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Highlights • This paper explores the effects of four dimensions of social exclusion on self-rated health and depression among older people in China. • Lower level of exclusion from social relationships was associated with less likely to report fair or poor SRH. • Lower level of subjective feelings of exclusion was associated with less likely to report fair or poor SRH. • Lower level of subjective feeling of exclusion was associated with less likely to report depression. • Lower level of exclusion from financial products was associated with less likely to report depression. Abstract Background It is well established that social exclusion is a key social determinant of health; however, such association between social exclusion and health outcomes among older people remain a relatively under-researched area. This paper explores the effects of four dimensions of social exclusion on self-rated health and depression among older people in China. Methods This paper includes 8038 individuals aged 60 and over from the first wave national multi-stage probability sample (2014) from the China Longitudinal Aging Social Survey (CLASS). Descriptive univariate information for individual variables and four dimensions of social exclusion are presented. Multinomial and binary logistic regression models are used to examine the associations between social exclusion and self-rated health and depression. Results Older people who were in the lower level of exclusion from social relationships or subjective feelings of exclusion were significantly less likely to report fair or poor self-rated health than people in the higher level of exclusion (lower level of exclusion from social activities was significantly associated with being less likely to report poor SRH only). Older people who were in the lower level of subjective feeling of exclusion or exclusion from financial products were significantly less likely to report depression. Conclusions Different dimensions of social exclusion have different effects on self-rated health and depression. Social policies need to reflect this and efforts of services could usefully be oriented to prevent multi-dimensions of social exclusion. Ultimately, such policies should have the potential to enhance the health of older people in China. [ABSTRACT FROM AUTHOR]

Background Chronic patients are frequent users of healthcare services and are prone to hospital admissions. In Valencia (Spain) the Valcronic programme aims to manage chronic patients through different levels of telemonitoring and telecare. This paper examines the impact of the Valcronic programme on self-perceived HRQOL in a one-year period and on perceptions of satisfaction and usefulness in a sample of older adults with chronic diseases. Methods The sample ( n = 74) was randomly selected from Valcronic users and was stratified considering different variables. HRQOL was assessed using the EQ-5D questionnaire at two points in time: before the beginning of the Valcronic programme and after a one-year follow-up. Satisfaction and usefulness were evaluated one year after users’ inclusion. Results The whole sample experienced improvement, although not significant, of its HRQOL; patients over 75 showed impairment. Patients with at least one problem in the EQ-5D dimensions decreased after one year (82.43% vs. 74.32%). Users’ perceptions of satisfaction and usefulness were highly positive. Conclusions Our sample benefited from the Valcronic programme, experiencing an improvement in their HRQOL, a decreased use of health resources or high satisfaction levels. Implications Further adjustments are needed to address a comprehensive response to the needs of the global population of reference. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present paper was, first, to analyze a four level biopsychosocial model to examine the interaction of various initial health behaviors and, second, their consequences with respect to the course of physical fitness (PF) and health of adults over the course of 18 years. Design: Longitudinal study based on medical examinations and self-ratings. Method: Path analysis along with latent growth curve analysis was based on the German study about the relationship of physical activity, fitness and health (1992–2010). Data were collected from 495 adults (243 women) with an average age of 45.03 years in 1992 (SD = 7.45). Participants were randomly selected from the official registers of local residents' registration offices in the community of Bad Schönborn. Results: For the mean PF and health levels in 1992, direct and indirect influences were shown on four levels including socioeconomic status and immigration on the first level, outcome expectations and stress coping strategies on the second level as well as eating patterns and physical activity on the third level; furthermore, the course of PF and the course of health (from 1992 until 2010) were affected by the initial behaviors (physical activity and eating patterns in 1992); finally PF and health were not related. Conclusions: Influences on four levels provided evidence for the complexity of PF and health (outcome level). Initial behaviors predicted current PF and health status, as well as their course. Thus, preventive measures should ensure that healthy behaviors are adopted early in adulthood. [Copyright &y& Elsevier]

Abstract: Aims: This paper is aimed to develop and validate the hypertension scale of the system of Quality of Life Instruments for Chronic Diseases, QLICD-HY. Methods: The QLICD-HY instrument was developed based on programmed decision procedures with multiple nominal and focus group discussions and pilot testing. A total of 157 inpatients with hypertension were used to provide the data measuring QOL three times before and after treatment. The psychometric properties of the scale were evaluated with respect to validity, reliability and responsiveness employing correlation and factor analyses, and t-tests. Results: Correlation and factor analyses confirmed good construct validity and criterion-related validity when using Short Form (36) Health Survey (SF-36) as a criterion. Test–retest reliability coefficients (Pearson r and intra-class correlation (ICC)) for the overall instrument score and all domains except for the hypertension-specific domain (SPD) (0.75) were higher than 0.80 with a range of 0.75–0.91; the internal consistency α for all domains except for the hypertension-specific domain (0.66) was higher than 0.70. The overall score and scores for most facets within each domain except for the social domain (SOD) had statistically significant changes (t-tests) after treatment with moderate effect sizes. Conclusion: QLICD-HY has good validity, reliability, responsiveness and can be used as the quality-of-life instrument for patients with hypertension. [Copyright &y& Elsevier]

Abstract: Social structures and socioeconomic patterns are the major determinants of population health. However, very few previous studies have simultaneously analysed the “social” and the “economic” indicators when addressing social determinants of health. We focus on the relevance of economic and social capital as health determinants by analysing various indicators. The aim of this paper was to analyse independent associations, and interactions, of lack of economic capital (economic hardships) and social capital (social participation, interpersonal and political/institutional trust) on various health outcomes. Data was derived from the 2009 Swedish National Survey of Public Health, based on a randomly selected representative sample of 23,153 men and 28,261 women aged 16–84 year, with a participation rate of 53.8%. Economic hardships were measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. Social capital was measured by social participation, interpersonal (horizontal) trust and political (vertical/institutional trust) trust in parliament. Health outcomes included; (i) self-rated health, (i) psychological distress (GHQ-12) and (iii) musculoskeletal disorders. Results from multivariate logistic regression show that both measures of economic capital and low social capital were significantly associated with poor health status, with only a few exceptions. Significant interactive effects measured as synergy index were observed between economic hardships and all various types of social capital. The synergy indices ranged from 1.4 to 2.3. The present study adds to the evidence that both economic hardships and social capital contribute to a range of different health outcomes. Furthermore, when combined they potentiate the risk of poor health. [Copyright &y& Elsevier]

Abstract: As a social determinant of health, religiosity remains not well understood, despite the prevalence of religious activity and prominence of religious institutions in most societies. This paper introduces a working measure of Religious Social Capital and presents preliminary associations with neighborhood social capital and urban stressors. Religious social capital is defined as the social resources available to individuals and groups through their social connections with a religious community. Domains covered include group membership, social integration, values/norms, bonding/bridging trust as well as social support. Cross-sectional data come from a convenience sample of 104 community dwelling adults residing in a single urban neighborhood in a large US city, who also provided information on neighborhood social capital, and experiences of urban stressors. Results suggest that religious social capital is a valid construct that can be reliably measured. All indicators of religious social capital were higher among those who frequently attended religious services, with the exception of bridging trust (trust of people from different religious groups). A weak, inverse, association was also observed between religious and neighborhood social capital levels. Levels of religious social capital were correlated with higher levels of reported urban stressors, while neighborhood social capital was correlated with lower urban stressor levels. A significant percent of the sample was unaffiliated with a religious tradition and these individuals were more likely to be male, young and more highly educated. Social capital is a promising construct to help elucidate the influence of religion on population health. [Copyright &y& Elsevier]

Abstract: Although the literature on housing and health is extensive, most research comes from developed countries. Relatively little work on the topic has been done in developing countries such as Ghana where socio-economic and cultural characteristics are generally different. This paper reports on primary research that investigates the relationship between housing and self reported general and mental health in Accra, Ghana. The study focused on how the social and economic dimensions of housing, specifically, demand, control and material attributes (affordability, dwelling type) influence individuals’ attachment to their home as a refuge for daily living. A cross-sectional survey was administered to a randomly selected sample (n = 562) in three contrasting neighbourhoods. Overall, housing conditions, demand and control residents have to where they live, emerged as significant predictors of self reported general and mental health status. The influence of these variables superseded well known correlates of health status, income and educational attainment, attesting to their importance in a worsening housing environment. The findings point to the need for policy that recognizes that housing is not only a physical shelter but also an important health resource. [Copyright &y& Elsevier]