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PubMed1989

Survival compared to the general population and changes in health status among intensive care patients.

In order to evaluate intensive care, all adult patients (980) admitted to a multidisciplinary intensive care unit (ICU) during 1 year were followed prospectively. The ICU mortality was 9.6%. One year after admission the survival was 73.6%. By that time the surviving patients had a further survival that was 96% of that of the general population. Of the 1-year survivors, 22.3% had deteriorated in health status compared to 3 months before the stay in ICU. In the admission groups with high mortality the survivors had a more pronounced deterioration in health status. Increased age and length of stay in the ICU were associated with higher mortality but not with changes in health status. We conclude that the outcome of intensive care can be evaluated by studying only the survival, since the survival rate is correlated to changes in health status among survivors in the different admission groups. One year after admission most of the surviving patients had regained their previous health status and their further survival was almost the same as that of the general population.

Adolescent↗
PubMed2002

Evaluation of healthcare utilization and health status of patients with Parkinson's disease treated with deep brain stimulation of the subthalamic nucleus.

OBJECTIVE: To assess the effects on motor functioning, health status and direct medical costs of high-frequency stimulation of the subthalamic nucleus (DBS-STN) in patients with idiopathic Parkinson's disease (PD). In addition, the cost-effectiveness of DBS-STN vs. drug treatment was investigated. METHODS: 16 consecutive patients with PD from two centers (Düsseldorf/Cologne; Kiel) treated by DBS-STN were prospectively evaluated. Clinical evaluations were done at baseline and 1, 3, 6, 12 months following surgery by means of the Unified Parkinson's disease Rating Scale (UPDRS). Health status of PD patients was assessed using the Sickness Impact Profile (SIP) at baseline and 6 months following surgery. Relevant economic data were taken from the medical records and costs (1999) were derived from different German medical economic resources. Costs were determined from the perspective of the health care provider. RESULTS: Following DBS-STN UPDRS scores (subscores and sum score) as well as health status improved considerably in PD patients. The overall SIP score and the physical dimension score (p < 0.009) were significantly different (p < 0.01) six month after surgery compared with baseline values. Mean costs of DM 40,020 (US dollars 20,810, EURO 20,410, GB pounds 12,810) per patient were spent during the 12 month observation period for in-patient and out-patient care. These expenses included already the costs for the electronic device for bilateral stimulation. Following DBS-STN medication was considerably reduced. Mean daily drug costs at baseline were DM 46.7+/-21.8 (US dollars 24, EURO 24, GB pounds 15) and DM 18.3+/-17.7 (US dollars 10, EURO 9, GB pounds 6) at 12 months following DBS-STN. Accounting for the decreased drug consumption, total annual costs amounted to DM 31,400 (US dollars 16,330, EURO 16,010, GB pounds 10,050). Further, we estimated the incremental cost effectiveness as DBS-STN had higher costs but was more effective than baseline treatment. The incremental total cost-effectiveness ratio for DBS-STN was DM 1.800 (US dollars 940, EURO 920, GB pounds 580) for one point decrease of the UPDRS. CONCLUSION: DBS-STN is an effective treatment that considerably alleviates the severity of signs and symptoms and improves the health status of patients with PD. Compared with drug treatment, however, the expenditures associated with DBS-STN are increased when only direct medical costs are considered in a one year horizon. However, on a long-term basis costs will decrease considerably because of the reduction of the drug expenditure and improved functioning in all activities of daily living. To adequately evaluate the cost-effectiveness of DBS-STN compared with standard drug regimen for PD it is necessary to include direct, indirect and intangible costs on a long-term basis and under standardized circumstances.

Aged↗
PubMed2000

Cross sectional study of primary care groups in London: association of measures of socioeconomic and health status with hospital admission rates.

OBJECTIVES: To calculate socioeconomic and health status measures for the primary care groups in London and to examine the association between these measures and hospital admission rates. DESIGN: Cross sectional study. SETTING: 66 primary care groups in London, total list size 8.0 million people. MAIN OUTCOME MEASURES: Elective and emergency standardised hospital admission ratios; standardised admission rates for diabetes and asthma. RESULTS: Standardised hospital admission ratios varied from 74 to 116 for total admissions and from 50 to 124 for emergency admissions. Directly standardised admission rates for asthma varied from 152 to 801 per 100 000 (mean 364) and for diabetes from 235 to 1034 per 100 000 (mean 538). There were large differences in the mortality, socioeconomic, and general practice characteristics of the primary care groups. Hospital admission rates were significantly correlated with many of the measures of chronic illness and deprivation. The strongest correlations were with disability living allowance (R=0.64 for total admissions and R=0.62 for emergency admissions, P<0.0001). Practice characteristics were less strongly associated with hospital admission rates. CONCLUSIONS: It is feasible to produce a range of socioeconomic, health status, and practice measures for primary care groups for use in needs assessment and in planning and monitoring health services. These measures show that primary care groups have highly variable patient and practice characteristics and that hospital admission rates are associated with chronic illness and deprivation. These variations will need to be taken into account when assessing performance.

Adolescent↗
PubMed2006

Predictors of health status in women with fibromyalgia: a prospective study.

Although cross-sectional studies have identified correlates of dysfunction in fibromyalgia (FM) patients (e.g., psychological distress and pain), predictors of health status have not been previously investigated using a longitudinal research design. We gathered data from 156 women who met American College of Rheumatology criteria for primary FM recruited from both tertiary care and community settings. Stepwise multiple linear regression analysis indicated that poorer health status (p < .0001) and more comorbidity (p = .0089) at baseline were predictors of poorer health status 6 months later. After controlling for these covariates, psychological distress contributed significantly to the model (p = .01). There was a trend indicating that palliative coping styles (i.e., self-care, energy conservation) altered the impact of pain on 6-month health status (p = .06). These findings highlight the need for multidisciplinary interventions that target psychological distress, coping, and comorbidity in patients with FM.

Adult↗
PubMed1996

Measurement of health status in patients with vertigo.

In order to assess how much disability is caused by vertigo, health status scores of patients referred with dizziness or vertigo were compared with local population normative data and with the severity of illness, measured by a disease-specific questionnaire. The questionnaires were administered by post to patients awaiting an ENT out-patient appointment. There was a strong correlation (P = 0.001) between the eight dimensions of the SF-36 (Mos 36 item short-form health survey) and disease severity, measured by the Dizziness Handicap Inventory questionnaire. Compared with the general population, vertigo sufferers had significant role limitation due to physical problems and social functioning (men) and physical problems and vitality (women). General health status is significantly affected by both the presence and severity of vertigo and the SF-36 may prove useful in assessing outcomes.

Activities of Daily Living↗
PubMed2004

Analysis of the health status of foreign brides in a community hospital in Taipei County.

BACKGROUND: Very few studies regarding the health status of foreign brides in Taiwan are so far available. The purpose of this study was to analyze the health status of foreign brides in a community hospital setting in Taipei County. METHODS: We retrieved and analyzed 493 foreign brides' medical records recorded between November 1, 2002 and October 31, 2003. The records included a medical history, physical examination parameters, serological test data for infectious diseases, urinalysis for drug use, stool sample data for intestinal parasites, and chest radiography mainly to rule out tuberculosis. RESULTS: Of the 493 foreign brides included in this study, 247 were from China (50.1%); 122 from Burma (24.7%), 55 from Indonesia (11.2%), and 32 from Vietnam (6.5%). A small proportion of women, 69 (14%), were infected with intestinal parasites. Seven subjects (1.4 %) had tuberculosis, of which 4 (0.8%) were diagnosed as having old tuberculosis. None of the foreign brides was positive for the HIV antibody or on the syphilis screening. The seronegative rate of anti-rubella IgG among the foreign brides was 14.4%. Three percent of the brides had an elevated morphine level (> or = 300 ng/mL), but none of them was positive (> or = 500 ng/mL) for amphetamine. CONCLUSIONS: Future national statistics should include brides from China. The main concerns about foreign brides are the low vaccination rate against rubella virus, the high infection rate with intestinal parasites, and the high prevalence of tuberculosis. A nationwide survey should be carried out in order to assess the health status of all foreign brides in Taiwan.

Emigration and Immigration↗
PubMed2002

Dietary behavior in relation to socioeconomic characteristics and self-perceived health status.

The purposes of this study were to examine the relationship between dietary behavior and self-perceived health status and to demonstrate the relative significance of people's socioeconomic characteristics in relation to their dietary behavior. Data came from the 1994 Behavioral Risk Factor Surveillance System of South Carolina. Descriptive statistics were performed to provide a profile of the general characteristics of the sample. Multivariate linear regression modeling was used to examine the relative significance of socioeconomic status in relation to dietary behavior and the association between dietary behavior and self-perceived general, physical, and mental health status, controlling for other behavioral risk factors, such as smoking and sedentary lifestyle. Socioeconomically disadvantaged individuals with low income and low educational level were more likely to engage in poor dietary practice than were their counterparts. Dietary behavior was found strongly associated with self-perceived general and mental health status.

Adult↗
PubMed2000

Use of health status measures in patients with low back pain in clinical settings. Comparison of specific, generic and preference-based instruments.

OBJECTIVE: To evaluate the discriminative performance over time of specific, generic and preference-based instruments in patients with low back pain (LBP) in clinical settings. METHODS: Forty-six consecutive patients with LBP participated in the study. Self-response questionnaires were administered at baseline and 3 and 6 months, including the following instruments: Oswestry (specific for LBP), SF-36 (generic), EuroQol (EQ-5D) and Health Utilities Index (HUI) (preference-based). EQ-5D and HUI weights were derived from previously published evaluations in the general population. Patients were asked to compare their health status with their baseline health and were categorized on the basis of an ordinal scale as: (a) improved; (b) stable; or (c) worse. Changes in the instruments were evaluated by rescaling the instruments over the same scale interval and by estimating standardized effect sizes between two time points for the three categories of change. RESULTS: Thirty-seven patients (80%) completed both the baseline and the 3-month questionnaire and 34 the baseline and 6-month questionnaires (74%). Overall, at both time points, approximately half of the patients reported no changes in their health status. Correlations between instruments were generally low, suggesting that they measure different health domains. The scales which discriminated best between patients who improved and those who deteriorated at 3 months were the Oswestry, the HUI, the EQ-5D and the SF-36 bodily pain and emotional role subscales. The SF-36 subscales appeared to have a floor effect for those patients who had deteriorated. CONCLUSIONS: Most SF-36 subscales did not adequately reflect changes in the health status of patients with LBP, mostly for those who reported deterioration. Preference-derived quality-of-life scores appeared to discriminate among patients who improved and those who deteriorated, although not as consistently as the disease-specific measure (Oswestry). Additional research is needed to evaluate the role of generic measures of quality of life in the assessment of patients with LBP before they can be widely implemented in clinical settings or outcomes research.

Data Collection↗
PubMed2006

Is acamprosate use in alcohol dependence treatment reflected in improved subjective health status outcomes beyond cognitive behavioural therapy alone?.

OBJECTIVE: To examine whether the addition of acamprosate to Cognitive Behavioural Therapy (CBT) outpatient alcohol dependence treatment impacted on subjective health status. METHOD: Among 268 patients consecutively treated for alcohol dependence, 149 chose CBT alone. A matched design was used. From a possible pool of 119 Acamprosate + CBT and 149 CBT-only patients, 86 Acamprosate + CBT subjects were individually matched with 86 CBT-only patients on parameters of gender, age, prior detoxification and alcohol dependence severity. Health Status (SF-36) and Psychological Well-Being (GHQ-28) was assessed pre- and post-treatment. RESULTS: Pre-treatment, both self-reported health status and psychological well-being was markedly below normative (community) ranges. Program completers significantly improved across both measures over 12 weeks of treatment and some health domains approximated community levels. No treatment group differences were observed. CONCLUSIONS: Participants who completed the CBT-based treatment showed significant improvement in self-reported health status. The use of acamprosate did not register additional improvement on either SF-36 or GHQ-28, beyond CBT alone.

Acamprosate↗
PubMed1996

Self-perceived health status and inequalities in use of health services in Spain.

BACKGROUND: Socioeconomic differences have been described among the Spanish population. The purpose of this study was to investigate whether these variations are associated with differences in the use of health services between socioeconomic groups in Spain, taking into account self-perceived health as a measure of need. METHODS: Data were obtained from the 1987 Spanish National Health Survey. Socioeconomic position was measured by educational level and household income. Health care use was measured in two ways: prevalence of having consulted a doctor and of hospitalization over a defined period of time. Logistic regression models were used to analyse the relationship of interest. RESULTS: After adjustment for age, an inverse association was seen between education and both consultation with a doctor and hospitalization. A very different picture emerged when the association between socioeconomic position and probability of health service use was examined according to level of self-perceived health. Among those with poor or very poor health, people in higher educational groups showed the greatest probability of consulting a doctor (odds ratio [OR] = 1.41, 95% confidence interval [CI] : 0.89-2.23) or of being hospitalized (OR = 1.79, 95% CI : 1.09-2.93) compared to those in the lower educational groups. The corresponding OR for household income were 1.02 (95% CI : 0.74-1.42) for consultation with a doctor and 1.67 (95% CI : 1.15-2.44) for hospitalization. These finding were broadly similar for men and women. CONCLUSIONS: There is a socioeconomic variation in the pattern of use of health services in Spain in the sense that among those with poor self-perceived health, the more privileged have higher levels of health services use than others.

Adolescent↗
PubMed2002

Development of a preference-weighted health status classification system in France: the Health Utilities Index 3.

The Health Utilities Index is a generic multiattribute preference-based system for assessing health-related quality of life, devised by Torrance et al. It is being used in cost-effectiveness evaluations in North America and in international multicentre studies but was not available in France. Following adaptation of the HUI3 classification in France, the purpose of the reported investigation was to derive French preference weights. This article provides a reminder of the theoretical foundations used to model the multiattribute utility function. Within this framework, a multiattribute multiplicative aggregate utility function was constructed in accordance with the explicitly decomposed approach. The study took place in June 1999 over a sample of 365 persons from the French general population, aged between 20 and 65, and not suffering from any chronic or incapacitating illness. The recruitment procedure was based upon a random selection of individuals, using the phone book. Interviews took place in the homes of the interviewees. The methods of revelation (VAS and SG) were applied by setting the value of the best possible state of the HUI3 a priori at 1, and leaving a choice between two states (worst possible state, death) for 0. The aggregated individuals (person-mean and median) were calculated and the multiplicative utility functions constructed. A comparison of the calculated utilities with the observed ones provides a primary indicator of the validity of the person-mean or median functions constructed. The slight absolute differences obtained between observed and calculated utilities and the low RMSE scores lead us towards a favourable conclusion.

Adult↗
PubMed2000

Job uncertainty and health status for nurses during restructuring of health care in Alberta.

The Alberta health care system experienced dramatic changes after provincial funding cuts to health care from 1993 to 1996. As a result, stressors for nurses increased. The question of whether job uncertainty, working conditions, cognitive appraisal, and coping strategies influence the health of registered nurses in a context of health care restructuring was examined. Lazarus and Folkman's Transactional Model of Stress was used as the conceptual framework. A total of 271 registered nurses employed in a large, urban, acute-care teaching hospital responded to a self-administered survey questionnaire. Using multiple regression analysis, depression and self-reported physical health were analyzed. The data suggest that the threat of being placed on recall, having a coworker bumped or laid off, and perceived job security were adversely related to physical health. High primary appraisal of threat was associated with high levels of depression and poor physical health. In addition, the findings suggest that various coping strategies had both buffering and exacerbating effects on physical health and depression.

Adult↗
PubMed1988

Health status of Vietnam veterans. II. Physical Health. The Centers for Disease Control Vietnam Experience Study.

The Vietnam Experience Study was a multidimensional assessment of the health of Vietnam veterans. From a random sample of enlisted men who entered the US Army from 1965 through 1971, 7924 Vietnam and 7364 non-Vietnam veterans participated in a telephone interview; a random subsample of 2490 Vietnam and 1972 non-Vietnam veterans also underwent a comprehensive medical examination. During the telephone interview, Vietnam veterans reported current and past health problems more frequently than did non-Vietnam veterans, although results of medical examinations showed few current objective differences in physical health between the two groups. The Vietnam veterans had more hearing loss. Also, among a subsample of 571 participants who had semen samples evaluated, Vietnam veterans had lower sperm concentrations and lower mean proportions of morphologically "normal" sperm cells. Despite differences in sperm characteristics, Vietnam and non-Vietnam veterans have fathered similar numbers of children.

Adult↗