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PubMed2004

Oral health status of institutionalised elderly in Hong Kong.

OBJECTIVES: To describe the oral health status of institutionalized elderly in Hong Kong. METHODS: Older adults in 56 elderly homes were clinically examined in the institution by one of two calibrated dentists using standard methods recommended by the World Health Organization. Information on their perceived oral health status and behaviour was obtained from an interview. RESULTS: A total of 3153 elderly aged 65 years or above (mean = 79.8) were examined. Around 20% of them were edentulous. The mean DMFT score was 23.0 (DT = 2.6; MT = 20.1; FT = 0.3). The percentage of dentate subjects with healthy gingivae, bleeding on probing, calculus, shallow pockets, and deep pockets (according to the highest CPI score) were 1, 2, 41, 37 and 20 respectively. Two-thirds of the elderly reported having difficulties chewing, and over half had not visited a dentist for over 5 years. CONCLUSION: The oral health status of institutionalised elderly in Hong Kong is poor and needs to be improved.

Aged↗
PubMed1991

Implications of health status in analysis of risk in older persons.

This article explores the hypothesis that health status in old age acts as a summary measure of health exposures over time and, as such, plays a central role as a determinant of survival and morbidity trajectories in old age. Evidence is presented for the utility of health status as a modifier of risk in other areas of gerontologic research, and an example of modification pertinent to the cholesterol-heart disease controversy in old age is presented. The potential of differential health status in old age to affect both risk factors and risk estimates in epidemiologic analyses may be an important principle as epidemiologists continue to development research to preserve and augment the quality of life in old age.

Activities of Daily Living↗
PubMed2006

Predictors of early recovery of health status after intensive care.

OBJECTIVE: To identify factors predictive of good or poor recovery of health status and health-related quality of life (HRQOL) 90 days after admission to an intensive care unit (ICU). DESIGN AND SETTING: Prospective international multicentre study in 19 ICUs participating in the HRQOL substudy of the SAPS 3 project. INTERVENTION: The EuroQol questionnaire (EQ) was administered to discharged ICU patients 90 days after admission. A question to compare present health status with that 3 months before ICU admission (same/better/worse) was added. PATIENTS: Six hundred and eighteen patients who spent >24h in an ICU and survived for 90 days. EQ data and health comparison were available in 559 (90.5%) of them. MEASUREMENTS AND RESULTS: Patients reported their general level of health to be better (33.8%), the same (31.1%), or worse (35.1%) in comparison with baseline. Recovery was considered to be good for answers "better" or "the same". Regression analysis showed that transplantation surgery [odds ratio (OR) 0.07, 95% confidence interval (CI) 0.01-0.63], coronary artery bypass surgery without valvular repair (OR 0.39, 95% CI 0.17-0.92) and being admitted to the ICU from a ward or other location (OR 0.55, 95% CI 0.31-0.95) predicted good recovery of health. Predictors of poor recovery (all present at the time of ICU admission) were unplanned ICU admission, hypothermia, serum creatinine level >or=2mg/dl, pH<or=7.25 and metastatic cancer. CONCLUSIONS: More than 60% of ICU patients report good recovery of their health 90 days after ICU admission, depending on their illness and circumstances of ICU admission.

Argentina↗
PubMedDate not supplied

Using 1990 national MCH objectives to assess health status and risk in an American Indian community.

The authors used data from birth records to assess changes in health risks and health status of American Indians (AI) living in Umatilla County, OR, from 1973 to 1986. They compared the AI health risks and health status with those of other persons (non-AI) living in Umatilla County, and assessed the progress of both AI and non-AI populations toward selected 1990 national health objectives. This AI population is likely to achieve the 1990 national health objective calling for less than 5 percent of births to be low birth weight (LBW); the LBW rate decreased from 5.0 percent in 1977-80 to 4.1 percent in 1984-86. However, the population is not likely to achieve the 1990 objective calling for at least 90 percent of women to begin prenatal care during the first trimester, even though the proportion of AI women who began prenatal care in the first trimester increased from 42.3 percent in 1973-76 to 62.6 percent in 1984-86. The Yellowhawk Indian Health Center began offering clinical services to AI in Umatilla County in 1976. Compared with non-AI women, AI women closed large gaps in key health risk and health status indicators during the period from 1973 to 1986. For example, from 1973 to 1976, 14.6 percent of AI mothers compared with 6.3 percent of non-AI mothers began prenatal care in the last trimester. By 1984 to 1986, only 9.0 percent of AI and 7.9 percent of non-AI mothers began prenatal care in the last trimester. Several other desirable health indicators improved more for AI than for non-AI from 1973 to 1986. These indicators included receiving at least one prenatal care visit during pregnancy, beginning prenatal care before the last trimester, and a larger proportion of mothers more than 18 years of age.Data from vital records can be used to monitor the health status of minority populations in small areas, such as counties. Clinic personnel serving minority groups can incorporate national and local health objectives into their strategy for improving community health.

Adolescent↗
PubMed2006

Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis.

OBJECTIVE: The reporting of depressive symptoms following myocardial infarction may be confounded by complaints originating from the myocardial infarction. Therefore, it is difficult to estimate the effects of post-myocardial infarction depression and its treatment on cardiovascular prognosis. The authors' goal was to study the relationship between depressive symptom dimensions following myocardial infarction and both somatic health status and prospective cardiovascular prognosis. METHOD: In two studies of myocardial infarction patients (N=494 and 1,972), the Beck Depression Inventory was used to determine the dimensional structure of depressive symptoms following myocardial infarction. Three symptom dimensions-somatic/affective, cognitive/affective, and appetitive-were compared with baseline left ventricular ejection fraction, Charlson comorbidity index, Killip class, and previous myocardial infarction. The relationship between depressive symptom dimensions and prospective cardiovascular mortality and cardiac-related readmissions was also examined (mean follow-up duration=2.5 years). RESULTS: Somatic/affective symptoms were associated with poor health status (left ventricular ejection fraction, Charlson comorbidity index, Killip class, and previous myocardial infarction) and predicted cardiovascular mortality and cardiac events. Cognitive/affective symptoms were only marginally associated with somatic health status and not with cardiovascular death and cardiac events. Appetitive symptoms were related to somatic health status but did not predict cardiovascular death or cardiac events. CONCLUSIONS: Somatic/affective depressive symptoms following myocardial infarction were confounded by somatic health status yet were prospectively associated with cardiac prognosis even after somatic health status was controlled. Cognitive/affective depressive symptoms were only marginally related to health status and not to cardiac prognosis. These findings suggest that treatment of depression following myocardial infarction might improve cardiovascular prognosis when it reduces somatic/affective symptoms.

Cause of Death↗
PubMedDate not supplied

Heterogeneity in the relationship between the standard-gamble utility measure and health-status dimensions.

The authors assessed the relationship between the standard-gamble utility measure and the RAND-36 health-status dimensions, taking into account possible heterogeneity among patients in the weights they assign to different health-status dimensions. A questionnaire including both measures was completed by 68 patients with symptomatic peripheral arterial disease. Conventional multiple regression analysis, assuming a homogeneous relationship for the total population between the standard-gamble utility and the RAND-36 health-status dimensions, demonstrated that only the dimension social functioning was significant (p < 0.05), which accounted for 10% of the variation. Assuming that the population consisted of two separate classes demonstrated superior representation of the data. Latent class analysis was used to estimate the unknown parameters and class memberships. In the first class, consisting of 65% of the patients, the relationship between the standard-gamble utility and the dimension general health perception was significant. The within-R2 was 12%. The second class represented 35% of the patients and showed significant coefficients for the dimensions social functioning and role limitations due to physical problems, which accounted for 80% of the variation. The overall percentage of variation explained by latent class analysis was 49%. The results suggest that patients with symptomatic peripheral arterial disease belong to a variety of classes, all with class-specific relationships between the standard-gamble utility and the RAND-36 health-status dimensions.

Activities of Daily Living↗
PubMed1984

Cognitive determinants of the perception of mental health status.

This paper suggests that an individual's perception of his health and mental health status may be largely determined by his concept or definitions of health and mental health and that how one defines these terms are a function of one's level of awareness of higher needs. A conceptual model is presented that locates these cognitive variables within the causal framework relative to help-seeking behavior and provides the theoretical basis for a methodology of determining the mental health needs of a population, especially in a developing country, based on self-assessment of health status.

Cognition↗
PubMed2006

Difficulty taking medications, depression, and health status in heart failure patients.

BACKGROUND: Little is known about medication nonadherence in heart failure populations. We evaluated the association between 1 aspect of medication nonadherence, patient-reported difficulty taking medications as directed, and health status among heart failure outpatients, and then examined whether this association was explained by depression. METHODS AND RESULTS: A total of 522 outpatients with left ventricular ejection fraction <0.40 completed clinical evaluation, Kansas City Cardiomyopathy Questionnaire (KCCQ), Medical Outcomes Study-Depression questionnaire, and categorized their difficulty taking medications (5-level Likert-scale question). Multivariable regression was used to evaluate the cross-sectional association between difficulty taking medications and health status, with incremental adjustment for medical history and depressive symptoms. Patients with difficulty taking medications (n = 64; 12.2%) had worse health status (8.2 +/- 2.7 point lower mean KCCQ summary scores; P = .008) and more depressive symptoms (43.8% versus 27.1%; P = .006). Adjusting for demographic and clinical factors had little effect on the association between difficulty taking medications and health status (8.0 +/- 3.2 point lower KCCQ scores; P = .01); however, the relationship was attenuated with adjustment for depressive symptoms (4.7 +/- 2.9 point lower KCCQ scores; P = .11). CONCLUSIONS: Among heart failure outpatients, difficulty taking medications is associated with worse health status. This association appears to be explained, in part, by coexistent depression. Future studies should evaluate interventions such as depression treatment to improve medication adherence and health status.

Aged↗
PubMed2006

Using the SF-12 health status measure to improve predictions of medical expenditures.

BACKGROUND: Relatively few studies have used self-reported health status in models to predict medical expenditures, and many of these have used the SF-36. OBJECTIVES: We sought to examine the ability of the briefer SF-12 measure of health status to predict medical expenditures in a nationally representative sample. METHODS: We used data from the 2000-2001 panel of the Medical Expenditure Panel Study. Respondents (n = 5542) completed the SF-12 in a questionnaire. Interviews obtained data on demographics and selected chronic conditions. Data on expenditures incurred subsequent to the interview were obtained in part from provider records. We examined different regression model specifications and compared different statistical estimation techniques. RESULTS: Adding the SF-12 to a regression model improved the prediction of subsequent medical expenditures. In a model with only age and gender, adding the SF-12 increased R from 0.06 to 0.13. The coefficients for the Physical Component Summary (PCS) and the Mental Component Summary (MCS) of the SF-12 for this model were -0.045 (P < 0.01) and -0.012 (P < 0.01), respectively. In a model including demographic characteristics, chronic conditions, and previous expenditures, adding the SF-12 increased the R from 0.26 to 0.29. The coefficients for the PCS and the MCS for this model were -0.025 (P < 0.001) and -0.005 (P = 0.15), respectively. A single general health status question performed almost as well as the full SF-12. Models estimated using ordinary least squares had undesirable properties. In terms of R, a generalized linear model (GLM) with a Poisson variance function was consistently superior to a GLM with a gamma variance function. CONCLUSIONS: Information on self-reported health status is useful in predicting medical expenditures. The extent to which the SF-12 adds predictive power over a comprehensive array of diagnostic data remains to be examined.

Adolescent↗
PubMed2004

Epidemiology of hip and knee pain and its impact on overall health status in older adults.

OBJECTIVES: To obtain prevalence rates of hip and knee pain in elderly people and compare combinations of symptoms with overall health status. METHODS: We performed a cross-sectional postal survey of a random sample of 5500 Oxfordshire residents aged 65 yr and older. Prevalence estimates were based on the screening question: 'During the past 12 months, have you had pain in or around either of your hip/knee joints on most days for one month or longer?' Overall health status was assessed with the SF-36 questionnaire. RESULTS: The response rate was 66.3% (3341/5039 eligible people), and was highest (approximately reverse similar 72%) for the 65-74 yr age-group. The percentage reporting hip pain was 19.2% [95% confidence interval (CI) 17.9-20.6], and 32.6% (95% CI 31.0-34.3) reported knee pain. The percentage reporting hip and knee pain was 11.3%, and 40.7% reported hip or knee pain. Less than half (48%) of the symptomatic respondents had unilateral problems affecting one hip or knee joint only. SF-36 scores worsened as the number of symptomatic hip and knee joints increased (P<0.001 for physical function, physical role limitation and bodily pain). CONCLUSIONS: Patterns of hip and knee symptoms are complex in older people. Amongst the symptomatic, most have more than one hip/knee affected. This has implications for treatment and health status measurement. In the absence of hip and knee symptoms, general health status scores of elderly people are similar to those of people aged under 65 yr.

Aged↗
PubMed1992

Measurement of general health status of non-oxygen-dependent chronic obstructive pulmonary disease patients.

Chronic obstructive pulmonary disease is a prevalent condition causing a high level of disability, and it is one of the leading causes of death. To assess the general health status of moderate to severe Chronic obstructive pulmonary disease patients, we studied 76 male patients attending an outpatient hospital clinic who were not dependent on oxygen and who did not present bronchial obstruction reversibility. We assessed clinical status (dyspnea, six-minute walking distance) and functional respiratory impairment (spirometry, and blood gas analysis) of the patients and also asked them to respond to the Spanish version of the Nottingham Health Profile, a multi-dimensional generic health status measure. Patients scored especially higher than the general population (denoting more level of distress) in energy, physical mobility and sleep Nottingham Health Profile dimensions. The former two dimensions scores had a high correlation with dyspnea (respectively Spearman Rs = 0.60, and Rs = 0.64; P less than 0.01). High levels of sleep disturbances were found for patients reporting low or very low dyspnea level. Health status measurement (Nottingham Health Profile dimension scores) and functional respiratory impairment were not correlated. Results underscore the importance of measuring symptoms carefully when assessing these patients, whose health status is substantially affected by the Chronic obstructive pulmonary disease. They also suggest that it is relevant to assess sleep disturbances in these patients.

Activities of Daily Living↗
PubMed2003

[Study on physical and mental health status and influencing factors of middle-aged intellectuals].

OBJECTIVE: To understand physical and mental health status of middle-aged intellectuals and related risk factors on mental health under the present social conditions. METHODS: Stratified-cluster sampling and questionnaire survey were used. One thousand five hundred and three middle-aged intellectuals were investigated by SCL-90 test and influential reasons, using general relative risk model. Effects and interaction modes of risk factors were analyzed. RESULTS: The prevalence rate of middle-aged intellectuals was 241.5 per thousand per two weeks, while the prevalence rate of chronic disease was 306.7 per thousand. 6.9% of the middle-aged intellectuals (male 6.1%, female 7.8%) had mental health problems. Results suggested that the major risk factors were, as listed in a order of their effects on mental health disorders: divorced or losing spouse, exposure to poison and noisiness, lack of hobbies, long working hours, having chronic diseases. CONCLUSION: Physical and mental health status of middle-aged intellectuals were under by many kinds of pressures. Multiple measures should be taken to improve the health status of the middle-aged intellectuals.

Adult↗
PubMed1996

Health status and hypertension: a population-based study.

We describe the relation between self-reported hypertension and measures of health-related quality of life (HRQOL) in a community-dwelling population. In a cross-sectional study, 1430 randomly selected adults, aged 45 to 89 years, were interviewed to obtain a medical history and health status measures, including the SF-36 questionnaire, the Quality of Well Being (QWB) index, and time trade-off (TTO) assessments. A total of 519 participants reported being affected by hypertension (HTN group). The HTN group, compared to the No HTN group, had significantly lower age-adjusted health status scores measured by the General Health scale of the SF-36 and by TTO, with differences between groups for each measure comprising approximately 5% of the total scale. HTNs also had a significant decline in general health status measures associated with increasing numbers of antihypertensive medications but not with specific classes of medications. We conclude that hypertension and hypertension drug therapy are associated with clinically meaningful decreases in reported health status.

Aged↗
PubMed2004

Depression and health status in patients with advanced heart failure: a prospective study in tertiary care.

BACKGROUND: Depression impairs health status among patients with coronary disease. The effect of depression on patients with heart failure has been studied to date only in hospitalized patients. METHODS AND RESULTS: Prospective cohort study of 113 outpatients with advanced heart failure. At baseline, 19% (n = 21) had major depression or dysthymia, 9% (n = 10) had minor depression, and 72% (n = 82) had no current depression diagnosis. Repeated measures analyses of covariance adjusting for demographic and clinical differences demonstrated that the depression groups differed on observed function (6-minute walk distance [F = 4.8, P = .01]), and self-reported generic (SF-36) and disease-specific (Kansas City Cardiomyopathy Questionnaire) health status. Depression groups also differed in severity of self-reported breathlessness, chest pain, and fatigue. Subject- and spouse-reported role function also differed between the groups. Partial correlation (controlling for the same covariates) between baseline Hamilton Depression Scale scores and these outcomes was highly significant at baseline and follow-up. CONCLUSIONS: Depression is prospectively associated with poorer health status in patients with advanced heart failure. Physical and role function, symptom severity, and quality of life are all significantly affected.

Cohort Studies↗
PubMed1998

Relationship of job strain and iso-strain to health status in a cohort of women in the United States.

OBJECTIVE: This study examined the relationships of job strain and iso-strain psychosocial work-environment exposures to health status in a cohort of working women in the United States. METHODS: In a cross-sectional survey, 33689 women responded to the Karasek job content and the MOS SF-36 health status questionnaires. The psychosocial work-environment exposures were characterized using the job strain and iso-strain frameworks. Health status was assessed with the following 6 scales: physical functioning, vitality, freedom from pain, mental health, role limitations due to physical health, and role limitations due to emotional health. RESULTS: When compared with active work, high-strain work (high job demands and low job control) was associated with lower vitality, mental health, higher pain, and increased risks of both physical and emotional role limitations. Iso-strain work (high strain and low work-related social support) increased the risks further. Job insecurity was also associated with lower health status. CONCLUSIONS: The analyses supported the hypothesis that the psychosocial work environment is an important determinant of health status among working women. The findings suggest that incorporating social conditions at work into the measurement of psychosocial work-environment exposure improves the identification of high-risk work arrangements.

Adult↗
PubMed1996

Health status measurement and the assessment of medical care.

This article reviews the role of health status measures in the assessment of medical care. It is argued that such measures are of only limited value in assessing the performance of health care professionals and institutions because of confounding factors, problems of data collection and the play of chance. Nevertheless, health status measures should be incorporated as outcome measures into clinical trials since they can provide information on how individuals and institutions can improve performance and give health policy makers information about the effectiveness of interventions. It is concluded that the development of simpler measures of performance would be more practical than trying to overcome the limitations of health status measures in monitoring the quality of health care institutions.

Health Policy↗
PubMed2004

Health status as measured by SF-36 reflects changes and predicts outcome in chronic musculoskeletal pain: a 3-year follow up study in the general population.

The SF-36 is a well-validated health status instrument measuring eight different health concepts. One aim of this study was to compare health status as measured by SF-36 in subjects from the general population with no chronic pain (NCP), chronic regional pain (CRP), and chronic widespread pain (CWP). A second aim was to assess if SF-36 could reflect changes in pain status over time. A third aim was to study if health status at baseline, measured by SF-36, could predict pain status 3 years later. The study was designed as a 3-year follow up with a postal questionnaire, including the SF-36 health survey, to 2357 subjects from the general population aged 20-74 years. The results were controlled for age, sex, co-morbidity, and socio-economic status. At baseline, all eight health concepts of SF-36 discriminated between subgroups with NCP, CRP and CWP. Changes in SF-36 over the 3-year follow up time coincided with improvement or deterioration of pain status. Baseline SF-36 scores predicted pain outcome 3 years later. These results support that both physical and mental aspects of health status as measured by SF-36 are affected by the burden of musculoskeletal pain, are sensitive to changes in pain status, and also predict the further development of pain.

Adult↗
PubMed1993

Patient acceptance of two health status measures: the Medical Outcomes Study Short-form General Health Survey and the Duke Health Profile.

BACKGROUND: The Medical Outcomes Study Short-Form General Health Survey (MOS-SF) and the Duke Health Profile (DUKE) are brief, reliable, valid, and practical health status measures with potential applications in clinical research. We compared patient acceptance, ease of completion, and adequacy of capture (of the patient's self-perception of health) of these instruments in a primary care setting. METHODS: The MOS-SF, DUKE, and assessment questionnaires were administered to 79 patients in a university-based family practice. Patient acceptance of each instrument was assessed with Likert scale questions. Patients then compared the two instruments for relative ease of completion, preference, and completeness of capture. RESULTS: Both forms assessed each item well, but the DUKE scored statistically significantly better than the MOS-SF on four of six patient acceptance questions and both ease of completion items. There were no significant differences for capture items. CONCLUSIONS: Although both instruments are well accepted, investigators may favor the DUKE over the MOS-SF for situations in which patient acceptance or ease of completion is a key issue.

Adult↗