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Vitamin status, health statistics and capacity for work of miners of Karagandinsky coal field were studied. It was shown that inadequate vitamin nutrition of miners in combination with harmful occupational and environmental factors negatively influence the miner's health status and capacity for work.
OBJECTIVES: To assess the perceived health status of disabled people. DESIGN: Perceived health status was evaluated with the Short Form 36 Health Survey (SF-36) and the Nottingham Health Profile as part of a needs assessment project exploring systematic differences in unmet needs for rehabilitation as perceived by disabled people, carers and professional staff. Disabled participants completed these health status questionnaires, as part of a face-to-face interview in participants' own homes. SUBJECTS: Ninety-two disabled people aged 16-65, recruited into the study from two disability registers. OUTCOME MEASURES: The Office of Population Censuses and Surveys (OPCS) Disability Severity Scale, Nottingham Health Profile, SF-36. RESULTS: Ninety-six disabled people took part in this study. Four were later excluded because of overwhelming communication difficulties. Median OPCS category was 8 (interquartile range 6-9.75). The pain and physical mobility domains of the Nottingham Health Profile were not completed by 46/92 participants (50%) because many questions referred to activities that these people could not perform, particularly walking. The physical functioning domain of the SF-36 showed severe floor effects. It was not therefore possible to use these measures to test the effectiveness of services provided to disabled people, particularly in the areas of physical functioning and pain. CONCLUSIONS: There is a continued need to develop and test instruments that can measure the outcomes of rehabilitation in severely disabled populations.
The measurement of children's health status in community surveys is hampered by both methodologic and substantive problems. These include relatively low prevalence of medical conditions among children, appropriate selection of sample questionnaire items, and difficulties in measuring health status change. There is potential value in including measures of health risk instead of, or in addition to, health status measures. This may overcome problems of low prevalence, and provide a broader base for testing the effects of program and policy changes.
To examine selection bias in terms of demographics, self-reported health practices, professionally evaluated health status, and prior health care utilization by employees and dependents, we examined health insurance choice between traditional insurance and a health maintenance organization (HMO) by central office employees of a large southwestern utility company. The HMO attracted a relatively younger and female population compared with the traditional plan. We found no difference in health practices and health status measures between the two groups. Consistent with recent studies, the HMO group experienced lower health claims cost the year prior to enrollment compared with persons who remained in the traditional plan. This difference was largely due to dependents' utilization-a factor that should be examined in future studies and considered by those structuring insurance premiums for HMOs and traditional plans.
BACKGROUND: The study of the relationship between self-reported morbidity, health status and health care utilization presents methodological problems due to the variety of illnesses and medical conditions that one individual may report. In this article, correspondence analysis was use to analyse these relationships. METHODS: Data from the Spanish National Health Survey pertaining to the region of Catalonia was studied. Statistical analysis included multi-way correspondence analysis (MCA) followed by cluster analysis. RESULTS: The first factor extracted is defined by self-assessed health perception; the second, by limitation of activities, and the third is related to self-reported morbidity caused by chronic and acute health problems. Fourth and fifth factors, capture residual variability and missing values. Acute problems are more related to perception of poor health while chronic problems are related to perception of fair health. Also, it may be possible to distinguish self-reported morbidity due to relapses of chronic diseases from true acute health problems. Cluster analysis classified individuals into four groups: 1) healthy people; 2) people who assess their health as being poor and those with acute health problems; 3) people with chronic health problems, limited activity and a perception of fair health; and 4) missing values. CONCLUSIONS: Correspondence analysis is a useful tool when analyzing qualitative variables like those in a health survey.
India is characterized by significant rural-based living, population heterogeneity, financial constraints, and reverse sex ratio. Traditions of joint families, life-long physical activity, vegetarianism, and social and spiritual enrichment, all known to promote healthy aging, are widely prevalent. With the increasing pace of population aging, the health of older persons in India has been the focus of recent attention. Existing data indicate a significant morbidity among the aged, much of which may remain subclinical. Considerable variations in morbidity exist with respect to gender, place of residence (rural vs. urban), and socioeconomic status. Rapid demographic transition without a concomitant epidemiological transition is responsible for the dual load of infections and degenerative diseases in older persons, these being common causes of death. Most age-related morbidity is preventable. Health promotion and cost-effective interventions based on the primary health care approach over a lifelong course, especially at the village level, will greatly help towards achieving the goal of healthy aging. The rapidly changing socioeconomic scenario in India also calls for appropriate policy actions to achieve this goal.
PURPOSE: Adolescent survivors of cancer in childhood face particular challenges due to their maturational trajectory, including psychosocial adjustments, self-help skills, intellectual functioning and socialization. To better understand these, we assessed the health status and health-related quality of life (HRQL) in a 20-year cohort of such survivors in a single institution. METHODS: Health status and HRQL were measured with a self-complete questionnaire from the Health Utilities Index (HUI) family of multi-attribute, preference-based instruments that provide utility scores for single attributes and overall HRQL. RESULTS: Eighty-four (42 males, 42 females) of 129 eligible subjects (65%) participated. More than 80% of the respondents reported some form of morbidity. Overall HRQL utility scores were lower for both the males and females than for corresponding members of the Canadian general population. Female survivors self-reported a significantly greater burden of morbidity (mean overall HUI2/HUI3 scores: .83/.73 vs. .90/.84 for males, p < .02), which was most evident in the attributes of emotion and cognition. CONCLUSIONS: The majority of adolescent survivors of cancer in childhood carry a morbidity burden into their teen and young adult years. These findings may guide the support required by this population.
The hemophilias are a group of disorders associated with a chronic burden of morbidity and early mortality. Improvements in these adverse features have been achieved by the use of clotting factor concentrates within comprehensive centers of specialized care providing home infusion programs. Offsetting effects from transfusion-transmitted hepatitis and HIV infection are in recent decline. The net impact of these changes merits assessment. To test the a priori hypotheses that increasing severity of factor VIII deficiency would be associated with an increasing burden or morbidity and that hepatitis and HIV positivity would impair health status further, a cross-sectional study of a population-based cohort was undertaken in a regional hemophilia program in Ontario, Canada. A survey was made of mild, moderate, and severe hemophiliacs over 13 years of age who self-reported their health status using a standard 15-item questionnaire. The responses were converted to levels in the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) health status classification systems to form multi-element vectors from which single-attribute morbidity and overall health-related quality of life utility scores were determined. The burden of morbidity was greater in hemophiliacs than in the general population and correlated with the category of disease (mild < moderate < severe). Hepatitis and HIV positivity conferred additional burdens of morbidity, which were mainly in the attributes of mobility (HUI2), ambulation (HUI3), and pain (HUI2/3), all of these differences reaching levels of statistical significance. Despite demonstrable improvements in the safety, effectiveness, and utilization of clotting factor concentrates, hemophiliacs continue to experience an important burden of morbidity. Measurement of this burden, as reported here, provides a basis for future economic evaluation of the costs and consequences of health care interventions provided to this population.
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The aim of this study was to evaluate interrater and intermodality agreement in assessing health status using the Health Utilities Index. A random sample from a Dutch cohort of 14-year-old Very Low Birth Weight children and their parents were invited to participate in a face-to-face (n = 150) or telephone (n = 150) interview. All 300 participants were also sent a questionnaire by mail. Response rate was 68%. Interrater and intermodality agreement were high for the physical HUI3 attributes and poor for the psychological attributes. Children and parents reported more dysfunction in the psychological attributes when interviewed than when completing the mailed questionnaire. High agreement on the physical attributes may have resulted from the fact that hardly any dysfunction was reported in these attributes, and poor agreement in the psychological attributes may have been a result of the fact that in these attributes much more dysfunction was reported. In measuring children's health status using the HUI3, the results and their interpretation vary with the source of information and the modality of administration. For maximum comparability between studies, written self-report questionnaires seem the preferred option.
We report the association between single health practices and self-assessed health status. Data were collected by telephone survey applied to all adults in a sample of households in metropolitan St. John's; questionnaires were completed for 3,300 subjects. Five health practices--smoking, exercise, sleep, weight and drinking--as defined by previous studies were compared with self-assessed health status--good or poor--using logistic regression; linear and quadratic functions were fitted, plots were prepared and the direction and strength of the associations studied using odds and odds ratios. For sleep, smoking, weight and exercise, our results confirm the definitions used in previous studies. Current non-drinkers in our sample do not report good health as frequently as moderate drinkers. Breakfast--which was analyzed by conventional cross-tabulation--showed no association with health status.
OBJECTIVE: To describe key methodological challenges in the validation of measures of pediatric health status, functional status, and health-related quality of life (HRQOL) and ways to address them. METHODS: Validation strategies of measures of pediatric health status, functional status, and HRQOL were reviewed. RESULTS: Three key challenges were identified: 1) clarifying and testing measurement models; 2) measuring responsiveness to clinically meaningful change; and 3) considering data from multiple respondents. CONCLUSIONS: Research strategies to enhance validity of measures include specifying intended validity and measurement models, documenting sensitivity of measures to clinically meaningful change, and considering data from multiple informants.
OBJECTIVE: The aim was to analyse differences between female and male general practitioners (GPs) in health status and lifestyle and compared with the general population in health-related quality of life. DESIGN: A simple random sample of 1004 GPs from the whole of Sweden (71.2%) participated in a survey in May 1996 about self-reported health status, smoking habits, physical activity, and SF-36 quality of life survey. They were compared as regards SF-36 with the general population in Sweden in three approximately similar-sized age groups of women and men aged 30-44, 45-49, and 50-64. RESULTS: Female GPs had a higher risk than male GPs of impaired health status. Of the female GPs aged 45-49, 22.8% reported that their health was impaired compared with 12.6% of male GPs. Less than 5% of the GPs younger than 45 were daily smokers. Female GPs had higher means for physical functioning but lower means for vitality, social functioning, and role emotional and mental health compared with the general population. CONCLUSIONS: The significant increased risk in poor health among female GPs, especially those aged 45-49, is worrying and argues for appropriate analysis and prevention that are tailored to their working conditions.
Health and functional status data have been shown to have clinical utility in predicting outcome. Various metadata registries in the form of patient self-administered health assessment questionnaires have been incorporated into routine clinical care and clinical research of patients with rheumatic disease. Examples of such health assessment instruments are the Clinical Health Assessment Questionnaire (CLINHAQ) and the Modified Health Assessment Questionnaire (MHAQ). These instruments contain concepts that are an integral part of the health and functional status domain. Using an automated indexing tool we examined the clinical content coverage by SNOMED RT and the Unified Medical Language System (UMLS) Metathesaurus for health and functional status concepts identified in the MHAQ and CLINHAQ. Significant differences existed between the overall representational ability of SNOMED and UMLS for concepts identified in the MHAQ (49%, vs. 77% respectively, p < .005) and for concepts identified in the CLINHAQ (30% vs. 64% respectively p < .005). Representational capability by SNOMED-RT and UMLS for concepts in a given health assessment instrument was carried across four semantic classes of "attitudes", "symptoms", "activities", and "social attributes". The conceptual content coverage of health status assessment concepts contained in the MHAQ and CLINHAQ by SNOMED-RT and UMLS was incomplete but better for UMLS with its panoply of vocabulary sources. This observed overall improved representation by UMLS appeared to be due to better representation of concepts in "activities" and "social attributes" semantic classes. Representation of health or functional status concepts in a computerized medical record should be founded on a universally agreed concept model of that domain. Established functional and health status metadata registries can serve as important sources for concepts and candidate classes within that domain.
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Von Willebrand disease (VWD) is the commonest inherited disorder of hemostasis and the majority of women with this disorder experience excessive uterine bleeding. Yet very little information is available on the health-related quality of life (HRQL) in individuals with VWD. To test the a priori hypotheses that these individuals will have poorer HRQL than members of the general population, and that this burden of morbidity will correlate with the severity of VWD, a cross-sectional study was undertaken of a population-based cohort in a regional hemophilia program in Ontario, Canada. A survey was made of individuals over 13 years of age with VWD who self-reported their health status using a standard 15 item questionnaire. The responses were converted to levels in the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) health status classification systems to form multi-element vectors from which single attribute morbidity and overall HRQL utility scores were determined. As a group, individuals with VWD were shown to have poorer HRQL than members of the general population and those with Type 2 disease carried a greater burden of overall morbidity than those with Type 1 disorder. Morbidity was evident mainly in the attributes of emotion, cognition with pain. A striking difference was observed between males and females, with the latter having overall HRQL utility scores similar to those reported previously for HIV positive, severe hemophiliacs. It is possible that this remarkable burden of morbidity reflects chronic iron deficiency associated with menorrhagia. A national study has been proposed to address this likelihood as it offers an opportunity for effective therapeutic intervention (iron supplementation) with a concomitant gain in health status and HRQL.
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