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PubMed2002

Reverberations of family illness: a longitudinal assessment of informal caregiving and mental health status in the Nurses' Health Study.

OBJECTIVES: . This study examined the association between caregiving for disabled or ill family members, estimated to occur in more than 22 million US households, and change in mental health. METHODS: We assessed 4-year change in mental health among 37 742 Nurses' Health Study participants with the Medical Outcomes Study Short-Form 36. RESULTS: Women who provided 36 or more weekly hours of care to a disabled spouse were almost 6 times more likely than noncaregivers to experience depressive or anxious symptoms (multivariate odds ratio [OR] = 5.6; 95% confidence interval [CI] = 3.8, 8.3). Caring for a disabled or ill parent (>or= 36 weekly hours) was associated with a less dramatic elevation in depressive or anxious symptoms (multivariate OR = 2.0; 95% CI = 0.9, 4.3). CONCLUSIONS: In this population, caregiving was associated with increased risk of depressive or anxious symptoms.

Adult↗
PubMed1980

Disability, health status, and utilization of health services.

Change in the patterns of utilization of services is an important indicator of the influence of policies and programs concerning health care. This paper focuses on these patterns as revealed in a survey of a probability sample of the U.S. adult population conducted in 1972. The analysis sought to assess the influence of a number of health dimensions, as well as economic and sociodemographic characteristics, on utilization. Coverage through insurance or other payment plants constituted one of the independent factors in the analysis. The dimensions of health included indicators of disabilities in work and independent living, limitations in physical and emotional performance, and the existence and severity of pathology and impairment. A discriminant analysis was employed to assess the relative importance of these variables in their influence upon the utilization of services. Finally, the paper presents information about unmet needs for care.

Activities of Daily Living↗
PubMed1989

[Relative risk areas in the Louvain region. An ordinal geographical analysis of the health status and the distribution of health care].

The analysis of the absolute figures of 21 socio-economic, hygienic and demographic indicators for the 30 communes of the district of Leuven did not show significant differences. A fourfold ordinal analysis, however, revealed a systematic pattern of differences for wealth, hygienic amenities, migration, birth rate and SMR. Six types of communes with two relative risk areas were described: cities and city-like communes, residential areas, rural villages with high emigration rates, poor economic areas, and transition areas between rural villages and cities and between wealthy and poor economic areas. The same pattern was found, though to a lesser degree, in the distribution of the facilities for health care and social welfare. The more wealthy communes were very well provided by these services, while the relative risk areas were overlooked.

Belgium↗
PubMed1995

Measuring health status in psoriatic arthritis: the Health Assessment Questionnaire and its modification.

OBJECTIVE: The Health Assessment Questionnaire (HAQ) has proven to be a reliable and valid measure of outcome for a variety of arthritides. A recent modification of HAQ for spondyloarthropathy (HAQ-S) has also been reported. Our purpose was to evaluate the HAQ and HAQ-S as outcome measures in the assessment of patients with psoriatic arthritis (PsA). METHODS: The HAQ, including HAQ-S was administered to all patients attending our Psoriatic Arthritis Clinic between June and December, 1993. Clinical and radiological assessments were performed according to a standard protocol that measures disease activity, fibrositic tender points (TP), disease severity and damage. Analysis was performed using SAS for the PC. RESULTS: The patient population included 114 patients, 70 men and 44 women with a mean age of 49.3 years and a mean arthritis duration of 15.1 years. The mean HAQ score was 0.50, while the mean HAQ-S score was 0.53 (scores range 0 to 3 for this instrument). The overall HAQ and HAQ-S disability scores were highly correlated with several clinical measures of function, including grip strength (r = -0.63 and -0.59, respectively). American College of Rheumatology functional class (r = 0.59 and 0.60, respectively), as well as the number of fibrositic TP (r = 0.54 and 0.57, respectively). These disability scores also correlated highly with the overall number of actively inflamed joints (r = 0.49 and 0.50, respectively); however, they correlated only moderately or poorly with other measures of disease activity such as morning stiffness, total number of joint effusions, erythrocyte sedimentation rate (ESR) and the PASI score for psoriasis and with all measures of disease severity. A similar pattern of correlations was found between the individual subscales of the HAQ and HAQ-S and the clinical measures of function, activity, and severity, as well as between the pain scale and the various clinical measures. However, the correlations are generally lower. CONCLUSION: Our data suggest that HAQ and HAQ-S capture clinical measures of function and pain in PsA but do not correlate with disease severity. The HAQ and its modification for spondyloarthropathy may reflect fibromyaglia as a measure of pain and tenderness in these patients. Thus, the clinical assessment of disease activity and both clinical and radiological assessments of joint damage remain important outcome measures in PsA.

Activities of Daily Living↗
PubMedDate not supplied

Psychosocial factors and health status in women with rheumatoid arthritis: predictive models.

INTRODUCTION: Health status, and consequently productivity and quality of life, depends on a multitude of factors. Numerous psychosocial factors have been associated with the concurrent health status of individuals with chronic disease. Previous studies have examined the relationship between singular psychosocial factors and health status in rheumatoid arthritis. This study evaluated the simultaneous interrelationships among selected psychosocial variable and health outcomes using data from a study of younger women diagnosed with rheumatoid arthritis (RA). METHODS: The hypothesized models were examined using data from a survey of 185 women with a mean age of 43 years, diagnosed with RA for an average of 6.6 years. Participants in the study completed the following measures: (1) Arthritis Impact Measurement Scales, (2) Multidimensional Pain Inventory, (3) Daily Hassles Scale, (4) Interpersonal Support Evaluation List, and (5) Perceived Self-Efficacy Scale. RESULTS: Using path analysis, the information provided by the LISREL program, and extant theory, two models were tested. The data provided support for all but two of the hypothesized relationships in the model predicting physical functioning. Pain severity and self-efficacy emerged as important variables in understanding individual variations in perceived physical functioning. In the second model, using perceived well-being as the outcome, two bidirectional relationships were noted: one between affective distress and social support, and the second between perceived well-being and daily stress. CONCLUSIONS: The models evaluated in this study support the provision of multifaceted interventions aimed at enhancing a woman's ability to manage her pain and stress while also enhancing her beliefs in her own abilities.

Activities of Daily Living↗
PubMed2005

The WHO-DAS II: psychometric properties in the measurement of functional health status in adults with acquired hearing loss.

The World Health Organization's (WHO) Disability Assessment Scale II (WHO-DAS II) is a generic health-status instrument firmly grounded in the WHO's International Classification of Functioning, Disability and Health (WHO-ICF). As such, it assesses functioning for six domains: communication, mobility, self-care, interpersonal, life activities, and participation. Domain scores aggregate to a total score. Because the WHO-DAS II contains questions relevant to hearing and communication, it has good face validity for use as an outcome measure for audiologic intervention. The purpose of the present study was to determine the psychometric properties of the WHO-DAS II on a sample of individuals with adult-onset hearing loss, including convergent validity, internal consistency, and test-retest stability. Convergent validity was established by examining correlations between the WHO-DAS II (domain and total scores) and the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Hearing Aid Handicap for the Elderly (HHIE), two disease-specific measures, as well as with the Short Form-36 for veterans (SF-36V), a second generic measure. Data on all four measures were collected from 380 older individuals with adult-onset hearing loss who were not hearing aid users. The results of the convergent validity analysis revealed that the WHODAS II communication domain score was moderately and significantly correlated with scores on the APHAB and the HHIE. WHO-DAS II interpersonal and participation domain scores and the total scores were also moderately and significantly correlated with HHIE scores. These findings support the validity of using the WHO-DAS II for assessing activity limitations and participation restrictions of adult-onset hearing loss. Several WHO-DAS II domain scores and the total score were also significantly and moderately-markedly correlated with scores from the SF-36V. These findings support the validity of the WHO-DAS II as a generic health-status instrument. Internal consistency reliability for all the domain scores was adequate for all but the interpersonal domain. Test-retest stability for all the domain scores was adequate. Critical difference values were calculated for use in clinical application of the WHO-DAS II. From these findings, we concluded that the WHO-DAS II communication, participation, and total scores can be used to examine the effects of adult-onset hearing loss on functional health status. Further work examining the utility of the WHO-DAS II as an outcome measure for hearing aid intervention is warranted.

Activities of Daily Living↗
PubMed2000

Health status of young offenders and their families.

PURPOSE: To describe the health status of youth committed and detained by the Maryland Department of Juvenile Justice. The problem of complex health needs of young offenders is gaining importance as the number of youth under the care of state juvenile justice systems steadily increases. METHODS: The health status of a random sample (N = 350) of male and female committed or detained young offenders was assessed utilizing a record review and a self-report health survey. RESULTS: Ninety-seven percent of the sample reported levels of physical discomfort and 92% reported emotional discomfort. Nearly half (45%) of the youth had some medical condition, 53% had been abused, 20% injured, 16% sustained a gunshot or stab wound. Of youth reporting physical injury, 12% did not receive treatment. Family members, including siblings experienced similar health problems. CONCLUSIONS: Patterns of physical and behavioral health problems were noted within these families, as were patterns of criminal behavior. Trans-generational patterns of at-risk behaviors were evident. Most youth (86%) perceived themselves to be healthy. However, when specific health indicators were examined, discrepancies between health status and health perceptions were noted.

Adolescent↗
PubMed1998

Functional health status of adults with achondroplasia.

Little is known regarding the functional health status of individuals with achondroplasia. This cross-sectional survey of adults with achondroplasia was undertaken to assess the functional health status of this population and its determinants. The study sample consisted of members of the Little People of America (LPA) who completed a mailed questionnaire consisting of a demographics component, a general and disease-specific comorbidities component, and the Short Form 36 (SF-36) health status questionnaire. Univariate analyses and multivariate linear regression models were used for data analysis. Four hundred thirty-seven individuals with a mean age of 38 years completed the survey. The age- and gender-adjusted Mental Component Summary (MCS) scores did not significantly differ from those of the general population. In contrast, the age- and gender-adjusted Physical Component Summary (PCS) scores were significantly lower than the general population starting in the fourth decade of life. Musculoskeletal diseases were most prevalent and had the greatest impact on the PCS scores. Two-thirds of this cohort had undergone at least one operation. Only musculoskeletal procedures were significantly associated with PCS and MCS scores. The functional health status of adults with achondroplasia, as measured by the SF-36, is not drastically reduced in comparison with that of the general U.S. population.

Achondroplasia↗
PubMed2000

Quality of life and health status in pediatric tonsil and adenoid disease.

OBJECTIVE: To assess the baseline global health status and quality of life (QOL) in children with tonsil and adenoid disease. DESIGN: Cross-sectional multicenter survey series. SETTINGS: A tertiary academic pediatric specialty hospital and a tertiary academic hospital in 2 different cities. PATIENTS AND OTHER PARTICIPANTS: Consecutive series of 55 parents of children who were seen for tonsil and adenoid disease. INTERVENTION AND METHOD: Cross-sectional survey of the health status of affected children to assess their QOL and its relationship to tonsil and adenoid disease. MAIN OUTCOME MEASURES: Quality-of-life subscale scores of affected children on the Child Health Questionnaire version PF28 (CHQ-PF28); comparisons of population data from healthy normal children and children with asthma and juvenile rheumatoid arthritis. RESULTS: The overall health status and QOL of children with tonsil and adenoid disease is significantly worse than those of healthy normal children, as demonstrated by lower mean scores on several CHQ-PF28 subscales, including general health, physical functioning, behavior, bodily pain, and parental impact (emotional). In addition, the general health perception of children with tonsil and adenoid disease is similar to the perceptions of children with asthma and juvenile rheumatoid arthritis, but several aspects of health status, as measured by CHQ-PF28 subscale scores, were significantly worse in children with tonsil and adenoid disease. CONCLUSION: The health status impact of tonsil and adenoid disease appears to be quite significant, particularly in aspects related to the parental impact of the child's disease.

Child↗
PubMedDate not supplied

The influence of dental insurance on institutionalized older adults in ranking their oral health status.

To assess whether dental insurance influences how institutionalized older adults ages 65 and older rank their oral health status, a census survey was designed for residents of Durham's (Canada) Municipal Homes for the Aged. The odds ratio (OR) and the Cochran & Mantel-Haenszel's OR were used to estimate the crude and adjusted effect of dental insurance on oral health status, respectively. Overall, 64 percent participated in the interview. Oral health status was ranked as "good," "very good" or "excellent" by 57 percent of the participants. This ranking was clearly unrelated to the residents having dental insurance, as only 28 percent had dental coverage. Significant effect modifiers included age, dental status and whether the participant had visited the dentist within the last year. Dental insurance positively influenced how dentate participants ranked their oral health status (OR = 2.26; 95 percent CI = 1.19; 4.28). In edentulous participants, age and visiting the dentist within the last year modified the effect of dental insurance on oral health status. Having dental insurance reduced the odds of reporting "good," "very good" or "excellent" oral health (OR = 0.20; 95 percent CI = 0.08; 0.49) among the participants ages 85 and older who did not visit the dentist within the last year; however, the opposite was true for their younger counterparts who visited the dentist within the last year (OR = 7.20; 95 percent CI = 1.08; 47.96). In this population, therefore, dental insurance was associated with higher oral health status rank among the dentate, but its effect on the edentulous population depended on age and the pattern of visiting the dentist.

Activities of Daily Living↗
PubMed2007

Mechanisms by which childhood personality traits influence adult health status: educational attainment and healthy behaviors.

OBJECTIVE: The purpose of this study was to test a life span health behavior model in which educational attainment and health behaviors (eating habits, smoking, and physical activity) were hypothesized as mechanisms to account for relations between teacher ratings of childhood personality traits and self-reported health status at midlife. DESIGN: The model was tested on 1,054 members of the Hawaii Personality and Health cohort, which is a population-based cohort participating in a longitudinal study of personality and health spanning 40 years from childhood to midlife. OUTCOME: Childhood Agreeableness, Conscientiousness, and Intellect-Imagination influenced adult health status indirectly through educational attainment, healthy eating habits, and smoking. Several direct effects of childhood traits on health behaviors and health status were also observed. CONCLUSION: The model extends past associations found between personality traits and health behaviors or health status by identifying a life-course pathway based on the health behavior model through which early childhood traits influence adult health status. The additional direct effects of personality traits indicate that health behavior mechanisms may not provide a complete account of relations between personality and health.

Adolescent↗
PubMed1998

[The Dutch version of 'Functional Status II(R)': a questionnaire measuring the functional health status of children].

OBJECTIVE: Clinimetric evaluation of the Dutch version of the Functional Status II(R) (FS II), measuring children's behaviour and the effect of disease on it. DESIGN: Descriptive. SETTING: University of Utrecht, department of General Practice Medicine, and Julius Centre for Patient-linked Research. METHODS: Parents of children (6 months-11 years of age) with or without asthma were questioned using the Dutch translation of the FS II. Parents of children with asthma and of control children were questioned again using the FS II after 24 hours and after one month. A child version of the FS II, developed by our group, was used for children between 8 and 12 years of age. We tested internal consistency, test-retest reliability, discriminant validity, sensitivity to parents' opinion on presence or absence of health complaints and agreement between the parent and the child version. RESULTS: The group included 124 parents of asthmatic children and 224 parents of control children, 111 of whom were aged 8-12 years. The parent version of the FS II showed good reliability and validity. Cronbach's alpha, measuring internal consistency, was between 0.66 and 0.90, and the 24-hour test-retest reliability was between 0.83 and 0.92. FS II-scores of children with asthma were significantly lower than those of children in the control group, and scores of children with health complaints were significantly lower than those of children without any health complaints, cross-sectionally as well as longitudinally. Reliability and validity figures of the child version of the FS II were far behind those of the parent version. Scores on the child version were only weakly related to those on the parent version. CONCLUSION: The parent version of the Dutch FS II is recommended as a generic measure of functional health status of children for medical research. The child version should be improved first.

Adult↗
PubMed2004

Alcohol screening results in elderly male veterans: association with health status and mortality.

OBJECTIVES: To evaluate the association between alcohol screening results and health status or mortality in elderly patients. DESIGN: Cross-sectional and longitudinal cohort studies. SETTING: Primary care clinics at seven Veterans Affairs medical centers. PARTICIPANTS: A total of 16,958 male patients aged 65 and older. MEASUREMENTS: Alcohol screening questionnaires were used to divide patients into four mutually exclusive groups: drinkers who screened negative or positive for problem drinking and nondrinkers (in the previous year) who screened negative or positive for problem drinking. A subset of patients (n=12,491) completed a measure of health status, the Medical Outcomes Study Short Form (SF-36). All-cause mortality was ascertained using Veterans Affairs data over a mean follow-up of 2.8 years. RESULTS: Forty-eight percent of participants reported drinking in the previous year. Half of the drinkers and nondrinkers screened positive for problem drinking. The SF-36 item scores were consistently higher for drinkers than for nondrinkers and for patients who screened negative for problems than for those who screened positive. Similarly, survival was consistently better in drinkers than nondrinkers (mortality hazard ratio (HR)=0.74, 95% confidence interval (CI)=0.68-0.82) and in patients who screened negative for problem drinking than in those who screened positive (mortality HR=0.87, 95% CI=0.80-0.95). Nondrinkers who screened positive for problem drinking had the poorest health status and survival, whereas drinkers who screened negative for problem drinking had the best health status and survival. CONCLUSION: Elderly patients who reported drinking alcohol and those who screened negative for problem drinking had consistently better health status and survival than those who did not drink and those who screened positive.

Aged↗