Search

Self-rated health (SRH) is an independent predictor of mortality; studies have investigated correlates of SRH to explain this predictive capability. However, the interplay of a broad array of factors that influence health status may not be adequately captured with parametric multivariate regression. This study investigated associations between several health determinants and SRH using recursive partitioning methods. This non-parametric analytic approach aimed to reflect the social-ecological model of health, emphasizing relationships between multiple health determinants, including biological, behavioral, and from social/physical environments. The study sample of 3648 men and women was drawn from the year 15 (2000-2001) data collection of the CARDIA Study, USA, in order to study a young adult sample. Classification tree analysis identified 15 distinct, mutually exclusive, subgroups (eight with a larger proportion of individuals with higher SRH, and seven with a larger proportion of lower SRH), and multi-domain risk and protective factors associated with subgroup membership. Health determinant profiles were not uniform between subgroups, even for those with similar health status. The subgroup with the largest proportion of higher SRH was characterized by several protective factors, whilst that with the largest proportion of lower SRH, with several negative risk factors; certain factors were associated with both higher and lower SRH subgroups. In the full sample, physical activity, education and income were highest ranked by variable importance (random forests analysis) in association with SRH. This exploratory study demonstrates the utility of recursive partitioning methods in studying the joint impact of multiple health determinants. The findings indicate that factors do not affect SRH in the same way across the whole sample. Multiple factors from different domains, and with varying relative importance, are associated with SRH in different subgroups. This has implications for developing and prioritizing appropriate interventions to target conditions and factors that improve self-rated health status.

An understanding of factors influencing health in socioeconomic groups is required to reduce health inequalities. This study investigated combinations of health determinants associated with self-rated health (SRH), and their relative importance, in income-based groups. Cross-sectional data from year 15 (2000 - 2001) of the CARDIA study (Coronary Artery Risk Development in Young Adults, USA) - 3648 men and women (mean 40 years) - were split into 5 income-based groups. SRH responses were categorized as 'higher'/'lower'. Health determinants (medical, lifestyle, and social factors, living conditions) associated with SRH in each group were analyzed using classification tree analysis (CTA). Income and SRH were positively associated (p

Introduction Microfinance initiatives have become popular, particularly in low- and middle-income settings, as a means of promoting rural development, (1) increasing the bargaining power of women and improving household welfare. [...], Objective To assess the impact on health-related outcomes, of group microfinance schemes based on collective empowerment. Methods We searched the databases Social Sciences Citation Index, Embase, MEDLINE, MEDLINE In-Process, PsycINFO, Social Policy & Practice and Conference Proceedings Citation Index for articles published between 1 January 1980 and 29 February 2016. Articles reporting on health impacts associated with group-based microfinance were included in a narrative synthesis. Findings We identified one cluster-randomized control trial and 22 quasi-experimental studies. All of the included interventions targeted poor women living in low-or middle-income countries. Some included a health-promotion component. The results of the higher quality studies indicated an association between membership of a microfinance scheme and improvements in the health of women and their children. The observed improvements included reduced maternal and infant mortality, better sexual health and, in some cases, lower levels of interpersonal violence. According to the results of the few studies in which changes in empowerment were measured, membership of the relatively large and well-established microfinance schemes generally led to increased empowerment but this did not necessarily translate into improved health outcomes. Qualitative evidence suggested that increased empowerment may have contributed to observed Improvements in contraceptive use and mental well-being and reductions in the risk of violence from an intimate partner. Conclusion Membership of the larger, well-established group-based microfinance schemes is associated with improvements In some health outcomes. Future studies need to be designed to cope better with bias and to assess negative as well as positive social and health impacts. Objectif Evaluer les consequences sur les resultats sanitaires de projets de microfinancement de groupe axes sur la responsabilisation collective. Methodes Nous avons recherche dans les bases de donnees Social Sciences Citation Index, Embase, MEDLINE, MEDLINE In-Process, PsyclNFO, Social Policy & Practice et Conference Proceedings Citation Index des articles publies entre le 1 er janvier 1980 et le 29 fevrier 2016. Les articles qui rendaient compte des consequences sur le plan de la sante liees au microfinancement de groupe ont ete inclus dans une synthese descriptive. Resultats Nous avons retenu un essai controle randomise par groupe et 22 etudes quasi experimental. Toutes les interventions incluses ciblaient des femmes pauvres vivant dans des pays a revenu faible ou intermediate. Certaines comprenaient un volet axe sur la promotion de la sante. Les resultats des etudes de meilleure qualite ont demontre un lien entre l'adhesion a un projet de microfinancement et Amelioration de la sante des femmes et de leurs enfants. Les ameliorations observees se traduisaient par une reduction de la mortalite maternelle et infantile, une meilleure sante sexuelle et, dans certains cas, une diminution des niveaux de violence interpersonnelle. Selon les resultats des rares etudes dans lesquelles ont ete mesures les changements lies a la responsabilisation, l'adhesion a des projets de microfinancement relativement importants et bien connus a, en regie generate, favorise la responsabilisation, mais ne s'est pas forcement traduite par de meilleurs resultats sanitaires. Des donnees qualitatives permettent de penser que le renforcement de la responsabilisation a pu contribuer a des ameliorations concernant l'emploi de contraceptifs et le bien-etre mental ainsi qu'a la diminution du risque de violence au sein du couple. Conclusion L'adhesion a un projet de microfinancement de groupe important et bien connu est associee a I'amelioration de certains resultats sanitaires. De futures etudes doivent etre envisagees pour venir a bout de tout parti pris et evaluer les consequences positives, mais aussi negatives, sur le plan social et de la sante. Objetivo Evaluar el impacto sobre los resultados relacionados con la salud de planes de microfinanciacion de grupos basados en el empoderamiento colectivo. Metodos Se realizaron busquedas en las bases de datos de Social Sciences Citation Index, Embase, MEDLINE, MEDLINE In-Process, PsycINFO, Social Policy & Practice y Conference Proceedings Citation Index para encontrar articulos publicados entre el 1 de enero de 1980 y el 29 de febrero de 2016. Articulos que Informan sobre los efectos sobre la salud relacionados con la microfinanciacion de grupos se incluyeron en una siiitesis narrativa. Resultados Se identificaron un ensayo controlado aleatorizado y 22 estudios cuasiexperimentales. Todas las intervenciones incluidas apuntaban a mujeres pobres que vivian en paises con ingresos bajos o medios. Algunas incluian un componente de fomento de la salud. Los resultados de los estudios de mayor calidad indicaron una relacion entre la pertenencia de un plan de microfinanciacion y mejoras en la salud de las mujeres y sus hijos. Entre las mejoras observadas se encontraban una reduccion de la mortalidad Infantil y materna, una mejora de la salud sexual y, en ciertos casos, menores niveles de violencia interpersonal. Segun los resultados de los pocos estudios en los que se midieron los cambios en el empoderamiento, la pertenencia de los planes de microfinanciacion relativamente grandes y bien constituidos ha dado lugar, en terminos generales, a un mayor empoderamiento, pero esto no se traduce necesariamente en unos mejores resultados sanitarios. Las pruebas cualitativas sugirieron que un aumento del empoderamiento puede haber contribuido a mejoras observadas en el uso de metodos anticonceptivos y el bienestar mental, asi como un descenso del riesgo de violencia domestica. Conclusion La pertenencia de planes de microfinanciacion por grupos mayores y bien constituidos esta vinculada a mejoras en algunos resultados sanitarios. Es necesario disenar futuros estudios para afrontar mejor la parcialidad y para evaluar los impactos sanitarios y sociales positivos y negativos.