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PubMed2002

Women's health status in Poland in the transition to a market economy.

Since 1989 Poland has been experiencing large-scale social and economic changes as a result of the reforms associated with the transition to a market economy. This study uses a 1996 Health Survey of over 20,000 women to examine the impact of the new socio-economic situation and of women's multiple roles on their health at the early stage of transition. We investigated the importance of selected economic, socio-demographic and cultural determinants in explaining differences in women's health status in Poland, focusing on education level, (un)employment, living conditions, marital status, smoking and life style. There are health inequalities between men and women in Poland based on life expectancy, chronic diseases and health self-assessment. Some of these, especially the large differences between life expectancy at working ages, may be attributed to the difficult socio-economic situation. The multivariate analysis of women's self-assessed health and morbidity from selected chronic diseases indicated substantial inequalities in health. Together with the behavioural and cultural risk factors recognized by medicine, such as obesity, lack of physical exercise and smoking, the paper shows the crucial role of economic factors in influencing Polish women's health. Women whose financial position is poor are more likely to assess their health as less than good, to suffer from respiratory and circulatory systems' diseases and report neurotic problems. Other factors, strongly connected with the transition process in Poland, which contribute to health problems are lack of employment and low educational level, particularly for younger women. Women's marital and parental status are also important predictors of some categories of health problems; however, their influence varies for women of different ages. Our survey also supports the thesis that loneliness in old age, defined on the basis of living in a one-person household, may be negatively correlated with health status.

Adolescent↗
PubMed1989

Health care expenditure and other data.

This international compendium from the Organization for Economic Cooperation and Development Secretariat contains available data for the 24 Member countries for 1960 through 1987. The Federal Republic of Germany is listed as Germany. Tables are presented for expenditure on health, health care pricing trends, social protection and public participation, utilization of medical services and available personnel resources, selected variations in common medical care practice, selected health status indicators, and demographic and general economic background data. There may be some inconsistencies between the data presented in the articles in this issue and those in this data compendium. The articles were based on earlier versions of the Health Data File. As a result, revisions to the data in a number of countries, including Canada, France, Germany, and Italy, are not reflected in the articles. However, the changes are relatively minor and do not affect the results presented in the articles in any substantive way.

Canada↗
PubMed2006

Using the SF-36 to determine perceived health-related quality of life in rural Idaho seniors.

The purpose of this study was to establish the perceived health-related quality of life (HRQoL) in people aged 65 and older in rural southeastern Idaho. Ninety-five people aged 65 and older completed the Short Form 36 version 2 (SF-36 v2), a valid and reliable HRQoL instrument. Subject scores were then compared to established normative values for the general U.S. adult population and specifically to normative values for people aged 65 and older. In general, the participant's HRQoL was lower than that of the general population. However, females aged 75 and older had higher physical component summary (PCS) scores than their age- or gender-matched mates, and PCS scores of all participants aged 75 and older were higher than those of their age-matched mates. Results of a regression analysis indicated that number of prescription medications taken (p = 0.004) was the only variable predictive of PCS scores. The results of this study show a decrease in the physical aspects of HRQoL of participants, signifying that HRQoL does decline with age. Results suggest that participants aged 75 and older have a higher HRQoL than suspected, which could indicate that rural residence is not an immediate indicator of decreased quality of life in the elderly.

Age Factors↗
PubMed2001

Associations of income with self-reported ill-health and health resources in a rural community sample of Austria.

OBJECTIVES: Three levels of health indicators (1) self-reported ill-health, (2) internal health resources, and (3) external health resources were analysed in relation to a four-category house-hold income distribution in order to describe possible social gradients. The particular aim of this study was to obtain information on the association of income data with self-reported ill-health. METHODS: This cross-sectional study was based on a health survey. The sample represents around 10% of the rural population of some communities in Styria, randomly selected from the population registry. Interview data was collected from 3781 participants aged 15 years and older, 1559 males and 2222 females. RESULTS: The results show that individuals from lower house-hold income classes are disadvantaged with regard to indicators of ill-health, internal and external health resources. Overall, the link between low income and poor health is highly consistent within our data. CONCLUSIONS: Considering our results we conclude that internal and external health resources are as unequally distributed over income levels as health outcome indicators.

Adolescent↗
PubMed1991

The production of health and the demand for health care in Finland.

A structural equation model of the determinants of health and of the demand for health care, treating health status as a latent variable, was developed using cross-sectional sample survey data representing the adult noninstitutionalized population (n = 10,712) of Finland in 1987. Attention was paid to evaluating the relative effects of different factors affecting health and demand for health care in order to make generalizations for health policy. The maximum likelihood estimates of MIMIC (multiple indicators and multiple causes) models are presented. The results indicate the important role of lifestyle variables as health production factors, and stress the importance of decreasing smoking and reducing overweight as targets for health policy. Under the assumptions of the model, smoking and overweight also have considerable effects on health care utilization. The socioeconomic variables--income, education and occupation--seem to have almost equal impacts on health, although their separate direct effects are somewhat smaller than the effects of the two lifestyle factors. The results of demand for doctor visits and prescribed medicines stress factors such as time cost and the supply of doctors as important determinants of utilization, and confirm the fact that a significant portion of health utilization depends on doctors decisions and is generated by patient-doctor contacts.

Cross-Sectional Studies↗
PubMedDate not supplied

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↗
PubMed1983

The effects of psychiatric symptoms on quality of life assessments among the chronic mentally ill.

This study of chronically mentally disabled persons in community residences examined the discriminant validity of subjective quality of life indicators and self-report mental health indices to determine the potential confounding effects of psychopathology on the assessment of quality of life (QOL). Factor analyses and difference-score reliabilities identified a general QOL construct and a general mental health construct with 27% common variance. However, psychiatric symptoms did not significantly (p less than .05) alter the bivariate and multivariate relationships among the QOL ratings, except in the health domain in which the correlations of health-related QOL indicators with global QOL were significantly (p less than .05) attenuated after removing the effects of psychopathology. The results suggest that psychopathology does not introduce bias into the overall structure of QOL data, but they also indicate the importance of controlling for mental health effects in the assessment of patients' self-rated health and satisfaction with health care.

California↗
PubMedDate not supplied

[Information for health equity in Chile].

OBJECTIVES: To estimate the magnitude of geographical health inequalities in Chile through key indicators based on data and information that are routinely collected and easily obtained, and to characterize the current situation with respect to the availability, quality, and access to information on health equity that official sources routinely collect. METHODS: A conceptual framework proposed by the World Health Organization was used to study health equity in terms of four dimensions: 1) state of health, 2) health determinants, 3) resources for and the supply of health system services, and 4) utilization of health system services. For each of these four dimensions, indicators were selected for which there was available information. The information was aggregated according to geographical and administrative units in the country: communes (342 in Chile), sanitary districts called "Health Services" (28), and regions (13). The aggregated information was analyzed using univariate analysis (distribution characteristics), bivariate analysis (correlations and frequency tables), and tabulation of values for selected indicators for the communes. RESULTS: With respect to the first dimension, state of health, we found an inverse relationship between mortality and average family income in the communes (r = -0.24; P < 0.001; n = 191 communes). With health determinants, there were important differences among the communes with regard to average household income, years of schooling, literacy, quality of housing, drinking water supply, and the wastewater disposal system. In terms of resources for and the supply of health system services, the municipal governments of the communes with higher average household incomes tended to contribute more funds per beneficiary (r = 0.19; P = 0.013). The financial contributions from the national government were targeted well, but they only partially compensated for the more limited resources available in poorer communes. With respect to the utilization of health care services per beneficiary in the different sanitary districts, we found some large differences. In terms of the ratio between the highest rate of utilization in any of the districts and the lowest rate in any other district, the ratio for primary-care visits per beneficiary was 2.8, the ratio for emergency-care visits was 3.9, and the ratio for hospitalizations was 2.0. CONCLUSIONS: There are important geographical differences in Chile with respect to mortality and other health outcomes, income and environmental conditions, and the financing and utilization of health care services. The information that is collected regularly and is available to characterize the health-related variables frequently has limitations in terms of quality, sustainability, and access. In Chile it would be pointless to focus the greatest efforts on reorganizing the information systems. The existing indicators showing marked inequalities are adequate to support the planning of interventions aimed at making urgently needed improvements in the situation of the worst-off Chileans.

Chile↗
PubMed1980

Evaluation of patients with advanced cancer using the Karnofsky performance status.

The Karnofsky Performance Status Scale (KPS) was designed to measure the level of patient activity and medical care requirements. It is a general measure of patient independence and has been widely used as a general assessment of patient with cancer. Although there is a long history of use of the KPS for judging cancer patients, its reliability and validity have been assumed without formal investigation. The interrater reliability of the KPS was investigated in two ways, both of which gave evidence of moderately high reliability. The patients evaluated in their home were usually assigned a lower KPS score compared with a similar evaluation at the same time done in the outpatient clinic. Costruct validity of the KPS was demonstrated by strong correlation with several variables relating to physical function. On-study KPS score accurately predicted early death, but high initial KPS scores did not necessarily predict long survival. Patient deterioration with subsequent death within a few months could be predicted to a limited extent by a rapidly dropping KPS. These results suggest that the KPS has considerable validity as a global indicator of the functional status of patients with cancer and might be helpful for following other patients with chronic disease.

Adult↗
PubMedDate not supplied

Mental health of community residents in the metropolitan Montreal area: some results of the "Santé Québec Survey".

In 1987, the "Santé Québec Survey" reached 2,696 individuals over 15 years old, living in the Montreal area. A self-administered questionnaire included two scales that measured the positive and negative aspects of mental health. Controlling for the effects of socio-demographic factors and global health status indicators, a multidimensional analysis computed the odds of being at risk of psychological wellbeing and psychological distress if exposed to social isolation or stressful life events. Results show that the quality of integration to the social environment is a better predictor of mental health than poverty by itself.

Female↗
PubMed1979

Psychiatric impairment in rural communities.

This household survey of 713 adults residing in nine rural Middle Tennessee counties was conducted to estimate the prevalence of psychiatric impairment in the rural population, to determine which groups in the population are characterized by higher levels of impairment, and to assess the validity of three indices of psychiatric impairment (HOS, CES-D, and GWB). The data indicate that approximately 12% of the rural population may be impaired and that impairment is most likely among females, the divorced, widowed, or separated, and those in lower socioeconomic strata. While depression was more common among the young, physical and psychosomatic complaints were more common among older respondents. Further, respondents classified as impaired by the indices tended to view themselves as having "substantial" or "major" problems and were likely to feel that they might require professional help. While the GWB appeared to discriminate between users and non-users of services, the other indices were less effective as predictors of service utilization.

Female↗
PubMed2000

The role of social and health statistics in measuring harm from alcohol.

Since excess use of alcohol contributes to so many varieties of health and social harms, in most countries, there are many potential sources of data indicative of alcohol-related harms. In few instances, compilation and interpretation of these data are straightforward, but, mostly, they are open to various sources of measurement error, which need to be taken into account if they are to be applied for research purposes. Police and health statistics are the major source of such information, but the underlying systems are not usually set up with the purpose of monitoring alcohol-related events. In both of these domains, types of events can be identified, which are wholly attributable to excess alcohol use, i.e. drunk-driving, alcoholic liver cirrhosis. Specific alcohol-related events are particularly prone to variations in, respectively, police enforcement practices, medical diagnostic fashion and sensitivity to prejudices about alcohol-related problems. A case will be made in this paper for the use of multiple surrogate measures of alcohol-related harm drawn from several sources in order to measure and track local, regional and national trends. For health statistics on mortality and morbidity, the aetiologic fraction (AF) method will be recommended for such monitoring purposes. It will also be recommended that these data be categorised by the degree to which cases are attributable to alcohol and also by whether the underlying hazardous drinking pattern is a brief drinking bout or a sustained pattern of heavy intake over a number of years. Nighttime occurrences of road crashes, public violence from both police and emergency room attendance data will also be recommended. It will be argued that routine recording of alcohol relatedness of events is usually unreliable, and the above surrogate measures are preferable. Recommendations will also be made for utilising national surveys of drinking behaviour to improve the calculation of alcohol-related morbidity and mortality, as well as refine estimates of per capita alcohol consumption, another major 'surrogate' measure of alcohol-related harm. The arguments will be illustrated with reference to Australia's National Alcohol Indicators Project and related research projects.

Alcohol-Related Disorders↗
PubMed1978

Occupation, education, and income as socioeconomic indicators in relation to cardiovascular risk factors in the urban African.

A yardstick is needed for measuring the medical consequences of socioeconomic change in developing countries. Education, income, and a newly developed occupation index were studied in urban African males in relation to six coronary artery disease risk factors. Occupation was the status indicator best known to a man's family, correlated best with the risk factors, and was not age dependent.

Adult↗
PubMed2004

[Validity and clinical applicability of the Japanese version of amyotrophic lateral sclerosis--assessment questionnaire 40 (ALSAQ-40)].

We studied validity and clinical applicability of the Japanese version of amyotrophic lateral sclerosis (ALS) assessment questionnaire 40 (ALSAQ-40). The original version contains forty questions measuring five areas (domains) of health status: Physical Mobility, ADL/Independence, Eating and Drinking, Communication and Emotional Functioning. Data were obtained from 39 ALS patients and from their physicians at 15 centers in Japan. Patients completed the ALSAQ-40 and the SF-36, and provided information on their age and their status of ventilator use. Their physicians provided information on the date of diagnosis, type of disease and clinical characteristics, and ALSFRS-R. The patients' average age was 58.5 years, and 64% were men. The mean duration since diagnosis was 39.1 months. Forty four percent were classical ALS patients and 46% were receiving a respiratory intervention. Although there was much heterogeneity, the scores for Physical Mobility and ADL/Independence were higher(indicating worse health status)than the scores for the other domains. Item-scale correlations were strong, except for the item "felt embarrassed in social situations" in the Emotional Functioning domain. All the domains had very high internal consistency: Cronbach's alphas ranged 0.95 to 0.97. With regard to the cluster structure of the forty items, the Eating and Drinking domain and the Communication clustered together. The reason might be that the former consisted of only three items and both domains measure bulbar symptoms. Domain scores correlated significantly with scores of related dimensions in the SF-36 and ALSFRS-R, and did not correlate strongly with unrelated domains. The five items of the ALSAQ-5 correlated with all five domain scores on the ALSAQ-40. These results should be interpreted with caution because we analyzed together data from ALS patients with various characteristics. In conclusion, although we may need to add and remove some items and modify the wording of others, the Japanese version of the ALSAQ-40 had high validity and is likely to be useful in evaluating of QOL in ALS patients. Whether the ALSAQ-5 can be used in place of the ALSAQ-40 is a matter for further study.

Activities of Daily Living↗