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Health status and the development of health services in colonial state: the case of British Malaya.

The health of a population and the development of health services in a country at a particular time in history are directly linked to the socioeconomic system. This paper discusses health and health services in Malay Peninsula during the time that it was a British colony. Economic production under British colonialism, which is basically a capitalist system, is organized primarily for the purpose of realizing profits. The health of the population is in direct conflict with and generally subordinated to this main objective. The pattern of health that emerges reflects this general framework. Moreover, health services under the colonialist system are developed primarily to serve the economic interests of the colonialists. Hence, the structure of health services is biased toward curative medicine and centered mainly in the urban areas.

Communicable Diseases↗

Approaches to improving health status in chronic obstructive pulmonary disease: one or several?

Health outcomes represent a broad group of endpoints used in clinical practice to assess the efficacy and effectiveness of interventions and to assess disease outcomes. Health status is one of the widely applied patient-reported health outcomes. The outcome of a variety of interventions, targeting local impairment or local airway inflammation, is evaluated by health status measurements; these global or summative outcomes indeed quantify the overall effect of a number of biological processes. Targeting the systemic compartment to improve health status is already widely applied in the domain of pulmonary rehabilitation. Challenging developments targeting systemic inflammation and biological processes related to systemic inflammation are particularly addressed in this review.

Administration, Inhalation↗

Health status in patients with disturbed sleep and obstructive sleep apnea.

The health status of 435 consecutive patients with sleep disturbances necessitating polysomnography was investigated. Patients underwent overnight polysomnography and health status assessment, including the Medical Outcomes Study SF-36 Health Survey and the Pittsburgh Sleep Quality Index. Based on a respiratory distress index (RDI) greater than 10 to define apnea, patients with apnea were significantly (P < 0.05) more likely to be male, be older, and have higher body mass index and lower oxygen saturation levels than patients without apnea. Multiple domains of the SF-36 Health Survey and the Pittsburgh Sleep Quality Index were significantly worse (P < 0.05) for this population when normative data were compared. Although few differences were observed between the apneic and nonapneic patients when a cutoff point for apnea was defined as an RDI greater than 10 or 20, increasing RDI was significantly associated with worsening physical functioning scores. Overall, decrements in health status measures were more strongly correlated with the number of oxygen desaturations below 85% than with increasing RDI. We conclude that patients with sleep disturbances demonstrate significant decrements in general and sleep-specific health status, but these decrements are more closely associated with oxygen desaturation than RDI.

Age Factors↗

[A multicriteria tool for the analysis of health status indicators of a population. Application to the elaboration of a typology for the use of health indicators].

The authors have designed a multicriteria framework for the analysis of health indexes in order to provide a tool for the comparison of population health status indexes and to establish a typology of these indexes regarding their use for public health. This framework allows for (a) shedding some light on the conceptualization of health underlying each index, (b) understanding the nature of the phenomenon which are effectively measured, (c) understanding the principles of the construction of the index, (d) giving some details concerning its main properties, (e) and finally understanding its possible uses. Using this multicriteria framework for analyzing and comparing 16 different population health status indexes, the authors suggest some guidelines for choosing an index regarding its future utilization (identification of priorities, resources allocation, evaluation). Finally, the limits of the utilization of health status indexes within the process of decision making in public health are underlined.

Health Status Indicators↗

A minimum data set and empirical model for population health status assessment.

BACKGROUND: The need to assess the health status of American communities in a comprehensive and systematic manner has been widely acknowledged. This study attempts to empirically derive a minimum core data set of indicators, in order to produce a uniform parsimonious model for population health status monitoring. METHODS: Five years of secondary data (1992-1996) for 113 indicators of community health for each of Florida's 67 counties were organized into 11 conceptual groups. Principal component analysis with orthogonal rotation was conducted separately on each group of indicators for each year. The component scores were converted to standard scores to further study the relationships among the conceptual groups measuring community health. A causal model was hypothesized and tested using ordinary least-squares path analysis. RESULTS: Nineteen principal components composed of 78 indicators were identified. The model demonstrated a large difference in the ability to explain variance in adult mortality (56%) compared with variance associated with adverse birth outcomes (13%). Both demographic and socioenvironmental factors have a direct effect on adult mortality. Socioeconomic factors, on the other hand, influence adult mortality indirectly through adequacy of primary care and other available resources. CONCLUSIONS: Minimum core data sets of indicators drawn from extant databases can be used to uniformly describe and explain variation in adult mortality. This research suggests caution in regard to the creation of integrated indices that combine mortality, morbidity, and other concepts such as quality of life into a single measure of community health. Further validation research employing a national sample of counties is recommended.

Adolescent↗

Comparison of the responsiveness of different disease-specific health status measures in patients with asthma.

BACKGROUND: Disease-specific health status measures are characterized by higher responsiveness than generic measures and may be preferred in clinical trials. However, comparisons of responsiveness between various disease-specific measures have rarely been performed in asthma studies. STUDY OBJECTIVE: We investigated and compared the responsiveness of health status scores in asthmatic patients during treatment using three different disease-specific measures: the Juniper Asthma Quality of Life Questionnaire (AQLQ), the Living with Asthma Questionnaire (LWAQ), and the Airways Questionnaire 20 (AQ20). METHODS: We attempted to follow up 170 patients with newly diagnosed asthma over a 6-month period. Patients underwent treatment with inhaled corticosteroids in accordance with the guideline. A health status evaluation using three disease-specific measures, and pulmonary function tests were performed on the initial visit, and at 3 months and 6 months. The effect size and the standardized response mean were used as responsiveness indexes. RESULTS: A total of 109 patients completed the 6-month follow-up and were then analyzed. All health status scores and FEV(1) measures improved during the first 3 months (p < 0.001). The total of the AQLQ scores showed high responsiveness indexes ranging from 1.28 to 1.46 between baseline and 3 months, and baseline and 6 months. Spearman correlation coefficients were smaller between the change in FEV(1) and the change in the LWAQ. Although the AQ20 also demonstrated high responsiveness, a ceiling effect was indicated. CONCLUSIONS: The AQLQ was the most responsive measure during asthma treatment. The relationship between the change in airflow limitation and the change in the LWAQ was weaker compared to the AQLQ and the AQ20. Although the AQ20 was also responsive and its simplicity is favorable, the ceiling effect should be considered when using it.

Adolescent↗

The relationship between self-rated health status and the overall quality of dietary intake of US adolescents.

The objective of this study was to compare the quality of overall dietary intake of US adolescents by self-rated health status. Using 2 nonconsecutive days of dietary recall data and responses to a single question describing self-rated health status from the Continuing Survey of Food Intakes by Individuals 1994-1996, linear regression analysis was used to detect differences in Healthy Eating Index (HEI) scores by self-rated health status for 1,504 adolescents, ages 11 to 18 years. After adjusting for factors related to both overall dietary quality and self-rated health status, overall HEI scores did not differ by self-reported health status. However, two individual HEI component scores were found to be significantly related to adolescent self-rated health status: the vegetables score (P=0.01) was higher among those with positive self-rated health status, and the total fat score (P=0.01) was higher among those with negative self-rated health status. Self-perception of health status is not related to the overall quality of the adolescent diet; therefore, food and nutrition professionals should focus on understanding motivators other than health status when exploring adolescent dietary behaviors.

Adolescent↗

Airway inflammation contributes to health status in COPD: a cross-sectional study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow limitation and airway inflammation, accompanied by decreased health status. It is still unknown which factors are responsible for the impaired health status in COPD. We postulated that airway inflammation negatively contributes to health status in COPD. METHODS: In 114 COPD patients (99 male, age: 62 +/- 8 yr, 41 [31-55] pack-years, no inhaled or oral corticosteroids, postbronchodilator FEV1: 63 +/- 9% pred, FEV1/IVC: 48 +/- 9%) we obtained induced sputum and measured health status (St. George's respiratory questionnaire (SGRQ)), postbronchodilator FEV1, hyperinflation (RV/TLC), and airway hyperresponsiveness to methacholine (PC20). Sputum was induced by hypertonic saline and differential cell counts were obtained in 102 patients. RESULTS: Univariate analysis showed that SGRQ total and symptom score were positively associated with % sputum macrophages (r = 0.20, p = 0.05; and r = 0.20, p = 0.04, respectively). Multiple regression analysis confirmed these relationships, providing significant contributions of % sputum macrophages (B = 0.25, p = 0.021) and RV/TLC (B = 0.60, p = 0.002) to SGRQ total score. Furthermore, SGRQ symptom score was associated with % sputum macrophages (B = 0.30, p = 0.03) and RV/TLC (B = 0.48, p = 0.044), whilst SGRQ activity score was associated with % sputum macrophages (B = 0.46, p = 0.002), RV/TLC (B = 0.61, p = 0.015), and PC20 (B = -9.3, p = 0.024). Current smoking and FEV1 were not significantly associated with health status in the multiple regression analysis. CONCLUSION: We conclude that worse health status in COPD patients is associated with higher inflammatory cell counts in induced sputum. Our findings suggest that airway inflammation and hyperinflation independently contribute to impaired health status in COPD. This may provide a rationale for anti-inflammatory therapy in this disease.

Adult↗

Health status following recessional ulnar osteotomy.

This study describes the health status of 31 patients who underwent recessional ulnar osteotomy for ulnocarpal impingement. An additional lunotriquetral fusion was performed in 11/31 patients for joint degeneration. Outcomes included the DASH (Disability of arm, shoulder and hand) questionnaire, SF-36 Acute Health Survey, complications, and satisfaction with surgical outcome. Patients were stratified into two groups for analysis: osteotomy alone and osteotomy + fusion. The overall results indicated that osteotomy plus fusion in patients with more advanced ulnocarpal impingement did not equalise patients' post-operative health status to that reported by patients requiring osteotomy alone. Mean DASH and SF-36 physical component scores indicated better health status in the osteotomy group compared with the osteotomy + fusion group after surgery. Forty-one point nine per cent of patients required plate removal, and scar pain persisted in 58%. One patient in each group developed a non-union requiring revision surgery. Patients in both groups were generally satisfied with their surgical result, with a higher proportion of very or completely satisfied patients in the osteotomy group (65%) compared to the osteotomy + fusion group (27%). Overall, recessional ulnar osteotomy appears to be a successful procedure for the treatment of ulnocarpal impingement.

Adult↗

[Patient-centered evaluation of the health status in a longitudinal quality management system in the hospital].

OBJECTIVE: The objective was to assess the value of self-reported health status as an indicator of outcomes of acute hospital care, to identify potential practical limitations, and develop strategies for future applications. METHODS: 180 patients from 4 acute care hospitals in Germany participated in a comprehensive and longitudinal assessment of outcome of care in general internal medicine between 8/1/99 and 10/31/99. Self-administered SF-36 surveys were completed at admission and 4 weeks after discharge. Additionally, nurses and physicians answered questions regarding the patients' health status. Linear relations between health status assessments were quantified as correlation coefficients. Odds ratios (OR) and 95% confidence limits from multivariate logistic regression models were reported for predictors of non-returned questionnaires. RESULTS: 33% of SF-36 surveys handed out at discharge were returned. Patients with impairments and referred patients were more likely not to return the survey (OR = 1.3 [1.09; 1.66] and OR = 3.7 [1.37; 9.87]). The linear relation of SF-36 and SF-12 scores in the same patients were r = 0.95 [0.91; 0.97] for physical health and r = 0.91 [0.85; 0.94] for mental health. Physicians and nurses moderately agreed in their assessment of patients' health (r = 0.38 [0.22; 0.52]) but both professional groups showed poor agreement with self-reported health (r = 0.15 [-0.08; 0.36] and r = -0.01 [-0.23; 0.21]). CONCLUSIONS: 1. Self-reported health status should be considered in the assessment of outcomes of acute care as a dimension that is to some extent independent of health status assessment by professionals, 2. shorter instruments, i.e., the SF-12, can be used instead of the SF-36, 3. a self-reported health status assessment is feasible 4 weeks after discharge, and 4. patients with multiple impairments or those who are transferred should get specific support in the completion of questionnaires to increase response or to receive at least minimal information about their health status.

Aged↗

Changes in health status for persons with wrist or hand impairments receiving occupational therapy or physical therapy.

OBJECTIVE: The purpose of this study was to describe changes of health status as perceived by clients with hand or wrist impairments who received rehabilitation in acute, orthopedic outpatient facilities from occupational therapy or physical therapy personnel. METHOD: One thousand three hundred ninety-nine adults with wrist (n = 692) or hand (n = 707) impairments who were treated between July 1996 and June 1997 were selected from the Focus On Therapeutic Outcomes, Inc. (FOTO) national rehabilitation database. Each client completed a health status questionnaire on intake and discharge. Data consisted of number of outpatient visits, duration of treatment episode, and health status scores for six functional scales. Measures of intensity, global health status, global utilization, and client satisfaction were calculated. Outcomes were evaluated across occupational therapists and physical therapists. RESULTS: Clients perceived improvement (p < .05) in their health status over the course of therapy. Number of visits and measures of health status and client satisfaction were similar across type of therapist. Episode duration was longer (p < .05) and intensity was less (p < .05) for clients seen by occupational therapists. CONCLUSION: Clients receiving rehabilitation in acute orthopedic outpatient centers perceived improvement in their functional abilities and health and well-being (global health status and individual functional scales) over the time during which treatment was provided. Results confirm the responsiveness of the outcomes instrument to clinical change in the clients' perception of their health status over the course of therapy and support the use of health status as a measure of clinical outcome.

Activities of Daily Living↗

Exercise capacity predicts health status in alpha(1)-antitrypsin deficiency.

Resting lung function is only weakly related to health status in chronic obstructive pulmonary disease, reflecting the multifactorial causes of impairment and the heterogeneous nature of the condition. The current study examined whether density mask analysis of high-resolution computed tomography (HRCT) or exercise capacity were better surrogates for health status in a well-defined, homogeneous group of patients with alpha(1)-antitrypsin deficiency (PiZ). Twenty-nine patients with predominantly lower zone emphysema on HRCT were studied. Exercise was assessed by incremental treadmill (V O(2) peak) and shuttle walking tests (ISWT) and health status by the St. George's Respiratory Questionnaire (SGRQ) and SF-36. Although lower zone expiratory HRCT was related to exercise capacity (rho = -0.64 and -0.63 for V O(2) peak and ISWT, respectively, p < 0.001), multiple regression analysis suggested that FEV(1) was a marginally better predictor (rho = -0.64 and -0.65, p < 0.001). HRCT also related significantly to health status (rho = -0.37 for SGRQ activity, p < 0.05), although again FEV(1) showed a stronger relationship (rho = -0.43, p = 0.01). However, exercise capacity was the best predictor of health status with the ISWT accounting for up to 55% of the variability seen in SGRQ total and up to 53% of the SF-36 domain scores (physical functioning). Although both HRCT and lung function relate to health status, exercise capacity is the best predictor of patients disability in these patients with predominantly lower zone emphysema.

Exercise Test↗

Why are we weighting? A critical examination of the use of item weights in a health status measure.

There is currently much interest in the measurement of self reported health status. A number of health status measures have been designed. However, such questionnaires are often long and complicated, or are disease specific. The most famous generic British health status instrument is the Nottingham Health Profile (NHP) which is a short questionnaire designed for ease of completion. However, this paper addresses a number of related issues concerning the weights attached to particular items on this questionnaire. It is argued that the weighting of items by Thurstone's method of paired comparisons is inappropriate and can lead to logically inconsistent results.

Health Status Indicators↗

Class, paid employment and family roles: making sense of structural disadvantage, gender and health status.

The British tradition of analysing differences in health has been dominated by class, with women belatedly entering this debate. The American tradition has been dominated by role analysis, with women's health considered primarily in terms of their marital, parental and employment roles, with recent research coming to contradictory conclusions. Research in both traditions has reached an impasse. This paper uses a sample of over 25,000 men and women from the 1985 and 1986 British General Household Survey to show how both traditions need to be reformulated and integrated. The ways in which family roles are associated with women's health status is determined by material circumstances, but the material circumstances cannot be captured by occupational class alone. Participation in the labour market and consumption divisions, in the form of housing tenure, are crucial additional indicators of structural disadvantage. Standardised limiting long-standing illness ratios and multivariate logit analysis confirm that occupational class and paid employment are the most important attributes associated with health status for women and men. Family roles are important for women; women without children and previously married women have particularly poor health status especially those not in paid employment and living in local authority housing.

Age Factors↗

A comprehensive multiattribute system for classifying the health status of survivors of childhood cancer.

PURPOSE: A multiattribute health status classification system was devised to describe comprehensively the health status of survivors of childhood cancer. METHODS: The system consists of seven attributes: sensation, mobility, emotion, cognition, self-care, pain, and fertility. Three to five levels of functioning are defined for each attribute. Any specific combination of seven attribute levels constitutes a health state. In the first survey, the system was used to classify the health status of 20 children currently undergoing therapy for high-risk acute lymphoblastic leukemia (ALL), Wilms' tumor, or neuroblastoma, and eight who had completed treatment. A second survey consisted of 13 children with brain tumors on active treatment. RESULTS: In general, independent ratings by clinicians were in agreement, and consensus was readily achieved in 1 to 2 minutes per patient. Children on therapy experienced a higher burden of morbidity than those off treatment. Brain tumor patients experienced more morbidity than patients in the first survey. CONCLUSION: The multiattribute system provides a compact but comprehensive tool for long-term follow-up of survivors of childhood cancer. It captures both multiple sequelae and varying levels of severity. By using a mathematical utility function, a single summary score of health-related quality of life may be assigned to each health state. Additional studies to establish reproducibility, validity, responsiveness, and generalizability are indicated.

Activities of Daily Living↗

Grandparents parenting grandchildren: assessing health status, parental stress, and social supports.

This study describes the physical and emotional health of grandparents raising grandchildren and the extent to which the health of this at-risk population is affected further by the caregiving role. A sample of 17 grandparents who are primary caregivers to their grandchildren and reside within a three-state metropolitan area were interviewed in their homes during a 1-year period. Data were collected on physical and mental health status and health problems, level of health, level of stress, economic difficulties, and family and supports. Qualitative data analyses using a panel of experts and NUD*IST, and quantitative methods were used. Results showed wide variation in physical and mental health status; however, most participants tended to score high on parental stress-particularly in the child domain. Disruption of social activities, financial problems, and alterations in family relationships were of significant concern.

Adolescent↗

Health status among women with menstrual symptoms.

PURPOSE: Chronic diseases have been associated with decrements in health status, as measured by the Medical Outcomes Study's Short Form-36 (SF-36). Menstrual symptoms (including irregular menses, menorrhagia, dysmenorrhea and premenstrual symptoms) are common, but little is known about their impact on health status. We sought to determine the prevalence of menstrual symptoms and the degree to which these symptoms affect health status. METHODS: This was a mailed survey including questions about sociodemographic characteristics, military experiences, current physical symptoms and medical conditions, mental health, health status (SF-36), and life experiences. The participants were a nationally representative, randomly selected sample of women veterans who had made at least one ambulatory visit to a Veterans Affairs facility between July 1, 1994 and June 30, 1995. The main outcome measures were eight domains of the SF-36 health status questionnaire. RESULTS: Among 3632 respondents (58.4% response rate), 1744 were menstruating women and formed the analytical sample for this study. Among these women (mean age 35.8), 67% reported one or more menstrual symptoms. Women with menstrual symptoms had significantly lower scores for all domains of the SF-36 (p < 0.01), except energy and vitality (p < 0.05), both before and after adjusting for sociodemographic, psychosocial, and comorbidity variables. CONCLUSIONS: Women veterans who report one or more menstrual symptoms have significantly lower health status compared with those reporting none. Clinicians providing care for women should be attuned to the potential impact of menstrual symptoms on the lives of their patients.

Adult↗