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PubMed2002

[Long-term follow-up of the health status of opiate abusers treated with methadone--pilot study].

BACKGROUND: Examination of the health status of patients abusing opiates can be substantiated by their high morbidity. The aim of the work was to describe the actual health status and the extent and seriousness of the affliction before the substitution therapy with opioid receptors agonist--methadone. METHODS AND RESULTS: The group of drug abusers consisted of 101 persons (average age was 28.5 years, within the range of 20 to 47 years, 77 men and 24 women). Among the pathological findings, values of the levels of hepatic enzymes ALT, AST (35 and 31%), GMT (9%), low haemoglobin levels (24%) and elevated values of IgM (38%) and CRP (25%) belonged to the most frequent ones. Because of the simultaneously positive tests for hepatitis (C and B, 70% and 61%), the alteration is fully obvious. Low testosterone levels in males (63%) indicate the dysfunction of the hypothalamus-hypophysis-gonadas axis. Increased values of thyroxin (14%), P (20%) and atherogenity index (19%) remain unexplained. Several other laboratory-biochemical parameters remained within the physiological range. Imaging methods revealed hepatomegaly in 28% and splenomegaly in 27%, echotexture indicating steatosis was found in 15% of studied persons. CONCLUSIONS: In chronic drug abusers before the onset of the substitution therapy, it is possible to expect frequent alterations, namely that of hepatic functions, positive test for hepatitis B and C, alteration of immunoglobulines level and testosterone deficits (in males).

Adult↗
PubMed2006

The impact of diabetes on one-year health status outcomes following acute coronary syndromes.

BACKGROUND: Diabetes is an important predictor of mortality patients with ACS. However, little is known about the association between diabetes and health status after ACS. The objective of this study was to examine the association between diabetes and patients' health status outcomes one year after an acute coronary syndrome (ACS). METHODS: This was a prospective cohort study of patients hospitalized with ACS. Patients were evaluated at baseline and one year with the Seattle Angina Questionnaire (SAQ). Socio-demographic and clinical characteristics were ascertained during index ACS hospitalization. One year SAQ Angina Frequency, Physical Limitation, and Health-Related Quality of Life (HRQoL) scales were the primary outcomes of the study. RESULTS: Of 1199 patients, 326 (37%) had diabetes. Patients with diabetes were more likely to present with unstable angina (52% vs. 40%; p < 0.001), less likely to present with STEMI (20% vs. 31%; p < 0.001), and less likely to undergo coronary angiography (68% vs. 82%; p < 0.001). In multivariable analyses, the presence of diabetes was associated with significantly more angina (OR 1.36; 95% CI 1.01-1.38), cardiac-related physical limitation (OR 1.94; 95% CI 1.57-3.24) and HRQoL deficits (OR 1.43; 95% CI 1.01-2.04) at one year. CONCLUSION: Diabetes is associated with more angina, worse physical limitation, and worse HRQoL one year after an ACS. Future studies should assess whether health status outcomes of patients with diabetes could be improved through more aggressive ACS treatment or post-discharge surveillance and angina management.

Acute Disease↗
PubMed1991

Relationship between the self-assessment and clinical assessment of health status and work ability.

Clinical assessments of health status and work ability were compared with subjective assessments reported on a questionnaire. The clinical examinations included cardiorespiratory, musculoskeletal, and psychological measurements. The subjective work ability comprised an index based on estimations of work ability in relation to diseases, job demands, and psychological resources. For the clinical examinations 89 male and 85 female workers aged 44-58 years were selected according to health and subjective work ability as reported on the questionnaire. Half of the group was healthy and half suffered from either coronary artery disease (men) or low-back pain (women), and the subjective estimations of work ability varied from good to poor. The results indicated that the questionnaire responses on health and work ability related well with the clinically assessed factors at the group level. Some divergence was detected at the individual level, but it could usually be explained on the basis of the available data.

Attitude to Health↗
PubMed2000

Long-term survival and health status after prolonged mechanical ventilation after cardiac surgery.

OBJECTIVE: To determine hospital mortality, weaning from mechanical ventilation, long-term survival, and functional health status in patients receiving > or =7 days of mechanical ventilation after cardiac surgery. DESIGN: Retrospective chart review and prospective patient interviews. SETTING: A university-affiliated, tertiary care medical center. PATIENTS: A total of 124 patients that received > or =7 days of mechanical ventilation after cardiac surgery. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Hospital and long-term death, liberation from mechanical ventilation, and functional health status. MEASUREMENTS AND MAIN RESULTS: A total of 19 (15%) patients died in hospital. Of the 105 survivors, 104 (99%) were completely weaned from mechanical ventilation. Patients who died in the hospital were more likely to have had a preoperative stroke or to have a new postoperative stroke, more likely to have postoperative renal failure, and less likely to have chronic obstructive pulmonary disease. Kaplan-Meier survival was 59% at 5 yrs and expected median survival was 6.2 yrs. Patients who died anytime after discharge were more likely to have preoperative renal dysfunction or stroke, took longer to be weaned from mechanical ventilation and to be discharged, and were more likely to have postoperative complications such as stroke or renal dysfunction. Also, they were more likely to be too debilitated to walk or eat. By multivariate analysis, admitting creatinine, aortic valve surgery, number of ventilator days, and discharged on tube feedings remained significant predictors of mortality. A total of 40 of 53 survivors were interviewed. Participants were similar to nonparticipants (p > .10 for all characteristics). A few (16%) had limitations of their activities of daily living (eating, dressing, bathing), and most had limitations of moderate activity (60%) and vigorous activity (94%). Only 36% could climb stairs or walk uphill without limitations, 54% could walk a block, and 41% had no limitations in house or job work. Half the participants had no body pain; 38% had moderate and 4% severe pain. Most (59%) described their general health as good to excellent. Only 10% said it was poor. CONCLUSION: Patients' chances of being liberated from mechanical ventilation are excellent. Their long-term survival and health status are good.

Aged↗
PubMed2002

Development of an index of physical functional health status in rehabilitation.

OBJECTIVE: To describe (1) the development of an index of physical functional health status (FHS) and (2) its hierarchical structure, unidimensionality, reproducibility of item calibrations, and practical application. DESIGN: Rasch analysis of existing data sets. SETTING: A total of 715 acute, orthopedic outpatient centers and 62 long-term care facilities in 41 states participating with Focus On Therapeutic Outcomes, Inc. PATIENTS: A convenience sample of 92,343 patients (40% male; mean age +/- standard deviation [SD], 48+/-17y; range, 14-99y) seeking rehabilitation between 1993 and 1999. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients completed self-report health status surveys at admission and discharge. The Medical Outcomes Study 36-Item Short-Form Health Survey's physical functioning scale (PF-10) is the foundation of the physical FHS. The Oswestry Low Back Pain Disability Questionnaire, Neck Disability Index, Lysholm Knee Questionnaire, items pertinent to patients with upper-extremity impairments, and items pertinent to patients with more involved neuromusculoskeletal impairments were cocalibrated into the PF-10. RESULTS: The final FHS item bank contained 36 items (patient separation, 2.3; root mean square measurement error, 5.9; mean square +/- SD infit, 0.9+/-0.5; outfit, 0.9+/-0.9). Analyses supported empirical item hierarchy, unidimensionality, reproducibility of item calibrations, and content and construct validity of the FHS-36. CONCLUSIONS: Results support the reliability and validity of FHS-36 measures in the present sample. Analyses show the potential for a dynamic, computer-controlled, adaptive survey for FHS assessment applicable for group analysis and clinical decision making for individual patients.

Adolescent↗
PubMed2006

Are malnourished patients complex patients? Health status and care complexity of malnourished patients detected by the Short Nutritional Assessment Questionnaire (SNAQ).

BACKGROUND: This article describes the characteristics of patients identified as malnourished using the Short Nutritional Assessment Questionnaire (SNAQ) in terms of health status (quality of life, functional capacity, and body composition) and care complexity. We expected that by using the quick and easy SNAQ method of screening on malnutrition, inferences could be made about general health status and care complexity. This information can be used for optimal multi-disciplinary treatment of the malnourished patient. METHODS: The research population consisted of a group of 588 patients admitted to internal medicine and surgery wards of the VU university medical center. Patients with a SNAQ score of at least 3 points were considered malnourished. The SNAQ score was compared to the health status, which was determined by serum albumin, hand grip strength, quality of life, body composition, and estimated care complexity. RESULTS: At admission, 172 patients (29%) had a SNAQ score of at least 3 points. These patients had a significantly poorer quality of life, poorer physical functioning, a lower fat free mass index, and higher care complexity. CONCLUSION: These findings confirm our assumption that a considerable proportion of malnourished patients should be considered as complex patients and that malnutrition is an important aspect and indicator of overall health status of the patients. The SNAQ is a simple malnutrition screening tool, applicable in the current complex hospital situation, to identify these complex, malnourished patients.

Journal Article↗
PubMed2004

Personal characteristics, health status, physical activity, and quality of life in cardiac rehabilitation participants.

The purpose of this study was to examine the relationships between personal factors, health status, and adherence to physical activity behavior, and quality of life in cardiac rehabilitation participants. The record of 146 subjects, who met inclusion criteria were obtained from the University Cardiac Rehabilitation Database. Change scores in physical activity were used as a proxy for adherence. Participants who were categorized as not working, female gender, and at high-risk health status had lower means and lower improvement scores from repeated measures analysis of variance. This study found that some personal factors and health status are significant factors influencing the participant's adherence to physical activity recommendations and quality of life in this cardiac rehabilitation program.

Activities of Daily Living↗
PubMed1981

The Duke-UNC Health Profile: an adult health status instrument for primary care.

The Duke--UNC Health Profile (DUHP) was developed as a brief 63-item instrument designed to measure adult health status in the primary care setting along four dimensions: symptom status, physical function, emotional function and social function. Reliability and validity were tested on a group of 395 ambulatory patients in a family medicine center. Temporal stability Spearman correlations ranged from 0.52 to 0.82 for the four dimensions. Cronbach's alpha for internal consistency was 0.85 for emotional function. Guttman's reproducibility coefficients were 0.98 for physical function and 0.93 for social function, and the scalability coefficients were 0.89 for physical and 0.71 for social. Observed relationships between DUHP scores and demographic characteristics of the respondents correlated well with those predicted by the investigators (overall Spearman correlation 0.79). Convergent and discriminant validity was supported by strong associations between components of DUHP and those on the Sickness Impact Profile (SIP), the Tennessee Self-Concept Scale (Tennessee), and the Zung Self-Rating Depression Scale (Zung). DUHP with SIP monocomponent-heteromethod Spearman correlations ranged from 0.34 to 0.45, and those for DUHP with Tennessee ranged from 0.68 to 0.81. DUHP with Zung monoitem--heteromethod correlations ranged from 0.54 to 0.57. It is concluded that this evidence supports the reliability and validity of the DUHP as an instrument suitable for studying the impact of primary health care on the health outcomes of patients.

Adolescent↗
PubMed1990

Older patients' health status and satisfaction with medical care in an HMO population.

Few studies have examined the relationship between older patients' satisfaction with medical care and their health status, and none of these investigations has been based at an HMO. To examine this question, data on 532 patients older than 70 years in an HMO were analyzed. Patients' reports of satisfaction with medical care were examined in relation to several dimensions of health status (based on self-reports, chart data, and physicians' ratings), their own sociodemographic characteristics, and characteristics of their primary physicians. Greater satisfaction was significantly associated with better self-rated health and physical function, less emotional distress, and more social activity but was not related to physicians' health ratings, number of diagnoses, or cognitive function. Mean levels of satisfaction were also significantly different for patients of different physicians but not appreciably related to patients' sociodemographic characteristics. When patient sociodemographic characteristics were controlled for, the relations of health status variables to satisfaction were essentially unchanged. It was concluded that the key issues to be resolved are whether better health leads to greater satisfaction or vice versa, and, in either case, whether the relations are mediated by factors relating to the patient's experience of medical care.

Aged↗
PubMed1993

Oral health status of a long-term-care, veteran population.

The Department of Veterans Affairs (VA) operates the largest, integrated health care system in the United States of America. The projected need for long-term-care in the VA health care system parallels an expected increase in need for care in the United States, but precedes the need for care in the general population by 25-30 yr. The VA's Office of Dentistry, in an effort to estimate the resource requirements of this swelling group of veterans, initiated in 1986-7 an oral health survey of long-term care patients. The overall goals were to describe the oral health status of VA nursing home care units (NHCU) residents and to develop a methodology for estimating future dental health services utilization. This study describes the oral health status of the study population. Demographic and oral health data were collected for 650 long-term care residents of six VA NHCUs between October 1986 and July 1987. Data were collected on sociodemographic status, medical history, dental caries, periodontal diseases, oral soft tissue pathology, and the presence of dental prostheses. Caries and periodontal disease were evaluated using the United States National Institute of Dental Research Survey of Employed Adults and Seniors protocols. The oral health status of the population is described using DMF and ESI indices, the prevalence of oral lesions, levels of tooth loss, oral hygiene scores, and the status of existing dentures. Findings show moderate levels of untreated dental caries and periodontal disease and significant tooth loss which increased with age. A need for preventive therapy, restorative dentistry, conservative periodontal therapy, and prosthodontic care was evident.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

Domestic violence among Druze women in Israel as reflected by health status and somatization level.

Women with a history of physical or emotional abuse demonstrate a higher incidence of medical disorders but may be reluctant to disclose the abuse to health care providers. The present study explored whether measures of health status may serve as an indication of violence against women. Sixty-two Druze women (18-50 years old) completed health status (SF-36 survey), somatization (Brief Symptom Inventory-BSI), and abuse (the Abuse Assessment Screen-AAS) questionnaires during a visit to the family physician in the community primary care clinic. Higher somatization symptoms and diminished health status were associated with severity of violence. Results attest to the value of these measures as an additional indirect device for screening victims of domestic violence in general and among traditional societies in particular.

Adult↗
PubMedDate not supplied

Walking speed predicts health status and hospital costs for frail elderly male veterans.

This study evaluated the use of walking speed as an indicator of function and health status in acutely ill, hospitalized, older male veterans. Hospital inpatients in a Department of Veterans Affairs (VA) study of Geriatric Evaluation and Management (GEM) (n = 1,388, age 74.2 +/- 5.7, 98% male) were followed for 1 year. The results indicate that each 0.10 m/s reduction in baseline walking speed was associated with poorer health status (36-item short form [SF-36] beta = 4.5 [95% confidence interval (CI) 2.8 to 6.1]), poorer physical functioning (beta = 2.1 [6.9 to 14.8]), more disabilities (beta = 0.63 [0.53 to 0.73]), additional rehabilitation visits (2.0 [1.4 to 2.5]), increased medical-surgical visits (2.8 [1.9 to 3.7]), longer hospital stays (2.2 [1.4 to 2.9]), and higher costs ($1,334 [$869 to $1,798]). In addition, each 0.10 m/ s/yr increase in walking speed resulted in improved health status (SF-36 beta = 8.4 [6.0 to 10.7]), improved physical function (beta = 2.9 [2.5 to 3.3]), fewer basic disabilities (0.30 [0.2 to 0.4]), fewer instrumental disabilities (0.7 [0.6 to 0.8]), fewer hospitalization days (2.3 [1.3 to 3.3]), and 1-year cost reductions of $1,188 [-$65 to $2,442]. Walking speed is useful for the functional assessment of acutely ill, hospitalized older adults. Measurement of walking speed over time may help predict those who will need and use more health-related services.

Aged↗
PubMedDate not supplied

A comparative study on the periodontal health status of adult populations of Kenya and India.

The purpose of this study was to compare the oral hygiene and periodontal health status of 497 randomly selected Kenyan and Indian adult populations aged between 20 and 35 years. Oral hygiene and periodontal health status were assessed using Silness and Loe plaque Index and Russel's Periodontal Index respectively. Results revealed that the overall mean plaque and periodontal index scores of Kenyan participants were significantly lower than those of Indians. Increase of mean Periodontal index with age was found to be significant among Kenyan participants and insignificant among Indian participants Kenyan female participants were found to have significant lower mean plaque and periodontal index scores than males. However, the mean periodontal index score of Indian male participants was found to be lower than that of female participants. It is concluded that Kenyan participants had better periodontal and oral hygiene status than Indian participants and that Indian females unlike Kenyan females had poorer periodontal health status than male.

Adult↗
PubMed1999

[Lifestyle and health status of homeless people around Shibuya Station, Tokyo].

The number of homeless people in Tokyo is estimated to be 3,200-3,300. While studies on the health status of homeless people, including illness, injury and deaths have been previously reported, most of these reports concern the homeless who resided in housing facilities for the homeless or who admitted to hospitals. We undertook a comparison of lifestyle and health status between homeless people and people who live in houses (as a control group). Health status was also analyzed for differences among homeless people. Subjects were asked by questionnaire regarding their age, the length of being homeless, former and present employment, sleeping condition, food, whether they have friends or not, the amount of smoking per day, and Short-Form-36 Health Survey (SF36). As objective findings, measurement of blood pressure and blood testing were also performed. Fifty-three homeless people, 49 male, 4 female, average age 52, from the areas around Shibuya station and Yoyogi park, were enrolled. While 98% of the homeless people had previous employment, 73% were not working when the study was performed. Compared with control group, the homeless had fewer meals per day, fewer friends, excessive smoking, greater history of gastro-duodenal ulcer and injury, greater limitation due to physical problems, and higher general mental health as measured by SF36. The diastolic blood pressure of the homeless was higher than that of the control. The blood testing showed higher white blood cell counts and platelet counts. It was suggested that changes in the social structures were largely influential in causing life, and that access to health care was limited because of financial and social barriers. Further studies with more samples, survey of social volunteers involved in care of homeless and qualitative data would be necessary to find and develop better support system for the homeless.

Adult↗
PubMed2002

Ambulatory and admitted laparoscopic cholecystectomy patients have comparable outcomes but different functional health status.

BACKGROUND: Laparoscopic cholecystectomy is frequently an ambulatory procedure, but some patients are best admitted for a brief hospital stay. In this study, we compared the functional health status, symptoms, and outcomes of patients undergoing ambulatory elective laparoscopic cholecystectomy to those with brief hospital admission. The purpose was to assess patient satisfaction and to identify factors that might assist in selecting patients for ambulatory vs short-stay operations. METHODS: A total of 140 patients scheduled for elective cholecystectomy completed the SF-36 health survey and provided additional information regarding symptoms preoperatively, at 2 months, and at 6 months after operation. RESULTS: All patients had symptomatic gallstones; 76 were admitted to the hospital, and 64 were ambulatory. Admitted patients reported more emotional role limitations on preoperative SF-36. They also reported symptoms of depression more often. Patients in both groups were equally relieved of symptoms of pain, nausea, vomiting, and tenderness. Satisfaction with care was similar for both groups; however, at 2 and 6 months, admitted patients continued to report significantly poorer functional health status than ambulatory patients. CONCLUSION: A reliable, reproducible measure of functional health status, such as the SF-36, may be useful for identifying patients who are appropriate for short-stay hospital admission after laparoscopic cholecystectomy as part of a decision process that tries to optimize outcomes while utilizing resources efficiently.

Ambulatory Care↗
PubMed1994

Religious involvement and health status among African-American males.

Previous studies document the importance of religious involvement in African-American communities. This study examines the extent to which religious involvement is associated with health status among African-American males. The data come from a community sample of 537 males residing in a major US urban area. Three indicators of religious involvement were used: denominational affiliation, frequency of church attendance, and overall religiosity. Measures of health status included a self-assessment of physical health, depressive symptoms, self-reported hypertension, cigarette smoking, and daily drinking of alcohol. The results show significant associations between selected indicators of religious involvement and measures of health status. Fewer depressive symptoms are associated with having a denominational affiliation, while no or low frequency of church attendance is associated with current smoking and daily drinking. Implications for health-related interventions with African-American males are discussed in light of these findings.

Adolescent↗
PubMed2004

An instrument to measure the health status in children with hydrocephalus: the Hydrocephalus Outcome Questionnaire.

OBJECT: In the measurement of clinical outcome in pediatric patients with hydrocephalus the condition's effects on a child's physical, emotional, cognitive, and social health are frequently ignored. The authors developed a quantitative health status measure, the Hydrocephalus Outcome Questionnaire (HOQ), designed specifically for children with hydrocephalus, which can be completed by the children's parents. METHODS: The standardized steps in the development of a health status measure were followed. Item generation required involvement of health professionals and focus groups with parents of children with hydrocephalus. A comprehensive list of 165 unique health status items was thus generated. To streamline the list, questionnaires were sent to 69 sets of parents to solicit their opinions regarding the most important of these health issues, and the 51 most significant items were then selected to represent the following health domains: physical, social-emotional, and cognitive. In another cohort of 90 sets of parents, the 51-item questionnaire was then tested for reliability and construct validity against the following independent measures of specific components of health: Health Utilities Index, Wide Range Achievement Reading Test, Strengths and Difficulties Questionnaires, and Functional Independence Measure for Children. The HOQ took approximately 10 to 15 minutes for the parents to complete and demonstrated excellent test-retest reliability (0.93, 95% confidence interval [CI] 0.88-0.96), interrater reliability (0.88, 95% CI 0.79-0.93), and internal consistency (Cronbach alpha 0.94). Pearson correlation testing demonstrated very good construct validity between domain scores and their respective independent measures. CONCLUSIONS: The HOQ for children with hydrocephalus demonstrated excellent reliability and validity properties. This tool will be valuable for a wide range of clinical research projects in pediatric hydrocephalus.

Adolescent↗