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PubMed1998

Sleep-disordered breathing and self-reported general health status in the Wisconsin Sleep Cohort Study.

OBJECTIVE: To determine the relationship between sleep-disordered breathing and self-reported general health status. breathing status assessed by overnight in-laboratory polysomnography. SETTING: General Community. SUBJECTS: Employed men (n=421) and women (n=316), ages 30-60 years, enrolled in the Wisconsin Sleep Cohort Study. INTERVENTIONS: None. OUTCOME MEASURE: Self-reported general health profile and life satisfaction measured by the Medical Outcomes Survey Short Form-36 and obtained by interview. RESULTS: Sleep-disordered breathing was associated with lower general health status before and after adjustment for age, sex, body mass index, smoking status, alcohol usage, and a history of cardiovascular conditions. Even mild sleep-disordered breathing (apnea-hypopnea index = 5) was associated with decrements in the Medical Outcomes Short Form 36 Survey health constructs comparable to the magnitude of decrements linked to other chronic conditions such as arthritis, angina, hypertension, diabetes, and back problems. CONCLUSIONS: Sleep-disordered breathing is independently related to lower general health status, and this relationship is of clinical significance. Given the growing emphasis of the importance of patients' perceptions of health, these findings are relevant to estimating the overall impact of sleep-disordered breathing.

Adult↗
PubMed2004

Health status of young children during therapy for advanced neuroblastoma.

BACKGROUND: The purpose of this study was to describe the health status experienced by young children during various phases of therapy for advanced neuroblastoma. METHODS: Nineteen patients aged 2.00-4.99 years at the time of diagnosis of neuroblastoma (stages 3 or 4) who received active therapy between 1996 and 2000 were enrolled on the study. Their parents provided proxy assessments of their health status at a maximum of 10 assessment points during therapy using the Comprehensive Health Status Classification System for Pre-school Children (CHSCS-PS), which assesses level of function on 10 separate health domains. RESULTS: Eighty-six assessment questionnaires were completed. Maximum morbidity was reported immediately following diagnosis and in the 2-3 weeks following bone marrow transplantation. The greatest morbidity was observed in the pain, self-care, mobility, and emotion domains. CONCLUSIONS: In addition to facing a high risk of mortality, young children being treated for advanced neuroblastoma also experience considerable morbidity.

Child, Preschool↗
PubMed1981

Health status as a measure of need for medical care: a critique.

At the national level there has been a desire to assure that individuals have access to effective personal medical care services. Accordingly, there has been an interest in linking policies on access to care to the health needs of diverse population groups. This article critiques three measures of access linked to health status: the Use-Disability Ratio, the Symptoms-Response Ratio, and the Episode of Illness Analysis. Their utility in determining whether a given level of health-service utilization is appropriate for the optimization of health status in a population is considered. As part of this task, we review the concept of health, its measurement, and data on the relationship between changes in utilization and changes in health status. Although the Use-Disability ratio may be a useful instrument to measure access equity, it appears less suited for the purpose stated above. Elements of both the Symptoms-Response Ratio and the Episode of Illness Analysis appear better suited for this purpose. Recommendations are provided on 1) the scope of services that should be included in a comprehensive construct designed to assess access related to health status, and 2) the required research to develop such a construct.

Health↗
PubMed1995

A comprehensive index for longitudinal monitoring of child health status.

The aim of this study was to develop a single comprehensive index of child mortality for longitudinal assessment of health status of children. The need for such a comprehensive index arose from conflicting trends in different child mortality indicators. The data for the study was taken from the Sample Registration System (SRS) reports of the Registrar General of India. SRS is known to provide reliable estimates of births and deaths at the State and the National level. The study included five child mortality indicators, namely, under five mortality rate (U5MR), infant mortality rate, neonatal mortality rate, perinatal mortality rate and still birth rate. These were available for fifteen states of India over the years 1972-1988. To develop this index we modified an earlier method based on factor analysis. Factor analysis of data on various indicators of child mortality revealed two factors which together explained 78% to 93% of the total variation in different years. The first factor was identified as representing mortality after birth and the second as before and during birth. The comprehensive index was obtained as a linear combination of these two factors. The resultant index thus fairly represented all five mortality indicators and provided a comprehensive and reasonably correct picture of child mortality. The lower the magnitude of this index, the better was the child health status. Trends in the index showed that the highest decline in the magnitude was in the state of Kerala followed by Punjab, Andhra Pradesh, Gujarat and Maharashtra in that order. This indicates steady improvement of the child health status over years in these states. In the State of Jammu and Kashmir, the index remained more or less constant over the years though the magnitude was low in the cross-sectional comparison with other states. Thus the comprehensive index developed by using factor analysis of the various mortality indicators can be used for the longitudinal monitoring of child health status in the states of India.

Child↗
PubMedDate not supplied

Family influences on child health status.

Concern about the effect of family characteristics on child health status, as measured by comprehensive screening examination, prompted this study. Family routines and home environment for 110 children enrolled in a Head Start program revealed significant correlations with a summative variable from child health data recorded on school records. These findings indicate that higher levels of family routines and more stimulating home environments are significantly correlated with child health status. Knowledge about these important family influences can assist health care providers to better define family risk factors and aid in the development of more specific suggestions for improved family life, especially among low socioeconomic families.

Child Welfare↗
PubMed1997

Differences in health status of older adults with pain in the hip or knee only and with additional mobility restricting conditions.

OBJECTIVE: To determine differences in health status of people aged 55 to 74 years with pain in the hip or knee only and with additional mobility restricting conditions. METHODS: A subsample from a community based study on pain, disability, comorbidity, and radiological osteoarthritis (OA) was used to identify a group with current pain in the hip or knee only (n = 62), a group with additional mobility restricting conditions (n = 124), and a reference group without pain and radiological OA (n = 72). Health status was measured with the IRGL instrument (Impact of Rheumatic diseases on General health and Lifestyle). Additional mobility restricting conditions were self-reported. RESULTS: The most reported additional conditions were more widespread joint pain and stiffness, and cardiovascular and respiratory problems. The group with pain in the hip or knee only had less mobility than the reference group (p < 0.05), but had higher mobility (p < 0.05), less pain (p < 0.001), less psychological distress (p < 0.01), and less effect of symptoms on daily life (p < 0.001) than the group with additional conditions. No differences were found in background variables or comorbidity. Multivariate logistic regression analysis showed that the group with additional conditions differed from the group with knee or hip pain only with respect to joint pain (OR 1.18), cheerfulness (OR 0.9), and effect on daily life (OR 1.1). CONCLUSION: The health status of people with pain in the hip or knee only is comparable to that of a reference group without pain. Health status is lower when pain in the hip or knee is present in combination with additional mobility restricting conditions. This last group is at greater risk of psychological distress and physical dysfunctioning.

Activities of Daily Living↗
PubMed2006

The effects of type 1 diabetes and its long-term complications on physical and mental health status.

OBJECTIVE: To analyse how type 1 diabetes mellitus (DM) and the symptoms of its chronic long-term complications correlate with health status domains in the adult population in Finland. METHODS: A representative sample of patients with type 1 DM was selected randomly from the Finnish drug reimbursement registry. Participants reported symptoms, diagnoses and treatments indicating the presence and time of appearance of long-term complications, and completed the RAND 36 questionnaire. A principal component analysis was performed to compress the eight RAND 36 dimensions into composite domains of health status. The results were validated with split-sample analysis. Regression analyses were used to estimate the effects of age, sex, symptoms of long-term complications and comorbidities on the component T-scores. RESULTS: Of the 752 (70.8%) responders, 592 fulfilled the criteria of type 1 DM. Of these, 82.6% fully completed the RAND 36 questionnaire. Principal component analysis of our data supports the theory of the 2-factor model of health, as physical and mental health domains were reflected unambiguously by different RAND 36 dimensions. The regression results show that the symptoms of long-term complications correlate more strongly with the physical than the mental domain of health status. CONCLUSION: Type 1 DM, and especially the symptoms of its long-term complications, correlate mainly with the physical domain of health, although the mental domain is also affected. The prevalence of long-term complications with type 1 DM is sufficiently high within the Finnish population to substantially influence the health status of people with type 1 DM.

Adult↗
PubMed1990

Perceived health status, self-esteem and body image in women with rheumatoid arthritis or systemic lupus erythematosus.

A cross-sectional, descriptive, comparative design was used with a sample of 26 women with rheumatoid arthritis (RA), 23 women with systemic lupus erythematosus (SLE), and 28 healthy (HLT) women to examine: (a) the relationship of illness to perceived health status, self-esteem and body image, (b) the relationships between perceived health status and both self-esteem and body image, (c) the relationship between these three variables and age and time since diagnosis, and (d) the problems, needs and fears of women with RA and SLE. Perceived health status differences were found between the ill and healthy subjects, but self-esteem differences were nonsignificant; mean scores on body image of RA and HLT groups approximated each other, while SLE subjects had lower scores. Perceived health status was directly related to self-esteem, but not to body image. Age and time since diagnosis were weakly positively related to perceived health status. Both similarities and differences were identified in the problems, needs and fears of RA and SLE subjects.

Activities of Daily Living↗
PubMed1994

Monitoring dialysis patients' health status.

We report 3 years of experience with quarterly assessments of the self-reported health of dialysis outpatients using the Short Form-36 (SF-36) Health Survey. The SF-36 measures eight different dimensions of health: physical function, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social function, role limitations due to emotional problems, and general mental health. On each dimensions, the respondent receives a score from 0 to 100. A higher score indicates better health. Program logistics and results are described, including reliability coefficients, standard deviations, and standard errors of measurement for the SF-36 in this patient population. The SF-36 was completed an average of 4.4 times by 112 patients over an average 14-month follow-up; 40 patients responded at least six times. On most dimensions, the dialysis patients' scores were lower and more variable than those of a sample of the general US population matched for age and sex. For example, mean initial physical function score (+/- SD) was 48.5 +/- 31.2 for the dialysis patients and 84.8 +/- 23.3 for the general population. The mean initial general health perception score of the dialysis patients was 43.7 +/- 23.9 with 71.9 +/- 20.3 for the general population. In contrast, general mental health scores were more comparable. The mean initial general mental health score was 69.6 +/- 17.5 for our patients and 75.5 +/- 18.0 for the general population. Reliability (Cronbach's alpha) ranged from 0.77 for general mental health to 0.93 for physical function. The 95% confidence intervals around individual scores were approximately 20 points, except for role-physical and role-emotional, which were both approximately 30 points. Two case reports compare information obtained from the SF-36 with the dialysis team's assessments of the patient, as recorded in the medical record. The two patients' comments on reviewing their SF-36 results are also summarized. Patient reactions to the health status assessment program are explored, and potential benefits and areas for further work are outlined. Serial measurement of the health status of dialysis patients allows the recognition of clear patterns in individual patient responses. These patterns sometimes suggest that the patient is either substantially more or less impaired than the dialysis team had thought. Changes in these patterns, both transient and protracted, frequently exceed 95% confidence intervals for patient-level scores. Longitudinal health status profiles of individual dialysis patients, accumulated by repeated self-assessment using the SF-36, enhance rather than merely restate the providers' intuitive judgments expressed in the medical record.

Adolescent↗
PubMed2006

Health status of lymphatic filariasis assessed from patients using seven domains five levels (7D5L) instrument.

Health status is the standardized description of health condition of individuals either normal or ill due to diseases and is presented as multidimentional profiles. In an effort to develop an indicator to assess the impact of morbidity intervention against lymphatic filariasis (LF), we assessed the health status of seven different clinical manifestations (health states) of LF from the patient's perspective. One hundred and seventy-four filarial patients either with hydrocele or lymphoedema were involved in the study. Acute episode of adenolymphangitis (ADL) among chronic patients was considered as co-morbidity. Severity levels, focusing on physical, mental and social dimensions of health were defined and quantified, using seven domains and five levels (7D5L) instrument, an extended form of EuroQol (5D3L). All the seven domains of health are affected by filarial disease, with the levels of severity varying with health states. The mean severity score of ADL (25.8) was significantly higher compared to lymphoedema (10.7) and hydrocele (6.9) (P<0.05). In males, the mean score of lymphoedema (11.6) was significantly higher in comparison to hydrocele (P<0.05). The severity scores increase with the progression of filarial disease but independent of gender. The health states of LF were further classified based on the percentage of severity according to International Classification of Functioning, Disability and Health (ICF) on impairments. Lymphoedema grade 4 (oedema with skin changes) and ADL were ranked as severe. The importance of these findings is discussed in view of priority setting and evaluating the morbidity management under Global Programme for Elimination of Lymphatic Filariasis (GPELF).

Adolescent↗
PubMed1989

A new measure of health status for clinical trials in inflammatory bowel disease.

We have developed a measure of subjective health status (quality of life) for patients with inflammatory bowel disease (IBD). Ninety-seven patients with IBD described problems they had experienced as a result of the disease; the 32 most frequent and important items were included in the Inflammatory Bowel Disease Questionnaire (IBDQ). Sixty-one IBD patients were evaluated twice. One month separated the evaluations, at which disease activity indices, the IBDQ, and a number of other questionnaires were administered. Reproducibility studies in 19 stable patients showed improvement in scores, but also a small within-person standard deviation. Responsiveness studies revealed large changes in scores in patients who had improved or deteriorated and suggested that the IBDQ was more responsive than a general health status measure. Responsiveness appeared greater in patients with ulcerative colitis than in those with Crohn's disease. Predicted and observed correlations between changes in IBDQ score and changes in other measures were similar. We conclude that although further testing is required, particularly in examining the relation between changes in the IBDQ and changes in the activity of Crohn's disease, the IBDQ shows promise as a measure of health status for clinical trials in IBD.

Attitude to Health↗
PubMed1984

Sexual satisfaction among middle-aged couples: correlation with frequency of intercourse and health status.

The central hypothesis of this investigation is that the greater the sexual satisfaction that a couple reports from their sexual relationship, the better will be their adjustment to the changes that occur during middle age, as reflected in their reported health status and health behaviour. Forty-seven married couples, of North African Jewish origin, were investigated, the women being in the age range 48-53 yr. The findings regarding reported frequency of sexual intercourse and sexual satisfaction of women and men separately showed that a great majority of both men (87%) and women (74%) reported a decrease in sexual activity over the 5 yr preceding the study. Most of the men (56%) said the change was due to the aging process, whereas the women's responses were more varied and included aging, worries and decrease in sexual interest or desire. Eighty percent of the men reported satisfaction in their sexual relationship with their wives, but only 43% of the women stated that they were satisfied. A significant correlation was found, for women only, between the degree of satisfaction and the change in frequency of intercourse. Among the women there was also a positive correlation between general life satisfaction and sexual satisfaction. The hypothesis in regard to mutual (couple) sexual satisfaction was not confirmed in the men. It was validated in the women in regard to only two of the four criteria used - their perception of their health status and of their well-being. The women perceived the sexual satisfaction of their husbands much more accurately than the husbands perceived that of their wives.

Adaptation, Psychological↗
PubMedDate not supplied

Primary care experience and racial disparities in self-reported health status.

CONTEXT: Access to high quality primary care was identified by Healthy People 2010 as one of the mechanisms through which racial and ethnic disparities in health might be reduced. Despite the well-established connections between good primary care and health, the scientific evidence on whether good primary care can reduce racial disparities in health is sparse. OBJECTIVE: To examine whether better primary care experience can attenuate racial and ethnic disparities in self-reported health status. DATA SOURCES: The 1996 to 1997 and 1998 to 1999 data from the Community Tracking Study (CTS) sponsored by the Robert Wood Johnson Foundation. STUDY DESIGN: Cross-sectional, bivariate, and multivariate analyses of inter-relationships between self-rated general and mental health status, access to and interpersonal relationship with primary care provider, and vulnerability measured by race and poverty status. RESULTS: We found that higher quality primary care levels are associated with reduced racial and ethnic disparities in health status, as measured by self-rated general and mental health. This relationship is particularly pronounced for the racial and ethnic minorities living at or below poverty level. Based on the data from 1996 to 1999, the study also confirmed the presence of significant and persistent health differences across racial and ethnic groups. CONCLUSION: Promoting primary care may be a viable approach toward reducing racial and ethnic disparities in self-reported health status.

Adult↗
PubMed2003

Correlation between annual change in health status and computer tomography derived lung density in subjects with alpha1-antitrypsin deficiency.

BACKGROUND: There is increasing recognition that questionnaires of health status and lung density measurements are more sensitive tools for assessing progression of emphysema than forced expiratory volume in 1 second (FEV(1)) and transfer coefficient (KCO). A study was undertaken to investigate prospectively the correlation between annual change in health status and computer tomography (CT) derived lung density in subjects with alpha(1)-antitrypsin deficiency. METHODS: Twenty two patients of mean (SD) age 40.7 (9.2) years with ZZ type alpha(1)-antitrypsin deficiency were investigated at baseline and 30 months later by FEV(1) and KCO, St George Respiratory Questionnaire (SGRQ), and by a spiral CT scan of the chest. CT data of chest images were analysed using software designed for automated lung contour detection and lung density measurements. The density data were corrected for changes in inspiration levels. RESULTS: Changes in lung density, expressed as 15th percentile point or relative area below -950 HU, correlated well with changes in health status (SGRQ total score): R = -0.56, p = 0.007 or R = 0.6, p = 0.003. Neither changes in health status nor changes in lung density correlated significantly with changes in FEV(1) or changes in KCO. CONCLUSIONS: The SGRQ total score (which is a global measure in COPD) and lung density (a specific measure of emphysema) are sensitive to deterioration in patients with alpha(1)-antitrypsin deficiency. This finding may facilitate future studies with new drugs specific for emphysema, a frequently occurring component of COPD.

Adult↗
PubMed1999

Long-term outcome and functional health status following intensive care in Hong Kong.

OBJECTIVES: To assess mortality and functional health status of patients at 1 yr following admission to a multidisciplinary intensive care unit (ICU) in Hong Kong. To determine which factors are associated with a poor long-term outcome. DESIGN: Prospective data collection and review. SETTING: A 14-bed multidisciplinary ICU in a 1,400-bed tertiary care university hospital. PATIENTS: Data from 2,268 consecutive patients admitted over a 2.5-yr period was analyzed, including follow-up at 1 yr in 853 adult survivors. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The patients' clinical details and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were recorded on day 2 of admission and reviewed at time of discharge or death. The mean APACHE II score on admission was 18. Survival status at 1 yr was ascertained and the sickness impact profile (SIP) scored as a measure of functional health status for survivors. Sixty-five percent of patients survived to discharge from hospital and 44% of patients were known to survive to 1 yr; 6% of patients could not be traced at 1 yr. Functional health status was assessed in 85% of eligible adult patients. Survivors to 1 yr were younger than nonsurvivors and had lower APACHE II scores. The median SIP score was 5.1, (25th and 75th percentiles: 0 to 15), and 76% of patients had SIP scores < or = 15, i.e., normal health to moderate disability. Five percent of the patients were not working or had retired for health-related reasons. Stepwise logistic regression to identify factors associated with poor functional health status defined as a SIP score >15 at 1 yr found increasing age, cardiac/ respiratory arrest, intracranial hemorrhage, and trauma to be associated with poor outcomes. A correlation was found between APACHE II scores and SIP scores (Spearman's correlation coefficient = 0.13, p < .001). CONCLUSIONS: The SIP scores indicated that the majority of patients who survived to 1 yr after ICU admission enjoyed reasonable functional health status. A poor functional health status at 1 yr did not relate to the severity of the acute illness suffered, but appeared to relate to the prognosis of the underlying disease process.

APACHE↗
PubMed1975

A review of the research on general health status indexes.

During the mid-1960's, recognition of the spiraling cost of health care motivated Congress to enact several major pieces of legislation designed to underwrite efforts to improve the delivery of health services. The increased level of federal fiscal participation in the health service system has forced greater consciousness of the need for better accountability of the effectiveness and efficiency of the allocation of the dollar. Demands were articulated for precision tools which could evaluate the imput to output linkage between need and response; however, the tools were nascent and had limited applicability. Cost-effectiveness and cost-benefit analysis are two procedures that have since been applied with varying levels of success. A third tool, also developed as an outgrowth of the desire for a more accurate characterization of the planning concerns of an efficient/effective health service system, is the general health status index. The purpose of this article is to provide the reader with a comprehensive review of the literature on general health status indexes. Common objectives and constraints are presented, as well as a discussion of the expanding role of general health status indexes.

Activities of Daily Living↗
PubMed2005

Risk of restenosis and health status outcomes for patients undergoing percutaneous coronary intervention versus coronary artery bypass graft surgery.

BACKGROUND: Previous comparisons of percutaneous coronary interventions (PCIs) and coronary artery bypass graft (CABG) surgery have demonstrated similar survival but have also generally found better health status outcomes (symptoms, function, and quality of life) with CABG. The principal limitation of PCI has been the occurrence of restenosis. No previous studies comparing the health status outcomes of PCI and CABG have examined differences in these outcomes as a function of patients' preprocedural risk for restenosis. METHODS AND RESULTS: We examined the health status outcomes, using the Seattle Angina Questionnaire (SAQ), among 1459 consecutive patients (1027 treated with PCI and 432, with CABG), stratified by their risk for restenosis. In multivariable-adjusted, linear regression analyses, no differences in 1-year angina or quality of life were observed among the 37.4% of patients at low risk for restenosis. However, among the 46.7% at intermediate risk for restenosis, 1-year health status scores were moderately better after CABG surgery compared with PCI (difference in SAQ angina frequency scores favoring CABG=6.1+/-1.7 points, P=0.0003; difference in SAQ quality of life=5.8+/-1.6 points, P=0.0004). Even larger differences in 1-year outcomes favoring CABG surgery were observed in patients at high risk for restenosis (SAQ angina frequency difference=10.8+/-4.2, P=0.01; SAQ quality of life difference=10.8+/-3.9, P=0.006). CONCLUSIONS: The relative health status benefits of CABG surgery compared with PCI increase as the risk of restenosis increases. Although selecting CABG or PCI is complex, preprocedural restenosis risk should be considered. It should also be tested as a means for considering drug-eluting as opposed to bare metal stents in PCI.

Aged↗
PubMed1990

Age, self-assessed health status, and cognition.

Data from a recent project involving 362 adults ranging from 20 to 79 years of age were reanalyzed to examine the effects of statistical control of self-assessed health status on the age trends in several measures of cognitive functioning. The major result was that the age trends were virtually identical with, and without, control of the health-status variable. Implications of the views that the lack of health influences was due to a narrow range of health status or to insensitive assessment of health status were discussed.

Adult↗