Average Physical Health Research Articles

One-Year Results After Implantation of the CorCap for Dilated Cardiomyopathy and Heart Failure

We conducted a prospective study of the clinical outcomes and health-related quality of life after implantation of the CorCap support device (Acorn Cardiovascular Inc, St Paul, MN) for dilated cardiomyopathy. The criteria adopted for CorCap implantation were dilated cardiomyopathy (left ventricular [LV] end-diastolic diameter≥60 mm, LV ejection fraction≤0.30 and >0.10), and New York Heart Association functional class II or III despite maximal medical therapy. Echocardiographic follow-up and evaluation with the Short Form-36 questionnaire were performed. Included were 39 patients: 5 in New York Heart Association class II and 32 in class III. At 13.3±2.5 months of follow-up, a statistically significant improvement was evident in mean LV volume (LV end-systolic volume from 202±94 to 138±72 ml. p=0.005) and systolic function (LV ejection fraction from 0.26±0.05 to 0.36±0.05, p<0.001). The mean LV sphericity index was significantly increased at the end of the follow-up (p=0.009). Ischemic etiology, diabetes, advanced age, and LV ejection fraction of less than 0.15 predicted lesser reversal of the LV alterations. Operative mortality was 5.1%. Cumulative follow-up mortality was 10.2%. The average Physical Health domain scores (Physical Functioning, Role Physical, General Health) were improved. Average Mental Health domain scores were also increased. The cardiac support device obtains reverse remodelling of the LV and is useful to improve the quality of life of patients with dilated cardiomyopathy and New York Heart Association class III symptoms of heart failure. The integration of different and complementary strategies (cardiac support device and resynchronization therapy) may represent the key to success for more complex patients, although further studies are required.

The Association Between Income Inequality and Mental Health: Testing Status Anxiety, Social Capital, and Neo-Materialist Explanations

The 'income inequality hypothesis' holds that beyond a certain level of gross domestic product (GDP) per capita, the association between absolute income, health and mortality weakens, and the distribution of income across a society becomes more important as a determinant of a range of outcomes including average mental and physical health. Recent reviews suggest that the empirical reality of the income inequality hypothesis is now established but fierce debate remains about what explains the association. In this article we describe three hypotheses that have emerged in the literature to explain the association—the social capital, the status anxiety and the neo-materialist hypotheses before operationalizing each, and testing their ability to explain the relationship between income inequality measured using the GINI coefficient and mental well-being measured using the WHO5 scale. We use multi-level models and data from the European Quality of Life Survey which contains information from 30 countries and over 35,000 individuals. Results give most support to the status anxiety and social capital hypotheses and almost no support to the neo-materialist hypothesis. Measures representing the social capital hypothesis reduce the coefficient measuring income inequality by 55% in high GDP countries and render it insignificant as well as providing the best fitting model as measured by AIC and BIC value. However, variables representing the status anxiety hypothesis reduce the income inequality coefficient by more in lower GDP countries.

Adult Household Smoking Is Associated With Increased Child Emotional and Behavioral Problems

Although maternal smoking has been associated with child emotional and behavioral problems, to our knowledge, no study has evaluated the association between overall household smoking and such problems. To investigate whether children who live with smokers are more likely than children who do not live with smokers to have emotional or behavioral problems and to explore this association in households with nonsmoking mothers. Nationally representative data from the 2000 to 2004 medical expenditure panel surveys, involving 30,668 children aged 5 to 17 years, were used. Associations between child emotional or behavioral problems and household smoking, and child, maternal, and family characteristics were examined. SUDAAN software was used to adjust for complex sampling design. Overall score on the Columbia Impairment Scale, a 13-item parent-report measure of child emotional or behavioral functioning (range, 0-52, >or=16 indicates a child with such problems). Children in smoking versus nonsmoking households were significantly more likely to have behavioral problems (17.39% vs 9.29%, p < .001). After adjusting for all covariates, male sex, older age of child, younger age of mother, unmarried mother, maternal depression, and below average maternal physical and mental health, each were independently associated with increased likelihood of emotional and behavioral problems, as was the presence of one or more adult smokers in the household (adjusted odds ratio 1.42; 95% confidence interval: 1.26-1.60). The odds of Columbia Impairment Scale score >or=16 increased with increasing number of smokers in the household, even among children whose mothers did not smoke. Children living with smokers are at increased risk for emotional or behavioral problems, and rates of such problems increase with increasing numbers of smokers in the household, even in the absence of maternal smoking.

Fit and Well at Eighty

While aging is associated with physical decline and increased risk of illness, older age is not inevitably a time of ill-being. Data from the Australian Longitudinal Study on Women's Health challenge negative stereotypes of aging and illness. While an accelerating decline in average physical health was observed over the first 6 years of the study, an important and large proportion of the women experienced minimal change in their physical health during this period. Also, while chronic disease was a strong risk factor for declining health, many women aged well in spite of longstanding medical conditions. This paper presents trends in health and illness as women age and explores some of the many physical, social, and healthcare factors that mark out those women who remain "fit and well."

Social inequalities in self reported health in early old age: follow-up of prospective cohort study

Objective To describe differences in trajectories of self reported health in an ageing cohort according to occupational grade.Design Prospective cohort study of office based British civil servants (1985-2004).Participants 10 308...

Using individual growth model to analyze the change in quality of life from adolescence to adulthood

BackgroundThe individual growth model is a relatively new statistical technique now widely used to examine the unique trajectories of individuals and groups in repeated measures data. This technique is increasingly used to analyze the changes over time in quality of life (QOL) data. This study examines the change from adolescence to adulthood in physical health as an aspect of QOL as an illustration of the use of this analytic method.MethodsEmploying data from the Children in the Community (CIC) study, a prospective longitudinal investigation, physical health was assessed at mean ages 16, 22, and 33 in 752 persons born between 1965 and 1975.ResultsThe analyses using individual growth models show a linear decline in average physical health from age 10 to age 40. Males reported better physical health and declined less per year on average. Time-varying psychiatric disorders accounted for 8.6% of the explained variation in mean physical health, and 6.7% of the explained variation in linear change in physical health. Those with such a disorder reported lower mean physical health and a more rapid decline with age than those without a current psychiatric disorder. The use of SAS PROC MIXED, including syntax and interpretation of output are provided. Applications of these models including statistical assumptions, centering issues and cohort effects are discussed.ConclusionThis paper highlights the usefulness of the individual growth model in modeling longitudinal change in QOL variables.

Functional outcome and quality of life of Gustilo IIIB open tibial fractures requiring free tissue transfers: A report of eight cases

Eight patients with type IIIB open tibial fractures requiring free tissue transfers were retrospectively reviewed. The functional outcome was evaluated by using a scoring system developed by Puno et al. (Microsurgery 17:167-173, 1996). Short Form 36 (SF-36) was used as a measurement of individuals' quality-of-life (QOL) scores. The average total score of all cases was 77.6. An excellent or good functional outcome was achieved in 37.5% (3/8). Six patients were evaluated by SF-36. The average physical health summary (T-PH) score was 47.9, the average mental health summary (T-MH) score was 53.5, and the average total general health summary (T-GH) score was 50.7. The mean T-MH score was significantly higher than the mean T-PH score (P < 0.05). Treated cases showed an acceptable QOL, considering the results of the T-GH. The mental QOL was higher than the physical QOL. In severe open tibial fractures, it is difficult to obtain a good or excellent functional outcome, even with reconstruction using free tissue transfers.

Factors associated with health status of older Americans.

health status is increasingly used as a measure of healthcare effectiveness. How diseases and symptoms are associated with health status is not completely understood. to find diseases, symptoms and demographic factors associated with physical and mental health status in older Americans. we analysed data from a survey of over 100 000 Medicare beneficiaries aged 65 and older. We used the short-form 36 physical and mental summary scores as measures of health status. Other data collected included demographic details, symptoms and diagnoses. age as a single variable explained 4% of variation in physical health status. Adding other demographic information and increased disease burden explained variation to 8% and 27% respectively. Together, shortness of breath, back pain, difficulty getting in and out of chairs, arthritis of hip or knee, a recent change in health and age explained 54% of variation. All available variables explained 59%. The role of age as an independent factor decreased markedly after disease and symptoms were considered. Similar factors were associated with lower mental health status, but age was not. these data suggest that heart and lung disease and back pain are the most important factors affecting the average physical health status of older people. Sex, marital status and race have very little independent effect. Efforts to improve average physical health status scores might best be targeted at these conditions rather than demographic characteristics. Mental health status does not decline with age, and similar factors affect it but to a lesser degree.

Role of One Day Epidural Adhesiolysis in Management of Chronic Low Back Pain: A Randomized Clinical Tria

Epidural fibrosis is seen as a common phenomenon among postlumbar laminectomy syndrome patients, contributing to approximately 60% of symptom recurrence. Percutaneous epidural lysis of adhesions has been described as a modality to effectively manage chronic low back pain secondary to epidural fibrosis. Forty-five patients were randomly assigned, with fifteen patients in the control group, or Group I, who were treated with conservative modalities of treatments, including medication, physical therapy, and an exercise program; and, thirty patients in Group II, who were treated with percutaneous epidural adhesiolysis and hypertonic saline neurolysis. The patients were evaluated over a period of 1 1/2 years to 3 years. Results showed that cumulative relief, defined as relief greater than 50% with one to three injections, in the treatment group was 97% at 3 months, 93% at 6 months, and 47% at 1 year. The study also showed that overall health status improved significantly in the treatment group in all parameters with average pain, physical health, mental health, functional status, psychological status and narcotic intake. Analysis also showed that this is a cost-effective treatment, with cost for 1-year improvement of quality of life at $2693. In conclusion, epidural adhesiolysis with hypertonic saline neurolysis performed on a 1-day basis is an effective modality of treatment in managing chronic low back pain in patients who failed to respond to fluoroscopically directed epidural steroid injections and also were demonstrated not to have facet joint mediated pain.

Women physicians and stress.

Most women physicians enjoy better than average physical health and lead satisfying and productive lives. However, higher than average rates of depression, anxiety, marital problems, and substance abuse have been reported by some, but not all, authors. This quantitative survey of 196 women physicians and qualitative focus groups with 48 other women physicians was conducted to determine perceptions of their health, stress, satisfaction, knowledge, and abuse rates in medical practice. Eight specialties plus family practice physicians participated. The average age was 44.1 years (SD 8.8, range 23-77). Seventy-four percent of women physicians were married, with children. Specialists and family physicians were similar in all demographic characteristics except that family physicians were more significantly likely to be divorced, separated, or widowed (p < or = 0.01). Specialists perceived their personal physical health to be better than that of family doctors (p < or = 0.05), and family physicians rated their medical knowledge better than that of specialists (p < or = 0.0001). Women physicians over age 50 or with children over age 19 reported the best mental health (p < or = 0.0001 and 0.003, respectively). Overall, 49% of women physicians reported usually having high levels of stress, 44% felt mentally tired, and 17% took antidepressant drugs. Seventy-three percent reported verbal abuse at work (71% in the last year), and 33% reported physical assault at work (11% in the last year). Focus groups identified three major sources of stress: high expectations, multiple roles, and work environment. These results are discussed and compared with the literature. Both personal and systemic strategies are required to solve the problems identified. Women physicians can facilitate the adoption of some of these strategies by sharing information about successes, challenges, and solutions.

Natural history of male psychological health, XIV: Relationship of mood disorder vulnerability to physical health.

A 55-year prospective study attempted to determine the antecedents and consequences of positive mental and physical health in adult men. A substudy was conducted to look at the late-life physical health of men selected to be as unlike men with major depressive disorder as possible. Of 237 men selected for health and followed since college, 64 undistressed men had never used mood-altering drugs or consulted a psychiatrist before the age of 50. The health at age 70 of these 64 men was compared with that of 20 men classified as depressed at age 70, 109 men classified as neither healthy nor depressed at age 70, and 44 men classified as having alcohol dependence or abuse at age 70. At age 70, the 64 undistressed men enjoyed significantly better health than the 109 men in the intermediate group. Only three (5%) of the 64 undistressed men were dead or disabled by age 70, compared with 30 (28%) of the 109 men in the intermediate group and nine (45%) of the 20 depressed men. The mean age of the subjects' maternal grandfathers at death also significantly differentiated the three groups. The differences in longevity among the three groups could not be explained by personality disorder, by cigarette, dietary, or alcohol abuse, or by longevity of the subjects' other first-degree ancestors. These findings lend support to the hypothesis that risk of affective disorder may lie along a continuum. At one extreme may be men with stable lifestyles, a lifelong resistance to mood disorder, and unusually good physical health in late life. At the other extreme of the continuum may be men with vulnerability to mood disorder and accelerated physical aging.

The Elderly and Poor in the Medical Outcomes Study

To the Editor. —The report of health outcomes for elderly and poor, chronically ill patients 1 provoked alarming headlines in the lay press: Aged, Poor Fare Worse in HMOs, Study Says. 2 However, the data presented by the authors support neither the conclusions of the article nor the subsequent headlines. We are especially troubled by this study's potential negative impact on the physician-patient relationships of the nation's 3.6 million Medicare risk beneficiaries. Our major concern about this study is the unequivocal language regarding the association between prepaid financing and worse health outcomes. In this study, changes in average physical and mental health scores were not statistically significant across either the age or poverty categories. Presumably, the sample size estimate was based on this analysis. It is the standard approach to analyzing such data, and it showed no difference. For this finding to be omitted from the Results section of the

Physicians' use of mood-altering drugs. A 20-year follow-up report.

Abstract A prospective study carried out over a 20-year period showed that a group of 45 physicians took more tranquilizers, sedatives and stimulants than 90 matched controls. As college sophomores both groups had been selected for the study because of better than average physical and psychologic health. The physicians drank alcoholic beverages and smoked cigarettes to the same extent as the controls.