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Evaluation of the Consensus Health Status Indicator for assessing adolescent pregnancies and births.

The authors used vital statistics and population data for DeKalb County, GA, in an evaluation of the accuracy of the Consensus Health Status Indicator for assessing adolescent pregnancies and births. The indicator used was the number of births to females 10-17 years of age, expressed as a percentage of all births in the population. The investigators found no significant changes in the proportions of births to adolescents for the period 1982-90. Births to adolescents were 5.3 percent of all births during 1982-84 and 5.2 percent during 1988-90. However, the pregnancy rate for adolescents in those years increased significantly, from 27.9 per 1,000 births for 1982-84 to 33.1 per 1,000 for 1988-90. The results indicate that, in localities with substantial changes in the age distribution of the population, the health status indicator does not adequately reflect trends in pregnancies among those 10-17 years of age.

Adolescent↗

Health status indicators: definitions and national data.

In July 1991 the Centers for Disease Control (CDC) released a set of 18 health status indicators and encouraged their use by federal, State, and local health agencies. The indicators were developed in response to Objective 22.1 of Healthy People 2000 through a consensus process described in a previous Statistical Notes. This article recommends detailed definitions, suggests national data sources, and provides national baseline data for each indicator.

Centers for Disease Control and Prevention, U.S.↗

Using subjective oral health status indicators to screen for dental care needs in older adults.

A study was undertaken to assess the ability of a number of subjective oral health status indicators to identify community-dwelling older adults who need dental treatment. The indicators consisted of a single-item self-rating of treatment need, a 15-item psychosocial impact index and the 49-item Oral Health Impact Profile (OHIP). Data for the study were collected as part of an oral health survey of Canadians aged 50 years and over. The associations between these subjective indicators and clinically defined dental treatment needs were assessed using statistics for determining the predictive power of a diagnostic test. Although there were statistically significant associations between the subjective and clinical measures, values for statistics such as sensitivity, positive predictive values and positive likelihood ratios were low. Although the measures did not perform well as screening tests, they did identify a sub-group of individuals whose clinical conditions impacted significantly on daily life and who would probably benefit the most from dental treatment. In this respect, the subjective measures assessed here can themselves be interpreted as indicators of need which complement conventional clinical measures of needs for dental care.

Activities of Daily Living↗

Incidence of sickness certification. Proposal for use as a health status indicator.

Cause-, sex-, and age-specific incidences of sickness certification in a total population are reported. The population at risk of having a sickness certificate issued was 106,019 employed persons 16-69 years of age. The annual incidence of sickness certification was estimated at 580 per 1,000 employed persons per year (females 596, males 568). The most frequent causes of sickness certification, according to diagnostic groups, were diseases of the respiratory system, musculoskeletal/connective tissue diseases, mental disorders, and injuries. Adjusted for age, injuries were found to be less frequent causes of sickness certification among females than males (p less than 0.001), while the reverse was true for mental disorders (p less than 0.01). Among single diagnoses, "other nonarticular rheumatism" (including myalgia) was more frequent among females than males, while the opposite was true for "backpain without radiating symptoms" (p less than 0.001). Comparisons with morbidity studies indicate that diagnoses stated on initial certificates, issued to employed persons in the total population, give a reflection of a population's health problems. This suggests that sickness certification may provide a basis for a health status indicator which may prove useful in planning and evaluation of occupational health, general practice, and community health.

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↗

Improving dental health status indicators for evaluation.

Central to the evaluation of any dental health programme is the dental status of the population it serves. The DMFT index has been widely used to indicate dental status in evaluations, however, there are a number of characteristics of the DMFT index which undermine its value in evaluating programmes. The aim of this study was to compare DMFT, five utility weighted versions of this index, and single measures of caries experience, in order to determine their relative validity. The indices were investigated in terms of two criteria: 1) the percentage of variance explained by a set of antecedent and behavioural variables in a series of multiple regression analyses; and 2) percentage changes in the indices following re-examination of the population after five years. Results show that the variance explained by the different composite indices ranged between 29% and 46%, while it varied between 16% and 49% for the single measures. The size of percentage changes after five years ranged between 0% and 4.5%), and indicated that utility weighted indices were generally not more sensitive than the DMFT, but that some single measures were. Where composite indices are required, a full quality adjusted tooth years (QATY) approach, rather than utility weighting the DMFT index, may be required to improve the validity of dental health status indicators. Single rather than composite measures also provide valid information for evaluating dental programmes.

Adolescent↗

Associations between xerostomia and health status indicators in the elderly.

AIMS: This study investigated the associations between xerostomia (dry mouth) (low, moderate and high) with other categorical variables (e.g. demographic and health status indicators). This paper aims to report on the severity of xerostomia in the elderly population and investigate the relationship with other aspects of perceived health. METHOD: Data were obtained from a cross-sectional survey of 225 elderly people from a large multilevel geriatric care centre. The centre consists of three levels of care: an apartment building in which residents live more or less independently, a home for the aged, and a chronic care hospital. Participants in the study were recruited when they attended the dental care facility. Data were collected by means of a personal interview conducted either at the dental care facility or the participant's residence. RESULTS: The mean age was 83 years. Most were females (72%) and almost all (99%) reported one or more chronic medical conditions; 88% had physical disabilities. Xerostomia was recorded on a seven-point scale. Scores were categorised as low, medium or high and the proportions were 49.3%, 30.3% and 20.4% respectively Bivariate analysis showed no association between dry mouth and sex, age, general health change or life satisfaction. However, when the high xerostomia group was separated out and odds ratios calculated they were 2.3 to 4.9 times more likely to experience a negative impact on health than the low group. Xerostomia did not have a significant impact on chewing capacity, morale or stress, although it contributed to the variability of the oral health-related quality of life measures. It was the only variable with a significant effect (OR 2.55) for the Oral Health Impact Profile-14 and displayed a higher odds ratio (2.76) for the Geriatric Oral Health Assessment Index. Self-reported xerostomia in the elderly population can be categorised into a severity scale. Those suffering most from xerostomia are more likely to experience a negative impact on general health. CONCLUSION: The key finding in this study is that xerostomia has a significant and negative impact on the quality of life of elderly individuals, though oral function may be less affected.

Aged↗

Comparison of health status indicators in chicago: are Black-White disparities worsening?

OBJECTIVES: This study examined Chicago residents' progress toward the Healthy People 2000 goal of reducing racial disparities in health and compared the results with a recent analysis of US data. METHODS: Non-Hispanic Black-to-non-Hispanic White rate ratios were computed for 14 health status indicators for 1990 and for 1998. RESULTS: Nationally and in Chicago, indicators for both Blacks and Whites improved between 1990 and 1998; however, Whites consistently fared better. Nationally, gaps narrowed on 10 indicators; for Chicago, they widened on 10 indicators. CONCLUSIONS: Nationally, there is apparent progress in reducing Black-White disparities; this is not true for Chicago. Whether failure to reduce racial disparities is unique to Chicago or is common to other urban centers remains an open question with important implications.

Adolescent↗

Maternal and child health: use of health status indicators in coordinating and targeting federal programs.

The United States has achieved dramatic improvements in overall maternal and child health status, yet faces disturbingly wide variations in the health status of many population subgroups. The Surgeon General in 1980 published specific quantitative objectives to stimulate further improvements in the health of the American people by 1990. A critical step in meeting relevant objectives is the more effective use at national, state, and local levels of available data, particularly infant, perinatal, neonatal, and maternal mortality rates and the incidence of low weight births. This paper reviews variations in infant mortality rates and five current federal "categorical" programs that aim to improve maternal and child health: Supplemental Feeding Program for Women, Infants and Children; Head Start; Maternal and Child Health; Family Planning; and Community Health Centers. Several examples are cited of effective use of data in the coordination and targeting of resources from these large public programs. Recommendations are made for enhancement of federal maternal and child health programs within current funding levels. These recommendations will be all the more relevant if the Congress enacts block grants to the states with lower total funding.

Child Health Services↗

[Health status indicators in elderly persons receiving various amounts of carbohydrates in their food].

The authors studied factual nutrition and the health status in 272 practically healthy elderly persons aged 60 to 74 years. Depending on the content of carbohydrates in the food, they were divided into 2 groups. The first group comprised persons, in whose diets the carbohydrate component was either equal to 45% of the average daily caloric value or was lower; the second group comprised test subjects with this component amounting to 60% and even higher. Analysis of the chemical composition of the diets of the group 2 test subjects demonstrated that the basic nutritive substances were unbalanced, and protein, vitamins and mineral elements were deficient. A close correlation was found between the carbohydrate content of the diet, which determined to a considerable degree the magnitude of its caloric value, and the health status of the elderly persons. Excess carbohydrates in the diet and its caloricity exerted an unfavourable effect on the general clinical condition, body weight, function of the cardiovascular system, the degree of changes in both lipid and carbohydrate metabolism, and promoted the development of more remarkable clinical manifestations of the atherosclerotic process in the elderly persons.

Age Factors↗

Evaluation of subjective oral health status indicators.

OBJECTIVES: This paper reports the results of a study to evaluate the performance of a battery of subjective oral health status indicators originally developed for use in large scale surveys of older adults. The aim was to assess their generalizability, efficiency, reliability, and validity when used in a study of adults aged 18 years and over and to compare their performance with respect to younger and older adults. METHODS: Data were collected by means of a mail survey and self-complete questionnaire of a random sample of the population aged 18 years and older. RESULTS: The results suggested that the measures were sensitive to the oral health concerns of adults of all ages and that item nonresponse was within acceptable limits. Test-retest and internal consistency reliability statistics were good and all hypotheses designed to assess concurrent and construct validity were confirmed. CONCLUSIONS: The results confirm an earlier, but more limited, evaluation and suggest that these indicators are useful for descriptive oral health surveys of general populations.

Adolescent↗