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PubMed1998

Effects of musculoskeletal neoplasms on patient self assessment of health status.

Eighty-five consecutive patients referred to the Musculoskeletal Tumor Service completed a standardized short form questionnaire to evaluate their health status and function. Each patient completing the Short Form-36 questionnaire had a diagnosis of musculoskeletal neoplasm, including benign soft tissue and bone tumors, malignant soft tissue and bone tumors, and metastatic tumors. The results of this preliminary study show that the authors' patient population experienced health status and functional deficits in each of the eight Short Form-36 assessed domains. Data show that the most severe deficits were experienced by patients who had diagnoses of bone tumors and malignant tumors. This study shows that the Short Form-36 is a practical and effective method for documenting perceived deficits in health status in patients with musculoskeletal tumors. These data allow the physician to understand the presenting condition from the patient's perspective. This is an important and often neglected aspect of the overall assessment of the health of patient on presentation. An understanding of these deficits is critical for effective planning of treatment and evaluation of treatment effectiveness.

Bone Neoplasms↗
PubMed2004

Content comparison of osteoporosis-targeted health status measures in relation to the International Classification of Functioning, Disability and Health (ICF).

The most frequently used instruments for health-related quality of life (HRQL) in patients with osteoporosis are the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) and the Osteoporosis Assessment Questionnaire (OPAQ 2.0 and OPAQ SV). Since HRQL- and International Classification of Functioning, Disability and Health (ICF)-based approaches have both strengths and weaknesses, it is expected that they will be used simultaneously in clinical practice and research. Therefore, we investigated the relationship between osteoporosis-targeted instruments and the ICF. All three selected instruments cover body functions, including pain in back and emotional functions. Sleep functions and energy are represented in the QUALEFFO-41 and OPAQ 2.0 but not in the OPAQ SV. Body structures and environmental factors are covered only by the OPAQ 2.0 and OPAQ SV. The ICF provides an excellent framework when comparing the content of osteoporosis-targeted HRQL instruments and may be useful when selecting health status instruments for clinical studies.

Activities of Daily Living↗
PubMed2005

[Health Status of the German population: results of a representative survey using the EuroQol questionnaire].

PURPOSE: The EuroQol questionnaire (EQ-5D) is an instrument for subjectively describing and valuing health states. The purpose of this study was to measure the health status of the German population using the EQ-5D and to analyse the influence of sociodemographic factors. METHODS: As part of the European Study of the Epidemiology of Mental Disorders (ESEMeD) a representative sample of the non-institutionalised population aged 18 and above in Germany was surveyed by personal computer-based interviews in 2002/2003. Besides questions relating to the prevalence of psychiatric disorders and their risk factors, the health status of 3552 respondents was recorded using the EQ-5D. Frequency and factors of influence on problems in the EuroQol items mobility, self-care, usual activities, pain/discomfort, anxiety/depression as well as the valuation of health state on the visual analog scale (VAS) were analysed. RESULTS: 36 % of the respondents report problems in at least one of the EuroQol items; most frequent were problems in the dimension pain/discomfort (28 %), followed by mobility (17 %), everyday activities (10 %), anxiety/depression (4 %) and self-care (3 %). The mean VAS score was 77.4. Except for anxiety/depression the frequency of problems increased significantly with age and decreased with income. Women reported significantly more problems than men with regard to pain/discomfort and self-care. Having received more than 9 years of school education and being employed was associated with significantly fewer problems in all dimensions of the EuroQol. Living with a partner was associated with significantly fewer problems in the dimensions of self-care, usual activities and anxiety/depression. Multivariate analyses confirmed the effect of age, school education and employment on the frequency of problems, whereas for living with a partner only effects on self-care and anxiety/depression, and for gender only effects on pain/discomfort were confirmed. Income had no effect on frequency of problems in multivariate analyses. Young age, more than 9 years of school education, employment and living with a partner had a significantly positive effect on VAS score in multivariate analyses, while gender and income had no effect. CONCLUSIONS: The EQ-5D is a simple health state classification system, that can be used to detect variations in the health status of a population. This study provides EQ-5D-norm values for the German population.

Adolescent↗
PubMed1997

[Health status in the population using contraceptives].

In order to partially understand the health status of women under contraceptive therapy and their possible social hazard of it, a descriptive, prospective and transversal study was undertaken in a 500 individuals, ages 20-35 years old, who currently were regulation their fertility. Data were obtained by means of predetermined questions from subjects attending several clinics of the IMSS. Anyone refusing to participate was discharged questions. The analysis excluded 8/500 due to incomplete responses. In 334/492, hormonal practice was in use; the IUD met 36.6% and the minor groups of 4.4 and 2.8% the method chosen was surgical or natural respectively. The IUD had been used over three years in 60/187, while in 39/145 were on the pill the same period of time; only 23/100 preferred the injectables. No previous medical advice was carried out in order to prescribe the contraceptive and furthermore in 461/492 no laboratory clinical tests were required before. In only 22% of the population the Pap-smear had been taken two years before and in 89/492 was never considered. The contraceptive strategies was induce risks in the future with no solid etiology if a prescription is decided, before the health status is evaluated. It looks like that present report is the first description associating health and risks in a non-selected population under contraceptive methodology.

Adult↗
PubMed2000

Health status, perceptions of coping, and social support immediately after discharge of survivors of acute myocardial infarction.

BACKGROUND: The period immediately after discharge from the hospital after an acute myocardial infarction is a stressful and vulnerable time about which little is known. OBJECTIVE: To explore health status, perceptions of coping, and social support among survivors of a recent myocardial infarction in the first 3 weeks after discharge from hospitals in southwestern Sydney, Australia. METHODS: A descriptive, exploratory approach with a triangulated methodology was used to assess the experiences of 38 survivors, detect patterns in these experiences, explore the health-support needs of survivors, and determine changes in health status in the first 3 weeks after discharge. Quantitative data were collected with the Medical Outcomes Study SF-36, New York Heart Association classification, Canadian Cardiovascular Society Angina Scale, and the Jalowiec Coping Scale. A semistructured interview schedule provided additional qualitative data about the experiences of the survivors. RESULTS: The health status of participants was relatively stable during the 3-week period; most had no activity limitation due to dyspnea or angina. However, the subjects' health status was considerably lower than that of their age-matched population. The most common and most effective coping strategies adopted during this period were confrontation, optimism, and self-reliance. In addition, the subjects experienced anxiety, depression, ambiguity and uncertainty, fear of recurrence of the infarction and of deterioration in health, of boredom and of inertia. CONCLUSION: These findings can help nurses in hospital and community settings assist survivors of acute myocardial infarction to prepare for and deal effectively with experiences during convalescence.

Adaptation, Psychological↗
PubMed1989

[Health status of young children from industrial cities].

Health status of infants in an average city with petroleum refining industry is worse in comparison with that of infants living in a city with automobile industry. Unfavorable impact of air polluted by petroleum enterprises on the functional state of the circulatory system, immunity, intracellular enzymes, degree of body resistance and morbidity rates has been established. The study results specify the necessity of further active environment-protective and other preventive measures in the primary health care system aimed at health promotion of infants, their rehabilitation following the disease under the conditions of average cities with the developed petroleum refining industry.

Air Pollutants↗
PubMed2003

Measuring health status in early juvenile idiopathic arthritis: determinants and responsiveness of the child health questionnaire.

OBJECTIVE: To assess the determinants and responsiveness of the Norwegian version of the Child Health Questionnaire (CHQ) in patients with early juvenile idiopathic arthritis (JIA) and to compare health status in patients and controls. METHODS: A total of 116 children (median age 8.4 yrs) with JIA and < 2.5 years of disease duration (median 11.0 mo) were examined by a pediatric rheumatologist and reassessed after a median of 10.0 months. Physical and psychosocial health were assessed by means of the CHQ, which provides summary scores for physical and psychosocial health, the Childhood Health Assessment Questionnaire (CHAQ), and the Child Behavior Checklist (CBCL, n = 32). Matched controls (n = 116), randomly selected from the general population, completed the CHQ at baseline. RESULTS: The patients with JIA had poorer physical health and slightly impaired psychosocial health compared with the controls [41.2 +/- 13.6 vs 55.2 +/- 7.3 (p < 0.001) and 51.0 +/- 7.5 vs 54.1 +/- 5.7 (p = 0.002), respectively]. The most important determinants of the CHQ physical summary score were the child's pain, morning stiffness, the CHAQ disability index, erythrocyte sedimentation rate (ESR), overall well-being, and physician's global assessment of disease activity. The psychosocial summary score correlated with the CBCL level of internalizing, externalizing, and total behavior problems. The standardized response mean for the physical summary score was large (0.96) for those who improved, and moderate (-0.60) for those who became worse. CONCLUSION: The CHQ discriminated between patients with early JIA and controls. The most important determinants of the CHQ physical summary score were the child's pain, morning stiffness, CHAQ, ESR, overall well-being, and physician's global assessment of disease activity. The CHQ was sensitive to clinical changes in children with JIA.

Adolescent↗
PubMed1990

The health status and life satisfaction of first-year medical students.

The self-reported health status and life satisfaction of 286 first-year Duke University medical students in four consecutive classes were measured at the beginning and end of the school year and compared statistically with relevant sociodemographic and behavioral factors. Health status, quantitated in terms of Duke Health Profile scores, was generally lower for women than for men. Although there was a definite trend of worsening along all parameters of health and satisfaction during the year for both women and men, the most marked change was the increase in depressive symptoms. The students who were very satisfied with life had fewer symptoms of depression and anxiety; higher self-esteem, better physical, mental, and social health; stronger social ties; more physical activity; more sleep; and fewer stressful life events. Strong social ties was the factor most positively related to better health and life satisfaction.

Depressive Disorder↗
PubMed2003

Determinants of self-perceived changes in health status among pre- and early-retirement populations.

Using data from the 1992 and 1994 waves of the Health and Retirement Study (HRS), this study described reasons reported by pre- and early-retirement populations for perceived changes in global health status over a 2-year period. It then analyzed the association between self-perceptions of change and the actual changes in objective health conditions, controlling for demographics, emotional health status, and the changes in work status and health-affecting habits. The results were compared to the determinants of self-ratings of health at wave 2. Existing or increasing impairments in functional abilities were found to contribute to self-perceptions of decline. However, a diagnosis of new chronic disease and the experience of a major medical event per se did not universally contribute to self-perception of decline. The relationship between cross-sectional self-ratings of health and objective health conditions was more straightforward. Self-perception of improvement among people with serious health problems most likely owed to medical interventions and improvement in symptoms, the most frequently mentioned reasons for perceived improvement, and reflected the subjects' selective optimization and resiliency.

Activities of Daily Living↗
PubMed2002

A comparison of the recovery of health status after percutaneous coronary intervention and coronary artery bypass.

BACKGROUND: Selection of the optimum mode of coronary revascularization should not only be directed by technical outcomes, but should also consider patients' postprocedural health status, including symptoms, functionality, and quality of life. METHODS: Health status was analyzed and compared after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using the Seattle Angina Questionnaire (SAQ). The SAQ was administered to 475 patients (252 PCI and 223 CABG) preprocedure and then monthly for 6 months and again at 1 year. Differences in baseline characteristics were controlled by multivariable risk adjustment, and outcomes over time were compared using repeated-measures analysis of variance. RESULTS: In-hospital, 6-and 12-month clinical outcomes were not different; however, 25% of PCI patients required at least one reintervention during the study period, compared with only 1% of CABG patients (p < 0.001). Although physical function decreased for CABG patients at 1 month (p < 0.001), it improved and was better than the PCI group by 12 months (p = 0.008). Relief of angina was greater for CABG than PCI when analyzed over time (p < 0.001), principally due to the adverse effects of restenosis in the PCI group. Multivariable analysis confirmed that CABG independently conferred greater angina relief compared with PCI (p < 0.001). At 12 months postprocedure, quality of life had improved to a greater extent for CABG than PCI (p = 0.004). CONCLUSIONS: Over 12 months of follow-up, health status was improved to a greater extent for CABG patients than for PCI patients, primarily due to the adverse influence of restenosis after PCI.

Aged↗
PubMed2005

Comparison of lung volume reduction surgery and physical training on health status and physiologic outcomes: a randomized controlled clinical trial.

STUDY OBJECTIVES: In 1996, researchers in Sweden initiated a collaborative randomized study comparing lung volume reduction surgery (LVRS) and physical training with physical training alone. The primary end point was health status; secondary end points included survival and physiologic measurements. DESIGN: After an initial 6-week physical training program, researchers' patients were randomized to either LVRS (surgical group [SG]) with continued training for 3 months, or to continued training alone (training group [TG]) for 1 year. SETTING: All seven thoracic surgery centers in Sweden. PATIENTS: All patients in Sweden with severe emphysema fulfilling inclusion criteria for LVRS. INTERVENTIONS: Patients randomized to surgery underwent a median sternotomy, except for a few patients in whom thoracotomy or video-assisted thoracoscopy were performed. In the TG, supervised physical training continued for 1 year; in the SG, supervised physical training continued for 3 months postoperatively. MEASUREMENTS AND RESULTS: Fifty-three patients were included in each group. Six in-hospital deaths occurred after surgery (12%), and one more death occurred during follow-up. Two deaths occurred in the TG. The difference in death rates between the groups was not statistically significant. Health status, as measured by St. George Respiratory Questionnaire (SGRQ) [total scale score mean difference at 1 year, 14.7; 95% confidence interval (CI), 9.8 to 19.7] as well as by the Medical Outcomes Study Short-Form General Health Survey (physical function scale score mean difference at 1 year, 19.7; 95% CI, 12.1 to 27.3) was improved from baseline in the SG compared with the TG. FEV(1), residual volume, and shuttle walking test values also improved in the SG but not in the TG after 6 months and 12 months. CONCLUSIONS: In severe emphysema, LVRS can improve health status in survivors but is associated with mortality risk. The effects are stable for at least 1 year. Physical training alone failed to achieve a similar improvement.

Exercise Therapy↗
PubMed2002

Health status and satisfaction of patients receiving ambulatory care at osteopathic training clinics.

Little is known about the health status and level of satisfaction of patients receiving care at osteopathic training clinics. Previous studies report favorable responses to medical student participation in ambulatory clinics. The health status and level of satisfaction for 2700 patients attending six family medicine training clinics at a college of osteopathic medicine were measured from 1996 through 1998. Clinic response rates ranged from 74% to 98%. Data from the Medical Outcomes Study 36-Item Short Form (SF-36) were used to compute standardized scores in the following eight health scales for English- and Spanish-speaking patients: physical functioning, role limitations because of physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations because of emotional problems, and mental health. Patients at these osteopathic training clinics reported poorer health than the general population on all eight scales (P < .001). Patients who were English speakers reported significantly better health than their Spanish-speaking counterparts on four of the eight health scales, although the Spanish-speaking patients reported greater vitality. There were significant differences in patient health across clinics. More than 92% of patients at these six osteopathic training clinics reported that they were satisfied or very satisfied with their healthcare. This study suggests that osteopathic medical students are well accepted in ambulatory clinic encounters and that these students may encounter differing levels of patient health depending on where they receive their training.

Ambulatory Care Facilities↗
PubMed2000

Evaluation of the feasibility of and results of measuring health-status changes in patients undergoing surgical treatment for skeletal metastases.

The goal of treating patients with skeletal metastases is to decrease pain and improve or maintain physical function. Assessment of the effectiveness of treatment should therefore include evaluation of patient-rated measures of quality of life. The primary objective of the study was to determine the feasibility of studying the effect of surgical treatment of skeletal metastases on quality of life. The secondary objective was to provide data that begin to characterize this effect. The characteristics of patients with skeletal metastases are heterogeneous, patient enrollment in the study may be low, high attrition occurs secondary to death, and well accepted health-status measures (such as the Short Form-36) may be ineffective at detecting changes in health status; therefore, it is difficult to study these patients. High attrition and adjuvant treatment with radiation or chemotherapy made it impractical to draw firm conclusions about the effect of surgical treatment, but a trend toward improvement in selected health-status measures for both physical and mental health was noted. Analysis of patient-rated health-status scores as predictors of survival indicates that improvement in these scores 6 weeks after surgery is associated with an increase in the length of survival following surgery.

Adult↗
PubMed1998

Self-perceived health status of women three to five years after the diagnosis of gestational diabetes: a survey of cases and matched controls.

OBJECTIVE: Our purpose was to determine the long-term effect on self-perceived health status and maternal perceptions of the offspring's health status after women had been labeled with a diagnosis of gestational diabetes. STUDY DESIGN: We designed a mail survey of women who had participated in a large cohort study 3 to 5 years earlier. A tentative address list was developed for 139 women diagnosed with gestational diabetes and 406 matched controls; 33 and 89 questionnaires, respectively, were returned as "wrong address," but 106 case and 317 control addresses were potentially valid. The primary analysis compared cases and controls on the general health scale of the SF-36. Secondary outcomes included comparisons of the groups' mean results on a worry scale, ratings of the health of the child born in the index pregnancy, disability days, physician visits, diabetes preventive behaviors, and diabetes risk appraisal. RESULTS: The usable response rates were 65 of 106 (61.3%) and 197 of 317 (62.1%), with no meaningful demographic differences found between respondents and nonrespondents. For general health, the mean score for cases was 68.9 (SD 22.34) vs 73.8 (SD 19.86) for controls, p = 0.05 (prespecified, one-tailed). After factors found to be independently related to health perception (age, race, birth place, and comorbidity) were controlled, the differences narrowed, with a mean score for cases of 70.09 versus 73.38 for controls, p = 0.11, two-tailed. Compared with controls, cases were more worried about their own health (p = 0.02, two-tailed), rated their children as less healthy (p = 0.005, two-tailed), and perceived themselves as more likely to have diabetes (p < 0.0001, two-tailed). CONCLUSION: The diagnosis of gestational diabetes may lead to long-term changes in how women view their own health status and that of the child born during the affected pregnancy.

Adult↗
PubMed2002

Health status of school-aged children with cerebral palsy: information from a population-based sample.

In this study parents' systematic accounts of the health status of 408 school-aged children with cerebral palsy (CP) are reported (221 males, 187 females; mean age 8 years 5 months, SD 1 year 11 months; range 5 to 13 years), as are relations between severity of functional motor impairment and eight functional health status domains. Data were collected as part of a longitudinal study of the motor development of a population-based, stratified, random sample of children with CP from across Ontario, Canada. The Gross Motor Function Classification System (GMFCS) was used to classify severity of CP and functional health status was described with the eight-level Health Utilities Index-Mark 3. Rates of functional limitations in Mobility, Dexterity, Speech, and Vision were statistically significantly associated with GMFCS levels (all p<0.01), with correlation values (tau-b) of 0.82, 0.58, 0.46, and 0.36, respectively. Functional limitations in hearing (tau-b=0.16; p=0.04) and cognition (tau-b=0.27; p<0.01) were both statistically significantly associated with GMFCS levels, though correlations were low. Neither emotion (tau-b=0.03; p=0.24) nor pain (tau-b=0.07; p=0.37) was associated with degree of functional limitation as described by the GMFCS. Clinical and epidemiological implications of findings are discussed.

Activities of Daily Living↗
PubMed2003

PTSD, depression, and health status in Lebanese civilians exposed to a church explosion.

OBJECTIVE: This study examined the effect of stressors on PTSD, depression, and health status in a sample of Lebanese civilians exposed to a church explosion and their comparison groups (33 victims, 30 family members, and 30 neighbors) one year after the event. METHOD: This descriptive study used interviews that were conducted with the participants in their homes. The main outcome measures were the Clinician Administered PTSD Scale Version I, Beck Depression Inventory, and change in health service utilization in the past year. Multivariate analysis was done using logistic regression to predict the study outcomes. RESULTS: PTSD was present in 17.2% of the total sample, depression in 41.9% and the mean increase in doctors' visits was 2.05 +/- 2.97. In the victims' group, 39% met PTSD diagnostic criteria, 51% were depressed, and 45% reported deterioration in their health status. These rates were significantly higher than those in the comparison groups. Also, females were 2.62 times more at risk than males for depression. Victims were 7.35 times and those with financial problems 2.67 times more at risk of having increased doctor's visits than their family or neighbor comparison groups. CONCLUSION: The results suggest that PTSD, depression, and health status deterioration in trauma victims may persist over time. Resources such as social support can help attenuate the symptoms of those at a higher risk.

Adult↗
PubMed2003

Oral health status of prison inmates--New South Wales, Australia.

BACKGROUND: This paper assesses the oral health status in a prison population and identifies risk factors associated with oral health. METHODS: Cross-sectional stratified random sample of 789 prisoners (657 males and 132 females) from 27 correctional centres across New South Wales, stratified by sex, age and aboriginality. A face to face interview was used to collect information on health status and behavioural risk factors. A subset of participants (312 males and 22 females) received an oral examination which enabled the decayed, missing or filled permanent teeth (DMFT) score to be calculated. RESULTS: In the last 12 months 391 (50 per cent) inmates had visited a dentist. Reports on treatment received at this last visit were mainly for dental examinations, (62 per cent), dental fillings, (38 per cent), and dental extractions (28 per cent). Self-reported dental needs indicated that 42 per cent perceived the need for a check-up; the perceived need for dental fillings was highest in females compared with males. The mean DMFT for the population was 20.4 and 3.4 for decayed teeth. CONCLUSIONS: This survey demonstrates that the standard of past oral health care for prison inmates is low. There is a need to be more attentive to oral health promotion as eventually respondents will be returning to the community.

Adolescent↗
PubMed1996

The relationships among gender, perceived financial barriers to care, and health status in a rural population.

This study examined the relationships among gender, perceived financial barriers to health care, and selected health status indicators in a randomly selected rural Appalachian sample. The data were gathered through the Johnson County Health Survey. The survey was conducted through personal interviews with 207 females and 178 males representing 197 households. The Duke Health Profile was used to measure the perceived health of the respondents. Analysis of variance, t tests, and descriptive statistics were used to analyze the data. Analysis of the data revealed that women perceive financial barriers to health care significantly more than men (P < 0.01), even when living in the same household; women had significantly poorer health than men (P < 0.01); and both women and men with perceived financial barriers experienced poorer health (P < 0.01) than those who did not perceive such barriers. Conclusions from the study suggest that in this rural sample women were the most compromised by both gender and health status, and that they perceived that their health care needs were not being adequately met.

Community Health Centers↗