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PubMedDate not supplied

The relationship between cognitive performance and employment and health status in long-term survivors of the acute respiratory distress syndrome: results of an exploratory study.

Survivors of acute respiratory distress syndrome (ARDS) are at risk for long-lasting cognitive decline due to hypoxemia, sepsis and/or psychological sequelae associated with aggressive supportive care in the intensive care unit (ICU). We conducted an exploratory study to assess cognitive performance in long-term survivors of ARDS and to investigate how cognitive functioning is related to employment status and health-related quality of life (HRQOL). At median time of 6.0 years after ICU discharge, forty-six ARDS survivors were tested with SKT, a short cognitive performance test for assessing deficits of memory and attention. A measure of HRQOL (SF-36 Health Status Questionnaire) was also administered, and in a brief psychiatric interview, employment status was rated. 23.9% (n=11) of the patients showed cognitive impairments. However, no extreme and severe cognitive deficits were recorded. They primarily revealed low levels of cognitive function in various tasks assessing attention skills. Disability was found in 41.3% (n=19) of the patients. All ARDS survivors with cognitive deficits were disabled, whereas only 22.9% (n=8) of the cognitively not impaired patients gave evidence of disability. The SF-36 values of the ARDS survivors indicated impaired health status on seven out of eight domains when compared to normative population data. Patients with cognitive deficits described the lowest HRQOL with major limitations in the domains role-physical and social functioning when compared to patients without cognitive impairments. In conclusion, long-term ARDS survivors exhibit impaired health status and the presence of cognitive deficits is associated with disability and considerable impairments in HRQOL. More detailed psychiatric research is required to establish the etiology of these cognitive impairments.

Acute Disease↗
PubMed1991

Health status (arthritis impact) in children with chronic rheumatic diseases. Current measurement issues and an approach to instrument design.

Arthritis outcome measures in adults have evolved from biologic "disease activity," to observations of motor/movement based "functional status," to assessment of "health status." This monograph suggests a framework for developing a pediatric arthritis health status (impact) instrument in which measurable global outcome dimensions include psychological, social, ADL, pain, school, family, behavioral, and developmental variables. Physical and laboratory parameters of inflammation/disease activity are not part of either functional status or arthritis impact, but rather perhaps the most important predictor variable of outcome. Juvenile rheumatoid arthritis (JRA) is a prototypic chronic disease for development of a health status instrument for children. Prior obstacles have been (a) that systemic, polyarticular, and pauciarticular JRA appear to have very different amounts of impact on health status; and (b) although juvenile arthritis has proven a useful term for medical and public education, its value as a study entry criterion for functional status instrument development is limited. Any new pediatric arthritis impact instrument must fulfill five criteria: enable quantification; demonstrate reliability, validity, and precision; and specify data collection procedures. Important design issues include (a) developing a self-report format for children, (b) ensuring generalizability across age groups, and (c) the parent as proxy in most patient-related dialogue and interventions. Instrument elements could come from 8-10 adult and pediatric health/functional status instruments already in use. By 10 years of age, children can provide much independent information. Whether global assessments by patient, parent, and physician should be included, or be a separate "gold standard," is not yet clear. The creation of better health status measures is an important and formidable challenge for pediatric rheumatology.

Age Factors↗
PubMed1995

Stability of health status measurement in rheumatoid arthritis.

Health status measures in rheumatoid arthritis that have been extensively validated for use in clinical trials are generally used also in correlative studies, e.g. to predict future health status. This application requires stability (repeatability of measurements). The purpose of our study was to determine the stability of commonly used health status measures. Two measurements at an interval of 6 months were then in 99 patients. High stability (alpha = 0.78 to 0.94) was observed for five biomedical measures (grip strength, walking time, platelet count, haemoglobin and erythrocyte sedimentation rate) and five self-report measures (mobility, self care, impact daily activities, anxiety and cheerful mood). Moderate stability (alpha = 0.65 to 0.72) was observed for joint scores, pain, C-reactive protein and depressive mood. The highly stable measures most adequately reflect individual differences, may be applied most reliably in correlative studies and appear to have the largest clinical utility with regard to long-term prediction of health status.

Adult↗
PubMed2006

Oral health status of mississippi delta 3- to 5-year-olds in child care: an exploratory study of dental health status and risk factors for dental disease and treatment needs.

OBJECTIVES: For poor and minority young children, disparities exist in dental health and treatment. In rural impoverished areas, institutions that reach young children and potentially offer access to care are limited. In the current Mississippi Delta study, child care centers were examined as potential venues for oral health intervention and research, and potential risk factors for dental caries and treatment urgency in high-risk preschool children were explored. METHODS: Child care centers were selected and attending children recruited. Data on oral health practices were collected from surveys of center directors and parents/caregivers. Children were examined for caries and treatment urgency at centers by dentists. Bivariate and multivariate analyses with a 0. 05 alpha were used to examine data. RESULTS: A total of 346 preschool children at 15 participating centers were examined: 46% were female, 68% minority. Minority children and those with public insurance were more than twice as likely to have caries and urgent treatment needs as non-minorities or those with private insurance. The odds of children having caries were half as great if parents reported using floss and nearly twice as great if the parent had experienced a dental abscess. For every soft drink the parent consumed daily, the odds of dental caries for children increased by 44%. CONCLUSIONS: Conducting oral health exams and research in child care venues was possible, yet presented challenges. The combined use of two parental variables, reported soft drink consumption and abscess history, appears promising for caries prediction. Implementation of oral health programs and research in child care venues merits further exploration.

Carbonated Beverages↗
PubMed1991

A scale for estimating the health status of opioid users.

The health status of injecting drug users has both clinical and research relevance. In order to evaluate the impact of treatments for opiate dependence on drug users' health status we need valid and reliable instruments which are short and easily administered by non-medical personnel. This paper describes the construction of a brief interviewer administered scale for assessing the current health status of injecting drug users. Data evaluating its reliability and validity are presented which indicate that the scale has excellent psychometric properties.

Adolescent↗
PubMed2003

What lies behind the subjective evaluation of health status?

The evaluation of health or subjective health (SH) is considered a legitimate indicator of overall health status, providing a valid, reliable and cost-effective means of health assessment. This study looks at factors reported by respondents as influencing their SH, it analyzes to which extent people compare themselves with others when evaluating their health, and examines the difference between people with optimal or sub-optimal SH. Face-to-face interviews were conducted with 383 Israeli residents. Three models for judging health status were identified: the biomedical or disease oriented, the emotional or "general feeling", and the functional-related model. The reported influence of some factors for the evaluation of health changed by age and by level of subjective health. Respondents with sub-optimal health reported tiredness and pain as more influential. Most interviewees spontaneously reported comparing their health to reference groups. Age and level of subjective health were associated with the way people compare their health to others. The young reporting sub-optimal health did not compare themselves to people their age, but a high percentage of the old did so. Among those with excellent health, the young rather than the old were more likely to compare themselves to people their age. These findings imply that each individual tries to find ways to evaluate his/her health in a more positive light. When old and not healthy they tend to compare themselves to friends or people their age, but if young and not healthy they do not perform the comparison so as not to feel worse. Understanding how people evaluate their health can contribute to the conceptual development of subjective health.

Adult↗
PubMed2003

Do employment and family work affect the health status of women with fibromyalgia?

OBJECTIVE: To assess health status differences of women with fibromyalgia syndrome (FM) who are employed and not employed, and to evaluate whether employment and family work influence the health status of women with FM as it does for women in community studies. METHODS: Participants were 287 women recruited from 118 randomly selected rheumatology practices. They completed telephone interviews that collected data on demographic characteristics, health status, symptoms, family work, and social support. One hundred thirty-seven were employed and 150 were not employed. Formal statistical analysis, including estimation and testing, focused on the relationship between employment and 4 health status measures: Modified Health Assessment Questionnaire (MHAQ), visual analog scale (VAS) for pain on the interview day, number of painful areas, and VAS for fatigue on the interview day. The relationship between employment and these measures was evaluated using analysis of variance, chi-square, linear regression, and ordinal logistic regression. RESULTS: The majority of participants reported high levels of symptoms and poor health status. In the bivariate analyses, employed women reported significantly less pain, less fatigue, and better functional status than those who were not employed. In the multivariate analyses, employment remained a significant factor in explaining number of painful areas, functional status (MHAQ), and fatigue, with employed women reporting better health status than those not employed. Employment was not associated with pain on the day of the interview when other factors were considered in the analysis. The psychological demands of family work were consistently related to all dependent measures of health status, as those with greater psychological demands reported worse health status. CONCLUSION: As in community studies, employed women with FM report better health status than women who are not employed. The demands of family work exert a serious and significant effect on every dimension of health status and should be the focus of greater clinical attention. Further followup will assess whether employment has a protective effect for women with FM as in community studies or whether women with less severe FM tend to remain in the workforce.

Activities of Daily Living↗
PubMed2003

A comparison of the responsiveness of different generic health status measures in patients with asthma.

Generic health status has been recommended to be measured separately from disease-specific health status, because they can yield complementary information. In particular, generic health status can provide comprehensive health ratings across various disorders. However, the weakness with generic measures is that they may be less responsive to clinical changes than disease-specific ones. Therefore, when using generic health status as an endpoint in clinical trials, the instrument to be used is a problem with respect to responsiveness. In the present study, we investigated and compared the responsiveness of health status measures during asthma treatment using three different generic instruments: the Medical Outcomes Study Short Form 36-items Health Survey (SF-36), the Nottingham Health Profile (NHP) and the EQ5D (EuroQoL), as well as one disease-specific instrument, the Asthma Quality of Life Questionnaire (AQLQ). Fifty-four new patients with asthma who consulted our clinic were recruited. The health status measurements were performed on the initial visit, and at 3 and 6 months. All subscales of the SF-36 showed a significant improvement during the first 6 months. Each dimension of the EQ5D showed stronger ceiling effects than the SF-36. With respect to the responsiveness indices, the SF-36 was regarded as more responsive than the NHP or EQ5D utility. The changes in the SF-36 had a weak to moderate correlation with the changes in the AQLQ. In conclusion, the SF-36 had a higher responsiveness for asthma as a generic measure than the NHP or EQ5D, and evaluated different aspects from the AQLQ. The SF-36 can be used effectively in asthma clinical trials.

Asthma↗
PubMed1992

Benefits and obstacles for development of health status assessment measures in clinical settings.

Health status measures offer scientific, humanistic, and economic benefits for clinical medicine. The main problem is the many intellectual and pragmatic obstacles that block successful development of these measures. The inventory of such problems includes the following: definition of health; medical components of health status; who makes the choice about what to include and emphasize; attributes to be rated by patients or clinicians; indexes to be created from those attributes (including mega-variable indexes, global indexes, and oligo-category indexes); different measurements of the same entity; and clinimetric problems in nonclinimetric models. Several solutions to these multiple, complex difficulties can be offered: 1) ensure that a specific purpose, focus, and setting are clearly identified for every health status index; 2) recognize that an off-the-shelf index with high statistical scores for so-called reliability and validity may not be pertinent for a given current situation in which it is to be used; 3) avoid indexes involving combinations of excessive numbers of variables; 4) let patients choose the most significant foci and components of the indexes; 5) seek greater communication and understanding among multidisciplinary collaborators, who may have many differences in the ethos and goals with which they approach the construction of health status indexes; and 6) recognize that the construction of suitable health status indexes is an outstanding challenge in basic scientific inquiry, and, in this spirit, support major alterations in the current ideology for conceptualization and funding of what is basic science in clinical medicine.

Health Services Accessibility↗
PubMed1987

Using insurance claims to measure health status: the Illness Scale.

Health insurance systems are generating large numbers of claims filed by physicians and hospitals for reimbursement and accounting purposes. This paper describes and evaluates a measure of health status derived from physician and hospital claims filed for a sample of older Canadians during 1970-1977. Information on the number, type, and seriousness of reported diagnoses and the number and duration of hospitalizations and surgeries during each year were combined to generate annual Illness Scales ranging from 0 to 24. Alpha coefficients, measures of internal consistency, were between 0.82 and 0.84. Consistent with high validity, Illness Scale scores increased with age, were significantly associated with other health measures, and were strongly predictive of death and hospitalization in the following year. The ability to develop valid and reliable health status measures from insurance claims substantially expands the potential use of these data for research and evaluation.

Age Factors↗
PubMed2003

Linking osteoarthritis-specific health-status measures to the International Classification of Functioning, Disability, and Health (ICF).

OBJECTIVES: The objective of this study was to link the Western Ontario and McMaster Universities (WOMAC) and Lequesne-Algofunctional indices to the ICF on the basis of linking rules developed specifically to accomplish this aim. The linking process enables the understanding of the relationship between health-status measures and the ICF. METHODS: Since the fifth World Health Organisation/International Liege Against Rheumatism (WHO/ILAR) Task Force and the Outcome Measures in Rheumatology Clinical Trials (OMERACT) group recommend the use of WOMAC and the Lequesne-Algofunctional indices in patients with osteoarthritis of the hip and knee in clinical trials, these two health-status measures have been used in this study. Both health-status measures were linked to the ICF separately by two trained health professionals. Consensus between health professionals was used to decide which ICF category should be linked to each item/concept of the two questionnaires. To resolve disagreements between the two health professionals, a third person trained in the linking rules was consulted. RESULTS: Except for the concept of 'morning stiffness', both health professionals agreed on the ICF category chosen to link all the items/concepts of both questionnaires. Altogether, 29 different ICF categories have been linked. Five ICF categories belong to the ICF component 'body functions', 23 categories to the component 'activities and participation', and one category to 'environmental factors'. Both questionnaires have 10 ICF categories in common. CONCLUSIONS: The results of the linking process reflect both the structure of the two questionnaires studied and the relationship between them, showing that the ICF classification can become the cardinal reference for existing health-status measures.

Activities of Daily Living↗
PubMed2000

Distinction of quality of life, health related quality of life, and health status in children referred for rheumatologic care.

OBJECTIVE: Current health status measures [sometimes called quality of life (QOL) measures] are based on the values of their designers. QOL, though, reflects the idiosyncratic values of each individual. We investigated whether children referred for rheumatologic care differentiate between the concepts of health related quality of life (HRQOL), overall QOL, and health status. METHODS: One hundred twenty-two consecutive children seen at a pediatric rheumatology referral clinic completed a new global self-report quality of life scale (Quality of My Life), a functional impairment scale (Childhood Health Assessment Questionnaire), and a disease severity visual analog scale. Sixty children were seen for a followup assessment. RESULTS: HRQOL was somewhat lower than overall QOL (median 6.6 vs 8.6 out of 10; respectively) in this sample of patients. Our subjects did differentiate between overall QOL and HRQOL and health status. Health status, as measured by disease severity, accounted for only a moderate amount of variability in HRQOL (R2 = 0.25, p< or =0.0001). Health status measured by functional disability accounted for even less of the variability in HRQOL (R2 = 0.047, p = 0.013). Similarly, HRQOL accounted for only a moderate amount of the variability seen in overall QOL (R2 = 0.31, p< or =0.0001). CONCLUSION: The goal of most health professionals is to improve their patients' overall QOL. QOL, though, appears to be a broad and idiosyncratic construct affected only moderately by health. Health status, global HRQOL, and overall QOL all provide independent information. All 3 measures should be considered for use in research studies. HRQOL and overall QOL reflect patients' own values, and therefore may offer important information for clinicians in addition to health status.

Adolescent↗
PubMed1987

Black-white differences in health status: methods or substance?

Apparent differences in the health status of blacks and whites vary according to methods of measurement, errors in the measurement process and interpretation of the measures, and types of measures used. This article uses the literature and secondary analysis of available data to explore the impact of methods on health status comparisons by race. Methods to measure health status include records, direct observations, and self-reports. Blacks generally show the greatest health deficits based on observation and least on some types of self-reports. Major types of errors in health status estimates are random errors and biases. Random errors tend to be greater for blacks because samples used to estimate their characteristics have often been smaller than white samples. Biases include noncoverage or failure to include some types of individuals in the reporting systems at all, nonresponse or lack of complete information on some persons, and use of inaccurate information due to faulty data collection or processing. Such biases tend to be greater for black persons than for whites. Their impact often is to give the illusion that blacks may be in better health than is actually the case. The types of measures that show blacks in the poorest health status are those considered to be most objective: mortality rates and some clinical examinations and health provider records. Subjective measures of dissatisfaction with health level also show blacks to be much less healthy than whites. In contrast, self-reports of illness conditions, symptoms, and restricted-activity days show blacks, particularly children, to be relatively well off compared to whites. These self-reports may be misleading due to differential perceptions of illness and reporting biases between blacks and whites. There is no doubt that measured differences in the health status of blacks and whites often reflect substance. There are also significant methodological problems, however, in comparing health status by race, which tend to underestimate the problems experienced by the black population. This article and others in this volume stress the need to know much more about the sources and impact of these methodological problems. In the meantime, these problems need to be recognized and adjusted for, where possible, when health status measures are compared. It is particularly important to consider them when policy questions of equity and resource allocation are to be decided using indicators of health status.

Black or African American↗
PubMed1997

Worry about health status among the elderly: patient management and health policy implications.

Health care reform depends on reducing inappropriate utilization and improving access. Elderly people, major consumers of primary care, are a place to begin reforms, but progress has been slow. We combined primary care screening questions for objective (medical condition as wellness) and subjective (perception of health as worry) health in a study of 767 elderly people in Youngstown, Ohio. The worried well (31.2%), a group likely to consume medical care inappropriately, and unconcerned ill (4.4%), a group likely to avoid seeking necessary medical care, account for more than one-third of the elderly. The unconcerned well (57.0%) and worried ill (6.9%) pose fewer problems. Family physicians can predict utilization and access problems for targeted groups (older people, minorities, and women), along with health beliefs and other indicators of health status. Although findings in this study are preliminary, they do point to positive uses in health policy and patient management. Extensive usage of the sure would require financial reimbursement to health care providers.

Aged↗
PubMed1994

Validity of Euroqol--a generic health status instrument--in patients with rheumatoid arthritis. Economic and Health Outcomes Research Group.

The main aim of this pilot study was to test the 'construct' validity of Euroqol, a new generic health status instrument which consists of a questionnaire and visual analogue scale. Its ability to measure both current health status and change in health status was assessed in 55 patients with RA. The Euroqol questionnaire and visual analogue scales showed significant and clinically relevant correlations with other condition-specific instruments measuring loss of function, joint pain, joint tenderness and mood; change in these symptoms as measured by the condition-specific instruments was also predictive of change in Euroqol scores. Either component of the Euroqol instrument provide an index of current clinical status and these data provide preliminary evidence for the 'construct' validity of Euroqol in RA. Further work is needed to evaluate more fully the sensitivity of Euroqol to change over time.

Adolescent↗