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Identifier 000397241
Title Prevalence of multiple behavioral risk factors for chronic diseases in European population ,aged 50+ ,in relation to physical /mental health status and health services utilization (SHARE study)
Alternative Title Συχνότητα εμφάνισης πολλαπλών συμπεριφορικών παραγόντων κινδύνου για χρόνια νοσήματα σε πληθυσμούς της Ευρώπης,ηλικίας 50+ ετών ,και η σχέση τους με τη σωματική & ψυχική υγεία και τη χρήση υπηρεσιών υγείας (μελέτη SHARE)
Author Λιναρδάκης, Εμμανουήλ Κ
Thesis advisor Φιλαλήθης, Αναστάσιιος
Reviewer Τζανάκης, Νικόλαος
Μοσχανδρέα, Ιωάννα
Λιονής, Χρήστος
Τσατσάκης, Αριστείδης
Παρθενάκης, Φραγκίσκος
Μπερτσιάς, Γιώργος
Abstract Background Behavioral risk factors (BRFs) refer to lifestyle habits such as smoking, physical inactivity, risky alcohol consumption and high body weight. Individually or in clusters, they contribute cumulatively to the development of non-communicable diseases and especially to cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease, arthritis and certain types of cancer. Aim The aim of this study was to assess the prevalence of individual BRFs and multiple BRFs in adults, aged 50+ from eleven European countries (SHARE study), according to i) their basic characteristics and ii) the potential differences in BRF accumulation between the different countries/regions. Moreover, we assessed the association of BRF presence with: iii) physical and mental health status, iv) preventive health services utilization and v) religious and spiritual beliefs. Subjects and methods We used a subset of data from the 1st wave (2004/5) of the “Survey of Health, Ageing and Retirement in Europe” (SHARE), from eleven European countries: Austria, Belgium, Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden and Switzerland. The SHARE Survey is organized and coordinated by Mannheim Research Institute for the Economics of Ageing (MEA, Germany), in collaboration with >60 research teams, including the Faculty of Social Medicine of the University of Crete. The selected sample in the current study consisted of 26,743 individuals aged 50+ years, and corresponds to a target estimated population of 105 million. The studied population was selected according to the complex multistage stratification design in order to be representative of the European population aged over 50 years. Response rates ranged from 73.7% (Spain) to 93.3% (France). Validated questionnaires were used that assessed demographic characteristics, physical and mental health, social activities, behavioral risks etc. The prevalence of four BRFs (1: presence, 0: absence) in adults was also assessed as the presence of high body weight (overweight/obese), smoking, physical inactivity and risky alcohol consumption. For the estimation of the prevalence of BRFs accumulation (multiple clustering), an average clustering or mean factors, score was calculated by adding up the number of individual BRFs, whereas the accumulation of 2+ risk factors was considered to be an indication of increased risk for chronic diseases. Moreover, we used participants’ social and demographic characteristics, their morbidity status, their utilization of preventive health services and their religious and spiritual beliefs. xi Data were analyzed using the IBM-SPSS v21.0. Weights were applied according to the complex sampling design of the study, reflecting non-responses and stratification design. The prevalence of BRFs and the respective 95% confidence intervals (95% CIs) were estimated according to the complex sampling design and/or by bootstrap techniques. Throughout the complex samples procedure, multivariate regression models were applied, estimating differences and relationships. Moreover, in regional differences, simple correspondence analysis was used to graphically illustrate the accumulation of BRFs in the eleven participating countries. Results In total, 71.2% of participants were physically inactive, while 59.8% had high body weight. 53.4% had 2+ MBRFs, while males presented higher prevalence of BRFs clusters than females (58.5% vs. 49.0%, p<0.001). Females displayed lower odds of increased alcohol consumption (OR=0.16, p<0.001) and higher odds of physical inactivity (OR=1.47, p<0.001) than males. Participants who lived alone, compared to those living with a partner, and those with more, compared to fewer education years, exhibited a significantly higher and lower, respectively, mean BRFs score (p<0.001). The cluster of ‘high body weight and physical inactivity’ had the highest prevalence of BRFs (35.4%), with higher prevalence in Southern Europe (p<0.05). The ‘smoking and alcohol consumption’ cluster presented the greatest degree of multiple BRF clustering (observed to expected ratio=2.44). Participants from Southern European countries had a higher mean number of BRFs (p<0.05), whereas the highest prevalence of clustering (2+ BRFs) was observed in Spain (61.65) and Greece (60.6%) (p<0.05). With regards to physical and mental health status, physically inactive adults had, in comparison to their counterparts, a higher mean number of conditions (1.33 vs. 1.26, p=0.009), whereas risky drinkers had a higher mean score in the depression scale (2.84 vs. 2.47, p=0.003). Adults with 2+ BRFs had significantly higher odds of having 1+ condition (males:1.52; 95%CI,1.20-1.91, females:1.73; 95%CI,1.42-2.12), compared to those with 0-1 BRFs. Adults with 2+ BRFs also had significantly higher prevalence of ‘high blood pressure or hypertension’ (37.8%; 95%CI,36.4-39.1; vs. 28.2%; 95%CI,26.9-29.6). Among participants presenting with 2+ BRFs, Belgian adults had the highest mean number of chronic diseases and/or functional limitations and symptoms. xii With regards to preventive health services utilization (PHSU), adults with high body weight had a lower odds ratio for seeing a dentist/dental hygienist (0.75, p<0.05) or having sigmoidoscopy-colonoscopy (0.70, p<0.05) and higher odds of receiving advice by a general practitioner (GP) to get regular exercise (1.56, p<0.05). Smokers had lower odds of having a mammogram (0.76, p<0.05) or detecting hidden blood in stool (0.63, p<0.05). Adults with high body weight (p=0.001), smokers (p=0.001) and risky drinkers (p=0.008) had a lower mean score of PHSU, while the PHSU score did not differ according to clustering of the BRFs (p=0.218). Among adults with 2+ BRFs from all participating countries, the lowest mean score of PHSU was found in Greece with 28.0 (p<0.05). Finally, and with regards to prayer use, lower prevalence of smoking was found in males (20.6% vs. 29.4%, p<0.05), as well as in females (13.1% vs. 22.6%, p7lt;0.05) who prayed ‘&ge;1 time/day’, compared to those who never prayed. Categorical regression analysis revealed that the presence of 2+ BRFs was negatively associated with religious education (standardized beta=-0.048, p<0.001) and positively with low frequency of prayer use (standardized beta=0.056, p7lt0.001). Conclusion The prevalence of BRFs for chronic diseases was considerably high in this sample of European adults, and higher in Southern European countries. Individually or in clusters, BRFs were related with indexes of physical and mental health, whereas they seem to contribute to less preventive health services utilization. Nevertheless, a lower presence of BRFs is associated with the presence of co-habiting, higher education levels or religious and spiritual beliefs. These findings can be used for the design of multi-ethnic primary healthcare programs by health professionals, in order to reduce the adoption and prevalence of BRFs, thus contributing to health promotion at the population level.
Language English, Greek
Subject Prayer use
Prevalence
Religiosity
Επιπολασμός
Επιπολασμός
Θρησκευτικότητα
Προληπτικές υπηρεσίες υγείας
Χρήση προσευχής
Issue date 2015-12-18
Collection   Faculty/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
Permanent Link https://elocus.lib.uoc.gr//dlib/0/c/7/metadata-dlib-1452789888-173597-7638.tkl Bookmark and Share
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