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PubMed1990

Comparisons of five health status instruments for orthopedic evaluation.

This study represents a long-term effort to find optimal techniques for evaluating outcome in patients who have undergone total joint arthroplasty. Sensitivity of five health status questionnaires was studied in a longitudinal evaluation of orthopedic surgery. The questionnaires (Arthritis Impact Measurement Scales [AIMS], Functional Status Index [FSI], Health Assessment Questionnaire [HAQ], Index of Well Being [IWB], and Sickness Impact Profile [SIP]) were administered to 38 patients with end-stage arthritis at three points in time: two weeks before hip or knee arthroplasty, and at three-month and 12- to 15-month follow-up. Response values (i.e., changes within patients) were calculated on four scales: global health, pain, mobility, and social function. By the three-month follow-up, most instruments detected large mean responses in global health, pain scores, and mobility. Smaller changes on these scales were found between three and 12 to 15 months. Social function showed small to modest gains at successive follow-ups. Standardized response means were calculated to assess sensitivity to detect change. Confidence intervals for these indices were constructed using a jackknife procedure, and significance tests were performed by pairing selected indices. Finally, the study projected sample sizes required to assess a new therapy, using each response. These statistical tools facilitated comparisons among instruments and may prove useful in other settings.

Aged↗
PubMed2006

Outcome at 6 months after admission for pediatric intensive care: a report of a national study of pediatric intensive care units in the United kingdom.

OBJECTIVE: The goal was to measure, by using the Health Utilities Index, the health status of children 6 months after admission to PICUs in the United Kingdom. METHODS: All PICUs in the United Kingdom were invited to participate. Children who were > or = 6 months of age at admission and were discharged alive from participating units during a 1-year period were eligible for this study. Children with completed consent forms who had survived to 6 months after admission received the Health Utilities Index questionnaire. RESULTS: Admission data on 7214 admissions to 22 units were collected between March 2001 and February 2002. Of those patients, 6786 survived to unit discharge, and consent for follow-up contact was obtained for 2642. At 6 months after admission, the mortality rate was estimated at 11.1% and 2034 children were still alive and contactable. Of those children, Health Utilities Index questionnaires were returned by 1455. No impairment was indicated for 767, 951, 940, 919, 962, and 939 children with respect to the Health Utilities Index sensation, cognition, emotion, pain, mobility, and self-care attributes, respectively. The mean +/- SE Health Utilities Index utility score was 0.73 +/- 0.01, with 397 children (27.3%) in full health. CONCLUSIONS: Death after pediatric intensive care in the United Kingdom is uncommon, making assessment of health status important. At 6 months after admission, there is significant morbidity. To assess the impact of strategies to improve or to optimize care on longer-term outcomes, standardized collection of data on preexisting comorbidities and illness severity is required.

Child↗
PubMed1978

Patient outcomes in alternative long-term care settings.

The purpose of this study was to compare health status outcomes in three alternative long-term care settings in the Veterans Administration : 1) home care; 2) community-based nursing home care; and 3) hospital-based nursing home care. Patients were measured on a behavioral index of health status, at two points in time: when transferred from the acute care hospital to one of the three treatment programs (pretest and three months later (posttest). Since patients could not be randomly distributed to programs, two methods were employed to control for potential sample selection bias: the choice of a nonequivalent control group design, and multivariate analytic techniques. First, within each program type, patients were randomly selected from both a hospital that offered only that program as a long-term care alternative and from a hospital that provided all three treatment settings. Second, multiple regression analysis was used to control for pretest differences among patients. Patients placed in the home care program displayed the greatest mean improvement in functional health status, holding all other variables constant. This treatment effect was not uniform, however; patients showed differential rates of improvement across the three programs, based upon both initial health status and prognosis.

Adult↗
PubMed1988

The association of health with stressful life changes, social supports, and coping.

Cross-sectional associations of social stressors, social supports, and coping strategies with health status were explored in a self-selected sample of 157 white adults. Using a mailed questionnaire, stressful life changes were assessed by a 40-item version of the Social Readjustment Rating Scale, social supports were measured by a 13-item index, and health status was assessed by the 63-item Duke-UNC Health Profile (DUHP). Responses to a recent stressful event were categorized by method of coping and by focus of coping. In a multivariate analysis controlling for the effects of age, gender, and education level, higher 12 month life change score was related to lower composite DUHP score. The use of active-cognitive coping was directly associated and the use of avoidance-coping was inversely associated with health status. When interaction terms were included in the multivariate analysis, avoidance-coping potentiated the adverse health effect of stressors and weak social supports potentiated the harmful effect of avoidance-coping on health. The findings suggest that the propensity to engage in avoidant behavior in response to a stressful experience is associated with health impairment, particularly when social supports are weak.

Adaptation, Psychological↗
PubMed1998

Validation of a self-report measure of somatic health.

The primary purpose was to assess the validity of a new self-report inventory of general somatic health status. In addition, we sought to examine the influence of social desirability and negative affectivity on health reports and to learn whether asking respondents to report concrete, memorable aspects of illness episodes such as seeing a doctor or staying home in bed for all or most of a day would enhance validity. The somatic component of the Cornell Medical Index was used as a criterion measure of health status because that Index has been shown to reflect medical records with great accuracy. Scores on the new health inventory correlated highly with the Cornell somatic scores, and this relationship was independent of negative affectivity and social desirability. The addition of the "concrete, memorable" aspects of illness accounted for no additional variance in the Cornell Index somatic scores beyond that accounted for by mere reporting of the presence of the symptom or illness. This study offers evidence supporting the validity of the Inventory of Health Status as a predictor of somatic health independent of social desirability and negative affectivity and also indicates that a simple indication of whether the patient had the symptoms is sufficient.

Adult↗
PubMed1999

Randomised controlled trial of effectiveness of Leicester hospital at home scheme compared with hospital care.

OBJECTIVE: To compare effectiveness of patient care in hospital at home scheme with hospital care. DESIGN: Pragmatic randomised controlled trial. SETTING: Leicester hospital at home scheme and the city's three acute hospitals. PARTICIPANTS: 199 consecutive patients referred to hospital at home by their general practitioner and assessed as being suitable for admission. Six of 102 patients randomised to hospital at home refused admission, as did 23 of 97 allocated to hospital. INTERVENTION: Hospital at home or hospital inpatient care. MAIN OUTCOME MEASURES: Mortality and change in health status (Barthel index, sickness impact profile 68, EuroQol, Philadelphia geriatric morale scale) assessed at 2 weeks and 3 months after randomisation. The main process measures were service inputs, discharge destination, readmission rates, length of initial stay, and total days of care. RESULTS: Hospital at home group and hospital group showed no significant differences in health status (median scores on sickness impact profile 68 were 29 and 30 respectively at 2 weeks, and 24 and 26 at 3 months) or in dependency (Barthel scores 15 and 14 at 2 weeks and 16 for both groups at 3 months). At 3 months' follow up, 26 (25%) of hospital at home group had died compared with 30 (31%) of hospital group (relative risk 0. 82 (95% confidence interval 0.52 to 1.28)). Hospital at home group required fewer days of treatment than hospital group, both in terms of initial stay (median 8 days v 14.5 days, P=0.026) and total days of care at 3 months (median 9 days v 16 days, P=0.031). CONCLUSIONS: Hospital at home scheme delivered care as effectively as hospital, with no clinically important differences in health status. Hospital at home resulted in significantly shorter lengths of stay, which did not lead to a higher rate of subsequent admission.

Adult↗
PubMed1993

Evaluation of indicators for use in vitamin A intervention trials targeted at women.

This paper examines the ability of three indicators to detect changes in women's vitamin A status. Serum retinol concentration, milk vitamin A concentration, and milk vitamin A per gram milk fat were used to assess the vitamin A status of mildly deficient Indonesian women before and after supplementation in a randomized intervention trial. Choice of indicator made a fourfold difference in the sample size required to measure a statistically significant change in vitamin A status. Milk vitamin A per gram milk fat was the best indicator of response, milk vitamin A concentration was intermediate, and serum retinol concentration performed most poorly. Serum retinol concentration was equally responsive across the range of vitamin A status in this population. The milk indicators were more responsive among women of lower status than women of higher status. Milk vitamin A is an efficient indicator for monitoring the effects of vitamin A interventions in women.

Adult↗
PubMed2005

Breakfast and the diets of Australian adults: an analysis of data from the 1995 National Nutrition Survey.

The aim of this study was to describe the nutrients provided to Australian adults by the breakfast meal and to compare the food and nutrient intakes and health of regular breakfast eaters and breakfast skippers. The Australian Bureau of Statistics was commissioned to undertake additional analysis of data collected in the 1995 Australian National Nutrition Survey (NNS). The survey included 24-h recalls, physical measurements and a food habits questionnaire collected during the period February 1995-March 1996, with a nationally representative sample of 10,851 Australians aged 19 years and older. The median nutrient intakes at breakfast and the proportion of the daily total contributed by breakfast were calculated. Differences between regular breakfast eaters and breakfast skippers in terms of nutrient intake, body mass index and health status were compared using Student t-tests. The findings show the typical Australian breakfast was low in fat, high in carbohydrate and a good source of thiamin, riboflavin, niacin, calcium and magnesium. In the NNS regular breakfast eaters had more adequate diets overall, particularly those aged 65+ years. People who did not eat breakfast cereal were much more likely to have inadequate nutrient intakes, especially of thiamin, riboflavin, calcium, magnesium and iron. Regular breakfast eaters were more likely to rate their health as excellent or good than those who skip breakfast, but there was no difference between the fat intake or the body mass index of regular breakfast eaters compared with breakfast skippers. Regular breakfast consumption is associated with better diets for adults overall.

Adult↗
PubMedDate not supplied

Health status of the rural elderly according to farm work history: the Iowa 65 + rural health study.

In a geographically defined survey of 3,097 rural Iowans who were at least 65 yr of age, we examined the association between prior farm experience (greater than or equal to 25 yr) and various measures of current health status; we controlled for age, current working status, and, where appropriate, smoking and alcohol consumption. Health status was indexed by self-reported morbid conditions, symptoms, and physical function. After controlling for smoking behavior, it was found that both men and women with previous farm exposure currently experience a greater prevalence of all nine respiratory symptoms employed in the study relative to non-farmers. Farm men report a lower prevalence of Parkinson's disease and prostate conditions, but report a greater prevalence of stroke and a lower level of self-perceived health status. Women with a farm work history experience a greater level of physical function and fewer symptoms associated with mental illness. Overall significant benefits as well as risks associated with a history of farm work were identified. However, of those who survived to age 65, extended exposure to farm work did not have a major impact on the overall current health status of men and women.

Activities of Daily Living↗
PubMed1996

Randomised controlled trial of general practitioner versus usual medical care in an urban accident and emergency department: process, outcome, and comparative cost.

OBJECTIVE: To see whether care provided by general practitioners to non-emergency patients in an accident and emergency department differs significantly from care by usual accident and emergency staff in terms of process, outcome, and comparative cost. DESIGN: A randomised controlled trial. SETTING: A busy inner city hospital's accident and emergency department which employed three local general practitioners on a sessional basis. PATIENTS: All new attenders categorised by the triage system as "semiurgent" or "delay acceptable." 66% of all attenders were eligible for inclusion. MAIN OUTCOME MEASURES: Numbers of patients undergoing investigation, referral, or prescription; types of disposal; consultation satisfaction scores; reattendance to accident and emergency department within 30 days of index visit; health status at one month; comparative cost differences. RESULTS: 4684 patients participated. For semiurgent patients, by comparison with usual accident and emergency staff, general practitioners investigated fewer patients (relative difference 20%; 95% confidence interval 16% to 25%), referred to other hospital services less often (39%; 28% to 47%), admitted fewer patients (45%; 32% to 56%), and prescribed more often (41%; 30% to 54%). A similar trend was found for patients categorised as delay acceptable and (in a separate analysis) by presenting complaint category. 393 (17%) patients who had been seen by general practitioner staff reattended the department within 30 days of the index visit; 418 patients (18%) seen by accident and emergency staff similarly reattended, 435 patients (72% of those eligible) completed the consultation satisfaction questionnaire and 258 (59% of those eligible) provided health status information one month after consultation. There were no differences between patients managed by general practitioners and those managed by usual staff regarding consultation satisfaction questionnaire scores or health status. For all patients seen by general practitioners during the study, estimated marginal and total savings were Ir1427 pounds and Ir117,005 pounds respectively. CONCLUSION: General practitioners working as an integral part of an accident and emergency department manage non-emergency accident and emergency attenders safely and use fewer resources than do usual accident and emergency staff.

Adult↗