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PubMed2001

The self-perceived health status of Norwegian physicians compared with a reference population and foreign physicians.

AIMS: To compare the self-perceived health status of a representative sample of Norwegian physicians with a general reference population; and to investigate differences in health status among groups of physicians. METHODS: A cross-sectional postal survey was carried out of 1,126 Norwegian physicians and 1,742 subjects in a general reference population, using the widely used general health status questionnaire--Short Form 36 (SF-36). Scores were adjusted for differences in age, gender and education where applicable. RESULTS: The health status of Norwegian physicians was better than that of subjects with a lower level of education in the four dimensions of the SF-36 related to physical health. Male physicians scored better on the physical functioning scale and lower on vitality and social functioning than comparable university graduates. Older physicians scored better than younger in dimensions related to mental health and social functioning. Norwegian general practitioners reported better health status than colleagues in Sweden and the UK. CONCLUSIONS: The self-perceived health status of Norwegian physicians was as good or better than that of the general population. The cross-national differences could be caused by cultural differences, or be related to practice style or job strain.

Adult↗
PubMed2004

Health status of people of slums in Nairobi, Kenya.

The objective of this study was to describe the health status of people living in the slums of Nairobi. It was designed as a cross-sectional study based on data from visitors at a clinic at Trnava University located in Mukuru slum in Nairobi. There were about 16,000 visits registered at Mary Immaculate Clinic of Trnava University in Nairobi during 2 years of operation. A random 5% sample was drawn from the paper-card database of this clinic to assess basic characteristics and health complaints of visitors. Both self-reported health complaints and diagnoses written by physicians were used to assess health status of participants. More females with average age (by slum) ranging from 20.46 to 21.30 years than males with average age ranging from (by slum) 15.86 to 19.49 years are the visitors of the clinic. The major self-reported health complaints of visitors were cough, abdominal pain, and headache for both sexes. The most frequent diagnoses were consequently virosis, acute respiratory infections, and bronchitis. Differences in health complaints by slums were observed and are described herein. The major health complaints and diagnoses in addition to the differences in health complaints and diagnoses by slum show that environmental conditions can have major influences on health status. Therefore, environmental improvements are important in the improvement of health status. A very high prevalence of respiratory complaints and gastrointestinal problems signify that improvements in air pollution reduction, drinking water provision, and waste management in slums can lead to more significant and sustainable improvements in health status than just simple treatment. This fact should be taken into account when planning future relief programs.

Adolescent↗
PubMed2005

Stress, social support and housing are related to health status among HIV-positive persons in the deep south of the United States.

Self-report health status measures are consistently associated with medical outcomes and are cost-effective. Studies using such measures find that those who live in rural areas or have limited access to support experience poorer health status and poorer outcomes. A survey addressing these issues was administered to 401 HIV-positive persons throughout Alabama. Hierarchical regression models examined the relation of housing stability, stress, substance use and other variables to physical (PCS) and mental (MCS) health status. The sample was 34% female and 66% African-American. Most were receiving antiretroviral medications, and nearly 20% were in unstable housing. Age showed a significant negative relationship to health status. CD4 cell count (p < 0.01) was positively associated with PCS; perceived general stress (p < 0.02) and housing stability (p < 0.04) were negatively associated. The model accounted for 14% of the variance in PCS (p < 0.001). For MCS, general stress (p < 0.001) was negatively associated and substance use tended towards a negative association (p < 0.075). Social support (p < 0.02) was positively associated with MCS. The model accounted for nearly 31% of the MCS variance (p < 0.001). Health status among HIV-positive persons may be improved by assessing and addressing social issues such as social isolation, life stressors and housing.

Adult↗
PubMed1998

Self-assessed health status and selected behavioral risk factors among persons with and without health-care coverage--United States, 1994-1995.

Persons without health-care coverage are more likely to have poor health and be at greater risk for chronic disease outcomes than persons who have health-care coverage. In the United States, the number of persons and the proportion of the population without health-care coverage has increased each year since 1987. State-specific surveillance of health-care coverage can be used to identify subgroups of the population who lack such coverage and may be at increased risk for poor health. To determine state-specific estimates of the prevalence of self-assessed health status and risk factors for chronic disease by health-care coverage status among adults aged 18-64 years, CDC analyzed data from the 1994 and 1995 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis and indicates that adults without health-care coverage were more likely than those with health-care coverage to have poor health status, to be current smokers, and to be less physically active.

Adult↗
PubMed1995

Individual-patient monitoring in clinical practice: are available health status surveys adequate?

Interest has increased in recent years in incorporating health status measures into clinical practice for use at the individual-patient level. We propose six measurement standards for individual-patient applications: (1) practical features, (2) breadth of health measured, (3) depth of health measured, (4) precision for cross-sectional assessment, (5) precision for longitudinal monitoring and (6) validity. We evaluate five health status surveys (Functional Status Questionnaire, Dartmouth COOP Poster Charts, Nottingham Health Profile, Duke Health Profile, and SF-36 Health Survey) that have been proposed for use in clinical practice. We conducted an analytical literature review to evaluate the six measurement standards for individual-patient applications across the five surveys. The most problematic feature of the five surveys was their lack of precision for individual-patient applications. Across all scales, reliability standards for individual assessment and monitoring were not satisfied, and the 95% CIs were very wide. There was little evidence of the validity of the five surveys for screening, diagnosing, or monitoring individual patients. The health status surveys examined in this paper may not be suitable for monitoring the health and treatment status of individual patients. Clinical usefulness of existing measures might be demonstrated as clinical experience is broadened. At this time, however, it seems that new instruments, or adaptation of existing measures and scaling methods, are needed for individual-patient assessment and monitoring.

Health Status Indicators↗
PubMed1994

Symptoms and health status before and six weeks after open cholecystectomy: a European cohort study.ECHSS Group. European Collaborative Health Services Study Group.

The impact of open cholecystectomy on patients' symptoms and health status and their level of satisfaction has been examined to provide a basis for comparison with newer rival treatments. A prospective cohort study using patient and surgeon completed questionnaires before and six weeks after surgery was carried out in 14 general hospitals in eight European countries. Five hundred and eighty three patients were recruited consecutively in 1990 to 1991. Information on their symptoms, general health status, activities of daily living, and satisfaction with their care were collected. After surgery 42.8% of patients reported that they were free of symptoms. Symptoms varied in their responsiveness to surgery--six weeks after surgery 89% of those who had complained of vomiting had improved, 81% of nausea, 69% of loss of appetite, 65% of abdominal pain, and 51% of flatulence. In contrast 28.1% of patients still suffered from flatulence and 23.5% continued to complain of abdominal pain. Most patients' (62.7%) general health improved, 28% were unchanged, and 9.3% were worse. After surgery most patients reported no restrictions in their normal social activities (75-90% depending on the activity) and most (89.5%) felt the results of their operation had been as expected or better than expected. Most patients undergoing open cholecystectomy reported an improvement in their symptoms, health status, and social functioning. This was reflected in their high level of satisfaction. Some patients, however, gained no benefit and a small proportion were worse than before surgery.

Activities of Daily Living↗
PubMed1997

The health status of women with cerebral palsy.

OBJECTIVE: To determine preliminary associations between collected health status variables of women with cerebral palsy (CP) residing in the community. DESIGN: Cross-sectional study using survey research. PARTICIPANTS: Sixty-three women residing in the community were administered the Telephone Questionnaire when contacted to arrange their visit to the study site located within the medical clinic of a local developmental services office. During the course of their visit to the study site, all 63 women completed the CP Study Protocol, in addition to the Mail-in Questionnaire upon completion of study participation. The women ranged in age from 20 to 74 years. MAIN OUTCOME MEASURES: Health status, consisting of four elements: (1) self-reported health status; (2) associated conditions; (3) secondary conditions; and (4) health behaviors (alcohol and tobacco use, physical activity, diet, and health care visit). RESULTS: Women with CP residing in community living arrangements perceived themselves as healthy. The majority of women did not smoke (98%), had not consumed alcohol in the previous month (95%), and ate a balanced diet (52%). Participants also reported engaging in common physical activities (83%) and stretching and doing range-of-motion exercises in the previous week (43%), and participation in aerobic exercise in the previous week (43%). Sixty-eight percent (41 of 60) of the women walked, and more than 50% of the women did not require assistance with activities of daily living. The ability to walk and the use of a wheelchair were associated with participation in the common physical activities. The women reported associated conditions of mental retardation (34%), learning disabilities (26%), and a seizure history (40%). Additionally, the women in the sample reported the occurrence of several secondary conditions common among individuals with CP, including pain (84%), hip and back deformities (59%), bowel problems (56%), bladder problems (49%), poor dental health (43%), and gastroesophageal reflux (28%). Poor dental health was associated with a history of seizures, and associations were also found between pain and mental retardation, and between gastroesophageal reflux and mental retardation. CONCLUSIONS: Women with CP residing in the community perceived themselves as healthy, and the observed health status measures (eg, self-reported health, associated conditions, secondary conditions, and selected health behaviors) support this concept. For the most part, independent relationships were found between several of these measures indicating no significant association among the variables. Where associations were found, however, such as between walking and participation in physical activity, further investigation is warranted for a better understanding of their ramifications in the design of health promotion activities for women with CP.

Activities of Daily Living↗
PubMed2003

Effects of physician-related factors on adult asthma care, health status, and quality of life.

PURPOSE: To study the association of physician characteristics, the characteristics of their practice settings, patient mix, and reported frequency of prescribing asthma medication with patients' health status and health-related quality of life in asthma. METHODS: We conducted a mail-back survey of physicians (n = 147) that included demographic characteristics, practice and training characteristics, and reported prescribing frequencies for common asthma treatments. We also conducted structured telephone interviews with 317 of their patients, assessing demographic characteristics, health status (as measured by the Short Form-12 [SF-12] physical component score), and asthma-specific quality of life (as measured by the Marks questionnaire). RESULTS: In adjusted analyses, pulmonary specialists were more likely to report using leukotriene modifiers (odds ratio [OR] = 4.7; 95% confidence interval [CI]: 1.2 to 18) and theophylline (OR = 3.0; 95% CI: 1.0 to 9.0) in adult patients with asthma. Working in a practice of >75% health maintenance organization (HMO)- or preferred provider organization (PPO)-insured patients was associated with a lower likelihood of prescribing leukotriene modifiers (OR = 0.1; 95% CI: 0.01 to 0.5). Adjusting for patient demographic characteristics and steroid dependence, physician prescribing tendencies were not associated with patients' perceived health status or quality of life. Although an HMO- or PPO-predominant practice was associated with better physical health status (mean difference in SF-12 physical component score, 3.1; 95% CI: 0.05 to 6.2; P = 0.05), there was no statistical association with quality of life. CONCLUSION: The characteristics of physicians, their practices, and the asthma medication prescribing strategies that they adopt are not strongly associated with patients' perceived outcomes.

Adult↗
PubMed1992

Recent developments and future issues in the use of health status assessment measures in clinical settings.

This paper provides a broad overview of the assessment of health status in clinical practice in three parts. Yesterday: The nation has undergone a paradigm shift in health-related thinking. The former paradigm emphasized only disease; the new emphasizes health, functioning, well-being, and disease. Measures of health and disease have evolved to reflect the new paradigm. Many are designed for clinical settings, based on measurement science, and are relatively brief. These newer measures have been used to document the natural history of disease, evaluate treatment effectiveness, and improve clinical case management. Today: Two barriers block full-scale use in clinical settings. The first barrier involves the meaning and interpretation of health status scores. Patients' scores are influenced by several types of patient mix variables and the timing of measurements. Interpretation is enhanced by valid normative data displaying the variability in health status among homogenous patient groups. The second barrier is utilization and mainstreaming. It involves all of the issues associated with changing the day-to-day behavior of clinicians and providers' routine processes to facilitate routine use of health status measures in clinical settings. Tomorrow: In the next decade, the nation will attempt to overhaul the health care system. As it does so, it will struggle with many issues: 1) clarifying the true aim of health care; 2) standardizing measures of health across patients, providers, and settings to evaluate benefit; 3) establishing cause and effect among structural-input factors, care delivery processes, and health outcomes valued by society; and 4) determining if and when cost containment actions have adverse effects on health outcomes. In this context, the importance of interpreting change in health status has a central role.

Activities of Daily Living↗
PubMedDate not supplied

The family contribution to health status: a population-level estimate.

PURPOSE: Clinical studies have shown strong family influences on individual health, but the aggregate importance of family effects for population health is unknown. Our objective was to estimate, at a population level, the variance in individual health status attributable to the family. METHODS: Secondary data were used from the Community Tracking Study, a stratified random sample of the US population. Hierarchical linear modeling was used to estimate the individual and family components of health status. The setting was 60 US communities, which account for approximately one half of the population. Participants were US residents aged 18 years and older who shared a household with family members in the study (N = 35,055). Main outcome measures were the Short Form-12 (SF-12) self-reported physical and mental subscales. RESULTS: Depending on the family configuration, 4.5% to 26.1% of the variance in individual health status was derived from the family. The proportion was highest for older married persons. The family effect on health status was generally similar for physical and mental health. Including age, family income, and health insurance status in the regression equations moderately reduced the family variance component. CONCLUSIONS: At a population level, the family contribution to individual health status is measurable and substantial. The shared characteristics of income and health insurance account for only a modest portion of the effect. Health policy and interventions should place more emphasis on the family's role in health.

Adolescent↗
PubMed2005

Health status, utilization patterns, and outcomes of persons with intellectual disabilities: review of the literature.

A literature review was conducted to analyze existing data on health status, health care utilization, and medical outcomes of persons with intellectual disabilities. We found that barriers exist, but evidence indicates that (a) individuals with intellectual disability and medical needs are living in the community, (b) people with significant medical conditions can be maintained in community settings, and (c) medical supports can and are provided to people with intellectual disabilities and allied medical conditions to enable community living. However, some people had unmet medical needs, and the availability of and access to community-based services were problematic for others. These contradictory findings indicate that it is possible to provide services in the community, but the service delivery system needs improvement.

Adult↗
PubMed1994

Health status of individuals entering a cardiac rehabilitation program as measured by the medical outcomes study 36-item short-form survey (SF-36).

BACKGROUND AND PURPOSE: The goal of health care for individuals with chronic disease is the improvement of function and well-being. Although the individual's perception of his or her quality of life may be the best indicator of achievement of this goal, measurement of self-perceived quality of life, or health status, is not a routine component of evaluation. The purposes of this article are to describe the health status of individuals upon entry into a cardiac rehabilitation program and to demonstrate the use of a comprehensive, generic health status measure in this group. SUBJECTS: The subjects of this study were 789 men and women enrolled in one of 13 cardiac rehabilitation programs in the state of Massachusetts. METHODS: As part of a large database, subjects completed a 36-item generic questionnaire, Short Form 36 (SF-36), that examines eight health concepts. Scores range from 0% to 100%; a higher score is consistent with better health status. Results. Mean uncontrolled scores ranged from 26.6 to 70.8. Mean scores adjusted for sex, age, and education ranged from 27.1 to 70.9. In light of previously published data using a similar 20-item scale, our results show that cardiac disease is associated with reductions in health-related quality of life. CONCLUSION AND DISCUSSION: Health status measurement provides information that can supplement the usual measures of impairment in patients with cardiovascular disease. The findings of this study contribute to the understanding of health status of individuals who enroll in cardiac rehabilitation programs. The health status instrument used in this study has potential as a useful, practical measurement tool for use in the clinical setting.

Activities of Daily Living↗
PubMed1999

Longitudinal relationships between lifestyle and cardiovascular and bone health status indicators in males and females between 13 and 27 years of age; a review of findings from the Amsterdam Growth and Health Longitudinal Study.

UNLABELLED: The Amsterdam Growth and Health Longitudinal Study is longitudinal co-hort study on 181 males and females initially aged 13 years, with follow-up measurements at ages 14, 15, 16, 21 and 27 years. METHODS: Anthropometrical, biological and lifestyle parameters, and age 27 also bone mineral density (BMD) of the lumbar spine (L2-L4), were measured repeatedly. Adolescent dietary intake and physical activity was related to adult cardiovascular and bone health status indicators by MLR; longitudinal relationships between physical activity and dietary intake, and cardiovascular health status indicators were assessed hy GEE-analysis. RESULTS: Adolescent physical activity was not related to most of the indicators of adult cardiovascular health status, with the exception of a positive relationship with the waist-to-hip in females; in males 'energetic' adolescent physical activity contributed significantly to adult BMD; both in males and females, when taking the entire longitudinal period into account, peak strain physical activity was a relatively more important predictor of adult BMD than 'energetic' physical activity; calcium intake during adolescence was not a significant predictor of bone health status measured at age 27, both in males and females; a consistent significant positive longitudinal relationship was found between physical activity and serum HDL-cholesterol and significant negative longitudinal relationships were found with the subscapular skinfold and with body fat mass; a positive longitudinal relationship was found between serum total cholesterol (TC) and cholesterol intake, saturated fat (SFA) intake and the Keys-score; a negative longitudinal relationship was found between TC and polyunsaturated fit and total energy intake; for HDL a positive longitudinal relationship was found with SFA intake; low tracking was found for physical (in-) activity and dietary intake variables.

Adolescent↗
PubMed2003

Humor coping, health status, and life satisfaction among older adults residing in assisted living facilities.

The present study examined the relationships between humor coping, health status, and life satisfaction among older residents of assisted living facilities. A structural equation model with latent variables was specified for the three variables. Health status was expected to directly affect humor coping and life satisfaction. Humor coping was hypothesized to have a direct association with life satisfaction and indirectly affect the relationship between health status and life satisfaction. Participants completed the Multidimensional Functional Assessment Questionnaire, Coping Humor Scale, and Life Satisfaction Index A. The relationships between health status and humor coping and health status and life satisfaction were statistically significant. Both the direct association of humor coping on life satisfaction and the intervening role between health status and life satisfaction were not supported. Humor as a coping strategy seems to be available to older adults who are in better health.

Adaptation, Psychological↗
PubMed2004

Longitudinal changes in health status using the chronic respiratory disease questionnaire and pulmonary function in patients with stable chronic obstructive pulmonary disease.

Long-term changes in health status have been less evaluated in patients with chronic obstructive pulmonary disease (COPD), in comparison to the changes in forced expiratory volume in 1 s (FEV1). Accordingly, we examined the clinical course of health status as well as pulmonary function in COPD patients, and investigated the relationship between the change in health status and the change in pulmonary function in a 3-year longitudinal study involving 224 patients with COPD. Health status using the Chronic Respiratory Disease Questionnaire (CRQ) and pulmonary function were measured at baseline and every six months over three years. We used the random effects model for the slopes to estimate the longitudinal changes. A total of 147 patients completed the 3-year study. The dyspnoea, fatigue, and emotional function domains of the CRQ declined slowly but significantly over 3 years (p = 0.001, 0.003, and 0.004, respectively) with a mean decline rate of 0.08/year. This means that it would take about 6 years to reach the minimal important change of 0.5 on the CRQ. The mean decline in post-bronchodilator FEV1 was 60 ml/year. None of the changes in any of the domains of the CRQ were significantly correlated with the changes in pulmonary function. We have found that, in comparison to the decline in pulmonary function, health status evaluated by the CRQ declined significantly but very slowly in three of four domains over three years in patients with COPD. Furthermore, we have demonstrated that there was no significant relationship between the change in health status and the change in pulmonary function.

Aged↗
PubMed2001

A patient-oriented health status measure in outpatient rehabilitation.

OBJECTIVES: The purpose of this study was to assess the utility of a patient-centered health status measurement tool in multiple outpatient rehabilitation clinics and to characterize health status before and after an outpatient physical therapy intervention as part of that assessment. DESIGN: Six outpatient rehabilitation clinics voluntarily agreed to incorporate a standardized patient-centered health status questionnaire into everyday practice. Patients completed the SF-36 health status questionnaire before initiating treatment and again at discharge. Only nonsurgical patients without comorbidities were enrolled. RESULTS: Voluntary application of the SF-36 on a small scale was achieved over a period of 3-4 mo. All health concepts improved except general health perceptions. CONCLUSION: The results suggest that (1) a standard patient-oriented health status questionnaire can be incorporated into outpatient rehabilitation clinics, and useful information can be derived regarding outcomes; (2) careful administrative coordination is necessary to optimize follow-up and decrease burden on both patients and clinicians; (3) although improvements in health status were demonstrated, small sample sizes and the lack of control groups prevents conclusions regarding the effectiveness of physical therapy treatment; and (4) the magnitude of effect sizes suggests that controlled studies could be performed by clinicians partnering with researchers to improve outpatient rehabilitation.

Adult↗
PubMed1997

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

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

Adolescent↗
PubMed1994

Using health status surveys in medical consultations.

The goal of this research was to identify patients' preferences for physician inquiry into various aspects of health status and to examine whether the preconsultation availability of health status data (collected from the SF-36 Health Status Questionnaire) influenced the physician's conduct during the consultation. Results from 58 prenatal patient visits yielded the following findings. First, patients expressed strong preferences for physicians to ask about the patient's perceptions of health in general and about physical dimensions of health status such as pain, vitality, and role limitations due to physical functioning. Patients also were more satisfied when doctors were perceived as having asked about these issues. Second, patients varied considerably in their preferences for physician inquiries into psychosocial issues such as social functioning, mental health, and role limitations due to emotional problems. Approximately half the patients wanted these matters discussed, whereas the remainder either did not care or preferred that doctors not ask about these topics. Third, the preconsultation availability of health status information had little effect on the degree to which physicians asked about the patient's health-related quality of life. Clinical implications are discussed.

Adolescent↗