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PubMed2002

Health status in patients awaiting hip replacement for osteoarthritis.

BACKGROUND: Hip osteoarthritis is a major cause of pain and disability, especially in the elderly. As part of a study investigating factors that could be associated with advanced osteoarthritis of the hip, we compared the health status of patients awaiting arthroplasty for hip osteoarthritis with controls. We further investigated the interaction of hip osteoarthritis with other variables (age, gender, social class and concurrent pain) in relation to health status. METHODS: A case-control study was performed in two English health districts (Portsmouth and North Staffordshire) during 1993-1995. A total of 611 patients (210 men and 401 women) listed for hip replacement because of osteoarthritis over an 18-month period formed the case group and were compared with an equal number of controls selected from the general population and individually matched for age, gender and general practice. Cases and controls completed a structured interviewer-administered questionnaire, which included queries about their medical condition, occupation (from which a measure of social class was derived), and general health status using the SF36. RESULTS: Physical function (t=32.1, P<0.001), social function (t=16.8, P<0.001) and perceived general health (t=4.1, P<0.001) were worse in the case group, but energy/vitality and mental health showed little difference between cases and controls. Cases were more likely to report knee pain than controls, but case-control status was not associated with pain in the fingers or shoulders, or with social class. However, differences in physical and social function between cases and controls did vary with socio-demographic factors and concurrent knee pain status. CONCLUSION: Patients awaiting hip-replacement because of osteoarthritis were more likely to be restricted in their physical and social life than adults in the general population, but mental state and vitality appear unimpaired in this group. This contrasts with findings from other chronic pain disorders. Manual social class is not linked to being on a waiting list for osteoarthritic hip replacement but does add to the burden on health status, particularly social functioning in those with osteoarthritis of the hip.

Aged↗
PubMed2003

Postoperative pain detracts from early health status improvement seen after video-assisted thoracoscopic lung volume reduction surgery.

OBJECTIVES: To assess the impact of lung volume reduction surgery (LVRS) on postoperative pain. METHODS: Fifty-two patients, 34 male/18 female, median age 59 (46-70) years, underwent unilateral video-assisted thoracoscopic (VAT) LVRS. FEV(1), TLC, RV and RV/TLC ratio were assessed preoperatively and at 3, 6, 12 and 24 months post surgery. At the same time interval health status was assessed by Euroquol and SF 36 questionnaires. RESULTS: Significant improvements in health status, as assessed by SF 36, persisted from 3 months to 1 year. However, in the pain domain there was a worsening of the mean score from 74 preoperatively to 64 at 3 months, 68 at 6 months, 73 at 12 months and 65 at 24 months. The improvements in Euroquol score were not statistically significant. However, they became significant for at least 2 years postoperatively, when those patients who had a worsening pain score postoperatively were excluded. While the percentage of patients with a worsening of pain scores measured with SF 36 remained between 40 and 45% even 2 years after LVRS, when using Euroquol this percentage did decrease from 30% at 3 months to 14% at 2 years. There was no significant correlation between the change of scores and length of operation, hospital stay or air leak. It was also not statistically significant whether these patients had an extra procedure (redo thoracotomy or insertion of extra drain postoperatively). There were some significant correlations between changes in hyperinflation and changes in pain scores but this was not consistent for Euroquol and SF 36. CONCLUSION: Postoperative pain detracts from global improvement in health status after LVRS even after unilateral VATS. There may be an influence of alterations in chest mechanics after surgery on the development of pain.

Aged↗
PubMed2004

Effects of sustained audit/feedback on self-reported health status of primary care patients.

PURPOSE: Because limited audit/feedback of health status information has yielded mixed results, we evaluated the effects of a sustained program of audit/feedback on patient health and satisfaction. METHODS: We conducted a group-randomized effectiveness trial in which firms within Veterans Administration general internal medicine clinics served as units of randomization, intervention, and analysis. Respondents to a baseline health inventory were regularly mailed the 36-Item Short Form (SF-36) and, as relevant, questionnaires about six chronic conditions (ischemic heart disease, diabetes, chronic obstructive pulmonary disease, depression, alcohol use, and hypertension) and satisfaction with care. Data were reported to primary providers at individual patient visits and in aggregate during a 2-year period. RESULTS: Baseline forms were mailed to 34,050 patients; of the 22,413 respondents, 15,346 completed and returned follow-up surveys. Over the 2-year study, the difference between intervention and control groups (as measured by difference in average slope) was -0.26 (95% confidence interval [CI]: -0.79 to 0.27; P=0.28) for the SF-36 Physical Component Summary score and -0.53 (95% CI: -1.09 to 0.03; P=0.06) for the SF-36 Mental Component Summary score. No significant differences emerged after adjusting for deaths. There were no significant differences in condition-specific measures or satisfaction between groups after adjustment for provider type, panel size, and number of intervention visits, or after analysis of patients who completed all forms. CONCLUSION: An elaborate, sustained audit/feedback program of general and condition-specific measures of health/satisfaction did not improve outcomes. To be effective, such data probably should be incorporated into a comprehensive chronic disease management program.

Aged↗
PubMed2001

The health status of rural and urban ambulatory elderly in Taipei County.

BACKGROUND: To study the differences in the health status of rural and urban ambulatory elderly in Taipei County. METHOD: Non-compulsory general health check-up for elderly people over 65 years old in rural and urban areas. The content of the health examination included past medical history, health behavior, physical examination, laboratory examination, electrocardiogram and x-ray. Chi square test, t-test and logistic regression were applied for analysis. Risk factors relating to the cardiovascular system were included in the study. Gender differences affecting the prevalence of diseases and health behavior were also considered in the analysis. RESULTS: Significantly higher proportions of the rural elderly men smoked, drank alcohol, and had hypertension and impaired renal function. On the other hand, higher proportions of rural elderly women were obese and had diabetes, hypertension and renal impairment. The mean plasma glucose level of newly-diagnosed diabetic patients in the rural area was significantly higher than that in the urban area (p < 0.05). Diabetes, obesity, hypercholesterolemia and smoking were significantly associated with hypertension. The odds ratio for hypertension between rural and urban areas was 1.45 (p < 0.0001). The cardiovascular risk-rating score of rural elderly was statistically higher than that of urban elderly (p < 0.001). CONCLUSION: There were some minor differences in health status between urban and rural elderly. Health promotion should be varied according to the needs of various communities and various risk groups. Further studies should concentrate on prospective cohort research with well-defined determinants to evaluate whether cost-effective biopsychosocial intervention is necessary.

Aged↗
PubMedDate not supplied

Health status in VA patients: results from the Veterans Health Study.

Recently, the Veterans Administration (VA) Under Secretary for Health has designated functional status as one of the domains of value for the system, given its increasing importance for clinical care. The Veterans Health Study (VHS) was designed to assist the VA in monitoring outcomes and measuring the case mix of patients who use the VA. The Veterans SF-36 (short form functional status assessment for veterans) was administered to 2425 veterans receiving ambulatory care. Measures of the Veterans SF-36 were strongly correlated with sociodemographics and morbidities of the veterans. Young veterans had poorer mental health status than older veterans. Veterans who used ambulatory care in the VHS reported lower levels of health status, reflecting more disease than a non-VA civilian population. These measures of health are important indicators of the disease burden or case mix of the patients and are pertinent to health systems such as the VA for resource allocation decisions and as outcomes of care.

Adult↗
PubMed1992

Ongoing assessment of health status in patients with diabetes mellitus.

In 1990, the Division of Endocrinology and Metabolism of Henry Ford Hospital established an Outcomes Management data base for patients with Type I and Type II diabetes. A first cohort of 117 patients completed a baseline and 6-month follow-up assessment; a second cohort of 116 patients completed the baseline assessment. Assessment at each time point includes: the Short Form--36 Questions (SF-36) health status instrument; a set of clinical variables known as the Diabetes TyPE scale Form 2.2 abstracted from the medical record; and the physicians' ratings of patient's health status along the major dimensions of the SF-36. Success with both face-to-face and mailed administration of the SF-36 has been good, with response rates of over 85% using both methods. Comparison of patient and physician ratings of patient health status indicated a significant discrepancy on ratings of general health status, with physicians' ratings higher than those of patients themselves. "Tight" glycemic control (as measured by glycosylated hemoglobin) was associated with somewhat lower ratings on the various SF-36 dimensions for all patients in the first cohort and for Type I patients in the second cohort. However, this effect did not seem to be attributable to those features of a complex regimen used to achieve tight control, but rather reflected a complex combination of age, education level, and number of daily injections associated with achieving good control.

Activities of Daily Living↗
PubMed2006

Health status function after treatment with thermal balloon endometrial ablation and levonorgestrel intrauterine system for idiopathic menorrhagia: a randomized study.

AIM: To compare patients' health status function after treatment with thermal balloon endometrial ablation (TBEA) and levonorgestrel intrauterine system (LNG-IUS) for idiopathic menorrhagia. METHODS: Forty-four patients were recruited into a randomized trial comparing their health status after treatment with TBEA or LNG-IUS for idiopathic menorrhagia. RESULTS: At 1 year follow-up, the mean haemoglobin was significantly higher in women treated with TBEA (12.6 g/dl vs. 10.3 g/dl, p = 0.018). Iron deficiency occurred in 13.3% from the TBEA arm and in 50% from the LNG-IUS arm (p = 0.026). The women's mean Short Form 36 Questionnaire general health perception scores (54.9 vs. 40.5, p = 0.024) and mental health scores (49.5 vs. 38.3, p = 0.021) in TBEA arm were significantly higher than in the LNG-IUS arm. The mental health domain score was also significantly lower in the LNG-IUS arm (46.1 vs. 38.3, p = 0.041). CONCLUSION: TBEA appears to offer better health status function at 1 year follow-up and to be more acceptable to our Chinese population in the treatment of idiopathic menorrhagia following failed medical treatment.

Adult↗
PubMedDate not supplied

[Health status of adolescents deprived of parental care].

INTRODUCTION: Children deprived of parental care are a vulnerahle population with complex needs and health problems. The aim of our study was to assess health status of this population and compare it with children living in their biological families. MATERIAL AND METHODS: Our study included 41 adolescents living in foster families (22 boys and 19 girls, mean age 14.66 + 1.39 and 43 adolescents living in child foster homes (16 boys and 27 girls, mean age 14.99 +/- 1.3). The control group consisted of their classmates living with their biological families (45 adolescents, 20 boys and 25 girls, mean age 14.69 +/- 1.43). Health status was assessed by analyzing their medical records. Results There were no differences in regard to anthropometric characteristics (body weight, body height, body mass index) and prevalence of body deformities in studied groups. Acute bronchitis was significantly more fequent in children living in foster families (41.5%) than in other two groups (16.3%--foster homes: 17.8%--biological families). Headaches were significantly more common in groups living in foster families (31.70%) and foster homes (25.6%) than in children living with their biological families. The same was established for myopia (46.3% foster families: 32.6%--foster homes; 1 7.8%--biological families). CONCLUSION: Even though there were no differences in regard to characteristics which are indicators of general health, it is apparent that children deprived of parental care present with particularities of health status. Additional researches are necessary in order to get insight into the causality of these phenomena.

Adolescent↗
PubMed2000

The effect of surgery for rotator cuff disease on general health status. Results of a prospective trial.

BACKGROUND: Previous studies of the effect of rotator cuff surgery have concentrated on limb-specific or surgeon-based outcome criteria. We conducted a prospective trial to determine the effect of surgery for rotator cuff disease on general health status. METHODS: Seventy-one patients (fifty of whom were men and twenty-one of whom were women) with a mean age of 56.1 years were enrolled in the study. In addition to routine clinical and radiographic evaluation, all patients completed the Short Form-36 (SF-36) health-status questionnaire and five limb-specific questionnaires preoperatively and at six, twelve, eighteen, and twenty-four months postoperatively. All patients had a standard open acromioplasty and resection of the subacromial bursa. Thirty-one patients had repair of an associated rotator cuff tear. Sixty-seven patients (94 percent) completed the study; the remaining four patients were lost to follow-up. RESULTS: The preoperative SF-36 scores for physical function (60.6, p = 0.02), role function-physical (20.8, p = 0.001), pain (38.6, p = 0.003), physical component summary (37.0, p = 0.001), and mental component summary (45.6, p = 0.02) were significantly decreased compared with normative data. The preoperative limb-specific scores also were low. At the time of the most recent follow-up evaluation, there was improvement that approached or reached significance both in the limb-specific scores (p < or = 0.0026) and in the general-health-status scores for pain (p = 0.0001), role function-physical (p = 0.06), vitality (p = 0.01), and physical component summary (p = 0.01). The presence of a rotator cuff tear had a significant negative effect on limb-specific scores both preoperatively (p = 0.04) and postoperatively (p = 0.05). Although operative treatment of rotator cuff disease led to improved scores, patients who had filed a Workers' Compensation claim had lower limb-specific and SF-36 scores both preoperatively (p = 0.02 and p = 0.01, respectively) and postoperatively (p = 0.01 and p = 0.005, respectively). CONCLUSIONS: Surgery for chronic rotator cuff disease reliably and significantly improves general health status.

Acromion↗
PubMed2006

Oral condition and health status of elderly 8020 achievers in Aichi Prefecture.

The purpose of this study was to investigate differences in oral condition and health status between persons with 20 or more teeth at the age of 80 (8020 elderly) and persons of the same age with less than 20 teeth (non-8020 elderly). This study was conducted by a team belonging to the Aichi Dental Association. Number of remaining teeth, Community Periodontal Index of Treatment Needs (CPITN), salivary blood test, masticatory ability, bone mineral density (BMD), grip strength, balance test (length of time one can stand on one leg with eyes open), height, weight and body mass index (BMI) were all examined. The percentages of CPITN code 0, 1 and 2 were 68% in the 8020 male elderly and 72% in the 8020 female elderly. The positive percentage in the salivary blood test in the 8020 elderly was lower than that in the non-8020 elderly. Masticatory ability was 1.55 g in the 8020 male elderly, and 1.53 g in the 8020 female elderly. Relative masticatory ability in the 8020 female elderly was 20% higher than that in the non-8020 female elderly. BMD in the 8020 female elderly was significantly higher than that in the non-8020 female elderly. Grip strength in the 8020 elderly was also significantly higher than that in the non-8020 elderly. The duration of balance test in the 8020 male elderly was 2.2 times longer than that in the non-8020 male elderly. The 8020 elderly showed good oral condition and health status was found to be better in the 8020 elderly than in the non-8020 elderly.

Aged, 80 and over↗
PubMed1995

Changes in dyspnea, health status, and lung function in chronic airway disease.

The purpose of this study was to examine longitudinal changes in clinical parameters in patients with chronic obstructive pulmonary disease (COPD). We postulated that progressive dyspnea and decline in lung function over time would influence or impact patient's health status. Clinical ratings of dyspnea, general health status, and physiologic lung function were measured every 6 mo over a 2-yr period in an original group of 110 male patients with stable but symptomatic COPD and no significant comorbidity. At enrollment, age was 67 +/- 8 yr (mean +/- SD), forced expiratory volume in one second (FEV1) was 1.28 +/- 0.59 I (44 +/- 17% of predicted), and forced vital capacity (FVC) was 2.84 +/- 0.84 I (68 +/- 18% of predicted). A total of 34 patients "dropped out" because of death (n = 20), relocation (n = 7), and other reasons (n = 7). Dyspnea was measured using the transition dyspnea index (TDI), which represented changes from the baseline state; general health status was measured using the Medical Outcomes Study (MOS) 20-item short-form survey; physiologic lung function was assessed by spirometry (FVC and FEV1) and inspiratory muscle strength (PImax). Statistical analyses were performed using all available data for each patient, including results until the time at which patients died or were lost to follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Patient-reported outcome in total hip replacement. A comparison of five instruments of health status.

Our aim was to define the minimum set of patient-reported outcome measures which are required to assess health status after total hip replacement (THR). In 114 patients, we compared the pre-operative characteristics and sensitivity to change of the Oxford hip score (OHS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), the SF-36, the SF-12 (derived from the SF-36), and the Euroqol questionnaire (EQ-5D). At one year after operation, very large effect sizes were found for the disease-specific measures, the physical domains of the SF-12, SF-36 and the EQ-5Dindex (1.3 to 3.0). Patients in Charnley class A showed more change in the OHS, WOMAC pain and function, the physical domains of the SF-36 and the EQ-5Dvas (p < 0.05) compared with those in the Charnley B and C group. In this group, the effect size for the OHS more than doubled the effect sizes of WOMAC pain and physical function. We found high correlations and correlations of change between the OHS, the WOMAC, the physical domains of the SF-12 and the SF-36 and EQ-5Dindex. The SF-36 and EQ-5D scores at one year after operation approached those of the general population. Furthermore, we found a binomial distribution of the pre-operative EQ-5Dindex score and a pre-operative discrepancy and post-operative agreement between the EQ-5Dvas and EQ-5Dindex. We recommend the use of the OHS and SF-12 in the assessment of THR. The SF-36 may be used in circumstances when smaller changes in health status are investigated, for example in the follow-up of THR. The EQ-5D is useful in situations in which utility values are needed in order to calculate cost-effectiveness or quality-adjusted life years (QALYs), such as in the assessment of new techniques in THR.

Aged↗
PubMed1988

Social networks and health status of the unemployed.

Results of a study of the relationship between social networks and the health status of the unemployed, which used data gathered in the National Survey of Personal Health Practices and Consequences, are described. The number of and contact with close friends and relatives were predictive of health status for unemployed people beyond what is attributable to demographic factors. The relationship among these factors for the unemployed was compared with that in the total population and in an employed population, and the factors were found to be significantly more important for the unemployed.

Adolescent↗
PubMed2006

Evaluation of oral health knowledge and oral health status in mothers and their children with cleft lip and palate.

OBJECTIVE: To assess the oral health knowledge of mothers of children with cleft lip and/or palate, analyzing the practical application of this information on the basis of the oral hygiene of the children and caries prevalence of mothers and children. DESIGN: Cross-sectional. SETTING: Pediatric Dentistry sector of the Hospital for Rehabilitation of Craniofacial Anomalies. PATIENTS: Mothers (n = 300) and their children with cleft lip and/or palate, ages 3 years to 5 years 6 months. MATERIALS AND METHODS: An interview with questions related to dietary habits and oral health knowledge and habits was conducted. Children and their mothers also were evaluated by intraoral clinical examination. RESULTS: Of the mothers, 47.3% displayed poor oral health status (Group A) and 52.7% had a satisfactory oral health status (Group B). Children in Group A presented a mean dmft of 6.0, whereas children in Group B had a mean dmft of 5.6. No significant differences were observed between groups. Mothers demonstrated a reasonable knowledge on prevention of dental caries and oral hygiene. CONCLUSION: Even though the mothers interviewed had some knowledge on the causes and prevention of dental caries, other factors should be regarded as relevant in the caries process.

Attitude to Health↗
PubMed1995

Long-term health status and quality of life outcomes of lung transplant recipients.

STUDY OBJECTIVE: Health status and quality of life (QOL) in lung transplant candidates and recipients were compared to determine the impact of transplantation, and whether recipients experience continued improvements in the years after transplant surgery. DESIGN: Two patient groups, adult lung transplant candidates (n = 44) and adult lung transplant recipients (n = 54), completed self-report QOL questionnaires. Eighteen of the 54 recipients completed QOL questionnaires on two occasions, about 18 months apart, after lung transplant. The questionnaire included the Medical Outcome Study Health Survey (MOS 20) that assesses six dimensions of health-related QOL: physical, role and social function, mental health, health perceptions and bodily pain, as well as a self-report Karnofsky Index and other indicators of QOL. SETTING: University medical center transplant service. RESULTS: Compared with candidates, recipients reported higher levels of happiness and more satisfaction with their life and their health. They also reported better function on the Karnofsky Index and in every MOS 20 dimension (p < 0.0001), except pain. No significant differences were found in comparisons among recipients, grouped by the time since their transplant. Eighteen recipients completed two QOL questionnaires after transplant. No significant differences were found between the earlier (median, 11 months) and later (median, 29 months) QOL responses for this group overall. However, recipients (n = 5) who developed obliterative bronchiolitis between assessments showed decrements in their health-related QOL. Dimensions particularly affected were physical and social functioning and bodily pain. CONCLUSIONS: Dramatic improvements in health status and QOL occur after successful lung transplant and remain stable over time. Obliterative bronchiolitis results in notable QOL reductions.

Activities of Daily Living↗
PubMed1996

Quality of life assessment in children: a review of conceptual and methodological issues in multidimensional health status measures.

STUDY OBJECTIVE: To clarify concepts and methodological problems in existing multidimensional health status measures for children. DESIGN: Thematic review of instruments found by computerised and manual searches, 1979-95. SUBJECTS: Nine health status instruments. MAIN RESULTS: Many instruments did not satisfy criteria of being child centered or family focussed; few had sufficient psychometric properties for research or clinical use; underlying conceptual assumptions were rarely explicit. CONCLUSIONS: Quality of life measures should be viewed cautiously. Interdisciplinary discussion is required, as well as discussion with children and parents, to establish constructs that are truly useful.

Adolescent↗
PubMed1997

Comparison of the Musculoskeletal Function Assessment questionnaire with the Short Form-36, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Sickness Impact Profile health-status measures.

We compared the reliability, validity, and responsiveness of the Musculoskeletal Function Assessment (MFA) questionnaire with those of three commonly used health-status measures: the Short Form-36 (SF-36), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Sickness Impact Profile (SIP). The MFA, like the other health-status measures, demonstrated good reliability (intraclass correlation coefficients of more than 0.70), good sensitivity and specificity (more than 70 per cent), good criterion validity that correlated with physicians' ratings (p < 0.01), and good construct validity that correlated with the characteristics of the patients (p < 0.01). It also demonstrated better content validity than the other questionnaires, with no ceiling or floor effects for the total score. In addition, it was more responsive than the SF-36; for eight of the eleven comparisons, it was more efficient (relative efficiency of more than 2.00) in measuring changes in function between the baseline values and the values determined at the latest follow-up evaluation. These findings suggest that the MFA can be used to assess the health status of patients who have a musculoskeletal disorder.

Activities of Daily Living↗
PubMed1982

Maternal and child health: use of health status indicators in coordinating and targeting federal programs.

The United States has achieved dramatic improvements in overall maternal and child health status, yet faces disturbingly wide variations in the health status of many population subgroups. The Surgeon General in 1980 published specific quantitative objectives to stimulate further improvements in the health of the American people by 1990. A critical step in meeting relevant objectives is the more effective use at national, state, and local levels of available data, particularly infant, perinatal, neonatal, and maternal mortality rates and the incidence of low weight births. This paper reviews variations in infant mortality rates and five current federal "categorical" programs that aim to improve maternal and child health: Supplemental Feeding Program for Women, Infants and Children; Head Start; Maternal and Child Health; Family Planning; and Community Health Centers. Several examples are cited of effective use of data in the coordination and targeting of resources from these large public programs. Recommendations are made for enhancement of federal maternal and child health programs within current funding levels. These recommendations will be all the more relevant if the Congress enacts block grants to the states with lower total funding.

Child Health Services↗