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PubMed2004

Socio-economic status, health and lifestyle.

The role of lifestyle in mediating the relationship between socio-economic characteristics and health has been discussed extensively in the epidemiological and economic literatures. Previous analyses have not considered a formal framework incorporating unobservable heterogeneity. In this paper, we develop a simple economic model in which health is determined (partially) by lifestyle, which depends on preferences, budget and time constraints and unobservable characteristics. We estimate a recursive empirical specification consisting of a health production function and reduced forms for the lifestyle equations using Maximum Simulated Likelihood (MSL) for a multivariate probit (MVP) model with discrete indicators of lifestyle choices and self-assessed health (SAH) on British panel data from the 1984 and 1991 Health and Lifestyle Survey (HALS). We find that sleeping well, exercising, and not smoking in 1984 have dramatic positive effects on the probability of reporting excellent or good SAH in 1991, and that these effects are much larger having accounted for endogeneity. The failure of epidemiological analyses to account for unobserved heterogeneity can explain their low estimates of the relevance of lifestyle in the socio-economic status-health relationship. Indicators for prudent alcohol consumption and eating breakfast in 1984 are not found to be statistically significant determinants of SAH in 1991.

Choice Behavior↗
PubMedDate not supplied

Sexual and physical abuse history in gastroenterology practice: how types of abuse impact health status.

OBJECTIVE: There is an increasing amount of literature pointing to a relationship between sexual and/or physical abuse history and poor health status, although few studies provide evidence concerning which aspects of abuse may impact on health. In female patients with gastrointestinal (GI) disorders, the present study examined the effects on health status of: 1) history of sexual abuse and physical abuse, 2) invasiveness or seriousness of sexual abuse and physical abuse, and 3) age at first sexual and physical abuse. METHOD: The sample included 239 female patients from a referral gastroenterology clinic who were interviewed to assess sexual and physical abuse history. RESULTS: We found the following: 1) 66.5% of patients experienced some type of sexual and/or physical abuse; 2) women with sexual abuse history had more pain, non-GI somatic symptoms, bed disability days, lifetime surgeries, psychological distress, and functional disability compared to those without sexual abuse; 3) women with physical abuse also had worse health outcome on most health status indicators; 4) rape (intercourse) and life-threatening physical abuse seem to have worse health effects than less serious physical violence, and sexual abuse involving attempts and touch; and 5) those with first abuse in childhood did not appear to differ on health from those whose first abuse was as adults. CONCLUSIONS: The authors conclude that asking about abuse should be integrated into history taking within referral-based gastroenterology practices.

Adolescent↗
PubMed1995

Reliability of the Health Utilities Index--Mark III used in the 1991 cycle 6 Canadian General Social Survey Health Questionnaire.

This study presents information on the test-retest reliability of the Health Utility Index--Mark III (HUI) system used in cycle 6 of the Canadian General Social Survey (GSS). The HUI system used in this reliability study consists of an eight-attribute health status classification system (HSCS) and a function for generating a summary score of health-related quality of life. To estimate test-retest reliability, a stratified random sample of individuals (n = 506) completing GSS telephone interviews during August and September, 1991 were interviewed again 1 month later. Weighting adjustments based on the probability of selection were invoked during the analyses to provide unbiased estimates of test-retest reliability for all GSS respondents in the August-September period. The results indicate that the individual questions, attributes and provisional index scores generally provided reliable information on health status in the GSS. The exceptions to this were limitations in speech and dexterity which were reported very infrequently. Kappa estimates of test-retest reliability for individual questions varied from 0.184 to 0.766. For the eight attributes, kappa estimates varied from 0.137 to 0.728. Using the provisional index scores to quantify health overall, a test-retest reliability of 0.767 was obtained (intra-class correlation coefficient).

Activities of Daily Living↗
PubMed2005

Prostate cancer survivors' and partners' self-reports of health-related quality of life, treatment symptoms, and marital satisfaction 2.5-5.5 years after treatment.

PURPOSE/OBJECTIVES: To describe health-related quality of life (QOL), health status, and marital satisfaction of couples as many as 5.5 years after treatment for prostate cancer. DESIGN: Survey with longitudinal, comparative, and predictive elements. SETTING: A tertiary care nonprofit medical center in the southwestern United States. SAMPLE: Convenience sample of prostate cancer survivors (192 enrolled, 137 completed) and their partners (126 enrolled, 104 completed). Men averaged 70 years of age, women 66. Most men (86%) and women (89%) were white, and 71% had at least some college education. METHODS: Questionnaires were mailed annually. Women were enrolled 3.5 years after their partners were treated. Study participants received separate questionnaire packets. MAIN RESEARCH VARIABLES: Health-related QOL, health status including post-treatment symptoms, and marital satisfaction. FINDINGS: Men's health-related QOL, general physical health, and vitality decreased; urinary and sexual post-treatment symptoms increased. Men were concerned about their sexual functioning although few sought treatment. Couples' health-related QOL and marital satisfaction were associated more closely than their health status. CONCLUSIONS: Regardless of type of treatment, health-related QOL and general health tend to decrease for prostate cancer survivors; men in watchful waiting tended to have poorer health outcomes. Men are concerned about sexual functioning, yet few are taking steps to remedy problems. Couples' health-related QOL and marital satisfaction are linked; however, health status indicators are less associated. IMPLICATIONS FOR NURSING: Nurses are in a key position to assess health-related QOL and sexual functioning concerns for prostate cancer survivors and their partners.

Aged↗
PubMed1984

Development of indicator scales for the Comprehensive Assessment and Referral Evaluation (CARE) interview schedule.

The objective of this research was to develop indicator scales for major health and social problems of individuals aged 65 or over who live in the community. A semistructured interview technique, the Comprehensive Assessment and Referral Evaluation (CARE), was used in two large surveys in London and New York City. Twenty-two indicator scales were developed by using items that met certain clinical and statistical criteria. These indicator scales are intended for use in developing a general taxonomy of the problems of older individuals, for clinical assessment and referral of such individuals, and for use in geriatric epidemiological research. The scales were developed to be comprehensive with regard to the CARE, to be relatively independent of one another, and to have satisfactory content, clinical, and face validities, and interrater and internal consistency reliabilities.

Activities of Daily Living↗
PubMed2001

Health development experience in North and South Korea.

The purpose of this study is to compare the difference in health status between South Koreans and North Koreans and to identify factors responsible for the remarkable improvements in the health status of South Koreans. In order to examine the causes of the difference in health level, the health indices and their determinants of two Koreas were analyzed in time order. As of the year 2000, the average life expectancy at birth is 71.0 years for men and 78.6 years for women in South Korea, which is longer than that of North Korea by 8.1 for men and 11.2 for women. Infant mortality rate in 1998 was 9.0 per 1,000 live births in South Korea and 54.0 in North Korea. Since being liberated from Japanese ruling in 1945, South Korea has achieved remarkable economic growth under democracy and a market economy system. On the other hand, North Korea has maintained a socialistic system. North Korea has suffered from economic crisis since the 1990s. From this point it could be said that economic status is the major factor for the differences in health level between the two Koreas. Economic status not only directly influences health level but also indirectly affects it through influences on nutrition, hygiene, health resources, and other intervening factors. The South Korean government has concentrated its limited resources on public health activities such as tuberculosis control, family planning (FP), and maternal and child health (MCH) programmes whereas the private sector has taken charge of constructing the health delivery system including health facilities and human resources. In order to solve the problem, which might occur in the private-oriented medical care system, the South Korean government has introduced the national health insurance programme and enforced regulation policies. Many developing countries which are suffering from poverty and disease, can learn from the experience of Korea that had suffered from similar problems up to the early 1970s.

Delivery of Health Care↗
PubMed2000

Later-stage cancer in relation to medically underserved areas in Connecticut.

Health status indicators, including advanced stage at diagnosis of cancer, have been proposed as indicators of health care access and quality to be considered in revising the definition of medically underserved areas (MUAs). Using the population-based Connecticut Tumor Registry, "outlier" census tracts were defined as those that had a high proportion of breast, colorectal, or cervical cancer diagnosed at later stage, relative to all tracts in the state. In the six Connecticut cities that had MUAs, MUAs comprised the majority of outlier tracts, but non-MUA outliers were often located on the fringes of MUAs. The findings are discussed in relation to revising the criteria for defining MUAs and to targeting interventions for early detection of cancer in urban areas.

Aged↗
PubMed1977

The health status of foster children.

A study of the health care and needs of foster children in the New York City area indicated a prevalence of serious physical, mental and developmental problems. The level of pathology was roughly comparable to that of other disadvantaged child populations.

Adolescent↗
PubMed1999

Quality of life before and after liver transplantation for cholestatic liver disease.

Liver transplantation (LT) is an established therapy for patients with end-stage primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). In this report, we describe the health status and quality of life (QOL) in patients with these cholestatic liver diseases before and after LT. A QOL questionnaire was completed by 157 adult patients with PBC or PSC before and 1 year after liver transplantation at the Mayo Clinic or Baylor University Medical Center. This questionnaire measured four aspects of QOL, including symptoms; physical, social, and emotional functioning; health perceptions; and overall QOL. Changes in these QOL parameters before and after LT were described, and regression analysis was used to assess the relationships between clinical and QOL factors. There were no differences in QOL parameters between patients with PBC and PSC. QOL following transplantation was substantially better than before transplantation. This was observed in all four aspects of QOL. The degree of improvement as measured by effect size (difference in mean scores divided by the pretransplantation standard deviation) was 0.53 for symptoms (P <.01), 1.16 for function (P <.01), 2.37 for health satisfaction (P <.01), and 1.16 for overall QOL (P <.01). Patients' overall QOL before transplantation was significantly related to subjective and objective health status indicators and clinical factors such as ascites and renal dysfunction. QOL at 1-year follow-up, however, could not be adequately predicted by the pretransplantation subjective health status and clinical factors. Patients with end-stage cholestatic disease undergoing LT experience substantial improvement in all aspects of QOL addressed in this study. The patients' QOL 1 year after LT could not be predicted by pretransplantation variables used in this study.

Adult↗
PubMed1995

Stability and trends over 3 years of data.

Because the health status of a population does not usually respond immediately to interventions, whether social or medical, the ability to analyze change over time is important. Therefore, patterns of change and stability in health status and health care use of Manitoba residents during a 3-year period from 1990 to 1992 were analyzed using the Population-based Health Information System. This article presents summary findings and discusses methodological and policy issues arising from the analyses. A small but significant decrease in premature mortality (the primary health status indicator) was observed in most regions of the province, but two remote, northern regions, those whose residents scored at high socioeconomic risk, remained distinguished for their poor health status. These "poor health" regions also had the highest contact rates with primary caregivers, raising questions about the role of the health care system in improving the health of the population. A persistent increase in surgery was observed in several regions, led by increases in outpatient surgery over and above increases in the elderly population and beyond substitution for inpatient procedures. This trend (not obvious before these analyses) is important as hospitals move to expand their outpatient facilities in response to restraints on inpatient care.

Adolescent↗
PubMed1982

Health status of refugees from Vietnam, Laos, and Cambodia.

More than 0.5 million refugees from Southeast Asia have immigrated to the United States. We undertook a prospective evaluation of 709 refugees within two months of their resettlement in San Diego. The sample included 164 Vietnamese, 356 Cambodians, 139 Laotians, and 50 Hmong. The prevalence of abnormalities was high: intestinal parasites, 61%; positive tuberculin test (PPD) results 55%; anemia, 37%; hepatitis B antigenemia, 14%; and abnormal VDRL test results, 12%. Except for hepatitis, significant differences were noted among the Vietnamese, Cambodian, Laotian, and Hmong subjects on each of these health status indicators. The refugee population should not be considered a homogeneous group of Indochinese, particularly by those responsible for their health care.

Adolescent↗
PubMed2006

Psychiatric morbidity and acute hospitalization in elderly people.

BACKGROUND: Few studies have investigated the association of psychiatric morbidity with acute hospitalization risk in elderly people. METHOD: We examined this association using population-based data for 1092 older adults aged > or =60 years in Singapore, including subjects who reported at least one acute hospitalization from any medical condition(s) in the 12 months prior to interview (N = 136). Psychiatric morbid/comorbid disorders were diagnosed using the Geriatric Mental State examination. RESULTS: In a multivariate analysis, comorbid psychiatric disorders were independently associated with hospitalization [adjusted odds ratio 2.76, 95% confidence interval 1.20-6.33], after controlling for age, ethnicity, employment status, number of medical comorbidities, number of activities of daily living limitations, hearing and visual impairment, SF-12 Physical and Mental Component Summary scores, social, productive, fitness and health activities, and regular visits to health-care providers. Neither dementia diagnosis nor cognitive impairment measured by the Mini-mental State Examination was associated with increased hospitalization risk. CONCLUSION: Psychiatric morbidity in old age was significantly associated with increased hospitalization risk. This finding underlines the importance of treating psychiatric illness to reduce the risk of acute hospitalization in elderly patients.

Activities of Daily Living↗
PubMed1997

Reducing perinatal mortality in developing countries.

The perinatal mortality rate (PNMR) is a key health status indicator. It is multifactorial in aetiology and is significantly influenced by the quality of health care. While there is an ethical imperative to act to improve quality of care when deficiencies are apparent, the lack of controls--when an interventions is applied to an entire service--makes it difficult to infer a causal relationship between the intervention and any subsequent change in PNMR. However, by specifically measuring avoidable perinatal deaths (those due to error or omission on the part of the health service), this limitation is partially overcome, and the impact of the intervention can be more rigorously evaluated. This paper reports the impact of perinatal audit in a rural African health district between 1991 and 1995. A total of 21,112 consecutive births were studied: the average number of deliveries increased by 31% from 325 to 424 per month. The PNMR (birth weight > or = 1000g) in 1991 was 27/1000, increased to 42/1000 in 1992, and fell steadily to 26/1000 in 1995 (40% reduction; p = 0.002). The proportion of avoidable deaths fell from 19% in 1991 to zero in the second half of 1995 (p = 0.0008). While factors associated with perinatal mortality are many, complex, and interrelated, this report suggests that mortality can be reduced significantly in resource-poor settings by improving quality of health care. Including the measurement of avoidable deaths in perinatal audit allows the impact of interventions to be more rigorously assessed than by simple measuring the PNMR.

Africa↗
PubMed1997

Evaluation and use of an index of oral health status.

OBJECTIVES: The goals of this investigation were (1) to evaluate the Oral Health Status Index in relation to demographic characteristics, socioeconomic status, and preventive behaviors of an adult population; and (2) to understand how individual index components performed as indicators of oral health status compared to the composite index. METHODS: The Oral Health Status Index (OHSI) was used on a probability sample of adults, aged 18-93 years, living in the Detroit tricounty area. Data were collected on 509 subjects via in-home dental examinations. Bivariate and multivariate analyses were used to compare the OHSI and its components, including decayed, missing, and replaced teeth, free ends, and moderate and severe periodontal disease measures. RESULTS: The mean OHSI score for subjects was 77.3 (SE = 1.83) with a range of -8.0 to 100.0. In regression analyses, OHSI scores were positively correlated with subjects' education level, self-rated oral health scores, and frequency of dental checkups and negatively correlated with age, nonwhite race, and smoking. Of the index components, missing teeth performed well as an indicator of oral health status. Missing teeth were positively correlated with age, nonwhite race, and smoking and negatively correlated with education level, self-rated oral health, and use of Medicaid. About 53 percent of variance in OHSI scores was explained by the multivariate models, compared to 46 percent for missing teeth. CONCLUSIONS: Choosing an indicator of oral health status likely will depend upon the characteristics of the population to be studied. As a composite measure of oral health status, the OHSI performed acceptably; however, missing teeth, an index component, also worked well. Continued evaluation of the OHSI is warranted.

Adolescent↗
PubMed2004

Challenges confronting the health workforce in sub-Saharan Africa.

Sub-Saharan Africa and the international health community face a daunting challenge to deal with an extraordinary disease burden and improve the health status of Africans. Despite decades of effort to provide effective, equitable and affordable health care services, the health indices of Africans have stagnated and in some instances have deteriorated. Africa is the only continent that has not fully benefited from recent advances in biomedical sciences that brought health tools and technologies to tackle most of the disease burden. The emergence of the HIV/AIDS epidemic has confounded the health scene and posed further challenges. Several factors are responsible for this state of affairs: macro factors, that represent the broader socio-cultural environment that impact on health, and micro factors, which are largely health sector specific. There is increasing recognition that the major limiting factor to improved health outcomes is not lack of financial resources or health technologies but the lack of implementation capacity which depends on the presence of a functional health system. The drivers and architects of this are health workers, 'the most important of the health system's input'. The Commission on Macroeconomics and Health advocates a greatly increased investment in health rising in low income countries to a per capita expenditure of US $34 per year and states that the problem in implementing this recommendation is not difficulty in raising funds but the capacity of the health sector itself to absorb the increased flow. Yet, until fairly recently sufficient attention has not been directed to the role of the health workforce. The failure to develop and deploy an appropriate and motivated health workforce, and the environment necessary for the workforce to perform optimally is clearly a critical determinant of the health status of Africans. This paper summarizes key issues facing the workforce and outlines a framework to develop strategies to address them.

Africa South of the Sahara↗