Health manpower in transition.
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Health Occupations↗
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Predictors of declining self-rated health during the transition to menopause.
OBJECTIVE: To determine factors associated with declining self-rated health as measured annually for 8 years in a prospective population-based cohort of middle-aged Australian-born women. In particular, to investigate the potential role of the menopausal transition in changing self-rated health. METHODS: A total of 262 women from the Melbourne Women's Midlife Health Project were asked to rate their present health compared with other women about the same age as worse than, the same as or better than most. RESULTS: Women reporting their health to be "better than most" decreased from 51.2% at Year 1 to 41.3% at Year 8. In the year prior to the late menopausal transition, women reporting their health to be 'better than most' declined by 5%. Comparing women who experienced the menopausal transition with women whose menopausal status did not change, there was no significant difference in changes in self-rated health. Change in body mass index (OR = 1.53; 95% CI = 1.13 to 2.06) and change in feelings for partner (OR = 0.38; 95% CI = 0.17 to 0.86) predicted a change in self-rated health from a baseline status of 'better than most.' Having an operation or procedure in the last year (OR = 8.63; 95% CI = 1.84 to 40.4) and an increase in the number of symptoms (OR = 1.32; 95% CI = 1.01 to 1.72) predicted a decline in self-rated health from baseline status of 'same as others.' CONCLUSION: This prospective study found a small decline in self-rated health with age but no significant effect of the menopausal transition. Different factors relate to differing self-rated health groupings. Further studies involving other ethnic groups and larger sample sizes are needed.
Cohort Studies↗
Patient centered assessment of ankylosing spondylitis-specific health related quality of life: evaluation of the Patient Generated Index.
OBJECTIVE: To evaluate the Patient Generated Index (PGI) for the measurement of individualized health related quality of life in ankylosing spondylitis (AS). METHODS: The PGI asks patients to nominate areas of their lives affected by their disease that they consider the most important. Semistructured interviews with AS patients produced a trigger list of areas of life affected by AS. The PGI was self-completed by UK patients taking part in a multicenter postal survey. The instrument was assessed for data quality, reliability, validity, and responsiveness. RESULTS: The PGI had acceptable completion rates. Scores covered the available range and approximated normality. Test-retest reliability estimates support the use of the PGI in group evaluation (intraclass correlation coefficient > 0.80). Comparisons with scores for other health status instruments provided evidence for the validity of the PGI. The largest levels of correlation were found for the AS Quality of Life Questionnaire (ASQoL) and the EuroQol. The informed and open format of the PGI had the strongest linear relationship with responses to both specific and general health transition questions (p < 0.01), and was the most responsive format of the PGI. CONCLUSION: The PGI is the first AS-specific individualized measure of health related quality of life. There is good support for the content validity of the instrument and patient acceptability is high. Adequate levels of data quality and reliability support the use of the PGI in group evaluation. Moderate levels of responsiveness to changes in health were produced by the informed and open format of the PGI.
Adult↗
Ethnic differences in the relationship between depressive symptoms and health-related quality of life in people with type 2 diabetes.
OBJECTIVE: To examine ethnic differences in the relationship between depressive symptoms and specific aspects of heath-related quality of life in people with type 2 diabetes. DESIGN: Cross-sectional data from 190 people with type 2 diabetes of Native Hawaiian (50%), Filipino (16%), Japanese (18%), and mixed-ethnic (16%) ancestries from the rural community of North Kōhala, Hawai'i were examined in this study. Depressive symptoms were measured with the Center for Epidemiological Studies-Depression (CES-D) scale. Health-related quality of life was measured with the Short Form-36 Health Survey (SF-36). Eight health-related quality of life constructs were examined: Physical Functioning, Role-Physical Functioning, Role-Emotional Functioning, Social Functioning, Bodily Pain, Vitality, General Health, and Health Transition. RESULTS: Hierarchical regression analyses of the interaction between ethnicity and the SF-36 subscales of Physical Functioning, Role-Emotional Functioning, Bodily Pain, Vitality, and General Health indicated statistically significant associations with CES-D scores after controlling for sociodemographic factors, glycemic status, and social support. CONCLUSION: Ethnicity moderated the relationship between depressive symptoms and the health-related quality of life aspects of physical and role-emotional functioning, bodily pain, vitality, and general health perception in people with type 2 diabetes. This relationship was strongest for Filipinos followed by Native Hawaiians and people of mixed-ethnic ancestries.
Analysis of Variance↗
Geography of health: some trends and perspectives.
The present evolution of geography of health is highlighted through a selection of recent publications. Some current research trends are listed, such as disease ecology in a changing environment, geography of AIDS, urbanization, epidemiological transition, health care delivery. The most salient future perspectives are pointed out.
Acquired Immunodeficiency Syndrome↗
[The island of Mauritius: insularity, tropicality, modernity, a dialogue in the form of a lesson].
Mauritius, a lost volcanic island in the indian ocean situated at the 20th degree of latitude, is a tiny state which got its independence in 1968. The isolation, the tropicality, the demographic boom, the ethnic diversity and the absence of raw materials could funnel this peaceful beauty to become a hot-bed of desperation and violence. This place which is one of the most densely populated areas, is an example of modern democracy and cultural coexistence. Owing to a skillful and pragmatic politic, its leaders have transformed handicaps into trump cards. The allocation of a part of the GNP for social and hygienic investments had been the locomotive pulling the train of improvements and raising the standard of living for the inhabitants. The ageing population, the rapidity of evolution the demographic and health transitions are expression of this skillful politic. In less than twenty years, this island conquered underdevelopment and proved that there is no tropical fatality when a programme of health accompanies development.
Developing Countries↗
Roots, shoots, but too little fruit: assessing the contribution of COPC in South Africa.
Community-oriented primary care (COPC) originated in South Africa during the 1940s and 1950s, where it served to inform local church-based and nongovernmental organization-based initiatives during the apartheid years. During the 1990s, COPC played an inspirational role in the process of national health policy formulation. Yet COPC's contribution to current health practice remains more symbolic than substantive. Despite a policy framework that favors the widespread introduction of COPC, various political, structural, managerial, and human resource obstacles constrain its effective implementation. Notwithstanding a rapidly changing health care environment and well-established health transition from infections and nutritional disorders to non-communicable diseases and injury, COPC and its variants remain abidingly relevant to South Africa's-and Africa's-health care reality.
Community Health Centers↗
The UK version of the Seattle Angina Questionnaire (SAQ-UK): reliability, validity and responsiveness.
The study assesses the reliability, validity and responsiveness of the UK version of the Seattle Angina Questionnaire (SAQ-UK). The instrument was anglicised and administered by self-completed postal questionnaire to 959 patients recruited from general practices in the North East of England. A total of 655 (68.3%) patients returned a completed questionnaire. Principal component analysis produced three important dimensions: physical limitations, anginal frequency and perception and treatment satisfaction. Four items that performed poorly were removed from the instrument. The removal of items greatly increased the number of computable scale scores. Estimates of internal reliability for the three dimensions ranged from 0.83-0.92. Estimates of test-retest reliability were above accepted standards. The correlation between the SAQ-UK scores and the SF-12, EuroQol and health transition was evidence for the validity of the instrument. The SAQ-UK produced responsiveness statistics that were comparable to the parent instrument and was more responsive to improvements in health than the generic instruments. The SAQ-UK is recommended as a measure of health outcome for the evaluation of angina management.
Adult↗
Quality of life in multiple sclerosis: influence of interferon-beta1 a (Avonex) treatment.
BACKGROUND: Numerous data argue for initiating treatment with interferon-beta (IFN-beta) at an early stage in multiple sderosis (MS). The consequences of its use may negatively influence the MS patient's quality of life (QoL). OBJECTIVE: To evaluate the QoL of MS patients before and after a one-year period of treatment with IFN-beta1a (Avonex). PATIENTS AND METHODS: QoL was assessed using the SF-36 in 121 relapsing-remitting MS patients. We compared QoL before and after treatment and with data from a normal population. We also studied the possible influence of disease progression on the SF-36 scores. RESULTS: One hundred six patients completed the study (87%). Compared to a normal population, patients were, at baseline, worse off for all QoL scales, varying from a minimum decrease of 0.73 SD in mental health, to a maximum decrease of 1.55 SD in general health. After treatment, we found no significant changes in any of the QoL scores, except for physical function, where we noted a slight but significant decrease (p = 0.03). Furthermore, there was no significant change either in the physical component summary (PCS) or mental component summary (MCS). The 'reported health transition' item was significantly improved compared to baseline (p = 0.001). At indusion, significant correlations were found between EDSS scores and scores of physical function (p < 0.001), role - physical (p < 0.01), general health and social function (both p < 0.01), and with the PCS (p < 0.01). Patients with dinical relapses and/or disability progression had a more significant decease in physical function (p < 0.05) and also in social function (p < 0.05). CONCLUSION: The QoL, assessed by the SF-36 scale, is correlated with disability in MS. IFN-beta1a treatment (Avonex) has no negative effect on MS patient's QoL.
Adjuvants, Immunologic↗
Oral health-related quality of life of stroke survivors on discharge from hospital after rehabilitation.
The study aimed to investigate oral health-related quality of life (OHR-QoL) of stroke survivors on hospital discharge after rehabilitation. It was a cross-sectional study involving 43 elderly survivors of mild to moderate stroke about to be discharged from hospital after rehabilitation and a comparison group of 43 community-dwelling elderly people. The Medical Outcomes Short Form 36 (SF-36) measure, the General Oral Health Assessment Index (GOHAI) and an oral health transition scale were administered prior to a dental examination. Median SF-36 subscale scores were significantly different between groups (P < 0.05). In physical function, role-physical, role-emotional and mental health domains, stroke survivors had significantly lower scores indicating poorer health. The median GOHAI score for the stroke group was 52 and 54 for the comparison group with no significant difference between groups although more stroke survivors had difficulty speaking compared with the comparison group. About 75% of stroke survivors considered their appearance to be worse, half of them felt that speech was worse and about a third had difficulty chewing hard food compared with the pre-stroke condition (P < 0.05). Most participants were partially dentate with no significant difference in DMFT scores or prosthetic status between groups (P > 0.05). Health-related quality of life in general was significantly poorer after stroke although patients were considered physically well enough to be discharged from hospital. There was some impairment of OHR-QoL. The nature of the stroke, the hospital environment including diet, coping strategies and elderly Chinese peoples' perception of health should be taken into account when interpreting measures of health status in stroke survivors.
Activities of Daily Living↗
[Tuberculosis control strategy in Asia for the 21st century--tuberculosis control in the Western Pacific Region of World Health Organization].
The unprecedented and rapid changes at the global level posed a big challenge to public health. The tuberculosis disease as one of major health problems today should be viewed from this context. These global challenges include 1) population issue particularly on growth and ageing; 2) epidemiological issue such as health transition; and, 3) social and environmental issues such as rapid urbanization and global warming. Furthermore, we should also take into account other changes such as the role of the government in the health service delivery, clinical or cure-oriented approach to prevention, increasing consumer demand and health financing. The burden of tuberculosis is devastating. Everyday in the Western Pacific Region (WPR), about 1000 people lose their life due to tuberculosis. Most of them are between the ages 14-54, which are the so-called economically productive age group. The economic impact, therefore, is significant. In addition TB is a disease of poverty of which the risk of getting TB is higher in poor who have less access to TB services due to financial barrier and lack of knowledge. Despite this devastating situation, TB has a significant and cost effective tool called DOTS. WPRO put highest priority in TB control programme not only because of the facts mentioned above but I also consider TB as an agenda carried over from the last century. I would like, then, to commit myself to this cause for the betterment of the future of the next generation.
Asia↗
Understanding the role of health care providers during the transition of adolescents with disabilities and special health care needs.
PURPOSE: To evaluate the role of health care providers in the transition from pediatric to adult health care for adolescents with disabilities and special health care needs (SHCN) from both the families' and providers' perspectives. METHODS: A total of 753 parents of adolescents with SHCN (e.g. developmental, physical, behavioral/emotional, learning, or health-related disabilities) were surveyed by questionnaire to assess their perceptions of their health care provider's level of involvement in various transition activities and the extent to which they felt it was the provider's responsibility to assist in a particular activity. One hundred forty-one health care providers (primarily pediatricians) completed a parallel survey to assess their level of participation in the same transition activities and the extent to which they felt it was their responsibility to assist with each transition activity. The questionnaire listed 13 different transition activities health providers may engage in to help young people prepare for adulthood and also asked questions about areas such as employment and health insurance. To investigate whether parents and providers share the same views regarding the involvement and responsibility of providers across the 13 transition activities, two sets of Student's t-tests were calculated. RESULTS: There were significant differences between providers and parents concerning both the level of provider involvement and the extent to which it was the provider's responsibility to assist in various transition activities (e.g., health providers reported significantly more involvement than did parents for 11 of the 13 transition activities and, compared with parents, providers reported that it was more within their role to assist in these 11 transition activities). CONCLUSIONS: The findings suggest a need for health care providers and parents to have open discussions about the nature and extent to which providers assist families in key transition activities.
Adolescent↗
The determinants of successful collaboration: a review of theoretical and empirical studies.
Successful collaboration in health care teams can be attributed to numerous elements, including processes at work in interpersonal relationships within the team (the interactional determinants), conditions within the organization (the organizational determinants), and the organization's environment (the systemic determinants). Through a review of the literature, this article presents a tabulated compilation of each of these determinant types as identified by empirical research and identifies the main characteristics of these determinants according to the conceptual work. We then present a "showcase" of recent Canadian policy initiatives--The Canadian Health Transition Fund (HTF)--to illustrate how the various categories of determinants can be mobilized. The literature review reveals that very little of the empirical work has dealt with determinants of interprofessional collaboration in health, particularly its organizational and systemic determinants. Furthermore, our overview of experience at the Canadian HTF suggests that a systemic approach should be adopted in evaluative research on the determinants of effective collaborative practice.
Cooperative Behavior↗
Searching for an optimum solution to the Bangladesh arsenic crisis.
Searching for an optimum solution to the Bangladesh arsenic crisis: Thirty years ago Bangladesh experienced very high levels of infant and child mortality, much of it due to water-borne disease in deltaic conditions where surface water was highly polluted. In what appeared to be one of the great public health achievements, 95% of the population were converted to drinking bacteria-free tubewell water from underground aquifers. Recently, it has been shown that perhaps 20% of this water is arsenic contaminated and alternatives to tubewell water have been sought. This paper reports on two national surveys collaboratively carried out in 2000 by the Health Transition Centre, Australian National University and Mitra and Associates, Dhaka: A census of tubewells and a household survey of tubewell use and arseniosis. The study found that the tubewell revolution has been promoted not only by health considerations but also by the demand for a household water facility and the desire by women to reduce workloads associated with using surface water. Because of this, and because the population had absorbed the message about safe tubewell water, it is argued that the movement away from the use of tubewell water should be as limited as possible, even if this means using safe tubewells which are often found in the neighbourhood. To enable such a move the most urgent need is not changing the source of water but comprehensive national water testing providing essential information to households about which wells are safe and which are not.
Arsenic↗
A new insight into morbidity and mortality transition in Italy.
"Average life expectancy in Italy more than doubled over the last 100 years, rising from 36 years in 1887 for both sexes to 72 and 79 years for men and women, respectively, by 1986.... The aim of the present study is to interpret this trend in the light of the mortality dynamic by age and...the health transition which began in Italy at the close of the last century. By reconstructing the annual data necessary for this purpose it will be possible to pin-point how and when changes took place in the cause-specific mortality structure and what impact these changes had in either accelerating or curbing improvements in life expectancy." (SUMMARY IN FRE AND ITA)
Cause of Death↗
Health status of the Pakistani population: a health profile and comparison with the United States.
OBJECTIVES: The health status of the Pakistani population was compared with that of the US population to provide a better understanding of the health problems in a developing nation and shed light on the dynamics of selected diseases. METHODS: Results from the National Health Survey of Pakistan (n = 18,315) and the US National Health and Nutrition Examination Survey (n = 31,311) were compared. Standardized and comparable methods were used in both surveys. RESULTS: Indicators of undernutrition among children were high throughout Pakistan. Among adults, there were urban-rural differences and economic gradients in indicators of undernutrition and risk factors for heart disease and cancer. In comparison with the US population, the Pakistani population has a higher rate of undernutrition, a lower rate of high cholesterol, and an approximately equal rate of high blood pressure. CONCLUSIONS: There are major inequalities in health within Pakistan and between Pakistan and the United States. Standardized national health examination survey methodology can be used to monitor health status and plan health transition policy in developing countries.
Adolescent↗
Comparison of health related quality of life with cardiopulmonary exercise testing in adolescents and adults with congenital heart disease.
OBJECTIVES: To compare self reported quality of life with measured exercise capacity in patients with congenital heart disease. DESIGN: Prospective cross sectional clinical study. SETTING: Tertiary referral centre for congenital cardiology. PATIENTS AND METHODS: 149 patients (60 female, 14-60 years old) with various congenital heart defects completed a health related quality of life questionnaire (medical outcomes study 36 item short form). Then they performed a cardiopulmonary exercise test on a bicycle in a sitting position. RESULTS: Peak oxygen uptake correlated significantly with the physical functioning (r = 0.521, p < 0.0005) and general health scales (r = 0.313, p < 0.0005) but not with role-physical, bodily pain, vitality, social functioning, role-emotional, mental health, and health transition scales. Closer examination of the data showed that despite an overall good correlation a substantial number of patients overestimated their physical capabilities. CONCLUSIONS: Exercise tests and quality of life instruments should be used together to get an appropriate overview of the health status of patients with congenital heart disease.
Adolescent↗
Informal payments for health care in transition economies.
There is considerable evidence that unofficial payments are deeply embedded in the markets for health care in transition countries. Numerous surveys indicate that these payments provide a significant but possibly distorting contribution to health care financing. Unofficial payments can be characterised into three groups: cost contributions, including supplies and salaries, misuse of market position and payments for additional services. There is evidence from across the region on the presence of payment in each category although it is often difficult to distinguish between payment types. Regulatory policy must address a number of issues. Imposing penalties may help to reduce some payments but if the system is simply unable to provide services, such sanctions will drive workers into the private sector. There appears to be some support for formalising payments in order to reduce unofficial charges although the impact must be monitored and the danger is that formal fees add to the burden of payment. Regulation might also attempt to increase the amount of competition, provide information on good performing facilities and develop the legal basis of patient rights. Ultimately, unless governments address the endemic nature of payments across all sectors, policy interventions are unlikely to be fully effective.
Cost Sharing↗