This study aimed to investigate the relationships among overactive bladder (OAB) symptom severity, bother, help-seeking behavior, and quality of life (QOL) in patients with type 2 diabetes. A total of 127 diabetic patients, aged at least 18 years, with overactive bladder from a hospital in Shandong Province, China, were recruited for this study. Symptom severity, bother, and quality of life were assessed using the Overactive Bladder Symptom Score (OABSS), Patient Perception of Bladder Condition (PPBC), and Overactive Bladder Questionnaire Short Form (OAB-q SF), respectively. Help-seeking behavior was assessed by asking patients whether they consulted health care professionals or received treatment for their bladder problems. A two-step path analysis was performed to analyze the data. OAB symptom severity was directly associated with lower levels of QOL, and the strength of this association was no longer significant when taking bother and help-seeking behavior into account. Bother increased with OAB symptom severity, and patients with bothersome OAB tended to have lower levels of QOL. Moreover, bother increased help-seeking behavior; however, patients who sought help tended to have lower levels of QOL. Our findings highlight the role of bother and help-seeking behavior in the relationship between OAB symptom severity and QOL. To improve a patient’s QOL, health care providers should focus not only on symptom bother but also on dysfunctional help-seeking patterns.

Objectives We used nationally representative samples of China and the US older population to investigate (1) whether factors influencing self-rated health among older Chinese were similar to those among older Americans; and (2) whether there was a significant cross-national difference in self-rated health between China and the USA after controlling those available influencing factors. Design A cross-sectional study. Data came from the 2014 Health and Retirement Study and China Health and Retirement Longitudinal Study conducted from 2014 to 2015. Participants Our final sample size totaled 8905 older adults in the USA and 4442 older adults in China. Outcome The response variable was self-rated health. Ordered logistic regression models were conducted to investigate factors influencing self-rated health among older adults. Results More than three-fourths (78%) of older adults in China reported fair or poor health status, while almost 74% of older adults in the USA reported excellent, very good or good health status. In the overall ordered logistic regression model, when controlling statistically for sociodemographics, family structure, functional limitations, cognition, chronic conditions, mental health and health-related behaviours, the Chinese survey respondents were much more likely to rate their health as being poorer than the US respondents. The odds of having better versus poorer health was almost five times greater in American older adults than those in China (OR=4.88, 95% CI 4.06 to 5.86). Older adults in China living alone rated their health better than those living with spouse/partner; however, no significant difference was found between these two living arrangements in older Americans. In contrast, older adults in the USA living with others rated their health worse compared with those living with spouse/partner. In addition, older adults who had more activities of daily living limitations, poorer self-reported memory, worse mental health and chronic health conditions had lower self-rated health in both countries. Conclusions We found a striking difference in self-rated health between China and the USA even after controlling for measures of disease, functional status and other influencing factors. Relative to their American counterparts, Chinese elders were much more likely to report worse health.

Background Hospitalisations are very common among nursing home residents and many of these are deemed inappropriate or preventable. Little is known about whether clinical care quality is related to hospitalisation, especially potentially preventable hospitalisations (PPHs). Among the few studies that have been conducted, the findings have been inconsistent. The objective of this study was to examine the relationship between quality indicators and overall and PPHs among Medicaid beneficiaries aged 65 years and older receiving care at nursing homes in Minnesota. Methods 23 risk-adjusted quality indicators were used to assess nursing home quality of care. Quality indicators and other facility-level variables from the Minnesota Nursing Home Report Card were merged with resident-level variables from the Minimum Data Set. These merged data were linked with Medicaid claims to obtain hospitalisation rates during the 2011–2012 period. The sample consisted of a cohort of 20 518 Medicaid beneficiaries aged 65 years and older who resided in 345 Minnesota nursing homes. The analyses controlled for resident and facility characteristics using the generalised linear mixed model. Results The results showed that about 44 % of hospitalisations were PPHs. Available quality indicators were not strongly or consistently associated with the risk of hospitalisation (neither overall nor PPH). Among these 23 quality indicators, five quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, pressures sores, bladder continence and activities of daily living [ADL] dependence) were related significantly to hospitalisation and only four quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, ADL dependence and urinary tract infections) were related to PPH. Conclusion Although general quality indicators can be informative about overall nursing home performance, only selected quality indicators appear to tap dimensions of clinical quality directly related to hospitalisations.