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PubMed2003

Determinants of health policy impact: a theoretical framework for policy analysis.

This paper addresses the role of policy and evidence in health promotion. The concept of von Wright's "logic of events" is introduced and applied to health policy impact analysis. According to von Wright (1976), human action can be explained by a restricted number of determinants: wants, abilities, duties, and opportunities. The dynamics of action result from changes in opportunities (logic of events). Applied to the policymaking process, the present model explains personal wants as subordinated to political goals. Abilities of individual policy makers are part of organisational resources. Also, personal duties are subordinated to institutional obligations. Opportunities are mainly related to political context and public support. The present analysis suggests that policy determinants such as concrete goals, sufficient resources and public support may be crucial for achieving an intended behaviour change on the population level, while other policy determinants, e.g., personal commitment and organisational capacities, may especially relate to the policy implementation process. The paper concludes by indicating ways in which future research using this theoretical framework might contribute to health promotion practice for improved health outcomes across populations.

Evidence-Based Medicine↗
PubMed2006

Determinants of health related quality of life and health state utility in patients with age related macular degeneration: the association of contrast sensitivity and visual acuity.

BACKGROUND: There has been increasing interest in the use of measures of health related quality of life (HRQoL) and health state utility values in Age Related Macular Degeneration (ARMD). Visual acuity has been found to be an important determinant of such measures in previous studies. More recently, another measure of visual impairment, contrast sensitivity has received considerable attention. We designed a study to examine whether the contribution of contrast sensitivity in explaining HRQoL and health utilities over and above that of visual acuity. METHODS: 209 patients with unilateral or bilateral ARMD were recruited into a cross-sectional study of patients from a large teaching hospital. Patients underwent visual tests (near and distant visual acuity, contrast sensitivity) and completed a vision function questionnaire, the VF-14, HUI3, and time trade-off. RESULTS: Using multivariate regression analysis, the study revealed that contrast sensitivity remained a statistically significant predictor of all outcome measures even when visual acuity was included. This result was supported by the correlation coefficients between measures. CONCLUSIONS: The measurement of contrast sensitivity appears to be better related to a person's HRQoL and health utility. Future studies should consider incorporating contrast sensitivity in addition to visual acuity. Studies, in particular economic evaluations, may underestimate the effect of treatment unless contrast sensitivity is considered.

Adult↗
PubMed2002

Mental health professionals' determinations of adolescent suicide attempts.

The degree of ambiguity in the term suicide attempt was examined among 14 expert suicidologists, and 59 general mental health clinicians who either did or did not receive a standard definition of the term. The participants judged whether each of ten vignettes of actual adolescent self-harm behaviors was a suicide attempt. Low levels of agreement were found within each group, although agreement was better for the most and least serious cases. Possible explanations were examined, including how professionals weight suicidal intent and medical lethality in their suicide attempt decisions, and the use of a "fuzzy," natural language conceptualization of suicide attempts was proposed.

Adolescent↗
PubMed2006

Health-related determinants of perceived quality of life: a comparison between first-year university students and their working peers.

This study compares aspects of the health-related behaviors and working life of first-year university students with those of their working counterparts and assesses the roles of these aspects as predictors of each groups' perceived quality of life (QoL). Subjects were taken from two cross-sectional data sets (a student survey and a population survey) from the Swedish central-western region of Ostergötland. Male and female respondents aged 20-35 years were extracted and comparison were made considering in turn socio-demographic characteristics, health-related behaviors, exposure to abusive events at work and perceived QoL. University students smoked and used oral snuff in smaller proportions, they were not as frequent drinkers as their working counterparts, but they tended to drink more when they did drink. Threats and violence were less prevalent among students, but sexual harassment, were almost as common. The strongest predictors of perceived QoL for both groups are expected and former perceived QoL, followed by current self-rated health.

Adult↗
PubMed1995

Approach to health risk determination for metals and their compounds under the Canadian Environmental Protection Act.

The Canadian Environmental Protection Act (CEPA) authorizes the Ministers of the Environment and of Health in Canada to investigate a wide variety of substances that may contaminate the environment and cause adverse effects on the environment and/or on human health. Under the Act, assessments have been completed for 44 environmental contaminants on the first Priority Substances List, including four metals and their compounds. The principles developed for the assessment of risk to human health for priority substances under CEPA are outlined, with specific emphasis on the metals. These include general aspects such as estimation of total exposure from all media, the development of exposure potency indices for carcinogens in lieu of low-dose risk estimates, and incorporation of toxicokinetic and toxicodynamic data, where available, to modify traditionally adopted uncertainty factors for development of tolerable intakes, or concentrations, for nonneoplastic effects. Aspects of the approach to human health risk assessment more specific to the metals considered under CEPA (i.e., arsenic, cadmium, chromium, and nickel) and implications for the subsequent strategic options process are also addressed, including the extent to which various chemical forms could be assessed (i.e., speciation) and essentiality.

Adolescent↗
PubMed1989

Are sociodemographic variables markers for psychological determinants of health?

Argues that the robust associations between sociodemographic variables and the major causes of morbidity and mortality are due in part to correlated psychological factors. To make this case concrete, the article reviews the psychological determinants of morbidity and mortality that are correlated with educational attainment and sex. It discusses the importance of health psychologists' studies of age, sex, ethnicity, and educational/occupational status to understanding why, how, and in whom psychological factors are contributors to disease.

Educational Status↗
PubMedDate not supplied

Is environmental health a determinant or an afterthought in policies ranging from water quality to global warming?

The goal of this discussion is to draw attention to the regrettable fact that health repercussions are not being addressed in policy setting. This absence covers a spectrum from policies as technically focused as that governing water quality, where the health dimensions are well known, to policies as broad as those dealing with global warming, where the health dimensions are still being defined. This situation is likely to worsen unless the environmental health community accepts the responsibility to do more outreach. The presentation also gives examples of how inclusion of environmental health in policy deliberations can increase economically quantifiable benefits and can help justify investments that are otherwise considered too costly. Despite advances in environmental health, many, if not most, important decisions affecting human health are being made without the input of health specialists. At best, considerations of environmental health are afterthoughts in the policies of business, commerce, industry, and many government agencies that are involved--even if inadvertently--with creating most environmental health problems, and by implication, are potentially responsible for their solutions. Examples of situations where the health dimensions are well known, such as with water quality, are provided from some 200 past World Bank projects in water supply, waste disposal, transportation, housing, urban development, and telecommunications, designed mainly by engineers and economists. The absence of health input is not necessarily detrimental if agency policies or environmental reviews can compensate for the absence of direct health input by other means such as environmental assessments, which currently do not systematically include health.

Environmental Health↗
PubMed1984

Socioeconomic factors associated with malaria in Colombia.

In spite of progress made to control tropical diseases many developing countries in the world still show high rates of incidence. A program for malaria eradication has been in operation in Colombia since 1953, and the malaria incidence rate was falling until 1971. However, in recent years the rate has begun to rise again in affected areas of the country. The resurgence of the disease leads one to think that traditional methods of controlling it are approaching the saturation point, and a reassessment of the determinants of the problem is needed in order to identify social and economic factors that might be playing an important role by themselves or in association with epidemiological or health determinants of the disease. The purpose of this paper is to present a methodology which is being applied to the analysis of social, economic and health determinants of malaria incidence in Colombia. The model is theoretically based on a home economics framework. However, an expansion of the original version is made to take into account social and organizational factors which are thought to be important in the Colombian case. Economic variables included in the testing of the model are income, wealth and occupation. Social variables include education and housing conditions. Health factors considered are nutrition and health services. The model is tested using data collected in July 1982 in one of the most malaria affected areas of Colombia, and preliminary results are presented.

Colombia↗
PubMedDate not supplied

Quality and outcome determination in health care and orthopaedics: evolution and current structure.

Quality health care has many definitions. Among those definitions is "care that consistently contributes to the improvement or maintenance of the quality and/or duration of life." The current evolution in health care has been fueled by three necessities frequently demanded by payers and employers: improvement in access, lowering of cost, and definition and quantification of the quality of care. This evolution has been facilitated by the so-called industrialization of medicine. This concept includes the adoption of industrial economic principles and techniques that facilitate the measurement of processes and outcomes. Quality health care is currently recognized as health care that is characterized by three elements: the use of practice guidelines or standards, the implementation of continuous quality improvement techniques, and the use of outcome determination and management. Practice guidelines demand the adoption of evidence-based principles in evaluation and care, as well as minimization of variations in evaluation and care. Continuous quality improvement seeks to determine why variations in processes of care occur and then to minimize those variations. Outcomes may be measured in terms of both very objective and very subjective variables and also on the basis of cost-efficiency. Most tools currently used to quantify outcomes, especially in orthopaedics, involve measurements of general health and of specific body part or organ system function. This evolution in health care is producing significant alterations in methods of traditional health-care delivery. The accumulating evidence indicates that these changes, although frequently unpopular, are improving the quality of health care.

Female↗
PubMed1993

Adapting the systemic lupus erythematosus self-help (SLESH) course for Latino SLE patients.

The Systemic Lupus Erythematosus Self-Help (SLESH) Course is an effective self-management program that provides knowledge and enabling skills to people with systemic lupus erythematosus (SLE) and their families to assist them in coping with the disease. However, many acknowledge that the program has largely failed to meet the needs of people from diverse cultural backgrounds. In order to better understand how the SLESH Course can be more responsive to the needs of people from diverse cultural groups, we conducted a case study to analyze the content, process, and logistics of the course. The purpose of our study was to determine the essential variables to be considered in adapting the program for Latino SLE patients. Utilizing a three-phase approach that involved key-informant interviews, focus groups, and evaluation of skill-building activities, we found that culturally determined health beliefs, language of preference, and outreach efforts are the key variables that must be considered in adapting the SLESH Course for the target population. Culturally determined health beliefs, such as the importance of family roles rather than individual need and an emphasis on the interdependency of family members, need to be considered in adapting self-help programs like the SLESH Course for Latino SLE patients.

Adaptation, Psychological↗
PubMed1999

Review of methods to determine VA health care costs.

BACKGROUND: Estimates of health care cost are needed to conduct cost-effectiveness research at the facilities operated by the US Department of Veterans Affairs. METHODS: The medical literature was searched for VA studies to characterize different cost methods and identify their advantages and disadvantages. RESULTS: Different methods are appropriate for different studies. Analysts who wish to capture the effect of an intervention on resources used in a health care encounter may wish to create a detailed pseudo-bill by combining VA utilization data with unit costs from the non-VA sector. If a cost function can be estimated from non-VA data, VA costs may be determined more economically from a reduced list of utilization items. If the analysis involves a new intervention or a program that is unique to VA, direct measurement of staff time and supplies may be needed. It is often sufficient to estimate the average cost of similar encounters, for example, the average of all hospital stays with the same diagnosis and same length of stay. Such estimates may be made by combining VA cost and utilization data bases and by applying judicious assumptions. CONCLUSIONS: Assumptions used to estimate costs need to be documented and tested. VA cost-effectiveness research could be facilitated by the creation of a universal cost data base; however, it will not supplant the detailed estimates that are needed to determine the effect of clinical interventions on cost.

Cost-Benefit Analysis↗
PubMed2004

Perceived cognitive function is a major determinant of health related quality of life in a non-selected population of patients with coronary artery disease--a principal components analysis.

OBJECTIVE: To assess health related quality of life (HRQL) and explore its underlying structure in a non-selected population of patients with coronary artery disease (CAD). DESIGN, SETTING AND SUBJECTS: HRQL was estimated by the disease specific Cardiac Health Profile (CHP) questionnaire and the EuroQol-VAS (EQ) in 253 consecutive unselected CAD patients in Södertälje, Stockholm County, Sweden. Explorative factor analysis was used to identify independent dimensions of HRQL. Current angina was ranked according to Canadian Cardiovascular Society Classification (CCS). RESULTS: Four independent principal factors representing perceived cognitive, physical, social and emotional functions underlying the patients' HRQL were found. Identical factors were recognized with an alternate technique. The major factor--explaining 43 % of HRQL--was perceived cognitive function reflecting ability to concentrate, activity drive, memory and problem solving. Cognitive function correlated to EQ but not to CCS. Perceived physical function/general health explained 9% of HRQL and was as expected related both to EQ and CCS. Total CHP scores differed significantly to those of healthy controls. CONCLUSIONS: Perceived cognitive function seems to be a major determinant of HRQL in CAD patients. This, in addition to earlier reports of possible prognostic information of reduced cognitive function, would prompt us to propose that HRQL assessments should include questions aimed to assess cognitive function.

Aged↗
PubMed2000

[Determinants of health and health policies. Part I. Causality in medicine and its modeling].

Causality is the relation between the antecedent and consequence. Association between those two notions represents causal determinacy allowing understanding the subject, and the theory of probability, which deals with supposed contradiction of the chance and necessity. Understanding how health can be impaired enables to precede the disease, to change its natural history and to cure it. Causality in medicine is based on the conception of complex action of biological, psychological and social factors, which may have either positive or negative effects on our health. Empirical data forming basis for the search of aetiology represent a conglomerate of causal and indifferent elements. To identify them, various models are employed (black box, Rubik's cube, Chinese box, model of multiple accidental phenomena and others). Appropriate epidemiological methods enable not only to determine the preference, but also to signalize fallacies of looking for the origin of disease. Permanent problem of the medicine reveals the existence of the objective accident and the uncertainty in the professional decision.

Causality↗
PubMedDate not supplied

Determinants of health in children and the problem of early childhood caries.

Early childhood caries (ECC) is a significant dental problem for many low-income and minority children in the United States. The diagnosis, prevention, and management of ECC have been based upon both experiential knowledge and scientific evidence. In the prevention and management of ECC, the focus has been on modifying the dental, infectious, and behavioral determinants of the disease. The purpose of this concept paper is to expand the paradigm used to understand the etiology of ECC and design programs to prevent and manage this condition.

Cariostatic Agents↗