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PubMed2004

[Cribra orbitalia, dentin hypoplasia and life expectancy of 20-year-old persons as social and sex specific stress indicators in correlation with the health status of an early medieval population].

The aim of this study is based on the analysis of diachronically social and sexual specific considerations on the life situation of the early medieval population of Schleitheim, Kanton Schaffhausen, Switzerland. Cribra orbitalia and the linear enamel hypoplasia of the teeth are considered as stressors. This study is based on the life expectancy of the 20 years old, as the life expectancy gives information on the health condition of a social group or an entire population. The considered indicators show the same tendencies in three of the four social groups (women social group A and group B/C, men of the social group A). The female and male population of the social group A show a steady decrease in the indicator from the 5th century to come to its lowest level in the 7th century. The same parameters indicate a continuous increase in stress for the female population of the group B/C. Only one of the three indicators, the Cribra orbitalia, shows a positive tendency in the male population of the social group B/C from the 6th century to the following period, while hypoplasia and the life expectancy on the other hand indicate a negative tendency. The results show equal tendencies in the three independent indicators concerning three of the four social groups. This proves the high reliability of the indicators. These results are astonishing in two ways. First of all, the tendencies show that the originally better life situation of women of the higher ranking social group decreases in the following periods, whereas the women of the lower social group show an inverse development. This female population of low life situation in the 5th century shows an increase in life qualities in the following periods. Remarkable, too, is the fact, that the female population of both social groups shows a lower level of stress than the corresponding male population. This fact is astonishing, as we would expect inverse results in a patriarchal society. This may point to a well known fact: Women show a higher vitality than the male population.

Adult↗
PubMed2001

The effects of a collaborative model of primary care on the mortality and hospital use of community-dwelling older adults.

BACKGROUND: This study evaluates the ability of a model of collaborative primary care practice to reduce mortality and hospital use in community-dwelling elderly persons. METHODS: Four rural and four urban clinic sites in east central Illinois were randomized to form treatment and comparison clinics from which patients were enrolled and followed prospectively for 2 years. Patients from the practices of participating physicians were eligible if they were aged 65 and older, were living in the community, and had at least one risk factor as determined prior to the study. Medicare hospital data were obtained from the Health Care Financing Administration. Demographic and health status measures were obtained by telephone interview every 12 months throughout the study. RESULTS: The treatment group experienced a 49% reduction in all-cause mortality during the second year of the study (odds ratio, 0.51, 95% confidence interval, 0.29-0.91, p = .02). There were no significant differences between treatment and comparison patients in percentage of persons hospitalized, hospital length of stay, or Medicare payments. Although measures of health status indicated that the treatment group was significantly sicker at baseline at the end of 1 year, these differences disappeared by the end of 2 years. CONCLUSIONS: The collaborative primary care model evaluated in this study significantly reduced mortality in the second year, without increasing hospital use. These findings suggest that a collaborative primary care team that enhances primary care practice can result in better patient outcomes.

Aged↗
PubMed1997

Health status during the transition in Central and Eastern Europe: development in reverse?

This paper reports on a study of the cross-national trends in health status during the economic transition and associated health sector reforms in Central and Eastern Europe (CEE). The central premise is that before long-run gains in health status are realized, the transition towards a market economy and adoption of democratic forms of government should lead to short-run deterioration as a result of: (i) reduction in real income and widening income disparities; (ii) stress and stress-related behaviour; (iii) lax regulation of environmental and occupational risks; and (iv) breakdown in basic health services. Analysis focused on three broad indicators of health status: life expectancy at birth, infant mortality rate and the probability of dying between the ages of 15 and 65 years, shown by the notation '50q15'. The study revealed significant new information about health status and the health sector which could not have been obtained without a proper cross-national study. Infant mortality rates in former socialist economies (FSE) follow the global trend, declining as per capita income rises. However, rates are lower than would be predicted given their income levels. Despite declining infant mortality, life expectancy at birth in the former socialist economies decreases as per capita income rises, in marked contrast to global trends. This is because rising income level is associated with greater probability of death between the ages of 15 and 65: the wealthier the society, the less healthy is its population, particularly for its males. Causes of death in the FSE follow global trends: higher death rates due to infectious and parasitic diseases in poorer countries, and higher death rates due to chronic diseases in wealthier countries. However, age-standardized death rates for chronic diseases generally associated with unhealthy lifestyles and environmental risk factors are very high when compared with wealthier established market economies (EME). Policies and procedures which alter the effectiveness of health services have had a demonstrable but mixed impact on health status during the early phase of transition. Effective preventive health strategies must be formulated and implemented to reverse the adverse trends observed in Central and Eastern Europe.

Adolescent↗
PubMed1991

Health care in crisis: understanding nursing turnover in northern Canada (1).

For decades nurses have provided 24 hour comprehensive health care in isolated communities of Canada. As the only health care personnel in most communities of the north, nurses must meet all health care needs ranging from veterinary assistance to health education, emergency care to mental health counselling. This paper will focus on the structural and psychosocial factors affecting isolated post workers. Considering the intense nature of professional responsibility in these isolated settings, it is not surprising that there is frequent turnover of nurses. The constant change in staff results in poor community and staff morale, limited success of programs and increased expenditures for government due to the high costs of additional relief staff, travel, and orientation. Utilizing a mailed survey (N = 55) and on-site interviews (N = 17) collected in two regions of northern Canada, this paper will outline key issues which produce nursing dissatisfaction and ultimately decrease the effectiveness of health care programs. The paper will conclude with suggestions to increase nursing satisfaction and ultimately improve the provision of health care in northern areas. Native health care is in crisis. Health status indicators such as infant mortality and life expectancy lag far behind national statistics. Death due to accidents and violence are almost six times the Canadian rate. Incidence of suicide is three times the national statistics (1-6). The rate of nursing staff turnover in northern communities is high, and most nurses stay less than 2 years in the north (7,8). Native health demands are increasing and it is becoming more difficult for find nurses to provide health care service.(ABSTRACT TRUNCATED AT 250 WORDS)

Arctic Regions↗
PubMed1983

Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living.

The aging of the population of the United States and a concern for the well-being of older people have hastened the emergence of measures of functional health. Among these, measures of basic activities of daily living, mobility, and instrumental activities of daily living have been particularly useful and are now widely available. Many are defined in similar terms and are built into available comprehensive instruments. Although studies of reliability and validity continue to be needed, especially of predictive validity, there is documented evidence that these measures of self-maintaining function can be reliably used in clinical evaluations as well as in program evaluations and in planning. Current scientific evidence indicates that evaluation by these measures helps to identify problems that require treatment or care. Such evaluation also produces useful information about prognosis and is important in monitoring the health and illness of elderly people.

Activities of Daily Living↗
PubMed1991

[Indicators of the complex evaluation of health status of the rural population of the Novgorod district].

General morbidity rate (according to the number of visits to medical institutions) among urban population of Novgorod Region constituted 1092.7 visits per 1,000 population including 968.2 ambulatory visits (per 1,000 population) and 124.5 visits to in-patient facilities (for diseases unknown to ambulatory and out-patient institutions during one year period). Among hospital diagnoses of which ambulatory network of institutions had no information 36.8 percent accounted for chronic diseases. As the result of medical examinations conducted additionally 2585.4 chronic diseases and conditions (for which nobody sought care during a year) were identified (per each 1,000 persons examined). Out of these diseases 1438.2 cases or 55.6 percent were identified by experts as requiring either treatment or follow-up (per 1,000 examined). Actual morbidity of urban population constituted 2530.9%. The data of complex evaluations of urban population health indicate that healthy and practically healthy people (those having risk factors) constitute 24.0%, sick--76.0%. Among children the proportion of healthy and practically healthy constituted 70.8%, sick--29.2%. With age the ratio is changing towards reducing the proportion of the healthy and increasing the proportion of the sick. The data obtained were used by us for determining the norms of population requirements in all kinds of medical care, formulating complex and target programmes of regional public health development for the future.

Adolescent↗
PubMed2005

[Sport and health among adults in Germany].

Regularly participating in sports activities can have a positive effect on people's health and is therefore an important area of health promotion. Data of the Telephone Health Survey 2003 indicate that until now there is an unexploited potential for programmes promoting sports: in total 37.3% of men aged 18 years and above and 38.4% of equally aged women do not participate in sports at all; another 20.9% of men and 28.4% of women only engage in sports activities for up to 2 h/week. The highest prevalence of sports activity is seen among young adults, whereas it is lowest among older people. However, the latter slightly increased their sports activity during the last 10 years, while the trend observed among younger adults seems to point rather in the opposite direction. Also relevant for the planning and implementation of group-specific interventions is the observation that persons with low socioeconomic status tend to engage less often in sports than people with middle or high status do. The present study underlines the health relevance of sports participation by presenting inverse relationships between sports activity and behaviour-related health risks such as smoking and obesity as well as a positive effect of sports on self-assessed health.

Adult↗
PubMed1982

Unemployment and health in macro-social analysis.

The hypothesis that unemployment is related to bad health arises from a general acceptance of the relationship between living standards and longevity. To confirm the hypothesis three analytical statements have to be true: (a) an increase of prosperity leads to a decrease of mortality; (b) a decrease of prosperity leads to an increase of mortality; (c) people with the relatively lowest prosperity, in this case the unemployed, have the relatively highest mortality and so are the least healthy. For this purpose important types of macro-social research are described and the results are interpreted, briefly evaluated and discussed. Research comparing differences in life-expectancy in rich and poor countries, shows rough differences; Research applying a new method, diffusionalist comparison, shows that increased prosperity does not infinitely lead to improvement of life expectancy; Research on economic fluctuations and mortality is the only type of research attempting to describe a process, not a state of affairs; Research on socio-economic categories within countries (classes, neighborhoods) shows differences in mortality and morbidity, but not why these differences exist; Research on the relationship between a population's body height (as a health indicator) and poverty/unemployment gives rise to more differentiated conclusions, but neither provides final answers; Some small retrospective researches with divergent methodologies and using small hospital samples give different results.

Adult↗
PubMed2000

Functional limitations and key indicators of well-being in children with disability.

OBJECTIVES: To compare measures of well-being in children with and without different types and severity of limitations. DESIGN: Nationally representative data for American children aged 5 to 17 years were drawn from the 1994 and 1995 National Health Interview Surveys on Disability (NHIS-D) (N = 41,300) and the Year 2000 Health Supplement to the 1994 NHIS-D (N = 9530). Family resources, safety, health status, and health access were measures of environment. The presence and severity of limitations were measured in the domains of mobility, self-care, communication, and learning. RESULTS: Children with functional limitations were more likely to live in families with limited resources and have greater exposure to secondhand smoke, less access to health care, and lower health status. Children with a limitation were not less likely to have a regular source of medical care, but they more often were delayed or prevented from getting necessary health care due to cost or insurance. CONCLUSIONS: Standard measures of child well-being were appropriate for children with functional limitations and showed their unfavorable situations. Children with functional limitations more often have unfavorable family resources, less healthy home environments, poorer health status, and less health service access than other children, making them more susceptible to developmental difficulties beyond those difficulties associated with the challenges of their specific functional limitations.

Activities of Daily Living↗
PubMed1999

The association of the SF-36 health status survey with 1-year socioeconomic outcomes in a chronically disabled spinal disorder population.

STUDY DESIGN: The Short Form Health Survey (SF-36) was administered to patients with chronic spinal disorders both before and after tertiary rehabilitation. The association of the SF-36 with various socioeconomic outcomes was then examined. OBJECTIVES: To assess the correlation of scores on SF-36 with treatment program completion and clinically meaningful 1-year socioeconomic outcomes. SUMMARY OF BACKGROUND DATA: There has been much interest in identifying variables that can predict which disabled workers with chronic spinal disorders will have good versus poor socioeconomic outcomes after tertiary rehabilitation. Results of previous research have indicated that psychosocial factors are better predictors of such outcomes than physical factors. A more recent trend in research is assessing health-related quality of life from the health care recipient's perspective. METHODS: The SF-36 was administered to a cohort (n = 146) of patients chronically disabled by spinal disorders before entry into a tertiary functional restoration program. Of this cohort, preprogram SF-36 scores and 1-year socioeconomic data were available for 128 program completers and 18 program noncompleters. The pre- and postprogram SF-36 scores of program completers for each of the outcome variables were compared. RESULTS: Better scores on the preprogram SF-36 Social Functioning and Bodily Pain scales were found to be associated with successful completion of the treatment program. Postprogram SF-36 scores were more frequently associated with outcomes than were preprogram scores. Most SF-36 scores, especially the physical domain scales, were associated with the variables of return to work, work retention, and use of health care resources. The overwhelming majority of significant associations were between higher (i.e., better) SF-36 scores and "good" treatment outcomes (e.g., return-to-work). CONCLUSIONS: The large number of associations between SF-36 scores and outcome variables highlights the importance of assessing the health-related quality of life of patients, and supports the use of the SF-36 in accomplishing this task. Among the findings, perhaps the most significant was the value of assessing health-related quality of life, particularly the subjective physical components, after completion of a functional restoration program. Prediction of long-term socioeconomic outcomes is likely to be improved if assessment is conducted at the end of the treatment process. SF-36 is recommended for assessing general health status, and more spine-specific measures are recommended for assessing spinal pain and disability variables.

Adult↗
PubMed1999

Light on population health status.

A new approach to illustrating and analysing health status is presented which allows comparisons of various aspects of health in a population at different times and in different populations during given periods. Both quantitative and qualitative elements can be represented, the impact of interventions can be monitored, and the extent to which objectives are achieved can be assessed. The practical application of the approach is demonstrated with reference to the health profiles to Tunisia in 1966 and 1994.

Adult↗
PubMed2004

[Health status and socioeconomic factors related to home remedy practices among elderly subjects living in a community in Okinawa].

OBJECTIVE: The purpose of the present study was to clarify health status and socioeconomic characteristics of elderly persons who practice home remedies as complementary alternative medicine. Whether such usage is associated with health-related factors was also assessed. METHODS: The subjects are 243 independent elderly living at home in A-village of Okinawa prefecture, aged 65 years or older. A self-administered questionnaire was mailed to all subjects in 2001. Included were questions on socioeconomic indicators, health status, IADL, health habits, social network, social support and home remedy practices. All data were statistically analyzed by Student's t test and the chi-square test. In addition logistic regression was used to calculate the odds ratios for current practitioners for each of the factors. RESULTS: The present study included 200 subjects who responded and completed all questions. (Table 2). The main results are as follows: The practitioner rate for home remedies was 50.8% in males and 71.9% in females, the difference being significant (P<0.05). Usage was found to be significantly related to hypertension (P<0.05), arthritis and rheumatic disease (P<0.01), some health habits and provision nursing of social support (OR = P<0.05). Logistic regression analysis adjusted for age, gender, and income revealed current practitioners of acupuncture to have a significantly higher level of history of hospital admission in the previous year (OR = 0.2 P<0.05), food control habits (OR = 4.3 P<0.05) and provision nursing of social support (OR = 4.2 P<0.05) than non-current practitioners. CONCLUSION: The findings of this study suggest that home remedy practices are associated with health-related habit and provision of social support for good quality of elderly life. The purpose is not only physical care but also health maintenance and promotion.

Aged↗
PubMed1997

Health-related quality of life after elective surgery: measurement of longitudinal changes.

OBJECTIVE: To examine the responsiveness of the 36-Item Short Form Health Survey (SF-36) to clinical changes in three surgical groups and to study how health-related quality of life (HRQL) changes with time among patients who undergo total hip arthroplasty, thoracic surgery for treatment of non-small-cell lung cancer, or abdominal aortic aneurysm (AAA) repair. DESIGN: Prospective cohort study with serial evaluations of HRQL preoperatively and at 1, 6, and 12 months after surgery. SETTING: University tertiary care hospital. PATIENTS: Of 528 patients, more than 50 years of age, who were admitted for these elective procedures, 454 (86%) provided preoperative health status data and are members of the study cohort. At 12 months after surgery, 439 (93%) of the cohort was successfully contacted and 390 (90%) provided follow-up interviews. MEASUREMENTS AND MAIN RESULTS: The Medical Outcomes Study SF-36, the Specific Activity Scale, five validated health transition questions, and a 0 to 100 scale measure of global health were used to assess changes in health status at 1, 6, and 12 months after surgery. Change in health status as measured by the SF-36 demonstrated that physical function and role limitations due to physical health problems were worse 1 month after these three surgeries. However, by 6 months after surgery, most patients experienced significant gains in the majority of the dimensions of health, and these gains were sustained at 12 months after surgery. Longitudinal changes in the SF-36 were positively associated with responses to the five health transition questions, to changes on the Specific Activity Scale and global health rating question, and to clinical parameters for persons who had AAA repair. These findings indicate that the SF-36 has evidence of validity and is responsive to expected changes in HRQL after elective surgery for these procedures. CONCLUSIONS: For the total hip arthroplasty patients, responsiveness was greatest for the SF-36 scales that measure physical constructs. However, for the two other procedures and at various points of recovery, significant changes were observed for all eight subscales, suggesting that responsiveness was dependent on the type of surgery and the timing of follow-up, and that multidimensional measures are needed to fully capture changes in HRQL after surgery.

Aged↗
PubMed1982

On the measurement of happiness. An examination of the Bradburn scale in the Canada Health Survey.

Certain characteristics of the Bradburn scale of psychologic well-being which have been criticized in recent discussions are re-examined using data from the 1978-1979 national Canada Health Survey. This large data set (N = 17,279) enabled the authors to examine the questions in a representative sample of the noninstitutionalized population. Reference standards are derived showing response frequencies by age and sex. In addition, the validity of the theoretic foundation of the scale is examined. The conclusions suggest that the items measure two dimensions of affect and are applicable in at least two different cultural groups. However, under certain circumstances the affect balance score does not provide the most adequate summary of the data, and the notion of independence between positive and negative affect does not hold for all of the questions. The authors conclude that two of the questions in particular appear weak, but that the design of the scale as a whole shows advantages over alternative instruments as an indicator of emotional well-being in general population surveys. They advocate that the scale continue to be used until a more adequate set of questions can be developed.

Adolescent↗
PubMed1996

[A disease substitution index: construction and validation].

Empirical research dealing with health and illness often has the problem that the data sets contain a variety of health related variables but no variables abou the appearance of diseases and complaints. In order to solve this problem a disease substitution index (DSI) based on data of the German Socio-Economic Panel (GSOEP, 1985) and the national health survey conducted in the framework of the German Cardiovascular Prevention Study (GCP, 1984-1986) was constructed. Consisting of the variables "medical attendance", "hospital attendance" "existence of chronical diseases" the DSI shows statistically significant association with a series of diseases and complaints. These findings indicate that the DSI can be used to substitute diseases and/or complaints in datasets with the mentioned variables but no informations about diseases or complaints.

Adult↗
PubMed1995

Living with an impaired elderly person: the informal caregiver's physical and mental health.

Although it is acknowledged that providing an elderly relative with informal assistance can be stressful and burdensome, previous research does not provide clear evidence of the impact of informal caregiving on the physical and mental health of caregivers. The objective of this research was to compare health indicators of coresidents of elderly people who have physical or cognitive impairments with those of two comparison groups: individuals living with a nonimpaired person aged 55 or over and individuals who were not living with a person of that age. Samples were drawn from the Qu/ebec Health Survey database. Although very few differences in physical health were observed between coresidents (n = 292) and individuals in the comparison groups, coresidents systematically presented poorer psychological health indicators. This result supports previous findings related to the low level of psychological well-being of informal caregivers. This suggests that informal caregivers should be regarded as a target population for which health and social services should be carefully planned.

Caregivers↗
PubMed2004

A comparison of the grade of membership measure with alternative health indicators in explaining costs for older people.

An important focus in empirical econometric studies of health care concerns estimation of the relationship with health. This paper describes a non-parametric technique, the grade of membership (GoM) procedure, which is used to construct summary indicators of health. Health status is also assessed using three alternative measures commonly employed in the literature: an index of problems of activities of daily living (ADL), an index of health conditions and overall self-rated health. Using data from a sample of frail older people, the relationship between costs and different measures of health are estimated using ordinary least squares (OLS) and instrumental variables (IV) methods. The results show that health influences costs more strongly than other variables, an effect which persists after controlling for potential endogeneity. It is shown that health can be usefully classified using GoM techniques. An alternative measure, based on an index of ADL, also performs well. Measures based on overall self-assessed health and the number of health conditions present were less satisfactory. Although health indicators derived from GoM techniques may be more theoretically attractive, in terms of capturing more fully the multidimensional nature of health, simpler alternatives such as those based on ADL indices may offer practical computational advantages.

Activities of Daily Living↗
PubMedDate not supplied

Trends in self-rated health in Finland 1972-1992.

BACKGROUND: Self-rated health is a useful indicator of the population's health. Yet follow-up studies on perceived health trends are scarce. The aim of this paper is to assess perceived health trends in Finland between 1972 and 1992. METHODS: Five cross-sectional studies were done in two areas in eastern Finland every 5th year since 1972 and in a third area in southwestern Finland since 1982. The total number of respondents was 33,962. The respondents filled in a questionnaire, followed by a health examination. The subjects were categorized by age, education, and household income. RESULTS: In 1972, one-third of the population reported good health, whereas in 1992 the rates were 50 and 60% for men and women, respectively. Younger persons reported better general health than older persons. High education and high household income were undisputed indicators of good health. Among men, their importance as predictors of good health diminished during the 20 years. CONCLUSIONS: Finnish people today not only live longer but also feel healthier. In order to achieve good health for all population groups we need continual efforts to diminish the socioeconomic disparities.

Adult↗