V codes: supplementary classification of factors influencing health status and contact with health services.
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Abstracting and Indexing↗
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[Model for an epidemiological study of the health status of a population of health workers].
The authors describe a model of retrospective research on the state of health in a sample of the staff in a big hospital. The sample was composed of selected sub-groups taken from professional categories notoriously exposed to risk at work. The aim was to help define a model in simple ad versatile epidemiologic research and by applying it to a sample population of health operators, to verify the extent, the prevalence and incidence, the evolution in pathologies in order to make comparisons with the normal population, thus making it easier, for future research, to study casual phenomena and correlate between them. General criteria of retrospective "control case" have been adopted and the anamnestic data gather in has been done by filling in the "health book of individual risk", together with special questionnaires for this investigation. The originality of this work consists in its having abandoned the concept of pre-determine the nature and size of the test sample. In fact, considering the large number of variables, they should have made use of much bigger dimensions than the ones of the population examined with the elaborated original model. Which mean it is possible to obtain significant and reliable results by operating on a reduced but statistically valid sample, chosen with random method and whose entity has been determined with support from others experience in different sector. Therefore it is reasonable to consider the described model as a simple, agile and economic instrument adaptable to other cases, although still to be perfected. In particular it underlines the possibility of testing the state of health of categories at risk before stating complicated analysis (and organi) or big populations, thus improving instruments ad organization. To accomplish a continuous system of data in a short time thus verifying the stages of development and application of more complex projects of epidemiologic research aimed at entire populations. To obtain useful information wherever it's not possible to conduct complete and rapid research on workers' health in an on going way.
Epidemiologic Methods↗
[Health status and utilization of health care services among a sample of female prostitutes in Oslo. An interview study].
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Adult↗
Health status: what does it mean for payers and patients?
Disturbances to health can be divided broadly into limitations of basic activities of daily living (washing, dressing, etc.) that are common to all patients and other limitations that depend on individual circumstances. A distinction should be drawn between health status and health-related quality of life. Health status questionnaires are standardized for "typical patients," and this should be borne in mind when interpreting such scores from studies that give an average result using population-based measurements. Such studies give a good indication to payers of the average effects of a treatment, but provide no indication other than probability of benefit to individuals. This applies even more with health improvements that manifest uniquely in each patient. Two widely used disease-specific questionnaires in chronic obstructive pulmonary disease-the Chronic Respiratory Questionnaire and the St. George's Respiratory Questionnaire-are health status, rather than quality of life, instruments. Health status scores from questionnaires provide measures of the effects of disease, not measures of the disease itself. The relationship between high health status score and increased risk of dying is due to the fact that both reflect underlying disease activity. In therapeutic studies, health status improves because the underlying disease activity has been moderated by therapy. Improved health does not improve mortality or morbidity per se. It is also important to appreciate that the impact of any measured change in health may also be determined by the patient's baseline state.
Disease Management↗
Can patients use an automated questionnaire to define their current health status?
Patient management decisions rarely incorporate standardized health status assessments, since accurate and reliable measures are difficult and expensive to obtain. In prior research with various methods for obtaining health data from patients, it was found that physicians' acceptance of a method was improved if it provided an individualized printout. It was also determined that patients will readily complete a health status questionnaire on a computer when the computer does not look like a computer. Patients' acceptance was greatest when they were presented with a single line of large, pressure-sensitive buttons with which they could respond to questions about their health histories. Using such an instrument, the HealthQuiz, the current study found the same discrepancy rate (3%) between patients' responses to health questions presented on HealthQuiz and during interview as between their responses to questions asked during two separate interviews. Further, to ascertain health status, rules determined by an expert panel were applied to patients' responses to health questions presented on the HealthQuiz screen. It was found that the numerical health status derived from answers to the automated presentation of questions was similar to numerical health status derived by a physician after a patient-physician interview.
Aged↗
[Attitudes and health status as determinants of participation in individually oriented health promotion].
In a cross-sectional health survey among employees of a large German metal company with 974 study participants, attitudes and aspects of the individual health status were identified which predispose employees to take part in individual health promotion activities. Apart from higher participation rates in women and white collar employees, participants reported on average a less favourable subjective health status, more complaints and diseases, better health related behaviours, and a more intensive utilization of curative and preventive medical services than nonparticipants. Among men, participation in all types of courses increased from the youngest to the oldest group, among women only until the middle-aged groups with a consequent decline thereafter. In men, the image of a person living health-consciously showed the strongest positive association with participation, and not the degree of internal control and responsibility with respect to the maintenance of health or the acquisition and overcoming of disease. The low participation of blue collar workers compared to white collar employees could be attributed to group specific differences in individual health consciousness only to a very small extent. Blue collar participants reported a positive image of a person living health-consciously that was more similar to that of white collar participants than to that of nonparticipants of their own occupational group. Advertisement for health promoting activities should place more emphasis on increasing the image of personal health promotion than on internal control and responsibility for health.
Adult↗
[Health status and problems of medical care of public health personnel].
Presents the data characterizing health status, conditions of life, and life style of medical workers in comparison with other population groups. The health status of medical workers with regard to many parameters is worse, and they experience real difficulties in correction of abnormalities; many of their problems are due to poor material status of workers engaged in health service.
Adult↗
[Factor analysis for dental health status of junior high school students with experience or non-experience of fluoride mouthrinse. Part 1: Effects of fluoride mouthrinse experience on dental health status].
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Child↗
Health status questionnaires.
Because they accurately and efficiently tap into important aspects of rheumatic disease status and outcome, health status questionnaires have found increasing use in the clinic, controlled clinical trials, and observational studies. This article reviews utility assessment methodologies as well as generic and disease-specific health status questionnaires relevant to rheumatology.
Health Status↗
Impact of a major thermoelectric plant on self-perceived health status.
BACKGROUND: Measuring self-perceived health status and risk perception according to environmental factors remains a major open issue with important health policy implications. METHODS: To measure self-perceived health status in an area where a major thermoelectric plant has been active since 1994, in October 2001, we conducted a two sample survey using the SF-12 Health Survey. The study sample (2001 individuals) representative of the population living in the plant area (Montalto di Castro, Central Italy) was compared with a random sample of the general Italian population (1928 individuals). Mean values were adjusted for age, sex and education. RESULTS: SF-12 summary scales means are comparable in both samples: 50.2 (SE: 0.3) versus 49.9 (SE: 0.3) for the physical score, and 47.7 (SE: 0.4) versus 48.7 (SE: 0.4) for the mental score for Montalto di Castro area and Italian sample respectively. CONCLUSION: People living near a major thermoelectric plant have a subjective health status comparable to that reported by the general Italian population.
Adolescent↗
The structure of health status among older adults: disease, disability, functional limitation, and perceived health.
This article builds on earlier conceptualizations of the structure of health status to propose a more complex, multiequation model that examines the interrelationships among its various dimensions. As such, the focus is not merely on the identification of the direct effects of a variety of factors on perceived health status, but on how the constructs of disease, functional limitation, and self-rated health interrelate. In so doing, we expose the inherent problems of several complex and contaminated items routinely included in applications of established functional health status measures. The source of these problems lies in the lack of specificity or conceptual clarity for the individual items in these established measures. Potential biases are discussed, and several methods and strategies for addressing these problems are explored. Alternative scales are constructed and their psychometric properties are presented. Researchers who rely on public use data bases containing these scales should be aware of the potential biases and either modify the scales or use other appropriate methodologies to control for the measurement contamination.
Activities of Daily Living↗
Work disability, functional limitations, and the health status of kidney transplantation recipients posttransplant.
A primary objective of renal replacement therapy is patient rehabilitation. Studies have consistently shown that transplant recipients are better rehabilitated than patients maintained on dialysis, but diabetic transplant recipients do not do as well as nondiabetics. Few studies have evaluated the rehabilitation status of transplant recipients based upon their outcome following transplantation. Data were collected from 226 patients associated with 5 major transplant centers in the United States at 2.5-3.5 years posttransplant. Established survey procedures were followed and standard measures of work status, functional ability, and health status were incorporated into self-administered questionnaires. Patients were stratified into 3 groups based upon transplant outcome--those with functioning grafts, those whose grafts failed and were retransplanted, and those who returned to dialysis after graft failure. The presence of diabetes was also documented. Regardless of graft outcome, more patients were able to work than were actually working (61.5% vs 43.4%), although patients with successful transplants, and those who were retransplanted, were both better able to work than patients whose grafts had failed, necessitating a return to dialysis. Diabetic and nondiabetic patients differed in their ability to work (74.4% vs 34.7%). All patient groups reported work-related limitations in activity and associated functional impairments. These were less severe for patients who had functioning grafts. Perceived as well as actual health status varied according to graft outcome and primary disease diagnosis, with both dialysis patients and diabetics reporting poorer health status than patients who had retained their first grafts or who had been retransplanted. Graft outcome and primary renal diagnosis prior to transplant are important predictors of ability to work, functional ability, and health status posttransplant. Retransplantation is not detrimental to patient rehabilitation, whereas return to dialysis results in a measurable decline in activity status. Despite a successful graft, diabetes severely limits the rehabilitation potential of transplant recipients.
Activities of Daily Living↗
Measuring health status and quality of life for US children: relationship to race, ethnicity, and income status.
OBJECTIVE: Accurately measuring the health of the increasingly diverse population of US children requires instruments that are comparable and valid across cultures, economic background, and language. This paper asks: Has the field of pediatric health status measures reached this level of comprehensiveness? METHODS: Children's health status and quality of life measures commonly used in the United States were reviewed to assess how they have included racial/ethnic minority and low-income groups. Four generic and 2 condition-specific instruments (asthma) were examined for total sample size, percent of sample from racial/ethnic and low-income groups, language availability, translation methods for US-Spanish, reading level, and separately reported psychometric findings and outcomes/scores. RESULTS: Most measures have included minority groups, usually African American or Hispanic children, although with little information by Hispanic subgroup. Children's measures have generally been tested on relatively small samples, without separate analyses by subgroups. When done, tests of reliability and validity find few differences from the general population. Some studies report information on health by racial or ethnic group, but the findings are inconclusive. Economic status is usually measured in some way, but rarely are psychometric findings examined separately by income. When differences in health outcome are reported by income, lower income children usually have poorer health. CONCLUSIONS: Much has been accomplished in advancing health status measures for children. Next-generation issues include the influence of race, ethnicity, and income on health and health reports.
Child↗
Effects of chronic airway disease on health status of geriatric patients.
BACKGROUND AND AIMS: The impact of chronic airway disease on the health status of elderly patients is only to some extent explained by indexes of airflow limitation. The present study was designed to assess to what extent: 1) asthma, chronic obstructive pulmonary disease (COPD) and chronic bronchitis with normal FEV1 (simple bronchitis) differ in their impact on health status; 2) health status depends upon non-respiratory factors. METHODS: A total of 1601 outpatients over 65-198 with asthma, 228 with COPD, 91 with simple bronchitis, and 1084 with non-respiratory illnesses (control group)--were studied by collection of five health status indexes and multidimensional assessment. Discriminant analysis was used to identify health status profiles of groups. Demographic, anthropometric, clinical and respiratory function correlates of selected health status profiles were identified. RESULTS: Only 26 and 28% of asthma and COPD patients vs 43% of simple bronchitis and 50% of non-respiratory patients showed group-specific health status profiles. These profiles were characterized by lower 6-min walked distance and greater index of disturbed sleep in asthmatics, and by worse performance on Barthel Index, 6-min walking test and Mini-Mental State Examination in COPD patients. More severe bronchial obstruction, a greater index of comorbidity and a longer occiput-wall distance characterized COPD patients with the worst health status. CONCLUSIONS: The health status of elderly patients with COPD or asthma is highly heterogeneous. On average, COPD is characterized by more severe physical impairment, and asthma by poorer quality of sleep. Comorbidity and severity of bronchial obstruction, but not age, contribute toward defining a subset of COPD patients with the worst health status.
Aged↗
[Health status of elderly persons in Korea].
This Study was done to design and test an instrument to measure the health status of the elderly including physical, psychological and social dimensions. Data collection was done from July 18 to August 17, 1990. Subjects were 412 older persons in Korea. A convenience sample was used but the place of residence was stratified into large, medium and small city and rural areas. Participants located in Sudaemun-Gu, Mapo-Gu, and Kangnam-Gu, Seoul were interviewed by brained nursing students, and those in Chungju, Jonju, Chuncheon, and Jinju by professors of nursing colleges. Rural residents were interviewed by community health practitioners working in Kungsang-Buk-Do, Kyngsang-Nam-Do, Jonla Buk-Do, and Kyung Ki-Do. The tool developed for this study was a structured questionnaire based on previous literature and then tested for reliability and validity. This tool contained 20 physical health status items, 17 mental-emotional health status items and 38 social health status items. Physical health status items clustered in to six factors such as personal hygiene, activity, home management, digestive, sexual, sensory, and climatization functions. Mental-emotional health status items clustered into two factors, mental health and emotional health. Social health status items clustered into seven factors, grandparent, parent, spouse, friend, kinships, group member and religious role functions. Data analysis included percentage, average, S.D., t-test and ANOVA. The results of the analysis were as follows: 1. The tool measuring the health status of the elderly and developed for this research had a relatively high reliability indicated by a Cronbach = 0.97793. 2. Average score of the subjects physical health status was 4,054 in a 5 point likert scale, mental-emotional health status was 3.803, social health status was 2.939 and the total average was 3.521. The social status of the subjects was the lowest and the next was mental-emotional health status; physical health status was the highest. 3. Educational background, perceived health status, the amount of pocket money were related to physical and mental-emotional health status and family structure was related mental-emotional physical and social health status. Occupation was related to physical and mental-emotional status. Area of residence was related to mental-emotional and social status. Source of living in the expenses was related to physical and mental-emotional health status marital status to mental-emotional and social health status, and the number living in the home physical health status and religion to social health status.(ABSTRACT TRUNCATED AT 400 WORDS)
Aged↗
Health status estimation on the basis of MIMIC-health care models.
In this paper we propose a new method for deriving health indexes from MIMIC-health care models. This method differs from the traditional approach in that the health indexes are not based on the causes of health but on transformations of the health indicators. These transformations are employed mainly to correct for the effects of variables which do influence the health indicators but not health status, H*, itself, like availability of medical specialists. The method is applied to a MIMIC-health care model, which is estimated on a Dutch database. The estimated parameters of this model and the derived health indexes may be used in future research to collect only those health indicators and related variables which appear to contain relevant information on H*.
Analysis of Variance↗
Preliminary production functions describing change in mental health status.
Change in mental health status is analyzed as a function of hours of professional treatment, patient attributes, treatment characteristics, and environmental factors for each of seven clusters of conditions typically seen by psychiatrists, psychologists, or social workers. One of two regression strategies was effective in characterizing the relationship between status change and the input variables for each condition cluster. In each model, initial severity was significantly associated with change in mental health status, and it captured most of the unexplained variance. Provider time was predictive of improvement for only some conditions and providers. On average, mental health services appear to make patients better, but improvement is not terribly impressive. Moreover, the marginal benefits of treatment fall off as the number of contact hours increases.
Age Factors↗
Chronic disease, functional health status, and demographics: a multi-dimensional approach to risk adjustment.
OBJECTIVE: The goal of this study was to develop unbiased risk-assessment models to be used for paying health plans on the basis of enrollee health status and use propensity. We explored the risk structure of adult employed HMO members using self-reported morbidities, functional status, perceived health status, and demographic characteristics. DATA SOURCES/STUDY SETTING: Data were collected on a random sample of members of a large, federally qualified, prepaid group practice, hospital-based HMO located in the Pacific Northwest. STUDY DESIGN: Multivariate linear nonparametric techniques were used to estimate risk weights on demographic, morbidity, and health status factors at the individual level. The dependent variable was annual real total health plan expense for covered services for the year following the survey. Repeated random split-sample validation techniques minimized outlier influences and avoided inappropriate distributional assumptions required by parametric techniques. DATA COLLECTION/EXTRACTION METHODS: A mail questionnaire containing an abbreviated medical history and the RAND-36 Health Survey was administered to a 5 percent sample of adult subscribers and their spouses in 1990 and 1991, with an overall 44 percent response rate. Utilization data were extracted from HMO automated information systems. Annual expenses were computed by weighting all utilization elements by standard unit costs for the HMO. PRINCIPAL FINDINGS: Prevalence of such major chronic diseases as heart disease, diabetes, depression, and asthma improve prediction of future medical expense; functional health status and morbidities are each better than simple demographic factors alone; functional and perceived health status as well as demographic characteristics and diagnoses together yield the best prediction performance and reduce opportunities for selection bias. We also found evidence of important interaction effects between functional/perceived health status scales and disease classes. CONCLUSIONS: Self-reported morbidities and functional health status are useful risk measures for adults. Risk-assessment research should focus on combining clinical information with social survey techniques to capitalize on the strengths of both approaches. Disease-specific functional health status scales should be developed and tested to capture the most information for prediction.
Adult↗