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A proposal for an integrated system of analysis of complex health problems in ecological hazard areas in comparison with reference least polluted area is presented. The proposed procedure can be used in identifying priorities in health promotion.
Standardised health status questionnaires are widely used to obtain subjective assessments of health. However, little research has investigated the meaning of the data they produce. Statistical tests will highlight some problems with the structure and wording of a questionnaire but they cannot shed any light on the way in which respondents interpret questions or their intended meaning when they select a response. Various qualitative techniques are being used within disciplines such as sociology and psychology to test both the language of survey instruments and the cognitive bases of surveys. This paper outlines some of these methods and reports findings from a qualitative research study in the UK with a widely used questionnaire--the Short-Form 36 Health Status Questionnaire. The value of including in-depth, qualitative validation techniques in the development and testing of surveys used to collect subjective assessments of health is clearly demonstrated by the findings of the study.
This paper advances a new concept in health insurance. Health status insurance is a health insurance whose primary aim is to improve health status and decrease inequality in health within the covered population. Redistribution and control of cost is a secondary aim, closely integrated with the health status aim. Health status insurance differs from conventional health insurance in four respects: 1) the health status and health risks of enrollees are assessed and individual plans are developed jointly by the providers and enrollees to raise their health status to a given level; 2) interventions are not limited to the patients, but they extend to the patients' physical and social environments; 3) supplementary income or help in organizing are provided to enrollees who do not have an income sufficient to maintain their health or who need help to overcome local environmental situations adverse to their health, respectively; and, 4) the health status insurance organization actively champions national policies to change the social environment for the improvement of health. The concept of health status insurance is applicable to national health insurance systems, large private health insurance systems, or, national health service (when the responsible governmental agency becomes the health status insurer). Three modalities of implementation are presented. The readiness of society and governments to adopt health status insurance is discussed from a historical perspective.
BACKGROUND: health status is increasingly used as a measure of healthcare effectiveness. How diseases and symptoms are associated with health status is not completely understood. OBJECTIVES: to find diseases, symptoms and demographic factors associated with physical and mental health status in older Americans. METHODS: we analysed data from a survey of over 100 000 Medicare beneficiaries aged 65 and older. We used the short-form 36 physical and mental summary scores as measures of health status. Other data collected included demographic details, symptoms and diagnoses. RESULTS: age as a single variable explained 4% of variation in physical health status. Adding other demographic information and increased disease burden explained variation to 8% and 27% respectively. Together, shortness of breath, back pain, difficulty getting in and out of chairs, arthritis of hip or knee, a recent change in health and age explained 54% of variation. All available variables explained 59%. The role of age as an independent factor decreased markedly after disease and symptoms were considered. Similar factors were associated with lower mental health status, but age was not. CONCLUSION: these data suggest that heart and lung disease and back pain are the most important factors affecting the average physical health status of older people. Sex, marital status and race have very little independent effect. Efforts to improve average physical health status scores might best be targeted at these conditions rather than demographic characteristics. Mental health status does not decline with age, and similar factors affect it but to a lesser degree.
Measuring health status over time is problematic when some subjects die, because death does not have a defined value on most health status measures. This situation is different from the usual missing data problem because the health status of the dead is, in a sense, known. We examined eight strategies for incorporating deaths into such analyses using three health status measures taken from two data sets, after which we used computer simulation to explore more fully the effect of deaths. The strategies differed in the amount of influence given to the deaths, varying from none (deaths were discarded) to complete (mortality itself was the health measure). The strategies that gave less influence to deaths tended to show more favorable changes in health over time, and therefore, tended to favor the group that had more deaths. The strategies that were more influenced by death showed more negative changes over time and favored the group with fewer deaths. The choice of strategy should depend on the goals of an intervention. For health promotion studies, we recommend recoding the health variables to estimate the probability that a person will be healthy in 2 years (or in some other period that can be estimated from the data).
The health profile of American adults is heavily influenced by lifestyle behaviors. Therefore, working adults have a unique opportunity to take personal action to decrease their risk of cancer, heart disease, and other chronic illnesses and to improve their health status outcomes. Health status outcomes of working adults were evaluated through this quantitative study. Four structural variables (demographics, psychologic status, social status, and economic status), two modifying variables (access and cost), and three process variables (preventive care, including exercise/nutrition/stress management; client involvement; and family involvement) were examined as to their relationship to health status outcomes (client perception of health, amount of exercise, body mass index, and percent body fat). Results support the importance of the variables in the Albrecht nursing model in explaining health status outcomes in working adults. These factors may therefore be suitable targets for interventions to encourage healthy lifestyle behaviors at home. Nursing administrators, occupational health nurses, and home health nurses can use these findings to guide effective planning for wellness programs in the home and work setting.
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.
The health status and the prevalence of hypertension, diabetes mellitus, glaucoma and visual disorders of 123 elderly people (56 men, 67 women) in the Marigot Health District, Dominica, were assessed by means of four questionnaires; collection of data from their medical records; physical examination, measurement of blood pressure, visual acuity and intra-ocular pressure (IOP); and testing for glucosuria. The overall health status was good, but 20% were dependent on care. 74% were independent in the activities in daily life, with only moderate limitations in activities. The health status decreased considerably in those over 75 years of age. There were slight perceived differences in health status between men and women. About 40% of the study population were known to be hypertensive, and another 13% had an elevated blood pressure on examination. Diabetes mellitus was present in 15%. 20% had a visual acuity of 0.1 or below, and 10% had an elevated IOP. During the study, a considerable number of new cases of hypertension, diabetes mellitus and elevated IOP were diagnosed. 50% of the study population who were on medication used this more than as prescribed. This study indicates a high prevalence of the secondary complications of hypertension, diabetes mellitus, cataract, glaucoma and osteo-arthritis that cause disability and dependency in the elderly population. Education, diagnosis at an early stage and appropriate treatment of these disorders may prevent or delay their development. We sugggest the development of a programme oriented approach of primary health care for the elderly to support this.
A variety of measures was used to assess the relationship of psychosocial distress and perceived health status among 1,034 older (65+) members of an HMO. Distress was measured by recent life events, four types of social strain, and the CES-D, a measure of depression/demoralization. The distributions of these measures and perceived health status indicate that this sample was relatively healthy and undistressed. The strength of the associations within each group of variables is significant but generally modest. Using hierarchical multiple regression analysis with demographic variables, social support, and religiosity as controls, the strongest associations are between health status and the CES-D, life events, financial strain, and the strain of being single (unmarried respondents only).
This article describes the assessment of self-reported health status as one indicator of the performance of health care delivery systems. This work took place in the context of a larger effort to measure performance in health care. The Consortium Research on Indicators of System Performance (CRISP) project is developing measures of the performance of integrated health care systems, rather than plans or providers. The system focus leads to measurement of the health status of defined populations and an analysis of health care episodes and processes extending beyond the physician's office or hospital that relate directly to patient outcomes and satisfaction. This focus provides opportunities for application of performance measures to quality improvement efforts, since outcomes can be logically linked to identifiable and measurable processes. After a discussion of the purpose and the history of CRISP and how populations were defined within the systems, some preliminary data on the health status of populations are presented.
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Nutritional status represents the satisfaction of the human body with nutritive and protective substances and is the reflection of these physical and physiological characteristics, bio-chemical composition, functional capability and the health status. The aim of the examinations and nutritional status monitoring was the early discovery of nutritive disorders in an individual and/or population and undertaking of the appropriate preventive measures. During 1996 in Subotica was performed the measuring of body height, body weight, and systolic and diastolic blood pressure in 887 youths, aged 17-24, during the systematic examinations. Analyzing the nutritional status of youths aged 17-24 in Subotica in relation to the reference values of body mass index--BMI (kg/m2) we have registered 25.03% of youth with values of BMI < 20, 55.81% with values of BMI 20-25. Overweight (BMI > 25) was discovered in 19.16%. We have registered 3.34% of young men with systolic hypertension and 1.67% with diastolic hypertension. Increased values of total cholesterol were found in 21.69% and hypertriglyceridemia compared in 20.40% to the total number of examinees. Monitoring of nutritional status of youths by the application of consistent methodology and information system, might represent the measure of health care and the potential of the population. Besides, on the national level, it is an important indicator of health status and the basis for population nutrition improvement through the interventive and preventive programs of nutrition.
OBJECTIVES: To determine the magnitude of racial disparity in lower urinary tract symptom (LUTS) severity and bother by combining two large comparable epidemiologic studies of community-dwelling white and black men, thereby avoiding many of the referral biases present in previous studies. Prior studies evaluating racial differences in benign prostatic hyperplasia have been hampered by selection bias, because nearly all have used surgical treatment as a marker for benign prostatic hyperplasia. METHODS: Data from the Olmsted County Study of Urinary Symptoms and Health Status and the Flint Men's Health Study were combined for a total study sample of 2480 men. We examined LUTS severity and associated bother as measured by the self-administered American Urological Association Symptom Index and Symptom Problem Index. RESULTS: Overall 34% of white men reported moderate/severe LUTS compared with 41% of black men (P <0.001). These patterns were consistent across age and persisted after adjustment for age and other sociodemographic factors. The relationship between LUTS severity and bother differed by race in that black men reported less bother for each unit increase in LUTS (P <0.001). CONCLUSIONS: In contrast to studies based on clinical populations, our community-based study demonstrated greater LUTS severity in black men compared with white men but black men reported less bother for any given level of LUTS severity. Although these findings suggest a racial disparity in benign prostatic hyperplasia, additional studies of anatomic, physiologic, and molecular factors may clarify whether these racial differences are real or due to sociocultural differences in reporting symptom morbidity.
Primary health care (PHC) services have been advocated as a means by which less developed countries may improve the health of their populations even in the face of poverty, low levels of literacy, poor nutrition and other factors that negatively influence health status. Using aggregated data from the World Bank and UNICEF this study examined which factors, both within the health care system and outside of it, are associated with under-5 mortality rates in 22 countries of Latin America and the Caribbean during the 1990s. In a multivariate analysis using generalized estimating equations for repeated measures, five factors were found to be independent predictors of lower under-5 mortality rates (U5MRs). These were vaccination levels, female literacy, the use of oral rehydration therapy, access to safe water and GNP per capita. When the magnitude of these associations were assessed, higher levels of GNP per capita was found to be very weakly associated with lower U5MRs, compared with female literacy and vaccination rates. These findings suggest that government policies which focus only on promoting economic growth, while not making important investments in PHC services, female education and access to safe water are unlikely to see large improvements in health status.
BACKGROUND: Recent reviews and studies suggest distinctive health needs among gay men. METHODS: Swiss residents in the Geneva Gay Men's Health Survey (GGMHS, n=477) were matched with controls from the Swiss Health Survey (SHS, n=477) along sex, age, nationality, and region of residence and compared along standard indicators of health status, health behaviors, and health care utilization. Both health surveys were conducted in 2002 using probability sampling--i.e., time-space sampling (GGMHS) and household probability telephone sampling (SHS). RESULTS: Although gay men were significantly less likely to be overweight (adjusted odds ratio (AOR)=0.54), they reported significantly more and severe physical symptoms (AOR ranged from 1.72 to 9.21), short-term disability (AOR=2.56), risk factors for chronic disease--i.e., high cholesterol, high blood pressure, high glucose, and smoking (AOR ranged from 1.67 to 3.89), and greater health services utilization (AOR ranged from 1.62 to 4.28), even after adjustment for differences in socio-demographic characteristics and health behaviors. CONCLUSIONS: Evidence of greater morbidity among a community sample of gay men along standard health indicators underlines the relevance of sexual orientation as a socio-demographic indicator in public health in general and in the health inequalities discourse in particular.
This study had the purpose of identifying the health needs of the elderly population of a small urban Italian community for the purpose of planning sociomedical services. The data were collected by interviewing a stratified random sample of 1291 individuals over sixty years of age. About one third sample reported poor health. However, health complaints, both physical and mental, were particularly common among the persons living in disadvantaged social and economic conditions. The great majority of the respondents were found to be self-sufficient, and ambulatory. The results indicate that the present health needs of the elderly living in the community require new health services, such as home care, which will permit the elderly to avoid future hospitalization.
The prevention of cardiovascular diseases belongs to priorities of the Czech public health care. Medical personnel should therefore set the example in the healthy way of life. At the meeting of the Working Group for Arrhythmia and Permanent Cardiostimulation at the Czech Cardiological Society, a questionnaire-based investigation for the evaluation of basic risk factors in workers engaged in cardiology (physicians, nurses, technicians) was performed. Our employees represent a paragon for the population in terms of motion activities and smoking in men. All of them also evaluate their subjective health better than the general population does. However, they consume larger amounts of alcohol and keep correct nutrition habits at a lower standard than the general population practices.
A total of 23 maternity centres and 8 youth welfare centres in the county town of Magdeburg were inspected in 1987 and 1988 to review the condition of buildings and layout of rooms. Checks were also made on anti-infectious routines and compliance with the vaccination regulations. In all of these areas a number of deficiencies were found, and the results of follow-up inspections clearly show that the attention being given to public health regulations for sterilization and disinfection and to the storage of vaccines, is still inadequate. Urgent action is also required to improve conditions which are beyond the control of staff, such as buildings in need of repair, lack of space and the installation of washbasins, toilets, etc.