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PubMed2003

Surveillance for health behaviors of American Indians and Alaska Natives. Findings from the Behavioral Risk Factor Surveillance System, 1997-2000.

PROBLEM/CONDITION: In the United States, disparities in risks for chronic disease (e.g., diabetes, cardiovascular disease, and cancer) and human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are evident among American Indians and Alaska Natives (AI/ANs) and other groups. This report summarizes findings from the 1997-2000 Behavioral Risk Factor Surveillance System (BRFSS) for health-status indicators, health-risk behaviors, and HIV testing and perceived risk for HIV infection among AI/ANs, compared with other racial/ethnic groups in five regions of the United States. REPORTING PERIOD COVERED: 1997-2000. DESCRIPTION OF SYSTEM: BRFSS is a state-based telephone survey of the civilian, noninstitutionalized, adult (i.e., persons aged > or =18 years) population. For this report, responses from the 36 states covered by the Indian Health Service administrative areas were analyzed. RESULTS: Region and sex-specific variations occurred in the prevalence of high-risk behaviors and health-status indicators. For example, the prevalence of current cigarette smoking ranged from 21.2% in the Southwest to 44.1% in the Northern Plains, and the awareness of diabetes was lower in Alaska than in other regions. Men were more likely than women to report binge drinking and drinking and driving. For the majority of health behaviors and status measures, AI/ANs were more likely than respondents of other racial/ethnic groups to be at increased risk. For example, AI/ANs were more likely than respondents of other racial/ethnic groups to report obesity (23.9% versus 18.7%) and no leisure-time physical activity (32.5% versus 27.5%). INTERPRETATION: The 1997-2000 BRFSS data demonstrate that health behaviors vary regionally among AI/ANs and by sex. The data also reveal disparities in health behaviors between AI/ANs and other racial/ethnic groups. The reasons for these differences by region and sex, and for the racial/ethnic disparities, are subjects for further study. However, such patterns should be monitored through continued surveillance, and the data should be used to guide prevention and research activities. For example, states with substantial AI/AN populations, and certain tribes, have successfully used BRFSS data to develop and monitor diabetes and tobacco prevention and control programs. PUBLIC HEALTH ACTIONS: Federal and state agencies, tribes, Indian health boards, and urban Indian health centers will continue to use BRFSS data to develop and guide public health programs and policies. The BRFSS data will also be used to monitor progress in eliminating racial and ethnic health disparities. Regional Indian health boards, tribal epidemiology centers, and Indian Health Service Area Offices can use the findings of this report to prioritize interventions to prevent specific health problems in their geographic areas. Moreover, tribes and other institutions that promote AI/AN health care can use the report to document health needs when applying for resources.

AIDS Serodiagnosis↗
PubMed1987

[Indicators of disability-free life expectancy. Global indicators of the health status of populations].

Disability free life expectancy (DFLE) is an index of mean length of healthy life. It aims at measuring the evolution in the populations state of health. The first calculations were achieved at the end of the 60s and about ten experimental calculations have been made until now, mostly in the United States, Canada, Japan and France. Nowadays this index is very well accepted. Its major qualities are its usefulness for setting health targets and determining the present and future needs. Is DFLE destined for becoming a conjonctural index of health state? The circumstances are undoubtedly propitious. Nevertheless, in order to be used in routine the DFLE index must answer three conditions, which the current approach does not fulfil i.e. the viability of disability measurement for comparisons in time; a registration of period data which is based on the incidence of entrance in disability; a calculation which is adapted to the disability whether it is reversible or not.

Aged↗
PubMed1989

The relationship between retrospective health insurance claims and a health risk appraisal-generated measure of health status.

This research examined the relationship between a measure of health status (defined as the health index--the difference between actual and appraised ages) derived from a health risk appraisal and retrospective health insurance claims taken from one cooperating work organization. A model was defined consisting of 3-year retrospective medical claims as the criterion and age and the health index as predictors. Using a cube-root transformation of medical claims, a significant inverse relationship for age and the health index was identified for men. No relationships were found for women. It was concluded that, for men when age is held constant, a negative relationship exists between retrospective medical claims and a health risk appraisal-generated health status indicator, the health index.

Adult↗
PubMed1993

Comparison of spinal health indicators in predicting spinal status in a 1-year longitudinal study.

A 1-year longitudinal study was performed to assess and compare the predictive qualities of spinal health indicators (excluding the cervical spine) among aircraft assembly workers having at least 1 year seniority in a large assembly plant. Ten health indicators were compared to determine their sensitivity and predictive power with regard to back compensation and absenteeism in 12 months follow-up, and the presence of any limitation at work due to the back, or symptoms to the back at the end of the interval. The initial response to a self-administered questionnaire was obtained from 269 male workers, of whom 205 (76.2%) completed the follow-up questionnaire. Initial prevalence of symptoms to the back was 42.3%, limitation in performing at work was 28.1%, consultation of a health professional was 7.3%, and a history of compensation for the back (ever) was reported by 30.4%. During the year of follow-up, 16 (6%) of the 269 workers initially enrolled were granted 17 compensated episodes. Of the 205 workers who responded to the follow-up, 33 (16.1%) have been absent from work (with or without compensation) because of their back. The presence, at the beginning of the study, of a limitation in performing at work or in activities of daily living and a history of compensation (ever) were the three indicators independently associated with the occurrence of compensation or absenteeism (total work disability) related to a back problem during the following year.(ABSTRACT TRUNCATED AT 250 WORDS)

Absenteeism↗
PubMed1977

Sociocultural barriers to medical care among Mexican Americans in Texas: a summary report of research conducted by the Southwest Medical Sociology Ad Hoc Committee.

This paper summarizes research findings from members of the Southwest Medical Sociology Ad Hoc Committee concerning sociocultural barriers to medical care among Mexican Americans in Texas. Committee members individually, or in two-person groups, studied a number of factors concerning Mexican-American medical care in Texas such as: 1) mortality, morbidity, and other health status indicators; 2) health manpower and educational needs; 3) political factors impeding economical health care; 4) alienation, familism, and their relationship to utilization of the health services; 5) language and communication barriers; and 6) folk medicine. Findings include documentation that structural alienation of Mexican-Americans from mainstream Anglo-American middle-class society is carried over into their relation with utilization of the health care delivery system; that their emphasis on familism works alternatively to encourage and discourage their seeking access to health care; the language differences serve to perpetuate certain cultural differences that are inimical to health care delivery; and that curanderismo can be seen as complementing other types of health care. The report concludes with a number of recommendations for accomplishing cultural integration that will lead to better care for this segment of the health population.

Communication↗
PubMed1991

[Absenteeism as an indicator of health status of patients with long-term and frequent diseases]].

Results of the feasibility analysis of using sickness absenteeism as a measure of worker health condition, especially in long (above 30 days p.a.) and often (above 3 cases p.a.) ailing workers have been reported. Information on health condition of 5197 random-selected textile industry workers and their sickness absenteeism over one year period served as teh basis of the study. Sensitivity, specificity, negative and positive predictive value of the sickness absenteeism due to most frequently diagnosed illnesses in the investigated population were employed. Sickness absenteeism has proved to be a specific, but not very sensitive health condition measure. In the groups of long and frequently ailing persons, sickness absenteeism has proved to be the more sensitive but less specific measure than in the whole investigated group. Among the frequently ailing group, the percentage of persons absent because of digestive system diseases, circulatory system diseases and back diseases satisfactorily approximates the percentage of the chronically sick.

Absenteeism↗
PubMed1991

[Life expectancy free of disability: global indicator of health status].

BACKGROUND: Due to the limitations of mortality and morbidity as measures of the health status in developed countries, the elaboration of health indexes which include quality of life in addition to life duration has been proposed. The aim of the present article is to report the results of the calculation for Spain in 1986 of one of these indexes, the expectancy of life free from disability (ELFD). METHODS: The life expectancy (LE) and the ELFD were calculated on the basis of data from health surveys by interview and mortality data from routine statistics. This method was proposed by Sullivan in 1971 on the basis of the procedure of life tables. RESULTS: The results showed that the difference in LE between sexes was reduced when the years lived in disability were taken into account. Thus, while LE at birth was 79.6 years in females and 73.2 in males, the ELFD was 62.6 and 60.8, respectively. CONCLUSIONS: The important reduction in the difference between sexes regarding LE when ELFD is accounted for shows that the gain in years of life in females is obtained at the expense of years lived in disability. ELFD appears as a useful index for the evaluation of needs and the planning of social health services.

Adolescent↗
PubMed2001

Epidemiological profile of India: historical and contemporary perspectives.

Knowledge and understanding of the epidemiological profile is an essential pre-requisite to assess and address public health needs in the country and to enable efficient programme planning and management. The need for adequate and accurate health information and data to undertake such an exercise cannot be over-emphasized. The present effort is a modest attempt to critically analyse the epidemiological profile of India from the historical and contemporary perspective. In order to assess the successes achieved as well caution against the daunting challenges awaiting the country, parameters such as disease burden and health status indicators, are increasingly being used. Changes in the population age structure, improvements in the nation's economic status, altered life-styles of people and duality of disease burden testify to the demographic, development and health transition occurring in the country. Population stabilization, poverty alleviation, life-style modification, surveillance and control of communicable and non-communicable diseases constitute the major challenges demanding urgent attention in the future.

Birth Rate↗
PubMed2002

Indicator-based assessment of environmental hazards and health effects in the industrial cities of upper Silesia, Poland.

Using an indicator-based approach, we assessed environmental hazards and related health effects in populations of industrial cities with more than 100,000 inhabitants in Upper Silesia, Poland, and analyzed the relationship between environment and health. We adopted the method developed by Dutkiewicz et al. for assessing large geographic areas. Based on routinely collected environmental and health data, two groups of indicators, environmental indicators (EIs) and health status indicators (HSIs), related to environmental contamination were selected. The EI and HSI values were normalized and aggregated into synthetic measures using Strahl's taxonometric method. The synthetic measures indicated the intensity of environmental hazards and health outcomes. We used a three-level index scale to compare and rank the cities under the study and, consequently, to facilitate decision making. Findings of the assessment identified cities where actions aimed at reducing environmental hazards and improving population health status should be established as priorities. These cities included Chorzów, Katowice, Sosnowiec, Bytom, and Zabrze. We found a high correlation between the synthetic measures of environmental indicators and the synthetic measure of health status indicators (r = 0.77), as well as a high level of consistency between environmental hazard indices and environmental-related health status indices (73%). This may indicate the existence of a causal relationship between the environmental contamination within industrial cities and the health status of their inhabitants.

Adolescent↗
PubMed1995

Case mix of home health patients under capitated and fee-for-service payment.

OBJECTIVE: We compare case mix of Medicare home health patients under HMO and FFS payment. STUDY DESIGN: A pseudo-experimental design was employed to study case mix using three types of Medicare-certified home health agencies (HHAs): HMO-owned agencies, pure FFS agencies that admit few Medicare HMO patients (less than 5 percent of admissions are Medicare HMO patients), and mixed (or contractual) agencies that admit at least 15 Medicare FFS patients and 15 Medicare HMO patients per month. SAMPLES OF PROVIDERS AND PATIENTS: Random samples of Medicare-aged patients (> or = 65 years) were selected at admission between June 1989 and November 1991 from the 38 study HHAs. Sample sizes by agency type were: 308 patients from 9 HMO-owned agencies; 529 patients from 15 pure FFS agencies; and 381 HMO patients and 414 FFS patients from 14 contractual agencies. DATA: Primary longitudinal data were prospectively collected at admission for all patients on health status indicators, demographics, admission source, and home environment. MEASURES: The most important case-mix measures were functional and physiologic indicators of health status, including (instrumental) activities of daily living ([I]ADLs). Selected indicators of demographic variables, prior location, living situation, characteristics of informal caregivers, mental/behavioral factors, and resource needs were also used. PRINCIPAL FINDINGS: (a) The case mix of Medicare FFS patients compared with Medicare HMO patients was more intense in terms of impairments in ADLs, IADLs, and various physiologic conditions. Pressure ulcers as well as neurological and orthopedic impairments requiring rehabilitation care were also more prevalent among FFS patients. (b) Relative to HMO patients admitted to contractual agencies, HMO patients admitted to HMO-owned agencies were moderately more dependent in ADLs and IADLs. However, only 62 percent of HMO patients admitted to HMO-owned agencies, in contrast to 77 percent of HMO patients admitted to contractual agencies, had been hospitalized during the 30 days prior to home health admission. (c) In all, the case mix of patients receiving care from HMO-owned agencies is more heterogeneous than the case mix of HMO patients receiving care from contractual agencies. CONCLUSIONS: The case-mix (and selected utilization) findings indicate that HMOs use home health care differently than does the FFS sector. The greater diversity of case mix for HMO-owned agencies and the narrower or less diverse case mix that characterizes HMO patients receiving home care on a contractual basis point to the likelihood of cost differences among the two types of HMO patients and FFS patients, and raise the question of possible outcome differences.

Activities of Daily Living↗
PubMed2004

Dimensions of osteoarthritis self-management.

Our aims were to determine whether a taxonomy of self-management strategies for osteoarthritis could be identified, and whether the resultant dimensions of such a taxonomy demonstrate predictable relationships with health status indices. Participants (n = 117) from community-based self-help groups and a general rheumatology outpatient clinic completed a self-management inventory consisting of 11 items, answered for both the past 7 days and a day on which symptoms were worse than usual. Duration of symptoms, level of pain, perceived functional ability and self-rated health were recorded as indicators of health status. Three essentially identical factors were obtained for both past 7 days and worse day items. Resultant scales were labeled passive, complementary and active, respectively. Correlations with health status measures provided modest evidence for the construct validity of these self-management scales. Compared with a simple aggregate score based on the total number of strategies used, the scales provided a clearer understanding of the relationship between self-management and health. The study provided a useful extension to existing research, addressing a number of shortcomings identified by previous researchers. The identified self-management dimensions offered a greater insight into the self-management choices of patients. Suggestions for further improvements to the measurement of self-management are outlined.

Aged↗