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PubMed2000

Disability and health status: ethnic differences among women in the United States.

STUDY OBJECTIVES: There are few data describing disability and health status for ethnic groups. The disablement process involves social influences, which may include minority status. Cross sectional data were examined to investigate the relation of ethnicity to disability. DESIGN: A stratified random digit dialled sample of women aged 40 and older. Disability and health status were measured as functional and activity limitations, work disability, and days of poor physical and mental health. SETTING: United States. PARTICIPANTS: Women interviewed by telephone included 774 white, 749 African-American, 660 Hispanic, and 739 Native American women. MAIN RESULTS: The prevalence of disability was higher among minority women when classified by general health status, and the need for personal care assistance. There was a striking excess of work disability: 3.5% of white women compared with 7.1% to 10.3% for minority women. The differences were reduced when adjusted for other risk factors and socioeconomic status. White and minority women reported more similar disability when it was defined by poor mental and physical health days. CONCLUSIONS: Disability is correlated with social and demographic characteristics as well as medical diagnoses. Ethnicity also is associated with disability and may be part of a social context for disablement. Future research should concentrate on the temporal sequence of disability. Consistent definitions of disability will facilitate this research.

Adult↗
PubMed1995

The structure of physical health status. Comparing proxies and self-respondents.

Because gerontological studies often need to rely on the use of proxy respondents, the comparability of proxy and self-respondents is of particular interest. However, it is often impossible to evaluate response agreement between proxy and self-respondents because the necessary data are not available. This study addresses the problem by using a model of health status to evaluate differences between proxy and self-respondents regarding the conceptualization of health status. The model included three dimensions of physical health: chronic illness, functional limitations, and subjective health. Three groups of respondents who differ regarding proxy status and/or physical health status were compared. A subset of matched self-respondents (n = 146) was selected to be comparable in objective health status to respondents who have proxies (n = 140). The third group consisted of physically healthier self-respondents (n = 1,425). Data came from the Study of Well-Being of Older People in Cleveland, OH. No support was found for the expectation that proxies and self-respondents would weight objective health information differently when providing summary statements of subjective health. The results suggest that proxies rely on a conceptualization similar to self-respondents when providing information about another person's health.

Activities of Daily Living↗
PubMed1989

Assessment of children's health status. Field test of new approaches.

The assessment of children's health status presents unique difficulties. These include parent-child differences in reports of functioning, knowledge of what constitutes age-appropriate functioning, obtainment of accurate information for child, and demonstration of the predictivity of health status measures. Recent measures (the Functional Status II-R and instruments from the RAND Health Insurance Experiment) address physical, social, and psychologic domains of children's health. The authors modified these instruments to develop short (7 and 14 items) questionnaires (RAND, FSQ) to assess child health. Scoring on these questionnaires was compared with traditional measures of illness severity and medical service utilization. The authors also evaluated coding illness-specific and general health limitations (FSQ-S and FSQ-G, respectively). Patients included the parents of 113 children with chronic illness (100 asthmatics). Measure stability was evaluated over a 6-month period in a subset of patients. Internal consistency (Cronbach's alpha) of the seven-item RAND measure was .78, the FSQ-S .78, and the FSQ-G .73 to .89 during repeated samplings over 6 months. The FSQ-S and Rand seven-item measure were moderately correlated (.47, P less than .001). The authors observed significant correlations among alternate codings of the FSQ and RAND and between the FSQ-S, FSQ-G, RAND, and severity measure with traditional indices of medical service utilization. Parents were more likely to attribute certain functional status problems (e.g., being tired) to illness than they were other problems (e.g., moodiness or interest in things). The findings demonstrate that these measures have acceptable psychometric properties and provide preliminary evidence of construct validity in a group of young children with asthma. Using general and specific measures will provide differing pictures of a child's functioning. No single measure completely taps the impact of illness as measured by a panel of traditional indicators of illness burden and medical service utilization.

Adolescent↗
PubMed1995

KEYNOTE ADDRESS OF THE SEVENTH INTERNATIONAL CONFERENCE ON THE HEALTH OF CHINESE IN NORTH AMERICA: Health Status of Chinese Americans: Challenges and Opportunities.

PURPOSE. This paper is based on the author's keynote address given at the Seventh International Conference on the Health Problems of Chinese in North America. METHODS. The author/speaker reviewed the literature related to Chinese American health problems within the context of the broader demographic and aggregated health data reported on Asian Americans and Pacific Islanders. FINDINGS. In addition to background demographic statistics provided on Chinese Americans, the author/speaker focused on two categories of diseases: (1) communicable diseases; and (2) chronic diseases because of the greater availability of data on these categories. Communicable diseases from which Chinese Americans appear to suffer disproportionally are tuberculosis and hepatitis B. Infection with the hepatitis B virus also makes Chinese Americans much more susceptible to chronic liver diseases including cancer. Chinese also suffer disproportionally more from nasopharyngeal cancer; because of higher than average adult male smoking rates, these men can be expected to suffer disproportionally from a future epidemic of lung cancer cases. Unhealthy acculturation patterns in food consumption point towards changing profiles of cardiovascular morbidity and mortality as well as higher rates of dietary related cancers. OBSERVATIONS. Rather than conclusions, observations of the current health status of Chinese Americans were offered. Four measures that organizations such as the Chinese medical societies and Chinese American health professionals can pursue to advance the health status of Chinese Americans, particularly in the area of heaslth policy, are: (1) voting; (2) collecting data on health status; (3) writing for professional journals; and (4) being active in policy development. KEY WORDS. Chinese Americans; health status; tuberculosis; hepatits B; cancer; diet; acculturation; smoking

Journal Article↗
PubMed1997

Breast cancer treatment-related patterns in side effects, psychological distress, and perceived health status.

PURPOSE/OBJECTIVES: To describe variations in side effects of treatment of breast cancer and concurrent variations in psychological distress and perceived health status. DESIGN: Data were collected at six collection points: 7-10 days, one month, two months, three months, six months, and one year postsurgery. Standardized inventories, including subscales from the Psychosocial Adjustment to illness Scale, the Multilevel Assessment Inventory, and the investigator-developed Treatment Recovery Inventory, were completed by subjects in their homes at the six data-collection points. SETTING: Self-report measures completed in subjects' homes. Private practices of breast surgeons at medical centers in the New York City metropolitan area SAMPLE: Convenience sample of 93 women from a main longitudinal study (x = 51.4 years of age). MAIN RESEARCH VARIABLES: Psychological distress, perceived health status, and side effects of treatment for breast cancer. FINDINGS: Fatigue and emotional distress were persistent issues. Psychological distress and perceived health status improved with no significant differences between breast-conserving and mastectomy groups. Significant differences existed between patients receiving chemotherapy versus no therapy between three and six months. Significant changes also existed in perceived health status and psychological distress in both the positive and negative node groups with no differences between groups. CONCLUSIONS: Adjustment, a multidimensional and complex process, occurs over time. IMPLICATIONS FOR NURSING PRACTICE: Patterns in side effects should enable clinicians to anticipate needs for planning methods of control over time. Nurses must assess side effects from a multidimensional perspective at all phases.

Adaptation, Psychological↗
PubMed2005

Impact of asthma on self-reported health status and quality of life: a population based study of Australians aged 18-64.

BACKGROUND: The impact of asthma has traditionally been measured in terms of the prevalence of the disease, mortality rates, and levels of healthcare utilisation, particularly hospital admissions. However, the impact of asthma extends beyond these outcomes to include effects on lifestyle, well being, and perceived health status. METHODS: Information on self-reported current asthma status, arthritis and diabetes as well as measures of life satisfaction, self-assessed health status, psychological distress, and interference with usual activities was obtained for 14 641 respondents aged 18-64 years in the 2001 National Health Survey of the general population in all states and territories in Australia. Log linear models were fitted separately for each of the dichotomised quality of life measures as dependent variables. The estimates of the adjusted rate ratio obtained from each model were used to compute the population attributable fraction (PAF) of self-reported asthma, arthritis, and diabetes for each of the health status and quality of life measures. RESULTS: The presence of asthma accounted for 3.18% (95% CI 2.13 to 4.23) of people reporting poor life satisfaction, 8.12% (95% CI 6.57 to 9.67) of people reporting poor health status, 5.90% (95% CI 4.19 to 7.61) of people reporting high psychological distress, and 3.58% (95% CI 2.16 to 5.01) of people reporting any reduced activity days. The proportions of people with these adverse health states attributable to asthma were higher than the proportions attributable to diabetes but lower than the proportions attributable to arthritis. CONCLUSION: Asthma is an important contributor to the burden of ill health and impaired quality of life in the community. A strategic approach is needed to develop and implement strategies to address the impact of asthma on quality of life.

Adolescent↗
PubMed2003

Performance of health-status scales when used selectively or within multi-scale questionnaire.

BACKGROUND: Little work has been done to investigate the suggestion that the use of selected scales from a multi-scale health-status questionnaire would compromise reliability and validity. The aim of this study was to compare the performance of three scales selected from the SF-36 generic health questionnaire when administered in isolation or within the entire SF-36 to patients with musculoskeletal disorders. METHODS: Two groups of patients referred to an orthopedic department completed a mailed questionnaire within 4 weeks prior to and a second questionnaire during their visit. The first group completed three SF-36 scales related to physical health (physical functioning, bodily pain, and general health perceptions) on one occasion and all eight SF-36 scales on the other occasion. The second group completed the entire SF-36 on two occasions. Results for patients who reported unchanged health status and had complete scores were analyzed; 80 patients in the first and 62 patients in the second group. RESULTS: The Cronbach alpha reliability and intraclass correlation coefficients exceeded 0.7 for all three scales for both groups. For the first group the mean difference between the scores was 0.4 point for physical functioning, 2.5 points for bodily pain, and 0.5 point for general health perceptions, which did not differ significantly from the corresponding differences for the second group (0.1, 1.9 and 1 point, respectively). CONCLUSION: The use of selected scales from a multi-scale health-status questionnaire seems to yield similar results compared to their use within the entire questionnaire.

Health Status↗
PubMed1993

[The complex assessment of the health status of children in the early period of primary tuberculous infection taking health groups into account].

Children belonging to different health groups aged 4-14 (n = 350) with a turn in tuberculin reactions were examined for a relation of their health status to the onset, course and chemotherapy outcomes of early tuberculous infection. Health groups 3 and 4 appeared risk factors by a turn in tuberculin reactions. An inverse relationship was revealed between children's health and their immune status, whereas general condition of the examinees and efficacy of their chemotherapy correlated directly.

Adolescent↗
PubMed2003

Measuring population health: a comparison of three generic health status measures.

OBJECTIVES: The relative performance of three widely used generic health status measures (EQ-5D, a modified HUI3 [mHUI3], and SF-12) was compared within a general population sample. MATERIALS AND METHODS: Data were taken from a cohort of persons identified from the patient list of a large general practice in York, UK. Two-way comparisons were made between EQ-5D and mHUI3 and EQ-5D and SF-12. The measures were assessed in terms of their practical viability, coverage, and discrimination. Practical viability was evaluated in terms of the extent of missing responses and the proportion indicating difficulty with a measure. Coverage examined the range of responses across the items in the measures. Discrimination examined the capacity of the measures to discriminate between persons according to their self-reported morbidity and socioeconomic status. RESULTS: One thousand one hundred twenty-six persons completed a postal questionnaire containing EQ-5D and either mHUI3 (n = 593) or SF-12 (n = 533). Missing responses were low across all three instruments. SF-12 showed a broad distribution of responses across its items however, responses on the mHUI3 hearing, speech and dexterity dimensions and the EQ-5D self-care dimension were highly skewed, with few persons reporting problems. In terms of summary scores, mHUI3 identified more mild health states than EQ-5D. EQ-5D and mHUI3 showed slightly better discrimination than SF-12. CONCLUSIONS: Despite the inherent differences in their descriptive systems and scoring functions, no one instrument performed better or worse than the other with respect to the criteria applied in this study. Some of the issues to be considered when choosing a population health measure are discussed.

Adolescent↗
PubMed2003

Associations between behavior disorders and health status among older adults with intellectual disability.

Few studies have examined the relationship of behavior and health status among aging persons with intellectual and developmental disabilities (I/DD). Behavioral disorders, which often are coincident with functional decline in older persons with I/DD, may be more related to medical morbidity than previously reported. This cross-sectional study examined the association between health status and behavior disorders with increasing age in a cohort of 60,752 adults with I/DD clustered into four adult-age groupings (21-44, 45-59, 60-74, and >74). Age grouping data suggested an association between morbidity and increased likelihood of behavior symptoms in all but the oldest age grouping. The magnitude of the association and trend varied by specific disease across age groupings compared to that found in healthy cohorts. About 25% of the adults with I/DD had psychiatric diagnoses and the frequency of such diagnoses did not decrease with age grouping. These results suggest that adverse health status may increase the likelihood of persistent behavioral disturbances in older persons with I/DD. Moreover, behavioral disorders may be sentinels for occult medical morbidity, which in turn may be responsive to intervention.

Adult↗
PubMedDate not supplied

Relationship among health habits, social assets, psychologic well-being, life change, and alterations in health status.

To examine variables which may temper life change and enable individuals to withstand high degrees of life change without developing illness, a questionnaire was mailed to a systematically selected sample of the residents of Renton, Washington, of which 548 (57 percent) were returned. The major statistical analysis was linear correlation and multiple regression. When relationships between the major variables--health habits, social assets, psychologic well-being, and life change--and the dependent variable-alterations in health status--were examined, the single best predictor of subsequent alterations in health status for respondents in this study was found to be the magnitude of the life change. As the life changes increased, the risk of becoming ill also increased. The notion that health habits, psychologic well-being, and social assets might temper life change and make it possible to avoid a change in health status was not borne but strongly in the results of the analysis of data. These variables were weakly associated, however, with maintenance of health status.

Adaptation, Psychological↗
PubMed1995

Measurement of general health status in obstructive sleep apnea hypopnea patients.

Sleep apnea hypopnea syndrome (SAHS) is an entity that occurs frequently in the population and produces an elevated morbidity and mortality, especially at an apnea index greater than 20 events per hour. To our knowledge there are only a few studies available addressing the general health status of sleep apnea hypopnea patients. Such information may be useful for both clinical management and better understanding of the physiopathological mechanisms of the disease, particularly with the consideration that not infrequently the physiological disturbances found in such patients do not always agree with their own health perception. Therefore, the aim of the present study was to assess the general health status and the degree of daytime somnolence, as a major symptom in SAHS patients, and relate them to the number of respiratory events per hour. Measurements of general health status and the degree of daytime somnolence were assessed in 103 consecutive patients 50.4 +/- 12 years old [mean +/- standard deviation (SD)] with an apnea/hypopnea index (AHI) of 38 +/- 27 events per hour. Forty nonsnoring healthy subjects were used as the control group. During the afternoon preceding the full polysomnography, a medical history was taken; basic anthropometric data and the presence of other diseases were recorded. The Nottingham Health Profile (NHP) questionnaire and a questionnaire assessing the degree of daytime somnolence were administered to the patients. No significant differences were found in the general health status and the degree of daytime hypersomnolence when patients were divided into three groups according to the severity of the respiratory events during the night, but there were significant differences between SAHS patients and control subjects. It was concluded that in spite of the fact that SAHS patients showed a deterioration of general health status parameters in comparison with healthy subjects, these parameters do not correlate with the physiological disturbances of SAHS, expressed as the number of respiratory events per hour.

Adult↗
PubMed1996

Health status assessment via the World Wide Web.

We explored the use of the World Wide Web to collect health status information for medical outcomes research. The RAND 36-Item Health Survey 1.0 (RAND-36), which contains the 36 multiple-choice questions of the Medical Outcomes Study SF-36 "Short Form" and differs only in its simplified scoring scheme, was made available for anonymous use on the Internet. Participation in the survey was invited through health-related Internet news groups and mailing lists. Participants entered data and received, their scores using the World Wide Web protocol. Entries were recorded from 15 June 1995 to 14 June 1996 (1 year). The survey was completed anonymously by 4876 individuals with access to the World Wide Web. Two-thirds completed the survey within 5 minutes, and 97% did so within 10 minutes. The item-completion rate was 99.28%. Values of Cronbach's alpha of 0.76 to 0.90 for the scoring scales matched the high reliability found in the Medical Outcomes Study. The World Wide Web provides a method of rapidly measuring individual health status and may play an important role in advancing health services research and outcomes-based patient care.

Computer Communication Networks↗
PubMed2005

Relative responsiveness of condition specific and generic health status measures in juvenile idiopathic arthritis.

OBJECTIVES: To compare the relative responsiveness of condition specific measures with that of a generic health status instrument for outcome assessment of intra-articular corticosteroid (IAC) injection in patients with juvenile idiopathic arthritis (JIA). METHODS: We examined 44 consecutive patients with oligoarticular JIA before an IAC injection and after 6 months. Condition specific measures included physician's and parent's global assessments, the Childhood Health Assessment Questionnaire (CHAQ), the articular indices, and laboratory indicators of systemic inflammation. The generic health status instrument was the Child Health Questionnaire (CHQ), which was divided into two parts: the physical score (PhS) and the psychosocial score (PsS). Responsiveness statistics were the standardised response mean, the effect size, and Guyatt's method. The discriminative ability of the clinical measures in distinguishing improved from non-improved patients was evaluated with the correlation and the receiver operating characteristic methods, using the physician's and the parent's judgements of the treatment outcome as external criteria. RESULTS: All responsiveness statistics and discriminative ability assessments consistently ranked the physician's global assessment of the disease activity as the most responsive measure. The CHQ-PhS revealed superior ability in detecting baseline versus 6 month change compared with the CHAQ and the CHQ-PsS; both summary scales of the CHQ revealed better discriminative ability than the CHAQ. CONCLUSIONS: The physician's global assessment of the disease activity proved the most responsive outcome measure in our patients with JIA. The relative evaluative properties of the generic health status instrument and the CHAQ should be further investigated.

Adolescent↗
PubMed1995

Health status and function with zidovudine or zalcitabine as initial therapy for AIDS. A randomized controlled trial. Roche 3300/ACTG 114 Study Group.

OBJECTIVE: To evaluate the functional and health status implications of prescribing zalcitabine or zidovudine for initial therapy of acquired immunodeficiency syndrome (AIDS). DESIGN: A substudy of a randomized controlled trial. SETTING: Private and public clinics and referral centers. PATIENTS: Had human immunodeficiency virus (HIV) infection, less than 0.20 x 10(9)/L (200 microliters) CD4+ cells, and either a history of Pneumocystis carinii pneumonia or symptoms of HIV infection. Fifty-eight percent (338/668) of main study enrollees representing 90% of enrollees at participating sites were included in this substudy. INTERVENTIONS: Either zalcitabine at 0.75 mg every 8 hours plus inactive capsules identical in appearance to zidovudine or zidovudine at 200 mg (later 100 mg) every 4 hours plus inactive tablets identical in appearance to zalcitabine. MAIN OUTCOME MEASURES: Results of a periodically completed self-report survey instrument containing specific questions about symptom impact, disability, work, functioning, and utilization as well as nine health and functioning scales adapted from the Medical Outcomes Study (MOS). RESULTS: Zalcitabine recipients were twice as likely to undergo an invasive procedure (P = .004) or be admitted to hospital (P = .01). Zalcitabine recipients reported greater than 40% more symptoms that interfered with activity (P = .001) and greater than 50% more disability days (P < .01). They also had a 7% lower employment rate and a 35% lower monthly income. Average observed health status scores were lower in zalcitabine recipients overall, but especially in the early portion of the study. New methods for combining survival and health status data showed that, over 76 weeks of study, a typical zidovudine recipient spent about 4 (10%) more weeks with at least the typical health state than did a typical zalcitabine recipient. CONCLUSIONS: Zidovudine has substantial advantages over zalcitabine in initial monotherapy of AIDS in terms of functional outcomes such as symptoms impact, disability, work, utilization, and health status. In this case, the differences in functional outcomes presaged differences in physiological and clinical measures. The inclusion of functional outcomes can greatly improve the information available from a clinical trial.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Do proxy evaluations of health status predict mortality?

The ability of self-evaluations of health to predict mortality remains despite efforts to explain their contribution. To further the understanding of global evaluations, this study investigated whether proxy evaluations of health status also predict mortality. Data from the Longitudinal Study of Aging were used. For men and women, the unadjusted odds ratios for proxy evaluations exhibited a monotone relationship to 3-year and 7-year mortality rates and were predictive of 7-year mortality. This monotone relationship remained even after controlling for other factors when predicting 7-year mortality rates. However, only the fair and poor evaluations were significant, and only for men. The adjusted relationship when predicting 3-year mortality was not completely monotone, although good and poor proxy evaluations were significant. This suggests that proxy evaluations are useful, and that there are aspects of health status that are currently unmeasured but that should lend themselves to being quantified.

Activities of Daily Living↗
PubMed2002

A multilevel analysis of the relationship between institutional and individual racial discrimination and health status.

OBJECTIVES: This study examined whether individual (self-perceived) and institutional (segregation and redlining) racial discrimination was associated with poor health status among members of an ethnic group. METHODS: Adult respondents (n = 1503) in the cross-sectional Chinese American Psychiatric Epidemiologic Study were geocoded to the 1990 census and the 1995 Home Mortgage Disclosure Act database. Hierarchical linear modeling assessed the relationship between discrimination and scores on the Medical Outcomes Study Short-Form 36 and revised Symptom Checklist 90 health status measures. RESULTS: Individual and institutional measures of racial discrimination were associated with health status after control for acculturation, sex, age, social support, income, health insurance, employment status, education, neighborhood poverty, and housing value. CONCLUSIONS: The data support the hypothesis that discrimination at multiple levels influences the health of minority group members.

Acculturation↗
PubMed2006

Irregular breakfast eating and health status among adolescents in Taiwan.

BACKGROUND: Regular breakfast eating (RBE) is an important contributor to a healthy lifestyle and health status. The aims of the present study were to evaluate the relationships among irregular breakfast eating (IRBE), health status, and health promoting behavior (HPB) for Taiwanese adolescents. METHODS: A cross-sectional, descriptive design was used to investigate a cluster sample of 1609 (7th-12th grade) adolescents located in the metropolitan Tao-Yuan area during the 2005 academic year. The main variables comprised breakfast eating pattern, body weight, and health promoting behaviors. Data were collected by a self-administered questionnaire. RESULTS: A total of 1609 participants were studied, 64.1% in junior high school and 35.9% in high school, boys (47.1%) and girls (52.9%) ranging in age from 12-20 years. Of the total participant population, 28.8% were overweight and nearly one quarter (23.6%) reported eating breakfast irregularly during schooldays. The findings indicated that adolescents with RBE had a lower risk of overweight (OR for IRBE vs. RBE = 1.51, 95% CI: 1.12, 2.04), and that the odds of becoming overweight were 51% greater for IRBE than for RBE even after controlling for demographical and HPB variables. IRBE also was a strong indicator for HPB. However, the profile of the high-risk IRBE group was predominantly junior high schoolchildren and/or children living without both parents. CONCLUSION: This study provides valuable information about irregular breakfast eating among adolescents, which is associated with being overweight and with a low frequency of health promoting behavior. School and family health promotion strategies should be used to encourage all adolescents to eat breakfast regularly.

Adolescent↗