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PubMed2003

Cognitive-behavioral interventions improve quality of life in women with AIDS.

OBJECTIVE: We tested the effects of a 10-week group-based cognitive-behavioral stress management/expressive-supportive therapy intervention (CBSM+) and a time-matched individual psychoeducational condition for 330 women with AIDS reporting moderate to poor baseline quality of life (QOL). The goal of this study was to examine treatment effects on total QOL and 11 QOL domains from baseline to post-intervention follow-up. METHODS: Participants were assessed at baseline, randomized to a treatment condition (individual psychoeducation condition n=180, group-based CBSM+ condition n=150), participated in the intervention for 10 weeks and assessed again within 4 weeks following the intervention. QOL was measured using the Medical Outcomes Study-HIV-30. RESULTS: QOL scores increased over the course of both interventions for the total QOL score and three QOL domains: cognitive functioning, health distress and overall health perceptions. While women in the CBSM+ group condition showed a significant improvement in mental health QOL from pre- to post-intervention, women in the individual condition did not change. No changes were observed for energy/fatigue, health transition, single-item overall QOL, pain, physical well-being, role functioning or social functioning in either condition. CONCLUSION: Results suggest that group-based CBSM+ and individual psychoeducational interventions are effective at improving certain aspects of QOL and that group-based CBSM+ may be particularly effective at increasing QOL related to mental health in this population of women with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Carolina in the Carolines: a survey of patterns and meanings of smoking on a Micronesian island.

Tobacco use--especially smoking industrially manufactured cigarettes--kills nearly 5 million people annually and is the leading preventable cause of death worldwide. Tobacco is a widely used global commodity embedded in cultural meanings, and its consumption involves a set of learned, patterned social behaviors. Seemingly, then, tobacco offers a most appealing anthropological research topic, yet its study has been relatively ignored by medical anthropologists when compared to research on alcoholic beverages and illegal drugs. To help fill this gap, this article sketches the historical background of tobacco in Micronesia, presents the results of a cross-sectional smoking survey from Namoluk Atoll, and describes contemporary smoking patterns and locally understood symbolic associations of tobacco. Intersections among history, gender, local meanings, the health transition, and the transnational marketing of tobacco are addressed, and cigarette smoking is seen as part of a new syndemic of chronic diseases in Micronesia.

Advertising↗
PubMed1993

Transition to adult health care for adolescents and young adults with cancer.

As the prognosis for children and adolescents with cancer improves, we must reconsider how we will provide care to the adolescents and young adults who have survived these conditions. On the premise that the global needs of adults are best served by health care obtained in the adult health-care system, the case is made for transition from pediatric to adult-oriented health care for adolescents and young adults with cancer. The benefits of transition, barriers to implementation, and models of care are discussed.

Adolescent↗
PubMed2001

Death, disease and diversity in Australia, 1951 to 2000.

There has been a substantial decline in mortality in Australia during the 20th century, with a major improvement in life expectancy. There has been a broad "health transition", from a pattern of high mortality from infectious diseases to one of lower overall mortality from non-communicable diseases and injury. From 1951, trends in death rates from major causes were evident, with the rise and partial fall of two epidemics (coronary heart disease and stroke, and lung cancer). This overall picture masks significant inequalities in health for Indigenous people and the socioeconomically disadvantaged.

Adolescent↗
PubMed2006

A population-based cohort study of longer-term changes in health of car drivers involved in serious crashes.

STUDY OBJECTIVE: Evidence about the burden of disability after motor vehicle crashes has relied primarily on trauma center-based studies. We examine the impact of serious crashes on the longer-term health of car drivers, independent of natural variation, in a population-based study in Auckland, New Zealand. METHODS: The study population comprised 218 car drivers surviving nonfatal crashes in Auckland, in which at least 1 occupant in the vehicle was admitted to a hospital, and a representative sample of 254 car drivers in the region, recruited from roadside surveys. All participants were interviewed at recruitment (subjects reported their precrash health) and 5 and 18 months later. The drivers' changes in health were obtained with a global health transition indicator and the Short Form-36, with analyses adjusting for potential confounders. RESULTS: Compared with 7% of drivers in the comparison group, 43% of crash drivers admitted to the hospital (adjusted odds ratio 10.4; 95% confidence interval 5.5 to 19.6) and 20% of those not admitted (odds ratio 3.3; 95% confidence interval 1.4 to 8.3) reported that their overall health at 18-month follow-up was worse than at baseline (precrash). Among the drivers reporting worsened health, prospectively ascertained Short Form-36 scores revealed greater reductions in physical health in those admitted after the crash, but these scores improved from 5 to 18 months. In contrast, mental and general health scores worsened from 5 to 18 months in admitted and nonadmitted crash drivers. CONCLUSION: A substantial proportion of drivers surviving serious crashes experience reductions in longer-term health, a burden likely to be underappreciated among those not admitted to a hospital. Emergency departments could serve as useful settings in which to develop and validate clinical decision rules that can help target services for crash survivors at increased risk of adverse outcomes.

Accidents, Traffic↗
PubMed1997

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); revisions to the eligibility requirements--DoD. Proposed rule.

This proposed rule revises the comprehensive CHAMPUS regulation pertaining to basic CHAMPUS benefits in accordance with several statutory changes. This proposed rule: sets forth the requirements for reinstatement of CHAMPUS eligibility for beneficiaries under age 65 who would otherwise have lost eligibility for CHAMPUS due to eligibility for Medicare as a result of disability or end-stage renal disease (ESRD); establishes new classes of CHAMPUS eligibles; establishes the Transitional Assistance Management Program which provides transitional health care for members (and their dependents) who served on active duty in support of a contingency operation and for members (and their dependents) who are involuntarily separated from active duty; allows former spouses who buy a conversion health policy to keep CHAMPUS eligibility for twenty-four (24) months for preexisting conditions that are not covered by the conversion policy; and makes minor technical revisions to the double coverage provisions. This proposed rule also adds a new category of eligible beneficiary under the Continued Health Care Benefit Program.

Adult↗
PubMedDate not supplied

An educational program to prepare acute care nurses for a transition to home health care nursing.

This article describes a continuing education program that prepares nurses with experience in acute care nursing for the transition to home health care nursing. The program is a 12-credit hour, two semester college program consisting of 8 hours of theory and 4 hours of clinical practicum. A coalition of hospitals, home health agencies and an educational institution designed the program to maintain the economic welfare of nurses in an era of hospital layoffs, promote professional development and enhance the transition of nurses to home health nursing.

Acute Disease↗
PubMed1999

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); revisions to the eligibility requirements. Department of Defense (DOD), Office of the Secretary of Defense. Final rule.

This final rule revises the comprehensive CHAMPUS regulation pertaining to basic CHAMPUS benefits in accordance with several statutory changes. This final rule: sets forth the requirements for reinstatement of CHAMPUS eligibility for beneficiaries under age 65 who would otherwise have lost eligibility for CHAMPUS due to eligibility for Medicare as a result of disability or end-stage renal disease (ESRD); establishes new classes of CHAMPUS eligibles; establishes the Transitional Assistance Management Program which provides transitional health care for members (and their dependents) who served on active duty in support of a contingency operation and for members (and their dependents) who are involuntarily separated from active duty; allows former spouses who buy a conversion health policy to keep CHAMPUS eligibility for twenty-four (24) months for preexisting conditions that are not covered by the conversion policy; and makes minor technical revisions to the double coverage provisions. In order to expedite compliance with the statutory requirements, all of these provisions have been implemented under interim instructions. This final rule also adds a new category of eligible beneficiary under the Continued Health Care Benefit Program.

Eligibility Determination↗
PubMed1999

Two approaches to measuring quality of life in the HIV/AIDS population: HAT-QoL and MOS-HIV.

OBJECTIVES: Reduce the number of HIV/AIDS-Targeted Quality of Life (HAT-QoL) items, assess psychometric performance of the shortened HAT-QoL, and compare psychometric performance of HAT-QoL to that of Medical Outcomes study HIV Health Survey (MOS-HIV). DESIGN/SUBJECTS: Convenience sample of 215 cross-sectionally studied seropositive individuals. METHODS: Subjects completed the HAT-QoL, MOS-HIV, and sociodemographic and disease-specific questions. HAT-QoL and MOS-HIV responses were entered, separately, into principal components analysis (PCA). Results from PCA, internal consistency and correlation assessments were used to aid the item removal process. Dimension characteristics (e.g., score distributions, internal consistency, scaling success rates, intercorrelations, construct validity) were evaluated. RESULTS: PCA of subjects' (80% male; 45% white; 62% gay/bisexual) responses revealed nine previously identified HAT-QoL dimensions. The measure was shortened by removing 12 items. Two HAT-QoL dimensions (HIV mastery and provider trust) had ceiling effects. All internal consistency coefficients were > 0.80, except those for sexual function (0.57) and medication concerns (0.57). HAT-QoL scaling success rates were > 90% for 7 of 9 dimensions, and a majority of dimensions showed minimal to low intercorrelations. Validity assessments indicated consistent, expected relationships (p < or = 0.05) for all dimensions except the medication concerns and provider trust dimensions. PCA indicated five MOS-HIV factors. Six of the 11 previously defined MOS-HIV dimensions--physical, role, social, and cognitive function, pain, and health transition--had substantial ceiling effects. MOS-HIV scaling success rates were > 90% for only 2 out of 8 evaluable dimensions; three dimensions had very low (40-73%) scaling success rates. Most MOS-HIV dimensions were moderately-to-highly intercorrelated. Validity assessments indicated consistent, expected relationships for all MOS-HIV dimensions. CONCLUSIONS: Six dimensions of the shortened HAT-QoL instrument (overall function, disclosure worries, health worries, financial worries, HIV mastery, and life satisfaction) exhibited good psychometric properties, including limited ceiling effects, low dimension intercorrelations, high internal consistency, and evidence for construct validity. All multi-item MOS-HIV dimensions had high internal consistency and all dimensions revealed consistent evidence for construct validity.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Epidemiological profile of India: historical and contemporary perspectives.

Knowledge and understanding of the epidemiological profile is an essential pre-requisite to assess and address public health needs in the country and to enable efficient programme planning and management. The need for adequate and accurate health information and data to undertake such an exercise cannot be over-emphasized. The present effort is a modest attempt to critically analyse the epidemiological profile of India from the historical and contemporary perspective. In order to assess the successes achieved as well caution against the daunting challenges awaiting the country, parameters such as disease burden and health status indicators, are increasingly being used. Changes in the population age structure, improvements in the nation's economic status, altered life-styles of people and duality of disease burden testify to the demographic, development and health transition occurring in the country. Population stabilization, poverty alleviation, life-style modification, surveillance and control of communicable and non-communicable diseases constitute the major challenges demanding urgent attention in the future.

Birth Rate↗
PubMed2000

Patient-assessed measures of health outcome in asthma: a comparison of four approaches.

The study compares the psychometric properties of four different approaches to patient-assessed health outcomes in asthma, including the Asthma Quality of Life Questionnaire (AQLQ), Newcastle Asthma Symptoms Questionnaire (NASQ), SF-12 and EuroQol. The instruments were administered by means of a self-completed postal questionnaire to 394 patients recruited from general practices in the North East of England. Patients completed a follow-up questionnaire at 6 months. The levels of missing data were assessed and instrument scores compared using correlational analysis. Scores were related to self-reports of smoking behaviour, socioeconomic status and health transition. Responsiveness was assessed using standardized response means. Two hundred and thirty-five patients took part in the study giving a response rate of 59.6%. There was a relatively large amount of missing data for the individualized section of the AQLQ. Correlational analysis provided evidence of convergent validity between the specific instruments; the largest correlation was found between NASQ scores and the asthma symptoms scale of the AQLQ (r = 0.84). The NASQ was found to be the most powerful at discriminating between smokers and non-smokers. All four instruments were linearly related to self-reported asthma transition (P<0.05); the specific instruments having the strongest association. The specific instruments showed good levels of responsiveness with the NASQ producing a large SRM of 0.82. SRMs for the AQLQ were of a moderate to large size (0.32-0.77) and the SRMs for the SF-12 and EuroQol were of a small size. The two specific instruments are capable of greater levels of discrimination between groups of patients and are more responsive to changes in health than the generic SF-12 and EuroQol. The greater responsiveness of the NASQ is probably due to its focus being restricted to symptoms of asthma compared to the broader focus of the AQLQ domains. The NASQ has a strong relationship with the AQLQ and is a more practical instrument that is more acceptable to patients. However, the AQLQ does measure broader patient concerns. The SF-12 and EuroQol have greater potential to capture side-effects and have wider scope for application in economic evaluation.

Asthma↗
PubMed2006

Use of applied theatre in health research dissemination and data validation: a pilot study from South Africa.

This article reports on a pilot study of the use of applied theatre in the dissemination of health research findings and validation of data. The study took place in South Africa, as part of the Southern Africa Stroke Prevention Initiative (SASPI) and was based at the University/Medical Research Council Rural Public Health and Health Transitions Research Unit (also known as the Agincourt Unit). The aim of SASPI was to investigate the prevalence of stroke and understand the social context of stroke. It was decided to use an applied theatre approach for validating the data and disseminating findings from the anthropological component of the study. The pilot study found that applied theatre worked better in smaller community groups. It allowed data validation and it elicited ideas for future interventions resulting from the health research findings. Evaluation methods of the impact of applied theatre as a vehicle for the dissemination and communication of research findings require further development.

Diffusion of Innovation↗
PubMed2000

Comparative responsiveness of Short-Form 12 and Minnesota Living With Heart Failure Questionnaire in patients with heart failure.

BACKGROUND: The Short-Form 12 (SF-12) and Living With Heart Failure Questionnaire (LHFQ) are commonly used to measure quality of life (QOL) in heart failure outcomes research. Their comparative responsiveness, however, has not been documented. METHODS AND RESULTS: A prospective cohort study was conducted among patients attending a university-based heart failure clinic between April 1997 and September 1998. All patients received comprehensive heart failure care management. QOL of patients was assessed by the SF-12 and LHFQ at baseline and 3 months. Of 87 patients completing follow-up, the mean change score was 10.1 for the LHFQ and 5.8 for the SF-12 (both Ps < .001). The change scores of the instruments were correlated (r = 0.61; P < .001). The SF-12 had a greater ability than the LHFQ to statistically detect change in physical health but was less sensitive to changes in mental health. The LHFQ performed better than the SF-12 in the ability to distinguish the differences in perceived global health transition. CONCLUSION: The LHFQ is more responsive than the SF-12 to changes in QOL. The SF-12 should not be used alone to measure the changes in QOL of patients with heart failure.

Adult↗
PubMed2006

Cause-specific mortality rates in sub-Saharan Africa and Bangladesh.

OBJECTIVE: To provide internationally comparable data on the frequencies of different causes of death. METHODS: We analysed verbal autopsies obtained during 1999 -2002 from 12 demographic surveillance sites in sub-Saharan Africa and Bangladesh to find cause-specific and age-specific mortality rates. The cause-of-death codes used by the sites were harmonized to conform to the ICD-10 system, and summarized with the classification system of the Global Burden of Disease 2000 (Version 2). FINDINGS: Causes of death in the African sites differ strongly from those in Bangladesh, where there is some evidence of a health transition from communicable to noncommunicable diseases, and little malaria. HIV dominates in causes of mortality in the South African sites, which contrast with those in highly malaria endemic sites elsewhere in sub-Saharan Africa (even in neighbouring Mozambique). The contributions of measles and diarrhoeal diseases to mortality in sub-Saharan Africa are lower than has been previously suggested, while malaria is of relatively greater importance. CONCLUSION: The different patterns of mortality we identified may be a result of recent changes in the availability and effectiveness of health interventions against childhood cluster diseases.

Adolescent↗
PubMed2002

Impact of war on health related quality of life in Croatia: population study.

AIM: To present health-related quality of life in post-war Croatia, focusing on the population as a whole rather than on the specific group of people. METHOD: The study was conducted in six Croatian counties in the 1997-1999 period. Three of those counties had been directly affected by the 1991-1995 war. The sample consisted of 1,297 randomly selected respondents aged 18 years and older. The questionnaire was anonymous, consisting of questions on sociodemographic characteristics of respondents and Medical Outcome Study 36-item short-form health survey (SF-36). SF-36 comprised the following nine subscales: physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE), mental health (MH), and health transition (HT). RESULTS: Mean subscale scores for the areas directly affected by war were PF 64.21; RP 52.70; BP 59.35; GH 49.02; VT 49.52; SF 68.29; RE 63.02; MH 57.95; HT 41.28; and for the areas not affected by war were PF 65.35; RP 62.01; BP 61.79; GH 50.45; VT 49.40; SF 71.41; RE 74.11; MH 60.33; HT 45.14. The two areas differed significantly in RP (p<0.001), SF (p=0.035), RE (p<0.001), MH (p=0.038), and HT (p=0.003). Respondents living in the areas directly affected by war achieved lower total health-related quality of life scores. Younger respondents, respondents with secondary education, and those with lower income were the groups mostly affected by war. CONCLUSION: War affects self-perceived health, physical ability, and emotional and mental health of the entire population affected by war, especially younger age groups, those with lower education, and lower income.

Adolescent↗
PubMedDate not supplied

[Nutritional transition and non-communicable diet-related chronic diseases in developing countries].

It is increasingly recognized that developing countries are undergoing an epidemiologic transition similar to that which occurred in industrialized countries in previous centuries. While infectious diseases are still the main cause of morbidity and mortality, there is a marked increase in chronic non-communicable diseases, particularly in the most advanced developing countries, and these diseases are expected to take the lead in a decade or two. Most of these diseases, above all coronary heart diseases, stroke and diabetes, are related to diet and lifestyles, for example tobacco and alcohol consumption. As a matter of fact, these societies are also facing a growing epidemic of overweight and obesity, due to the frequent energetic imbalance between energy-dense food consumption and reduced daily physical expenditure. This health transition, favoured by demographic changes towards aging populations, is occurring at an increased pace in urban societies widely exposed to the modernization of lifestyle, sedentary occupation, and to lipid- and sugar-rich food, often poor in fibre and micronutrients. Increased world access to cheaper vegetable oil is thought to have triggered off this accelerated and generalized trend, though animal food, rich in saturated fat, and imported or locally-made industrialized food also play a role. While increased national and household incomes facilitate the initial change, as the transition advances poor people progressively become the main victims, as has been observed in the more advanced developing countries. Metabolic imprinting due to intra-uterine and infant malnutrition, which are still common in these societies, is also thought to play a significant role in the increase in the expression of insulin resistance, obesity and chronic diseases when these children are exposed to abundant food and modern lifestyle, later in life. Treatment and secondary prevention of nutrition-related chronic diseases and associated disabilities have an ever rising cost in industrialized countries, which is far beyond the means of the still fragile economies of developing countries. This double burden of infectious diseases and undernutrition that still exist, and of non-communicable diseases and overnutrition represents a threat to the frequently unprepared health care services in developing countries. There is a clear need to focus health policies on the prevention of chronic diseases through primary health care services, the use of mass media for communication and education about healthy nutrition and lifestyle, and the adaptation of public policies. Nutritionists must also adapt to this changing nutritional situation which may result in apparently contradictory nutritional status findings within societies if not even within households.

Chronic Disease↗
PubMed1999

Trends in transition from pediatric to adult health care services for young adults with chronic conditions.

PURPOSE: The rationale underlying this study was the need to move the transition health services model from a theoretical framework to an empirically-based investigation. Thus, it was necessary to identify programs for youth with chronic or disabling conditions that assist in transitioning from child- to adult-focused health services by (a) discrete types, (b) functional categories, and (c) problems and issues faced by these programs. METHODS: Nominations for transition health services programs were solicited from 1025 organizational agencies at the local, state, regional, and national levels. Two solicitations yielded 277 nominees. After pilot testing, a survey of 163 forced responses and open-ended questions was mailed to each nominated transition health services program. A total of 122 programs returned completed surveys. RESULTS: Program services were categorized as adolescent-focused (38%), condition-focused (36%), and specialty-specific programs (26%). Few programs were primary care-based. Categories were subsequently collapsed into two types: adolescent-focused and condition-focused. No significant differences were noted between adolescent- and condition-focused programs regarding provision of mental health services, vocational counseling, self-efficacy training, or health education. The primary barriers to transition health services were identified as funding and access to key staff, rather than family and adolescent resistance. CONCLUSION: In general, self-identified transition health care programs do not achieve the goal of collaborative, coordinated, and integrative services to adolescents with chronic or disabling conditions. Furthermore, the barriers to attaining the goal are the limitations of the health care system itself.

Adolescent↗
PubMed2003

Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: a double-blind, randomized, placebo-controlled study.

PURPOSE: To evaluate the efficacy and safety of a combination analgesic tablet (37.5 mg tramadol/325 mg acetaminophen) for the treatment of fibromyalgia pain. METHODS: This 91-day, multicenter, double-blind, randomized, placebo-controlled study compared tramadol/acetaminophen combination tablets with placebo. The primary outcome variable was cumulative time to discontinuation (Kaplan-Meier analysis). Secondary measures at the end of the study included pain, pain relief, total tender points, myalgia, health status, and Fibromyalgia Impact Questionnaire scores. RESULTS: Of the 315 subjects who were enrolled in the study, 313 (294 women [94%], mean [+/- SD] age, 50 +/- 10 years) completed at least one postrandomization efficacy assessment (tramadol/acetaminophen: n = 156; placebo: n = 157). Discontinuation of treatment for any reason was less common in those treated with tramadol/acetaminophen compared with placebo (48% vs. 62%, P = 0.004). Tramadol/acetaminophen-treated subjects also had significantly less pain at the end of the study (53 +/- 32 vs. 65 +/- 29 on a visual analog scale of 0 to 100, P <0.001), and better pain relief (1.7 +/- 1.4 vs. 0.8 +/- 1.3 on a scale of -1 to 4, P <0.001) and Fibromyalgia Impact Questionnaire scores (P = 0.008). Indexes of physical functioning, role-physical, body pain, health transition, and physical component summary all improved significantly in the tramadol/acetaminophen-treated subjects. Discontinuation due to adverse events occurred in 19% (n = 29) of tramadol/acetaminophen-treated subjects and 12% (n = 18) of placebo-treated subjects (P = 0.09). The mean dose of tramadol/acetaminophen was 4.0 +/- 1.8 tablets per day. CONCLUSION: A tramadol/acetaminophen combination tablet was effective for the treatment of fibromyalgia pain without any serious adverse effects.

Acetaminophen↗