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PubMed2003

Factors which predict physical and mental health status in patients with amyotrophic lateral sclerosis over time.

OBJECTIVES: To determine which factors are predictive of physical and mental health one year after a first measurement of health status in amyotrophic lateral sclerosis (ALS) patients. METHODS: The Physical Component Summary (PCS) score and the Mental Component Summary (MCS) score of the SF-36 were used as the main outcome measures in patients enrolled in the European ALS Health Profile Study (ALS-HPS). Correlation and stepwise regression procedures were used to determine the relationship between patients' physical and mental health status at follow-up with baseline measures. RESULTS: A total of 1118 patients were recruited into the ALS-HPS, of which 918 (82.11%) returned fully or partially completed baseline and follow-up surveys. PCS scores declined over time. No significant changes were reported for the MCS scores over time for patients with ALS. Baseline scores were found to be significant predictors of patients' health status over time. CONCLUSIONS: Overall, patients' physical health status at the time of recruitment was the major predictor of the physical health status at both first and second follow-up time assessments. The same relationship was found between baseline and follow-up mental health status. The study also confirms the appropriateness of the use of the SF-36 in ALS patients.

Activities of Daily Living↗
PubMed1990

Health status reports in the care of patients with rheumatoid arthritis.

We examined the use of formal health status reports every 3 months over 1 year in the clinical care of patients with rheumatoid arthritis (RA). The reports consisted of single-page, computer-generated summaries of scores derived from either the AIMS (Arthritis Impact Measurement Scales) or the MHAQ (Modified Health Assessment Questionnaire) health status questionnaires. A total of 1920 subjects from 27 community practice sites were randomly assigned to three study groups in each practice: intervention, attention placebo and control. Results showed that 55% of the physicians found the reports to be at least moderately useful as an aid to patient management, primarily for improving the doctor-patient relationship. However, no detectable differences among the three groups were seen in terms of medication compliance, number of physician visits, number of referrals, frequency of major medication changes, attitudes towards the physician, patient satisfaction or change in health status over 1 year. The failure to demonstrate objective benefits of health status reports in this study may be due to physician unfamiliarity with health status scores, failure to link the report with an office visit, the relative stability of clinical status in the subjects over 1 year and the relatively short time-frame of the study.

Activities of Daily Living↗
PubMed1999

Associations between health status and utilities implications for policy.

BACKGROUND: If shape of a person's utility function is associated with his health status, as is predicted by Prospect Theory, the use of utilities from the healthy could result in 'de facto' discrimination against the sick. OBJECTIVES: To determine if patients' utilities for hypothetical states and for their current health were associated with their health status. DESIGN: A cross-sectional study of the health and values of patients with depressive illnesses. SETTING: Patients from three large primary care practices with various medical illnesses complicated by symptoms of depression. MEASURES: Short-Form 12 health status measurements, standard gamble, and visual analog scale preference measurements for patients' current health and for three hypothetical states. RESULTS: One hundred and forty nine patients enrolled in the study and 139 patients completed the survey. Utilities for the best and worst states were similar across different levels of health status; however, standard gamble utilities for intermediate health states were higher for patients in poorer health than patients in better health (P = 0.019,) suggesting utility functions with radically different shapes. Utilities for patients' current health were also associated with their health status. Patients in poor health tended to overvalue their current health relative to the most similar hypothetical state; whereas, patients in good health tended undervalue their current health state (P = 0.036). CONCLUSIONS: In patients with depressive illnesses, there were significant interactions between health and values, that were consistent with the predictions of Prospect Theory, and that could result in systematic under valuation of the health effects of treatments that primarily benefit more severely patients ill.

Adult↗
PubMedDate not supplied

Self-perceived health status of Irish breast cancer survivors.

BACKGROUND: There is a paucity of data on the health status of breast cancer survivors. AIMS: To measure the self-perceived health status of a cohort of breast cancer survivors by means of the SF-36 questionnaire. METHODS: The questionnaire was administered to 120 survey participants. Findings were compared with those of an external comparison group. RESULTS: The health status of the survey participants was found to be significantly better than that of the comparison group on four of the eight SF-36 dimensions--social functioning, mental health, vitality and general health perceptions. CONCLUSIONS: The self-perceived health status of breast cancer survivors merits further research in the Irish context. Inclusion of the SF-36 questionnaire as an outcome measure is recommended.

Adult↗
PubMed2006

Impaired health status in Type D patients following PCI in the drug-eluting stent era.

BACKGROUND: Drug-eluting stenting reduces restenosis post-percutaneous coronary intervention (PCI), but subgroups of patients may not benefit optimally from this procedure. We examined the impact of Type D personality on health status over time and the clinical relevance of Type D as a predictor of impaired health status at 12 months in unselected post-PCI patients. METHODS: Consecutive patients (n=692) participating in the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry completed the Type D Scale at 6 months and the Short Form Health Survey 36 (SF-36) at 6 and 12 months post-PCI. RESULTS: Although there was a significant improvement in health status over time (p<0.001), Type D patients reported a substantially lower score on all health status domains of the SF-36 compared with non-Type D patients (p<0.001). Type D personality was an independent predictor of impaired health status on all SF-36 sub domains at 12 months except for physical functioning, adjusting for baseline demographic and clinical variables and health status at 6 months. In these adjusted analyses, Type D personality increased the likelihood of impaired health status at 12 months post-PCI from 60% (OR: 1.60; 95% CI: 1.04-2.46) to almost 300% (OR: 3.99; 95% CI: 2.52-6.32), varying among the parameters analyzed. CONCLUSIONS: Type D personality was associated with impaired health status in post-PCI patients treated in the drug-eluting stent era. The role of personality factors as determinants of clinical outcome and health status should not be overlooked as these factors may have much explanatory power.

Adult↗
PubMed2002

Analysis of the factors related to mortality in chronic obstructive pulmonary disease: role of exercise capacity and health status.

In this study, we analyzed the relationships of exercise capacity and health status to mortality in patients with chronic obstructive pulmonary disease (COPD). We recruited 150 male outpatients with stable COPD with a mean postbronchodilator FEV1 at 47.4% of predicted. Their pulmonary function, progressive cycle ergometry, and health status using the Chronic Respiratory Disease Questionnaire, the St. George's Respiratory Questionnaire (SGRQ), and the Breathing Problems Questionnaire were measured at entry. Among 144 patients who were available for the 5-year follow-up, 31 had died. Univariate Cox proportional hazards analysis revealed that the SGRQ total score and the Breathing Problems Questionnaire were significantly correlated with mortality; however, with the Chronic Respiratory Disease Questionnaire, the total score was not significantly correlated. Multivariate Cox proportional hazards analysis revealed that the peak oxygen uptake and the SGRQ total score were both predictive of mortality, independent of FEV1 and age. Stepwise Cox proportional hazards analysis revealed that the peak oxygen uptake was the most significant predictor of mortality. We found that exercise capacity and health status were significantly correlated with mortality, although different health status measures had different abilities to predict mortality. These results will have a potentially great impact on the multidimensional evaluation of disease severity in COPD.

Aged↗
PubMed1999

Health status in 52 long-term survivors of pediatric brain tumors.

The percentage of children who survive childhood brain tumors is increasing. A number have neurological and other sequelae which impact on the quality of their survival. We reviewed long-term survivors using a standardized health status instrument. The mothers of 52 survivors of brain tumors were surveyed. Eight different aspects (attributes) of health status were scored. The first 6 of these attributes were scored in a health status index (HSI) developed at McMaster University. Subgroup analysis was performed. Limitation in the quality of life was found in one of the 8 attributes in all but 2 of the subjects. The health status index (HSI) score using the first 6 attributes of this survey had a median of 0.73 (range 0.16-1.00). This score is lower than that found in previously surveyed survivors of leukemia or other childhood cancers. Examination of age at diagnosis, extent of surgery, sex and therapeutic modalities used showed no correlation with HSI score. Those with supratentorial astrocytomas had a lower HSI score (0.65) than those with infratentorial astrocytomas (0.85) (p = 0.05). Children with craniopharyngiomas had a poor score (0.64). This survey shows that the survivors of brain tumors have an appreciable burden of morbidity. Most have deficits in health status that affect many areas of their lives. Apart from site of the primary tumor, there was little correlation between subgroups studied and health status. The health status of children who survive brain tumors is lower than that of survivors of other childhood malignancies.

Adolescent↗
PubMed2007

Predicting the changes in depressive symptomatology in later life: how much do changes in health status, marital and caregiving status, work and volunteering, and health-related behaviors contribute?

This study examined the unique effects of four variable groups on changes in older adults' depressive symptoms for a 2-year period: (1) baseline health and disability status, (2) changes in health and disability since baseline, (3) stability and changes in marital and caregiving status and in work and volunteering, and (4) stability and changes in health-related behaviors. With data from the 1998 and 2000 interview waves of the Health and Retirement Study, the authors used gender-separate multistep (hierarchical) residualized regression analyses in which the Center for Epidemiological Studies Depression scale (CES-D) score at follow-up is modeled as a function of the effect of each group of independent variables. As hypothesized, changes in health, disability, marital, and caregiving status explained a larger amount of variance than the existing and stable conditions, although each group of variables explained a relatively small amount (0.3-3.4%) of variance in the follow-up CES-D score.

Aged↗
PubMed2002

Trends in racial and ethnic-specific rates for the health status indicators: United States, 1990-98.

The Health Status Indicators (HSIs) were developed as part of the Healthy People 2000 process to facilitate the comparison of health status measures at national, State,and local levels. In this report national trends in racial and ethnic-specific rates for 17 HSIs are examined for the period from 1990-8. One of three overarching goals of Healthy People 2000 was to reduce health disparities. Examination of trends in the HSIs indicates that rates for most racial/ethnic groups improved. Rates for American Indian or Alaska Natives did not improve for six of the HSIs. An index of disparity, a summary measure of disparity among race/ethnic-specific rates, was used to measure changes in disparity between 1990 and 1998. The index of disparity decreased for 12 of the HSIs. Based on this index, racial/ethnic disparity in the percent of low birthweight infants declined by 19 percent, disparity in the percent of children under 18 years of age in poverty and in the syphilis case rate declined by 13 percent, and disparity in the stroke death rate declined by 11 percent. The index declined by less than 10 percent for eight other indicators. The index of disparity increased between 1990 and 1998 for the other five HSIs examined here. The index of disparity increased by more than 10 percent for work-related injury death rates, motor vehicle crash death rates, and suicide death rates. While rates for the HSIs have improved, not all groups have benefited equally and substantial differences among racial/ethnic groups persist.

Accidents, Occupational↗
PubMed2003

Self-reported health status among treated methamphetamine users.

Very little research has examined how drug abuse is related to general health status over the long term among both young and middle-aged adults. In this article, we investigate how self-reported health status is related to prolonged methamphetamine (MA) use in a diverse sample of MA users from ages 18 to 52 who have been treated for drug abuse in Los Angeles County. Using retrospective data, we investigate how prolonged MA use within younger and older age groups is related to two self-reported measures of current health status: the presence of a health condition that began after starting illegal drug use, and overall health. We control for the effects of drug use history, social and demographic factors, and other early experiences (e.g., early sexual abuse) that might be obstacles to achieving good health later in life. We find that having a current health condition is predicted by greater age and by more prolonged MA use, especially among younger people. Early sexual abuse predicts both measures of poor health. Current health status is predicted by several measures of drug use history and early experiences, but by fewer social and demographic factors. The results suggest that reduction of MA use among younger people is important in promoting their later health and that MA treatment services could be improved by a greater understanding of how early experiences influence later health.

Adolescent↗
PubMedDate not supplied

Historical and current predictors of self-reported health status among elderly persons in Barbados.

OBJECTIVE: To understand the relative contribution of past events and of current experiences as determinants of health status among the elderly in the Caribbean nation of Barbados, in order to help develop timely public health interventions for that population. METHODS: The information for this prevalence study was collected in Barbados between December 1999 and June 2000 as part of the "SABE project," a multicenter survey in seven urban areas of Latin America and the Caribbean that evaluated determinants of health and well-being in elderly populations (persons 60 and older). We used ordinal logistic regression to model determinants of self-reported health status, and we assessed the relative contribution of historical socioeconomic indicators and of three current modifiable predictor groups (current socioeconomic indicators, lifestyle risk factors, and disease indicators), using simple measures of association and model fit. RESULTS: Historical determinants of health status accounted for 5.2% of the variation in reported health status, and this was reduced to 2.0% when mediating current experiences were considered. Current socioeconomic indicators accounted for 4.1% of the variation in reported health status, lifestyle risk factors for 7.1%, and current disease indicators for 33.5%. CONCLUSIONS: Past socioeconomic experience influenced self-reported health status in elderly Barbadians. Over half of this influence from past events was mediated through current socioeconomic, lifestyle, and disease experiences. Caring for the sick and reducing lifestyle risk factors should be important considerations in the support of the current elderly. In addition, ongoing programs for poverty reduction and increased access to health care and education should be considered as long-term strategies to improve the health of the future elderly.

Aged↗
PubMed1996

Socioeconomic differences in the utilization of health services in a Dutch population: the contribution of health status.

The main question addressed here is to what extent socioeconomic differences in the utilization of health services in the Netherlands can be explained by health status. Our aim is to assess whether the health services has achieved equal assess for equal needs, and which health status measures best control for need. Cross-sectional survey data from 2867 respondents with respect to utilization of six different types of health services are used for analysis. Socioeconomic differences in utilization were present for all services after we controlled for age, sex and marital status. By controlling for health status, differences changed markedly for all health services analyzed. Differences in general practitioner contacts diminished but did not disappear (adjusted odds ratio primary education/university 2.22). The pattern of excess contacts with specialist physicians reverses (adjusted odds ratio 0.74). This is also true for the physiotherapist. The pattern of hospitalizations is unclear. Use of over-the-counter medicines is little affected by control for health status. Adjusted differences in use of prescription medicines become small. Control for health status is best achieved with a set of health measures covering several dimensions of health. Whether low relative utilization among those with low education reflects limited access, or whether higher use of other services is compensatory is hard to decide on the basis of the study. Monitoring access to health care is important for all sorts of systems, including those which are believed to be equitable.

Adolescent↗
PubMed2002

Haemophilia Utilization Group Study: assessment of functional health status in haemophilia.

The purpose of this study was to assess the relationship between health care and utilization of that health care, and to provide a base measurement of health status in patients with haemophilia. Provider interview and retrospective chart review of 336 patients with haemophilia treated during 1995 at one of five comprehensive haemophilia treatment centres was conducted to measure patient health status characteristics and utilization of health care. Two health status scales were included. The first, the Self-Care Measure, was a four-point single item scale measuring the patient's ability for basic self-care, which was scored by a chart review and an interview with the health-care provider. The second, the Haemophilia Utilization Group Study (HUGS) Functional Status Measure, is a four-item, 10-point scale developed specifically for patients with haemophilia. Our sample represents 27% of actively treated patients in region IX. The mean score on the HUGS Functional Status Measure was 8.7 (SD=2.4). The HUGS scale exhibited a ceiling effect across all four scales: attitude (n=269, 80.1%), overall wellbeing (n=263, 78.3%), working (n=254, 75.6%) and orthopaedic status (n=195, 58.0%). Both higher total health-care costs and factor VIII annual costs were significantly associated with lower scores on the HUGS Functional Status Measure. Health status is a critical component in the assessment of the utilization and outcomes of care. In the absence of the availability of a patient interview, the HUGS Functional Status Measure can be used as one characteristic that explains the variation in the utilization of health care by patients with haemophilia.

Activities of Daily Living↗
PubMed1992

Importance of sensitivity to change as a criterion for selecting health status measures.

OBJECTIVE: To assess the sensitivity to change over time of four health status instruments in relation to patients with rheumatoid arthritis. DESIGN: Observational three month study of four self assessed instruments (arthritis impact measurement scales (AIMS), health assessment questionnaire (HAQ), Nottingham health profile (NHP), functional limitations profile (FLP)). SETTING: One rheumatology unit. PATIENTS: 101 patients with definite or classic rheumatoid arthritis. MAIN MEASURES: Change scores for dimensions of instruments, as determined by effect size (mean change in score/baseline standard deviation of variable) and conventional rheumatological measures, at baseline and after three months. RESULTS: Change scores for comparable dimensions (mobility, activities of daily living, household, pain, mood or emotion, and social scales) of the instruments were compared among 30 patients who considered their health status to have improved over three months. For all dimensions of health status the magnitude of change varied considerably according to the instrument. Maximum range in effect size was for social scales (AIMS 0.06, NHP 0.24, FLP 0.60). No single instrument seemed consistently to show the most change over all dimensions. CONCLUSION: Selection of health status instruments for audit or evaluation may have a considerable impact on the pattern of results obtained, and the "responsiveness" of such scales should be as carefully examined as their reliability and acceptability when selecting outcome measures.

Activities of Daily Living↗
PubMed1994

Do patients' health status reports predict future hospital stays for patients with an acute myocardial infarction?

OBJECTIVE: Although patients' reports of health status and functioning have been shown to be reliable and valid measures for use in health care research, there is limited information on their practical utility in clinical settings. The purpose of this study was to determine if patients' reports of physical and psychosocial health status have prognostic value by predicting future hospital stays in acute myocardial infarction (AMI) patients. METHODS: Research design was an observational, longitudinal follow-up study involving a sample of 132 AMI patients recently discharged from nine community hospitals. One hundred twelve patients (85%) completed the study. Patient reports of general health status, diagnosis-specific measures of health status, medical history, and demographic characteristics were collected one to two months post AMI; follow-up data were gathered six months later to identify occurrence of new cardiac-related stays. RESULTS: Poor psychosocial functioning and cardiac symptoms were significantly associated with the likelihood of being rehospitalized (odds ratios of 4.62 and 4.00). Multivariate results, however, show that poor psychosocial function and younger age--but not cardiac symptoms--are significant independent predictors of new hospital stays, after controlling for medical history and demographic variables. CONCLUSION: Simple patient reports of health status, which physicians can obtain easily from AMI patients shortly after an infarction, are predictive of rehospitalization.

Acute Disease↗
PubMed1988

Residence differences in the health status of elders.

Using data from the 1984 Supplement on Aging to the National Health Interview Survey, this study examined residential differences on a selected group of health status measures among persons 65 years of age and older (N = 11,497). Mean values on indicators of health and impairment for each of the residence categories were examined before and after adjusting for distributional differences in background and demographic characteristics which are associated with both health and residence. Three important conclusions emerged from the analysis: (1) health status does not vary with residence in a unitary fashion; (2) the relationship between residence and health status does not appear to fall along a straightforward rural-urban continuum; and (3) there is both diversity in, and a general patterning of, the significant relationships between health and residence with the extremes of health status located in the rural categories.

Activities of Daily Living↗
PubMed1996

Progress towards the year 2000: assessing the health status of minorities in Texas.

In 1991, the Centers for Disease Control and Prevention released a consensus set of 18 health status indicators to help communities assess their general health status and focus local, state, and national efforts on tracking the year 2000 objectives. States and local communities were encouraged also to analyze the indicators for each major racial and ethnic population in their jurisdictions. This article presents an update of trends in Texas for the health status indicators for the total population, along with comparisons by race and Hispanic origin for the most recent data. Analysis of these data reveals that the health status for the total population is improving as we approach the year 2000. Yet despite these overall gains, significant disparities exist between the total population and the racial and ethnic minorities in Texas. Further efforts are needed to reduce these health disparities.

Adult↗