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PubMed1997

Can market-based solutions work for all of Medicare? Barriers to reform in the Medicare population residing in health professional shortage areas.

The proportion of the Medicare-eligible population living in health professional shortage areas (HPSAs), their demographics, and three health status indicators were examined in relationship to market-based reform proposals. Medicare-eligible residents of Georgia and Kentucky were classified as living in an HPSA (n = 154,812) or non-HPSA (n = 556,602). Chi-squares were computed for demographic variables and health status indicators. A Mantel-Haenszel summary chi-square was computed after stratification of health status indicators by poverty level. Elderly residents of HPSAs accounted for 22% of the study population. Significant differences in all demographic variables except sex were detected. HPSA residents were more likely to have a mobility limitation, self-care limitation, or both a mobility and self-care limitation. Elderly residents in HPSAs are significantly more likely to have poorer health status and mobility limitations. Physician supply in HPSAs may be inadequate to support market-based reforms.

Aged↗
PubMed1996

Progress towards the year 2000: assessing the health status of minorities in Texas.

In 1991, the Centers for Disease Control and Prevention released a consensus set of 18 health status indicators to help communities assess their general health status and focus local, state, and national efforts on tracking the year 2000 objectives. States and local communities were encouraged also to analyze the indicators for each major racial and ethnic population in their jurisdictions. This article presents an update of trends in Texas for the health status indicators for the total population, along with comparisons by race and Hispanic origin for the most recent data. Analysis of these data reveals that the health status for the total population is improving as we approach the year 2000. Yet despite these overall gains, significant disparities exist between the total population and the racial and ethnic minorities in Texas. Further efforts are needed to reduce these health disparities.

Adult↗
PubMed2003

Dental health status and indicators of treatment needs of four Hispanic subgroups in New York City.

This article presents the results of a study of four Hispanic subgroup residents of New York City. Utilizing National Institute of Dental and Craniofacial Research criteria and a specially designed survey instrument, the authors conducted oral examinations and interviews on 1,010 Hispanic adults. Results showed that the oral health status and the indicators of treatment needs differed among the subgroups. When conducting needs assessment and providing oral health care services for this population, differences among the subgroups must be considered.

Adolescent↗
PubMedDate not supplied

Health indicator development in Alberta health authorities: searching for common ground.

The ability to measure population health trends and improvements can be enhanced through collaborative efforts to describe existing knowledge and via shared development opportunities. This paper highlights a project undertaken in Alberta which has created an inventory of health status indicators in use in the province, and provides a framework for strategic progress in the development and use of a common set of indicators across the province. The work may provide a model for other regional health authorities interested in comparing the health of their populations across time and across health regions.

Alberta↗
PubMed1997

Dispersion Index: measuring trend assessment of geographical inequality in health--the example of under-five mortality in the Middle East/north African region, 1980-1994.

A Dispersion Index for the measurement of geographical inequality in the distribution of health status indicators across space and time is proposed. The Dispersion Index is computed independently of the mean and is robust to changes in distributional shape over time. Therefore, the Dispersion Index is shown to possess more desirable statistical properties as compared to the coefficient of variation for assessing trends in the geographical distribution of health status indicators. Application of the Dispersion Index to the 1994 under-five mortality data from the Middle East/North African region shows that regional inequality in the distribution of under-five mortality was reduced by 47% as compared to 1980. Curve-fitting illustrated that the trend in the Dispersion Index values was non-monotonic from 1980 through 1994. We suggest that apart from the World Summit for Children's under-five mortality target for the year 2000, intraregional targets to reduce geographical inequalities in under-five mortality should be specified. We also suggest that changes in the magnitude of the Dispersion Index be used for the assessment of progress made by a region or nation in achieving the specified numerical targets. From a policy perspective, the Dispersion Index has the potential to be useful in the evaluation of specific health strategies designed to reduce intraregional geographical inequality in the distribution of health status indicators within a specified period.

Africa, Northern↗
PubMed1996

Physical fitness and its relationship to other indices of health status in children with chronic arthritis.

OBJECTIVE: To compare aerobic and anaerobic fitness of a group of children w-th chronic arthritis with that of healthy controls, and to explore the relationship between physical fitness and other indices of health status in these children. METHODS: Thirty-one children aged 8 to 17 years with chronic arthritis of varying type and severity and 16 physically healthy controls participated in the study. Using a cycle ergometer, aerobic fitness was assessed by measuring peak oxygen uptake achieved in a 15 s period during exercise to volitional fatigue. Anaerobic fitness was assessed by measuring peak power in the legs in a 5 s period and total work completed (Wingate test). Joint pain experienced over the week before testing and during testing was measured using a 10 cm visual analog scale. Self-esteem was measured using the Self Perception Profile for Children Questionnaire. RESULTS: There were no significant differences between mean peak O2 uptake or mean peak anaerobic power for patients and controls; however, the mean values for both controls and patients were significantly lower than reported values for healthy children. Peak O2 uptake controlled for age, sex, and sum of skinfolds was negatively associated with disease severity, measured by physician global assessment (p = 0.04), but peak power was not. Neither aerobic nor anaerobic fitness were associated with disease activity measured by physician global assessment or active joint count, or with disease duration. There was a tendency for children with active arthritis to experience less pain during fitness testing than over the previous week (p = 0.06). Testing did not seem to exacerbate joint symptoms. Self-ratings of athletic competence were significantly correlated with peak O2 uptake achieved for children with arthritis (r = 0.43, p = 0.02), but not for controls. Global self-esteem was moderately correlated with self-rated athletic competence in controls (r = 0.49, p = 0.09), but was not in children with arthritis. CONCLUSION: In this sample of children, most of whom had limited joint involvement, we failed to demonstrate significant group differences in fitness between patients and controls. Disease severity may be related to fitness levels, but psychosocial factors may perhaps be more important determinants of fitness. Children with arthritis seem to have realistic perceptions of their own physical capabilities, and even those children who are less fit and perceive themselves as having less athletic competence do not appear to have lowered self-esteem.

Adolescent↗
PubMed1997

Health status and risk factors of seminomadic pastoralists in Mongolia: a geographical approach.

The particular lifestyle of nomadic or seminomadic people has much to do with their health status. This discussion of the conceptual basis and some preliminary results of the 1992-94 health status and risk factor survey in Mongolia serves to highlight some of the relationships existing between the general health status and potential risk factors observed among pastoral nomads. In addition to graphic description of the data, a statistical analysis suggests significant associations between certain health status indicators and gender, location, lifestyle factors (e.g. smoking) socio-economic status, preventive health care and the physical environment. With regard to locational factors, there are strong regional differences in a wide-ranging number of health status indicators. The results of this study, obtained as they were at the threshold of Mongolia's economic and political transformation, will serve as a baseline against which to evaluate future changes in the health of Mongolians.

Adolescent↗
PubMed1978

A new planning methodology to assess the impact of the health care system on health status.

This article summarizes a new methodology recently developed by the Rand Corporation which permits health planners to assess the impact of the local health care system on the health status of the population. The methodology, in algorithm form, should assist health planners in developing objectives and actions related to the occurrence of selected health status indicators and should be amenable to health care interventions. Emphasis has been placed on developing a simplified, approximate analysis that health planners will find both feasible and effective. No detailed mathematic analyses are called for. The data required are, in most instances, readily obtainable. The algorithm is a methodology by which HSAs can investigate determinants of health status, identify breakdowns in the health care system, and specify needed improvements in the system. The goal of these algorithms is to assist HSAs to obtain valid and sufficiently detailed data that will provide a basis for monitoring breakdowns in the health care system and to improve planning decisions aimed at preventing such breakdowns. This should, in turn, affect population health status in the planning area.

Breast Neoplasms↗
PubMed1995

The diffusion of innovation in AIDS treatment: zidovudine use in two New Jersey cohorts.

OBJECTIVE: This study investigates patterns of utilization of zidovudine (ZDV) by gender, race, risk group, and other respondent characteristics following approval of this treatment. STUDY POPULATION: Longitudinal observational data were used on a demographically diverse population participating in New Jersey's Medicaid waiver program for persons with symptomatic HIV disease. DATA EXTRACTION METHODS: Claims data were merged with administrative data on demographic characteristics, risk group, and functional status. Periods of ZDV utilization were determined by analysis of pharmacy claims. DESIGN: The proportion of respondents ever using ZDV (treatment incidence) and the proportion of time on ZDV among users (treatment persistence) were analyzed for a cohort enrolling in 1987 and 1988, and for a cohort enrolling in 1989 and 1990, with follow-up of utilization through August 1992. For each cohort, bivariate analyses were used to compare incidence and persistence by patient subgroup; logistic regression was used to investigate the predictors of incidence in a multivariate model; and OLS regression was used to analyze proportion of time on ZDV among those with any ZDV use. PRINCIPAL FINDINGS: For the 1987-1988 cohort, substantial race, gender, and risk group differences in utilization were observed, even though all participants in this Medicaid population had financial coverage for ZDV treatment. Treatment incidence was significantly lower for blacks than for others in bivariate comparison (45 percent versus 63 percent had any use of ZDV) and in a logistic regression controlling for a variety of demographic and health status indicators (relative risk .46, CI .31 a variety of demographic and health status indicators (relative risk .46, CI .31 to .69). Treatment persistence differences were also substantial in the 1987-1988 cohort: among ZDV users, women, blacks, and injection drug users (IDUs) had significantly less persistence in use, and the gender and risk group differences were significantly in a multivariate model. In the 1989-1990 cohort, however, both incidence and persistence of treatment converged: no significant differences were observed across demographic groups. CONCLUSIONS: Less-advantaged subgroups lagged in access to this new therapy, suggesting the presence of nonfinancial barriers to care. However, these initial differences subsequently converged. RELEVANCE/IMPACT: Socioeconomic differences have been observed in access to newly introduced treatments for a variety of diseases, reflecting nonfinancial as well as financial barriers to care. Such differences may or may not disappear as use of therapies becomes institutionalized. Monitoring patterns of treatment initiation as well as persistence of treatment over time, using merged data from claims and administrative files, can provide important information on the diffusion of treatments and the extent to which initial disparities are or are not reduced over time.

Acquired Immunodeficiency Syndrome↗
PubMed1982

Results of nutritional status surveillance in El Salvador, 1975-77.

Nutritional status surveillance data based on the clinical diagnosis of malnutrition and on weight-for-age, as well as diarrhoeal disease data for preschool age children attending government health clinics in El Salvador are presented for a 3-year period (1975 - 77). Surveillance results indicated consistently higher rates of clinical malnutrition and weight-for-age deficit in rural children as compared with urban children, and higher malnutrition rates in children 1 - 4 years of age as compared with infants less than 1 year old. Consistent seasonal increases in malnutrition were observed that were most pronounced in older preschool children (1 - 4 years) in rural areas. Seasonal peaks in malnutrition consistently followed 1 - 2 months after the major seasonal peak in diarrhoea at the onset of the rainy season, suggesting that diarrhoea may play a role in the etiology of malnutrition. A secondary seasonal peak in diarrhoea in the cooler, dry season was most prominent in infants but was not related to increased malnutrition. These results indicate that nutritional and health status indicators formed from data collected regularly at health centres can demonstrate consistent age group, urban/rural, and seasonal differences in nutritional status that may be useful in identifying risk groups and in monitoring nutritional changes for planning and evaluation purposes.

Body Weight↗
PubMed2005

South Florida: a national microcosm of diversity and health disparities.

South Florida is a microcosm of diversity that reflects a changing national population. The purpose of this paper is to examine some common health status indicators in the four counties that comprise South Florida. The researchers look at birthweight, neonatal and infant death rates, receipt of prenatal care, major causes of death, availability of health care facilities and services, and expenditures for health. Data indicate that, of the four counties, the most affluent has the worst health indicators, and the least affluent--with the highest proportion of minority residents--has some of the best health status indicators. The researchers provide implications for practitioners and future research.

Adolescent↗
PubMed1996

Addressing the epidemiologic transition in the former Soviet Union: strategies for health system and public health reform in Russia.

OBJECTIVES: This paper reviews Russia's health crisis, financing, and organization and public health reform needs. METHODS: The structure, policy, supply of services, and health status indicators of Russia's health system are examined. RESULTS: Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic. CONCLUSIONS: The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to noninfectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended.

Health Care Reform↗
PubMed1985

1984 update on the world economic crisis and the children: a United States case study.

A previously published report by these authors on the impact in the United States of recession on children's health emphasized four points: available monitoring systems are not adequate for reporting on the health of children in a timely fashion; the monitoring of maternal and child health must emphasize data on population subgroups, i.e., minorities, the poor and those hardest hit by recession; the health of poor children is adversely affected and their numbers dramatically increased during the recession of 1981-82; and comparisons between the recession of 1974-75 and that of 1981-82 suggest that expansion of health services and social support systems during the recession of 1974-75 had a cushioning effect that protected the health of children, while the curtailment of many of these programs during the 1981-82 recession is associated with adverse health trends, especially among the most vulnerable population subgroups. Data on these issues are appreciably better now than they were nine months ago, thus further validating the points made above. As with the previous report, officially released current data are abundant for economic indicators (even for early 1984), but are sparse for health status indicators. The previous report also observed that the health status of children is influenced by interdependent and interlocking factors that include economic well-being and access to health services and social supports. A new analysis attempts to unlock those relationships and measure the impact of lost welfare benefits, implemented as a result of the Omnibus Reconciliation Act of 1981 (OBRA), and the separate impact of the serious recession of 1981-82. That analysis shows the poverty rate for children increased by 7.6 percentage points between 1981 and 1982. Approximately 60 percent of the increase is attributable to the recession and 40 percent to social policy changes effected after 1981.

Child↗
PubMedDate not supplied

[The hygienic characterization of atmospheric pollution and indices of the health status of females and children under metal processing of naturally alloyed ores].

The agglocoking blast-furnace processing of naturally alloyed ores gives rise higher volumes of dust and gas wastes which on air dispersal yield to higher concentrations of air pollution with dust, sulfur-containing substances, as well as compounds of carbon monoxide, phenol, and ammonia than that of magnetic iron ore, which yields a higher prevalence of comparable forms or reproductive disorders in women and higher general morbidity in children.

Adult↗
PubMedDate not supplied

Discordance between LMP-based and clinically estimated gestational age: implications for research, programs, and policy.

This study examines the comparability between the last menstrual period-based and clinically estimated gestational age as collected on certificates of live birth. It explores whether sociodemographic or delivery characteristics influence their agreement and contrasts health status and health care utilization indicators, such as preterm, small for gestational age, and adequacy of prenatal care percentages, produced by each gestational age measure. The 1989-91 South Carolina public use live birth files were used for this analysis. A total of 169,082 single births to resident mothers were selected for investigation. The clinically estimated gestational age distribution exhibited a higher mean and a tendency toward even number digit preference. The last menstrual period-based measure produced higher preterm and postterm percentages. More than 60 percent of the last menstrual period-based preterm births were classified as preterm by the clinical estimate. The sensitivity of the clinical estimate was 27 percent for postterm births. The overall concordance (the percentage of cases with the same value for both measures) was 47 percent, but it varied considerably by gestational age. Between 30 and 35 weeks, the clinical estimate exceeded the last menstrual period-based value by 2 weeks or more for more than 40 percent of the cases. Concordance also varied by race of mother, hospital delivery size, trimester prenatal care began, and birth weight. The last menstrual period-based and the clinically estimated gestational age distributions exhibited notable dissimilarities, produced marked differences in health status indicators, and varied in concordance by gestational age and by sociodemographic, prenatal care, and hospital characteristics. These systematic differences suggest that a transition from the traditionally used last menstrual period-based measure to the clinical estimate or a composite measure will not produce uniform results across geo-political areas and at-risk groups but will be appreciably influenced by population and health care characteristics.

Birth Certificates↗
PubMed1987

Health status estimation on the basis of MIMIC-health care models.

In this paper we propose a new method for deriving health indexes from MIMIC-health care models. This method differs from the traditional approach in that the health indexes are not based on the causes of health but on transformations of the health indicators. These transformations are employed mainly to correct for the effects of variables which do influence the health indicators but not health status, H*, itself, like availability of medical specialists. The method is applied to a MIMIC-health care model, which is estimated on a Dutch database. The estimated parameters of this model and the derived health indexes may be used in future research to collect only those health indicators and related variables which appear to contain relevant information on H*.

Analysis of Variance↗
PubMed1991

Formaldehyde exposure and health status in households.

This report describes a case study concerned with acute and subacute health effects of formaldehyde in the indoor air, which is based on a large group of control houses and houses retroinsulated 4 to 5 years earlier with urea formaldehyde foam insulation (UFFI). Both groups underwent an environmental and health assessment on two occasions separated by an interval of 12 months, during which about one-half of the UFFI group performed remedial work on their houses. The results show that in the first survey of the study population, before remedial work, there was a moderate excess of many adverse health status indicators among the UFFI subset relative to the controls. This was associated with the presence of direct exposure-response relationships between formaldehyde levels in the UFFI houses and the prevalence of a number of symptoms. No comparable relationships were seen among the controls. At the second survey, performed following the removal of the UFFI, there was an appreciable reduction in the excess of most adverse health status indicators among the UFFI subjects. This improvement in health status among the UFFI removal subset was not associated with any significant diminution of formaldehyde exposures, although the previously observed exposure-response relationships had vanished. These observations imply that the findings obtained in the preremedial stage of the study cannot be explained by formaldehyde exposure alone.

Adult↗
PubMed2003

Deriving summary indices of health status from the Amyotrophic Lateral Sclerosis Assessment Questionnaires (ALSAQ-40 and ALSAQ-5).

OBJECTIVES: To use statistical procedures, operationalising what is known as item response theory (IRT), to assess the unidimensionality of the 40 item Amyotrophic Lateral Sclerosis Assessment Questionnaire, and consequently to develop a single index figure from the measure. A secondary objective is to compare scores gained on the ALSAQ-40 with a five item short form (the ALSAQ-5). METHODS: Postal survey of patients diagnosed with motor neurone disease (MND) on the MND Associations database. Copies of the ALSAQ-40 and, nested within it, the ALSAQ-5 were completed on two occasions. At time one, the survey contained the ALSAQ-40 and demographic questions. In addition, patients were asked to indicate if they were willing to take part in the follow up. Those who agreed to do so were sent another copy of the questionnaire after a period of three months. Respondents were also asked to indicate how much change they had experienced since baseline on each of the five domains of the questionnaire. Rasch analysis, a form of IRT methodology, was used to determine if the 40 items in the ALSAQ-40 tapped an underlying "latent trait", and were consequently measuring a unidimensional construct. The results from the ALSAQ-40 single index were then compared with those gained from the ALSAQ-5. RESULTS: Analyses indicated that, at both baseline and follow up, all items on the ALSAQ-40 fitted the Rasch model. Consequently the 40 items were summed to create a single index. Results on this instrument were compared with those gained by summing the five items of the ALSAQ-5. Results on the instruments were found to be highly correlated. CONCLUSIONS: Evidence from the analyses suggests that 40 item ALSAQ does contain a unidimensional scale, and can, therefore be summed to create a single index. Furthermore the ALSAQ-5 closely replicates the results of the patient measure.

Activities of Daily Living↗