[Life expectancy together with good health are health indicators of the public health status].
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Small group estimation for public health.
We used synthetic estimation and linear regression to estimate the prevalence of selected risk factors and health status indicators in small populations. The derivation was based on the sociodemographic characteristics of the populations and the relationships between these variables and the health variables, as measured by the Ontario Health Survey (OHS). The estimates were validated by a comparison with the direct results of the OHS (gold standards). Synthetic estimates were much less dispersed than the regression estimates or the direct OHS estimates. Regression estimates performed better than synthetic estimates on most validation indicators, and combined approaches performed marginally better yet, although there were few clear patterns. Although correlation coefficients with gold standards in excess of 0.8 were obtained for some variables, the estimates rarely met pre-determined criteria for accuracy. At present these techniques have limited value for public health workers, but further work is justified, especially on approaches combining synthetic and regression estimation.
Algorithms↗
['Public health status and perspectives' 1997. VII. Health care needs and health care consumption].
In the 'Public health status and forecasts' 1997 attention is given to the relationship between health status and health care. The theme report 'Health care need and health care consumption' integrates information about both phenomena and about waiting lists in the different sectors of health care. It is difficult to quantify the need for health care, because statements about need always imply a judgment by parties involved. In the literature need for health care is often operationalized by historical data on health care consumption or by health status indicators. At the national level only limited quantitative information is available to support policy on waiting lists and waiting times. The data are seldom disease-specific. Changes in size and distribution (by age and sex) of the population will increase health care cost over the period 1994-2015 in the Netherlands by 0.9-1.0% per year. More detailed demographic projections, however, indicate that there are large disease-specific differences.
Age Distribution↗
Factors associated with self-perceived excellent and very good health among Blacks--Kansas, 1995.
Self-perceived health is related to functional status, morbidity and mortality and is an important measure in determining health status and health-related quality of life (HRQOL) scales. In 1994, the group of health professionals who established the health status indicators for Healthy People 2000 recommended that states examine the indicators for major demographic subgroups (e.g., racial/ethnic groups). The Kansas Department of Health and Environment (KDHE) analyzed data from the 1995 Behavioral Risk Factor Surveillance System (BRFSS) supplemental survey of blacks in Kansas to determine the relation between self-perceived excellent and very good health (EVGH) and physical functioning, mental functioning, role limitations, access to care, and health behaviors among blacks--the largest racial/ethnic minority group in that state. This report summarizes the findings of the analysis, which indicate that several factors related to demographics, physical functioning, and health behaviors were associated with EVGH.
Adolescent↗
Levels of health development: a new tool for comparative research and policy formulation.
Levels of health development are formed by mathematically clustering countries using six health status indicators: crude birth, crude death, infant mortality and child death rates, and male and female life expectancy. Stratifying two international samples of 128 and 163 countries into levels of health development--groups with similar health status profiles--improves the results of regression analyses used to identify economic, political, social, educational, health and other health determinants. For this reason, health development levels are a systematic framework for delineation of health determinants. Earlier large scale statistical studies have been limited in their success in part because they did not partition their data sets prior to analysis, or used inappropriate criteria that blurred rather than heightened developmental differences in underlying social systems. These developmental differences regulate the way in which health status inputs are converted into health status outputs, defining the relative importance of health determinants at various developmental levels. At lowest health development levels (countries with poorer health status), the under-development of economic, health and educational infrastructures creates a vacuum which allows international intervention (aid, investment, export/import activities) to play a dominant role in health status determination. At middle health development levels, health and educational infrastructures are better developed, but still secondary in importance as health status determinants to basic economic infrastructure. Demographic problems are particularly apparent at these levels. At higher health development levels, education, women's status, and political structure are especially important health status determinants. This research has facilitated the identification of health status determinants for use in health policy analysis. Recommendations for future research include use of findings in health policymaking by individual countries and by comparative researchers, and development of appropriate health systems models for each level of health development.
Cross-Cultural Comparison↗
Writing to learn in community health nursing: the aggregate.
Writing to learn is a strategy that can be used to develop competencies of undergraduate students for the practice of community health nursing. It provides an opportunity for students to apply community health theory in a paper that integrates health status indicators, primary prevention, and aggregate-focused nursing interventions. It also develops students' writings abilities and creative approaches to community health nursing practice in a clinically applicable manner, thereby facilitating synthesis of professional principles and practices.
Community Health Nursing↗
CATCH/IT: a data warehouse to support comprehensive assessment for tracking community health.
A systematic methodology, Comprehensive Assessment for Tracking Community Health (CATCH), for analyzing the health status of communities has been under development at the University of South Florida since the early 1990s. CATCH draws 226 health status indicators from multiple data sources and uses an innovative comparative framework and weighted evaluation criteria to produce a rank-ordered list of community health problems. CATCH has been applied successfully in many Florida counties; focusing attention on high priority health issues and measuring the impact of health expenditures on community health status outcomes. Previously performed manually, we are using information technology (IT) to automate the CATCH methodology with a full-scale data warehouse, user-friendly forms and reports, and extended analysis and data mining capabilities. The automated system, CATCH/IT, will reduce the time to prepare community health status reports from months to days. In this paper, we present the current status of the project, along with the principal research and development issues and future directions of the project.
Community Health Planning↗
Health development and political policy: the lesson of Cuba.
In comparison to other Latin American countries at a similar or more advanced stage of economic development, Cuba has a relatively high ranking on major health status indicators. This paper examines the reasons for this contrast and concludes that they are largely political. This suggests that the severe health deficiencies of most developing countries are not inevitable consequences of poverty.
Adult↗
Consequences of differential residence designations for rural health policy research: the case of infant mortality.
In 1991, members of the rural caucus proposed numerous bills designed to attenuate the rural-urban differences in health care delivery and health status. Implicit in the legislative process is the assumption that "rural America" differs systematically from "urban America." However, research has consistently demonstrated that there is not a single rural America but rather, those areas outside of the major metropolitan areas represent a complex mosaic of varying social and environmental settings. Rural communities differ in meaningful ways along a number of socioenvironmental parameters, and accordingly, health status indicators also differ across rural communities. Thus, health outcome statistics averaged across rural communities will often mask important disparities experienced by certain population groups. Policies based on these aggregate indicators may overlook the needs of the most disadvantaged. While a number of measures of rurality have emerged in the last decade, much of the information presented to policy-makers is either too aggregated (i.e., metropolitan-nonmetropolitan) to identify important differences across the range of communities, or it is gathered in agency-specific categories that are not comparable. The central question under examination in the current context is the possibility of distorting the picture of infant health status by aggregating the diverse rural locales of the United States. Empirical results indicate that when considering infant mortality, any rural disadvantage is contingent upon how 'rural' and 'urban' have been defined. Further, the results indicate that conclusions must be conditioned on other important sociodemographic parameters such as region of the country and race.
Black or African American↗
Clinical correlates of changes in self-perceived oral health in older adults.
Although numerous investigators have reported on self-perceived oral health status in adult and older adult populations, few have examined how these perceptions change over time. This paper uses data from a longitudinal oral health survey of community-dwelling Canadians aged 50 years and over to explore this issue. Data were collected at baseline and after 3 years. Change was assessed using a global transition judgement and change scores on four subjective oral health status indicators. These indicators addressed chewing capacity, oral and facial pain symptoms, other oral symptoms, and the psychosocial impact of oral disorders. Overall, 23.0% reported that their oral health had worsened over this period, 66.5% that it had remained the same and 10.5% that it had improved. Change scores on the four indicators showed a similar pattern and were significantly associated with these global judgements. Over the same period, substantial proportions lost one or more teeth, acquired new coronal or root DFS increments or experienced loss of periodontal attachment. An additional 17% complained of dry mouth. However, the only clinical indicator associated with changing perceptions of oral health was tooth loss. Of interest was the fact that rates of tooth loss were equally high among those who reported a worsening of oral health and those who reported an improvement. This suggests that the impact of tooth loss on health status may be positive or negative depending upon the condition of the teeth lost.
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Comparing indicators of health or nutritional status.
The performance of an indicator of health or nutritional status depends on its sensitivity and specificity properties over a range of cut-offs. Frequently, it is of interest to compare indicators to pick the best for a given purpose, such as screening for disease or monitoring to detect changes in prevalence of inadequate nutriture. Relative operating characteristic (ROC) analysis provides an objective method for making this comparison, but the application of this methodology as described for epidemiologists in this Journal is now outdated for most indicators. Recent developments are noted and an alternative analysis for use with continuous Gaussian data is presented here. The estimators and statistical test procedures proposed here are compared with the previously described methods, by means of a computer simulation study. The new procedures are found to be superior for continuous Gaussian data, and have the practical advantage that they do not require use of a specialized computer program. The implications of these results for comparing indicators to be used to monitor population prevalences are discussed.
Computers↗
Uninsured maternity clients: a concern for quality.
Differences among demographic characteristics, health status indicators, and resource use of maternity clients privately insured, insured through public entitlement funds, or uninsured were examined in a public hospital. The uninsured were in their early twenties, black (44%), single (52%), lived in the central city area, employed in service occupations without health care benefits, and either sought prenatal care later in the pregnancy or not at all. Compared with the privately insured, the uninsured had more lifestyle risks. The uninsured women had a shorter hospital stay with more maternal complications. Insurance coverage and prenatal care were positive predictors of birth weight and lifestyle risk factors detracted. Length of stay was not influenced by insurance coverage but rather by health problems before delivery. Earlier discharge of the uninsured patients suggest the need for quality of care monitoring and outreach programs.
Adolescent↗
Using 1990 national MCH objectives to assess health status and risk in an American Indian community.
The authors used data from birth records to assess changes in health risks and health status of American Indians (AI) living in Umatilla County, OR, from 1973 to 1986. They compared the AI health risks and health status with those of other persons (non-AI) living in Umatilla County, and assessed the progress of both AI and non-AI populations toward selected 1990 national health objectives. This AI population is likely to achieve the 1990 national health objective calling for less than 5 percent of births to be low birth weight (LBW); the LBW rate decreased from 5.0 percent in 1977-80 to 4.1 percent in 1984-86. However, the population is not likely to achieve the 1990 objective calling for at least 90 percent of women to begin prenatal care during the first trimester, even though the proportion of AI women who began prenatal care in the first trimester increased from 42.3 percent in 1973-76 to 62.6 percent in 1984-86. The Yellowhawk Indian Health Center began offering clinical services to AI in Umatilla County in 1976. Compared with non-AI women, AI women closed large gaps in key health risk and health status indicators during the period from 1973 to 1986. For example, from 1973 to 1976, 14.6 percent of AI mothers compared with 6.3 percent of non-AI mothers began prenatal care in the last trimester. By 1984 to 1986, only 9.0 percent of AI and 7.9 percent of non-AI mothers began prenatal care in the last trimester. Several other desirable health indicators improved more for AI than for non-AI from 1973 to 1986. These indicators included receiving at least one prenatal care visit during pregnancy, beginning prenatal care before the last trimester, and a larger proportion of mothers more than 18 years of age.Data from vital records can be used to monitor the health status of minority populations in small areas, such as counties. Clinic personnel serving minority groups can incorporate national and local health objectives into their strategy for improving community health.
Adolescent↗
Self-ratings of health: do they also predict change in functional ability?
Self-ratings of health by individuals responding to surveys have shown themselves to be potent predictors of mortality in a growing number of studies; they appear to contribute significant additional independent information to health status indicators gathered through self-reported health histories or medical examinations. A key question raised by these studies is: What are the mediating processes involved in the association? Specifically, do poor self-ratings increase the risk of disability and morbidity, and are these outcomes intervening steps in the link to mortality? In this report we address the first question, of self-ratings predicting future levels of functional disability, our choice of an index of overall impact of morbidity. Data come from the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) site (N = 2,812). Results show that self-ratings of health in 1982, net of baseline functional ability, health and sociodemographic status, are associated with changes in functional ability over periods of one through six years. These findings extend our understanding of the meaning of excellent, good, fair, and poor ratings of health, and that they have implications not just for survival but for the loss or maintenance of functional ability in daily life.
Age Factors↗
[Evaluation of predictive effect of some health-related indices on deaths among ageing residents through a 8-years' follow-up study in Beijing].
OBJECTIVE: To study the predictive effects of some health status indicators to deaths in the elderly population. METHODS: In 1992, a cohort of 3257 people older than 55 years old was formed from Beijing urban and suburb area. Demographic and information of activity of daily living (ADL), self-rated health (SRH), chronic diseases history and other related variables were collected at baseline survey in 1992. MMSE and CES-D were studied in 2101 on 3257 elderly people. Follow-up surveys were conducted in 1994, 1997 and 2000, to find that a total number of or= 75), resident place (suburb) and education level (illiteracy). The functional disability, poor self-rated health status, history of chronic diseases and abnormal cognition function were the major predictors of deaths. Multinomial logistic regression analysis showed that after adjustment for sex, age, residential place, education level and history of chronic diseases, functional disability, poor self-rated health status and abnormal cognition function remained as significant independent predictors to death. CONCLUSIONS: Functional disability, poor self-rated health status and abnormal cognition function were the most valuable indicators of death. Not only they had joined predictive effects to death, but also remained relatively independent. They had important value in the evaluation on healthy prognosis and the life quality of the elderly.
Activities of Daily Living↗
The role of the black church in community medicine.
Historically, the black church has been the preserver and the perpetuator of the black ethos, the radix from which its defining values and norms have been generated, and the autonomous social institution that has provided order and meaning to the black experience in the United States. The traditional ethic of community-oriented service in the black ethos is highly compatible with the communitarian ethic of community medicine. Given this congruence and the much-documented fact that black Americans are an at-risk and under-served group regarding health status indicators and the provision of preventive health care, respectively, the black church is an extremely relevant locus for the practice of community medicine. A number of health programs based in or affiliated with the black church have operated throughout the United States, and these programs, along with the corpus of literature comprising conceptual articles favorable toward such a role for the black church, are reviewed within four areas of community medicine: primary care delivery, community mental health, health promotion and disease prevention, and health policy.
Black or African American↗
Validity of an instrument assessing oral health problems in people with Down syndrome.
AIM: The aim of this study was to validate a proxy measure of oral health designed to be completed by the English-speaking parents of people with Down syndrome (DS) aged four years or more. METHODOLOGY: Items were generated through literature review, interviews with parents of people with DS and professional experts and through frequency testing. Data were gathered from one population-based and two clinic-based samples for the separate aspects of validation. Validation consisted of evaluation of: i) internal reliability of the domain structure through Cronbach's alpha; ii) criterion validity against clinical indicators and a clinician's evaluation of some items; iii) construct validity involving an age-matched comparison of domain scores between people with DS and non-DS siblings, and within the DS group by health status indicators; and iv) test-retest reliability through the generation of intra-class correlation coefficients (ICC). RESULTS: A 20-item instrument with four domains (communication, eating, parafunction and symptoms) was developed. Cronbach's alpha by domain was 0.5-0.8. Indicators of criterion validity for domains against clinical indicators (Spearman's coefficient 0.1-0.4) and parent-rated items against clinician-rated items (weighted Kappa 0.1-0.8) were varied as anticipated. Indicators of construct validity (differences with non-DS siblings and correlations with medical status within the DS group) were excellent. Test-retest reliability was good (ICC range 0.64-0.84). CONCLUSION: These data suggest the test instrument is valid as a descriptive, discriminative, proxy English language measure of oral health problems in people with DS aged four years or more.
Adolescent↗
Chronic care clinics for diabetes in primary care: a system-wide randomized trial.
OBJECTIVE: To evaluate the impact of primary care group visits (chronic care clinics) on the process and outcome of care for diabetic patients. RESEARCH DESIGN AND METHODS: We evaluated the intervention in primary care practices randomized to intervention and control groups in a large-staff model health maintenance organization (HMO). Patients included diabetic patients > or = 30 years of age in each participating primary care practice, selected at random from an automated diabetes registry. Primary care practices were randomized within clinics to either a chronic care clinic (intervention) group or a usual care (control) group. The intervention group conducted periodic one-half day chronic care clinics for groups of approximately 8 diabetic patients in their respective doctor's practice. Chronic care clinics consisted of standardized assessments; visits with the primary care physician, nurse, and clinical pharmacist; and a group education/peer support meeting. We collected self-report questionnaires from patients and data from administrative systems. The questionnaires were mailed, and telephoned interviews were conducted for nonrespondents, at baseline and at 12 and 24 months; we queried the process of care received, the satisfaction with care, and the health status of each patient. Serum cholesterol and HbA1c levels and health care use and cost data was collected from HMO administrative systems. RESULTS: In an intention-to-treat analysis at 24 months, the intervention group had received significantly more recommended preventive procedures and helpful patient education. Of five primary health status indicators examined, two (SF-36 general health and bed disability days) were significantly better in the intervention group. Compared with control patients, intervention patients had slightly more primary care visits, but significantly fewer specialty and emergency room visits. Among intervention participants, we found consistently positive associations between the number of chronic care clinics attended and a number of outcomes, including patient satisfaction and HbA1c levels. CONCLUSIONS: Periodic primary care sessions organized to meet the complex needs of diabetic patients imrproved the process of diabetes care and were associated with better outcomes.
Adult↗