[Human salivary lactoferrin--a new health status index].
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Biomarkers↗
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[Construction of a health status index: methodological proposal and application].
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Chile↗
Methods for measuring levels of well-being for a health status index.
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Attitude to Health↗
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↗
[A multicriteria tool for the analysis of health status indicators of a population. Application to the elaboration of a typology for the use of health indicators].
The authors have designed a multicriteria framework for the analysis of health indexes in order to provide a tool for the comparison of population health status indexes and to establish a typology of these indexes regarding their use for public health. This framework allows for (a) shedding some light on the conceptualization of health underlying each index, (b) understanding the nature of the phenomenon which are effectively measured, (c) understanding the principles of the construction of the index, (d) giving some details concerning its main properties, (e) and finally understanding its possible uses. Using this multicriteria framework for analyzing and comparing 16 different population health status indexes, the authors suggest some guidelines for choosing an index regarding its future utilization (identification of priorities, resources allocation, evaluation). Finally, the limits of the utilization of health status indexes within the process of decision making in public health are underlined.
Health Status Indicators↗
The gross national health product: a proposed population health index.
A population health status index designated as the gross national health product (GNHP) is proposed as a general measure of the health of nations or population groups. The GNHP integrates mortality and disability data into a single number in units of disability-free life years lived per 100,000 population. It is based primarily on mortality ratios and life expectancies of component age groups of the population, modified by their respective disability experiences. A computational example with data currently available on U.S. geographic regions from publications of the National Center for Health Statistics shows that the GNHP was highest in the West, indicating the highest number of disability-free years lived. Because of simplicity in its computation and interpretation, the GNHP can be used by health systems agencies (HSAs) in monitoring their performance or in conducting comparative studies.
Adolescent↗
Weighted health status in the Medicare population: development of the Weighted Health Index for the Medicare Current Beneficiary Survey (WHIMCBS).
We present an approach to constructing an aggregate index of health at the population level with data from Medicare beneficiaries using the 1991 (N = 12,667), 1995 (N = 15,590), and 1997 (N=17,058) Medicare Current Beneficiary Survey (MCBS). Similar to other work with survey data, we develop a weighted health status index from which one can calculate a point in time health status score for any beneficiary. Scores range from 1.0, representing "excellent health and no activity limitation", to 0.0, representing deceased. Sequences of numerically weighted health states experienced over time can be summed to calculate years of healthy life for beneficiaries. We test both the stability of the scoring system when developed on independent samples, as well as the sensitivity of years of healthy life calculations to changes in scoring assumptions. Findings suggest that, in addition to mortality, morbidity appears to play a significant role in the years of healthy life accrued by Medicare beneficiaries since entry into the Medicare program. Further, the index scoring system is highly stable when derived on independent samples. Finally, calculations of years of healthy life are robust to changes in scoring assumptions. The weighted health index for Medicare current beneficiaries (WHIMCBS) is a stable overall index of health and may be a useful ongoing indicator of health within the Medicare population.
Activities of Daily Living↗
Minimally supervised home rehabilitation improves exercise capacity and health status in patients with COPD.
OBJECTIVE: The purpose of this study was to investigate the effects on exercise tolerance and quality of life of an outpatient rehabilitation program implemented at home without a physiotherapist's direct supervision in patients with chronic obstructive lung disease. DESIGN: Patients with moderate chronic obstructive pulmonary disease were studied. The rehabilitation program included lower limb exercise on a stationary bicycle and upper limb exercise and stretching, together with education, and it lasted for 12 wks. Every 2 wks, a physiotherapist contacted patients by phone to evaluate their compliance with the rehabilitation program and any adverse effects. The main measures of outcome were the Health Status Index, cycle ergometer test, forced expiratory volume in 1 sec, and forced vital capacity. Patients were evaluated at the baseline and at 12 wks. RESULTS: A total of 32 patients were recruited and 28 (mean age, 70.4 yrs) completed the trial. After pulmonary rehabilitation, a significant improvement was found in seven of the nine Health Status Index quality-of-life subscales. Exercise tolerance also improved significantly, whereas no variation was observed in pulmonary function tests. There was no correlation between the improvement in quality of life and the improvement in exercise tolerance. The improvements in the Health Status Index physical function and general health subscales correlated negatively with forced expiratory volume in 1 sec (percentage of predicted value) and positively with residual volume/total lung capacity ratio. The improvement in exercise tolerance (expressed in watts or as maximum oxygen uptake), but not in quality-of-life indexes, was associated negatively with age and positively with weight, cognitive function, and forced expiratory volume in 1 sec/forced vital capacity ratio. CONCLUSIONS: We conclude that an inexpensive home rehabilitation program can improve quality of life and exercise tolerance in patients with moderate chronic obstructive pulmonary disease. Furthermore, our results indicate that exercise tolerance evaluated by cycloergometry and quality of life evaluated by the mean of the Health Status Index questionnaire are independent outcome measures of pulmonary rehabilitation.
Aged↗
Association of body mass index and health status in firefighters.
This study evaluates the usefulness of body mass index (BMI) as a preventive screening tool for general health and duty fitness status among firefighters. Two major BMI categorization methods were used: (1) "standard" [low (< 27), medium (> or = 27 < 30), high (> 30)]; and (2) WHO [(normal (< 25), overweight (> or = 25 < 30), obese (> or = 30 < 39), morbidly obese (> or = 39)]. Using the "standard" categorization, nearly 60% of individuals had medium or high BMI's; using the World Health Organization categorization, 80.7% of individuals were found to be overweight, obese, or morbidly obese. Statistically significant, inverse correlation between BMI and each of the following parameters was noted: systolic and diastolic blood pressure, VO2max, METS, and total cholesterol. Inconsistent or statistically insignificant correlation was found between BMI and HDL, Chol/HDL ratio, triglycerides, FVC% predicted, and FEV1 second% predicted. Findings were similar to previous studies of such correlates. BMI continues to prove useful as a screening tool and may be useful in identifying individual firefighters for health and fitness intervention measures.
Adolescent↗
Quality of life comparison between bisoprolol and nifedipine retard in hypertension.
Quality of life with the selective beta1-blocker bisoprolol and the calcium channel blocker nifedipine as a retard formulation was compared in patients with essential hypertension. A multicenter randomized, double-blind, two-way, crossover study design was used. After a placebo run-in period (4-6 weeks), during which all antihypertensive therapy was withdrawn, 82 patients were randomized. During the active treatment periods (8 weeks each), patients received either bisoprolol once daily or nifedipine retard twice daily, using the double-dummy technique. A washout period (4-6 weeks) separated the treatment periods. Data at baseline (at randomization) and at the end of each treatment period were compared. Seventy-five patients completed the study. Blood pressure (168 +/- 2/103 +/- 1 mmHg) decreased (p < 0.001) similarly with bisoprolol (153 +/- 2/90 +/- 1 mmHg) and nifedipine (154 +/- 2/90 +/- 1 mmHg). Compared with baseline values, none of the quality of life variables investigated changed during bisoprolol or nifedipine retard use. Neither in the intention-to-treat nor the efficacy analysis were differences between bisoprolol and nifedipine found in quality of life variables, such as the Health Status Index, somatic symptoms, anxiety, depression, total psychiatric morbidity, cognitive symptoms, and hostility score. Only in the efficacy analysis did Health Status Index tend to be better (p = 0.055) during nifedipine intake when compared with bisoprolol. This trend was not present in the intention-to-treat analysis. The number of dropouts during bisoprolol (n = 2) and nifedipine (n = 3) treatment, and the number of patients reporting side effects (21% and 16%, respectively) did not differ (p = 0.64) between both treatments. It can be concluded that at equipotent antihypertensive dosages, an 8-week treatment period with the selective beta1-blocker bisoprolol or the calcium antagonist nifedipine as a retard formulation does not result in any difference in quality of life variables. It is not clear whether the trend of Health Status Index to become better during nifedipine intake, which was only found in the efficacy analysis and not in the intention-to-treat analysis, is of clinical relevance.
Administration, Oral↗
Construction of the Patient-Oriented Prostate Utility Scale (PORPUS): a multiattribute health state classification system for prostate cancer.
Health status indexes, such as the EuroQol, consist of a health state classification system and a set of utility weights. Indexes measure quality of life using a 0-1 utility score. Utilities for outcomes in prostate cancer (PC) are of unique importance, but generic indexes do not represent PC outcomes (e.g., sexual, urinary, bowel dysfunction) well, and may not capture their full impact. As a step toward improved utility measurement, we constructed a classification system for PC. We generated items for each of six health domains and rated their importance using interviews with 10 clinical experts and 80 patients. Key concepts were selected for each domain using item importance weightings, and a set of predetermined criteria. Text was developed to express levels of severity within each domain. Experts and two additional groups of patients (n = 40, n = 96) evaluated textual clarity and endorsed the content validity of the instrument. The final system consists of 10 domains with 4-6 levels each. The content validity of the system was endorsed by patients and experts. In conjunction with a set of utility weights, it may be used to develop a health status index, to improve utility measurement in patients, and to serve as a short psychometric (nonutility) instrument.
Health Status Indicators↗
Quality of life after myocardial revascularization. Effect of increasing age.
The effect of increasing age on quality of life, survival, and risk of reoperation was studied in 2479 patients followed up prospectively 2 to 20 years after myocardial revascularization. Quality of life was determined from annual questionnaires, which we used to calculate a health status index from the patient's symptomatic status and subjective response to the operation, which was graded between zero and 1.00 (asymptomatic). Four age groups were studied: age 49 years or less (AG40), 50 to 59 years (AG50), 60 to 69 years (AG60), and 70 years or older (AG70). Associated problems (left ventricular aneurysm, valve disease, acute myocardial infarction) necessitating treatment were present in 17% (61/361) of AG40 patients, 19% (165 of 859) of AG50 patients, 23% (213/927) of AG60 patients, and 31% (102/332) of AG70 patients. The hospital mortality rate was higher in older patients undergoing combined procedures but not in patients undergoing coronary bypass grafts only. Probability of survival and health status indexes were calculated excluding patients with valve disease and cardiogenic shock. Probability of survival was significantly better (p less than 0.001 by the Wilcoxon test) in patients less than age 60 than in those 60 years or older, but in patients with an ejection fraction greater than or equal to 0.40, probability of survival at 12 years was 0.64 (age less than 60) versus 0.62 (age greater than or equal to 60). The actuarial risk of reoperation, calculated as the difference between probability of survival and probability of survival without reoperation, progressively increased in younger patients but not in patients aged 60 years or older. At 15 years, the reoperation rates were 26% (AG40), 14% (AG50), 5% (AG60), and 7% (AG70). Mean health status index for years 1 to 5 was 0.85 in AG40 patients, 0.84 in AG50 patients, 0.89 in AG60 patients, and 0.90 in AG70 patients; for years 6 to 10, 0.81, 0.80, 0.86, and 0.89; and for years 11 to 15, 0.77, 0.78, 0.84, and 0.84, respectively. Thus quality of life after myocardial revascularization is better, improvement lasts longer, and reoperation rate is less in patients aged 60 years or older.
Actuarial Analysis↗
Impact of antihypertensive treatment on quality of life: comparison between bisoprolol and bendrofluazide.
OBJECTIVES: To compare quality of life with the selective beta1-blocker bisoprolol and the thiazide diuretic bendrofluazide in patients with mild to moderate hypertension. DESIGN AND SETTING: Multi centric, randomised, double-blind, two-way crossover study carried out at six general practice centres. SUBJECTS: Eighty-one patients with newly diagnosed or previously treated hypertension, who had a mean diastolic blood pressure (BP) of 95-120 mm Hg after receiving placebo for 4-6 weeks. INTERVENTIONS: In random order, patients received bisoprolol (5 mg once daily) or bendrofluazide (2. 5 mg once daily) for 8 weeks. MAIN OUTCOME MEASURES: Quality of life and antihypertensive effect. RESULTS: Decrease in systolic/diastolic BP did not differ between bisoprolol (10 +/- 2/13 +/- 1 mm Hg) and bendrofluazide (9 +/- 2/11 +/- 1 mm Hg). Between bisoprolol and bendrofluazide neither in the intention-to-treat nor in the efficacy analysis any difference was found in quality of life variables, such as Health Status Index, somatic symptoms, anxiety, depression, total psychiatric morbidity, cognitive symptoms and hostility score. Compared to baseline the Health Status Index improved (P < 0.05) during bisoprolol. None of the other investigated quality of life variables changed compared to baseline. No patients dropped out during bisoprolol or bendrofluazide treatment. Although, the total number of reported adverse events appeared lower during bendrofluazide than during bisoprolol treatment, it is unclear whether drug related adverse events also differ between the two drugs. CONCLUSIONS: At equipotent antihypertensive dosages, the effect of an 8-week treatment on quality of life does not differ between the selective beta1-blocker bisoprolol and the thiazide diuretic bendrofluazide.
Adult↗
Aggregate Health Status: a benchmark index for community health.
A qualitative review of population health assessment models used throughout the United States and Canada indicate both individual and community-level domains of health. Individual-level domains of health include health habits, education, public safety, environment, social, government, culture, and mobility. Community-level domains include the same general health domains but aggregated to the community level Aggregate Health Status (AHS). In the development of the AHS portion of our model, the dependent variable was the general health question from the Medical Outcomes Study. The remainder of the survey was partitioned into mutually exclusive individual measure subsets. A linear combination of these global variables then produces a single estimate relating the multiple domains of the broader determinants of health to health status. This global variable uniquely discriminates between the five categories of general health. This model serves as a framework and benchmark indicator that (1) provides a summary indicator of the overall health status of the population, (2) is broadly representative of populations rather than individuals, (3) is a population perspective rather than a provider perspective, and (4) emphasizes outcomes versus inputs and processes.
Benchmarking↗
Utilization of health care resources by obese Canadians.
BACKGROUND: The prevalence of obesity in Canada has been increasing in recent years. Using data from the National Population Health Survey (NPHS), the authors determined the prevalence of obesity among Canadians, the associated comorbidities and the patterns of resource utilization by obese people. METHODS: The NPHS, a cross-sectional survey conducted in 1994, was administered to 17,626 Canadians 12 years of age or older who were not long-term residents of hospitals or long-term care facilities and were not residing on First Nations reserves or Canadian Armed Forces bases, or in the Yukon and Northwest Territories. For the authors' analysis, the study population consisted of 12,318 Canadians aged 20-64 years who were not pregnant and for whom the body mass index (BMI) had been calculated. The prevalence of comorbidities, health status index scores, self-esteem, self-rated health, restriction of activity, health care resource utilization (physician visits, disability days, admissions to hospital and medication use) were determined for obese people (BMI of 27 or greater) and nonobese people. RESULTS: The NPHS data revealed that 35.2% of men and 25.8% of women in Canada were obese in 1994. Obese respondents were more likely than nonobese respondents to suffer from stress (adjusted odds ratio [OR] 1.20, 95% confidence interval [CI] 1.11-1.31), activity restrictions (adjusted OR 1.39, 95% CI 1.26-1.54) and a number of chronic comorbidities. Obese respondents were also more likely to consult with physicians (adjusted OR 1.32, 95% CI 1.22-1.43), be prescribed a number of medications and to require excess disability days (adjusted OR 1.22, 95% CI 1.08-1.36). INTERPRETATION: Obesity represents a substantial burden on the health of Canadians and on Canada's health care resources.
Adult↗
Health status in 52 long-term survivors of pediatric brain tumors.
The percentage of children who survive childhood brain tumors is increasing. A number have neurological and other sequelae which impact on the quality of their survival. We reviewed long-term survivors using a standardized health status instrument. The mothers of 52 survivors of brain tumors were surveyed. Eight different aspects (attributes) of health status were scored. The first 6 of these attributes were scored in a health status index (HSI) developed at McMaster University. Subgroup analysis was performed. Limitation in the quality of life was found in one of the 8 attributes in all but 2 of the subjects. The health status index (HSI) score using the first 6 attributes of this survey had a median of 0.73 (range 0.16-1.00). This score is lower than that found in previously surveyed survivors of leukemia or other childhood cancers. Examination of age at diagnosis, extent of surgery, sex and therapeutic modalities used showed no correlation with HSI score. Those with supratentorial astrocytomas had a lower HSI score (0.65) than those with infratentorial astrocytomas (0.85) (p = 0.05). Children with craniopharyngiomas had a poor score (0.64). This survey shows that the survivors of brain tumors have an appreciable burden of morbidity. Most have deficits in health status that affect many areas of their lives. Apart from site of the primary tumor, there was little correlation between subgroups studied and health status. The health status of children who survive brain tumors is lower than that of survivors of other childhood malignancies.
Adolescent↗
Measurement of the discomfort component of illness.
Discomfort is a prominent component of illness, but it is difficult to measure on a scale that allows its formal inclusion in a health status index. The authors tested the content validity of defining various discomforts in terms of their quality, duration, and intensity and found no responses that could not be categorized within this conceptual framework. They then analyzed the ability of patients to ascribe preference values to a sample of discomfort statements, based on this characterization of discomfort, and found them able to do this reliably using magnitude estimation. These results show that, although the universe of discomforts cannot be measured directly on a common scale, they can be compared using a scale of social preference. This will allow the formal incorporation of the discomfort component of illness into health status indexes based upon dysfunctions, discomforts, and prognosis.
Adult↗
Health status after myocardial revascularization: inferior results in women.
We followed up 1,335 patients (287 female, 1,048 male) for 2 to 18 years (mean, 4.3 years) after they had undergone coronary artery bypass grafting. A health status index was calculated on the basis of their responses to annual questionnaires. The female patients were older (64.1 +/- 0.3 versus 60.4 +/- 0.3 years) and had a higher incidence of diabetes (28.6% versus 16.1%). The risk profile of women was otherwise similar to that of men. The hospital mortality was significantly higher in the women, particularly in those younger than age 60. The probability of survival (Kaplan-Meier) at 5, 10, and 15 years was lower in female patients at each interval. The mean health status index was also lower in women at 5, 10, and 15 years, and also lower in all subsets. In nondiabetic patients, the hospital mortality and probability of survival at 10 years did not differ between the female and male patients. In the diabetic patients, the hospital mortality was 11.0% (women) and 3.6% (men); the survival at 10 years was 0.42 (women) and 0.56 (men) (p < 0.001). Thus, the health status in women is less satisfactory than that of men after myocardial revascularization, and the probability of survival is lower. The excess mortality in female patients may be due to the higher incidence of diabetes in this group.
Coronary Artery Bypass↗