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PubMed1993

Early educational intervention for very low birth weight infants: results from the Infant Health and Development Program.

OBJECTIVE: To examine the effect of early educational intervention after discharge from the hospital on the health and developmental status of very low birth weight (< or = 1500 gm) infants. DESIGN: Randomized, controlled trial, with post hoc analysis. SETTING: Eight sites, heterogeneous for sociodemographic and health care use. PARTICIPANTS: Infants (N = 280) born weighing < or = 1500 gm and selected for the Infant Health and Development Program. Eligibility was limited primarily by geographic distance from the day care center. One third were randomly assigned to the intervention (INT) group and two thirds to follow-up only. INTERVENTIONS: All children received intensive pediatric and developmental surveillance. The INT group received home visits and center-based educational interventions until 36 months of age (corrected for gestational age when final assessments were completed). OUTCOMES: Cognitive development (Stanford-Binet Intelligence Scale), behavioral competence (Achebach Child Behavior Checklist), and health status (indexes summarizing reported morbidity, the Functional Status II (R) Scale, and General Health Ratings Index). RESULTS: Cognitive development scores were 7.2 points higher (p = 0.002) in the INT group, after adjustment for baseline differences in site, sociodemographic characteristics, and neonatal morbidity, and were 9.4 points higher (p < 0.0003) when the 29 children with significant cerebral palsy were removed. No differences in behavior, serious morbidity, functional status, or health rating were found overall. The infants in the INT group who weighted < or = 1000 gm at birth had significantly lower behavior problem scores but no differences on other outcomes. All children in the INT group had slightly higher rates of less serious morbidity. CONCLUSION: The advantage conferred by being in the INT group, as previously reported for heavier infants, extends to very low birth weight children, supporting the use of early intervention in this group.

Cerebral Palsy↗
PubMed2004

Re-scaling social preference data: implications for modelling.

As applied in cost-utility analysis, generic health status indexes require that full health and dead are valued as 1 and 0, respectively. When social preference weights for health states are obtained using a visual analogue scale (VAS), their raw scores often lie on a scale with different endpoints (such as "best" and "worst" health). Re-scaling individual raw scores to a 0-1 scale leads to the exclusion of respondents who fail to value dead or full health. This study examined alternative approaches that do not impose such strict exclusion criteria. The impact of a different timing of re-scaling (before or after aggregation) and a different measure of central tendency (median or mean) is measured. Data from a postal valuation survey (n=722) conducted in Belgium are used. The following models are considered: (a) re-scaling values for EQ-5D health states on a within-respondent basis and using mean re-scaled values as proxies for social preference values, (b) using median re-scaled values as proxies for social preference values, (c) computing the median raw VAS values and then re-scale, and (e) re-scaling mean raw VAS values. Exclusion rates, health state rankings and valuations and incremental value differences between pairs of states are computed for each model. Models that use a different timing of re-scaling, are compared ceteris paribus to evaluate the importance of timing of re-scaling and models that use a different measure of central tendency are compared ceteris paribus to evaluate the importance of the measure of central tendency. The exclusion rates are above 20% in the models that re-scale valuations before aggregation and less than 5% in the models that re-scale after aggregation. Health state valuations are found to be different in all two by two comparisons. Although in some comparisons the incremental values are statistically significantly different between models, they are never clinically significantly different. Differences in health state rankings were larger between the models that use a different measure of central tendency than between the models that re-scale at a different time. This study shows that, for the data sample used, the choice of the measure of central tendency is more important for the social health status preference values than the timing of re-scaling. Using median original valuations in the analysis of EQ-5D valuation data is theoretically appealing because it builds on the "median voter" model and has the advantage of a lower respondent exclusion rate. Further analysis, on other data samples, will have to confirm the current findings.

Adult↗
PubMed1976

Indexes of severity: underlying concepts.

Six severity indexes proposed in the health services research literature are shown to be special cases of a class of ordinal ranking functions called additive value functions. Deficiencies manifest in each of the severity indexes are discussed in relation to the properties that additive value functions must satisfy. In that severity indexes are a subset of health status indexes, the properties that imply and are implied by additive value formulations are relevant to the larger class of indexes as well.

Disability Evaluation↗
PubMed1976

Indicators of health status in adolescence.

The study reported here is based on data obtained in 1968-1970 from a representative community sample of urban black youths in the United States aged 12-17 years, inclusive. Analysis is directed at conceptual and methodological issues in measureing health status. It suggests the need for greater attention to subjective self-evaluated self-reported components of health status, specified here as "ontological" health. This is related to health and illness behavior generally, to utilization of health services more particularly. The case is made for a multiple-indicator approach to measuring health status as being more consistent with the multidimensional phenomenon to which it refers. The method used in this study for deriving a composite health status index from four component self-reported indicators is described. The distribution of the sample on this composite was used to identify self-reported health conditions that warrant attention from providers of adolescent health services. Since subjective evaluations influence experienced severity of health problems, the health status composite index was applied in this study as a means of discriminating differntial seriousness in self-reported health problems. Finally, some differences between indications of "ontological" health and "medical" health also are analyzed for commonalities and differences between them.

Adolescent↗
PubMed1989

The effects of verapamil and propranolol on quality of life in hypertension.

Quality of life was evaluated in a four-month randomised double-blind trial of verapamil compared with propranolol in the treatment of hypertension in 94 patients in the UK. Scores on a health status index, measuring activity and perceived health, increased in verapamil patients compared to a decrease in propranolol patients (P = 0.01). Measures of psychiatric morbidity also tended to improve with verapamil and deteriorate with propranolol. Propranolol patients reported more symptoms overall compared with verapamil (P less than 0.05). The prevalence of certain symptoms--headaches, weak limbs and slower walking pace, increased significantly with propranolol compared with verapamil, but constipation was more common in verapamil patients (P less than 0.05). After four months, diastolic blood pressure averaged 86.2 mmHg with verapamil and 90.3 mmHg with propranolol (P = 0.02). However, this difference in final blood pressure did not explain the more favourable quality of life scores with verapamil, and the data suggest that health-related well-being is higher with this drug.

Adult↗
PubMedDate not supplied

The social dimension of health status measures in rheumatoid arthritis.

Fifty-six patients with rheumatoid arthritis (RA) were assessed on two occasions three months apart. They completed two health status instruments--the Arthritis Impact Measurement Scales (AIMS) and the Nottingham Health Profile (NHP)--and the Beck Depression Inventory. In addition, clinical and serological data were gathered in order to calculate severity of disease according to the Mallya and Mace index. Health status instruments and the severity of disease index showed agreement in the assessment of mobility; similar agreement was found for different assessments of emotions. However, the two instruments provided social interaction scores with little agreement either cross-sectionally or in terms of change over time. It is argued that the generic NHP may be a valid instrument as an outcome measure in RA but the NHP and AIMS assess different aspects of social interaction. Care is needed in the selection of outcome measures to evaluate interventions.

Adult↗
PubMed1976

Comments on health indicators: methodological perspectives.

This paper discusses several basic conceptual and methodological problems in the development and use of health indicators. We observe that two tendencies of the health indicators movement may deter progress toward producing informations of health status indexes and the tendency to conceptualize "health" in terms of expansive definitions should measure variables specified by a social system model and should be scaled according to units that are relevant to decision-making criteria.

Decision Making↗
PubMed2006

A comparative study of oral health status in a migrant/Japanese sample.

OBJECTIVES: The aim of this study was to compare the oral health status of migrants to Japan with that of Japanese using the questionnaire and the Oral Health Status Index (OHSI). METHODS: The questionnaire for collecting demographic and behavioral variables and the OHSI were applied in a mixed migrant/Japanese sample of patients from a dental clinic in Yokohama. A sample of 224 subjects, 52% of whom were migrants, was selected from new patients. RESULTS: The mean OHSI scores were 78.56 for migrants and 83.16 for Japanese (p<0.01). Multiple regression analysis of OHSI showed that the statistically significant contributors were: age, status (migrants / Japanese), reason for initial visit, perceived oral health, and flossing behavior. CONCLUSION: The oral health status of migrants was worse than that of Japanese even though they were younger than Japanese. The present public support system for foreign patients and their self-care behavior were considered to be the factors for the inequity in oral health status.

Adolescent↗
PubMed1999

Prevalence of lower urinary tract symptoms and self-reported diagnosed 'benign prostatic hyperplasia', and their effect on quality of life in a community-based survey of men in the UK.

OBJECTIVES: To assess the prevalence of lower urinary tract symptoms (LUTS) in a community-based population in the UK, to measure the impact of these symptoms on quality of life and health status in men with self-reported 'benign prostatic hyperplasia' ('BPH'), and to evaluate health-seeking behaviour in this population. SUBJECTS AND METHODS: A postal survey was distributed to an age-stratified random sample of 1500 men aged 50 years or older from throughout England, Scotland and Wales. The self-administered survey included: demographic questions; the EuroQoL (EQ-5D) instrument, consisting of a health-status index questionnaire and a visual analogue scale (VAS) on which participants rated their current health status; the International Prostate Symptom Score (IPSS) questionnaire; and a questionnaire assessing the participants' health-seeking behaviour and awareness of BPH. RESULTS: Responses to the survey were received from 1115 (74%) of the 1500 men. Overall, 41% (450/ 088) had an IPSS of > or =8, indicating moderate-to-severe LUTS, yet only 196 men (18%) reported that they had been diagnosed with 'BPH'. Both quality of life (as measured by the EQ-5D) and general health status (as measured by the VAS) decreased as urinary symptom severity increased, and the greater the severity, the more men who reported a problem with mobility, self-care, usual activity, pain/discomfort, and anxiety/depression (the five domains of the EQ-5D). The possibility of symptoms worsening appeared to be the key determinant in the respondents' decisions to consult a medical professional for their LUTS. Less than 11% of the respondents were aware of the availability of specific prescription drug therapies or surgical options for the treatment of 'BPH'. The most common first treatment strategy for those consulting for symptoms was watchful waiting (34%), followed by surgery (30%) and prescription drugs (21%). CONCLUSIONS: Moderate-to-severe LUTS were relatively common in this UK population of men over the age of 50, yet relatively few had been diagnosed with 'BPH'. As LUTS adversely affect quality of life, improved treatment options and increased public awareness of BPH and LUTS are needed to combat a problem facing the growing number of elderly men in the population.

Aged↗
PubMed1998

Quality of life in chronic heart failure: cilazapril and captopril versus placebo. Cilazapril-Captopril Multicentre Group.

OBJECTIVE: To measure quality of life (QOL) in patients with mild to moderate heart failure treated with angiotensin converting enzyme (ACE) inhibitors cilazapril or captopril. DESIGN: Randomised, double blind, placebo controlled, parallel groups trial. SUBJECTS: 367 patients with New York Heart Association (NYHA) heart failure class II (62%), III (36%) or IV (1%). METHODS: Patients were randomised to receive cilazapril 1 mg daily (n = 191) or captopril 25 mg three times daily (n = 90) for 24 weeks, or placebo for 12 weeks followed by cilazapril 1 mg daily for a further 12 weeks (n = 86). If patients had not responded after four weeks cilazapril was increased to 2.5 mg daily and captopril to 50 mg three times daily. QOL was assessed at baseline, 12, and 24 weeks using the sickness impact profile (SIP), the profile of mood states (POMS), the Mahler index of dyspnoea-fatigue, and a health status index (HSI). RESULTS: The physical dimension of the SIP averaged 7 units at baseline and improved after 12 weeks by 2.24 units in the cilazapril group, 2.38 units in the captopril group, and 1.51 units in the placebo group. The difference between drug and placebo was therefore 0.73 units (95% CI -0.86 to 2.32) for cilazapril, and 0.87 units (95% CI -0.96 to 2.70) for captopril, with small non-significant effect sizes (a statistical method for estimating the importance of a treatment related change) of 0.12 and 0.14. Similar results were observed for the total POMS and HSI scores. Although QOL improved more on the ACE inhibitors than on placebo, the effect sizes were not significant (< or = 0.26). CONCLUSIONS: Improvements in QOL in mild to moderate heart failure were small when treated with cilazapril or captopril compared with placebo.

Adult↗
PubMed1994

Assessment of health status in survivors of cancer.

The health status of 48 survivors of cancer was assessed using a rating system for six attributes: senses, mobility, emotion, cognition, self care, and pain. Paired assessments were made by doctors and patients (or their parents, or both) at routine clinic attendances. Sixteen (33%) assessments by the patient/parent and 19 (40%) assessments by the doctor identified no deficits in health status. The doctors identified fewer deficits in all attributes than the patients/parents, the differences being most marked for subjective attributes. Health status index scores on a scale of 0 (worst health state) to 1 (perfect health) were derived from the rating system and showed good overall agreement between the doctors and the patients/parents. Survivors of neuroaxial tumours tended to have lower scores than other diagnostic groups. This simple, compact system could be used in clinical trials to compare treatment strategies in terms of the health status of survivors. It could also be a valuable tool in the assessment of health status in other areas of paediatrics.

Activities of Daily Living↗
PubMed1990

Black health care in America: a political perspective.

Despite recent improvements in the health status of blacks, significant disparities continue to exist between blacks and whites in nearly every health status index. Contributing to these disparities are biases in the health system; economic bias being the most significant. This article assesses the competitive market strategy, the most recent federal initiative to promote equity in the access to health services in terms of the consequences for black health. Several policy actions are recommended to improve the health status of the black population.

Adolescent↗
PubMed1984

Describing health states. Methodologic issues in obtaining values for health states.

In health status index construction quantitative values for different states of health are frequently obtained by presenting written descriptions to raters whose values are elicited using one or more methods. In this study the authors examined the influence of several aspects of this measurement process upon the quantitative results obtained. They prepared a set of written descriptions of health states, each state being described in both a standard point-form and a narrative format. The narrative format was written in the first person singular, and listed all symptoms or problems associated with the state, whereas the point-form description included only the most severe symptom or problem. Values for these states were elicited from a group of 64 patients using two commonly employed methods, the standard gamble of Von Neumann and Morgenstern and category rating. The results indicate that the type of scenario presented to the rater and the sequence in which the methods of assessment were used had a major influence on the results. This work indicates that there is a need to examine systematically the process of obtaining quantitative values before reliance can be placed upon the results.

Adult↗
PubMed2001

Health status and healthy life measures for population health need assessment: modelling variability and uncertainty.

It is increasingly recognised that population health need assessments based on the comparison of clinical or demographic end points (e.g. area mortality rates) neglect population variation in broader aspects of health status and health-related quality of life. Similarly, outcome measures which neglect impacts on health-related quality of life may be an inadequate basis for assessing the effectiveness of health interventions. This paper reviews issues in assessing needs and outcomes at population level based on health status valuations. It considers especially the modelling of sources of uncertainty in measures of health status by using Bayesian sampling estimation methods which produce a distribution of summary outcome measures. The modelling issues are illustrated in models for individual level health status from survey responses and their incorporation in area life tables to derive total and healthy life expectancies. In particular, a health status index derived from Short Form 36 profile responses in a health and lifestyle survey in a London health authority provides a case study of community health needs assessment.

Adolescent↗
PubMed2003

A single European currency for EQ-5D health states. Results from a six-country study.

The EQ-5D questionnaire is a widely used generic instrument for describing and valuing health that was developed by the EuroQol Group. A primary objective of the EuroQol Group is the investigation of values for health states in the general population in different countries. As part of the EuroQol enterprise 11 population surveys were carried out in six Western European countries (Finland, Germany, The Netherlands, Spain, Sweden and the UK) to value health states as defined by the EQ-5D using a standardised visual analogue scale (EQ-5D VAS). This contribution reports how a European set of general population preference weights was derived from the data collected in the 11 valuation studies. The scores from this set of preference weights can be applied to generate a VAS-based weighted health status index for all the potential 243 EQ-5D health states for use in multi-national studies. To estimate the preference weights a multi-level regression analysis was performed on 82,910 valuations of 44 EQ-5D health states elicited from 6,870 respondents. Stable and plausible solutions were found for the model parameters. The R(2) value was 75%. The analysis showed that the major source of variance, apart from 'random error', was variance between individuals (28.3% of the total residual variance). These results suggest that VAS values for EQ-5D health states in six Western European countries can be described by a common model.

Journal Article↗
PubMed1999

Self-reported health status of low-income mothers.

PURPOSE: To determine the self-reported health status of low-income mothers before major health and welfare policy reform in the state of Ohio, to compare the health status of this group with the general population age-based norms, and to examine differences in health status among insurance and racial subgroups. Policy makers and others have a need for key health-status information about low-income mothers, a topic for which little empirical data currently exist. DESIGN: Descriptive using a cross-sectional survey with convenience sampling; 502 women were interviewed at intake sites in four countries in central Ohio, 1995 to 1996. METHODS: Health status was measured using the general health status index developed by J. E. Ware and colleagues (1995). Two summary measures, one indicating physical health and one indicating mental health, were used and compared with published norms. Multivariate logistic models were examined for depression and physical health status. FINDINGS: A significant level of depression in the population of low-income mothers was found as were differences in physical health scores by insurance group. People insured privately had the highest physical health scores, while those enrolled in fee-for-service Medicaid had scores indicating the poorest health. No significant difference was found between racial groups in self-reported health status. CONCLUSIONS: Self-reported mental health status is low among some low-income female populations. Physical health is worse for the Medicaid-enrolled group compared to both uninsured and privately insured groups. This poor state of health will likely diminish the success of welfare reform to improve the economic self-sufficiency of these women unless comprehensive health services are available.

Adult↗