples of adults aged 50 years and older. Forty items were used to construct the frailty index in each data set. Our study shows that the level of frailty was distributed along the socioeconomic gradient in both higher and lower income countries such that those individuals with less education and income were more likely to be frail. Frailty increased with age and women were more likely to be frail in most countries. Across samples we find that the level of frailty was higher in the higher income countries than in the lower income countries. [ABSTRACT FROM AUTHOR]

Background: The WHODAS-2 is a disability assessment instrument based on the conceptual framework of the International Classification of Functioning, Disability, and Health (ICF). It provides a global measure of disability and 7 domain-specific scores. The aim of this study was to assess WHODAS-2 conceptual model and metric properties in a set of chronic and prevalent clinical conditions accounting for a wide scope of disability in Europe. Methods: 1,119 patients with one of 13 chronic conditions were recruited in 7 European centres. Participants were clinically evaluated and administered the WHODAS-2 and the SF-36 at baseline, 6 weeks and 3 months of follow-up. The latent structure was explored and confirmed by factor analysis (FA). Reliability was assessed in terms of internal consistency (Cronbach's alpha) and reproducibility (intra-class correlation coefficients, ICC). Construct validity was evaluated by correlating the WHODAS-2 and SF-36 domains, and comparing known groups based on the clinicalseverity and work status. Effect size (ES) coefficient was used to assess responsiveness. To assess reproducibility and responsiveness, subsamples of stable (at 6 weeks) and improved (after 3 moths) patients were defined, respectively, according to changes in their clinical-severity. Results: The satisfactory FA goodness of fit indexes confirmed a second order factor structure with 7 dimensions, and a global score for the WHODAS-2. Cronbach's alpha ranged from 0.77 (self care) to 0.98 (life activities: work or school), and the ICC was lower, but achieved the recommended standard of 0.7 for four domains. Correlations between global WHODAS-2 score and the different domains of the SF-36 ranged from -0.29 to -0.65. Most of the WHODAS-2 scores showed statistically significant differences among clinical-severity groups for all pathologies, and between working patients and those not working due to ill health (p < 0.001). Among the subsample of patients who had improved, responsiveness coefficients were small to moderate (ES = 0.3-0.7), but higher than those of the SF-36. Conclusions: The latent structure originally designed by WHODAS-2 developers has been confirmed for the first time, and it has shown good metric properties in clinic and rehabilitation samples. Therefore, considerable support is provided to the WHODAS-2 utilization as an international instrument to measure disability based on the ICF model. [ABSTRACT FROM AUTHOR]

MHADIE project (Measuring Health and Disability in Europe: Supporting policy development) aimed at developing realistic, evidence-based and effective national policies for persons with disabilities. A preliminary step towards this goal was the demonstration on the feasibility of employing the ICF in clinical, educational and statistical fields, which corresponds to the recognised need to enhance the European Union's capacity of analysis of disability, as highlighted in its Disability Action Plan 2006-2007. The ultimate outcome of the project is the production of 13 policy recommendations, dealing with statistics clinical and educational areas, and four general policy recommendations focusing on: (a) the need of coordinating and integrating disability conceptualisation at all policy levels and across sectors; (b) the need of conducing longitudinal cohort studies which include children aged 0-6; (c) the need of reviewing transportation policies in light of the requirements of persons with disabilities; (d) the need of reviewing all disability policies to emphasise and support the role of the family, which is a consistent and substantial environmental facilitator in the lives of persons with disabilities. [ABSTRACT FROM AUTHOR]

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 of 52,150 community-dwelling adults who completed the adapted version of the Composite International Diagnostic Interview-Depression Module were included from SAGE and COURAGE in Europe studies. The presence of 12-month suicide ideation and attempts was measured among the participants who screened positively in the Depression Module. Global and national prevalence estimates of 12-month suicide ideation and attempts were calculated according to the total sample. Logistic regression analyses were conducted to separately determine factors associated with suicidal ideation and with suicide attempts in young-and-middle age adults and older adults. Results: Higher estimates of 12-month suicidal ideation were found for high-income countries and people aged 65 years and older. Higher negative affect, higher disability, and presence of food insecurity were associated with 12-month suicidal ideation and suicide attempts for young-and-middle-adults and older adults. Higher isolation, being female, and greater number of chronic health conditions were also related to 12-month suicidal ideation in both age groups. Younger age was associated with 12-month suicidal ideation for older people, and with suicide attempts in the young-and-middle age group. Finally, higher income was related to lower rates of 12-month suicidal ideation for the young-and-middle age group. Conclusions: Older people are at increased risk of suicidal ideation globally and of suicide attempts in some countries. There were common and different factors related to suicide in adults and older adults.

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.

Depression and loneliness act in a synergistic way among older adults. We tested two indicators of the perceived neighborhood built environment (BE) as moderators of the association between these conditions in older European adults. Positive perceptions of neighborhood BE were related to lower levels of loneliness but not to major depressive disorder (MDD). Reporting low BE usability was significantly related to a higher likelihood of feeling lonely except for those suffering from MDD, whereas reporting low BE walkability was significantly related with a high likelihood of loneliness particularly among those with MDD. Therefore, improving neighborhood BE and, specifically, its walkability, might result in a reduction in the prevalence of loneliness., Competing Interests: Declaration of competing interest The authors declare that they have no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

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., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background : Research addressing the impact of a large number of factors on unemployment is scarce. We aimed to comprehensively identify factors related to unemployment in a sample of persons aged 18-64 from Finland, Poland and Spain. Methods : In this cross-sectional study, factors from different areas were considered: socio-demographic indicators, health habits, chronic conditions, health state markers, vision and hearing indicators, and social networks and built environment scores. Results : Complete data were available for 5003 participants, mean age 48.1 (SD 11.5), 45.4% males. The most important factors connected to unemployment were health status indicators such as physical disability (OR = 2.944), self-rated health (OR = 2.629), inpatient care (OR = 1.980), and difficulties with getting to the toilet (OR = 2.040), while the most relevant factor related to employment were moderate alcohol consumption (OR = 0.732 for non-heavy drinkers; OR = 0.573 for infrequent heavy drinkers), and being married (OR = 0.734), or having been married (OR = 0.584). Other factors that played a significant role included presence of depression (OR = 1.384) and difficulties with near vision (OR = 1.584) and conversation hearing (OR = 1.597). Conclusions : Our results highlight the importance of selected factors related to unemployment, and suggest public health indications that could support concrete actions on modifiable factors, such as those aimed to promote physical activity and healthy behaviors, tackling depression or promoting education, in particular for the younger., Competing Interests: The authors declare no conflict of interest. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results. The views expressed in this paper are those of the authors, and do not necessarily represent the views or policies of the World Health Organization.

Background: Persons with brain disorders experience significant psychosocial difficulties (PSD) in daily life, e.g. problems with managing daily routine or emotional lability, and the level of the PSD depends on social, physical and political environments, and psychologic-personal determinants. Our objective is to determine a brief set of environmental and psychologic-personal factors that are shared determinants of PSD among persons with different brain disorders., Methods: Cross-sectional study, convenience sample of persons with either dementia, stroke, multiple sclerosis, epilepsy, migraine, depression, schizophrenia, substance dependence or Parkinson's disease. Random forest regression and classical linear regression were used in the analyses., Results: 722 subjects were interviewed in four European countries. The brief set of determinants encompasses presence of comorbidities, health status appraisal, stressful life events, personality changes, adaptation, self-esteem, self-worth, built environment, weather, and health problems in the family., Conclusions: The identified brief set of common determinants of PSD can be used to support the implementation of cross-cutting interventions, social actions and policy tools to lower PSD experienced by persons with brain disorders. This set complements a recently proposed reliable and valid direct metric of PSD for brain disorders called PARADISE24.

Objective: To test the hypothesis of 'horizontal epidemiology', i.e. that psychosocial difficulties (PSDs), such as sleep disturbances, emotional instability and difficulties in personal interactions, and their environmental determinants are experienced in common across neurological and psychiatric disorders, together called brain disorders., Study Design: A multi-method study involving systematic literature reviews, content analysis of patient-reported outcomes and outcome instruments, clinical input and a qualitative study was carried out to generate a pool of PSD and environmental determinants relevant for nine different brain disorders, namely epilepsy, migraine, multiple sclerosis, Parkinson's disease, stroke, dementia, depression, schizophrenia and substance dependency. Information from these sources was harmonized and compiled, and after feedback from external experts, a data collection protocol including PSD and determinants common across these nine disorders was developed. This protocol was implemented as an interview in a cross-sectional study including a convenience sample of persons with one of the nine brain disorders. PSDs endorsed by at least 25% of patients with a brain disorder were considered associated with the disorder. PSD were considered common across disorders if associated to 5 out of the 9 brain disorders and if among the 5 both neurological and psychiatric conditions were represented., Setting: The data collection protocol with 64 PSDs and 20 determinants was used to collect data from a convenience sample of 722 persons in four specialized health care facilities in Europe., Results: 57 of the PSDs and 16 of the determinants included in the protocol were found to be experienced across brain disorders., Conclusion: This is the first evidence that supports the hypothesis of horizontal epidemiology in brain disorders. This result challenges the brain disorder-specific or vertical approach in which clinical and epidemiological research about psychosocial difficulties experienced in daily life is commonly carried in neurology and psychiatry and the way in which the corresponding health care delivery is practiced in many countries of the world.

Background: The aim of this study was to evaluate the association of sarcopenia and sarcopenic obesity with disability among older adults (≥65years 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 ≥18years 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 ≥65years 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., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To construct a metric of the impact of brain disorders on people's lives, based on the psychosocial difficulties (PSDs) that are experienced in common across brain disorders., Study Design: Psychometric study using data from a cross-sectional study with a convenience sample of 722 persons with 9 different brain disorders interviewed in four European countries: Italy, Poland, Spain and Finland. Questions addressing 64 PSDs were first reduced based on statistical considerations, patient's perspective and clinical expertise. Rasch analyses for polytomous data were also applied., Setting: In and outpatient settings., Results: A valid and reliable metric with 24 items was created. The infit of all questions ranged between 0.7 and 1.3. There were no disordered thresholds. The targeting between item thresholds and persons' abilities was good and the person-separation index was 0.92. Persons' abilities were linearly transformed into a more intuitive scale ranging from zero (no PSDs) to 100 (extreme PSDs)., Conclusion: The metric, called PARADISE 24, is based on the hypothesis of horizontal epidemiology, which affirms that people with brain disorders commonly experience PSDs. This metric is a useful tool to carry out cardinal comparisons over time of the magnitude of the psychosocial impact of brain disorders and between persons and groups in clinical practice and research.

Objective: 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., Methods: 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)., Results: 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)., Conclusions: 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., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background/aims: Alcohol-related problems are relevant in the elderly, particularly in developed countries, but there is a lack of cross-country comparisons. The present work aims to examine the frequency and patterns of alcohol consumption in older adults across different European countries, and to analyze the relationship between socioeconomic status and gender with alcohol consumption., Methods: General population-based household surveys of randomly selected adults over 60 years of age in 14 European countries., Participants: 10,119 subjects [mean age: 70.4 (SD = 7.1)], 61.9% women., Results: There are marked differences in alcohol consumption across countries. Except for three countries from eastern regions, most people in all countries present moderate consumption regarding the amount of alcohol and pattern of use. However, there are marked gender differences, with a higher intake in men (effect sizes ranging from 0.57 to 1.27), although these differences are relatively proportional across countries. Finally, a higher socioeconomic status is positively related (B = 0.845, 95% CI: 0.30/1.40) with alcohol consumption after controlling for gender, age, health-functioning status and the country's development level., Conclusions: There are marked differences in consumption of alcohol in the elderly between the different countries, and male gender, as well as a higher SES, were associated with higher alcohol consumption., (© 2014 S. Karger AG, Basel.)

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.

Unlabelled: A tool to assess the built environment, which takes into account issues of disability, accessibility and the need for data comparable across countries and populations, is much needed. The Collaborative Research on Ageing in Europe (COURAGE) in Europe Built Environment Outdoor Checklist (CBE-OUT) helps us to understand when features of the neighbourhood environment have either a positive or negative impact on the accessibility of neighbourhoods for healthy ageing. The CBE-OUT is composed of 128 items that can be recorded when present in the evaluated environment. Audits were performed in households randomly selected from each cluster of the sample for Finland, Poland and Spain, following precise rules defined by experts. Global scores were computed both section by section and in the overall checklist, rescaling the resulting scores from 0 (negative environment) to 100 (positive). The total number of completed CBE-OUT checklists was 2452 (Finland, 245; Poland, 972; and Spain, 1235). Mean global score for our sample is 49.3, suggesting an environment composed both of facilitating and hindering features. Significant differences were observed in the built environment features of the three countries and in particular between Finland and the other two. The assessment of features of built environment is crucial when thinking about ageing and enhanced participation. The COURAGE in Europe project developed this tool to collect information on built environment in an objective evaluation of environmental features and is a recommended methodology for future studies., Key Practitioner Message: The CBE-OUT checklist is an objective evaluation of the built environment and is centred on technical measurement of features present in the environment and has its foundations in the concepts of disability and accessibility operating in the International Classification of Functioning, Disability and Health (ICF) model. The CBE-OUT checklist can be analysed using both the total score and the single section score, allowing an evaluation of the facilitating or hindering role of the environment and is usable for predictive analysis of ageing trends. The CBE-OUT checklist makes it possible to collect information about the built environment by means of an objective evaluation of environment features and is a recommended methodology for future studies about the built environment., (Copyright © 2013 John Wiley & Sons, Ltd.)

The collaborative research on ageing in Europe protocol was based on that of the World Health Organization Study on global AGEing and adult health (SAGE) project that investigated the relationship between health and well-being and provided a set of instruments that can be used across countries to monitor health and health-related outcomes of older populations as well as the strategies for addressing issues concerning the ageing process. To evaluate the degree to which SAGE protocol covered the spectrum of disability given the scope of the World Health Organization International Classification of Functioning, Disability and Health (ICF), a mapping exercise was performed with SAGE protocol. Results show that the SAGE protocol covers ICF domains in a non-uniform way, with environmental factors categories being underrepresented, whereas mental, cardiovascular, sensory functions and mobility were overrepresented. To overcome this partial coverage of ICF functioning categories, new assessment instruments have been developed. PRACTITIONER MESSAGE: Mapping exercises are valid procedures to understand the extent to which a survey protocol covers the spectrum of functioning. The mapping exercise with SAGE protocol shows that it provides only a partial representation of body functions and activities and participation domains, and the coverage of environmental factors is poor. New instruments are therefore needed for researchers to properly understand the health and disability of ageing populations., (Copyright © 2013 John Wiley & Sons, Ltd.)

Unlabelled: The built environment (BE) impacts on people's disability and health, in terms of overweight, depression, alcohol abuse, poor self-rated health and presence of psychological symptoms; it is reasonable to assume that BE also impacts on participation levels. This paper presents the validation of the COURAGE Built Environment Self-Reported Questionnaire (CBE-SR), an instrument designed to evaluate BE in the context of health and disability. Subjects participating to COURAGE, a cross-sectional study conducted on 10,800 citizens of Poland, Finland and Spain, completed a protocol inclusive of the CBE-SR. Psychometric properties and factor structure were analysed, and factor scores created. Gender differences, differences between persons from different age groups and persons reporting the environment as facilitating, hindering or neutral were calculated. Eight items were deleted so that the final version of CBE-SR comprises 19 items. Cronbach's alpha ranged from 0.743 to 0.906, and test-retest stability was demonstrated for the majority of items. Four subscales were identified: Usability of the neighbourhood environment; Hindrance of walkable environment; Easiness of use of public buildings, places and facilities; and Risk of accidents and usability of the living place. Younger respondents reported their neighbourhood as more usable but perceived walkways as more hindering and public buildings as less easy to use; gender differences were almost inexistent. The CBE-SR is a four-scale instrument with good psychometric properties that measures the person-environment interaction. It is sensitive across age groups and is consistent with the subject's overall judgement of the degree to which the environment is facilitating or hindering., Key Practitioner Message: Poor built environments have a negative impact on the level of a person's participation. However, instruments measuring the person-environment interaction are lacking. The CBE-SR is a valid and reliable instrument that researchers can use to assess the relationships between the intrinsic health state and the objective features of the environment. Understanding this relationship would provide further insight into the need of addressing the individual's functioning either by means of interventions directed to the individual or by making changes to the individual's environment., (Copyright © 2013 John Wiley & Sons, Ltd.)

Unlabelled: 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., 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., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: There is a need for short, specific instruments that assess quality of life (QOL) adequately in the older adult population. The aims of the present study were to obtain evidence on the validity of the inferences that could be drawn from an instrument to measure QOL in the aging population (people 50+ years old), and to test its psychometric properties., Methods: The instrument, WHOQOL-AGE, comprised 13 positive items, assessed on a five-point rating scale, and was administered to nationally representative samples (n = 9987) from Finland, Poland, and Spain. Cronbach's alpha was employed to assess internal consistency reliability, whereas the validity of the questionnaire was assessed by means of factor analysis, graded response model, Pearson's correlation coefficient and unpaired t-test. Normative values were calculated across countries and for different age groups., Results: The satisfactory goodness-of-fit indices confirmed that the factorial structure of WHOQOL-AGE comprises two first-order factors. Cronbach's alpha was 0.88 for factor 1, and 0.84 for factor 2. Evidence supporting a global score was found with a second-order factor model, according to the goodness-of-fit indices: CFI = 0.93, TLI = 0.91, RMSEA = 0.073. Convergent validity was estimated at r = 0.75 and adequate discriminant validity was also found. Significant differences were found between healthy individuals (74.19 ± 13.21) and individuals with at least one chronic condition (64.29 ± 16.29), supporting adequate known-groups validity., Conclusions: WHOQOL-AGE has shown good psychometric properties in Finland, Poland, and Spain. Therefore, considerable support is provided to using the WHOQOL-AGE to measure QOL in older adults in these countries, and to compare the QOL of older and younger adults.

Objective: To identify the cross-national prevalence of psychotic symptoms in the general population and to analyze their impact on health status., Method: The sample was composed of 256,445 subjects (55.9% women), from nationally representative samples of 52 countries worldwide participating in the World Health Organization's World Health Survey. Standardized and weighted prevalence of psychotic symptoms were calculated in addition to the impact on health status as assessed by functioning in multiple domains., Results: Overall prevalences for specific symptoms ranged from 4.80% (SE = 0.14) for delusions of control to 8.37% (SE = 0.20) for delusions of reference and persecution. Prevalence figures varied greatly across countries. All symptoms of psychosis produced a significant decline in health status after controlling for potential confounders. There was a clear change in health impact between subjects not reporting any symptom and those reporting at least one symptom (effect size of 0.55)., Conclusions: The prevalence of the presence of at least one psychotic symptom has a wide range worldwide varying as much as from 0.8% to 31.4%. Psychotic symptoms signal a problem of potential public health concern, independent of the presence of a full diagnosis of psychosis, as they are common and are related to a significant decrement in health status. The presence of at least one psychotic symptom is related to a significant poorer health status, with a regular linear decrement in health depending on the number of symptoms.

Objective: Our aim was to study the impact of depressive disorders on work disability to discover the determinants of depression for work disability in the European countries., Design: The sample was composed of 31,126 individuals from 29 countries included in the 2002 World Health Survey of the World Health Organization. National representative samples of countries from all regions of Europe and with different levels of economic development and health coverage were selected., Results: Estimates of people not working because of ill health did not differ among European countries in relation to levels of economic development or health coverage. Significant determinants of people with diagnosis of depression not working because of ill health (reference category) versus working were age (odds ratio = 0.97), female sex (odds ratio = 1.71), education (odds ratio = 1.11), marital status (being unmarried indicating less probability), lowest income level, and comorbidity with angina pectoris (odds ratio = 0.51). Moreover, according to previous studies, we found some determinants (comorbidity with other diseases, young age, and unemployment) impacting on health status., Conclusions: Depression is a substantial cause of work disability and it is a complex phenomenon that involves many variables. Investigation into this relationship should improve, focusing on the role of determinants.