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Economic incentives, health status and health services utilisation.

The impact on utilisation of differential public entitlements to free health services is analysed, using data for a large sample of Irish households. GP visiting rates are seen to be significantly higher for those on low incomes whose costs are covered by the State than for those who pay for such care, having controlled for other characteristics including health status. The importance of taking differences in health status into account in attempting to distinguish the effects of economic incentives is shown both for GP visits and hospital stays.

Adolescent↗

Health status of health care workers at Srinagarind Hospital: experience from the Annual Health Check-up Program.

The authors conducted this study to evaluate the efficacy of a health check-up program and the health status of health care workers at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. The authors reviewed all yearly-check up charts of personnel who worked at Srinagarind Hospital from 2002 to 2003 including history taking, physical examination, and laboratory testings. There were 606 office workers and 1,024 nursing staff enrolled The mean ages of both groups were 38.9 and 36.5 years old, respectively. The office workers visited physicians significantly more often than the nursing staff (553 of 606 vs 271 of 1,024; p-value = 0.00). Obesity was found much more in office workers (127 of 472 versus 129 of 749). There were significant differences between the groups on impaired fasting plasma glucose, DM, HT, high cholesterol level, high triglyceride level, and significant elevation of ALT or AST (all p-value = 0.00). In the obese group, there was also a significantly higher number of cases who had high blood pressure, defined as IFG or DM, high cholesterol level, and high triglyceride level (p-value = 0.00) except the significant elevation of ALT or AST level. Cases of obesity with significant elevation of hepatic enzyme had many atherosclerotic risk factors. Therefore, metabolic derangements are the important problem for health care workers.

Adult↗

Health status and health care use of Massachusetts women reporting partner abuse.

BACKGROUND: Studies indicate that women abused by their intimate partners are at increased risk for a number of health problems and have increased rates of health care utilization. However, these findings are based mainly on studies using clinic or health plan populations. In this study, we examined the association between intimate partner abuse (IPA) and health concerns and health care utilization in a population-based sample of adult women. METHODS: We analyzed data on 2043 women aged 18 to 59 who participated in the 1998 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), a population-based health survey that included questions on IPA. IPA was defined as experiencing physical violence by, fear of, or control by an intimate partner. Consequences of IPA and self-rated health status and health care utilization of women experiencing IPA were examined. RESULTS: A total of 6.3% of Massachusetts women aged 18 to 59 reported IPA during the past year. Women experiencing IPA were more likely than other women to report depression, anxiety, sleep problems, suicidal ideation, disabilities, smoking, unwanted pregnancy, HIV testing, and condom use. Women experiencing IPA were less likely to have health insurance, but received routine health care at similar rates as other women. CONCLUSIONS: These results indicate that women in the general population experiencing IPA are at increased risk for several serious emotional and physical health concerns. Most of these women are in routine contact with health care providers. These findings also suggest that the BRFSS may provide a valuable mechanism for tracking state-based IPA prevalence rates over time.

Adolescent↗

Health status and health service access and use among children in U.S. immigrant families.

OBJECTIVES: We examined the health status and patterns of health care use of children in US immigrant families. METHODS: Data from the 1999 National Survey of America's Families were used to create 3 subgroups of immigrant children: US-born children with noncitizen parents, foreign-born children who were naturalized US citizens, and foreign-born children with noncitizen parents. Chi-square and logistic regression analyses were used to examine relationships between immigrant status and health access variables. Subgroup analyses were conducted with low-income families. RESULTS: Foreign-born noncitizen children were 4 times more likely than children from native families to lack health insurance coverage and to have not visited a mental health specialist in the preceding year. They were 40% and 80% more likely to have not visited a doctor or dentist in the previous year and twice as likely to lack a usual source of care. US-born children with noncitizen parents were also at a disadvantage in many of these aspects of care. CONCLUSIONS: We found that, overall, children from immigrant families were in worse physical health than children from non-immigrant families and used health care services at a significantly lower frequency.

Adolescent↗

[Correlations of alternative medicine, health status and health care in Hungary].

INTRODUCTION: Alternative medicine has a growing popularity in Hungary as well as in other Western countries. However, we are in lack of accurate empirical data on the use of this kind of care and its relationship toward official health care system. AIMS: This paper focuses on the questions of the use of, prospective willingness to use, and attitudes toward alternative medicine with regard to the demographic background, general health status and habits of visiting doctors. METHOD: The source of data is a Baranya county health survey from 1999 (N = 2357). The statistical method of analysing data is regression analysis. RESULTS: Alternative medicine is popular mostly in groups of people with younger age, higher level of education and income. Preferring alternative care is connected to having more chronic, non-fatal illnesses while the number of fatal illnesses on one hand and activity restriction on the other have no significant role. Positive relationship to alternative medicine is connected to more overall visits of doctors but less of GP-s. CONCLUSIONS: Regarding the demographic background and health status alternative medicine in Hungary appears similar to what publications from Western countries have already enlighted. Data on utilization of official health care can refer to the possibility that alternative medicine might serve as an alternative of primary care but not of secondary care.

Adult↗

A comparison of two survey measures of health status.

Health service planning requires information on levels of health and illness in the population. Surveys, such as the British General Household Survey (GHS) rely on self-reports of health, illness and restriction, but interpretation of results is problematic. Multi-item measures such as the Nottingham Health Profile (NHP) tap different aspects of health and allow respondents less freedom to define health and illness. In a survey of 1862 adults, health questions from the GHS and the NHP were used, and the results compared. Responses to GHS questions were associated with NHP scores, but the strength of the associations between the four GHS questions and the six NHP items varied considerably. Reporting a recent restriction was only weakly associated with NHP scores. Associations between GHS questions and NHP scores were weakest for the NHP items measuring emotional reactions, sleep and feelings of social isolation. Reporting good health or no illness in response to GHS questions was no guarantee that respondents experienced no health problems. Those who use health data from the GHS, NHP or similar surveys should look closely at whether such data provide appropriate information for their purposes.

Adolescent↗

Health status and health care use in persons with inflammatory bowel disease. A national sample.

We randomly surveyed 997 members of the Crohn's and Colitis Foundation of America with inflammatory bowel disease (320 ulcerative colitis and 671 Crohn's disease) in order to: (1) assess their health status, (2) compare members with ulcerative colitis and Crohn's disease, and (3) determine the correlates of health care use. Data collection included variables relating to physical and psychological symptoms, medication use, daily functional status, perceptions of health, and coping styles. The findings indicate that: (1) despite a number of symptoms and complications related to inflammatory bowel disease, the health status of this population is generally good and may be a result of effective coping styles; (2) those with Crohn's disease have more psychosocial difficulties, which appear related to greater symptom severity; (3) both psychosocial and physical health variables are related to number of physician visits, while primarily physical health variables are related to number of hospitalizations and surgeries. Further studies are needed to determine the representativeness of this self-selected sample with others having IBD. In this study, we have provided the basis for developing a more sensitive measure of health status than currently exists, and one which may have implications for future clinical studies.

Adaptation, Psychological↗

Health status and health care utilisation of patients in complementary and conventional primary care in Switzerland--an observational study.

BACKGROUND: The study is part of a nationwide evaluation of complementary and alternative medicine (CAM) in primary care in Switzerland. OBJECTIVES: Patient health status with respect to demographic attributes such as gender, age, and health care utilisation pattern was studied and compared with conventional primary care. METHODS: The study was performed as a cross-sectional survey including 11932 adult patients seeking complementary or conventional primary care. Patients were asked to document their self-perceived health status by completing a questionnaire in the waiting room. Physicians were performing conventional medicine and/or various forms of complementary primary care such as homeopathy, anthroposophic medicine, neural therapy, herbal medicine, or traditional Chinese medicine. Additional information on patient demographics and yearly consultation rates for participating physicians was obtained from the data pool of all Swiss health insurers. These data were used to confirm the survey results. RESULTS: We observed considerable and significant differences in demographic attributes of patients seeking complementary and conventional care. Patients seeking complementary care documented longer lasting and more severe main health problems than patients in conventional care. The number of previous physician visits differed between patient groups, which indicates higher consumption of medical resources by CAM patients. CONCLUSIONS: The study supports the hypothesis of differences in socio-demographic and behavioural attributes of patients seeking conventional medicine or CAM in primary care. The study provides empirical evidence that CAM users are requiring more physician-based medical services in primary care than users of conventional medicine.

Adolescent↗

Changes in health status and health behavior among Finnish adults 1978-1993.

The patterning of trends in self-assessed health, and in the "Holy Four" of health-related behaviors, that is, smoking, drinking, the use of high-fat milk and butter, and physical exercise, was examined in the Finnish general population aged 25-64 years. There were considerable differences in the health status and health behavior by study year, gender, and educational attainment. The longer the education, the better the health and the more favorable the health behavior, except for the use of alcohol. From the late 1970s to the early 1990s smoking increased slightly among women but decreased among men. The use of alcohol increased, whereas the use of butter and high-fat milk decreased dramatically. Physical exercise during leisure time increased, especially among women. Unemployed men and women were more often smokers than employed persons.

Adolescent↗

The health status and health care utilization of deaf and hard-of-hearing persons.

OBJECTIVE: To evaluate whether health habits, self-reported health status, and communication with physicians play a role in the known altered health care utilization patterns of deaf and hard-of-hearing persons. DESIGN: A cross-sectional survey. Respondents were given the choice of completing either a self-administered written survey or an American Sign Language interview-administered survey. POPULATION: Eighty-seven deaf and hard-of-hearing members of various organizations serving this population in southeastern Michigan and 88 hearing patients from a family practice clinic in the same area. RESULTS: Deaf and hard-of-hearing persons visit physicians more frequently (P = .01), have a lower incidence of ever smoking tobacco (P < .0006) and of alcohol use (P = .04), have more difficulties communicating with physicians (P < .001), have trouble understanding physicians (P < .001), and feel less comfortable with physicians (P < .001). Lower current tobacco use among deaf and hard-of-hearing persons was only seen in persons who were not educated beyond high school. Increased frequency of physician visits for deaf and hard-of-hearing persons was especially noticeable in the group of persons 60 years of age and older. Our finding that use of interpreters is associated with increased utilization and decreased understanding suggests deaf and hard-of-hearing patients presenting with interpreters warrant more focused attention from physicians. Reasons for seeing physicians did not explain the difference in frequency of physician visits between the two groups. CONCLUSIONS: Deaf and hard-of-hearing persons report a lower subjective health status and higher physician utilization, as well as substantial communication difficulties with physicians. They also report better health-related behaviors, namely less use of tobacco and alcohol. The use of interpreters did not decrease physician utilization or improve the understanding of physicians by these persons. Overall, our results underscore the fact that deaf and hard-of-hearing persons constitute a minority population that experiences considerable difficulties in the patient-physician relationship.

Adult↗

Relationships between welfare status, health insurance status, and health and medical care among children with asthma.

OBJECTIVES: This study evaluated the relationships between health insurance and welfare status and the health and medical care of children with asthma. METHODS: Parents of children with asthma aged 2 to 12 years were interviewed at 6 urban clinical sites and 2 welfare offices. RESULTS: Children whose families had applied for but were denied welfare had more asthma symptoms than did children whose families had had no contact with the welfare system. Poorer mental health in parents was associated with more asthma symptoms and higher rates of health care use in their children. Parents of uninsured and transiently insured children identified more barriers to health care than did parents whose children were insured. CONCLUSIONS: Children whose families have applied for welfare and children who are uninsured are at high risk medically and may require additional services to improve health outcomes.

Adult↗

Effects of home environment, socioeconomic status, and health status on cognitive functioning in children with HIV-1 infection.

OBJECTIVE: To investigate the effects of the home environment, socioeconomic status (SES), and health status on cognitive functioning in a sample of children with HIV-1 infection in a cross-sectional study. METHODS: Forty-three caregivers and their children (2.5 to 12 years) participated. Caregivers completed two self-report measures of the home environment that included questions regarding the organization of the environment, play materials, parental involvement, variety of stimulation, and parental attitudes toward the provision of a cognitively stimulating environment. Cognitive functioning was assessed using a standardized intelligence (IQ) test. Children's medical charts were reviewed for HIV-1 classification status (CDC, 1994), CD4 cell counts, and current medication. RESULTS: This study revealed two primary findings. First, measures of the home environment mediated the association between SES and child IQ. Second, measures of the home environment had a stronger association with child IQ during the advanced stages of disease than earlier stages of disease. CONCLUSIONS: The home environment is associated with cognitive functioning among children with HIV-1 infection. Moreover, interventions aimed at enhancing the quality of the home environment may have a positive impact on these children's cognitive development.

Child↗

The health status and health needs of Chinese population in Glasgow.

This cross sectional study explored the health problems and health needs in the local Chinese community in Glasgow. Several data collection methods have been used in this study, including face-to-face and telephone structured interviews, postal and hand delivered questionnaires. A total of 800 questionnaires were processed, and 493 were completed, giving an overall response rate 61.6%. The results from the present survey indicated that the health status of Chinese residents in Glasgow is poorer than that of the local population. The most important findings of the study is that the Chinese community in Glasgow underuse health services, and unmet health needs exist in the community. The main barrier to effective use of present health services and benefit from the health promotion and health education programmes is language difficulties. Following discussion with the local community, options for improving the health services for the Chinese community in Glasgow were obtained. The findings of the study have implications for health service purchaser/providers of health care to the Chinese population generally in Scotland.

Adolescent↗

Patient satisfaction, self-rated health status, and health confidence: an assessment of the utility of single-item questions.

This study examined if known predictors of patient satisfaction would still be significant when single items are used. Approximately 5000 elderly persons were randomly sampled from 65 000 households in West Texas. Single-item questions about patient satisfaction, self-rated overall health status, self-rated mental health, and health confidence were analyzed by chi-square tests and logistic regressions. Slightly more than 12% of the participants were not satisfied or barely satisfied with health care received. Those who reported higher health confidence, lower self-rated overall health, having emotional problems, or who were men were less likely to be satisfied with health care. A simple survey tool based on single-item questions identified by the current study might be useful for monitoring patient satisfaction, self-rated health, and health confidence in primary care settings and hence might assist management in capturing the basic picture for improving health care quality.

Aged↗

Nutrition, general health status and oral health status in hospitalised elders.

Biological malnutrition was assessed and correlated with salivary flow rates and oral health in 99 elderly, hospitalised non-psychiatric patients. The indicators of protein malnutrition used were arm circumference and serum albumin level and the indicators of energy malnutrition the body mass-index and the triceps skin-fold thickness. Unstimulated and stimulated salivary flow rates were measured according to Sreebny et al. Of the patients, 40% showed severely and 46% moderately reduced serum albumin levels and the anthropometric measurements indicated malnutrition in about 50%. Unstimulated hyposialia (< or = 0.1 ml/min) and stimulated hyposialia (< or = 0.5 ml/min) were observed in 17% and 26.5%, respectively. Significant associations (P < or = 0.05) were found between stimulated/unstimulated hyposialia and biological malnutrition. There was a negative relationship between the number of masticatory movements until swallowing a standard biscuit and skin fold thickness (P < or = 0.05). Current weight loss and biological malnutrition were related to poor appetite (P < or = 0.05). The study has confirmed poor general and oral health status as well as protein-energy malnutrition among elderly hospitalised patients. This situation was associated with loss of appetite, reduced salivary flow rates and a certain impairment of masticatory function which could jeopardise the reversibility of malnutrition and lead to increased morbidity and mortality.

Aged↗

Health status measurement performance and health status differences by age, ethnicity, and gender: assessment in the medical outcomes study.

The comparative measurement performance of self-reported health status instruments for African American and Hispanic elderly has rarely been studied, despite evidence of their poor health status. This study examined psychometric performance and health status differences by age, ethnicity, and gender among 10,569 ethnically diverse patients who completed the Short-Form General Health Survey in the Medical Outcomes Study (MOS). Hispanics and African Americans tended to have slightly lower measurement performance than other ethnic groups. Compared with whites, health status scores for African American and Hispanic women were slightly but significantly lower. The small differences in health status by ethnicity may be due to the MOS sampling strategy, which excluded low-socioeconomic status minorities with poor education and no regular medical care. The psychometric performance of MOS health status measures should be examined in studies of ethnically diverse, community-dwelling, elderly populations who have poor access to care, poor education, and/or low socioeconomic status.

Adult↗

Educational differences in health status and health care.

Includes estimates by years of education for limitation of activity, restricted-activity days, assessed health status, physician contacts, hospital discharges and days, incidence of acute conditions, and prevalence of chronic conditions. Level of education is cross-classified by age, sex, race, poverty status, Hispanic origin, geographic region, place of residence, major activity, marital status, and employment status. All estimates are shown as unadjusted and age adjusted and are based on data collected in household interviews by the U.S. Bureau of the Census for the National Health Interview Survey during 1989.

Activities of Daily Living↗