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PubMedDate not supplied

Depression and health status in elderly patients with heart failure: a 6-month prospective study in primary care.

To determine the prevalence and effects of depression on health status among elderly outpatients with heart failure, the authors conducted a 6-month prospective cohort study of 139 older outpatients with heart failure managed in primary care and 80 of their spouses. Primary care heart failure diagnosis was confirmed through chart review. The Primary Care Evaluation of Mental Disorders psychiatric diagnostic interview and Hamilton Depression Rating Scale were administered by phone. EQ-5D feeling thermometer, Medical Outcomes Study Short Form 36-Item Questionnaire, Kansas City Cardiomyopathy Questionnaire, and heart failure symptom severity questionnaires were administered by self-report. Depression diagnoses at baseline were: major depression and/or dysthymia (n=12, 9%), minor depression (n=14, 10%), and no depression (n=113, 81%). After adjusting for age, gender, and medical comorbidity, these depression groups differed by repeated measures analysis of covariance on most health status measures including the EQ-5D feeling thermometer; Medical Outcomes Study Short Form 36-Item Questionnaire general health and physical role function subscales; Kansas City Cardiomyopathy Questionnaire total score, symptom total, physical limitations, and quality of life subscales; as well as severity of chest pain and fatigue. Depression has significant and persistent effects on health status of elderly patients with heart failure, including heart failure symptoms, physical and role function, and quality of life. This may help explain why depression has been associated with increased health care utilization and costs in this population.

Aged↗
PubMedDate not supplied

Sexual orientation and variation in physical and mental health status among women.

OBJECTIVE: To assess and compare the physical and mental health status of women of differing sexual orientation within a population-based sample. METHODS: We used a population-based telephone survey performed using random digit dialing techniques. Our study population was drawn from the 1999 Los Angeles County Health Survey and included women age 18-64 years who reported their sexual orientation (98%, n = 4135). These analyses include 4023 heterosexuals, 69 bisexuals, and 43 lesbians. RESULTS: We assessed the unique association of sexual orientation with physical and mental health status using bivariate and multivariate analyses. Both lesbians and bisexuals were more likely than heterosexual women to report a diagnosis of heart disease. Among women with a depressive disorder, lesbians were more likely than heterosexuals to be using an antidepressant medication. Compared with heterosexuals within the preceding 30 days, lesbians reported significantly more days of poor mental health, and bisexuals reported significantly more days of poor physical health. However, there were no significant differences by sexual orientation in impaired ability to perform daily activities due to physical or mental health. CONCLUSIONS: In this rare opportunity to use population-based data to study lesbian and bisexual health, we found that sexual orientation as a nonheterosexual woman was associated with increased rates of poor physical and mental health. We believe these findings support the need for the increased systematic study of the relationship between sexual orientation and health.

Adolescent↗
PubMedDate not supplied

Assessment of health status in chronic hemodialysis patients.

BACKGROUND: We compared three ways of assessing health status in chronic hemodialysis patients: generic questionnaire compared with population norms, disease-specific questionnaire, and open questions. METHODS: Hemodialysis patients (n=83) treated in Geneva canton, Switzerland, answered the Kidney Disease Quality of Life (KDQOL-SF) questionnaire, which combines 12 disease-specific scales with the generic Short-Form 36 (SF36) health survey, and open questions about the most disturbing and most positive aspects of having end-stage renal disease. SF36 scores were compared with those of the general population, and generic health scales were correlated with dialysis-specific scales. RESULTS: Hemodialysis patients had significantly lower scores than general population controls on 7 of 8 SF36 scales, especially physical functioning (-1.2 standard deviation (SD) units, p<0.001) and general health (-1.2 SD, p<0.001), but their mental health was similar (-0.2 SD, p=0.13). All 12 KDQOL dialysis-specific scores correlated significantly with the SF36 mental summary score, but only 6 correlated significantly with the SF36 physical summary score. Open comments suggested that dialysis itself is the chief problem confronting dialysis patients, but also that the predicament of end-stage renal disease may have a positive impact on the lives of some patients. CONCLUSIONS: While physical problems are the biggest difference between dialysis patients and controls, disease-specific scales and open comments highlighted the importance of psychosocial and treatment-related problems among hemodialysis patients. Generic and disease-specific questionnaires, and open comments provide different information about the health status of dialysis patients.

Adult↗
PubMed1995

Functional bowel disorders. A multicenter comparison of health status and development of illness severity index.

In a multicenter study of patients with painful functional bowel disorders (FBD), we compared the demographic, health status, and diagnostic features of patients with FBD and developed a functional bowel disorder severity index (FBDSI) for research and clinical care. Two hundred seventy patients with FBD in the United States, England, and Canada were surveyed on symptoms and health status, and their physicians made a diagnosis and rated illness severity as mild, moderate, or severe. Comparisons of 22 demographic and clinical variables were made by study site in addition to physicians' severity ratings. To develop the FBDSI, multiple regression analysis used the demographic and clinical variables to predict the physician's rating of severity. We found that most health status measures of patients with FBD across study sites are comparable and the derived and validated FBDSI scoring system uses three easy to obtain variables: FBDSI = [current pain by visual analog scale (0-100)] + [diagnosis of chronic functional abdominal pain (0 if absent and 106 if present)] + [number of physicians visits over previous six months x 11]. The FBDSI can be used to select patients for research protocols and/or follow their clinical outcome or response to treatments over time.

Abdominal Pain↗
PubMedDate not supplied

Health status and school achievement of children from Head Start and Free School Lunch Programs.

School health records of 332 children through the eighth grade were examined in a retrospective comparative analysis of physical health status and school achievement of children from Head Start and Free School Lunch Programs. The objective was to determine if nutrition early in the lives of children as a part of a comprehensive health and education program such as Head Start produces greater or different benefits for disadvantaged children than nutrition intervention later through free lunches when the child enters school. Cross-sectional longitudinal, and case-study approaches were used in the analysis. A group of no-food-program disadvantaged children and a group of advantaged children served as comparisons. Results showed that advantaged children performed better on all parameters of school achievement and health status compared with the disadvantaged children, regardless of the form of intervention. Measures of school achievement of Head Start and Free Lunch children did not differ from those of the disadvantaged comparison group, but there were significant differences in measures of health status between the disadvantaged groups. Fewer boys from Project Head Start fell below the 25th percentile for height compared with boys in the Free Lunch Program. Head Start children also scored higher in physical fitness and had fewer reported absences from school due to illness.

Achievement↗
PubMedDate not supplied

Children's health status instruments: their potential application in the emergency department.

OBJECTIVE: To provide an overview of child health status instruments and their potential application by emergency medicine researchers. CONCLUSIONS: Numerous instruments have recently been developed to measure children's physical, mental, and social health using sound principles of measurement science. These instruments differ from traditional clinical benchmarks of impairment. Health is conceived to be multidimensional and is measured from the child's and/or parents' perspective. Child health status instruments can be used to broaden the evaluation of emergency care in the following ways: 1) to evaluate emergency department (ED) interventions in terms of improvements in children's everyday activities and well-being; 2) to assess the appropriateness of ED disposition and follow-up services; and 3) to detect underlying health and social problems. Using these instruments in the ED will be challenging. Methodologic issues remain regarding the measurement of children's health. The most pressing issues are the absence of a universal definition of children's health, the need to take into account the developmental and social contexts of children, and the difficulties in eliciting information from very young children. In addition, the ED presents its own set of challenges. These include the lack of pre-injury/pre-illness measures, the absence of case-mix severity instruments, and the difficulty of isolating the effect of ED treatment on patients' health. RECOMMENDATIONS: Despite these challenges, it is time to use pediatric health status instruments in emergency medicine. Only with their adoption will instruments improve and advances in methodology occur. As patients, providers, and policy makers increasingly focus their attention on the nonfatal consequences of injury and illness, the broader use of these measures becomes imperative.

Child↗
PubMed2003

The impact of epilepsy on subjective health status.

Epilepsy is a chronic disorder that has complex effects on many aspects of personal health. Recent advances in the methods to reliably and validly assess subjective health status have allowed major advances in our understanding of these diverse effects, and have also provided evidence to guide treatment and future research. Studies that have included measures of quality of life, patient preferences, and disability in epilepsy have shown that the magnitude of the adverse effects of recurrent seizures on many aspects of subjective health status is as large as that seen with diabetes mellitus and active cardiovascular disease. Studies of patient-oriented, comprehensive outcomes after epilepsy surgery indicate positive treatment effects in broad areas of function and well-being. Although few trials of epilepsy drugs have included health outcome instruments, available studies suggest that greater than 50% seizure reduction is associated with improved quality of life. Adverse medication effects and depression appear to have a strong association with subjective health status in epilepsy, independent of seizure frequency.

Animals↗
PubMed2000

The impact of health status on waiting time for major joint arthroplasty.

This study was conducted to determine the impact of health status on waiting time for major joint arthroplasty in a universal publicly funded health system. Data were collected prospectively from a cohort of 553 patients waiting for total hip or total knee arthroplasty. The WOMAC and SF-36 health status instruments were administered at the time the patient was placed on the waiting list. The outcome measure was length of waiting time. Multivariate analyses found increased body mass index and decreased social function as the only determinants of waiting time. This model explained only 4% of the variance in waiting time. The association between health status and waiting time for arthroplasties appears to be small. These findings suggest that major joint arthroplasty is not prioritized on the basis of burden of illness.

Adult↗
PubMed2002

[Characteristics of the elderly in the study on assessment of the activity level of health status].

OBJECTIVE: The aim of the study carried-out in 1999 was to describe and analyse the health status and activity forms in elderly subjects (65 and older). METHODS: Health status was assessed on self-reported questionnaire information on: diseases, hospitalisation, disability, mobility, BMI, level of life enthusiasm, relationships and satisfaction. Reported activity has been classified as physical, intellectual (mental) and pro-social. Study group health status, activity (level, forms) demographic features were presented and analysed with the use of Epi-info6. RESULTS: Of this research study are presented in the second part of this paper.

Activities of Daily Living↗
PubMed1998

Comparison of health status, socioeconomic characteristics, and knowledge and use of HIV-related resources between HIV-infected women and men.

OBJECTIVES: The authors compared socioeconomic characteristics, and knowledge and use of human immunodeficiency virus (HIV)-related resources and health status measures between HIV-infected women and men registered within the Denver Health and Hospitals health care system. METHODS: Data collected through two Centers for Disease Control-funded surveillance initiatives (Adult Spectrum of Disease and Supplement to HIV/AIDS Surveillance) were linked. Health status measures were obtained using the Medical Outcomes Study (MOS-20) questionnaire. To compare health status measures between genders, men were matched to women based on disease stage, intravenous drug use, race, years of education, employment status, and age. RESULTS: Among all patients interviewed (n = 419), women (n = 52) were more likely to be minority, uneducated, intravenous drug users, and at earlier stages of HIV-disease than men (n = 367). Employment status was not significantly different. Knowledge of available services was generally good among both genders. Women received public assistance and had health insurance (Medicaid) more often than men. Women used support services, social work, and shelter assistance less often than men. The matched pairs analysis (n = 46 pairs) showed no significant differences between genders in physical and social function, mental health, pain, or general health perceptions; however, role function was better in women than in men (P<0.02). CONCLUSIONS: When controlling for factors that may influence health and access to health care, HIV disease generally impacts the health status of both genders similarly. Women scored higher in role function which may reflect family caretakers' responsibilities. Although knowledge of HIV-related resources was similar by gender, men made contact more often suggesting areas for enhanced outreach toward women.

Adolescent↗
PubMed1992

Measurement of health status in diabetic patients. Diabetes impact measurement scales.

OBJECTIVE: To develop an instrument to measure health status in adult insulin-dependent (type I) and non-insulin-dependent (type II) diabetic patients. RESEARCH DESIGN AND METHODS: Correlative study to examine psychometric properties of the questionnaire. Test-retest reliability, item-scale correlations, principal-components analysis, correlations with global clinical ratings, and correlations with clinical data extracted from medical records were examined at the diabetes clinics at the University of California, Davis, Medical Center. Patients were volunteer clinic patients able to complete the questionnaire. One hundred thirty patients completed a first administration of the questionnaire, and 52 completed a second administration. RESULTS: Test-retest reliability was satisfactory. Item-scale correlations showed that 40 of 44 questionnaire items were highly correlated with subscale and total scale scores. Principal-components analysis identified one major factor measured by the questionnaire. Cronbach's alpha, a measure of the scales' internal consistency, was of satisfactory magnitude. Global ratings of clinical status by patients and clinicians were highly correlated with scale scores. Correlations of scale scores with clinical data were generally of low magnitude but, where significant, were consistently in the direction hypothesized if the scale truly measures health status or disease impact. CONCLUSIONS: The Diabetes Impact Management Scales (DIMS) is an easily administered questionnaire with internal consistency and test-retest reliability. Preliminary correlative analyses support the validity of the instrument as a measure of health status in adult type I and type II diabetic patients. Further work will be necessary to firmly establish the validity of the DIMS and its usefulness in clinical outcomes research.

Adult↗
PubMedDate not supplied

Lifestyle and health status in long-term cardiac transplant recipients.

OBJECTIVE: The purpose of this pilot study was to describe the lifestyle and health status of long-term cardiac transplant recipients. DESIGN AND SETTING: The study was a descriptive correlational design at a health sciences center. MEASURES: We measured lifestyle, using the Health-Promoting Lifestyle Profile-II, and indicators of health status (eg, number of medications, infections, and rejections; systolic and diastolic blood pressure; lipid profile; and percent ideal body weight) in 47 patients after an annual evaluation or follow-up visit after patients received cardiac transplantation. RESULTS: Patients were primarily male, white, 56.5 years old and 75.6 months after transplant. Spiritual growth was the most frequently reported lifestyle characteristic (mean, 27.4; SD, 4.9). The least frequently reported lifestyle characteristic was engagement in physical activity (mean, 18.4; SD, 5.7). Factorial between-subjects analysis of variance demonstrated that women had a higher high-density lipoprotein level (P =.0001) and reported healthier dietary habits (P =.02) and greater spiritual growth (P =.006) than men. African Americans reported poorer stress management behaviors (P =.04). Recipients whose heart failure was due to ischemic cardiomyopathy had a lower percent ideal body weight than those with a nonischemic cause (P =.01). Recipients with cardiac allograft vasculopathy had a higher low-density lipoprotein cholesterol level (P =.05) and lower high-density lipoprotein cholesterol level (P =.05) than those without cardiac allograft vasculopathy, and those persons who required maintenance corticosteroid therapy reported poorer interpersonal relationships than those persons not receiving corticosteroids (P =.04). CONCLUSION: Cardiac transplant recipients did not consistently include health-promoting behaviors in their lifestyles although some of the behaviors were associated with a better health status. Future research should be aimed at identifying factors that affect the ability to make and sustain changes in lifestyle and improve health status.

Adult↗
PubMed1999

Health status, dyspnea, lung function and exercise capacity in patients with chronic obstructive pulmonary disease.

SETTING: A secondary hospital outside Oslo. OBJECTIVE: To assess relationships between health status and measures of dyspnea, lung function and exercise capacity in patients with chronic obstructive pulmonary disease (COPD), to identify dimensions where lung-specific instruments associate and discriminate better than general measures. DESIGN: We assessed health status in 59 out-patients with COPD, using the following instruments: Short Form 36 (SF-36)-a general health status measure, Respiratory Quality of Life Questionnaire (RQLQ)-a lung-specific measure, the Karnofsky performance scale, and a rating scale. All patients rated their dyspnea and had spirometry and exercise capacity measured. RESULTS: Mean (SD) patient age was 57.3 (9.7) years, FEV1 47% (15%) of predicted, 6 minute walk distance 503 m (122 m). Dyspnea was the strongest predictor for health status. Both SF-36 and RQLQ had dimensions associating well with dyspnea and exercise capacity. The associations with FEV1 ranged from none to moderate. CONCLUSION: All RQLQ scales had a moderate to substantial association with indices of dyspnea and exercise capacity, while the SF-36 associated well only in dimensions related to physical health. The general measure has a broader scope and complements the lung-specific measure. These findings support the construct validity of both the SF-36 and the RQLQ, and justify using a general measure to supplement a lung-specific measure.

Adolescent↗
PubMed2003

Methodological issues raised by preference-based approaches to measuring the health status of children.

This paper identifies and discusses a number of methodological issues that require consideration when applying preference-based approaches to the measurement of the health status of children. It is argued that the decision about which dimensions of health status to incorporate into health state descriptions or classifications should depend, in part, upon whether the measure will be used to inform resource allocation within or across age groups. In addition, the paper identifies and discusses a number of methodological issues surrounding the appropriate respondents for descriptions and valuations of health status in different contexts; potential sources of bias in the description and valuation processes; and the psychometric integrity of alternative measurement approaches.

Child↗
PubMedDate not supplied

Health status and life satisfaction among breast cancer survivor peer support volunteers.

Two measures of health-related quality of life (HRQOL), the Medical Outcomes Survey Short Form 36 (SF-36) and the Satisfaction with Life Domains Scale for Cancer (SLDS-C), were compared to examine the relationship between health status and life satisfaction among breast cancer survivors (BCSs). A total of 586 BCSs, all of whom were volunteers in peer support programs, met inclusion criteria and completed the self-report measures. Significant correlation coefficients were shown between life satisfaction and measures of health status. SF-36 scores were significantly higher for physical functioning, emotional well-being, and vitality subscales compared to population norms. BCSs expressed greatest dissatisfaction with their sexual ability, physical strength, and bodies in general. Small age differences were found. Results suggest that incorporating multiple measures of HRQOL contribute to the understanding and measurement of the effects of cancer on perceived health status and life satisfaction.

Adult↗
PubMed1996

Development of a musculoskeletal extremity health status instrument: the Musculoskeletal Function Assessment instrument.

Despite an increasing reliance on the use of health status measures to assess and evaluate medical care, no single instrument is currently available for use with the broad range of patients with musculoskeletal disorders of the extremities that is commonly seen in clinical practice. In this paper, we report on the development of the Musculoskeletal Function Assessment instrument, a 100-item self reported health status instrument that is designed to meet this need. The instrument was developed in two phases. During the first phase, items were selected on the basis of interviews with 135 patients and 12 clinicians and from reviews of existing health status instruments. The items then were grouped into categories. During the second phase, the instrument was tested for reliability and content validity using a sample of 327 patients with one of five musculoskeletal disorders of the upper and lower extremities (fractures, soft-tissue injuries, repetitive motion disorders, osteoarthritis, and rheumatoid arthritis). The patients were selected from both community and academic sites. Content validity also was demonstrated, based on a review of item selection procedures, expert opinion, and the distribution of scores on the instrument.

Adolescent↗
PubMed2004

The effect of health status on patients' satisfaction with out-of-hours care provided by a family doctor co-operative.

BACKGROUND: Systems for providing primary care outside normal hours have changed significantly in Europe over the last 20 years. The impetus for this change has come almost entirely from the medical profession, and it is important to consider the patients' perspective. Although patient's satisfaction with out-of-hours care has been studied extensively, the effect of patient's health status on satisfaction level has not been examined previously. OBJECTIVES: The primary objective of this study was to investigate whether health status has an influence on patient satisfaction with out-of-hours care provided by a family doctor co-operative. The secondary objective of this study was to investigate the impact of age, gender, socio-economic status and call outcome on patients' satisfaction with out-of-hours care. METHODS: All patients contacting the service over a designated 24 day period were forwarded a postal questionnaire. Health status was recorded using the Short Form-12 (SF-12) health survey. Patients' satisfaction was measured by using a version of the McKinley questionnaire. RESULTS: The response rate was 55% (531 out of 966). Overall satisfaction levels were high, with 88% of patients rating the service as either excellent or good. Logistic regression, modelling for the simultaneous effects of age, gender, socio-economic status, call outcome and health status on overall satisfaction, found that patients with lower physical and mental health status scores were significantly less likely to be satisfied with their out-of-hours care [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.07, P = 0.017; and 1.03, 95% CI 1.00-1.06, P = 0.046, respectively]. Patients with higher socio-economic status were also significantly less likely to be satisfied (OR 0.25, 95% CI 0.11-0.55, P = 0.001). Patient's age and gender, and call outcome did not significantly affect overall satisfaction levels. CONCLUSION: Family doctor co-operatives have significantly altered the way out-of-hours care is delivered. Patients with lower health status are significantly less likely to be satisfied with this new form of out-of-hours care. This finding has important implications for the future planning of out-of-hours primary care services.

Adolescent↗
PubMed2002

Health related quality of life and health status in adult survivors with previously operated complex congenital heart disease.

OBJECTIVE: To examine the impact of previously operated complex congenital heart disease on health related quality of life and subjective health status and to determine the relation between these parameters and physical status. DESIGN: Cross sectional; information on medical follow up was sought retrospectively. SETTING: Patients were randomly selected from the archives of the paediatric cardiology department, Leiden University Medical Centre, Leiden, The Netherlands, and approached irrespective of current cardiac care or hospital of follow up. PATIENTS: Seventy eight patients with previously operated complex congenital heart disease (now aged 18-32 years) were compared with the general population. MAIN OUTCOME MEASURES: Health related quality of life was determined with a specifically developed questionnaire (Netherlands Organisation for Applied Scientific Research Academic Medical Centre (TNO-AZL) adult quality of life (TAAQOL)) and subjective health status was assessed with the 36 item short form health survey (SF-36). Physical status was determined with the objective physical index, Somerville index, and New York Heart Association functional class. RESULTS: Health related quality of life of the patients was significantly worse than that of the general population in the dimensions gross motor functioning and vitality (p < 0.01). Correlations between health related quality of life and physical status were poor. Patients had significantly worse subjective health status than the general population in the dimensions physical functioning, role functioning physical, vitality, and general health perceptions (p < 0.01). Correlations between subjective health status and physical indices were weak. CONCLUSION: Adult survivors with previously operated complex congenital heart disease experienced limitations only in the physical dimensions of health related quality of life and subjective health status. Objectively measured medical variables were only weakly related to health related quality of life. These results indicate that, when evaluating health related quality of life, dedicated questionnaires such as the TAAQOL should be used.

Adolescent↗