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PubMed1991

Psychological determinants of health and performance: the tangled web of desirable and undesirable characteristics.

Correlations were determined for male (n = 225) and female (n = 242) college students between sets of undesirable personality traits (anxiety, stress reactivity, anger, and alienation) and desirable personality traits (instrumentality, achievement strivings, and optimism measured by the Scheier-Carver [1987] Life Orientation Test), and a series of outcome variables related to health (self-reported health complaints and health maintenance behaviors and beliefs) and academic performance (academic expectations and actual grade point average). Significant correlations were found between many of the personality variables and the outcome variables. However, partial correlations revealed different relationships for the various criteria. With other variables held constant, health complaints were related to several undesirable characteristics, whereas health maintenance behaviors and beliefs were related to several desirable attributes. Only achievement strivings made an independent contribution in both sexes to the 2 measures of academic performance. The theoretical and methodological wisdom of using measures of multiple personality constructs and outcome variables is discussed.

Achievement↗
PubMed2006

Social determinants of health - why we continue to ignore them in the search for improved population health outcomes!

There is now unequivocal evidence that the health status of individuals and of whole communities is socially and economically determined, as are many other aspects of our lives. This suggests, as advocates of public health and population health approaches argue, that our efforts in managing our health and wellbeing should focus much more on early intervention and prevention programs than has been the case to date. However, although this ideology of social and economic determinism is generally accepted, practice does not reflect such values. Indeed, as increasing demand at the critical end of health service provision sees us spending more and more of our limited health care resources on acute and chronic illness, less resources are devoted to constructing and maintaining health-creating communities and environments. Paradoxically, while most of our leaders, academics and policy makers have themselves been nurtured in a sound understanding of cause and effect in the world, they are ignoring these fundamental premises in their approaches to the provision and management of health care. This paper explores some of the reasons why this might be the case and draws on key evidence to suggest that the time has come for us to think more ideologically in approaching health care in the future.

Australia↗
PubMed1984

[Determining the health status of a population: role and quality of survey questions].

Measuring population health levels: role and quality of interview data. Role and quality of interview data are examined with respect to their importance for the measurement of population health levels. Starting from general information requirements in health services, the contribution of population survey data is described. Interview data constitute just a subset of such survey data. When role and quality of interview survey data are to be judged, survey methods are of major importance. They not only determine the quality but also the role of health interview survey data in the framework of all information about the population's health. If this is so, efforts to improve health survey data quality should not only be directed towards improvement of traditional methodological aspects (such as sampling procedures and response rates) but also towards the implementation of prerequisites for wider usage of health interview data. This may be achieved by improving their linkage potential, by implementing uniform minimal basic data sets, by introducing identical terms and definitions and by keeping identical terms and definitions and by keeping identical survey methods (including questions) for several years in a row. Quality of health interview data is, therefore, determined by the methodological standards underlying their collection and the potential for usage of these data sets determines the role they play as part of the information about the population's health.

Germany, West↗
PubMed2005

Prevalence, awareness and determinants of health care-seeking behaviour for urinary incontinence in Qatari women: a neglected problem?

OBJECTIVES: The aim of this study was to determine the prevalence, awareness and determinants of urinary incontinence (UI) among Qatari women and the sociodemographic factors involved in their health care-seeking behaviour. DESIGN: A cross-sectional study was used to determine the symptoms of UI experienced by Arabian Gulf women. SETTING: Primary Health Care (PHC) Centres and community-based study in Qatar. SUBJECTS: A multistage sampling design was used and a representative sample of 1000 Qatari women aged 45 years and above were included from January to June 2003. MEASUREMENTS: Participants completed a questionnaire assessing UI in the previous 12 months and health care-seeking behavior for urinary symptoms. RESULTS: Of 1000 women living in urban and semiurban areas who were asked, 798 (79.8%), representing the study sample, agreed to participate and completed the questionnaire. Of these, 164 (20.6%) were found to have UI. Overall, the reason for not seeking medical attention was mainly embarrassment (40.6%) at having to speak with doctor. Of the total study sample, 562 subjects (70.4%) believed that UI was abnormal and worth reporting to a doctor. Coping mechanisms among incontinent women included frequent washing (58.3%) and wearing a protective perennial pad (42.4%), changing underwear frequently (41.3%), decreasing fluid intake (19.8%) and stopping all work (4.9%). Sufferers were most troubled by their inability to pray (64%) and their marital relationship (47%), limitation of their social activities (20%), difficulty in doing housework (14%) and inconvenience during shopping (13%). Most (71.9%) of the incontinent subjects were self-conscious, ashamed of themselves and troubled by guilt (P < 0.001); 56% found it most embarrassing to discuss UI with their husbands. The majority of women (51.9%) believed child birth to be the major cause of UI, followed by ageing (49.5%), menopause (34.2%) and paralysis (25.3%). Most of the subjects (62.3%) believe that UI can cause infection, some (20.5%) believe that it can cause skin allergy and very few think that it can cause cancer or other disorders. CONCLUSIONS: Our findings indicate that although UI is relatively common in the community, it is underreported by Qatari women because of social and cultural attitudes and-most importantly-lack of information. This findings suggest that strategies to promote care-seeking for incontinence must be developed and employed in the community.

Aged↗
PubMedDate not supplied

Behavior, lifestyle, and socioeconomic variables as determinants of health status: implications for health policy development.

Health promotion has become an official health policy of this country, and it is being pursued through efforts to change individuals' health-related behavior. This approach is based on the assumption that it is in fact an individual's behavior that most directly determines his or her health status. But how good is the evidence that supports this assumption? Specifically, is the evidence sufficient for this assumption to outweigh the long-standing finding that social and economic conditions have a strong relationship to health status? The major support for the behavior approach derives from the coronary heart disease risk-factor studies and the Alameda County Study. In a series of reports over time, the relationship between individuals' health practices and their health status generally, as well as that between heart disease and cancer specifically, have been established by these studies. These observations, however, have not been confirmed when deliberate efforts have been made to change those practices. The evidence in support of the importance of social and economic conditions to health status has been documented through a long series of studies in this country, which have found a direct relationship between individuals' socioeconomic status and their health status. This relationship, however, has not in this country been tested by intervention. Only a few studies have examined the interrelationship between these two approaches to health promotion, but the evidence to date has failed to suggest that either one is the mediator of the other. We must, therefore, conclude that pursuing a policy of health promotion based on either approach to the exclusion of the other would indeed be short-sighted health policy.

Cardiovascular Diseases↗
PubMed1996

The annual guide to "America's best hospitals". Evidence of influence among health care leaders.

To determine health care leaders' opinions about a prominent guide to hospital quality, we surveyed 82 chief executive officers (CEOs) and 80 chiefs of staff of hospitals listed in the 1994 edition of the guide and 50 directors of employer based coalitions. Most of the CEOs (87%) and chiefs of staff (86%) said the guide was used in advertising. More than three quarters of the CEOs, chiefs of staff, and coalition directors who were familiar with the guide thought it was accurate, and most indicated that key constituencies (e.g., physicians, corporate managers) were aware of the guide. Our results demonstrate the likely influence of one prominent guide to health care quality and highlight the need for formal independent assessment of such guides.

Attitude of Health Personnel↗
PubMed1999

Racial differences in patients' perceptions of debilitated health states.

OBJECTIVE: To determine health utility scores for specific debilitated health states and to identify whether race or other demographic differences predict significant variation in these utility scores. DESIGN: Utility analysis. SETTING: A community hospital general internal medicine clinic, a private internal medicine practice, and a private pulmonary medicine practice. PARTICIPANTS: Sixty-four consecutive patients aged 50 to 75 years awaiting appointments. In order to participate, patients at the pulmonary clinic had to meet prespecified criteria of breathing impairment. MEASUREMENTS: Individuals' strength of preference concerning specific states of limited physical function as measured by the standard gamble technique. MAIN RESULTS: Mean utility scores used to quantitate limitations in physical function were extremely low. Using a scale for which 0 represented death and 1.0 represented normal health, limitation in activities of daily living was rated 0. 19 (95% confidence interval [CI] 0.13, 0.25), tolerance of only bed-to-chair ambulation 0.17 (95% CI 0.11, 0.23), and permanent nursing home placement 0.16 (95% CI 0.10, 0.22). Bivariate analysis identified female gender and African-American race as predictors of higher utility scores ( p </=.05). In multiple regression analysis, only race remained statistically significant ( p </=.02 for all three outcome variables). CONCLUSION: Comparisons of African-American values with those of whites concerning defined states of debility demonstrate greater than threefold increases in utility scores. This finding suggests that racial differences need to be taken into account when studying the effects of medical interventions on quality of life.

Activities of Daily Living↗
PubMed2005

Determining the "Health Benefit Basket" of the Statutory Health Insurance scheme in Germany: methodologies and criteria.

The issue of defining health benefit catalogues has recently gained new importance in Germany as a result of the creation of the new Institute for Quality and Efficiency. The Institute was designed to support the Federal Joint Committee conducting effectiveness studies for benefit coverage decisions. The Committee and the contractual partners (sickness funds and providers) define the benefit catalogues for the Statutory Health Insurance in the framework of Social Code Book V, Germany's most relevant health care scheme. Unlike other countries, the German federal government limits its regulatory role to defining procedures that determine the scope of Statutory Health Insurance services. The explicitness of the benefit catalogues varies greatly between different sectors. While benefits in outpatient care are rather explicitly defined, benefit definitions for inpatient care are vague. It is argued that the establishment of the new Institute and the development of the DRG system are initial steps towards a more effective and explicit benefit catalogue.

Germany↗
PubMed2001

Socioeconomic determinants of health- and food safety-related risk perceptions.

Individual and societal perceptions of food-related health risks are multidimensional and complex. Social, political, psychological, and economic factors interact with technological factors and affect perceptions in complex ways. Previous research found that the significant determinants of risk perceptions include socioeconomic and behavioral variables. Most of these past results are based on two-way comparisons and factor analysis. The objective of this study was to analyze the significance of socioeconomic determinants of risk perceptions concerning health and food safety. A multivariate approach was used and the results were compared with earlier bivariate results to determine which socioeconomic predictors were robust across methods. There were two major findings in this study. The first was that the results in the multivariate models were generally consistent with earlier bivariate analysis. That is, variables such as household income, number of children, gender, age, and voting preferences were strong predictors of an individual's risk perceptions. The second result was that the gender of the respondent was the only variable found to be robust across all three classes of health and food safety issues across two time periods.

Female↗
PubMed1986

Is counting the dead enough? Strategies for monitoring health needs in New York City.

Determining health care needs--especially unmet needs--in New York City should continue as a research and policy priority, especially in a rapidly changing health care environment. Among the many data sources that can be used in assessing needs are: mortality data; census data; other vital statistics; National Health Interview Survey data; other interview and survey data; physician examination of patients. Among the uses to which these and other data are being put in an effort to determine unmet need and health status are: predicting age-sex-specific demographic, health status, and utilization trends; analysis of sentinel health events; developing hierarchies of need for small areas; development of city and neighborhood "health profiles"; provider determination of needs for program planning. Obstacles to progress persist, however, including the increasing costs of data gathering and analysis; lack of popular or political support for needs assessment; and problems in defining what health care needs are. Among high priorities for those interested in better assessment of health care needs in New York City are: recreating public and political interest in the issue; garnering more financial support for research; countering trends toward privatization and fragmentation of data collection and analysis efforts; new relationships between academic and other researchers; better definition of need and refinement of research methodologies and data bases; development of a clear strategy for assessing health needs in New York City in the future, and garnering broad support for implementing it.

Data Collection↗
PubMed2005

Opportunities for health promotion in the Queensland women's prison system.

OBJECTIVE: To compare the health of Queensland women prisoners with that of community women using the target areas of public health promotion identified by Health Determinants Queensland as a framework. METHODS: Data from the Queensland Women Prisoners' Health Survey was compared with published community data in each of the target areas. RESULTS: Queensland women prisoners had poorer nutrition, did less exercise, had higher rates of smoking and had a greater prevalence of asthma and diabetes than women in the community. They seemed to have a greater prevalence of mental health disorders. CONCLUSIONS: Within the framework, women prisoners had significantly poorer measured outcomes than community women in all areas except cervical screening, breast cancer screening and overweight and obesity. IMPLICATIONS: The Health Determinants Queensland target areas for Queensland women are of even greater priority in the subgroup of women prisoners. Benefits for the health of prisoners, and therefore the community, could be gained by expanding existing community health promotion activities to prisons through collaboration and partnerships.

Adolescent↗
PubMed2006

The role of the spiritual dimension of the self as the prime determinant of health.

PURPOSE: To present a clinical commentary on the relationship of spirituality to healthcare for those with chronic physical conditions. METHOD: A spiritually based theory of self-identity was presented, based on selected literature to identify the process of health attainment for those with chronic conditions. The resultant Health Change Process Theory was then discussed in relation to relevant empirical research and the implications for rehabilitation practice were outlined. RESULTS: The development of a resilient, intrinsic, spiritually based concept of self was found to be pivotal to health outcomes in rehabilitation. This was then incorporated within a Health Change Process Theory to explain and predict the course followed by people with chronic disorders to achieve health. CONCLUSION: The Health Change Process Theory provides an inclusive framework within which acute and chronic rehabilitation healthcare can be merged to maximise health outcomes. Nevertheless, a need remains to develop a quantitative measure of individual holistic health, based on this theory, to facilitate its use in rehabilitation practice. This paper forwards an explanation for the process that people experiencing chronic physical disabilities undergo as they achieve health. A concept of self that identifies the spiritual core as the component that determines the constancy and continuity of self as a whole which is necessary for health is presented as the basis of the rehabilitative health process.

Adaptation, Psychological↗
PubMed1998

Access to public mental health services: determinants of population coverage.

OBJECTIVES: This study examined factors that affect access to Veterans Administration mental health services. METHODS: Data from national Veterans Affairs databases and the 1990 Decennial Census were used to estimate rates of Veterans Affairs mental health service use in each US county (n = 3,156) among all US veterans and in three subpopulations defined by eligibility and clinical status. Independent variables examined in standard multivariate analyses and using hierarchical linear modeling techniques included county-level sociodemographic characteristics (age, race, and income); "unmanaged" service system characteristics (those not directly controlled by Veterans Affairs program managers, eg, distance from residence to Veterans Affairs and to non-Veterans Affairs services, local supply of non-Veterans Affairs services); and "managed" service system factors (those directly controlled by Veterans Affairs program managers, eg, per capita Veterans Affairs funding level and the efficiency of Veterans Affairs service delivery). RESULTS: Altogether, 2.0% of US veterans used Veterans Affairs mental health services. More than one third (36%) of the variance in utilization was explained by sociodemographic factors; 8% was explained by unmanaged service system factors and 7% was explained by managed service system factors, with variations among subgroups. Substitution effects were demonstrated between Veterans Affairs and non-Veterans Affairs systems and appeared to be diagnosis-specific. CONCLUSIONS: Both per capita funding levels and efficient service delivery were significantly associated with increased access to mental health services. Implications for health system performance assessment and management are discussed.

Aged↗
PubMed2004

Distribution and determinants of health and work status in a comprehensive population of injury patients.

BACKGROUND: Insight into the distribution and determinants of both short- and long-term disability can be used to prioritize the development of prevention policies and to improve trauma care. We report on a large follow-up study in a comprehensive population of injury patients. METHODS: We fielded a postal questionnaire in a stratified sample of 4,639 nonhospitalized and hospitalized injury patients aged 15 years and older, at 2, 5, and 9 months after injury. We gathered sociodemographic information, data on functional outcome with a generic instrument for health status measurement (EuroQol EQ-5D+) and data on work absence. RESULTS: The response rates were 39%, 75%, and 68% after 2, 5, and 9 months, respectively. The reported data were adjusted for response bias and stratification. The 2-month health status of nonhospitalized patients was comparable to the general population's health when measured by the EQ-5D summary score, although considerable prevalence of restrictions in usual activities (24.0%) and pain and discomfort (34.8%) were reported. Hospitalized patients reported higher prevalences of disability in all health domains. Their mean EQ-5D summary score increased from 0.62 at 2 months to 0.74 at 5 months but remained below the population norm at 9 months, particularly for patients with a long hospital stay. Patients with injuries of the spinal cord and vertebral column, hip fracture, and other lower extremity fractures reported the worst health status, also when adjusted for age, sex, and educational level. Age, sex, type of injury, length of stay, educational level, motor vehicle injury, medical operation, intensive care unit admission, and number of injuries were all significant predictors of functioning. Nonhospitalized and hospitalized injury patients lost on average 5.2 and 72.1 work days, respectively. Of nonhospitalized patients, 5% had not yet returned to work after 2 months, and 39%, 20%, and 10% of hospitalized patients had not yet returned to work after 2, 5, and 9 months, respectively. In a multivariate regression analysis, length of stay, type of injury, level of education, and intensive care unit admission appeared to be significant predictors of absence duration and return to work. CONCLUSION: Injury is a major source of disease burden and work absence. Both hospitalized and nonhospitalized patients contribute significantly to this burden.

Adolescent↗
PubMed1999

[The scientific bases for determining the health losses of the affected population in catastrophic flooding].

The article focuses on methodological approaches to the determination of sanitary losses among population in a catastrophic flood. An emergency is considered that can arise in the destruction of the water-development project assemblies. The following items were taken account of in working out of the above approaches: population density in the territories found to be in the zone of flood: notification and evacuation of the population from the zone of catastrophe in a timely fashion, the distance from the site of formation of the wave of breaking to the populated locality, the height and velocity of the wave of breaking, time of the year and day of the catastrophe. Scientific and methodological approaches and the mathematical model "Povin'" ("Flood") developed with the aid of such approaches permit analyzing the situation having presented itself, working out administrative decisions for the territorial public health services directing bodies to be taken in the current situation, instituting measures designed to eliminate medicosanitary effects of the catastrophic flood within the shortest time possible.

Disaster Planning↗
PubMed2005

The Population Health Approach: health GIS as a bridge from theory to practice.

BACKGROUND: The Population Health Approach, proposed by Health Canada, is the articulation of a long advocated model of human health. This approach strives to ensure that the health system is appropriately oriented to improve health status by applying evidence based practices across the continuum from health determinants to service interventions. Although conceptually appealing, it has been difficult to implement widely in the existing program-based health care system. The Population Health Surveillance Unit (PHSU) of the Vancouver Island Health Authority (VIHA) has developed a health geographical information system (HGIS), where GIS is used as both platform for information integration and as an analytical tool supporting comprehensive data analysis. With the assistance of the HGIS, the theory of the population health approach can be transformed into a practical, stepwise process supporting health services and program planning. RESULTS: Three important components of a health service planning and evaluation framework grounded in population health theory are described in this article. In particular, a stepwise methodological process to enable the incorporation of the principles of a population health into practical applications is presented; the technical functionality to integrate multiple sources of information, with different levels and scales is discussed; and sources of information about the health of the population at the appropriate level to populate this frame are proposed. An application of the methodology in the planning of health services for a high needs neighbourhood is presented as an illustrative example. CONCLUSION: The population health approach incorporates the consideration of health determinants and the context within which the health conditions arise in communities. The complexity of these relationships requires the application of innovative methodologies such as Health GIS to frame the issues practically. A population health based foundation for the planning and evaluation of health services can now move from theory to practice.

Journal Article↗