When does poor subjective financial position hurt the elderly? Testing the interaction with educational attainment using a national representative longitudinal survey

<p>Abstract</p> <p>Background</p> <p>Several studies have demonstrated that perceived financial status has a significant impact on health status among the elderly. However, little is known about whether such a subjective perception interacts with objective socioeconomic status (SES) measures such as education that affect the individual's health.</p> <p>Methods</p> <p>This research used data from the Survey of Health and Living Status of the Middle Age and Elderly in Taiwan (SHLS) conducted by the Bureau of Health Promotion, Department of Health in Taiwan. Waves 1996, 1999 and 2003 were used. The sample consisted of 2,387 elderly persons. The interactive effects of self-rated satisfaction with financial position and educational attainment were estimated. Self-rated health (SRH), depressive symptom (measured by CES-D) and mortality were used to measure health outcomes.</p> <p>Results</p> <p>Significant interaction effect was found for depressive symptoms. Among those who were dissatisfied with their financial position, those who were illiterate had an odds ratio (OR) of 8.3 (95% CI 4.9 to 14.0) for having depressive symptoms compared with those who were very satisfied with their financial position. The corresponding OR for those with college or above was only 2.7 (95% CI 1.0 to 7.3). No significant interaction effect was found for SRH and mortality.</p> <p>Conclusions</p> <p>Although poor financial satisfaction was found to be related to poorer health, the strongest association for this effect was observed among those with low educational attainment, and this is especially true for depressive symptoms. Subjective financial status among the elderly should be explored in conjunction with traditional measures of SES.</p

Translating evidence into policy for cardiovascular disease control in India

Cardiovascular diseases (CVD) are leading causes of premature mortality in India. Evidence from developed countries shows that mortality from these can be substantially prevented using population-wide and individual-based strategies. Policy initiatives for control of CVD in India have been suggested but evidence of efficacy has emerged only recently. These initiatives can have immediate impact in reducing morbidity and mortality. Of the prevention strategies, primordial involve improvement in socioeconomic status and literacy, adequate healthcare financing and public health insurance, effective national CVD control programme, smoking control policies, legislative control of saturated fats, trans fats, salt and alcohol, and development of facilities for increasing physical activity through better urban planning and school-based and worksite interventions. Primary prevention entails change in medical educational curriculum and improved healthcare delivery for control of CVD risk factors-smoking, hypertension, dyslipidemia and diabetes. Secondary prevention involves creation of facilities and human resources for optimum acute CVD care and secondary prevention. There is need to integrate various policy makers, develop effective policies and modify healthcare systems for effective delivery of CVD preventive care

Effects of Acute Mental Stress and Exercise on T-Wave Alternans in Patients with Implantable Cardioverter Defibrillators and Controls

Background - Malignant cardiac arrhythmias can be triggered by exercise and by mental stress in vulnerable patients. Exercise-induced T-wave alternans (TWA) is an established marker of cardiac electrical instability. However, the effects of acute mental stress on TWA have not been investigated as a vulnerability marker in humans. Methods and Results - TWA responses to mental stress (anger recall and mental arithmetic) and bicycle ergometry were evaluated in patients with implantable cardioverter defibrillators (ICDs) and documented coronary artery disease (n=23, age 62.1±12.3 years) and controls (n=17, age 54.2±12.1 years). TWA was assessed from digitized ECGs by modified moving average analysis. Dual-isotope single photon emission computed tomography was used to assess myocardial ischemia. TWA increased during mental stress and exercise (P values \u3c0.001), and TWA responses were higher in ICD patients than in controls (arithmetic Δ=8.9±1.4 versus 4.3±2.2 μV, P=0.043; exercise Δ=21.4±2.8 versus 13.8±3.2 μV, P=0.038). TWA increases with mental stress occurred at substantially lower heart rates (anger recall Δ=9.7±7.7 bpm, arithmetic Δ=14.3±133 bpm) versus exercise (Δ=53.7± 22.7 bpm; P values \u3c0.001). After adjustment for heart rate increases, mental stress and exercise provoked increased TWA in ICD patients (P values \u3c0.05), but not in controls (P values \u3e0.2). Ejection fraction and stress-induced myocardial ischemia were not associated with TWA. Conclusions - Mental stress can induce cardiac electrical instability, as assessed via TWA, among patients with arrhythmic vulnerability and occurs at lower heart rates than with exercise. Pathophysiological mechanisms of mental stress-induced arrhythmias may therefore involve central and autonomic nervous system pathways that differ from exercise-induced arrhythmias

Age, anger regulation and well-being

Emotion regulation has been argued to be an important factor in well-being. The current study investigated the effects of adult aging on emotional expression, emotional control and rumination about emotional events, focusing on an emotion which is particularly important in social interaction: anger. Measures of anger regulation and well-being were obtained in a sample of 286 adults aged between 18 and 88. Older adults expressed anger outwardly less often, and reported more inner control of anger using calming strategies compared to their younger counterparts. These age differences were not explained by variance in social desirability of responding. Age improvements in negative affect and anxiety were partly explained by age differences in anger regulation suggesting an important role for anger management in good mental health amongst older adults. Further, age improvements in quality of life were explained by variance in anger regulation indicating that improved management of emotions with age is an important factor in maintaining well-being in old age