Breathlessness limiting exertion in very old adults: findings from the Newcastle 85+ study.

INTRODUCTION: Long-term breathlessness is more common with age. However, in the oldest old (>85 years), little is known about the prevalence, or impact of breathlessness. We estimated breathlessness limiting exertion prevalence and explored (i) associated characteristics; and (ii) whether breathlessness limiting exertion explains clinical and social/functional outcomes. METHODS: Health and socio-demographic characteristics were extracted from the Newcastle 85+ Study cohort. Phase 1 (baseline) and follow-up data (18 months, Phase 2; 36 months, Phase 3; 60 months, Phase 4 after baseline) were examined using descriptive statistics and cross-sectional regression models. RESULTS: Eight hundred seventeen participants provided baseline breathlessness data (38.2% men; mean 84.5 years; SD 0.4). The proportions with any limitation of exertion, or severe limitation by breathlessness were 23% (95% confidence intervals (CIs) 20-25%) and 9% (95%CIs 7-11%) at baseline; 20% (16-25%) and 5% (3-8%) at Phase 4. Having more co-morbidities (odds ratio (OR) 1.34, 1.18-1.54; P < 0.001), or self-reported respiratory (OR 1.88, 1.25-2.82; P = 0.003) or cardiovascular disease (OR 2.38, 1.58-3.58; P < 0.001) were associated with breathlessness limiting exertion. Breathlessness severely limiting exertion was associated with poorer self-rated health (OR 0.50, 029-0.86; P = 0.012), depression (beta-coefficient 0.11, P = 0.001), increased primary care contacts (beta-co-efficient 0.13, P = 0.001) and number of nights in hospital (OR 1.81; 1.02-3.20; P = 0.042). CONCLUSIONS: Breathlessness limiting exertion appears to become less prevalent over time due to death or withdrawal of participants with cardio-respiratory illness. Breathlessness severely limiting exertion had a wide range of service utilisation and wellbeing impacts.

Improving asthma care through implementation of the SENTINEL programme: findings from the pilot site.

Aim: Short-acting ß2-agonist (SABA) overuse adversely impacts asthma-related outcomes and the environment. The SABA rEductioN Through ImplemeNting Hull asthma guidELines (SENTINEL) programme aims to reduce SABA overuse through supported implementation of an adult asthma guideline, which advocates for a SABA-free maintenance and reliever therapy (MART)-preferred treatment where appropriate, across six primary care networks (PCNs) in the UK. We present findings on patient/disease characteristics, asthma prescribing patterns and exacerbation rates from the pilot PCN. Methods: Patients (aged ≥18 years, prescribed at least one inhaled therapy) and their prescribed asthma treatments were characterised using National Health Service data. Asthma treatments and exacerbations were analysed for three periods: 24‒12 months pre-, 12 months pre- and 12 months post-SENTINEL implementation (November 2020‒January 2021). Results: Of the 2571 registered asthma patients, 33.6% (n=864) underwent an asthma review, of whom 44.7% (n=386) were transitioned to MART. Fewer patients were prescribed three or more SABA canisters per year post-implementation in the overall asthma population (45.4% and 46.2% during 24‒12 months and 12 months pre-implementation, respectively, and 23.9% 12 months post-implementation), and in the two subgroups: 1) those who had an asthma review (74.5% and 83.6% during 24‒12 months and 12 months pre-implementation, respectively, and 26.5% post-implementation); and 2) those transitioned to MART following a review (76.4% and 86.5% during 24‒12 months and 12 months pre-implementation, respectively, and 16.3% post-implementation). A higher proportion of patients were exacerbation-free post-implementation in the overall asthma population and in the two subgroups. At least 71.5% of patients transitioned to MART were still prescribed MART 12 months post-implementation, of whom ≥86.7% were SABA-free. Conclusion: SENTINEL implementation led to reduced SABA prescribing, increased inhaled corticosteroid uptake and fewer asthma exacerbations. MART was considered appropriate for ∼50% of reviewed patients, with improved prescribing patterns sustained post-implementation.

Socioeconomic differences in adolescent health-related behavior differ by gender.

BACKGROUND: Many studies of adolescent health-related behaviors have assessed the effects of gender and parental socioeconomic position (SEP) but not their mutual modification. We investigated socioeconomic differences in health-related behaviors among Slovak adolescents and the potential modification of those differences by gender. METHODS: Data were collected in 2006 (n = 3547; 49.4% boys; mean [SD] age, 14.3 [0.6] years; response rate, 93.5%). The sample comprised students in the eighth and ninth grades of randomly selected elementary schools in Slovakia. Gender-specific prevalence rates for 9 types of health-related behaviors, including nutritional behavior, physical activity and substance use, were calculated for 3 socioeconomic groups, which were defined by the highest educational level attained by both parents. Gender differences in socioeconomic gradients for health-related behaviors were tested. RESULTS: Socioeconomic differences were found in nutritional behavior, physical activity, and smoking. Adolescents with lower parental education behaved less healthily. The largest relative socioeconomic difference was no daily vegetable consumption among girls (90.3% of those with high SEP vs 95.2% of those with middle SEP; odds ratio, 2.33). Regarding no daily fruit consumption, differences among girls were 1.51 times and 1.92 times as large as those among boys for children with medium and low SEP, respectively, as compared with those with high SEP. CONCLUSIONS: Socioeconomic differences in health-related behavior were small, especially for nutritional behavior and physical activity. Interventions that aim to improve health-related behaviors among adolescents with lower SEP should focus on these 2 behaviors, particularly on healthy nutrition in girls with low SEP.

Socioeconomic gradient shifts in health-related behaviour among Slovak adolescents between 1998 and 2006.

OBJECTIVES: We aimed to assess the development of the socioeconomic gradient in health-related behaviour (HRB) among Slovak adolescents between 1998 and 2006. METHODS: Data were collected in 1998 (n = 2,616; 14.9 ± 0.6 years) and in 2006 (n = 1,081; 14.3 ± 0.6 years). ORs of socioeconomic differences-as measured by parental education-were calculated for each cohort in smoking, alcohol consumption and physical inactivity, and the interactions of socioeconomic position and the time period on these behaviours were calculated. RESULTS: The higher odds of smoking in the low socioeconomic group compared to the high socioeconomic group decreased among boys (interaction OR 0.54), but became evident among girls (interaction OR 1.96). In alcohol consumption, no socioeconomic differences were found among boys, but the higher odds among girls from high socioeconomic position compared with those from low socioeconomic position disappeared in 2006. In physical inactivity, socioeconomic differences increased among boys but not among girls. CONCLUSION: During this period, socioeconomic differences in HRB developed in a different way among boys than among girls. Prevalence rates in substance use increased especially among girls from the low socioeconomic group. This group should be particularly targeted by prevention programs.

Gender differences in the relationship between religiosity and health-related behaviour among adolescents.

BACKGROUND: An inverse relationship between religiosity and adolescent health-related behaviour has been repeatedly documented, but evidence regarding gender is scarce. The aim of this study was to assess the association between a wide range of adolescent health-related behaviours and religiosity as well as gender differences in these associations. METHODS: Data were collected in 2010 in Slovakia on 3674 adolescents, with mean age of 14.9 years (response: 79.5%). ORs for levels of religiosity, measured by religious attendance and religious salience, were calculated for 15 behaviours, such as the use of various substances, nutritional behaviour and violent behaviour. The authors then assessed the interactions of religiosity and gender on these behaviours. RESULTS: Religiosity was inversely associated with health-risk behaviour in smoking, drunkenness, cannabis use, having breakfast, soft drinks consumption, screen-based activities and sexual intercourse among both genders and in truancy among girls only. This association was significantly stronger among girls than among boys in smoking, drunkenness and cannabis use. Religiosity was unrelated to the consumption of fruits, vegetables and sweets, physical inactivity, tooth brushing, fighting and bullying others in both genders. CONCLUSIONS: An inverse relationship between religiosity and health-risk behaviour was found in several behaviours (especially use of substances) but not in other behaviours (violent behaviours in particular). Gender seems to moderate this relationship in smoking, drunkenness and cannabis use. Further research is needed on the mechanisms leading to an association between religiosity and health behaviour and on the strength of this association in other countries and cultures.

Degree of urbanization and gender differences in substance use among Slovak adolescents.

OBJECTIVES: Substance use among adolescents varies with gender and between countries. Urbanization may contribute to this. The aim of our study is to explore the association between the degree of urbanization and gender differences in adolescent smoking, binge drinking, and cannabis use. METHODS: A cross-sectional questionnaire survey of Slovak adolescents was used (N = 3,493; mean age = 14.33), stratified by degree of urbanization. The effects of gender and urbanization of the area and their interaction on substance use (smoking, binge drinking, and cannabis) were analyzed using a logistic regression model adjusted for age. RESULTS: Gender and area and their interaction had statistically significant (p < 0.01) associations with substance use. The lower the urbanization of the area, the less riskily females behaved. An exception was found in the case of binge drinking where the results of the interaction of gender and degree of urbanization were not significant for the second least urbanized area. CONCLUSIONS: Prevalence rate of substance use among girls increased along with an increasing degree of urbanization, while the prevalence rate of substance use among boys remained constant.