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PubMed1985

Inequalities in health in the city of Bristol: a preliminary review of statistical evidence.

This article compares statistical indicators of health with those of material and social deprivation for 28 wards of the city of Bristol, England. Four general indicators of health were examined-a combined rate per 1,000 live births of stillbirths and infant deaths; deaths of persons aged 15 to 64 per 1,000 of that age; deaths of persons aged 65 and over per 10,000 of that age, and numbers of babies born after 40 weeks gestation weighing less than 2,800 (and 2,500) grams per 1,000 births having that period of gestation. Measures of average and cumulative rank were used to augment tests of the significance of correlations between different indicators. The degree of rank consistency was high, and several wards at the top and the bottom of the rankings were clearly distinct on all indicators. Five indicators of deprivation were also examined-the percentages of: 1) households with fewer rooms than persons; 2) households lacking a car; 3) economically active persons seeking work; 4) children aged 5 to 15 who receive school meals free; and 5) households experiencing disconnection of electricity in the previous 12 months. Again the consistency of ranking according to the five indicators was high, with marked differences on all five indicators between the highest and lowest ranking wards. Between 1971 and 1981 some forms of deprivation increased in nearly all wards. According to some criteria, deprivation increased more in wards already most deprived in 1971 than in those least deprived. Finally, a strong association between the two sets of indicators was found. On the data available to health and planning authorities poor health is significantly correlated with deprivation. There are therefore implications for new forms of joint policy-making on the part of different departments of local and central government.

Adolescent↗
PubMed1981

Absence of indicators of the influence of its physicians on a society's health; impact of physician care on society.

There are no established indicators for measuring the influence of its private physicians on a society's health. For a brief period the age-adjusted death rate, an important indicator of the public health effort, also served to reflect a portion of the influence of the personal physician system. Particular medical interventions could be linked to specific sites in the pathogenesis of microbial disease in a way not yet permitted by the available knowledge of the common nonmicrobial diseases. Our national allocations for health cannot be made rationally until we develop indicators for measuring incremental investments in either system, but especially for the personal physician system. For death rates per se fail to accurately reflect the workings of this system which is concerned primarily with prolonging effective life by preserving or restoring function in an individual person.

Age Factors↗
PubMed1988

The Nottingham Health Profile: an analysis of its sensitivity in differentiating illness groups.

A recent criticism of the Nottingham Health Profile (NHP) claimed it was an insensitive instrument for use in population surveys, because its modal response was zero, and domains measured by the instrument are insufficiently distinct. It is argued here that the NHP was designed specifically to uncover the chronically ill in populations and, further, research undertaken here indicates that the instrument is sufficiently sensitive to be successful in permitting variations within and between illness groups to be determined. However, the domains of mobility and pain, as measured by the instrument, are found to be confounded.

Adult↗
PubMed2001

The widening social class gap of preventive health behaviours in Spain.

As a way of forecasting future evolution of inequalities in disease burden and mortality, trends in preventive health behaviours by social class were examined. Using the Spanish National Health Survey from 1987 to 1997 the evolution of the Health Practices Index (smoking, alcohol consumption, physical exercise, sleep hours and the Quetelet index) is described for the Spanish non-institutionalised adult population. In the last 10 years the disadvantaged population of Spain (social class groups IV and V) has not opted for healthier behavioural choices. On the contrary the Health Practices Index figures have worsened during the study period. Conversely, the more affluent groups (social class groups I, II and III) have exhibited a net gain in the index. Due to this, an increase in the existing gap in health inequalities in Spain in terms of morbidity and mortality can be forecast for the near future. As time trends of a summary indicator of preventive health behaviours by social class have not been described in other countries, a replication of this study in different cultural, social and economic milieus could produce valuable information.

Adult↗
PubMed1999

Weight loss and mortality among free-living frail elders: a prospective study.

BACKGROUND: Numerous studies of the elderly population have indicated that body weight and weight changes are related to mortality, but the one group at particularly high risk of nutritional inadequacies--frail elders receiving home help services--has not been studied. METHODS: A prospective cohort of 288 frail elders (81 men; 207 women; mean age: 78.2 +/- 7.6 yrs) receiving home support services was followed for 3-5 years. Nutritional variables included baseline body mass index (BMI), weight loss prior to baseline, and energy and protein intake. Covariates included age, gender, smoking, and health and functional status. Cox's multivariate survival analysis was used to identify independent predictors of mortality. RESULTS: There were 102 deaths (35.4%) over the follow-up period. Univariate predictors included age, sex, BMI, weight loss, and functional status. In multivariate analysis, weight loss at baseline was a significant predictor of mortality, RR = 1.76 (95% CI: 1.15-2.71), as was male gender, RR = 2.71 (95% CI: 1.73-4.24), and age at baseline, RR = 1.40 (95% CI: 1.06-1.86). CONCLUSION: Among free-living frail elders, weight loss is a predictor of early mortality after controlling for smoking, and functional and health status indicators. From our observations, however, we cannot conclude that prevention of weight loss would lead to increased survival. This needs to be explored in an intervention study.

Aged↗
PubMed2001

An assessment of the construct validity of the SF-12 summary scores across ethnic groups.

BACKGROUND: The aim of the study was to determine the construct validity of the 12-item Short Form health survey questionnaire (SF-12) across ethnic groups in a large community sample of the United Kingdom. METHODS: A postal survey was carried out in English using a questionnaire booklet, containing the SF-12 and a number of other items relating to experiences of chronic illness and utilization of health care services. The dataset was the National Survey of NHS Patients. The sample consisted of 1000 residents within each Health Authority in England who were randomly selected from the electoral registers, giving an initial sample of 100000. RESULTS: A total of 61 426 (61.4 per cent) questionnaires were returned; 94.3 per cent of respondents classified themselves as white and 5.7 per cent classified themselves as members of other ethnic groups. Construct validity of the SF-12 was assessed by comparing results from the two summary scores (the Mental Health Component Summary (MCS) score and the Physical Health Component Summary (PCS) score) with overall self-assessed health and limiting longstanding illness. Although there were generally consistent patterns of association between overall self-assessed health or limiting longstanding illness and the MCS and PCS scores in all the ethnic groups, there were significant differences between the MCS and PCS scores of Indians, Pakistanis and Bangladeshis who understood English fluently and those who did not. Furthermore, there were differences in the completion rates of the SF-12 between ethnic groups and a reversal of the general pattern of increasing MCS scores with increasing age in Bangladeshis. CONCLUSION: The results indicate that the use of the SF-12 to measure the health of ethnic minorities seems acceptable in most instances, but may prove problematic in those instances where respondents complete the questionnaire via an untrained translator, such as a friend or family member. The systematic differences in MCS and PCS scores between ethnic minorities who understood English fluently and those who did not suggest that the meaning of specific SF-12 items may change when informally translated. Future research using the SF-12 to measure the health status of ethnic minorities in the United Kingdom via postal surveys must include questions on whether respondents completed the questionnaires via informal translations. In general, those wishing to measure the health of members of ethnic groups who are unable to read English might consider using different techniques to gain the information from these groups.

Adult↗
PubMed1986

[Application of health questionnaires for health management in small- and medium-sized enterprises].

Two kinds of health questionnaires, the Todai Health Index (THI) and Cumulative Fatigue Index (CFI), were applied as a screening device for health management of workers belonging to small-medium sized enterprises. A total of 495 workers composed of 452 male workers of a glass-bottle manufacturing factory and 43 male workers of a soft-drink bottling factory were the subjects of the present study. It was found that the two kinds of health questionnaires were different from each other and have their own characteristics. Twelve scales of THI were grouped into two, the first consisting of ten scales (SUSY, RESP, EYSK, MOUT, DIGE, IMPU, MENT, DEPR, NERV, and LIFE) and the second consisting of two scales (AGGR and LISC). Nine categories of CFI were grouped into one by using principal factor analysis. It was confirmed that the twelve scale scores of THI obtained at small-medium sized factories differed from those scale scores of a reference group investigated at a large-sized enterprise. It is on the basis of the scales of aggressiveness and lies and also of the scale of mental unstability which characterizes workers, locality, job (clerical or field work), and size of industry (large or small sized) that the difference could be evaluated. Urban life characterized by a life style of staying up late at night and waking up late in the morning has been reflected on the scale of life irregularity. Irregularity of life induced by transformation of working schedule, such as two or three shifts of work and overtime, was also reflected on this scale. Two scales of THI test, i.e., many subjective symptoms and digestive organ complaints, seemed to be the representative scales indicating a close relation between work load and health level. The discriminant score for diagnosis of psychosomatic diseases is considered to be one of the most useful assessments of the individual's health condition. As mentioned above, THI is recommended as a convenient assessment method for health management of workers and for screening individuals or groups requiring health management from the total respondents belonging to small-medium sized enterprises where health administrators or professionals for health services are not available. A combined use of THI and CFI is more effective in evaluating health status of field workers than the independent use of one of these two tests, because the causal relationship between work load and health status cannot be satisfactorily observed, only through THI.

Adult↗
PubMed1997

The quality of health data obtained in a new survey of elderly Americans: a validation study of the proposed Medicare Beneficiary Health Status Registry (MBHSR).

The Medicare Beneficiary Health Status Registry (MBHSR) is a proposed new survey program that would collect health status indicators annually from large probability samples of Medicine beneficiaries. For reasons of economy, the MBHSR would use mail survey procedures with telephone follow-up of nonrespondents. Because of concerns about response rates and the validity and reliability of the data obtained by such methods, a large-scale (N = 1,922) field test was conducted. The field test assessed the validity of MBHSR survey reports of past medical treatment and conditions by comparing those reports with Medicare claims data. It assessed the (internal) reliability of MBHSR survey responses by comparing responses with logically related survey questions from the MBHSR. Analyses indicate that the MBHSR survey procedures using a combination of mail data collection with telephone follow-up of nonrespondents produced relatively high levels of sensitivity and specificity in identifying medical treatments and procedures previously recorded in Medicare claims data. In addition, the MBHSR Field Test obtained, in general, relatively high levels of internal consistency in survey reports.

Aged↗
PubMed1984

Health needs of the Hispanic elderly.

This paper presents results of a study concerning the health care needs of the Hispanic elderly population of Los Angeles County. By use of the Comprehensive Assessment and Referral Evaluation (CARE) instrument, data on a sample of 704 subjects were employed to compute the scores for 22 Likert-type scales measuring the prevalence of numerous psychiatric, medical, and social problems. The data indicate that older Hispanics were affected by cognitive impairment (13.8 per cent), depression/demoralization (30.8 per cent), heart disorders (12.8 per cent), stroke effects (11.5 per cent), arthritis (28.3 per cent), hypertension (23.7 per cent), financial hardship (28.0 per cent), fear of crime (38.4 per cent), ambulation problems (17.2 per cent), or activity limitation (24.7 per cent); they also needed assistance (19.3 per cent) or used social services (22.0 per cent). Further analysis revealed that the prevalence of many of these problems varies significantly according to the age, sex, language, and income of respondents. The indicators of health care needs used in the study differed substantially from the more traditional measures based on the person's own perception of his or her health.

Aged↗
PubMedDate not supplied

Human development index adjusted for environmental indicators: case study in one Egyptian village.

The Egypt Human Development Report 2003 does not take account of the impact of the environment on human development indicators. A case study was made in one village in El-Montaza district, Alexandria governorate, Egypt. The environmental indicators used for calculating the human development index were access to safe water, access to sanitation and environment surrounding the house. The human development index for this village decreased from 0.622 to 0.595 after adjustment for environmental factors.

Data Collection↗
PubMed2002

Functional impairment in spondyloarthropathy and fibromyalgia.

OBJECTIVE: To compare the functional ability of patients with spondyloarthropathy (SpA) and fibromyalgia (FM) using the Bath Ankylosing Spondylitis Functional Index (BASFI), the Dougados Functional Index (DFI), and and the Health Assessment Questionnaire for Spondyloarthropathy (HAQ-S), to establish whether these indicators can differentiate between these patient groups, and to ascertain how well the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) functions in patients with FM. METHODS: Twenty-four patients with SpA and 70 with FM, all female, filled in 4 self-administered questionnaires: BASFI, DFI, HAQ-S, and the BASDAI; results were compared between the 2 groups. RESULTS: The decline in functional ability was similar in patients with SpA and FM when assessed by BASFI, but slightly greater in the SpA group when assessed by DFI and HAQ-S. BASDAI was significantly (p = 0.018) greater in the FM group. CONCLUSION: An almost similar functional decline was observed in both SpA and FM patients when measured by the indices developed for patients with AS and SpA. The specificity of BASDAI in measuring disease activity in SpA was poor, as disease activity in FM was rated higher than in SpA.

Activities of Daily Living↗
PubMed1987

Use of indicators in achieving 'Health for All' in South Africa, 1987.

This review evaluates South Africa's performance in achieving health when measured against the World Health Organization's global indicators designed to achieve 'Health for All' by the year 2000. As this programme has not been implemented in South Africa, a need exists for this country to announce indicators and targets. South Africa meets the World Health Organization's targets in terms of health expenditure but available information on many of the other indicators suggest that a large segment of the population falls outside the targets set. Lack of immunisation and poor nutrition are reflected in unacceptably high infant mortality rates and relatively low life expectancies. As accurate data are needed for planning at both national and local levels a national health survey should be conducted.

Health Status Indicators↗
PubMed2002

Physical and mental health effects of intimate partner violence for men and women.

BACKGROUND: Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men. METHODS: The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators. RESULTS: A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores. CONCLUSIONS: Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.

Adolescent↗
PubMed1999

The assessment of Big Five Personality Factors and Temperament Domains as modifiers of cardiovascular response to occupational stress.

The aim of the study was to explore the role of Big Five Personality Factors and Temperament Domains as the factors influencing cardiovascular response to work, and their moderating effect on the relationship between occupational stress and cardiovascular reactivity. The self-reported data on occupational stress and filled in NEO-Five Factor Inventory by Costa, and McCrae and Pavlovian Temperament Survey by Strelau et al. were collected from 97 bank clerks employed in large bank branches. The subjects also responded to the questionnaire on personal and professional background factors. A 24 hour monitoring of cardiovascular reactivity (heart rate and blood pressure) was also provided. Conscientiousness was found to be the only modifier of cardiovascular response to occupational stress reflected by systolic blood pressure. Several main, independent of stress effects of personality and temperament domains were also found. The ratio of heart rate at work to heart rate during sleep was associated with the strength of excitatory process, the percentage of maximum heart rate index with Conscientiousness, and systolic blood pressure at work was influenced by the strength of inhibitory process. However, generally speaking, physiological indicators of the cardiovascular system functioning were not very sensitive to changes in values of personality and temperament variables at the level of occupational stress reported by the bank clerks who participated in the study.

Adult↗
PubMedDate not supplied

The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity.

BACKGROUND: The application of health-related quality of life (HRQOL) as a pediatric population health measure may facilitate risk assessment and resource allocation, the tracking of community health, the identification of health disparities, and the determination of health outcomes from interventions and policy decisions. OBJECTIVE: To determine the feasibility, reliability, and validity of the 23-item PedsQL 4.0 (Pediatric Quality of Life Inventory) Generic Core Scales as a measure of pediatric population health for children and adolescents. DESIGN: Mail survey in February and March 2001 to 20 031 families with children ages 2-16 years throughout the State of California encompassing all new enrollees in the State's Children's Health Insurance Program (SCHIP) for those months and targeted language groups. METHODS: The PedsQL 4.0 Generic Core Scales (Physical, Emotional, Social, School Functioning) were completed by 10 241 families through a statewide mail survey to evaluate the HRQOL of new enrollees in SCHIP. RESULTS: The PedsQL 4.0 evidenced minimal missing responses, achieved excellent reliability for the Total Scale Score (alpha =.89 child;.92 parent report), and distinguished between healthy children and children with chronic health conditions. The PedsQL 4.0 was also related to indicators of health care access, days missed from school, days sick in bed or too ill to play, and days needing care. CONCLUSION: The results demonstrate the feasibility, reliability, and validity of the PedsQL 4.0 as a pediatric population health outcome. Measuring pediatric HRQOL may be a way to evaluate the health outcomes of SCHIP.

Adolescent↗
PubMed2004

Health-related quality of life in patients newly diagnosed with atrial fibrillation.

INTRODUCTION: Atrial fibrillation is the most common sustained cardiac rhythm disturbance encountered in clinical practice. Despite its high prevalence and the associated high number of hospital admissions, few studies document the actual impact of atrial fibrillation on the patient. PURPOSE: The purpose of this study was to describe the health-related quality of life (HRQOL) and to examine the impact of seriousness of illness on HRQOL in patients newly diagnosed with atrial fibrillation. METHODS AND RESULTS: A descriptive correlational and cross-sectional survey study included 81 subjects newly diagnosed with atrial fibrillation within 6 months prior to data collection through face-to-face interview by the Atrial Fibrillation Symptom Frequency and severity checklist (SCL) and the short form-36 health survey (SF-36). As the variables for HRQOL, subjects' perception of both physical health and mental health was poorer than that of general US population. The seriousness of illness had a significant inverse relationship with HRQOL, including both physical health and mental health. CONCLUSION: The findings of this study indicated that the HRQOL in patients newly diagnosed with atrial fibrillation was significantly impaired and the subjective seriousness of illness had a pivotal impact on HRQOL in atrial fibrillation.

Activities of Daily Living↗
PubMed2002

Trends in socioeconomic health inequalities in the Netherlands, 1981-1999.

STUDY OBJECTIVE: To determine changes in socioeconomic inequalities in self reported health in both the 1980s and the 1990s in the Netherlands. DESIGN: Analysis of trends in socioeconomic health inequalities during the last decades of the 20th century were made using data from the Health Interview Survey (Nethhis) and the subsequent Permanent Survey on Living Conditions (POLS) from Statistics Netherlands. Socioeconomic inequalities in self assessed health, short-term disabilities during the past 14 days, long term health problems and chronic diseases were studied in relation to both educational level and household income. Trends from 1981 to 1999 were studied using summary indices for both the relative and absolute size of socioeconomic inequalities in health. SETTING: The Netherlands. PARTICIPANTS: For the period 1981-1999 per year a random sample of about 7000 respondents of 18 years and older from the non-institutionalised population. MAIN RESULTS: Socioeconomic inequalities in self assessed health showed a fairly consistent increase over time. Socioeconomic inequalities in the other health indicators were more or less stable over time. In no case did socioeconomic inequalities in health seemed to have decreased over time. Socioeconomic inequalities in self assessed health increased both in the 1980s and the 1990s. This increase was more pronounced for income (as compared with education) and for women (as compared with men). CONCLUSION: There are several possible explanations for the fact that, in addition to stable health inequalities in general, income related inequalities in some health indicators increased in the Netherlands, especially in the early 1990s. Most influential were perhaps selection effects, related to changing labour market policies in the Netherlands. The fact that the health inequalities did not decrease over recent years underscores the necessity of policies that explicitly aim to tackle these inequalities.

Adolescent↗