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The health status of the Singaporean population as measured by a multi-attribute health status system.

BACKGROUND: This paper presents an assessment of the health status of the Singaporean population by the Health Utilities Index (HUI) Mark 3 system. The HUI approach is a generic health status measure that uses a Multi-Attribute Health Status Classification (MAHSC) system. The assessment describes the health status of the population on eight aspects or dimensions of health: seeing, hearing, speaking, walking, use of hands and fingers, feelings, memory and thinking, and pain. DISCUSSION: Differences in health status among different socio-economic and demographic groups are discussed. CONCLUSION: The results of the study may help to better understand population health and health care needs and to plan health care services.

Adult↗

Constructing social metrics for health status indexes.

Health status indexes used to make collective decisions satisfying the principles of equality and social minimum must incorporate a social metric for health. Any index or indicator applied to populations for determining health status or to health programs for evaluating outcome must confront the question of who prefers which states of health under which circumstances? Utility models, psychometric scaling, and empirical social decision valuation have been used to measure preferences for states of health. Efforts should be directed toward constructing social metrics for health that are prospective, context-independent, relevant, community-wide, ratio scalled, sensitive, empirically validated, and applicable to program evaluation. These efforts represent the application of normative social theory to research, an important advance in uncovering the mysteries of social action and its consequences.

Attitude to Health↗

Oral health status and oral health behaviour of 12-year-old urban schoolchildren in the People's Republic of China.

OBJECTIVE: To describe oral health status of urban Chinese children aged 12 years, to evaluate the pattern of oral health behaviour, and to assess the relative effect of socio-behavioural risk factors on dental caries experience. DESIGN: A cross-sectional survey of 12-year-old children was conducted in the Hubei Province of China, including urban and periurban groups. The sampling was in accordance with the WHO procedures as applied in the second national survey of oral health. Data were collected by clinical examinations and use of self-administered questionnaires. SETTING: The survey was initiated by the National Committee of Oral Health, China, in order to aid the planning and evaluation of school-based oral health care. SUBJECTS: A sample of 698 children aged 12 years (96 per cent of original sample) participated in the survey; the sample was balanced by gender and urbanisation (urban/periurban). OUTCOME MEASURES: The children were clinically examined according to the WHO basic methods and responded to standardised questionnaires on oral health behaviour, knowledge, and attitudes. RESULTS: The mean DMFT of the children was 0.77 and DT constituted most of the caries index. About 65 per cent of the children had CPITN maximum score 2 (gingival bleeding and calculus). Only 40 per cent brushed their teeth at least twice a day and 46 per cent had seen a dentist within the past year. Variations by urbanisation were observed and the multiple linear regression of dental caries experience revealed that consumption of surgary foods, location and dental visits were the most important independent variables. CONCLUSION: This study has shown that systematic oral health promotion programmes for children in China are urgently needed.

Attitude to Health↗

Chronic venous disease: health status of a population and care impact on this health status through quality of life questionnaires.

AIM: There is growing interest for patient-reported outcomes (PROs) in clinical research. Application of quality of life (QoL) questionnaires to patients suffering from chronic venous disease (CVD) is thought to be an important improvement in the assessment of results in these complex disorders. The aims of the study were to describe the health status of female patients suffering from CVD, and to assess the care impact through QoL questionnaires. METHODS: Symptomatic female patients suffering from CVD (all CEAP clinical classes), aged over 18, newly treated by their general practitioner with a phlebotropic drug were enrolled in the study. Every patient had to complete a self-questionnaire including the SF-12, the CES-D, the Epworth and the CIVIQ scales at day 0 (D0), day 3 (D3) and day 7 (D7). The CIVIQ scale assesses pain and the psychological, physical and social consequences of CVD. The SF-12 is a generic measure of health status. The CES-D scale studies presence of depressive symptoms (DS) in the general population. The Epworth scale measures daytime sleepiness. RESULTS: A total of 765 physicians took part in the survey from April to August 2003. The results of the study concern 1 045 patients. Analyses are realized on the 399 patients who filled out all 3 questionnaires. Mean age was 45 years (SD=11), patients average height was 164.39 cm (SD=5.99) for an average weight of 65.2 kg (SD=12.5). Concerning change in QoL between inclusion and Day 7, the mean CIVIQ total scores at inclusion were 26.7 in the CEAP class 0-2 group and 36.3 in the CEAP class 3-6 group. The mean CIVIQ total scores at D7 were 18.5 in the CEAP class 0-2 group and 27.3 in the CEAP class 3-6 group. The mean CIVIQ total scores demonstrated that QoL is more impaired for patients in the CEAP class 3-6 group. In both groups, an improvement in patients' QoL was observed following patient management (P<0.001). At inclusion time, MCS-12 and PCS-12 were respectively 44.7 (SD=10.6) and 46.4 (SD=8.4): at day 3 and day 7, these dimensions were respectively: D3: 46.5 (SD=10.2) and 46.2 (SD=8) D7: 48 (SD=10.3) and 46.2 (SD=7.8). For the mental dimension, the difference was statistically significant (P=0.0001). In our study a possible DS (score ?17) was reported for 36.3%, 32.3% and 29% respectively at day 0, D3 and D7 (P<0.01, n=328). Concerning daytime sleepiness the Epworth mean total score showed a decrease in daytime sleepiness for patients with severe CVD (C3-C6) between day 0 and D 7 (P=0.02). CONCLUSIONS: Our study demonstrates the high impact of CVD on health status and the validity of QoL questionnaires in this pathology. They show a significant improvement of the QoL after one week of medical management.

Bone Density↗

Critical thinking, perceived health status, and participation in health behaviors.

BACKGROUND: Critical thinking has been proposed as crucial for processing conflicting information when people make decisions about participation in health behaviors. The critical thinking of individuals about participation in health behaviors may depend on their perceived health status. OBJECTIVES: To examine the relations between critical thinking and participation in three categories of health behaviors, and to determine whether these relations are moderated by perceived health status. METHODS: A cross-sectional, correlational design was used to study a sample of 112 community-dwelling adults who resided in a large, urban Midwest community. The participants were women and men 18 to 90 years of age (mean, 55 +/- 20.47 years) who completed self-report, written questionnaires including the Test of Everyday Reasoning and the Health Practices Instrument. RESULTS: According to hierarchical multiple regression analyses, the relation between critical thinking and health promotion behaviors and the relation between critical thinking and secondary prevention behaviors were moderated by perceived health status, whereas the relation between critical thinking and health protection behaviors was not. CONCLUSIONS: The relation between critical thinking and participation in health behaviors depends on perceived health status and category of health behaviors. Researchers can explore the role of other variables (e.g., functional status and perceived susceptibility to disease) to explain why perceived health status moderates the relations between critical thinking and participation in various types of health behaviors differently.

Activities of Daily Living↗

An empirical comparison of four generic health status measures. The Nottingham Health Profile, the Medical Outcomes Study 36-item Short-Form Health Survey, the COOP/WONCA charts, and the EuroQol instrument.

OBJECTIVES: An empirical, head-to-head comparison of the performance characteristics of four generic health status measures. METHODS: The Nottingham Health Profile, the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), the COOP/WONCA charts, and the EuroQol instrument were simultaneously employed in a controlled survey measuring the impact of migraine on health status. The feasibility (number of missing cases per item), internal consistency (Cronbach's alpha), construct validity (correlation patterns and common factor analysis), and discriminative ability (Receiver Operating Characteristics analyses) of the four measures were investigated. RESULTS: The Nottingham Health Profile produced the lowest missing value rate. The internal consistency of the Nottingham Health Profile scales was lower than the scales of the SF-36. Combined factor analyses with data of the four instruments together resulted in two-factor solutions with a physical and a mental factor, explaining approximately 50% of variance. The SF-36 exhibited the best ability to discriminate between groups. Test-retest reliability and sensitivity to change over time could not be tested because of the cross-sectional character of the study. CONCLUSIONS: None of the instruments performed uniformly as "best" or "worst." Purely on the basis of the results of the psychometric analyses, the SF-36 appeared to be the most suitable measure of health status in this relatively healthy population. In general, the choice of the most suitable instrument for generic health status assessment in a particular study should be guided by the special features of each candidate instrument under consideration.

Adult↗

Consensus set of health status indicators for the general assessment of community health status--United States.

Healthy People 2000 establishes a framework for the development of an explicit prevention program for the nation (1); the Year 2000 Health Objectives Planning Act* provides legislative support for such a program. To address both the requirements of that act and Objective 22.1 of Healthy People 2000, a consensus set of 18 health status indicators has been developed to assist communities in assessing their general health status and in focusing local, state, and national efforts in tracking the year 2000 objectives. Priority in selecting the indicators was given to measures for which data are readily available and that are commonly used in public health.

Aged↗

Applications of health status assessment measures in clinical practice. Overview of the third conference on advances in health status assessment.

To what purposes can the measurement of health status and health-related quality of life in clinical practice be put? What success might be expected from such endeavors? What obstacles lie in the way of that success? This monograph reports on the proceedings of a conference (the third in a series on advances in health status assessment) convened to address those questions. It presents two papers concerned with barriers to and benefits of health status and quality-of-life measurement in clinical practice and another two on strategies for overcoming those barriers and exploiting the benefits; also included are papers on historical forces motivating the use of these measures, one special address on ethical issues, eight presentations on empirical research in clinical settings, several panel discussions, and four methods roundtables. A broad conclusion to be drawn from the conference proceedings is that good methods and tools for health status assessment are here and are being used in many ways, but mostly for purposes other than routine patient care. Enthusiasm for fostering the diffusion of assessment instruments into practice settings is real, but so are the doubts, particularly for clinicians "in the trenches" of everyday practice, that widespread understanding and use can be achieved easily or quickly. The challenge for the field is to be aware of and sensitive to the uncertainties and misgivings of those in clinical practice, to address those apprehensions through both formal research and practical tests, and to maintain the momentum of communication and collaboration carried forward by this third conference.

Activities of Daily Living↗

Epidemiologic indicators of health status to guide health care management decision making.

Health objectives, developed by the United States Department of Health and Human Services, were published recently in the document entitled Healthy People 2000: National Health Promotion and Disease Prevention Objectives. They were developed to guide national and local health policy toward actions to increase the health of the nation. To effectively apply these objectives locally, epidemiologists and health planners must work together. Through collaboration, the Healthy People 2000 objectives can be prioritized to guide health policy and planning on a regional basis. The purpose of this study was to assess certain health status indicators in southwestern Pennsylvania to determine whether it was likely that the year 2000 targets would be met if trends from the past 20 years were to continue. The following mortality rates were analyzed: heart disease, homicide, breast cancer, colon cancer, lung cancer, suicide, motor vehicle accidents, work-related injury, and infant mortality. In addition, incidence of the following diseases was evaluated against the year 2000 targets: gonorrhea, primary and secondary syphilis, measles, tuberculosis, and AIDS. By employing epidemiological principles and considering strategic planning needs, it is possible to prioritize some of the health care needs in local areas for the next decade.

Data Collection↗

General subjective health status or age-related subjective health status: does it make a difference?

This study examines the agreement between two subjective health measures, a general question on subjective health and an age-related question on subjective health. The study identifies specific groups differing in their answer to the two questions. These measures are used frequently in health-related studies where a short measure is needed to estimate health. Therefore, it is important to understand how the population estimates its health. The study based on 793 telephone interviews shows that among respondents aged 65-75 with no reported diseases and those with less than 12 years of education with no reported diseases, the agreement between the two questions was poor. These two groups reported better health when they were asked to compare their health to people of their age and sex. Excellent agreement between the two questions was reported in those aged 55-64 with no diseases. The respondents having more years of education reported better health than the less educated but only when using the age-related subjective health measure. These findings demand caution when using different wordings in questions on subjective health in non-homogeneous populations.

Age Factors↗

Illness aetiology constructs, health status and use of health services among Cambodians in New Zealand.

OBJECTIVE: The objectives of this study were to determine, among all adult Cambodians living in Dunedin: prevalence of illness aetiology beliefs; psychiatric and physical health status; pattern of use of health services; relationships between use of health services and demographic factors, illness aetiology constructs and health status; and problems encountered and improvements desired in the local health services. METHOD: 223 (i.e. 93.3% of all) adult Cambodians living in Dunedin were assessed, using a structured interview, in relation to their sociodemographic status, illness aetiology beliefs, physical health status and use of health services. The 28-item version of the General Health Questionnaire was used to assess psychiatric status. RESULTS: Subjects held multiple indigenous and Western illness aetiology constructs. Psychiatric morbidity using the 28item of the General Health Questionnaire (GHQ28) cutoff of 3/4 was 15.7%; despite this only six subjects had ever used specialist psychiatric services. Malaria, intestinal parasitic infestations and heart conditions were the three most frequently reported physical problems. Most subjects had used traditional services in Cambodia but very few had used them in New Zealand. Health service was related to duration of stay in New Zealand. Socio-economic status, both physical and psychiatric health status and some illness aetiology constructs. One hundred and forty-two (63.7%) subjects reported problems with use of health services in Dunedin. CONCLUSION: Despite methodological limitations, some useful preliminary data on factors pertaining to use of and satisfaction with health services among Cambodians were collected. Future research should examine family characteristics and the decision-making processes that determine service use.

Adolescent↗

Health status and satisfaction with health care: results from the medical outcomes study.

Relations between self-assessed health status and satisfaction with health care were examined using 2 waves of data obtained from participants in the Medical Outcomes Study. Using a multisample covariance modeling framework, separate models were examined for patients with significant symptoms of depression (n = 417) and patients with chronic physical health conditions (n = 535). The pattern of findings was essentially identical for both patient subgroups. General satisfaction with care was cross-sectionally associated with mental -- but not physical -- health status. In addition, significant cross-lagged effects were found linking baseline satisfaction with care to subsequent mental health and baseline mental health to subsequent satisfaction with care. By contrast, no cross-lagged directional effects linking satisfaction with care and physical health status were identified. Finally, no evidence was found that satisfaction with specific aspects of health care contributed independently to either mental or physical health.

Adult↗

Supplement use is associated with health status and health-related behaviors in the 1946 British birth cohort.

Use of dietary supplements may be one of a number of health-related behaviors that cluster together. The current study investigated the underlying diet, health-related characteristics, and behaviors of users and nonusers of dietary supplements in a longitudinal study of health. Participants (n = 1776) completed a 5-d food diary including information on dietary supplement use (vitamins, minerals, and nutraceuticals) at age 53 y. Sociodemographic information and data on smoking, alcohol, and physical activity were obtained along with anthropometric measurements, blood pressure, and a blood sample (nonfasting subjects). A significantly greater percentage of women reported supplement use compared with men (45.1 vs. 25.2%). Supplement use was associated with lower BMI, lower waist circumference, higher plasma folate and plasma vitamin B-12 concentrations, nonsmoking, participation in physical activity, and nonmanual social class in women and with plasma folate concentrations and participation in physical activity in men. Nonsupplement users tended to be nonconsumers of breakfast cereals, fruit, fruit juice, yogurt, oily fish, and olive oil and had lower dietary intakes of potassium, magnesium, phosphorus, iron, and vitamin C even after adjustment for sociodemographic and behavioral factors. Overall, supplement users tended to differ from nonsupplement users on a range of health-related behaviors and health status indicators, although there were fewer significant associations in men. Similarly, dietary supplements users tended to have underlying diets that, were healthier and those taking supplements may be the least likely to need them. These results support the notion of a clustering of healthy behaviors and cardiovascular risk factors, particularly for women.

Cohort Studies↗

Ethnicity of socioeconomic status? Health differences between elder Alaska Natives and whites.

We investigated self-reported health difference between elderly Alaska Natives and whites, and attempted to distinguish the effects of socioeconomic factors from other facets of ethnicity, upon health and physical well-being. Results indicate that elderly Alaska Natives suffer from a greater variety of impairments than do whites. Health differences disappear, however, in multivariate analyses that control for socioeconomic factors. Income, education, gender, and age appear to be more important determinants of health status among the elderly than ethnicity, per se.

Aged↗

Self-reported health status and access to health services in a community sample with Parkinson's disease.

A sample of people with Parkinson's disease (PD), identified from a 1992 Northampton Health Authority (NHA) Prevalence Study, and currently registered with a general practitioner, completed a postal survey. People with PD reported considerably worse health status than other individuals of the same age across a wide range of health-related dimensions. Health status was worse in those with longer-standing illness. The Parkinson's disease questionnaire (PDQ-39) identified particular problems associated with PD. The health status for those seen most recently by various health-related professionals was generally worse. Access to various services continues to be a problem for a substantial minority of people with PD. The health status of those reporting dissatisfaction with access to services was generally worse. More research, using feasible and relevant outcome measures, is needed to assess different interventions, and to assist in the determination of appropriate services.

Activities of Daily Living↗

Lifestyle, nutritional status, health, and mortality in elderly people across Europe: a review of the longitudinal results of the SENECA study.

This article provides an overview of the longitudinal Survey in Europe on Nutrition and the Elderly: a Concerted Action (SENECA) study, which was designed to assess differences in dietary and lifestyle factors among elderly Europeans, and to identify the factors that contribute to healthy aging. Elderly people from Belgium, Denmark, France, Italy, Portugal, Spain, Switzerland, and The Netherlands participated in the SENECA study. Standardized measurements were conducted at baseline in 1988-1989 and were repeated in 1993 and 1999. Diet, physical activity, and smoking, as well as maintenance of health and survival, were assessed. At baseline, considerable differences in lifestyle factors existed among elderly people. Mealtime patterns as well as dietary intake varied across Europe, and geographical patterns were apparent. Similar results were found for engagement in sport or professional activities. The smoking prevalence among women was generally low. Distinct geographical differences were also observed in percentages of deaths during the SENECA study and in overall survival time. A healthy lifestyle was related to stable self-perceived health, a delay in functional dependence, and mortality. Inactivity and smoking, and to a lesser extent a low-quality diet, increased mortality risk. A combined effect of multiple unhealthy lifestyle factors was also observed. The SENECA study showed that a healthy lifestyle at older ages is related to a delay in the deterioration of health status and a reduced mortality risk. Improving and maintaining a healthy lifestyle in elderly people across Europe is a great challenge for the European Community.

Activities of Daily Living↗

A Canadian Indian Health Status Index.

Health care services for registered "band" Indians in Ontario are provided primarily by the Canadian Federal Government. Complex management methods preclude the direct involvement of Indian people in the decisions for their health resource allocation. Health indicators, need, and health status indexes are reviewed. The biostatistics of mortality and demography of the Indian and reference populations are aggregated with hospitalization/morbidity experience as the Chen G'1 Index, as an indicator of normative and comparative need. This is weighted by linear measurements of perceived need for preventive medicine programs, as ranked and scaled values of priorities, Zj. These were determined by community survey on 11 Indian reserves using a non-probabilistic psychometric method of "pair comparisons," based upon "Thurstone's Law of Comparative Judgement.," The calculation of the aggregate single unit Indian Health Status Index [Log.G'1].Zj and its potential application in a "zero-base" budget is described.

Actuarial Analysis↗

[Health status and health-related quality of life. A facet in the evaluation of outcomes in orthopaedic surgery].

Traditional methods for evaluating the outcome of treatment in orthopaedic surgery include the assessment of clinical status, pain and radiography. For more than two decades, there has been an increasing interest in the use of health-status measures in clinical medicine. Outcome evaluation should not only consider clinical and radiographic parameters but also the patients' personal views on their health status and quality of life. Questionnaires developed from basic principles allow the measurement of these views objectively, as well as the comparison of data between groups. The current paper primarily addresses the orthopaedic surgeon and provides a review of quality of life and health-status measures commonly used in orthopaedic outcome studies. Generic and disease specific measures of health status can be used in orthopaedic surgery to complement an outcome assessment. Thereby, the personal view of the patient becomes an objective part of the evaluation.

Germany↗