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PubMed1976

Comparative analysis of community health planning: transition from CHPs to HSAs.

With the implementation of the National Health Planning and Resources Development Act, comprehensive health planning is moving into a new phase. In search of lessons to guide future planning efforts on the part of the Health Systems Agencies (HSAs) established by the act, this paper reviews organizational and operational characteristics of ten relatively "successful" local comprehensive health planning agencies. Several problems are delineated that HSAs will likely share with their predecessors and strategies for confronting these problems are suggested.

Community Participation↗
PubMed2004

Women's experiences of cervical cellular changes: an unintentional transition from health to liminality?

Cervical cancer screening is a preventive intervention directed towards women to both detect cervical cancer and identify those at risk for developing this disease. It has been argued that participation in screening programmes and early detection situations may lead to new kinds of sickness experiences. This article is based on qualitative phenomenological hermeneutical analysis of interviews with women who have received abnormal Pap smear test results through a population-based outreach screening programme in urban Sweden. The aim of this article is to illuminate the meaning, for the participating women, of the lived experience of receiving notification about an abnormal Pap smear result. The data are presented in terms of two themes: Pap smear for routine and recurrent confirmation of health and unexpected and ambiguous communication about Pap smear results. The findings are discussed as an unintentional transition from confirmation of health to liminality. Whereas medical diagnosis has been discussed as structuring the inchoate, an abnormal Pap smear did not create order for the interviewed women. On the contrary, the notification of an abnormal Pap smear created disorder as the women had expected to be confirmed as healthy but instead neither health nor disease were confirmed or excluded. Even 'simple' technology is shown to have an ontological dimension, with the ability to transform daily taken-for-grantedness of ourselves as primarily healthy to (potentially) unhealthy.

Cervix Uteri↗
PubMed1985

Families, transitions, and health: another look.

This paper critically reviews the Caroff-Mailick classification of families seen around health care crises, and of reciprocal roles suggested for health social workers depending on severity and trajectory of illness and on family's functioning levels. As balance, transitional crisis theory, holistic health concepts, and team approaches to the mobilized family as the unit of caregiver attention are discussed. Newer alternative family styles are reviewed which challenge middle class caregiver mores and practices. Family forces which may prejudice worker assessment are reviewed, and the need to mitigate unhealthy and constricting environmental conditions is stressed.

Adaptation, Psychological↗
PubMed1997

Health-related quality of life after elective surgery: measurement of longitudinal changes.

OBJECTIVE: To examine the responsiveness of the 36-Item Short Form Health Survey (SF-36) to clinical changes in three surgical groups and to study how health-related quality of life (HRQL) changes with time among patients who undergo total hip arthroplasty, thoracic surgery for treatment of non-small-cell lung cancer, or abdominal aortic aneurysm (AAA) repair. DESIGN: Prospective cohort study with serial evaluations of HRQL preoperatively and at 1, 6, and 12 months after surgery. SETTING: University tertiary care hospital. PATIENTS: Of 528 patients, more than 50 years of age, who were admitted for these elective procedures, 454 (86%) provided preoperative health status data and are members of the study cohort. At 12 months after surgery, 439 (93%) of the cohort was successfully contacted and 390 (90%) provided follow-up interviews. MEASUREMENTS AND MAIN RESULTS: The Medical Outcomes Study SF-36, the Specific Activity Scale, five validated health transition questions, and a 0 to 100 scale measure of global health were used to assess changes in health status at 1, 6, and 12 months after surgery. Change in health status as measured by the SF-36 demonstrated that physical function and role limitations due to physical health problems were worse 1 month after these three surgeries. However, by 6 months after surgery, most patients experienced significant gains in the majority of the dimensions of health, and these gains were sustained at 12 months after surgery. Longitudinal changes in the SF-36 were positively associated with responses to the five health transition questions, to changes on the Specific Activity Scale and global health rating question, and to clinical parameters for persons who had AAA repair. These findings indicate that the SF-36 has evidence of validity and is responsive to expected changes in HRQL after elective surgery for these procedures. CONCLUSIONS: For the total hip arthroplasty patients, responsiveness was greatest for the SF-36 scales that measure physical constructs. However, for the two other procedures and at various points of recovery, significant changes were observed for all eight subscales, suggesting that responsiveness was dependent on the type of surgery and the timing of follow-up, and that multidimensional measures are needed to fully capture changes in HRQL after surgery.

Aged↗
PubMed2002

Generic measures of health-related quality of life in ankylosing spondylitis: reliability, validity and responsiveness.

OBJECTIVE: To assess the acceptability and measurement properties of two generic measures of health-related quality of life (HRQL): the EuroQol and the Short Form 12-item Health Survey Questionnaire (SF-12) in ankylosing spondylitis (AS). METHODS: Instruments were administered by means of a self-completed questionnaire to AS patients recruited from across the United Kingdom. Instruments were assessed for data quality and scaling assumptions. Test-retest reliability was assessed in those patients reporting no change in general health at 2 weeks. The convergent validity of both instruments was assessed and scores were correlated with responses to health transition questions. Responsiveness was assessed for patients reporting change in health at 6 months. RESULTS: The instruments had high completion rates. Although slightly skewed towards better levels of health, scores covered the available range for both sections of the EuroQol [EQ-5D and EQ-visual analogue scale (EQ-VAS)]. Score distributions approximated normality for the SF-12. Test-retest reliability estimates support the use of both instruments in group evaluation and the SF-12 Physical Component Summary score (PCS) in individual evaluation (>0.90). Correlations between instruments were in the hypothesized direction and were of a moderate level. The EQ-VAS had the strongest linear relationship, with responses to both specific and general health transition questions (P<0.01). The EQ-VAS and SF-12 PCS were the most responsive instruments. The EQ-5D was the least responsive instrument. CONCLUSION: The instruments have undergone a comprehensive comparative evaluation to assess the measurement properties required for patient-assessed measures of health outcome in AS. Adequate levels of acceptability, reliability and validity were found for both instruments. Although evidence supporting instrument responsiveness was strong for the EQ-VAS and SF-12 PCS, it was very weak for the EQ-5D and SF-12 Mental Component Summary Scale (MCS). The EQ-VAS and SF-12 PCS can both be recommended for use in group evaluation, and the SF-12 PCS is recommended in routine practice or research. However, the lower reliability of the SF-12 MCS and the limited ability of both the EQ-5D and SF-12 MCS to detect change in health may restrict these roles.

Adolescent↗
PubMed2004

Spinal mobility in ankylosing spondylitis: reliability, validity and responsiveness.

OBJECTIVE: To evaluate the measurement properties of an evidence-based selection of measures of spinal mobility in patients with ankylosing spondylitis (AS). METHODS: Measurements of spinal mobility were taken by trained observers within a UK rheumatology centre. Inter-observer reliability was assessed. Intra-observer reliability was assessed in patients reporting no change in AS-specific health at 2 weeks. Validity was assessed and scores were correlated with responses to health transition questions. Responsiveness was evaluated for patients reporting change in health at 6 months. RESULTS: Reliability estimates support the use of all measures in individual evaluation (intraclass correlation>0.90). Correlations between measures of spinal mobility were in the hypothesized direction; the largest was between the modified Schober index (15 cm) (MSI) and the other measures. As hypothesized, small to moderate levels of correlation were found between mobility measures and patient-assessed health status. There was no significant linear relationship between mobility measures and self-reported health transition. Fingertip-to-floor distance following trunk forward flexion (FFD) was the most responsive mobility measure but was not as responsive as two AS-specific patient-assessed instruments, the Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The MSI and cervical rotation (Crot) also had evidence of responsiveness. Low levels of responsiveness were found for the remaining measures. CONCLUSION: All mobility measures had adequate levels of reliability and validity. The MSI had a strong relationship with all mobility measures, and the FFD and Crot were the most responsive to self-perceived changes in health at 6 months. The MSI, FFD and Crot are recommended for clinical practice and research.

Adult↗
PubMed2004

Healthy aging at older ages: are income and education important?

Being higher on the socio-economic scale is correlated with being in better health, but is there is a causal relationship? Using 3 years of longitudinal data for individuals aged 50 and older from the Canadian Survey of Labour and Income Dynamics, we study the health transitions for those who were in good health in the first year, focusing especially on income and education. The initial good health restriction removes from the sample those whose incomes may have been affected by a previous history of poor health, thus avoiding a well-known problem of econometric endogeneity. We then ask, for those in good health, whether later transitions in health status are related to socio-economic status. We find that they are-that changes in health status over the subsequent 2 years are related, in particular, to income and education.

Aged↗
PubMed2002

Cardiovascular diseases in the developing countries: dimensions, determinants, dynamics and directions for public health action.

The global burden of disease due to cardiovascular diseases (CVDs) is escalating, principally due to a sharp rise in the developing countries which are experiencing rapid health transition. Contributory causes include: demographic shifts with altered population age profiles; lifestyle changes due to recent urbanisation, delayed industrialisation and overpowering globalisation; probable effects of foetal undernutrition on adult susceptibility to vascular disease and possible gene-environment interactions influencing ethnic diversity. Altered diets and diminished physical activity are critical factors contributing to the acceleration of CVD epidemics, along with tobacco use. The pace of health transition, however, varies across developing regions with consequent variations in the relative burdens of the dominant CVDs. A comprehensive public health response must integrate policies and programmes that effectively impact on the multiple determinants of these diseases and provide protection over the life span through primordial, primary and secondary prevention. Populations as well as individuals at risk must be protected through initiatives that espouse and enable nutrition-based preventive strategies to protect and promote cardiovascular health. An empowered community, an enlightened policy and an energetic coalition of health professionals must ensure that development is not accompanied by distorted nutrition and disordered health.

Age Distribution↗
PubMed2002

Influencing public nutrition for non-communicable disease prevention: from community intervention to national programme--experiences from Finland.

A global health transition is currently underway. The burden of non-communicable diseases (NCDs) is increasing rapidly in the developing world, very much as a result of changes in lifestyles. In addition to changes in tobacco use and physical activity, major changes are taking place in diets, contributing greatly to the growing epidemic of NCD. Thus, a huge global public health challenge is how to influence the trends in diet and nutrition for effective global NCD prevention. The health transition took place rapidly in Finland after World War II and mortality from cardiovascular disease (CVD) was exceptionally high. The North Karelia Project was launched in 1972 as a community-based, and later as a national, programme to influence diet and other lifestyles that are crucial in the prevention of CVD. The intervention had a strong theory base and it employed comprehensive strategies. Broad community organisation and the strong participation of people were the key elements. Evaluation has shown how the diet (particularly fat consumption) has changed and how these changes have led to a major reduction in population serum cholesterol and blood pressure levels. It has also shown how ischaemic heart disease mortality in a working-age population has declined by 73% in North Karelia and by 65% in the whole country from 1971 to 1995. Although Finland is an industrialised country, North Karelia was rural, of rather low socio-economic level and with many social problems in the 1970s and 1980s. The project was based on low-cost intervention activities, where people's participation and community organisations played a key role. Comprehensive interventions in the community were eventually supported by national activities--from expert guidelines and media activities to industry collaboration and policy. Similar principles for nutrition intervention programmes could be used in developing countries, obviously tailored to the local conditions. This paper discusses the experiences of the North Karelia Project in the light of needs from the less-industrialised countries and makes some general recommendations.

Cardiovascular Diseases↗
PubMed2007

Successful reentry: the perspective of private correctional health care providers.

Due to public health and safety concerns, discharge planning is increasingly prioritized by correctional systems when preparing prisoners for their reintegration into the community. Annually, private correctional health care vendors provide $3 billion of health care services to inmates in correctional facilities throughout the U.S., but rarely are contracted to provide transitional health care. A discussion with 12 people representing five private nationwide correctional health care providers highlighted the barriers they face when implementing transitional health care and what templates of services health care companies could provide to state and counties to enhance the reentry process.

Continuity of Patient Care↗
PubMedDate not supplied

Buddy programs for people infected with HIV.

The purposes of this correlational study were to describe and compare clients' and volunteers' perceptions of a buddy program for people infected with HIV and to identify relationships between social support and clients' quality of life. Clients' social support was assessed with the Interpersonal Support Evaluation List(ISEL), and their quality of life was assessed with the Medical Outcomes Study-HIV (MOS-HIV) Scale. Clients' and volunteers' perceptions of satisfaction and assistance with activities were assessed with researcher-developed instruments. A convenience sample of 46 client-volunteer dyads was recruited from five AIDS service organizations. Clients perceived adequate levels of social support, moderate amounts of assistance, high levels of satisfaction with client-volunteer relationships, and moderate to low quality of life. A positive relationship was found between clients' and volunteers' perceptions of satisfaction. Relationships were found between ISEL subscales and the Health Transition and Mental Health subscales of the MOS-HIV and the MOS-HIV total scale scores. The findings of the study provide support for the continuation of buddy programs.

Adult↗