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PubMed1992

The Behavioral Risk Factor Survey and the Stanford Five-City Project Survey: a comparison of cardiovascular risk behavior estimates.

BACKGROUND: Nearly all state health departments collect Behavioral Risk Factor Survey (BRFS) data, and many report using these data in public health planning. Although the BRFS is widely used, little is known about its measurement properties. This study compares the cardiovascular risk behavior estimates of the BRFS with estimates derived from the physiological and interview data of the Stanford Five-City Project Survey (FCPS). METHOD: The BRFS is a random telephone sample of 1588 adults aged 25 to 64; the FCPS is a random household sample of 1512 adults aged 25 to 64. Both samples were drawn from the same four California communities. RESULTS: The surveys produced comparable estimates for measures of current smoking, number of cigarettes smoked per day, rate of ever being told one has high blood pressure, rate of prescription of blood pressure medications, compliance in taking medications, and mean total cholesterol. Significant differences were found for mean body mass index, rates of obesity, and, in particular, rate of controlled hypertension. CONCLUSIONS: These differences indicate that, for some risk variables, the BRFS has limited utility in assessing public health needs and setting public health objectives. A formal validation study is needed to test all the risk behavior estimates measured by this widely used instrument.

Adult↗
PubMed1988

Caring more about quality. Japan-U.S. health care comparison.

The author gives an overview of his nation's health and compares indicators with the USA. People live longer in Japan than anywhere in the world, yet 1 in 3.5 Japanese has health problems. Some 80% of patients are outpatients, and many regions now have an oversupply of hospital beds. Hospitals employ 60% of all doctors, and staff salaries account for approximately half of hospital outlay.

Data Collection↗
PubMed1978

An information system for monitoring health system adequacy.

The design and initial implementation of a system to monitor health system adequacy in Georgia is described. Five profiles on county or sub-county areas comprise the system: Health Resources--an inventory of facilities, personnel, and programs; Health Demands--econometric estimates of demand for selected health services; Health System Adequacy--objective and subjective assessments of the health service system; Health Status--selected health indicators; Area--pertinent demographic characteristics. Innovative aspects include (a) the econometric demand estimates and (b) the subjective adequacy assessments derived using factors analysis to reduce 320 health service assessments to 19 interpretable factors. Potential system role in regional planning under P.L. 93-641 is described.

Delivery of Health Care↗
PubMedDate not supplied

Cognitive performance in multiple trauma patients 3 years after injury.

OBJECTIVES: Patients with sequelae from multiple trauma commonly display cognitive disturbances, specifically in the areas of attention and memory. This study was designed to assess cognitive functioning 3 years after severe multiple trauma and to investigate how cognitive performance is related to head injury severity and psychological distress respectively. METHODS: Sixty-eight multiple trauma patients were tested with a screening battery consisting of six neuropsychological tasks 3 years after injury. A measure of psychological distress (20-item General Health Questionnaire, or GHQ-20) was also administered. RESULTS: Patients who neither showed signs of reduced consciousness on admission to the hospital nor reported significant psychological distress at follow-up tended to have normal test performance. In five of the six tasks, cognitive impairment was related to the severity of the traumatic brain injury as measured by the Glasgow Coma Scale (GCS). In both attention span tasks, patients designated as cases by the GHQ had significantly lower scores than noncase patients. These bivariate relationships were upheld in multiple regression analyses, in which age, sex, and GCS and GHQ scores were entered as independent variables. When patients with severe head injuries were excluded from the analyses, GCS scores still contributed to the variance in tests of verbal attention span and delayed recall, but performance on attentional tasks was more strongly related to psychological distress than to GCS scores. CONCLUSIONS: Cognitive deficits in multiple trauma patients were related both to the severity of the traumatic brain injury and to the degree of psychological distress. The strength of the association between brain injury as indicated by GCS scores and cognitive performance differed between different tasks. Neuropsychological testing may assist in differentiating primary organic from secondary psychogenic impairments.

Adolescent↗
PubMed1978

Individual character of variation in time-series studies of healthy people: II. Differences in values for clinical chemical analytes in serum among demographic groups, by age and sex.

Assessment of the significance of an observed set of serum chemical values for determining a person's state of health requires comparison with a set of defined reference values. We tested the assumption that a reference group of individuals, categorized by age and sex, gives a narrower range of variation than does a larger mixed population. If this were true, the demographic set would be a more sensitive reference than is the customary "normal range" for interpretation of values occurring in the individual. The ratio, R, of intra-personal to inter-personal (group) standard deviations was similar for defined age/sex classes and the overall group for 16 serum constituents. When the "raw" intra-individual variation (biological plus analytical variation) was adjusted to remove the average analytical component, the resulting R was less than 80 for all constituents except creatine kinase, which indicates that these are all particularly strong "discriminators" of individuality. These results imply the need for individual rather than population-based reference ranges, even if the latter are from persons of similar age and the same sex.

Adult↗
PubMed1981

Disability assessment in population surveys: results of the O.E.C.D. Common Development Effort.

In 1976, the OECD sponsored the "Healthfulness of Life" Common Development Effort under the direction of the Social Indicators Programme. With eight member countries and WHO participating, the group set out to develop and statistically define indicators of short and long-term disability for inclusion in population surveys. This paper concentrates on the development and validation testing of the long-term disability items. The technique adopted was one of measuring an individual's ability to perform tasks essential to daily living. The conceptual background and definitions are outlined along with the final recommandations for survey questions and indicator construction put forward to the OECD countries. In addition to the specific testing programmes carried out by the participating countries, the recommended items have been included in other large scale surveys such as the OECD Comprehensive Survey which has been carried out in several countries.

Activities of Daily Living↗
PubMed1983

How are you, nurse?

Nurses are not very well, according to a survey conducted among nurses in the northern region of Sydney. Smoking is the most common health risk. Fifty per cent of nurses smoke. This rate is double that of the population living in Northern Sydney. A tobacco knowledge questionnaire indicated nurses are not as well informed as they could be about the health consequences of smoking. As well, heavy smokers report the highest amount of severe anxiety. Nurses, especially young nurses, report considerable anxiety generated by the nursing profession and depression is common, specifically among the younger nurses. Sixteen per cent of nurses are severely overweight, 42% over 30 years of age are substantially overweight. Nurses also take more sleeping tablets and exercise less than people in the general population and are also more prone to respiratory tract infections, headaches and backaches. Some explanations of the poor health status of nurses are offered and ways of improving the health of nurses discussed.

Adult↗
PubMed1987

Double jeopardy to health for black older adults?

Previous health research on the double jeopardy of being Black and old is largely based upon subjective assessments of health. This article discusses the measurement of health with the understanding that health indicators vary in their degree of objectivity/subjectivity and examines the double jeopardy thesis with data from a national sample of older adults. The results indicate that older Blacks tend to have poorer health, as judged by perceived health and disability, than older Whites. However, there is no evidence that the health differential between elderly Whites and elderly Blacks varies with age; the results do not support the double jeopardy hypothesis. The analysis also illustrates ways to assess the difference of effects in a multivariate model applied to more than one group.

Black or African American↗
PubMed2002

[Monitoring of iodine in The Child and Adolescent Health Survey].

In the first quarter of 2003 a National Health Survey for Children and Adolescents will be started and carried out over a period of three years. In 11,300 children and adolescents between 6 and 18 years a comprehensive iodine monitoring will be realised. The volume of the thyroid gland will be determined sonographically, thyroid hormones and the urinary iodine excretion will be measured. Apart from the nutritional intake of iodine and the use of supplements, socio-demographic and other variables relevant to health will be recorded in a self-administered questionnaire. In the pilot study of the Health Survey for Children and Adolescents from March 2001 to March 2002 the method was tested on 426 children and adolescents and has proved feasible. The sample for the pretest was not representative for the population of children and adolescents in Germany but may already be an indication for the iodine supply. A low goitre prevalence of 4.2% was found. The total thyroid volume correlated significantly with height and weight. There was no significant difference between boys and girls or between a rural and an urban sample point.

Adolescent↗
PubMed2005

[Assessment of health-related quality of life with the German SF-8. A comparison of telephone and postal survey modes].

Within a comprehensive comparison of telephone and postal survey methods the SF-8 was applied to assess adult's health-related quality of life. The 1690 subjects were randomly assigned to a telephone survey and a postal survey. Comparisons across the different modes of administration addressed the response rates, central tendency, deviation, ceiling and floor effects observed in the SF-8 scores as well as the inter-item correlation. The importance of age and gender as moderating factors was investigated. Results indicate no or small statistically significant differences in the responses to the SF-8 depending on the actual mode of administration and the health aspect questioned. It was concluded that further investigations should focus on the exact nature of these deviations and try to generate correction factors.

Adult↗
PubMed1998

Mental health expectancy--the European perspective: a synopsis of results presented at the Conference of the European Network for the Calculation of Health Expectancies (Euro-REVES). Medical Research Council Cognitive Function and Ageing Study Group.

The increase in life expectancy observed over the last decade has particular relevance for mental health conditions of old age, such as dementia. Although mental disorders have been estimated to be responsible for 60% of all disabilities, until recently population health indicators such as health expectancies have concentrated on calculating disability-free life expectancy based on physical functioning. In 1994, a European Network for the Calculation of Health Expectancies (Euro-REVES) was established, one of its aims being the development and promotion of mental health expectancies. Such indicators may have an important role in monitoring future changes in the mental health of populations and predicting service needs. This article summarizes the proceedings and recommendations of the first European Conference on Mental Health Expectancy.

Aged↗
PubMed1977

The development and application of indices of health: general methods and a summary of results.

A multidisciplinary group has developed a health index questionnaire designed to measure the social, emotional, and physical function of free-living populations. The strategy has been found to be generally applicable, capable of application by lay interviewers, acceptable to interviewees, and amenable to index construction. Furthermore, initial evaluations of the resulting health indices suggest that they are biologically and clinically valid. These health indices have been successfully applied in a randomized trial of innovative primary care services. The comceptualization of individual sections of the health index questionnaire for each of these three functional areas, the generation of the instrument, and the evaluation of questionnaire responses for their biologic and clinical validity are summarized here.

Adolescent↗
PubMed2003

Validity and reliability of the revised convergence insufficiency symptom survey in children aged 9 to 18 years.

PURPOSE: To assess the validity and reliability of the Convergence Insufficiency Symptom Survey (CISS) in children aged 9 to 18 years. The CISS is the primary outcome measure for a pilot study evaluating two different treatments for convergence insufficiency (CI). METHODS: Children with CI were given the CISS twice to assess reliability. CISS scores for the first administration were also compared with scores from children with normal binocular vision to assess the validity of the CISS. RESULTS: Forty-seven children with CI and 56 children with normal binocular vision participated in the study. Reliability was assessed using intraclass correlation and 95% limits of agreement for the children with CI. For children with CI, the intraclass correlation was 0.77 (95% confidence interval, 0.613 to 0.873), and the 95% limits of agreement were -10.2 to +12.1. The mean (+/-SD) CISS score was 30.8 +/- 8.4 for the children with CI and 8.4 +/- 6.4 for the children with normal binocular vision. These means were significantly different (p < 0.0001). Good discrimination (sensitivity, 96%; specificity, 88%) was obtained using a score of >/=16. CONCLUSIONS: Children with CI showed a significantly higher CISS symptom score than children with normal binocular vision. The results of the study indicate that the CISS is a valid and reliable instrument to use as an outcome measure for children aged 9 to 18 who are enrolled in clinical research concerning CI.

Adolescent↗
PubMed2001

[Feasibility of using short form 36 in Chinese population].

OBJECTIVE: To explore the feasibility of using the SF-36 in Chinese population. METHODS: We tested the reliability and validity of the SF-36 in 1603 rural residents, 646 urban residents, 70 high school girls, 122 patients with osteoporosis, and 150 stroke patients. RESULTS: The reliability and validity of the SF-36 in general were acceptable, however, the reliability and validity varied among different domains and in different populations. The reliability and validity of the domains "limitations in physical activities", "limitations in usual role activities because of physical health problems", "bodily pain", and "general health perception" were better than those of the domains "vitality", "limitations in social activities", "limitations in usual role activities because of emotional problems", and "mental health". CONCLUSION: The results indicate that we can use the SF-36 in Chinese population, but we have to pay attentions to the variance of the reliability and validity in different populations, especially for the interpretation of the results of the domains related to mental and social functions.

Activities of Daily Living↗
PubMed2003

Age differences in allostatic load: an index of physiological dysregulation.

This preliminary report examines variation in allostatic load by age for a large nationally representative population of the United States. It uses data on 13 indicators of physiologic dysregulation from a nationally representative sample of the US population 20 years of age and over. Allostatic load is remarkably constant in the older ages after increasing sharply in the years from 20 to 60. We hypothesize that this represents mortality selectivity of the population by physiological status.

Adaptation, Physiological↗
PubMed1979

Social inequalities undiminished.

Traditional differences in death-rates by social class continue in Britain in the 1970s, mostly at lower levels of mortality. The professions do well, unskilled workers and their families particularly badly. Data on health services are scanty, but they suggest that lower-class families, with greater needs, do not make proportionate demands on some services and receive less of others. Continuing socioeconomic inequalities, disparities in child health and education, and current smoking and exercise habits indicate that inequalities in health will persist. Some ways of levelling up are suggested, starting with children: by creating more equal opportunities for the under-5s through education and day care, expanding child benefit and family endowment, concentrating health services on the socially disadvantaged, and setting an upgraded "health education" to the task--with mothers and children and the whole population.

Acute Disease↗
PubMed2002

Truancy, grade point average, and sexual activity: a meta-analysis of risk indicators for youth substance use.

Society increasingly holds schools responsible for the effectiveness of health promotion activities, such as drug abuse prevention efforts funded through the federal Safe and Drug-Free Schools program. Consequently, school districts use student surveys as a method for assessing trends and evaluating effects of programs on behavior. Because cost and practical concerns often preclude consistent population-based school survey sampling, risk indicators can provide an essential tool in analyzing needs assessment and program evaluation data. In this paper, three risk measures associated with substance use were selected from among commonly used school surveys. These measures--truancy, grade point average, and recent sexual intercourse--were compared, using meta-analysis techniques, to assess the reliability of risk measures across different survey instruments, different communities, and different points in time. Truancy was judged superior, because of its strong predictive value, particularly among younger students, and because rates can be compared to school records to assess sampling validity over time.

Absenteeism↗
PubMed2000

Validation of a questionnaire to assess fecal incontinence and associated risk factors: Fecal Incontinence Questionnaire.

PURPOSE: Although fecal incontinence is a topic of considerable importance, there are no validated self-report measures of fecal incontinence available. The aim of this study was to develop a questionnaire to measure fecal incontinence and its risk factors in the community. METHOD: The reliability and concurrent validity of the fecal incontinence questionnaire were measured by test-retest procedures in a population of clinic patients. The questionnaire was created for a sixth-grade reading level, with large print. Ninety-four adult patients were surveyed. Thirty-four patients repeated the questionnaire through the mail. Forty-one patients were independently retested over the telephone by a physician to assess concurrent validity. Nine patients refused retest, and ten patients did not respond to a second contact. RESULTS: The fecal incontinence questionnaire was well understood and well accepted. Reliability (overall median kappa, 0.68; interquartile range, 0.03-1) and validity (overall median kappa, 0.59; interquartile range, 0.27-1) were acceptable for the mailed retest and the telephone retest, respectively. The presence of fecal incontinence as measured by questionnaire was greatly increased when compared with physician history in clinical records; only 3 percent of patients reported no fecal incontinence on the questionnaire when the clinic chart had documented this problem. CONCLUSION: Our initial results indicated that this new self-report questionnaire is a useful tool for assessing the presence of fecal incontinence in the population and has greater sensitivity compared with a standard physician interview. Specific attention should be given to identifying fecal incontinence and associated symptoms during history taking.

Adult↗