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The health status was studied in 223 preschool children from a kindergarten in the town of Shatura, Moscow Region. All the children were divided into groups according to their health status and physical development. The proportion of children unready to go to school was 32.2%.
BACKGROUND: The most common indication for treating patients with peripheral arterial disease is to improve their health status: their symptoms, function, and quality of life. Quantifying health status requires a valid, reproducible, and sensitive disease-specific measure. The Peripheral Artery Questionnaire (PAQ) is a 20-item questionnaire developed to meet this need by quantifying patients' physical limitations, symptoms, social function, treatment satisfaction, and quality of life. METHODS: Psychometric and clinical properties of the PAQ were evaluated in a prospective cohort study of 44 patients undergoing elective percutaneous peripheral revascularization. To establish reproducibility, 2 assessments were performed 2 weeks apart and before revascularization. The change in scores before and 6 weeks after revascularization were used to determine the instruments' responsiveness and were compared with the Short Form-36 and the Walking Impairment Questionnaire. A series of cross-sectional analyses were performed to establish the construct validity of the PAQ. RESULTS: The 7 domains of the PAQ were internally reliable, with Cronbach alpha = 0.80 to 0.94. The test-retest reliability analyses revealed insignificant mean changes of 0.6 to 2.3 points (P = not significant for all). Conversely, the change after revascularization ranged from 13.7 to 41.9 points (P < or =.001 for all), reflecting substantial sensitivity of the PAQ to clinical improvement. The PAQ Summary Scale was the most sensitive of all scales tested. Construct validity was established by demonstrating correlations with other measures of patient health status. CONCLUSIONS: The PAQ is a valid, reliable, and responsive disease-specific measure for patients with peripheral arterial disease. It may prove to be a useful end point in clinical trials and a potential aid in disease management.
OBJECTIVE: There is an increasing amount of literature pointing to a relationship between sexual and/or physical abuse history and poor health status, although few studies provide evidence concerning which aspects of abuse may impact on health. In female patients with gastrointestinal (GI) disorders, the present study examined the effects on health status of: 1) history of sexual abuse and physical abuse, 2) invasiveness or seriousness of sexual abuse and physical abuse, and 3) age at first sexual and physical abuse. METHOD: The sample included 239 female patients from a referral gastroenterology clinic who were interviewed to assess sexual and physical abuse history. RESULTS: We found the following: 1) 66.5% of patients experienced some type of sexual and/or physical abuse; 2) women with sexual abuse history had more pain, non-GI somatic symptoms, bed disability days, lifetime surgeries, psychological distress, and functional disability compared to those without sexual abuse; 3) women with physical abuse also had worse health outcome on most health status indicators; 4) rape (intercourse) and life-threatening physical abuse seem to have worse health effects than less serious physical violence, and sexual abuse involving attempts and touch; and 5) those with first abuse in childhood did not appear to differ on health from those whose first abuse was as adults. CONCLUSIONS: The authors conclude that asking about abuse should be integrated into history taking within referral-based gastroenterology practices.
In a cross-cultural study, we investigated the relationships of trait anger, anger expression modes, and stress to physical and mental health in Turkish and American midlife women. Zero-order correlations and multiple regression analyses indicated that regardless of cultural origin, stress was a strong predictor of health status. Stress was negatively related to physical health and positively related to depression. Trait anger, the angry temperament dimension of trait anger, and anger-out were positively related to depression in both American and Turkish women. The negative relationship between somatic mode of anger expression and health was also consistent for both groups. However, anger-in was positively correlated with depression only in American women; suppression of anger was unrelated to health status in Turkish women. Cross-cultural comparisons indicated that Turkish midlife women were higher in trait anger, somatic anger symptoms, perceived stress, and depression than American women. American women, on the other hand, had higher scores on physical health status. These findings are discussed with regard to theory, previous research, and sociocultural context.
This study investigates the effects of coping style and cognitive hardiness on physical and psychological health status. Measures of coping styles (intrusive positive thoughts, intrusive negative thoughts, avoidance, problem-focused coping), cognitive hardiness, stress, health habits, psychological distress, and physical illness were collected for 194 professional employees. Multiple regression analyses revealed that intrusive negative thoughts and avoidance coping approaches significantly contributed to predictions of psychological distress and physical illness outcomes, respectively. Cognitive hardiness significantly contributed to predictions of psychological distress but not physical illness outcomes. Health habits were significantly related to both measures of health status. Two coping approaches, intrusive positive thoughts and problem-focused coping, did not significantly contribute to predictions of either physical or psychological health status.
BACKGROUND: Elbow function can be quantified with use of physician-based elbow-rating systems and health status questionnaires. Our hypothesis was that pain has a strong influence on these scores, which overwhelms the influence of objective factors such as motion. METHODS: One hundred and four patients were evaluated, at a minimum of six months (average, forty-six months) after the latest surgery for an intra-articular fracture of the elbow, with use of three physician-based evaluation instruments (Mayo Elbow Performance Index [MEPI], Broberg and Morrey rating system, and American Shoulder and Elbow Surgeons Elbow Evaluation Instrument [ASES]), an upper-extremity-specific health status questionnaire (Disabilities of the Arm, Shoulder and Hand [DASH]), and a general health status questionnaire (Short Form-36 [SF-36]). Multivariate analysis of variance and regression modeling were used to identify the factors that account for the variability in scores derived with these measures-in other words, which factors have the strongest influence on the final score. RESULTS: Pain alone accounted for 66% of the variability in the MEPI scores, 59% of the variability in the Broberg and Morrey scores, and 57% of the variability in the ASES scores. Models that included other factors accounted for only slightly more variability (73%, 79%, and 79%, respectively), and those that did not include pain accounted for only 22%, 41%, and 41% of the variability. Thirty-six percent of the variability in the DASH scores could be accounted for by pain alone, and 45% could be accounted for by pain and range of motion. Models not including pain accounted for only 17% of the variability in the DASH scores. CONCLUSIONS: Pain has a very strong influence on both physician-rated and patient-rated quantitative measures of elbow function. Consequently, these measures may be strongly influenced by the psychosocial aspects of illness that have a strong relationship with pain, and objective measures of elbow function such as mobility may be undervalued. It may be advisable to evaluate pain separately from objective measures of elbow function in physician-based elbow ratings.
PURPOSE/OBJECTIVES: To describe fatigue in women with breast cancer undergoing radiotherapy and to explore the impact of fatigue on their health status. DESIGN: Prospective, descriptive, repeated measures. SETTING: A major oncology center, Saint Savvas Cancer Hospital, in Athens, Greece. SAMPLE: Consecutive sample of 106 women (mean age = 55 + 12), with histologically confirmed diagnosis for stage I or II breast cancer who were receiving adjuvant radiotherapy for approximately six weeks. METHODS: Data were collected with the Revised Piper Fatigue Scale (PFS) and the Short Form-36 (SF-36) Health Survey Scale in the first two days of radiotherapy (T0), during the third week (T1), and during the last week of treatment (T2). MAIN RESEARCH VARIABLES: Fatigue, health status. FINDINGS: Across-subjects analysis revealed that fatigue increased during radiotherapy in patients with breast cancer regardless of stage, type of surgery, or whether they received chemotherapy (p 0.05). Between-subject analysis revealed that no differences existed in the PFS between different groups (chemotherapy versus no chemotherapy, breast conservation versus mastectomy, stage I versus stage II) at each measurement point. A negative correlation was found between the subscales of the PFS and all of the subscales of the SF-36. CONCLUSIONS: Fatigue intensity increased significantly during the course of radiotherapy, and patients experienced a significant deterioration in their overall health status. IMPLICATIONS FOR NURSING: Findings contribute to the growing body of evidence regarding fatigue and its impact on health status in Greek patients with breast cancer and provide insights for effective nursing assessment, patient education, and symptom management.
The World Federation of Hemophilia scoring system (WFH-1) evaluates primarily body functions and structures, whereas assessment of the whole area of functional health status is considered nowadays to be a better measure. In addition, the WFH-1 lacks psychometric properties (reliability, validity and sensitivity to change). This study aimed to gain insight into the clinimetric assessment of functional health status in patients with haemophilia by way of a systematic literature search. A standardized literature search and selection was performed on the databases of CINAHL (1982-2001), Medline (1966-2001), and PubMed (January-July 2001). Clinimetric instruments applied in the selected articles were classified based on the international classification of functioning, disability, and health (ICF) and analysed for their psychometric properties. In 19 articles published between 1979 and 2001, 34 clinimetric instruments were used to assess functional health status. Instruments were classified as measuring the ICF components body structure and function (n = 17), activities (12) and participation (4). Reliability was measured in four articles on three different instruments, the validity (construct) of the instruments for patients with haemophilia was reported in six articles on five instruments, and sensitivity to change in three articles on three instruments. The populations under study varied in number (7-9 35), mean age (21.6-50.8 years), and in the distribution of haemophilia severity. Reports on the evaluation of functional health status in patients with haemophilia are increasing. Further research on the psychometric properties of the instruments is warranted in more groups of patients with haemophilia. Development of the new core set of clinimetric instruments, the WFH-2, might benefit from this strategy.
This paper examines the relationship between satisfaction and functional health status of the patient. Based on a sample of 463 patients from three hospitals, there was no relationship between the physical component summary score of the SF-36 and overall Press, Ganey patient satisfaction score. There was a weak negative relationship between the mental health component summary score of the SF-36 and the Press, Ganey patient satisfaction score. Similar patterns were observed when the relationships between functional status and patient satisfaction are examined for specific treatment groups. The strength of the relationship between mental health and satisfaction was slightly stronger for cardiology patients. Among obstetrics patients there was no relationship between either health status measure and satisfaction. A weak positive relationship between physical health status and patient satisfaction was observed among medical/surgical patients. Based on the weak or non-existent relationships between the variables, patient satisfaction does not appear to be influenced by the health of the patient when discharged.
We examined the utility of health status scores as predictors of mortality in a 5-year study of patients with rheumatoid arthritis (RA). Of 279 patients with a known outcome after an average of 5 years of followup, 37 had died. Scores derived from the Arthritis Impact Measurement Scales indicated that mobility and general health perception were significant predictors of mortality with odds ratios (95% confidence interval) of: 1.19 (1.05, 1.33) and 1.27 (1.04, 1.55), respectively. These measures were particularly predictive of dying at worse levels of health status with a significant linear trend for mobility (p less than 0.05) and general health perception (p less than 0.01). Even after controlling for physical function, poorer levels of general health perception were significantly associated with mortality, (p less than 0.01 for linear trend). Our results confirm that certain health status measures are related to subsequent mortality in patients with RA.
SF-36 questionnaires were completed by 231 medical students of the Faculty of Medicine in Hradec Králové (1997, 1998). Results of measurements of eight health dimensions are presented here. Significantly lower values for bodily pain were found in the group of overweight students. Students with some reported cured diseases have significantly lower values for bodily pain and general health dimensions in comparison with students without any reported disease. In our sample a high rate of non-smokers (86.4% men and 93.6% women) and low rate of students with BMI > 25 (18.4% men and 3.8% women) were found. About 30% of respondents reported one or more cured diseases. In addition to the SF-36 questionnaire, students in 1998 completed also a special one-page form (3). The one-page form enabled direct estimates of the eight dimensions of the health status on a scale from 0% to 100%. This study compares the results of measurement of the health status for both instruments. Differences found here are compared and discussed with similar comparisons in an American study (3). Results in both studies are similar but not the same. An indirect measurement of health status with specific questions in the SF-36 is more objective than a direct measurement with the one-page form. Nevertheless, the SF-36 is limited in the number of possible answers for some dimensions (RP, RE). In that case, our results indicate that a percentage scale from the one-page form seems better. Additionally this study compares the results of the SF-36 in Czech medical students with comparable samples from other three European countries. On average, the health dimensions of SF-36 in Czech medical students achieved the worst values in comparison with samples from Switzerland, Germany and Great Britain.
PURPOSE: We investigated whether health status (i.e., need characteristics) and financial resources (i.e., enabling characteristics) were important predictors of two types of functional adaptations among elderly adults: home modifications such as putting nonslip tape on rugs or installing more telephones and use of equipment for mobility or activities of daily living (ADLs) such as canes or walkers. DESIGN AND METHODS: Participants were identified from the National Survey of Self-Care and Aging (n = 3,485), a nationally representative sample of noninstitutionalized U.S. adults aged 65 and older. Need and enabling characteristics were used to predict home modifications and equipment use in multinomial logistic analysis, controlling for predisposing characteristics. RESULTS: Although several health-status (need) variables had significant, direct effects on functional adaptations, the effects of ADL limitations were diminished at higher levels of impairment. Among the financial (enabling) variables, subjective income measures and supplemental insurance had significant, direct effects on functional adaptations. IMPLICATIONS: Promotion of functional adaptations among elderly people may benefit from both a proactive approach that targets elders with few limitations and a consideration of financial factors in addition to health status.
A comparative study of the subjective oral health status of 60-65-year-old residents was undertaken in two Liverpool electoral wards, Vauxhall, the most deprived, and Woolton, the most affluent in the city. The measuring instrument used was the Subjective Oral Health Status Indicators (SOHSI) questionnaire devised by Locker. The questionnaire was administered by post to random samples of 250 residents from each ward. The main aim of the study was to compare the reported impact of oral conditions on the lives of individuals living in deprived and affluent communities. Responses of 59.6% for the deprived ward and 77.7% for the affluent ward were achieved. The literature suggested that significant differences could be expected between the wards in the reporting of subjective impact. However, significantly greater impact for only one functional sub-scale and one psycho-social sub-scale was reported by residents from the deprived ward. Further analysis of the relationship between impact and socio-demographic variables revealed a strong association between self-reported general health status and the subjective oral health indicators. Finally, a stepwise regression analysis found that pain and chewing problems were the only significant predictors of psycho-social impact. This finding confirms that the individual's socio-economic circumstances are of secondary importance to pain and functional problems in determining the psycho-social effects of oral conditions, as predicted by the conceptual model on which the measuring instrument is based.
OBJECTIVES: The goal of this study was to compare health status (symptoms, function, and quality of life) outcomes of whites and blacks one year after an acute coronary syndrome (ACS). BACKGROUND: Although racial differences in the use of angiography and revascularization after ACS are known to exist, differences in health status outcomes have not been described. METHODS: We conducted a prospective registry of 1,159 consecutive ACS patients treated between February 1, 2000 and October 31, 2001. One-year health status was quantified with the Seattle Angina Questionnaire (SAQ) and Short Form-12 Physical Component Score (SF-12 PCS). Multivariable models were used to adjust for racial differences in sociodemographic, clinical, and treatment characteristics. RESULTS: Mortality rates were similar among the 196 black and 963 white patients (7.1% vs. 7.0%, p = 0.93); 81 died during follow-up, and 199 (17%) could not be interviewed. At one year, blacks had a higher prevalence of angina (43.4% vs. 27.1%), worse quality of life (SAQ score = 70.6 +/- 28.3 vs. 83.9 +/- 20.8), and poorer physical function (SF-12 PCS = 36.8 +/- 12.3 vs. 43.2 +/- 11.4; p < 0.0001 for all). Multivariable models, including hospital treatments, revealed a trend for more angina (odds ratio 1.46 [95% confidence interval 0.91 to 2.34]) and significantly worse quality of life (mean difference = -7.7 +/- 2.4, p = 0.002) and physical function (-3.6 +/- 1.3, p = 0.005). CONCLUSIONS: Blacks have more angina, worse quality of life, and worse physical function one year after an ACS than do whites. Closer surveillance of black ACS patients is needed to determine whether additional treatment can improve their outcomes.
OBJECTIVE: The purpose of this study was to describe the changes in perception of health status and quality of life from before treatment to 6 months after and the impact of uncertainty on these variables in survivors of life-threatening arrhythmia. DESIGN AND SETTING: A descriptive correlational design at a large urban teaching hospital. MEASURES: We measured health status, quality of life, and uncertainty before treatment and 6 months after a life-threatening arrhythmia. RESULTS: Survivors included 66 men and 15 women, 41 of whom received pharmacologic therapy and 36 of whom received an implantable cardioverter defibrillator (ICD), completed the Medical Outcomes Survey (SF-36), Ferrans and Powers Quality of Life Index (QLI), and the Mishel Uncertainty in Illness Scale (MUIS-C) before treatment and 6 months after. There were significant improvements in the mental and physical health composite summaries as measured by the SF36 (P <.01). Conversely, there were significant reductions in the overall score and specifically in socioeconomic and psychological/spiritual quality of life domains as measured by the QLI (P <.05). An increased perception of uncertainty was related to decreased perception of health status and quality of life at both measurement times, with higher correlations 6 months later. CONCLUSIONS: Survivors demonstrated improvements in perceived health status, although this did not appear to translate into improvements in the subjective domains of quality of life. The overall quality of life and the domains of psychological/spiritual state and socioeconomic status were lower 6 months after a life-threatening arrhythmia. Uncertainty had a significant impact on these perceptions, identifying an area for nursing interventions.
The Medical Outcomes Study Instrument (MOSI), a 20 item functional health status measure was sent to all women aged 30-40 years (n = 486) in a General Practice (list size 6447). There was a 73% response rate to two mailings. Lower scores on all six dimensions of the MOSI were associated with the number of diagnoses and identified mental illness on the patient summaries, unemployment and with positive scores on the Nottingham Health Profile. In two categories, General Health Perceptions and Mental Health, the scores were lower for those on long-term medication. The paper suggests that the MOSI may be a candidate for Health Status measurement in research and audit in primary care, but further research is required.
This study examined the reliability of a revised version of the Burn Specific Health Scale (BSHS). Two hundred fifty-four former patients recruited from eight burn centers in the southeastern United States participated in the study. Data were collected via chart review and mailed questionnaire. Factor analyses were used to identify seven subscales containing a total of 31 items. Subsequent analyses provided strong support for the reliability and validity of the revised measure. Each subscale exhibited a high level of reliability (Cronbach's alpha ranged from 0.82 to 0.94). Each subscale also correlated in a predictable manner with measures used for validation. The revised measure should improve the ability of both researchers and clinicians to assess the impact of non-fatal burn injury accurately and comprehensively.
Over the last 15 years, numerous self-report health status measures have appeared in the literature. An important parallel development has been the development of numerous strategies for assessing change in health status over time. The purpose of this article is to summarize and critique the more common design and analytic strategies for assessing the meaningfulness of change over time. Five commonly reported designs are presented, critiqued, and depicted using examples from the literature. Methods for analyzing results are reviewed and illustrated using two data sets. Insights into comparing competing health status measures are provided. In summary, the article suggests that some designs and analytic strategies are more adept than others at assessing change and that these methods should be considered when planning sensitivity-to-change studies.