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PubMed2001

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↗
PubMedDate not supplied

The International Disability Rights Movement and the ICF.

PURPOSE: To outline the thinking of disabled people about their situation and status before the formulation of the ICIDH (International Classification of Impairment, Disability and Handicap) in 1980, the growth of the international disability rights movement since 1980, its subsequent involvement in the revision process and then its hopes as to the effectiveness of the ICF (the International Classification of Functioning, Disability and Health-the revised ICIDH) in the future. METHOD: This is a personal analysis based on the author's experience as a disability rights activist and as a member of the World Council of Disabled Peoples' International (DPI), elected in 1987 to represent DPI in the revision process and who later became Chair of the Environmental Task Force. RESULTS: These are shown to be a major shift from the medical model of disability to the adoption of the interactive model and the impacts of environmental factors in all aspects of health and functioning. CONCLUSIONS: That proper use of the environmental factors within the ICF will ensure appropriate policies, systems and services for health care and support, provide measurable indicators for health status and sustainable development and underpin the recognition that disability is a human rights issue.

Activities of Daily Living↗
PubMed1979

The relationship between infant mortality rates and medical care and socio-economic variables, Chile 1960-1970.

Infant mortality rates (IMR) have traditionally been considered useful as health status indicators, and changes in these rates are thought to reflect changes in both medical care services and socio-economic circumstances. In order to explore this relationship of IMR with medical core and socio-economic factors in a developing country, Chilean health zone data for the decade 1960--1970 were used to construct 25 variables which were then classified into groups representing antenatal-obstetric services, acute and preventive medical services and socio-economic variables. In an analysis which involved developing a series of linear multiple regression equations for each year of the decade 1960--1970 with IMR as the dependent variable, the percentage of births with professional attention proved to be the stronger variable.

Child Health Services↗
PubMed1983

The application of the free-market economic model in Chile and the effects on the population's health status.

After the military coup in 1973, probably the most dogmatic application ever of free-market economic policies was implemented in Chile. The military junta has credited the drop in infant mortality since then to the free-market model. This article explores whether lower infant mortality rates are due to improvements in the socioeconomic conditions created by the free-market, or whether they are due to state-sponsored health care services. It concludes that the socioeconomic conditions since 1973 have generally deteriorated, while government supplemental feeding programs and maternal and child health care services have increased. It appears that the free-market has not been the primary determinant of the decline in infant mortality. Rather, state intervention appears to have been more important. Other morbidity statistics, however, indicate a decline in the population's health status since 1973.

Child Health Services↗
PubMed1997

Three-year changes in self-perceived oral health status in an older Canadian population.

Although change is a central goal of oral health care interventions, little attention has yet been paid to change in self-perceptions of oral health status. This is an important omission, given the current emphasis on assessing health outcomes. This paper reports the results of a study which examined changes over a period of three years in self-perceived oral health among 611 community-dwelling Canadians aged 50 years and over. Change in self-perceptions was measured by means of a global transition item and change scores derived from repeat administrations of four subjective oral health status indicators. Overall, 20.5% reported that their oral health had deteriorated over the three-year observation period, 68.5% that it had remained the same, and 10.5% that it had improved. There was a significant association between these global change categories and change scores for the four subjective indicators. Because of the small number of edentulous subjects, the analysis of baseline characteristics predicting change was confined to dentate subjects. Bivariate and logistic regression analyses were used to compare the two groups reporting change with those whose oral health status remained stable over the observation period. The results suggest that, when compared with this reference group, those who deteriorated and those who improved were similar in some respects but distinct in others. Those who improved appeared to have specific oral conditions at baseline causing pain. Those who deteriorated had poor oral health in general and came from more disadvantaged backgrounds. However, the explanatory power of logistic regression models predicting change in self-perceived oral health was poor when judged in terms of model sensitivities. This was to be expected, given that the models did not include variables documenting the incidence of disease, receipt of dental care, or changes in social and personal circumstances over the observation period.

Aged↗
PubMed2003

Country case report Uganda.

Health status indicators for Uganda are poor partly because of the repercussions of the historical conflicts. Poverty among the population is high. According to the Burden of Disease study done in 1995, over 75% of the life years lost due to premature death were due to ten preventable diseases. Government of Uganda, in collaboration with the Development Partners, has evolved a number of strategies to address priority concerns in the Health Sector. In 1999 a 10-year National Health Policy (NHP) was adopted together with the development of a five year Health Sector Strategic Plan (HSSP) to guide the implementation of the NHP. The NHP and the HSSP guide the current structure of the health services in the country, including the hospital services. However the focus in the reform process has been on primary health care but the hospitals have not been given sufficient attention. This country report concludes that the resources available for the health services in the country are very limited and the biggest challenge is to get the most out of these scanty resources. A further challenge identified is the need also to bring the hospitals in the mainstreamed health reform process. There is need for the hospitals to re-orientate themselves and strengthen the promotive and preventive services in addition to curative, rehabilitative and palliatives services. Finally, there is the need to improve access to hospital services as well as the standard of the hospital service.

Cause of Death↗
PubMed2007

Content of a novel online collection of traditional east African food habits (1930s-1960s): data collected by the Max-Planck-Nutrition Research Unit, Bumbuli, Tanzania.

BACKGROUND: Knowledge of traditional African foods and food habits has been, and continues to be, systematically extirpated. With the primary intent of collating data for our online collection documenting traditional African foods and food habits (available at: www.healthyeatingclub.com/Africa/), we reviewed the Oltersdorf Collection, 75 observational investigations conducted throughout East Africa (i.e. Tanzania, Kenya, and Uganda) between the 1930s and 1960s as compiled by the Max Planck Nutrition Research Unit, formerly located in Bumbuli, Tanzania. METHODS: Data were categorized as follows: (1) food availability, (2) chemical composition, (3) staple foods (i.e. native crops, cereals, legumes, roots and tubers, vegetables, fruits, spices, oils and fats, beverages, and animal foods), (4) food preparation and culture, and (5) nutrient intake and health status indicators. RESULTS: Many of the traditional foods identified, including millet, sorghum, various legumes, root and tubers, green leafy vegetables, plant oils and wild meats have known health benefits. Food preparatory practices during this period, including boiling and occasional roasting are superior to current practices which favor frying and deep-frying. Overall, our review and data extraction provide reason to believe that a diversified diet was possible for the people of East Africa during this period (1930s-1960s). CONCLUSIONS: There is a wealth of knowledge pertaining to traditional East African foods and food habits within the Oltersdorf Collection. These data are currently available via our online collection. Future efforts should contribute to collating and honing knowledge of traditional foods and food habits within this region, and indeed throughout the rest of Africa. Preserving and disseminating this knowledge may be crucial for abating projected trends for non-communicable diseases and malnutrition in Africa and abroad.

Africa, Eastern↗
PubMed1987

Inventorying community health promotion and risk reduction services: Virginia's approach.

Early in this decade the U.S. Centers for Disease Control gave a mandate to states receiving Health Education/Risk Reduction Funds (HERR) to inventory health promotion and risk reduction services. This article reports on the findings of the Northern Virginia Inventorying Project, in which an existing service classification system in use in a health planning district serving over one million people was modified to permit the annual inventorying of community health promotion and risk reduction services. The approach has utility for community health education needs assessments, ongoing evaluation of community services and progress vis-à-vis health status indicators, and for the diffusion of health promotion service information to service providers and the public.

Data Collection↗
PubMed2006

Mental health and health-related quality of life in Croatian island population.

AIM: To explore differences in self-perceived health as an indicator of health status and mortality, in six isolated populations from Croatian islands and to compare the results with control from general Croatian population obtained through the National Health Survey. METHOD: Health-related quality of life was measured using the Short Form Health Status Questionnaire (SF-36). The questionnaire was administered to 600 participants, inhabitants of 6 villages: Rab, Barbat, Lopar, and Supetarska Draga on island Rab, and Komiza and Vis, on island Vis, and to control group of 600 participants from the general Croatian population matched by age and gender to islanders. RESULTS: The islanders scored higher than controls on 3 out of 8 health dimensions, physical functioning (80.1+/-22.4 vs 73.2+/-24.8, P<0.001), vitality (61.0+/-20.3 vs 55.7+/-19.9, P<0.001), and pain (70.1+/-28.0 vs 65.9+/-26.5, P=0.008). Social functioning of islanders was significantly lower than in control group (73.4+/-18.6 vs 77.6+/-23.4, P=0.001). There was also a significant variation in health status among the islanders according to the isolation level, with the largest differences in general health perception and mental health. High isolation group reported the lowest score of all groups on mental health (P=0.018), physical functioning (P=0.045), general health (P=0.001), and vitality dimension (P=0.027). CONCLUSION: Inhabitants of Croatian islands in general showed better health-related functioning on the most of the health dimensions than general population. Islanders scored lower than controls only on social functioning which can be explained by their geographical isolation and small population. Low mental health score of islanders in the highly isolated group should be taken in account in planning health services for islands.

Croatia↗
PubMed1980

The health of Mexican Americans: evidence from the human population laboratory studies.

Data are presented from sample surveys conducted in 1974 (N = 3,119) and 1975 (N = 657) in Alameda County, California, by the Human Population Laboratory. Mexican Americans are compared to Anglos and Blacks on selected health status indicators; chronic conditions, disability, symptoms and a summary measure, the Physical Health Spectrum. Comparisons of crude percentages indicate that, compared to Anglos, Blacks report having more chronic conditions, more disability and more symptoms, while Chicanos generally report fewer health problems than these two groups. Controlling for the effects of age, sex, education, family income, marital status, and perceived health reduces the Anglo/Black differentials in reported health problems, primarily by reducing the rates for Blacks. However, even after adjustment the prevalence rates for Blacks remain higher. After controlling for the effects of the six covariates, the rates for Chicanos remain essentially unchanged in both samples, e.g., lower than the other groups. Results of binary regression analysis indicate that the two most powerful predictors of health status in both samples are age/sex and perceived health. Ethnicity overall is not a good predictor of health status, accounting for 1 per cent or less of the explained variance. Socioeconomic status, while predicting slightly better than ethnicity, still accounts for less than 2% of the variance in health status.

Adult↗
PubMed2002

Oral ill-health and deprivation among patients of a general dental practice in South Wales.

PURPOSE OF STUDY: This study aims to establish and report on whether individuals from deprived areas suffer more ill health than adults from areas considered not to be deprived when visiting a general dental practice. BASIC PROCEDURES: Between December 1998 and June 1999 registered dental patients over 18 years of age attending for routine care completed a questionnaire measuring functional, experiential and psychosocial impact of oral ill health. In addition the clinical impact of ill health was established from the patient examination and record card. Clinical outcome was assessed by numbers of standing teeth, oral health was assessed using the Subjective Oral Health Status Indicators (SOHSI). The patient's postcode was used to categorise individuals from areas of different deprivation states. MAIN FINDINGS: 99% were dentate with 88.4% having more than 20 teeth. A total of 71.8% were able to eat satisfactorily, 88.2% were able to speak satisfactorily, 54.6% were discontent, 99.4% were worried about their oral health and appearance, 62.8% were satisfied with their oral health, 44.8% experienced discomfort, 65.8% experienced other symptoms, and 86.8% experienced 'general well-being'. No differences were observed for clinical measures between the deprived groups. Only three out of eight oral health measures showed any differences between the deprived groups, namely, ability to speak, discontent and general well-being. More individuals from deprived areas experienced these impacts. PRINCIPAL CONCLUSIONS: It was anticipated that individuals from deprived areas would experience greater ill-health: this outcome was not as marked as expected.

Activities of Daily Living↗
PubMed1994

A system that 'walks the talk'. Using improved community health status for CEO evaluation and compensation. Interview by Karen Gardner.

Crozer-Keystone Health System, with corporate headquarters in Media, PA, is relatively new. The system was formed in 1990 to integrate four hospitals--roughly 1,160 acute care beds--five long-term care facilities, skilled nursing facilities and personal care facilities. According to President and CEO John C. McMeekin, the system comprises "very aggressive" programs in senior wellness, geriatric care, women's and children's health, behavioral medicine and psychiatric substance abuse. And it also has a large managed care organization that was undertaken as part of a joint venture with members of the hospitals' medical staff. The system is still defining itself, and perhaps that's why it has been willing to venture into an area that is virtually unique among health care organizations: using community health status indicators as part of the CEO's annual evaluation and compensation. Recently, Trustee editor Karen Gardner spoke to McMeekin and board Chairman Richard W. Billings about a major community needs assessment project that the system undertook in 1991 and how it is using the results of that study.

Chief Executive Officers, Hospital↗
PubMed2004

Inter-state disparities in health care and financial burden on the poor in India.

Over five decades of independence, India has made rapid strides in various sectors. However, its performance in social sectors and particularly the healthcare sector has not been too rosy. Being the State's responsibility the healthcare has traditionally been influenced by individual State's budgetary allocation. Consequently inter-state disparity in availability and utilization of health services and health manpower are distinctly marked. This has implications for achievement of Health for All for the nation as a whole. Keeping in view the significance of studying inter-state variations in healthcare, this study focuses on the performance of healthcare sector in 15 major States in India. This is attempted through a comparative analysis of various parameters depicting availability of health services, their utilization and health outcomes. Our analysis depicts the prevalence of considerable inequity favoring high income group of States. In terms of healthcare resources, for instance, it indicates that the high income States hold a superior position in terms of: per capita government expenditure on medical and public health, total number of hospitals and dispensaries, per capita availability of beds in hospitals and dispensaries and health manpower in rural and urban areas. These parameters of availability have an impact on utilization levels and health outcomes in these States. A comparative profile of high and low income States as well as middle and low income States, both in rural and urban areas, reaffirms a greater financial burden in availing treatment at OPD and inpatient in low income States. In line with the higher financial burden and low per capita health expenditure, the health outcome indicators also depict a disconcerting situation in regard to low income States. These States are marked by lower life expectancy and higher incidence of diseases as well as high mortality rates. In this regard, demand as well as supply side constraints are observed which restrain the optimum utilization of existing health services. Among the low income States the main constraints on the demand side include illiteracy, malnutrition, and lack of infrastructure in accessing the facilities. Certain state specific supply side factors add significantly to under-utilization in low income States. In some of the States, however, corrective actions have been initiated to overcome the problem of the quality and low utilization of health facilities. In due course of time, it is likely that proper implementation of these measures may result in improved utilization level of existing health services, which may be useful to improve health status indicators. Nonetheless, overcoming the current levels of regional disparities in healthcare across three income groups of States may also require additional resources. The latter could be mobilized through assistance of donor agencies and appropriate mix of social and private insurance. Ultimately mitigating the problem of regional disparities in healthcare and protecting the poor and vulnerable from financial burden may require establishing and maintaining proper linkages between socio-economic development and healthcare planning.

Cost of Illness↗
PubMed2004

Diversity and disparity: GIS and small-area analysis in six Chicago neighborhoods.

Small-area analysis in health is essential in uncovering local-level disparities often masked by health estimates for large areas (e.g., cities, counties, states). In this context, 14 health status indicators (HSIs) were examined for six Chicago community areas that reflect the substantial diversity of the city. HSIs were compared over time (from 1989-90 to 1999-2000) and across community areas. Important disparities among these community areas in mortality rates, birth outcomes, and infectious diseases were found. In many cases the disparities were in the expected direction with the richest and predominantly White community area experiencing the lowest rates. However, some surprises did manifest themselves. For example, only the poorest community area experienced a statistically significant decline in the infant mortality rate. Since so much of attention is now being paid to reducing and eliminating these disparities, it is important to examine their existence to better understand how to minimize them.

Chicago↗
PubMed2003

The self-assessed oral health status of individuals from White, Indian, Chinese and Black Caribbean communities in South-east England.

OBJECTIVES: To determine the level of self-assessed oral symptoms and the impact of such symptoms among individuals from four ethnic groups resident in South-east England and the relationship between self-assessed oral health status, age, gender, employment status, educational level and ethnicity. METHOD: Cross-sectional survey of a convenience sample of 366 individuals drawn from four ethnic groups. MEASURES: Subjective Oral Health Status Indicators (SOHSI). PARTICIPANTS: Individuals were recruited through community groups. All participants self-classified their ethnicity. Only completed questionnaires from participants categorising themselves as White, Black Caribbean, Chinese or Indian were included in the data analysis. FINDINGS: Univariate statistical analysis revealed significant differences between ethnic groups in all but one of the SOHSI scales. Age and ethnicity (in particular membership of the Chinese community) emerged as significant predictors of SOHSI scale scores. CONCLUSIONS: Within the limitations imposed by convenience sampling, it has been found that differences exist among four ethnic groups in the UK in their reporting of self-assessed oral health status. Ethnicity and age, in particular, predict the reporting of self-assessed oral symptoms and the impact of such symptoms.

Adolescent↗
PubMed2003

Health inequalities in the older population: the role of personal capital, social resources and socio-economic circumstances.

Older people now constitute the majority of those with health problems in developed countries so an understanding of health variations in later life is increasingly important. In this paper, we use data from three rounds of the Health Survey for England, a large nationally representative sample, to analyse variations in the health of adults aged 65-84 by indicators of attributes acquired in childhood and young adulthood, termed personal capital; and by current social resources and current socio-economic circumstances, while controlling for smoking behaviour and age. We used six indicators of health status in the analysis, four based on self-reports and two based on nurse collected data, which we hypothesised would identify different dimensions of health. Results showed that socio-economic indicators, particularly receipt of income support (a marker of poverty) were most consistently associated with raised odds of poor health outcomes. Associations between marital status and health were in some cases not in the expected direction. This may reflect bias arising from exclusion of the institutional population (although among those under 85 the proportion in institutions is very low) but merits further investigation, especially as the marital status composition of the older population is changing. Analysis of deviance showed that social resources (marital status and social support) had the greatest effect on the indicator of psychological health (GHQ) and also contributed significantly to variation in self-rated health, but among women not to variation in taking three or more medicines and among men not to self-reported long-standing illnesses. Smoking, in contrast, was much more strongly associated with these indicators than with self-rated health. These results are consistent with the view that self-rated health may provide a holistic indicator of health in the sense of well-being, whereas measures such as taking prescribed medications may be more indicative of specific morbidities. The results emphasise again the need to consider both socio-economic and socio-psychological influences on later life health.

Aged↗
PubMed1997

Serum albumin, coronary heart disease risk, and mortality in an elderly cohort.

We investigated associations of serum albumin with the incidence and mortality of coronary heart disease among men from the Zutphen Elderly Study. In 1985, 820 men were randomly selected from a population age 64-84 years and were followed for 5 years. We adjusted relative risks for traditional risk factors (age, body mass index, diastolic blood pressure, total and high-density lipoprotein cholesterol, smoking, and alcohol consumption) and also for baseline health status indicators (white blood cell count, physician's health score, self-rated health, and history of relevant diseases). Albumin was inversely associated with the incidence of coronary heart disease only among men with elevated total cholesterol levels (> or = 6.5 mmol per liter). The relative risk for a 1-standard deviation increase (2.5 gm per liter) in albumin was 0.60 [95% confidence interval (CI) = 0.38-0.96] and was not altered after additional adjustment for baseline health status. In all men, the relative risk for death due to coronary heart disease was 0.67 (95% CI = 0.49-0.92), and the relative risk was reduced to 0.84 (95% CI = 0.61-1.15) after adjustment for health status. We found comparable health status-adjusted relative risks for mortality from cardiovascular diseases (relative risk = 0.83; 95% CI = 0.67-1.02) and for mortality from all causes (relative risk = 0.86; 0.73-0.99). Independent of traditional risk factors, moderately low serum albumin is predictive of coronary heart disease and all-cause mortality in elderly men. Only part of this relation could be explained by baseline health status.

Age Distribution↗