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Self-reported health status and access to care were reported for 238 homeless adults in Los Angeles. One-third reported their health as fair or poor; women reported more health problems than men. Half (53 per cent) of the sample reported no regular source of care, and most (81 per cent) were without health insurance. Lack of financial resources and health insurance were reported as important barriers to care.
This study examined the changes in the self-reported health status of Department of Defense health care beneficiaries associated with the September 11th terrorist attacks. Responses to a single-item, general health measure from pre- and post-September 11 quarterly survey events for the calendar year 2001 were analyzed to compare the unfavorable health response rates before and after the attacks. Increases in rates of unfavorable health status following the terrorist attacks were reported by the total population and 39 of 44 subgroups examined. Statistically significant increases in unfavorable health were reported by active duty personnel and dependents of active duty personnel; beneficiaries under the age of 44 years; beneficiaries affiliated with the Army and Marines; and beneficiaries in the Mid-Atlantic, Mid-West/Central, and Pacific Rim regions. These findings suggest that stress associated with the likelihood of being deployed or having a family member deployed following the terrorist attacks significantly contributed to the increase in unfavorable health response reported on the post-September 11 survey.
Data from the Canada Health Survey were analyzed for the interrelationships of health practices and for the association of health practices with health status. Moderate alcohol use, not smoking, and seat belt use formed a cluster representing passive avoidance of direct risks; exercise and immunization made up another component, identified as active avoidance of abstract risks. These six practices clustered in the same fashion for both sexes; but for women, there was an additional factor, the avoidance of sex-specific risks. Separate health practice indices were created for men and women based on these behaviors. Index scores were shown to be significantly associated with four measures of health status. The association was particularly strong for the two indicators of emotional health for both sexes and for all four indicators for women. This study confirms the conclusions of earlier reports based on regional or highly selected samples and extends them to emotional health status; it is the first study to publish comprehensive data on this question from a sample survey representative of an entire national population.
AIM: To describe the level of oral disease in urban and rural schoolchildren in Southern Thailand; to analyse self-care practices and dental visiting habits of 12-year-olds, and to assess the effect of socio-behavioural factors on dental caries experience. DESIGN: A cross sectional study of 6- and 12-year-old children, urban and rural schools chosen at random from 19 districts of one province. SETTING: Suratthani Province, Southern Thailand. PARTICIPANTS: A total of 1,156 children of grade 1 (6 yrs) and 1,116 children of grade 6 (12yrs). METHODS: Clinical recordings of dental caries and periodontal CPI scores 0, 1 or 2 according to WHO; structured interviews of 12-year-olds (n=1,084) concerning oral health behaviour and attitudes. RESULTS: At age 6, 96.3% of children had caries and mean dmft was 8.1. In 12-year-olds, 70% had caries in permanent teeth and the level of DMFT was 2.4. Experience of pain during the previous 12 months was reported by 53% of 12-year-olds, 66% saw a dentist within the previous year and 24% reported that visits were due to troubles in teeth. Toothbrushing at least once a day was claimed by 88%. Significant numbers of the children reported having hidden sugar every day: soft drinks (24%), milk with sugar (34%), and tea with sugar (26%). Important predictors of high caries experience were dental visits, consumption of sweets, ethnic group (Muslim) and sex (girls) whereas lower risk was observed in children with positive oral health attitudes. CONCLUSIONS: Systematic health education may further improve the oral health of Thai children and the primary school provides a unique setting for such programmes.
This study was conducted to determine whether the size of an enterprise can make a difference to workers' health and to examine those factors, which influence workers' health. The subjects of this study included 26,324 workers employed in manufacturing industry who received medical examinations at the Industrial Health Center at Yonsei University in 1995, 1996 and 1997. Medical examination data were used as a measure of health. Each enterprise was classified by size into three categories: Small scale enterprises (SSE) that employ no more than 50 regular employees; middle scale enterprise (MSE) that employ from 50 to 300 regular employees; and large scale enterprise (LSE) that employ more than 300 regular employees. Health conditions, according to the size of the enterprise, were determined by comparing prevalence rates, and direct standardization methods were used based upon the Korean population, as a standard population, in order to adjust for differences in population structure. 1. The findings of the medical examinations showed that, the prevalence rate in SSEs was higher than in MSEs or LSEs, but that this relationship was reversed after standardizing for sex and age. 2. Logistic regression analysis showed that, although subjects of advanced age, prolonged work history, and male gender had higher risks of disease, the size of the enterprise had no significant effect upon these risks.
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The objective of this study was to identify factors associated with obesity and to examine the health habits of the obese and non-obese. In this study of over 44,000 insured individuals, obesity rates increased with age until age 65 and were highest among members of Samoan ancestry. Because the causes of obesity are multi-faceted, treatment approaches may need to address diet, exercise, pharmacotherapy and management of comorbid conditions.
OBJECTIVES: This paper describes the relationship between self-reported general health status and several facets of reproductive history. METHODS: We analyzed survey data on a national probability sample of 1341 women aged 50 and older from the Panel Study of Income Dynamics. We used multivariate regression techniques to control for differences in health indices that assessed health status and functioning. RESULTS: Women with a history of six or more completed pregnancies were found to be disadvantaged in educational attainment, financial resources, and health status compared with women with no or fewer pregnancies. When current sociodemographic factors were controlled, six or more pregnancies were associated with worse general health and worse physical role functioning. When sociodemographic factors and number of births were controlled, among women with at least one delivery, women who had experienced an infant's death reported worse health as measured by all three indices. Women with a first delivery before the age of 18 were more likely to report a functional limitation. CONCLUSIONS: Women with high parity status, a history of an infant's death, and an early first pregnancy may be at greater risk of poor health in later life.
This paper examines the impact of health status on the duration of unemployment spells and finds that individuals with impaired health will have significantly longer unemployment spells. These longer unemployment spells will result in the stock of unemployed being composed of a larger proportion of individuals with impaired health than the stock of employed. Although, this difference in composition between the stock of unemployed and stock of employed can account for some of the observed difference in mortality rates, it cannot explain all of the difference observed in earlier studies.
STUDY DESIGN: Cohort study. OBJECTIVES: To estimate the Minimal Clinically Important Change (MCIC) of the pain intensity numerical rating scale (PI-NRS), the Quebec Back Pain Disability Scale (QBPDS), and the Euroqol (EQ) in patients with low back pain. SUMMARY OF BACKGROUND DATA: MCIC can provide valuable information for researchers, healthcare providers, and policymakers. METHODS: Data from a randomized controlled trial with 442 patients with low back pain were used. The MCIC was estimated over a 12-week period, and three different methods were used: 1) mean change scores, 2) minimal detectable change, and 3) optimal cutoff point in receiver operant curves. The global perceived effect scale (GPE) was used as an external criterion. The effect of initial scores on the MCIC was also assessed. RESULTS: The MCIC of the PI-NRS ranged from 3.5 to 4.7 points in (sub)acute patients and 2.5 to 4.5 points in chronic patients with low back pain. The MCIC of the QBPDS was estimated between 17.5 to 32.9 points and 8.5 to 24.6 points for (sub)acute and chronic patients with low back pain. The MCIC for the EQ ranged from 0.07 to 0.58 in (sub)acute patients and 0.09 to 0.28 in patients with chronic low back pain. CONCLUSION: Reporting the percentage of patients who have made a MCIC adds to the interpretability of study results. We present a range of MCIC values and advocate the choice of a single MCIC value according to the specific context.
The objective of this research was to describe health conditions and health services utilization among Brazilian seniors. The study was based on 28,943 adults > 60 years (99.9%) from an overall National Household Survey (PNAD 1998). The results show that prevalence rates for at least one chronic disease (69.0%), hypertension (43.9%), arthritis (37.5%), and inability to feed oneself/bathe/use the toilet (2.0%) are very similar to those observed in other populations. Physician visits and hospitalization patterns are within the variation reported by different countries. The low prevalence rates of older adults who had interrupted activities because of a health problem (13.9%) or had been bedridden (9.5%) in the previous 2 weeks or hospitalized in the previous year (13.6%) show that the vast majority are not subject to these events. Considering that 50% of this population live on less than or equal to one Brazilian monthly minimum wage, expenditures on medications consume approximately one-fourth (23%) of total income for half of the elderly population.
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Explore the source record for details and available documents.
The question of the relationship between the evolution of health status and the activity of health care system in developed countries is treated frequently through epidemiological studies. However, there are numerous methodological difficulties linked to this type of investigation and it is not possible to give a certain answer to this question. Particular difficulties concern the choice of indicators (indicators of health status and indicators of health care system). This choice may influence largely the outcome of the results. If general mortality has tended to decline over the last thirty years, some causes of death have progressed and many studies show an increase of the level of morbidity and disabilities declared in the population and an increase of social disparities in health status. The analysis concerning the role of health care systems, in order to explain this evolution, does not lead to a single conclusion. Some works show the positive effect of the activity of health care systems (especially for infant mortality). According to other authors, the growth of chronic diseases must be considered as the negative aspect of the success obtained in the struggle against mortality. But above all, interpretation of results needs a continuous reference to methodologies used and it is only on this condition that such data may be useful for public health decisions.
Data from Wave 1 of the National Survey of Personal Health Practices and Consequences were used to examine the association between perceived control over future health and 13 health behavior indices. Analyses were conducted within three strata of health status, defined by a cross-tabulation of subjective and functional health ratings. Greater control expected over future health was associated with 11 of the 13 practices in the stratum of persons in best health, but with only 2 practices in the lowest and 3 practices in the middle health strata. Age, gender, education, and a regular source of health care were also important predictors. Overall, persons in the lowest health stratum had the fewest number and least consistent set of predictors of preventive practices. Although the rationales proposed for following preventive practices often rely upon individuals' favorable outlooks on their futures, the present data suggest that background health status may mediate the relationship. Health status can be viewed as a personal resource, which provides an opportunity for predispositions such as perceived control over future health to be consistently expressed in behavior. Attempts to develop theoretical frameworks and intervention programs that are applicable to several behaviors appear to face a difficult challenge, since few of the predictors were consistently related to more than a small number of the 13 practices. Health promotion programs may need to include health status as an additional characteristic around which to structure both the content of recruitment messages, and expectations for persons who will be relatively more easy or difficult to reach.
It is increasingly recognised that population health need assessments based on the comparison of clinical or demographic end points (e.g. area mortality rates) neglect population variation in broader aspects of health status and health-related quality of life. Similarly, outcome measures which neglect impacts on health-related quality of life may be an inadequate basis for assessing the effectiveness of health interventions. This paper reviews issues in assessing needs and outcomes at population level based on health status valuations. It considers especially the modelling of sources of uncertainty in measures of health status by using Bayesian sampling estimation methods which produce a distribution of summary outcome measures. The modelling issues are illustrated in models for individual level health status from survey responses and their incorporation in area life tables to derive total and healthy life expectancies. In particular, a health status index derived from Short Form 36 profile responses in a health and lifestyle survey in a London health authority provides a case study of community health needs assessment.
OBJECTIVE: Our purpose was to determine the efficacy of health status measurement in quantifying improvements in quality of care provided by an "angina clinic." STUDY DESIGN: In a pretest-posttest, nonequivalent control group design in the outpatient clinics of a Veterans Affairs Medical Center, 535 patients with coronary disease were followed up, without intervention, for 3 months and were defined as the "usual-care" group. Concurrently, a clinical trial that optimized the antianginal medications of 100 patients with chronic, stable coronary disease was conducted and defined as the "angina clinic" group. The 3-month change in scores for the Seattle Angina Questionnaire, a valid, reliable, and responsive disease-specific health status measure for patients with coronary disease, was used as the main outcome measure. RESULTS: After baseline differences between groups were controlled, the "angina clinic" conferred substantial improvement on patient symptom control (3-month benefit in angina frequency +9.4, P <.001; in angina stability +14.7, P <.001), treatment satisfaction (+8.6, P <.001), quality of life (+6.8, P <.001), and physical limitations resulting from coronary disease (+3.6, P =.047). Only the changes in physical limitation were not clinically significant. CONCLUSION: Disease-specific health status measures can provide valuable insights into the quality of care associated with innovations in health care delivery. These results suggest that patients in a clinical trial optimizing antianginal medications had greater improvements in symptom control, treatment satisfaction, and quality of life compared with similar patients receiving "usual care" in a general medicine clinic.