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PubMed2000

Health status and health professional visits in a rural area.

Visits to physicians (MDs), physician assistants (PAs) or nurse practitioners (NPs) by residents of a rural county in the upper-middle west of the United States were analysed in this study. A telephone survey yielded 250 responses. The dependent variable was the natural logarithm of the number of times the respondent had seen a health professional (MD, PA or NP) in the past two years. Predisposing, enabling and medical need variables were tested as potential predictors of visits. Self-rated health status, being unable to perform usual activities, and feeling upset or 'down in the dumps' proved to be important predictors, as was having a usual source of care. Health insurance coverage and family income was not, however. Unexpectedly, smokers also reported more visits. The implications for policy and future research are discussed.

Adult↗
PubMedDate not supplied

How trauma, recent stressful events, and PTSD affect functional health status and health utilization in HIV-infected patients in the south.

OBJECTIVE: In addition to biological markers of human immunodeficiency virus (HIV) disease progression, physical functioning, and utilization of health care may also be important indicators of health status in HIV-infected patients. There is insufficient understanding of the psychosocial predictors of health-related physical functioning and use of health services among those with this chronic disease. Therefore, the current study examines how trauma, severe stressful events, posttraumatic stress disorder (PTSD), and depressive symptoms are related to physical functioning and health utilization in HIV-infected men and women living in rural areas of the South. METHODS: We consecutively sampled patients from 8 rural HIV clinics in 5 southern states, obtaining 611 completed interviews. RESULTS: We found that patients with more lifetime trauma, stressful events, and PTSD symptoms reported more bodily pain, and poorer physical, role, and cognitive functioning. Trauma, recent stressful events, and PTSD explained from 12% to 27% of the variance in health-related functioning, over and above that explained by demographic variables. In addition, patients with more trauma, including sexual and physical abuse, and PTSD symptoms were at greater risk for having bed disability, an overnight hospitalization, an emergency room visit, and four or more HIV outpatient clinic visits in the previous 9 months. Patients with a history of abuse had about twice the risk of spending 5 or more days in bed, having an overnight hospital stay, and visiting the emergency room, compared with those without abuse. The effects of trauma and stress were not explained by CD4 lymphocyte count or HIV viral load; however, these effects appear to be largely accounted for by increases in current PTSD symptoms. CONCLUSION: These findings highlight the importance of addressing past trauma, stress, and current PTSD within clinical HIV care.

Adult↗
PubMed2004

Baseline assessment of the health status and health behaviors of African Americans participating in the activities-for-life program: a community-based health intervention program.

Obesity is a serious problem in the United States and is associated with hypertension, diabetes, and other health problems such as heart disease and some forms of cancer. There is a higher prevalence of being overweight among African American adults than among their Caucasian counterparts. The objective of this study was to assess baseline health behaviors and health status (hypertension, body mass indices, cholesterol and blood sugar levels) of African Americans participating in a community-based health education and physical fitness program. The sample consisted of 1.34 African American adults (30% males) from a low-income urban area in the Midwest. A health survey was administered to assess their health behaviors and previously diagnosed health problems. Additional data was obtained from health screenings to obtain current information on height, weight, and blood sugar, blood pressure and cholesterol levels. In addition to the sample being markedly overweight and obese (30% and 60% respectively), the results of the health screenings indicated a disproportionate number of participants (62%) with hypertension; 74% of the male participants had high blood pressure. Moreover, the self-reported data suggested that the participants had poor eating habits, sedentary lifestyles, and previously diagnosed health conditions (hypertension, diabetes, and high cholesterol levels) that were comparable to the results of their health screenings. These findings suggest that culturally-relevant, community-based programs that incorporate both nutritionl education and physical fitness are needed in order to educate and motivate participants to decrease behaviors that put them at risk for obesity and other health related problems.

Adult↗
PubMed1998

Gender difference in health status and health care facilities in some social groups and subgroups of southern West Bengal, India.

In recent years, social scientists are concerned with individual well-being and also in identifying the high-risk groups. In South Asia, gender is an important determinant of variation in resource allocation. Three contrasting social groups of southern West Bengal, India have been studied to find out whether there is any gender discrimination in allocation of health facilities and also to assess the health status of these groups. In general, a tendency towards favouring the males appears to exist in respect of allocation of health facilities. Also, females are more affected with the ailments associated with hard work.

Bias↗
PubMed2004

Insights into the 'healthy immigrant effect': health status and health service use of immigrants to Canada.

This paper combines multiple cross-sections of data drawn from the National Population Health Survey and Canadian Community Health Survey to confirm the existence of the 'healthy immigrant effect', specifically that immigrants are in relatively better health on arrival in Canada compared to native-born Canadians, and that immigrant health converges with years in Canada to native-born levels. The paper finds robust evidence that the healthy immigrant effect is present for the incidence of chronic conditions for both men and women, and results in relatively slow convergence to native-born levels. There is only weak evidence in terms of self-assessed health status. The inclusion of controls for region of origin and year of arrival does not account for the observed effects, although region of origin is an important determinants of immigrant health. The paper then considers some alternative explanations for the observed differences, and support is found for the idea that the healthy immigrant effect reflects convergence in physical health rather than convergence in screening and detection of existing health problems.

Adult↗
PubMed1988

DRGs U.K. style: a comparison of U.K. and U.S. policies for hospital cost containment and their implications for health status.

Health care cost containment in the U.K. has been characterised by the imposition of cash limits on health and personal social services. More recently performance appraisal has been introduced. The U.S. approach, on the other hand, has linked both cost containment and implicit performance appraisal by funding hospital activities on a DRG basis. Under the U.K. approach there is an internal inconsistency between the funding of hospital activities, primarily determined by the characteristics of the served population, and the appraisal of hospital performance by reference to the use of resources in relation to national norms not necessarily corresponding to the characteristics of the served population. Under the U.S. approach performance is appraised implicitly, not by the use of real resources but by the cost to the hospital of the service provision for each individual patient. Consequently the incentive is to minimise the cost of the service provision regardless of the output produced. The incentives, in both the U.K. and the U.S. approach, generate similar effects: an off-loading of responsibility for service provision at the margin onto other sectors of the health care system. They are the response to the incentive to minimise the costs incurred by the hospital in providing services to the patient. Until greater attention in paid to the monitoring of the outcomes achieved by all sectors of the health care system, and to the incentives generated to shift demands between the sectors, the respective policies will continue to be successful simply in controlling the resource cost of the hospital system.

Cost Control↗
PubMed2006

Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey.

OBJECTIVES: We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities according to race, income, and immigrant status. METHODS: We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender, age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care and as a predictor of disparities in these measures. RESULTS: In multivariate analyses, US respondents (compared with Canadians) were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but were more extreme in the United States. CONCLUSIONS: United States residents are less able to access care than are Canadians. Universal coverage appears to reduce most disparities in access to care.

Adult↗
PubMed1998

Health status, needs, and health care barriers among the homeless.

Perceived health status, health conditions, and access and barriers to care are important predictors of mortality and the use of services among the homeless. This study assesses these issues by structured interview of 128 homeless adults from San Francisco. Of these adults, 21.1 percent were women (mean age 37 compared to 42 for men). In terms of ethnicity, 38 percent were white; 30 percent were African American; 17 percent were Latino; and 15 percent were Asian/Pacific Islander, Native American/Alaskan, or of mixed ethnicity. Of these adults, 49 percent rated health as poor or fair. Men were four times as likely as women to report their health status as excellent or good. Persons of color were more likely to report unmet needs for shelter, regular meals, employment, and job skills/training. These findings add information on those homeless not often included in research and indicate that these marginalized individuals may be in the poorest health.

Adult↗
PubMed1996

Effect of orthotopic liver transplantation on employment and health status.

Employment, functional status, health status, and prevalence of anxiety and depression were assessed in patients who had undergone orthotopic liver transplantation at Duke University from 1984 to 1993 to identify social and economic factors that might influence return to work after liver transplantation. Patients were asked to complete mailed questionnaires. A transplant nurse coordinator assigned patients a Karnofsky score, unaware of the questionnaire responses. The response rate was 71% (52 of 72 patients). The median age of the post-liver transplantation patients was 49 years. Median years of education were 13. Sixty-five percent of patients were male. Sixty percent of patients were employed posttransplantation. Employed and unemployed posttransplantation patients showed no significant difference in age, education, gender, marital status, race, family coping skills, or cause of liver disease. Return to work after transplantation did not correlate with socioeconomic status or spouse's employment. Posttransplantation return to work was highly correlated with pretransplant employment (P < .0005). The prevalence of anxiety and depression, assessed by the Hospital Anxiety and Depression Scale (HAD), was 9% and was no different in the employed or unemployed patients. Health status, as measured by Karnofsky score, was excellent; all patients received Karnofsky scores > or = 80%. Health perceptions were compared in employed versus unemployed posttransplantation patients with the SF-36, a 36-item short form survey developed by the investigators of the Medical Outcome Study. This revealed significantly different values in the subscale, physical functioning, with a mean score of 70.6 in the employed and a mean score of 48.4 in the unemployed posttransplantation patients (P = .004) and role-physical with a mean score of 61.8 in the employed and a mean score of 27.6 in the unemployed posttransplantation patients (P = .005). Eighty percent of patients not returning to work cited "problems with their health" as their major obstacle to employment. Although objective health status was good to excellent in all patients after transplantation, patients perceived that their health status was poor, with the lowest scores observed in unemployed posttransplantation patients.

Adult↗
PubMed2005

Perceived health status and health-promoting behaviors of African-American and White informal caregivers of impaired elders.

Caregiving and its consequences are major concerns for nurses. Many studies have examined health-promoting behaviors in general (Duffy, 1993; Walker, Volkan, Sechrist, & Pender, 1988), but few studies have explored health-promoting behaviors of caregivers. The purpose of this study was to examine the effects of age, gender, race, and length of caregiving on perceived health status and health-promoting behaviors of African-American and White informal caregivers of impaired elders. Data from a larger study was used to examine a conceptual model linking perceived health status and health-promoting behavior. A sample of 136 (n = 136) African-American and 257 (n = 257) White caregivers was recruited from northeastern Ohio through random digit dialing and interviewed face to face. English-speaking caregivers were selected for study who provided unpaid assistance or care for a minimum of five hours a week to an impaired person 60 years of age or older living in the community. The Health-Promoting Behavior Questionnaire, perceived health status, and a demographic profile were used to measure the study variables. Data were analyzed using hierarchical multiple regression. Findings from this study suggest that the overall fit of the conceptual model was significant, and that moreover, the relationship found between perceived health status and health-promoting behaviors supported Pender's model of health promotion (Pender, 1987). The relationship between perceived health status and health-promoting behaviors has not been documented in prior studies of caregivers, or in studies comparing the two racial groups of African-Americans and Whites.

Adult↗
PubMed1995

The relationship of health professional shortage areas to health status. Implications for health manpower policy.

OBJECTIVE: To compare the health status of adult residents of health professional shortage areas (HPSAs) with adult residents of non-HPSAs. DESIGN: A random-digit dialing telephone survey. Respondents were subsequently classified by their county of residence as residing in an HPSA or non-HPSA. PARTICIPANTS: A sample of 470 adults (18 years or older) living in Kentucky. MAIN OUTCOME MEASURES: Health status was measured by the Medical Outcomes Study 20-Item Short-Form Health Survey's six subscales. RESULTS: Controlling for demographic variables in the multiple regression analysis, there were significant differences between HPSAs and non-HPSAs for the social, mental health, and pain subscales. An interaction between age and HPSAs in relation to health status was observed for the physical, social, mental health, health perception, and pain subscales. After stratification by age (18 to 44 years, 45 to 64 years, or 65 years or older), HPSA-designated areas were associated with poorer health status in all but the youngest age strata. Elders in HPSAs had the poorest health status. CONCLUSIONS: Health professional shortage areas are associated with poorer health status in the older segments of the adult population. Future policy may need to focus on increasing access not only to primary care services but also to specific types of services that may promote better health status of elderly residents of HPSAs.

Adult↗
PubMed2001

Health status and health-related quality of life in survivors of cancer in childhood in Latin America: a MISPHO feasibility study.

Cancer is an increasing cause of disease-related death in childhood within developing countries, where the great majority of the world's children reside. The improving prospects for survival in such children, and the corresponding challenge of undertaking economic evaluations of related health interventions, provide a stimulus to study the health-status and health-related quality of life in survivors of cancer in childhood in Latin America. Spanish language versions of questionnaires for proxy assessors, based on the Health Utilities Index (HUI), were used to elicit responses from parents and physicians. The HUI is a family of multi-attribute, generic, preference-linked measures of health status and health-related quality of life that are reliable, responsive and valid, and have been used previously in pediatric oncology. Valid responses were received from 178 parents and 144 physicians in 6 centres in 4 countries (Cuba, Honduras, Colombia and Uruguay). For children with acute lymphoblastic leukemia the major morbidity burdens were in the attributes of emotion, cognition and pain. The overall burden of morbidity was greater in children with non-Hodgkin's lymphoma. In survivors of Hodgkin's disease and Wilms' tumor the attributes most affected were emotion and pain. In general, there was considerable agreement between the assessments provided independently by parents and physicians. This study demonstrates the feasibility of conducting such measurements in developing countries, and reveals similarities in health status and health-related quality of life to comparable populations in more privileged societies.

Child↗