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PubMed2004

Outcome measurement: health status and quality of life.

Measures of health-related quality of life, which assess patients' symptoms, their functioning, and their satisfaction with their health status, have received increased attention. Quality-of-life measures specifically developed for patients with rheumatoid arthritis and ankylosing spondylitis have been reported, and generic quality-of-life measures have been validated in patients with diverse rheumatic diseases. Although many studies have assessed the psychometric properties of health status measures, few studies have focused on the interpretation and meaning of questionnaire results. New measures should identify the unique role they occupy in patient assessment.

Arthritis↗
PubMed2000

Measurement of health status and quality of life in neonatal follow-up studies.

Mortality and neuro-developmental outcome can be precisely measured but in order to interpret the significance of changes in them, further information is needed about health status, the effect of health status on lifestyle of survivors and their families, the quality of life experienced by survivors and the value placed by the public and survivors on different health states. The ability to measure such aspects of health now allows more relevant follow-up studies to be designed. This article discusses concepts of health status and quality of life and the problems in applying these to children. There follows a critique of modern instruments for measuring health status and quality of life and their application in neonatal follow-up studies. We recommend that only a small number of well-established instruments should be considered so that results are valid and can be compared with other studies.

Follow-Up Studies↗
PubMed2006

The health status of young adults in the United States.

The health issues of young adulthood have received relatively little attention compared with those of adolescence, although the critical issues in young adulthood parallel those of adolescence. Young adults often fare worse than adolescents on health indicators, with many measures of negative outcomes--including rates of injury, homicide, and substance use--peaking during the young adult years. The contextual factors shaping health status and access to care in young adulthood differ significantly from the context of adolescence. This article synthesizes national data to present a health profile of young adults, reviewing social indicators that describe the context of young adulthood and presenting measures of health status. We examine mortality, morbidity, risky behaviors, and health care access and utilization, identifying the most significant gender and racial/ethnic disparities. The article also identifies limitations of existing data and offers suggestions for future research and health monitoring in this area. We conclude with a discussion of current efforts to address the health and well-being of young adults and argue for creating a national health agenda for young adults that includes research, programs and policies to address health issues during this period of the lifespan.

Accidents↗
PubMed1999

Associates of health status in patients with systemic lupus erythematosus.

OBJECTIVE: To determine the health status of patients with systemic lupus erythematosus (SLE) and to identify the associations of this domain. METHODS: One hundred ninety-five consecutively attending patients with SLE were studied at 2 centers. Health status was measured by 8 composite scales of the Medical Outcomes Study Short Form 36 (SF-36). The mean scores for each subscale of the SF-36 for patients with SLE were compared to those of a healthy population. The effect of patients' age, sex, ethnic origin, marital status, education level, disease duration, disease activity (assessed by the Systemic Lupus Activity Measure), end organ damage (assessed by the Systemic Lupus International Coordinating Clinics/American College of Rheumatology Damage Index), social support (using the Interpersonal Support Evaluation List), and patients' satisfaction with medical care (using the Patient Satisfaction Questionnaire) on each SF-36 subscale was determined. Student's unpaired t test and multiple regression analysis were applied for statistical analysis. RESULTS: Patients with SLE had significantly lower scores in each subscale of the SF-36 compared to a control population. Higher disease activity was associated with worse physical function, role-physical, bodily pain, general health, vitality, and social function. Greater social support was associated with higher scores in physical function, bodily pain, general health, vitality, social function, role-emotional, and mental health. Increasing total end organ damage determined worse physical function and general health. Higher patient general satisfaction with care was associated with better general health. CONCLUSION: The health status of patients with SLE may be improved by increasing patients' social support and satisfaction with health care, as well as controlling SLE disease activity and preventing organ damage.

Adolescent↗
PubMed2002

Patient protection and risk selection: do primary care physicians encourage their patients to join or avoid capitated health plans according to the patient's health status?

BACKGROUND: Individual physicians who are paid prospectively, as in capitated health plans, might tend to encourage patients to avoid or to join these plans according to the patient's health status. Though insurance risk selection has been well documented among organizations paid on a prospective basis, such physician-level risk selection has not been studied. OBJECTIVE: To assess physician reports of risk selection in capitated health plans and explore potentially related factors. DESIGN AND PARTICIPANTS: National mailed survey of primary care physicians in 1997-1998, oversampling physicians in areas with more capitated health plans. RESULTS: The response rate was 63% (787 of 1,252 eligible recipients). Overall, 44% of physicians reported encouraging patients either to join or to avoid capitated health plans according to the patients' health status: 40% encouraged more complex and ill patients to avoid capitated plans and 23% encouraged healthier patients to join capitated plans. In multivariable models, physicians with negative perceptions of capitated plan quality, with more negative experiences in capitated plans, and those who knew at each patient encounter how they were being compensated had higher odds of encouraging sicker patients to avoid capitated plans (odds ratios, 2.0, 2.2, and 2.0; all confidence intervals >1). CONCLUSIONS: Many primary care physicians report encouraging patients to join or avoid capitated plans according to the patient's health status. Although these physicians' recommendations might be associated primarily with concerns about quality, they can have the effect of insulating certain health plans from covering sicker and more expensive patients.

Adult↗
PubMed2003

Relation of dietary quality, physical activity, and smoking habits to 10-year changes in health status in older Europeans in the SENECA study.

OBJECTIVES: This study investigated the effect of healthy lifestyle behaviors on self-rated health and self-care ability over a 10-year follow-up period in older persons in the SENECA study. METHODS: Health status and lifestyle behaviors were examined in 1988/1989, 1993, and 1999 in 216 men and 264 women, born between 1913 and 1918, from 7 European countries. RESULTS: Self-rated health and self-care ability declined in men and women with healthy and unhealthy lifestyle habits over the 10-year follow-up period. Inactive and smoking persons had an increased risk for a decline in health status as compared with active and nonsmoking people. No effect of a healthy, Mediterranean-like diet on the deterioration in health status was observed. CONCLUSIONS: Being physically active and nonsmoking delayed deterioration in health status in older participants aged 70 to 75 years in the SENECA study.

Aged↗
PubMed1998

Lifestyle and periodontal health status of Japanese factory workers.

The present study investigated the association of lifestyles to periodontal health status of workers in a manufacturing company in Japan. In a annual health checkup, periodontal health status was assessed by using the Community Periodontal Index (CPI) criteria and analysed by modified Miller's CPI score. Lifestyle information was also obtained by a self-administered questionnaire. Bivariate and multivariate analyses were used to examine the relationship between lifestyle and oral health care variables and 2 indicators of periodontal health status. These were the modified Miller's CPI score and the probability of subjects in the upper 25th percentile of CPI distribution as an indicator of poor periodontal health. The modified Miller's CPI score was found to increase with age, but to vary according to the workers' lifestyles. In bivariate analyses, significant variables were age, smoking, alcohol consumption, toothbrushing frequency, toothbrushing method, and use of interdental cleaners. In multivariate analyses, age, smoking, and use of interdental cleaners had significantly independent effects. Amount of smoking or alcohol consumption was associated with periodontal health status. Excessive use of alcohol may contribute to the development of periodontal disease, although further investigations are required to confirm this finding. The data from this study indicate that lifestyles which include smoking and insufficient oral health care have an independent association with periodontal disease.

Adult↗
PubMedDate not supplied

Impact of sexual and physical abuse dimensions on health status: development of an abuse severity measure.

OBJECTIVE: Despite the abundant literature showing a relationship of sexual and/or physical abuse history with poor health status, few studies provide evidence about which dimensions of abuse may have a worse impact on health. In female patients with gastrointestinal (GI) disorders, the present study aims to identify which dimensions of abuse history (eg, number of perpetrators, injury) might predict poor current health status, in order to develop an empirically based severity of abuse measure. METHODS: Of a sample of 239 female patients from a referral gastroenterology clinic, this paper primarily focuses on 121 women with a past history of contact sexual abuse (N = 99), and/or life threatening physical abuse (N = 68). RESULTS: Among those with a sexual abuse history, 24% of current health status was explained by serious injury during abuse (p = .0006), victimization by multiple perpetrators (p = .03), and being raped (p = .09). Among the physically abused, rape (in addition to life threat) (p = .0001), and multiple life-threatening incidents (p = .002) explained 39% of the variance in overall health. Among the women with a sexual and/or physical abuse history, the experience of rape, serious injury during sexual abuse, and multiple life-threatening incidents explained one fourth of the variance in current health status. Based on these three dimensions of abuse, we created an abuse severity measure which explained about one fourth of the variance in health status among the subgroup with abuse history, and among the entire clinic sample. CONCLUSIONS: Given the high prevalence of abuse in referral practice, and the potential health impact of previous abuse, it is important that history taking include details concerning the abuse experience. The severity of abuse measure developed in this paper should prove useful for both research and clinical practice.

Adolescent↗
PubMed1999

What makes the dyspeptic patient feel ill? A cross sectional survey of functional health status, Helicobacter pylori infection, and psychological distress in dyspeptic patients in general practice.

BACKGROUND: Dyspepsia is prevalent in about 30% of the general population in Europe, but only 25% of people with complaints consult their general practitioner. AIMS: To study the relation between the severity of dyspeptic complaints and the health status of patients presenting to the general practitioner; and the relation with patient characteristics, Helicobacter pylori infection, and psychological distress. METHODS: A cross sectional, general practice based survey of 360 unselected primary care dyspeptic patients from 92 general practices in The Netherlands was conducted. Symptom severity was measured using a validated symptom score, H pylori using a whole blood test, and psychological distress using the GHQ-12 test. Functional health status was assessed using the COOP/Wonca charts. RESULTS: Symptoms lasting more than three months and presence of relevant psychological distress were both associated with higher levels of dyspepsia. H pylori infection, frequency of symptoms, and age had no influence on dyspepsia severity. Severity of dyspepsia and psychological distress, but not H pylori infection or duration of symptoms, affected health status univariately. Dyspepsia correlated with general health, daily activities, and social activities. In logistic modelling, health status was far better predicted by psychological distress than by dyspepsia severity. CONCLUSION: The relation between dyspeptic symptom severity and health status is limited. H pylori infection relates neither to functional health status, nor to intensity of dyspepsia. Psychological distress is a major determinant of impaired health of dyspeptic patients in general practice and may be the clue to improvement of health status in many dyspeptic patients.

Adult↗
PubMedDate not supplied

[Trends in population health status according to data of sociological research].

Sociological study showed that 67.5% of respondents assessed their health status as satisfactory, 22.7% as poor, and 9.8% as good or quite satisfactory. Men are three times more often satisfied with their health status than women, and women almost three times more often consider their health poor. The characteristics of good health decreased almost twofold (1.9) over the last decade, this value for women is 2.8 times, while the values indicating deterioration of health status notably increased. In general, poor health is 1.7 times more frequent, judging from respondents' estimations. Self-assessment of the health status depends on respondent's age, education, and social status. The respondents consider that medical care should be free of charge and available. Only 4.7% of respondents admit paid care as regards additional specialized service, 92.7% of respondents wish to be free to select their doctor.

Female↗
PubMed2002

Health status and its correlates among Dutch community-dwelling older men with and without lower urogenital tract dysfunction.

OBJECTIVE: To study health status and its correlates in older men with and without lower urogenital tract dysfunction. METHODS: Cross-sectional population-based study on 1688 men aged 50-78 years without bladder or prostate cancer, radical prostatectomy, neurogenic bladder dysfunction or a negative advice from their general practitioner. Data were collected through self-administered questionnaires, including Sickness Impact Profile (SIP, three domains), Inventory of Subjective Health (ISH), International Prostate Symptom Score (IPSS) and International Continence Society (ICS) Male Sex questionnaire, medication use, socio-economic and lifestyle factors. Additional information was collected by measurement of blood pressure, transrectal ultrasonography of the prostate and uroflowmetry. Four health status domains were analyzed using the ISH and three domains of the SIP. Lower urinary tract symptoms (LUTS) were categorised using IPSS, erectile and ejaculatory dysfunction were defined using the ICS questionnaire. RESULTS: All urogenital characteristics and parameters were related to at least two of the health status domains. Multivariate regression analyses yielded that LUTS and cardiac symptoms were associated with suboptimal scores of all four domains. Chronic obstructive pulmonary disease and drugs for abdominal symptoms were related to three domains; erectile and ejaculatory dysfunction, muskuloskeletal or psycho(ana)leptic drugs and marital status to two domains. CONCLUSIONS: The impact of LUTS on health status was equally important as the impact of cardiac symptoms. The impact of sexual dysfunction was smaller than expected. Longitudinal studies are needed to determine how health status and illnesses interact.

Aged↗
PubMed2003

Improvement in indices of health status in outpatients with schizophrenia switched to ziprasidone.

Side effect and health status changes were measured in 3 studies in which outpatients experiencing suboptimal efficacy or tolerability with their current antipsychotic were switched to 6 weeks of open-label ziprasidone. The studies differed only in the patient's prior antipsychotic; 1 study group was on olanzapine (n = 104), a second on risperidone (n = 58), and third on a conventional antipsychotic (n = 108). Baseline and end point health status measures included weight and height, nonfasting cholesterol, and triglyceride levels, prolactin levels, and extrapyramidal side effects. Improvements in health indices and side effects were seen among all 3 groups, but the specific benefits depended on the preswitch antipsychotic. For example, patients switched from olanzapine experienced a mean weight loss of 1.76 kg (P < 0.0001), those switched from risperidone had a lesser reduction in weight (-0.86 kg; P = 0.015), and those switched from conventionals had a nonsignificant increase (+0.27 kg; P = 0.3). Prolactin levels decreased among those switched from risperidone (P < 0.0001) or conventionals (P = 0.05), but not for patients switched from olanzapine. EPS improved among those switched from conventionals (P < 0.0001) and to a lesser extent among those switched from risperidone (P < 0.01), but not in those changed from olanzapine (NS). Thus, in these studies, switching to ziprasidone in patients with continuing symptoms or side effects on their current medication was often associated with improved health status indices, lowered prolactin levels, or less EPS, with the magnitude benefit consistent with the known side-effect profile of the preswitch antipsychotic.

Adolescent↗
PubMed2005

[The international comparative study of the health status of medical university students in Lodz and Hanover].

During the academic year 2002/2003, we participated in a nation-wide research project aiming at the evaluation of the health status, lifestyle, social and material situation of medical university students. 285 surveys filled in by third-year students, including 167 Medical Faculty students, were subject to our analysis at the Medical University in Lodz. During the academic year 2003/2004, a similar research study was conducted among all third-year students of the Medical Faculty in Hanover. It was based on the translated questionnaire, which was adapted to the German realities. 281 surveys were qualified for further analysis. This paper presents selected elements of the health status of medical faculty students in both universities. They concern in particular the self-rated health status of students under study as well as the prevalence of certain disorders. Out of 167 medical faculty students in Lodz, 34 persons (20.4%) defined their health status as very good, 79 (47.3%) as good, 45 (27.0%) as average, and 8 persons (4.8%) thought it bad. Out of 281 medical faculty students in Hanover, 136 persons (48.4%) considered their health status to be very good, 129 (45.9%) good and 16 (5.7%) average. No student reported having a bad health status. The students from Lodz pointed out 991 disorders taking place during 4 weeks preceding the study (5.9 per student), whereas their German counterparts reported 2872 disorders (10.2 per student). The Lodz students cited most often: fatigue (83.8%), nervousness (73.1%), irritation (69.5%) and headaches (47.3%), while their Hanover colleagues suffered from fatigue (89.7%), headaches (80.4%), physical exhaustion in the evening (79.0%) and irritation (76.2%). 58.1% of the Lodz students never smoked, 12.6% smoked every day, and 9.6% smoked from time to time. 53.8% of the Hanover students never smoked, 14.6% smoked every day, and 20.6% smoked occasionally. Our anxiety was aroused by the reported frequent consumption of alcohol. Only 6.0% of the Lodz students did not drink at all, while it was 22.4% in Hanover. The share of everybody drinkers was similar in both samples (1.2% in Lodz, and 1.4% in Hanover). 32.9% of the Lodz students and 33.5% of this Hanover counterparts reported drinking alcohol at least once a week.

Adult↗
PubMedDate not supplied

[Health status evaluation in children].

A dependence of a health status on a condition of adaptation and of functional reserves of child's organism was studied. It was shown that the health status of contemporary schoolchildren is characterized, alongside with a higher prevalence of poly-organs' and morphological-and-functional deviations and chronic pathologies, by impaired rates and a lack of harmonic physical development as well as by a low level of reserve organism abilities. A variety of measures is suggested to promote the existing system of physical education.

Child↗
PubMed1998

Health status of refugees from former Yugoslavia: descriptive study of the refugees in the Netherlands.

AIM: To describe the health status of formally recognized refugees from the former Yugoslavia in the Netherlands, and analyze the relationship between experienced traumatic events and health status. METHODS: A random sample of refugees was taken from randomly selected municipalities. One hundred and two persons received a postal questionnaire. Forty percent filled out the questionnaire completely. Well-validated self-assessment scales were used to measure six dimensions of health status. Traumatic experiences were assessed by the Harvard Trauma Questionnaire. Physical aspects of health status were measured by the three dimensions of the Medical Outcome Study (MOS) Short-form General Health Survey (SF-20) which consisted of the dimensions "physical functioning", "subjective health", and "pain". Social health was measured by the two dimensions of the SF-20, "role fulfilling" and "social functioning". RESULTS: The refugees showed vulnerable health. A significant group had an accumulation of health problems. These were mostly unrelated to sociodemographic variables. Many of the refugees experienced several traumatic events. These experiences were clearly related to all health problems. CONCLUSIONS: The refugees from the former Yugoslavia scored low on standardized health measurement scales. This was primarily due to their traumatic experiences in combination with their refugee status. There is a need for health services to prevent the accumulation of (future) health problems.

Adult↗
PubMedDate not supplied

Religion, spirituality, and health status in geriatric outpatients.

BACKGROUND: Religion and spirituality remain important social and psychological factors in the lives of older adults, and there is continued interest in examining the effects of religion and spirituality on health status. The purpose of this study was to examine the interaction of religion and spirituality with self-reported health status in a community-dwelling geriatric population. METHODS: We performed a cross-sectional analysis of 277 geriatric outpatients participating in a cohort study in the Kansas City area. Patients underwent a home assessment of multiple health status and functional indicators by trained research assistants. A previously validated 5-item measure of religiosity and 12-item spirituality instrument were embedded during the final data collection. Univariate and multivariate analyses were performed to determine the relationship between each factor and self-reported health status. RESULTS: In univariate analyses, physical functioning (P < .01), quality of life (P < .01), race (P < .01), depression (P < .01), age (P = .01), and spirituality (P < .01) were all associated with self-reported health status, but religiosity was not (P = .12). In a model adjusted for all covariates, however, spirituality remained independently associated with self-appraised good health (P = .01). CONCLUSIONS: Geriatric outpatients who report greater spirituality, but not greater religiosity, are more likely to appraise their health as good. Spirituality may be an important explanatory factor of subjective health status in older adults.

Activities of Daily Living↗
PubMed2004

Impact of sputum bacteria on airway inflammation and health status in clinical stable COPD.

Chronic obstructive pulmonary disease (COPD) is characterised by sputum production, bacterial colonisation, neutrophilic bronchial airway inflammation and poor health status. The aim of this study was to determine the impact of sputum potentially pathogenic microorganisms (PPMs) on bronchial airway inflammation, health status and plasma fibrinogen levels in subjects with moderate-to-severe COPD during the clinical stable state. Sputum total cell and neutrophil counts, supernatant interleukin-8, leukotriene B4, tumour necrosis factor-alpha and neutrophil elastase levels, neutrophil chemotaxis and plasma fibrinogen levels were estimated. Health status was determined using the St George's Respiratory Questionnaire and the 36-item Short-Form Health Survey questionnaire. Twenty-seven (40%) subjects had PPMs and 40 (60%) non-PPMs in their sputum. Both groups were of similar age, body mass index, smoking history and lung function. The PPMs group showed significantly higher levels of interleukin-8, leukotriene B4, tumour necrosis factor-a, neutrophil elastase and increased neutrophil chemotaxis. They also exhibited worse health status and raised plasma fibrinogen levels compared to the non-PPMs group. In conclusion, subjects with clinically stable moderate-to-severe chronic obstructive pulmonary disease who had potentially pathogenic microorganisms in their sputum demonstrated an exaggerated airway inflammatory response, poorer health status and increased plasma fibrinogen levels than those who had nonpotentially pathogenic microorganisms.

Aged↗