Longitudinal analysis of ear infection and hearing impairment: findings from 6-year prospective cohorts of Australian children

BACKGROUND: Middle ear infection is common in childhood. Despite its prevalence, there is little longitudinal evidence about the impact of ear infection, particularly its association to hearing loss. By using 6-year prospective data, we investigate the onset and impact over time of ear infection in Australian children. METHODS: We analyse 4 waves of the Longitudinal Study of Australian Children (LSAC) survey collected in 2004, 2006, 2008, and 2010. There are two age cohorts in this study (B cohort aged 0/1 to 6/7 years N=4242 and K cohort aged 4/5 to 10/11 years N=4169). Exposure was parent-reported ear infection and outcome was parent-reported hearing problems. We modelled ear infection onset and subsequent impact on hearing using multivariate logistic regressions, reporting Adjusted Odds Ratios (AOR) and Confidence Intervals (95% CI). Separate analyses were reported for indigenous and non-indigenous children. RESULTS: Associations of ear infections between waves were found to be very strong both among both indigenous and non-indigenous children in the two cohorts. Reported ear infections at earlier wave were also associated with hearing problems in subsequent wave. For example, reported ear infections at age 4/5 years among the K cohort were found to be predictors of hearing problems at age 8/9 years (AOR 4.0, 95% CI 2.2-7.3 among non-indigenous children and AOR 7.7 95% CI 1.0-59.4 among indigenous children). Number of repeated ear infections during the 6-year follow-up revealed strong dose–response relationships with subsequent hearing problems among non-indigenous children (AORs ranged from 4.4 to 31.7 in the B cohort and 4.4 to 51.0 in the K cohort) but not statistically significant among indigenous children partly due to small sample. CONCLUSIONS: This study revealed the longitudinal impact of ear infections on hearing problems in both indigenous and non-indigenous children. These findings highlight the need for special attention and follow-up on children with repeated ear infections

Measuring and decomposing inequity in self-reported morbidity and self-assessed health in Thailand

BACKGROUND In recent years, interest in the study of inequalities in health has not stopped at quantifying their magnitude; explaining the sources of inequalities has also become of great importance. This paper measures socioeconomic inequalities in self-reported morbidity and self-assessed health in Thailand, and the contributions of different population subgroups to those inequalities. METHODS The Health and Welfare Survey 2003 conducted by the Thai National Statistical Office with 37,202 adult respondents is used for the analysis. The health outcomes of interest derive from three self-reported morbidity and two self-assessed health questions. Socioeconomic status is measured by adult-equivalent monthly income per household member. The concentration index (CI) of ill health is used as a measure of socioeconomic health inequalities, and is subsequently decomposed into contributing factors. RESULTS The CIs reveal inequality gradients disadvantageous to the poor for both self-reported morbidity and self-assessed health in Thailand. The magnitudes of these inequalities were higher for the self-assessed health outcomes than for the self-reported morbidity outcomes. Age and sex played significant roles in accounting for the inequality in reported chronic illness (33.7 percent of the total inequality observed), hospital admission (27.8 percent), and self-assessed deterioration of health compared to a year ago (31.9 percent). The effect of being female and aged 60 years or older was by far the strongest demographic determinant of inequality across all five types of health outcome. Having a low socioeconomic status as measured by income quintile, education and work status were the main contributors disadvantaging the poor in self-rated health compared to a year ago (47.1 percent) and self-assessed health compared to peers (47.4 percent). Residence in the rural Northeast and rural North were the main regional contributors to inequality in self-reported recent and chronic illness, while residence in the rural Northeast was the major contributor to the tendency of the poor to report lower levels of self-assessed health compared to peers. CONCLUSION The findings confirm that substantial socioeconomic inequalities in health as measured by self-reported morbidity and self-assessed health exist in Thailand. Decomposition analysis shows that inequalities in health status are associated with particular demographic, socioeconomic and geographic population subgroups. Vulnerable subgroups which are prone to both ill health and relative poverty warrant targeted policy attention

Unhappiness and mortality: evidence from a middle-income Southeast Asian setting

BACKGROUND A relationship between happiness and mortality might seem obvious, but outside of affluent settings in developed countries there is almost no actual evidence that this is so. FINDINGS We report our findings on happiness and mortality in Buddhist Southeast Asia. Our data are derived from a prospective nationwide cohort study of 60,569 Thai adults reporting in 2009 and followed up for all-cause mortality over the next four years (296 deaths). We also gathered data on a wide array of covariates and included these in the final model of the unhappiness-mortality effect. All final effect estimates were mutually adjusted odds ratios (AOR) and cohort members who reported being happy 'little' or 'none of the time' in 2009 were more likely to die (AOR 2.60, 95% Confidence Interval 1.17-5.80). Other significant covariates include being female (<40 years AOR 0.66, ≥40 years AOR 0.57), unmarried (AOR 1.64) and current smokers (AOR 2.45). CONCLUSION Our study provides empirical evidence that the epidemiological effect of happiness is not confined to affluent Western countries, but it also increases the probability of staying alive in a middle-income Asian country.This study was supported by the International Collaborative Research Grants Scheme with joint grants from the Wellcome Trust UK (GR071587MA) and the Australian National Health and Medical Research Council (268055), and as a global health grant from the NHMRC (585426)

Inequalities in risks and outcomes in a health transitioning country: A review of a large national cohort of Thai adults

This article reviews inequalities in health risks and outcomes based on a large longitudinal cohort study of distance-learning adult students enrolled at Sukhothai Thammathirat Open University (n = 87,134). The study began in 2005 and the first follow-up was completed in 2009. Risks analyzed for health inequalities were divided into demographic, socioeconomic, geographical, behavioral, and environmental groups. Unequal risks and outcomes identified that would be amenable to policy interventions in transitional Thailand include the following: heat stress—contributing to many adverse outcomes, including occupational injury, psychological distress, and kidney disease; urbanization—unhealthy eating, sedentary lifestyles, low social capital, and poor mental health; obesity—increasingly common especially with rising income and age among men; and injury— big problem for young males and associated with excessive alcohol and dangerous transport. These substantial inequalities require attention from multisectoral policy makers to reduce the gaps and improve health of the Thai population

Environmental tobacco smoke exposure and health disparities: 8-year longitudinal findings from a large cohort of Thai adults

BACKGROUND: In rich countries, smokers, active or passive, often belong to disadvantaged groups. Less is known of tobacco patterns in the developing world. Hence, we seek out to investigate mental and physical health consequences of smoke exposure as well as tobacco-related inequality in transitional middle-income Thailand. METHODS: We studied a nationwide cohort of 87,151 middle-aged and older adults that we have been following for eight years (2005–2013) for emerging chronic diseases. Logistic regression was used to identify attributes associated with passive smoke exposure. Longitudinal associations between smoke exposure and wellbeing (SF-8) or psychological distress (Kessler 6) were investigated with multiple linear regression or multivariate logistic regression analysis. RESULTS: A high proportion of cohort members, especially females, were passive smokers at home and at public transport stations; males were more exposed at workplace and recreational places. We observed a social gradient with more passive smoking in poorer people. We also observed a dose response relationship linking graded smoke exposures (current, former, passive, non-exposed) to less wellbeing and more psychological distress (p-trend < 0.001). Female smokers in general had less wellbeing and more distress. CONCLUSION: Our findings add to current knowledge on the impact of active and passive smoking on health in a transitional economy. Promotion of smoking cessation programs both in public and at home could also potentially reduce adverse disparities in health and wellbeing in middle and lower income settings such as Thailand.This study was supported by the International Collaborative Research Grants Scheme with joint grants from the Wellcome Trust UK (GR071587MA) and the Australian National Health and Medical Research Council (268055), and as a global health grant from the NHMRC (585426)

Psychosocial outcomes of children with ear infections and hearing problems:A longitudinal study

Background\ud \ud There is some evidence of a relationship between psychosocial health and the incidence of ear infections and hearing problems in young children. There is however little longitudinal evidence investigating this relationship. This paper used 6-year prospective longitudinal data to examine the impact of ear infection and hearing problems on psychosocial outcomes in two cohorts of children (one cohort recruited at 0/1 years and the other at 4/5 years).\ud \ud Methods\ud \ud Data from the Longitudinal Study of Australian Children (LSAC) were analysed to address the research aim. The LSAC follows two cohorts of children (infants aged 0/1 years – B cohort, n = 4242; and children aged 4/5 years – K cohort, n = 4169) collecting data in 2004, 2006, 2008 and 2010. In B cohort at baseline 3.7% (n = 189) of the sample were reported by their parent to have had an ear infection (excluding hearing problems) and 0.5% (n = 26) were reported by their parent to have hearing problems (excluding ear infections). 6.7% (n = 323) of the K cohort were identified as having had an ear infection and 2.0% (n = 93) to have hearing problems. Psychosocial outcomes were measured using the Strengths and Difficulties Questionnaire. Data were analysed using multivariate analysis of variance and logistic regression, reporting adjusted odds ratio and 95% confidence intervals of the association between reported ear infections (excluding hearing problems)/or hearing problems (excluding ear infections) and psychosocial outcomes.\ud \ud Results\ud \ud Children were more likely to have abnormal/borderline psychosocial outcomes at 10/11 years of age if they had been reported to have ongoing ear infections or hearing problems when they were 4/5 years old. When looking at the younger cohort however, poorer psychosocial outcomes were only documented at 6/7 years for children reported to have hearing problems at 0/1 years, not for those who were reported to have ongoing ear infections.\ud \ud Conclusion\ud \ud This study adds further evidence that a relationship may exist between repeated ear infections or hearing problems and the long-term psychosocial health of children and provides support for a more systematic investigation of these issues

Social capital dynamics and health in mid to later life: findings from Australia

Purpose The influence of social capital has been shown to improve health and wellbeing. This study investigates the relationship between changes in social capital and health outcomes during a 6-year follow-up in mid to later life in Australia. Methods Nationally representative data from the Household, Income and Labour Dynamics in Australia (HILDA) survey included participants aged 45 years and over who responded in 2006, 2010 and 2012 (N = 3606). Each of the three components of social capital (connectedness, trust and participation) was measured in Waves 2006 and 2010 and categorised as: ‘never low’, ‘transitioned to low’, ‘transitioned out of low’ and ‘consistently low’. Health outcomes in 2012 included self-rated overall health, physical functioning, and mental health based on the Short Form 36-item health survey (SF-36). Multivariable logistic regression assessed changes in social capital (measured in 2006 and 2010) predicted poor health (measured in 2012), adjusting for covariates. Results Consistently low trust was significantly associated with higher odds of transitions into poor physical functioning (AOR 1.54; 95% Confidence Interval 1.06–1.22), poor mental health (AOR 1.59; 95% CI 1.08–2.36) and poor self-rated health (AOR 1.86; 95% CI 1.27–2.72). Transition into low trust was also a predictor of poor self-rated health after adjusting for covariates (AOR 1.74; 95% CI 1.11–2.73). Changes in social connectedness in both directions (transitioned out of and into low) were statistically associated with poor self-rated health (AORs 1.40; 95% CI 1.00–1.97 and 1.61; 95% CI 1.11–2.34, respectively) after adjusting for confounders as well as other social capital components. Conclusions Our longitudinal findings reveal social capital dynamics and effects on health in mid to later life. Social trust and connectedness could be important enablers for older persons to be more active in the community and potentially benefit their health and wellbeing over time. Keywords Social capital Social participation Trust Self-rated health Ageing Middle and older adultsThis research was supported by the Australian Research Council Centre of Excellence in Population Ageing Research (CE110001029)

Happiness, Mental Health, and Socio-Demographic Associations Among a National Cohort of Thai Adults

Research on happiness has been of interest in many parts of the world. Here we provide evidence from developing countries; this is the first analysis of happiness among a cohort of Thai distance learning adults residing throughout the country (n = 60,569 in 2009). To measure happiness, we tested use of the short format Thai Mental Health Indicators (TMHI), correlating each domain with two direct measures of happiness and life satisfaction. Several TMHI domains correlated strongly with happiness. We found the mental state and the social support domains moderately or strongly correlated with happiness by either measure (correlation coefficients 0.24–0.56). The other two TMHI domains (mental capacity and mental quality) were not correlated with happiness. Analysis of socio-demographic attributes and happiness revealed little effect of age and sex but marital status (divorced or widowed), low household income, and no paid work all had strong adverse effects. Our findings provide Thai benchmarks for measuring happiness and associated socio-demographic attributes. We also provide evidence that the TMHI can measure happiness in the Thai population. Furthermore, the results among Thai cohort members can be monitored over time and could be useful for comparison with other Southeast Asian countries

The associations between unhealthy behaviours, mental stress, and low socio-economic status in an international comparison of representative samples from Thailand and England

BACKGROUND Socioeconomic status is a recognised determinant of health status, and the association may be mediated by unhealthy behaviours and psychosocial adversities, which, in developed countries, both aggregate in low socioeconomic sectors of the population. We explored the hypothesis that unhealthy behavioural choices and psychological distress do not both aggregate in low socioeconomic status groups in developing countries. METHODS Our study is based on a cross-sectional comparison between national population samples of adults in England and Thailand. Psychological distress was assessed using the General Health Questionnaire (GHQ-12) or three anxiety-oriented items from the Kessler scale (K6). Socioeconomic status was assessed on the basis of occupational status. We computed a health-behaviour score using information about smoking, alcohol consumption, fruit and vegetable consumption, and physical activity. RESULTS The final sample comprised 40,679 participants. In both countries and in both genders separately, there was a positive association between poor health-behaviour and high psychological distress, and between high psychological distress and low socioeconomic status. In contrast, the association between low socioeconomic status and poor health-behaviour was positive in both English men and women, flat in Thai men, and was negative in Thai women (likelihood ratio test P <0.001). CONCLUSION The associations between socioeconomic status, behavioural choices, and psychological distress are different at the international level. Psychological distress may be consistently associated with low socioeconomic status, whereas poor health-behaviour is not. Future analyses will test whether psychological distress is a more consistent determinant of socioeconomic differences in health across countries.AL and AS are supported by the British Heart Foundation. The Thai study was supported by the International Collaborative Research Grants Scheme with joint grants from the Wellcome Trust UK (GR071587MA) and the Australian National Health and Medical Research Council (268055), and as a Global Health grant from the NHMRC (585426)

Psychosocial job characteristics, wealth, and culture: differential effects on mental health in the UK and Thailand.

BACKGROUND: Most research on the influence of psychosocial job characteristics on health status has been conducted within affluent Western economies. This research addresses the same topic in a middle-income Southeast Asian country, enabling comparison with a Western benchmark. METHODS: We analysed and compared the Health Survey for England conducted in 2010 and the Thai Cohort Study data at 2005 baseline for workers aged 35-45 years. Multivariate logistic regression was used to assess relationships between psychosocial job characteristics and health, measured as Adjusted Odd Ratios (AOR), controlling for potential covariates in final analyses. RESULTS: In both UK and Thai working adults, psychological distress was associated with job insecurity (AOR 2.58 and 2.32, respectively), inadequate coping with job demands (AOR 2.57 and 2.42), and low support by employers (AOR 1.93 and 1.84). Job autonomy was associated with psychological distress in the UK samples (AOR 2.61) but no relationship was found among Thais after adjusting for covariates (AOR 0.99). Low job security, inability to cope with job demands, and low employer support were associated with psychological distress both among Thai and UK workers. CONCLUSIONS: Job autonomy was an important part of a healthy work environment in Western cultures, but not in Thailand. This finding could reflect cultural differences with Thais less troubled by individualistic expression at work. Our study also highlights the implications for relevant workplace laws and regulations to minimise the adverse job effects. These public health strategies would promote mental health and wellbeing in the population