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PubMed2006

Missing data due to a 'checklist misconception-effect'.

OBJECTIVES: To analyze the extent and relevance of a postulated "checklist misconception-effect" (a specific response pattern characterized by symptom-free persons not checking the "not at all"-category). METHODS: Our data is derived from a survey of blue collar workers (n = 228) who previously had filed in applications for medical rehabilitation benefits. We defined the "checklist misconception-effect" by the following response pattern: (1) at least one missing value and (2) at least one valid item response and (3) no 'not at all' responses. RESULTS: 75% of the responders had complete data, 16.2% a postulated 'checklist misconception-effect'. Substantial co-variations with socio-demographic characteristics or health status indicators could not be found. Additional imputation of missing values under the assumption of a "checklist misconception-effect" led to a reduction of missing data in the somatisation-subscale score from 12.3% to 0.4% compared to a simple manual-based calculation. Correlation with various external criteria (general health perception, level of functioning, depression) remained unchanged. CONCLUSIONS: Ignoring the "checklist misconception-effect" would overestimate symptom load. However, the validity of this effect has still to be proven in methodological studies.

Adult↗
PubMed1997

Life circumstances, lifestyles and oral health among older Canadians.

OBJECTIVE: To examine the contribution of life circumstances and lifestyles, and the interaction between them, to the oral health status of older Canadians. DESIGN: Subjects were recruited using a telephone interview survey, based on random digit dialling and subsequently interviewed and clinically examined. PARTICIPANTS: Four hundred and ninety-eight dentate subjects aged 53 years and over living independently in Ontario, Canada. MEASURES: Subjects were classified as living in deprived, middle or privileged life circumstances based on their social and personal attributes. They were also classified as having relatively poor or relatively favourable lifestyles based on their health behaviours. The oral health status indicators used were: the number of missing teeth, the number of decayed and filled root surfaces, mean periodontal attachment loss, the number of oral symptoms in the previous four weeks, self-rated oral health, and a psycho social impact score. RESULTS: In bivariate analyses, life circumstances were significantly associated with three of these six indicators and lifestyles with five. Healthy lifestyles had an effect on the oral health status of those living in deprived and middle circumstances but not on the privileged, although no overall interaction effect was observed in multivariate analyses controlling for gender and age. CONCLUSIONS: These data suggest that, among this population, life circumstances and lifestyles are both related to oral health. They also indicate that the role of these factors varies according to the condition and health indicator in question.

Age Factors↗
PubMed2001

Health and health care status of African-born residents of Metropolitan Washington, DC.

This study examines health status, health behaviors, and health care access and utilization among African-born residents of the metropolitan Washington, DC area. A telephone survey was administered to a random sample of 525 African-born adults. Results are compared to those for the general local and regional population. Twenty-nine percent of respondents were uninsured; 24% lacked a usual, appropriate source of primary care. Among female respondents, 44% and 34% reported never having had a mammogram or pap smear, respectively. Most health status indicators demonstrated relatively good health, but 15% of respondents reported one of the infectious diseases we investigated. Consumption of alcohol and tobacco was relatively low. African-born residents are generally at risk regarding access to health care, and certain segments (the uninsured, recent arrivals) face critical access barriers. Infectious diseases are a notable feature of health status, and use of some preventive and dental services is considerably lower than for the general population.

Journal Article↗
PubMedDate not supplied

Measuring outcomes in care of the elderly.

This observational study was designed to assess whether routine measurement of outcomes using standard instruments is possible as part of clinical routine in care of the elderly, and to establish if such instruments are responsive to clinical change. Indices of functional status, cognitive function and subjective health status were collected routinely on admission and discharge in 540 inpatients and 340 patients attending a day hospital. Data collection became integrated into clinical routine. Response rates were generally good and yielded acceptably complete data. For inpatients, outcome was reflected by measurement of survival, physical function (Barthel index) and social status, each of these indicators showing significant change between admission and discharge. For day hospital patients, neither these, nor the Nottingham ADL scale, nor a health status indicator proved sufficiently responsive to clinical change to merit recommendation as outcome indicators for routine use in older patients. In ambulatory care in older patients, such as those attending a day hospital, new approaches are needed to measure clinical outcomes.

Activities of Daily Living↗
PubMed2000

Measuring continuing medical education effectiveness and its ramification in a community hospital.

BACKGROUND: Is multi-interventional continuing medical education (CME) effective in changing one or more health care outcomes? METHOD: In a noncontrolled study (noncontrolled because of lack of adequate funding and support) of 328 volunteer recruits, a health status questionnaire including measuring serum cholesterol was obtained. After having identified deficiencies in the health status indicators, CME interventions, including didactic lectures to physicians and allied health professionals, announcements of data in physician lounges and departmental meetings, letters to physicians, and patient education, were introduced. Approximately 6 months after the first survey, a second survey was carried out and was compared with the initial data. RESULTS: Of 1,001 volunteers who were initially surveyed, only 328 returned for follow-up. Among seven relevant variables, the only change was an increase in dietary instruction by physicians and a reduction in serum cholesterol. CONCLUSION: In this noncontrolled multi-interventional CME study on the treatment of hyperlipidemia, there were indications of improvement in physician instructions on diet and a reduction in serum cholesterol.

Adult↗
PubMed2004

Syphilis as a social disease: experience from the post-communist transition period in Estonia.

Increased incidence of sexually transmitted diseases (STD) and radical social changes have taken place at the same time in Estonia. Our aim was to study the trends in syphilis incidence, selected sociodemographic factors and health status indicators during the economic transition. Associations were estimated by the ordinary least square regression method for change in and actual values of syphilis and tuberculosis incidence rate (IR), percentage of non-ethnic Estonians and urban population, homicides rate, unemployment rate and, birth rate. The analysis was performed by counties at three different time periods. Syphilis IR significantly correlated with the proportion of non-ethnic Estonians, urban population, tuberculosis IR and birth rate. Change of syphilis IR correlated significantly with concurrent changes in unemployment rate and tuberculosis IR. Our findings support the theory that syphilis is a social disease, thus emphasizing the importance of social factors in the occurrence of STDs.

Adult↗
PubMed2006

Socio-economic position, household composition, health status and indicators of the well-being of mothers of children with and without intellectual disabilities.

BACKGROUND: Many previous studies have reported that mothers of children with intellectual disabilities (IDs) are more likely to show signs of psychological distress and have lower well-being than mothers of 'typically developing' children. Our aim was to estimate the extent to which these differences may be accounted for by between-group differences in socio-economic position. METHODS: This study involved secondary analysis of happiness, self-esteem and self-efficacy variables in a nationally representative sample of 6954 British mothers with dependent children under the age of 17 years, 514 of whom were supporting a child with an ID. RESULTS: Mothers of children with IDs reported lower levels of happiness, self-esteem and self-efficacy than mothers of children without IDs. Statistically controlling for differences in socio-economic position, household composition and maternal characteristics fully accounted for the between-group differences in maternal happiness, and accounted for over 50% of the elevated risk for poorer self-esteem and self-efficacy. CONCLUSIONS: A socially and statistically significant proportion of the increased risk of poorer well-being among mothers of children with IDs may be attributed to their increased risk of socio-economic disadvantage.

Adolescent↗
PubMed2005

This place is killing me: a comparison of counties where the incidence rates of AIDS increased the most and the least.

BACKGROUND: The objective of this study was to identify the socioeconomic and health characteristics of communities with the largest proportional increases in incidence rates of acquired immunodeficiency syndrome (AIDS). METHODS: Reported AIDS cases (1981-1990 and 1995-1999) were used for a comparison between 20 US counties with the largest proportional increases in incidence rates of AIDS and 20 US counties with the smallest increases. Data were obtained from Community Health Status Indicators Reports of the Health Resources and Services Administration (HRSA) and from the US Census Bureau. RESULTS: Counties with the largest increases in the incidence of AIDS had lower levels of income, education, and literacy; higher incidence rates of syphilis, age-adjusted mortality (all causes), and infant mortality; more low-birth-weight infants; and higher levels on all 9 specific mortality measures in the HRSA reports. CONCLUSIONS: The incidence of AIDS increased the most in areas where many other health problems occurred. Research is needed to identify and address the root causes of ill health.

Adolescent↗
PubMedDate not supplied

Multi-trial biomarker approach in Meganyctiphanes norvegica: a potential early indicator of health status of the Mediterranean "whale sanctuary.".

The aim of this study was to propose a suite of biomarkers (BPMO activity, NADPH-cytocrome c reductase, NADH-ferricyanide reductase. esterases, porphyrins, vitellogenin and zona radiata proteins) and residue levels (organochlorines, PAHs and heavy metals) in the zooplanktonic euphausiid Meganyctiphanes norvegica as a potential multi-disciplinary diagnostic tool for assessment of the health status of the Mediterranean "whale sanctuary". Very little difference in BPMO was detected between sites, with values ranging from 0.75 to 2.68 U.A.F./mg prot/h. On the other hand larger differences between sites were found for reductase activities. Esterases (AChE), porphyrins (Copro-, Uro-, Proto-porphyrins) vitellogenin and zona radiata proteins were also detectable in this zooplanctonic species. Hg showed mean levels of 0.141 ppm d.w., Cd 0.119 ppm d.w. and Pb 0.496 ppm d.w. Total PAHs ranged from 860.7 to 5,037.9 ng/g d.w., carcinogenic PAHs from 40.3 to 141.7 ng/g d.w., HCB from 3.5 to 11.6 ng/g d.w., DDTs from 45.3 to 163.2 ng/g d.w. and the PCBs from 84.6 to 210.2 ng/g d.w.

Animals↗
PubMed2004

First results of Lichtenstein hernia repair with Ultrapro-mesh as cost saving procedure--quality control combined with a modified quality of life questionnaire (SF-36) in a series of ambulatory operated patients.

There are about 200,000 hernia repairs per year in Germany and about 770,000 in the U.S. In the United States most hernia repairs (80-90%) are performed as day surgery procedure; 90% of operations are open herniorrhaphies with mesh. Quality control includes the registration of complications, recurrence, and quality of life. In a prospective study 50 consecutive patients with inguinal hernia eligible for open mesh repair (modified Lichtenstein hernia repair), mostly Nyhus III and IV classification, were operated using light-weight Ultrapro-mesh (monocryl-prolene-composite, Ethicon Products), and interviewed 10 days after the operation according to a modified SF-36 questionnaire. Patients were examined three months later. There were 29 direct hernias, 21 combined (direct and indirect) hernias, 8 indirect hernias; 8 patients had hernias on both sides. 8 patients (16%) presented with recurrent hernias, mostly suture or laparoscopic repairs before. There were no intra-operative complications. 2 patients suffered from a moderate haematoma, which did not necessitate a surgical repair, after accidental intake of aspirin preoperatively in one case and after preoperative low-molecular-weight heparin prophylaxis. There were no other complications. All 50 patients (100%) had returned the questionnaire. 38 patients (78%) reported no or mild pain; only one patient (2%) suffered from severe pain, none had very severe pain. 32 patients (64%) applied no pain medication or only for 48 hours; only one patient (2%) used pain medication for more than 14 days. 34 patients (68%) admitted that their health status improved after the operation; 11 patients (22%) with good or very good health status indicated no change in health. Follow-up examination of the patients three months after the operation did not detect any recurrence. 49 patients (98%) were free of pain or restriction; one patient (2%) continued to have chronic pain which developed after two laparoscopic herniotomies performed at a different clinic before. There was no sign of mesh-related complication. The Ultrapro-mesh has been well accepted by the patients. In conclusion, open mesh repair according to Lichtenstein is safely done in specialised ambulatory day surgery clinics. Most patients benefit from this form of treatment according to a quality of life audit. The new light-weight mesh Ultrapro contributes to the improvement of hernia repair. There is evidence that ambulatory open mesh repair should be the method of choice for primary inguinal hernia. If in Germany an equal proportion of hernia repair as in the United States would be done as ambulatory procedure (80-90%), there would be an annual cost saving of several hundred million Euro.

Adolescent↗
PubMedDate not supplied

[Factual nutrition and several indicators of health status of urban schoolchildren of the regions of Ukraine].

Altogether 2334 schoolchildren (first-, fifth- and eighth-graders) were examined for the factual nutrition, health status and physical development. The diet received by the schoolgirls of the above grades and that of the first-grade boys correlated well with the recommended physiological standards, whereas the diet of the eight-grade boys and five-grade boys in particular was slightly lower as compared to those standards. Attention is drawn to an ever increasing number of obese children, which has an adverse effect on the percentage of harmoniously developed children, reducing it to 66.7%. To improve the nutrition of schoolchildren, the authors have developed sets of foods and exemplary menus which have been included into the methodological instructions for organization of schoolchildren's catering in nonspecialized schools of the Ukrainian Soviet Socialist Republic.

Adolescent↗
PubMed1996

An epidemiologic approach to assessing primary care needs in rural Illinois.

One persistent problem that faces state and federal health policy-makers is determining the level of primary care needs of the citizens they serve. To refine the decision making process in Illinois, a model was developed to compare the 84 rural counties of Illinois and their potential need for additional primary care interventions. Using expert panel methods, a group of public health professionals selected a set of 31 health status indicators that were available at the county level throughout the state. Next, the panel developed a weighting system for those indicators. These weighted values were then applied to the demographic and epidemiologic data from each of the counties to rank the counties on the basis of need. Indicators having the highest correlation with the weighted sum were the percent of the population enrolled in Medicaid, lung cancer mortality rate, general population mortality rate, proportion of population at poverty level, and percent of births to teens. Data also showed that the rural counties with the greatest needs clustered in five geographic regions. The identification of these five geographic clusters may facilitate collaborative efforts in meeting the primary care needs of these populations.

Epidemiologic Methods↗