Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Health Transition”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources
PubMed2003

Transitions in health status in older patients with heart failure.

BACKGROUND: We aimed to determine transitions in health perception and functional status in older Medicare patients with heart failure. METHODS: We used 1991 to 1994 data from the Medicare Current Beneficiary Survey, a database that combines Medicare claims with yearly longitudinal surveys. We identified 872 patients 65 years or older in 1991 with a diagnostic code of heart failure. RESULTS: At baseline, 58% of the patients rated their general health perception as "fair" or "poor." Over 1 year, 18% of the patients died. Transition matrices revealed that health perception, activities of daily living, and instrumental activities of daily living were strong correlates of mortality; that dramatic changes in health status were relatively uncommon over 1 year among survivors; and that decline was common in patients with "excellent" or "very good" health perception. The prior year's health status and comorbidity were powerful predictors of the subsequent year's health status. CONCLUSION: Many older patients with heart failure have worsening health status over time. Measures of prior health status can help predict chances of functional recovery.

Activities of Daily Living↗
PubMedDate not supplied

[Diabetes mellitus and the health care transition].

To document the existence of an epidemiologic and a health care transition in Mexico, diabetes mellitus (DM) mortality was analyzed. Age and sex adjusted mortality rates were estimated for each one of the states of Mexico, as well as the mean age at death, the number of years of potential life lost, and their percent distribution. The geographic distribution of these variables was plotted in maps according to tertiles or quartiles. The proportion of deaths due to acute and chronic complications of DM was classified according to community size. Polarized patterns of DM mortality as well as in the percentage contribution of deaths due to its acute and chronic complications were observed, in agreement with the postulated transitional process.

Acute Disease↗
PubMed1998

The effects of political and economic transitions on health and safety in Estonia: an Estonian-Swedish comparative study.

A general and dramatic deterioration of health in Estonia during the transition period 1990-1994 was analysed using Sweden as a comparative example. Though there were diverging trends between Estonia and Sweden in the leading cause of death, cardiovascular diseases, the gap in mortality from injury had increased most rapidly. While the injury mortality rate slightly decreased in Sweden from 1990 to 1994, it almost doubled in Estonia. In 1994, the total injury death rate for men was about 6 times higher in Estonia than in Sweden. The death rates for some types of injuries, such as alcohol intoxication and homicide, were many tenfolds higher in Estonia than in Sweden. Injury contributed the most to the widening health gap between the countries, especially in males. The mechanisms of this sudden health deterioration remain to be fully explained. It could be hypothesised that behind the traditional behavioural risk factors, the influence of socio-political factors related to economic and political reconstruction is present. A widespread risk-taking and unhealthy behaviour among Estonians can likely be partly explained as a way of coping with the distress created by the new demands of transition society. An important challenge on the way to improvement is creating the political will among policy-makers to confront the tremendous problems of controlling the factors in society that affect the population's health in Estonia.

Cardiovascular Diseases↗
PubMed2004

Unmet education and training needs of rheumatology health professionals in adolescent health and transitional care.

OBJECTIVES: To determine the perceived education and training needs of health professionals involved in transitional care for adolescents with juvenile idiopathic arthritis (JIA). METHODS: Two distinct questionnaires to identify transitional issues in JIA were distributed to key health professionals (n = 908) and clinical personnel involved in the implementation of a transitional care programme (n = 22). RESULTS: The first survey was completed by 263 professionals. Education needs were reported by 114 (43%) of health professionals. Transition issues and informational resources were the most frequently reported areas of need. The second survey was completed by 22 clinical personnel who rated 'lack of training', 'lack of teaching materials geared towards adolescents' and 'limited clinic time' as the main barriers to providing developmentally appropriate care to adolescents. CONCLUSION: Unmet education and training needs of health care professionals exist in key areas of transitional care and provide useful directions for the development of future training programmes.

Adolescent↗
PubMed2006

[Changes in the patterns of disease after the epidemiological transition in health in Chile, 1950-2003].

BACKGROUND: During the twentieth century there was a change in the pattern of diseases in Europe, with an increase in the incidence of allergies and autoimmune disorders, that paralleled a decrease of infectious conditions. The Hygiene hypothesis proposes that these phenomena are causally related. AIM: To evaluate the epidemiological changes of allergic, autoimmune, and infectious diseases in Chile between 1950 and 2003. MATERIAL AND METHODS: Search for the incidence and prevalence of these diseases in the national records published by the Ministry of Health, as well as through a systematic search of national literature using PubMed and Scielo as search engines. RESULTS: The annual incidence of tuberculosis, rheumatic fever, measles, and typhoid fever has progressively diminished in Chile since 1970. Figures for the national prevalence for asthma, rheumatoid arthritis, and type I diabetes are scarce and difficult to compare, but clearly show an increasing epidemiological trend in the last 20 years. CONCLUSIONS: The national figures suggest that, although the country has only recently gone through an epidemiological transition in health problems, there are detectable changes that show the same trends described in Europe.

Adolescent↗
PubMed1997

Improving the quality of the NCQA (National Committee for Quality Assurance) Annual Member Health Care Survey Version 1.0.

The National Committee for Quality Assurance (NCQA) developed a standardized survey instrument in 1995 designed to measure enrollee satisfaction with the care and services received from health plans across the United States. After the survey was administered for a large number of health plans and thousands of responses were received, some areas for survey improvement have emerged. The objective of this research was to evaluate the NCQA Annual Member Health Care Survey Version 1.0 (the standard form) relative to an alternate survey form created in cooperation with the HMO Group, Maritz Marketing Research, Inc., and Healthcare Research Systems, Ltd. The alternate form of the NCQA survey was constructed to test several theories of measurement improvement via rewording of items, reordering of items, deletion of items, and addition of items. The most important findings of the research project are reported herein. Ten geographically dispersed member health maintenance organizations (HMOs) of The HMO Group took part in the project. A split-half design was used to test the standard and alternate survey forms concurrently. Surveys were administered by using the NCQA-recommended mail methodology of survey and cover letter, reminder card, and second survey. Assuming a 50% response rate, a target of 400 responses (200 for each survey form) per HMO was planned. The window for responding was allowed to remain open 4 weeks beyond the mailing of the second survey to achieve the desired response rate. A total of 4,056 responses were collected (2,022 for the standard form and 2,034 for the alternate form). It was found that the addition of "No Experience" and "No Opinion" response options to the majority of satisfaction items reduced the random error associated with informed responses and produced statistically significant higher correlations with the global satisfaction items relative to the standard form items. Only four of the eight Short Form 12 summary scales, General Health, Reported Health Transition, Mental Health, and Social Functioning, were useful for adjusting data (covariation). The entire set of comorbidities (chronic disease checklist) could be eliminated without losing significant data adjustment capability. The multiple linear regression models generated by using the global satisfaction items on the alternate form had higher adjusted R2 values than the standard-form models. The alternate-form item Overall Value correlated highly with cost items and general satisfaction item, making it a useful global satisfaction variable for predictive modeling.

Health Care Surveys↗
PubMed2001

Probabilities of transition among health states for older adults.

GOAL: To estimate the probabilities of transition among self-rated health states for older adults, and examine how they vary by age and sex. METHODS: We used self-rated health (excellent, very good, good, fair, poor, dead) collected in two longitudinal studies of older adults (mean age 75) to estimate the probability of transition in 2 years. We used the estimates to project future health for selected cohorts. FINDINGS: These older adults were most likely to be in the same health state 2 years later, but a substantial proportion changed in both directions. Transition probabilities varied by initial health state, age and sex. Men were more likely than women to transition to excellent or dead. Women were more likely than men to transition to good or fair health. Although women aged 70 will have more years of life and more years of healthy life than men, they also have more years of unhealthy life, and the proportion of remaining life that is healthy is slightly higher for men. When observed and predicted years of healthy life (YHL) were compared in various subgroups, the YHL of persons with less favorable baseline characteristics was lower than predicted, and vice-versa. Differences, however, were small (about 5%). CONCLUSIONS: These transition probability estimates can be used to predict the future health of individuals or groups as a function of current age, sex, and self-rated health.

Age Factors↗
PubMed2002

Disease-specific, patient-assessed measures of health outcome in ankylosing spondylitis: reliability, validity and responsiveness.

OBJECTIVE: To assess the acceptability and measurement properties of four ankylosing spondylitis (AS)-specific, patient-assessed measures of health outcome: AS Quality of Life Questionnaire (ASQoL), Bath AS Disease Activity Index (BASDAI), the Body Chart and the Revised Leeds Disability Questionnaire (RLDQ). METHODS: Instruments were administered by means of a self-completed questionnaire to patients recruited from across the United Kingdom (UK). Instruments were assessed for data quality and scaling assumptions. Where appropriate, dimensionality was assessed using principle component analysis (PCA). Internal consistency reliability was tested using Cronbach's alpha. Test-retest reliability was assessed in those patients reporting no change in AS-specific health at 2 weeks. The convergent validity of the instruments was assessed and scores were correlated with responses to the health transition questions. Responsiveness was assessed for patients reporting change in health at 6 months. RESULTS: The BASDAI and Body Chart have low self-completion rates. Item responses for the RLDQ were skewed towards higher levels of functional ability. PCA supported instrument unidimensionality. Cronbach's alpha ranged from 0.87 (BASDAI) to 0.93 (RLDQ). Test-retest reliability estimates support the use of the ASQoL and RLDQ in individual evaluation (>0.90). Correlations between instruments were in the hypothesized direction; the largest was between the ASQoL and BASDAI (0.79). The BASDAI had the strongest linear relationship, with responses to both specific and general health transition questions (P<0.01). With the exception of the Body Chart, instruments had a stronger relationship with general health transition. The BASDAI was the most responsive instrument. The Body Chart and RLDQ had low levels of responsiveness. CONCLUSION: The instruments have undergone a comprehensive comparative evaluation to assess the measurement properties required for patient-assessed measures of health outcome. Adequate levels of reliability and validity were found for all instruments. The BASDAI and the ASQoL were the most responsive to self-perceived change in health, but the BASDAI had low levels of self-completion.

Adaptation, Physiological↗
PubMed2004

Interprofessional perspectives on transitional mental health services for young people aged 16-19 years.

This qualitative study investigated the need for transitional mental health services for young people aged 16-19 years in a health district, as perceived by professionals from mental health, social, education and non-statutory services. Semi-structured interviews with 39 managers and practitioners who planned or provided services for this age range, from a wide range of agencies, explored issues related to older adolescents' needs, service communication, transfer arrangements, current gaps, and recommendations. Interviews were transcribed verbatim and themes emerged according to grounded theory. The four identified themes, with 21 categories, were: (i) older adolescents have multi-faceted needs, (ii) statutory mental health services are not geared towards this age group, (iii) communication between services is variable, and (iv) there are no formal transfer arrangements from child to adult services. The findings support the need for specialist transitional services, and the adoption of an interprofessional service model incorporating education, social services and non-statutory agencies.

Adolescent↗
PubMed1984

Community health politics: transition of the Seattle USPHS Hospital.

To achieve transition of the Seattle US Public Health Service Hospital from federal to local control, the community overcame large obstacles; the most difficult was federal preference for closing the hospital rather than incurring additional costs essential for transition. The Washington State Congressional Delegation, local officials, hospital staff, patients and numerous community volunteers--individuals and private organizations--worked together to save the hospital and secure federal resources for its transition. Going through the transition influenced the hospital as it developed a new corporate structure, designed new administrative systems, and prepared to operate in a new environment while facing an uncertain future. The hospital has continued to cope with issues arising from transition, such as operating in a competitive context while reaffirming its community service heritage. Despite the difficulties of transition, Seattle preserved a valuable community health resource.

Community Participation↗
PubMed1997

Transitions in health care use and expenditures among frail older adults by payor/provider type.

OBJECTIVES: To assess whether transitions in health care expenditures differed over time by payor/provider type: Medicare fee-for-service (FFS), Medicaid-Medicare, and Medicare HMO. DESIGN: Longitudinal study. SETTING: A large, nonprofit healthcare system in San Diego, California. PARTICIPANTS: A total of 450 frail older people who responded to the baseline and follow-up surveys and who survived the 18-month study period. MEASUREMENTS: Measures included three total expenditure categories for each 6-month period: low users (< $4000); medium users ($4000-$19,999); or high users ($20,000+). Seven conceptually meaningful expenditure trajectories over time were identified: (1) consistently low expenditures, (2) consistently medium expenditures, (3) consistently high expenditures, (4) decreasing expenditures, (5) increasing expenditures, (6) U-shaped expenditures, and (7) inverted U-shaped expenditures. MAIN RESULTS: Logistic regression analyses showed that HMO enrollees were about twice as likely as Medicaid-Medicare beneficiaries to have consistently low expenditures, but no differences were found between the FFS and HMO groups on this trajectory. Other expenditure patterns showed no significant differences by payor/provider group. Significant interactions among payor/provider type, low/medium/ high expenditure status, and time were observed for inpatient hospital care, skilled nursing/rehabilitation care, and home health care. CONCLUSION: This study illustrates the complexity of frail older people with respect to their health care expenditures and service use. Expanded efforts to control health care expenditures for frail older people should focus first on those who are dually-enrolled. In addition, because mean medical expenditures for high users enrolled in different payor/ provider groups were surprisingly similar, the data suggest that containing expenditures for individuals in the highest usage group ($20,000+) presents challenges for physicians practicing in an era of healthcare reform, regardless of payor/ provider setting.

Aged↗
PubMed1996

Quality of life assessment in pregnant women with the human immunodeficiency virus.

OBJECTIVE: To describe the perceived quality of life and functional status of women with human immunodeficiency virus (HIV) during the antenatal, perinatal, and postpartum periods. METHODS: Medical Outcome Survey-Short Form questionnaires were completed during antenatal visits, 24 hours after delivery, and 6 months postpartum by 21 HIV-positive women and 21 HIV-negative controls matched for age, race, parity, and education. The Medical Outcome Survey-Short Form measures subject perceptions of overall health, pain, physical role, social and cognitive function, mental health, energy/fatigue, health distress, quality of life, and health transition. Median scores between 0 and 100 (with 0 indicating poorest health) were compared using the Wilcoxon signed-rank and Kruskal Wallis/Dunn tests. RESULTS: All HIV-positive patients were asymptomatic; the median CD4 count was 386 on entry into the study. Seropositive patients reported increased health distress (50.0 versus 87.5; P < .001) and worse health transition (60.0 versus 80.0; P = .01) during antenatal visits. During the perinatal period, HIV-negative patients had a decreased sense of overall health (40 versus 80; P < .001) and worse health transition (40.0 versus 60.0; P = .04). Six months postpartum, the HIV-positive women reported decreased cognitive function (41.7 versus 62.5; P < .005) and worse social function (33.3 versus 66.7; P = .02). In general, HIV-negative women reported better quality of life in the antepartum as compared with the perinatal or postpartum period. This overall trend was also seen in the HIV-positive population. CONCLUSIONS: This is the first longitudinal evaluation of perceived quality of life in HIV-positive pregnant subjects. We conclude that perceived quality of life differs between HIV-positive and HIV-negative pregnant women. These differences may not be manifest during initial antenatal visits but may develop as pregnancy, the disease process, and other life events specific to delivery and the postpartum period interact and affect overall perceived quality of life. Longitudinal evaluation of quality-of-life issues may be important in the comprehensive care of HIV-positive women during pregnancy.

Female↗
PubMed2002

Health equity in transition from planned to market economy in China.

This paper examines the impact of economic transition and health sector reform on health equities in the urban and rural populations of China in the 1990s. Since 1980, China has experienced a rapid economic development and fundamental transformation of its society. Three secondary data sources were used as the basis for the analysis and discussion: mortality data from the National Death Notification System; infant mortality from the National Maternal and Child Health Surveillance System; and morbidity, health care utilization and financing data from the National Health Household Interview Surveys. The analysis revealed a very complex picture with: general mortality rates decreasing in both urban and rural populations, but the differences between urban and rural increasing; declining infant mortality rates with narrowing of the urban-rural gap; health care needs declining in both urban and rural populations, but more rapidly in the urban areas; health service payments increasing in both urban and rural areas, while, at the same time, health insurance coverage decreased. The analysis suggests that despite overall improvements in the population's health status, the economic and health system policy reforms are leading to increased inequities in health care. The lowest income quintiles in both urban and rural areas are receiving less health care compared with their needs in 1998 than in 1993, and the urban-rural divide, in particular with regard to receiving inpatient health care, is widening appreciably. The reform of the health insurance system, combined with the market setting of prices for care, have had profound implications for all population groups, in particular the lower income segments and the rural populations. During the period 1993-98 the proportion of the urban population that had to cover the increasing cost of medical care themselves doubled.

China↗