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PubMed2003

Comparison of health estimates between Victorian Population Health Surveys and National Health Surveys.

OBJECTIVE: The computer-assisted telephone interviewing (CATI) method has grown rapidly in recent years as an epidemiological tool for obtaining data on health issues. However, it is still argued that coverage, methods and lower response rates from CATI surveys compared with face-to-face interviewing may have an impact on the validity of the health estimates obtained. This paper compares demographic and health estimates from the Victorian Population Health Survey (VPHS) 2001, using CATI, with the National Health Survey (NHS) 2001 that is based on face-to-face interviews. METHODS: The profiles of the VPHS (2001) and NHS (2001) respondents were compared, specifically demographic characteristics (age, gender, marital status, country of birth, and employment status) and health-related estimates such as self-reported health status, prevalence of diabetes and asthma, smoking status, daily intake of fruit, categories of psychological distress and private health insurance status. RESULTS: In both surveys, the demographic characteristics and health-related estimates of the adult population were remarkably similar as shown by the similarity of weighted estimates and overlapping confidence intervals. CONCLUSIONS: The degree to which derived estimates correspond in the two independent surveys lends support to the reliability of the CATI method used for collection of routine population health related data.

Adolescent↗
PubMedDate not supplied

The effect of clinic-based health promotion education on perceived health status and health promotion behaviors of adolescent and young adult cancer survivors.

More than 70% of children/adolescents diagnosed with cancer are long-term survivors. Little is known about the health perceptions and practices of this population, and limited previous studies have come exclusively from a risk reduction/health protection model rather than a health promotion model. This study was conducted to describe the perceived health status and health-promoting behaviors of adolescent/young adult cancer survivors. This study used Pender's revised health promotion model; perceived health status and health-promoting behaviors were measured using the General Health Index (GHRI) and the Health Promoting Lifestyle Profile II (HPLP-II). The sample consisted of 60 cancer survivors 2 years after completion of cancer treatment and attending a survivorship clinic. Mean baseline scores for the GHRI (76.66; SD, 10.41) indicate perceived health status is positive and similar to normative (noncancer survivor) adolescent/young adult samples. Surprisingly, there was no correlation between scores on the GHRI and the HPLP-II in this sample (r = 0.03).

Adolescent↗
PubMedDate not supplied

Health status and satisfaction with health care: a longitudinal study among patients served by the Veterans Health Administration.

As the Veterans Health Administration (VHA) places high priority on becoming a performance-based organization, there is an increasing need to quantify and refine its outcome measurement system. Using panel data from VHA ambulatory care patients (1996-1998), we conducted cross-lagged correlations and ordinary least squares regression to examine the relationship between 2 VHA health care values: health status and satisfaction with care. The study results indicated that patients' health status was significantly associated with their satisfaction with care, indicating that patients with better health status were more likely to be satisfied with health care. Although satisfaction with care was both a consequence and a determinant of health status, the effects of health status on satisfaction seemed to be more important than the effects of satisfaction on health status. More research is needed for a better understanding of the dynamic relationship between health status and satisfaction with care.

Adult↗
PubMed1995

The relationship between being satisfied with one's health, good health practices and personal symptoms of ill health.

The focus of this study was satisfaction with health and its relationship to good health practices, symptoms and current use of medication. A self-administered questionnaire was circulated to employees of a railroad company. 3,639 males aged 18 to 54 (41.4 +/- 7.61) were selected. Seven good health practices each scored 1 were not smoking including quitting, not drinking or drinking less than six days a week, exercise more than two days per week, body mass index (BMI) being 20 to 28, total nightly sleeping time between six and nine hours, having breakfast everyday, and not eating between meals. Each score was summed up as health practice index (HPI). We also asked about health satisfaction for the past year, subjective symptoms over the last two to three months, and present medication history. HPI increased significantly in the group aged 45 to 54, this group being satisfied with their health. A decrease in the percentage of eating between meals in the under 35 group, inappropriate BMI in the 45 to 54 group, and regular exercise in the group aged 50 or older was recognized. Health satisfaction was predicted using symptoms, present medication, age and health practice. Standardized discriminant coefficients of symptoms and present medication were 0.672 and 0.610, and they were more associated to health satisfaction than health practice.

Adolescent↗
PubMed1996

Factors influencing the type of health problems presented by women in general practice: differences between women's health care and regular health care.

OBJECTIVE: Differences between health problems presented by women (aged 20-45) to female "women's health care" doctors and both female and male regular health care doctors were investigated. This article explores the relationship of patients' roles (worker, partner, or parent) and the type of health care, controlling for education, to the presentation of psychological, social, and purely somatic problems in general practice. METHOD: Data was derived from a "women's health care" practice and twenty-one group practices providing regular care. The doctors registered detailed information about all patient contacts during a three-month period. Logistic regression analysis was used in order to calculate the likelihood of women attending their doctor to present with psychological, social, or somatic health problems. RESULTS: We found that the effect of education was much stronger than the effect of roles. Women attending women's health care presented more psychological and social problems and less somatic problems than women visiting regular health care doctors. Patients of female and male doctors providing regular care did not differ in this respect between each other. CONCLUSIONS: This study showed that patient characteristics, like roles and education, are related to the type of health problems presented to general practitioners. The type of health care was also important in explaining differences in the problems presented to them. Future research in primary care should include doctor characteristics to better understand how these characteristics might relate to patient outcomes.

Adult↗
PubMed1997

Family physicians and the mental health system. Report from the Mental Health Supplement to the Ontario Health Survey.

OBJECTIVE: To determine family physicians' role in the mental health care system. DESIGN: The Mental Health Supplement to the Ontario Health Survey is an epidemiologic, retrospective, home-interview survey. Results reported here are based on responses of a weighted sample of patients aged 15 to 64. SETTING: Ontario, 1990 to 1991. PARTICIPANTS: Random sample of 9953 household residents. MAIN OUTCOME MEASURES: Standardized assessment of mental disorders, associated risk factors and disability, and patterns of use of mental health services. RESULTS: More people seek mental health services from their family physicians (FPs) than from psychiatrists, social workers, or psychologists. Among patients who consulted for mental health purposes, more than 35.4% saw FPs only, 24.7% saw FPs and other mental health care providers (psychiatrists, psychologists, social workers, others), and 40% saw other mental health care providers only. There were few sociodemographic, diagnostic, or clinical severity differences between the FP-only group and the other two groups. Some evidence suggested FPs saw more recent onset cases, but they were also involved in joint care for more complex or disabled cases. More than 57% of those seeing FPs received medication; 43% received other forms of care. Those seeing FPs only made four visits per year; those who consulted other mental health professionals made 14 to 20. CONCLUSIONS: Our study confirms FPs' important role in the current mental health care system.

Adult↗
PubMed1998

Returns on investment in public health: effect of public health expenditures on infant health, 1983-1990.

In this study, we developed a broad conceptual framework focusing on how public health expenditures impact the nation's health. We then applied this framework to infant health outcomes and, using an eight-year state panel database, empirically analyzed how state public health expenditures, ceteris paribus, impact a state's level of teenage births and the receipt of prenatal care. Two hypotheses were tested. Hypothesis 1 states that over time, public health expenditures and public health activities, ceteris paribus, significantly decrease births to mothers less than 20 years of age. Hypothesis 2 states that over time, public health expenditures and public health activities, ceteris paribus, significantly decrease the number of infants whose mothers received late or no prenatal care. We find support for both hypotheses but observe that the way public health expenditures are measured has an impact on the findings. Other important implications of the study are noted. To our knowledge, this is the first article that has taken an aggregate state perspective over time and applied it to specific measures of infant health.

Adolescent↗
PubMed2006

[Female migrants in the health care system. Health care utilisation, access barriers and health promotion strategies].

Due to the evident interaction between social factors and health, migrants are exposed to specific risk factors and access barriers to health services. Some examples are the lower education level, the low social position and/or the insufficient language skills. This concept is further elaborated in the multi-factorial impacts of health literacy. Female migrants often experience additional discrimination because of their gender. Despite the lack of representative data, consistent studies show that female migrants do not regularly take advantage of health care prevention and present themselves with higher degrees of stress. The current "inadequate health care" manifests itself in a lack of care in the areas of prevention and health education and an abundance in the context of medication and diagnostic procedures. To meet these demands and to further reduce barriers, in particular language barriers, specific strategies for this target group involving both politics and the health care system have to be developed. Besides the employment of interpreters with a native cultural background and the distribution of information booklets, it is an important strategy to reduce structural obstacles such as cultural diversity. To contact these women in their living environment should help to increase their self-determined health promotion. Selected models of good practice in Austria with regard to the themes of FGM (female genital mutilation), violence, heart disease and breast cancer are presented to highlight the specific health situation and risk factors of female migrants as well as successful strategies to confront them.

Adolescent↗
PubMed2003

Reproductive health in school-based health centers: findings from the 1998-99 census of school-based health centers.

PURPOSE: To describe the state of reproductive health services, including access to contraception and health center policies, among school-based health centers (SBHCs) serving adolescents in the United States METHODS: We examined questionnaire data on provision of reproductive health services from the 1998-99 Census of School-Based Health Centers (response rate 70%). We examined 551 SBHCs in schools with high or middle school grades. We used logistic regression to define factors independently associated with services and policies. RESULTS: Most SBHCs (76%) were open full-time; over one-half (51%) of centers had opened in the past 4 years. Services provided, either on-site or by referral, included gynecological examinations (95%), pregnancy testing (96%), sexually transmitted disease (STD) diagnosis and treatment (95%), Human Immunodeficiency Virus (HIV) counseling (94%), HIV testing (93%), oral contraceptive pills (89%), condoms (88%), Depo-Provera (88%), Norplant (78%), and emergency contraception (77%). Counseling, screening, pregnancy testing, and STD/HIV services were often provided on-site (range 55%-82%); contraception was often provided only by referral (on-site availability = 3%-28%). SBHCs with more provider staffing were more likely to provide services on-site; rural SBHCs and those serving younger grades were less likely to provide these services on-site. Over three-quarters (76%) of SBHCs reported prohibitions about providing contraceptive services on-site; the sources of these prohibitions included school district policy (74%), school policy (30%), state law (13%), and health center policy (12%). While SBHCs generally required parental permission for general health services, many allowed adolescents to access care independently for certain services including STD care (48%) and family planning (40%). Older SBHCs were more likely to allow independent access. CONCLUSIONS: SBHCs provide a broad range of reproductive health services directly or via referral; however, they often face institutional and logistical barriers to providing recommended reproductive health care.

Adolescent↗
PubMed1995

Health insurance status and ill health: implications for health professionals.

The article examines the relationship between health insurance status and the instances of self-reported ill health among 1,235 Nebraska adults. Ill health conditions include episodes of both acute and chronic conditions. Health status is measured as Medicare, Medicaid, private health insurance, veterans' benefits, and uninsured. Both Medicare and Medicaid are related to frequency of reported episodes of ill health, but only Medicare is related to reports of chronic conditions. Health professionals interested in improving and sustaining acceptable quality of health care should focus attention on the Medicare and Medicaid populations and not be concerned that adding the currently uninsured to the privately or publicly insured populations would, in the aggregate, increase their burdens of providing care. The study demonstrates the value of using population-based survey data to help health professionals anticipate and respond to patient demand.

Acute Disease↗
PubMed1989

The relationship between retrospective health insurance claims and a health risk appraisal-generated measure of health status.

This research examined the relationship between a measure of health status (defined as the health index--the difference between actual and appraised ages) derived from a health risk appraisal and retrospective health insurance claims taken from one cooperating work organization. A model was defined consisting of 3-year retrospective medical claims as the criterion and age and the health index as predictors. Using a cube-root transformation of medical claims, a significant inverse relationship for age and the health index was identified for men. No relationships were found for women. It was concluded that, for men when age is held constant, a negative relationship exists between retrospective medical claims and a health risk appraisal-generated health status indicator, the health index.

Adult↗
PubMed2005

[Health status, health perception, and health promotion behaviors of low-income community dwelling elderly].

PURPOSE: The purpose of the study was to investigate the health status(present illness, ADL and IADL), health perception, and health promotion behaviors of low-income elderly who are receiving the visiting nurse service in the community. METHOD: The sample of the study was 735 elderly over 65 years old with basic livelihood security, who were conveniently selected from 245 public health centers nation-wide. Data collection was done using a structured questionnaire through interviews by visiting nurses. RESULT: The average number of present illnesses in the study subjects was 4.18. The average scores of ADL and IADL were 15.903.39 and 9.772.97 respectively, which indicates a relatively independent everyday life. However, 64.2% of the subjects perceived their health status as 'not healthy'. In terms of health promotion behaviors, 77.8% of the subjects had ceased smoking, 83.9% stopped drinking, 56.4% had a regular diet, 45.8% received regular physical check-ups during the past two years, and 66% received flu shots. Approximately 50% of the subjects were practicing 3-4 health promotion behaviors. Significant factors associated with health promotion behaviors were ADL, IADL and self-efficacy. CONCLUSION: Health promotion programs which focus on regular diet, exercise, and regular physical check-ups should be developed to improve independence of everyday life and quality of life among low-income elderly.

Activities of Daily Living↗
PubMed2005

Health@Home: the work of health information management in the household (HIMH): implications for consumer health informatics (CHI) innovations.

OBJECTIVE: Contemporary health care places enormous health information management demands on laypeople. Insights into their skills and habits complements current developments in consumer health innovations, including personal health records. Using a five-element human factors model of work, health information management in the household (HIMH) is characterized by the tasks completed by individuals within household organizations, using certain tools and technologies in a given physical environment. DESIGN: We conducted a descriptive-exploratory study of the work of HIMH, involving 49 community-dwelling volunteers from a rural Midwestern community. MEASUREMENTS: During in-person interviews, we collected data using semistructured questionnaires and photographs of artifacts used for HIMH. RESULTS: The work of HIMH is largely the responsibility of a single individual, primarily engaged in the tasks of acquiring, managing, and organizing a diverse set of health information. Paper-based tools are most common, and residents develop strategies for storing information in the household environment aligned with anticipated use. Affiliative relationships, e.g., parent-child or spousal, within the household serve as the organization that gives rise to health information management practices. Synthesis of these findings led to identification of several storage strategies employed in HIMH. These strategies are labeled "just-in-time," "just-because," "just-in-case," and "just-at-hand," reflecting location of the artifacts of health information and anticipated urgency in the need to retrieve it. CONCLUSION: Laypeople develop and employ robust, complex strategies for managing health information in the home. Capitalizing on these strategies will complement and extend current consumer health innovations to provide functional support to people who face increasing demands to manage personal health information.

Adolescent↗
PubMed2006

Public health, health promotion and the health of people in prison.

Recent policy changes in England and Wales have transferred commissioning and funding of prison healthcare from the prison service to the National Health Service for the first time in its history. Most health services in prisons are now provided by primary care trusts (PCTs), with the consequence that PCTs have a new highly vulnerable population for whom health needs must be assessed and services provided. This article describes what is currently known about the health needs of prisoners and the subsequent implications for public health and health promotion. Following a brief discussion of national and international policy on health promotion in prisons, an overview is given of recent national and local initiatives on public health issues.

England↗
PubMedDate not supplied

Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey.

BACKGROUND: The context in which patients consume health information has changed dramatically with diffusion of the Internet, advances in telemedicine, and changes in media health coverage. The objective of this study was to provide nationally representative estimates for health-related uses of the Internet, level of trust in health information sources, and preferences for cancer information sources. METHODS: Data from the Health Information National Trends Survey were used. A total of 6369 persons 18 years or older were studied. The main outcome measures were online health activities, levels of trust, and source preference. RESULTS: Analyses indicated that 63.0% (95% confidence interval [CI], 61.7%-64.3%) of the US adult population in 2003 reported ever going online, with 63.7% (95% CI, 61.7%-65.8%) of the online population having looked for health information for themselves or others at least once in the previous 12 months. Despite newly available communication channels, physicians remained the most highly trusted information source to patients, with 62.4% (95% CI, 60.8%-64.0%) of adults expressing a lot of trust in their physicians. When asked where they preferred going for specific health information, 49.5% (95% CI, 48.1%-50.8%) reported wanting to go to their physicians first. When asked where they actually went, 48.6% (95% CI, 46.1%-51.0%) reported going online first, with only 10.9% (95% CI, 9.5%-12.3%) going to their physicians first. CONCLUSION: The Health Information National Trends Survey data portray a tectonic shift in the ways in which patients consume health and medical information, with more patients looking for information online before talking with their physicians.

Adolescent↗
PubMed2003

Modelling health, income and income inequality: the impact of income inequality on health and health inequality.

A framework is developed to analyse the impact of the distribution of income on individual health and health inequality, with individual health modelled as a function of income and the distribution of income. It is demonstrated that the impact of income inequality can generate non-concave health production functions resulting in a non-concave health production possibility frontier. In this context, the impact of different health policies are considered and it is argued that if the distribution of income affects individual health, any policy aimed at equalising health, which does not account for income inequality, will lead to unequal distributions of health. This is an important development given current UK government attention to reducing health inequality.

Health Policy↗
PubMed1979

Natural history of male psychologic health: effects of mental health on physical health.

Four decades ago 204 men were selected as adolescents for an interdisciplinary study of health; since then they have been followed biennially. Of the 185 men who remained in the study and in good health until 1964 (age, 42 +/- 1 years), 100 men remained in excellent physical health over the next 11 years, 54 acquired minor problems, and 31 acquired serious chronic illness or died. Of 59 men with the best mental health, assessed from the age of 21 to 46 years, only two became chronically ill or died by the age of 53. Of the 48 men with the worst mental health from the age of 21 to 46, 18 became chronically ill or died. The relation between previous mental health and subsequent physical health remained statistically significant when the effects on health of alcohol, tobacco use, obesity, and longevity of ancestors were excluded by multiple regression analysis. The data suggest that good mental health retards midlife deterioration in physical health.

Adult↗
PubMed2001

Prioritization of occupational sentinel health events for workplace health and hazard surveillance: the Pan American Health Organization experience.

Within the ongoing strategy of the Workers' Health program at the Pan American Health Organization on strengthening surveillance in the field of workers' health in the Americas (the Region), a project was conducted in July 1999 in Washington, D.C. The objectives of the project were to discuss the problems found in the surveillance of workers' health, to develop a methodology and use it to prioritize and select the top three occupational sentinel health events for incorporation into the surveillance systems in the Region, and to develop the initial protocols for establishing the surveillance systems for the three chosen occupational sentinel health events. The Pan American Health Organization invited 24 occupational health experts from the Region to participate in the project. Over an intensive 3-day period, the experts heard reports of workplace surveillance activities in the various countries in the Region; developed prioritization methods; identified and prioritized a list of occupational sentinel health events; and developed three surveillance protocols, one each for occupational fatal injuries, pesticide poisoning, and low back pain. The results on the prioritization of occupational sentinel health events and the development of surveillance protocols are reported in this article.

Central America↗