Different Levels Of Health Research Articles

Psychometric Comparison of the Standard EQ-5D to a 5 Level Version in Cancer Patients

The objectives of this study were: 1) to determine whether expanding the number of levels (ie, response categories) on the standard 3 level EQ-5D (EQ-5D-3L) to 5-levels (EQ-5D-5L) would improve the descriptive richness and ability of the measure to discriminate among different levels of health, and 2) to examine the psychometric properties of each EQ-5D version in patients with cancer. U.S.-based cancer patients self-assessed their health using EQ-5D-3L and EQ-5D-5L. These versions were compared in terms of ceiling effects, convergent validity based on correlations with ECOG performance status and FACT-G, discriminative ability using Rasch analysis, and informational richness using Shannon's Evenness Index (J'). A ceiling effect was observed among a greater proportion of respondents to EQ-5D-3L, n=74/424 (17%), compared with EQ-5D-5L, n=47/424 (11%). Within the midlevel of EQ-5D-3L (some problems), substantial partitioning of the sample into the 3 nonextreme levels of the EQ-5D-5L was observed across dimensions. EQ-5D-5L demonstrated a trend towards slightly stronger correlations with ECOG performance status compared with EQ-5D-3L for all dimensions of health, ie, rs (5L/3L): rmobility=0.38/0.31; rself-care=0.35/0.31; rusual activities=0.55/0.47; rpain/discomfort=0.43/0.37; ranxiety/depression=0.23/0.16; rcrude summary score=0.56/0.49. EQ-5D-5L demonstrated a greater relative efficiency and ability to discriminate different levels of health. Informational richness and evenness of EQ-5D-5L was slightly higher (J'5L=0.75) than EQ-5D-3L (J'3L=0.69). Evidence supported the validity of both EQ-5D-3L and EQ-5D-5L in cancer. However, results suggest a 5-level classifier system has less ceiling effect and greater discriminative ability with potentially more power to detect differences between groups compared with EQ-5D-3L.

Design options for sample-based mortality surveillance

Reliable information on causes of death is a fundamental component of health development strategies, yet globally only about one-third of countries have access to such information. For countries currently without adequate mortality reporting systems there are useful models other than resource-intensive population-wide medical certification. Sample-based mortality surveillance is one such approach. This paper provides methods for addressing appropriate sample size considerations in relation to mortality surveillance, with particular reference to situations in which prior information on mortality is lacking. The feasibility of model-based approaches for predicting the expected mortality structure and cause composition is demonstrated for populations in which only limited empirical data is available. An algorithm approach is then provided to derive the minimum person-years of observation needed to generate robust estimates for the rarest cause of interest in three hypothetical populations, each representing different levels of health development. Modelled life expectancies at birth and cause of death structures were within expected ranges based on published estimates for countries at comparable levels of health development. Total person-years of observation required in each population could be more than halved by limiting the set of age, sex, and cause groups regarded as 'of interest'. The methods proposed are consistent with the philosophy of establishing priorities across broad clusters of causes for which the public health response implications are similar. The examples provided illustrate the options available when considering the design of mortality surveillance for population health monitoring purposes.

Democracy and health

Scholars of population and global health have grappled for decades with the complex relationship between health and its determinants. This growing literature has taught us much about proximal and distal health determinants, especially those in the socio-economic realm. Economics as it relates to health, in particular, has received considerable and recent investigation,1 but mounting evidence suggests that a country's economic status alone cannot entirely explain differences in health and health policy.2–8 Thus, societies with similar levels of economic development, such as Afghanistan and the Indian state of Kerala, can have radically different levels of health and health system development. It is therefore important to extend our analysis to broader structural factors, such as political institutions, to better understand global health inequalities. A country's political structure affects virtually every aspect of society, including health. There are few studies on the relationship between political institutions and health, at both theoretical and empirical levels9–11. One reason must certainly stem from the complexity of the health-politics nexus and the difficulty of identifying independent and interactive influences in both directions. The relationship can be defined in many ways, ranging from the study of political systems (e.g. democratic or authoritarian, legislative and executive governance, proportional or majoritarian electoral systems, constitutional structure); culture (e.g. political values); institutions (e.g. centralized or fragmented, presidential or parliamentary, responsiveness to citizenry, political parties); state capacity (technical and administrative capacity, level of corruption); and philosophy, to more nuts-and-bolts political process factors, such as personal politics (e.g. political leadership, powerful personalities, presidential tactics), political strategy and interest group representation (e.g. its strength or weakness in a political system). More recent influences on health policy include re-election incentives, financial contributions (e.g. in the US), and the depth and range of public opinion.12,,13 A recent issue of the …

The relative sensitivity of willingness‐to‐pay and time‐trade‐off to changes in health status: an empirical investigation

This paper directly compares the relative sensitivity of time-trade-off (TTO) and willingness-to-pay (WTP) values obtained for various levels of change in health status. This was achieved by administering a TTO and WTP survey to a population of 50 subjects, assessing their valuation of various degrees of change in health status. It was found that, overall, WTP is more sensitive than TTO in distinguishing between different dimensions of health at the same nominal level of health status (only four WTP values not significantly different, compared with eight TTO values). In addition, WTP was also more sensitive to differences in quality of life between different levels of health within each dimension (all values significantly different from each other, with TTO yielding three insignificant relationships). These results tentatively suggest, therefore, that WTP seems to be a more sensitive measure of change in health status than TTO.

Measuring Population Health: Correlates of the Health Utilities Index Among English and French Canadians

This study used cross-sectional data from the 1994/95 National Population Health Survey (NPHS) in Canada. The objective of the study was to examine the relationship between several established correlates of health status in the general population and the Health Utilities Index (HUI), a multi-dimensional, preference-based measure of health status. Analyses were carried out separately for the English-speaking (n = 9,853) and French-speaking (n = 1,519) respondents. The index correlated strongly with self-ratings of health status and functional disability and varied as expected according to age, sex, and income. Subjects classified to different categories of chronic conditions reported different levels of health, as predicted. The HUI was also associated with the use of drugs and recent history of hospitalization. No major differences in the findings were observed between the two cultural groups. The results should be treated with caution due to the cross-sectional design and other methodological limitations of the study.

Beta-Blockade and Response to Exercise: Influence of Training.

In brief: Beta-blockers and exercise training are recommended for treating cardiovascular disease and hypertension, and researchers have tried to determine the interaction of these two treatment modalities. Data from four studies conducted on 93 subjects over the past five years show that beta-blockade exerts a differential effect on the exercise capacity of subjects of different levels of health and fitness: It increases the capacity of angina patients; decreases the capacity of highly trained, fit individuals; and has little or no effect on the capacity of healthy, untrained individuals.

Measurement of values for states of health with linear analog scales.

Medical decisions may be greatly influenced by the values that patients place on different states of health. Previous attempts to obtain quantitative estimates of such values have assumed the numerical values assigned to different levels of health will remain constant regardless of the context in which the measurement is made. To examine this assumption, 64 ambulatory patients ranked five scenarios describing different states of health in order of preference. One of the scenarios was ranked as worse than death by 22 percent of raters, and two scenarios were ranked as worse than death by 31 percent of raters. The states were then rated using linear analog scales, first with the anchors or endpoints of perfect health and death, then with the anchor of perfect health replaced by each of the other health states, in descending order of preference, and finally with the anchor of death replaced by each of the other health states, in ascending order of preference. The numerical values assigned to scenarios were substantially and systematically influenced by the anchors on the scale. Relative to the values assigned to health states when anchors of perfect health and death were employed, the same states were assigned systematically higher values when the anchor of death was replaced by other health states, and systematically lower values when the anchor of perfect health was replaced. These findings persisted when states considered worse than death were excluded from the rating process. These results indicate that the quantitative values assigned health states are strongly influenced by the context in which the measurement is made, and that health cannot be regarded as a continuum with death as its lower boundary.

What's the Next Step afterMt. Laurel?

Abstract Since its beginnings, zoning has been at its core a tool for achieving exclusionary objectives. Judge Westenhaver, who wrote the lower court decision in Ambler Realty Co. u. Village of Euclid, 297 Fed. 307, 316 (N.D. Ohio 1924) invalidating the village's zoning ordinance, observed that its purpose “is really to regulate the mode of Living of persons who may here-after inhabit [the village]. In the last analysis, the result to be accomplished is to classify the population and segregate them according to their income or station in life.” In reversing his decision, Justice Sutherland classified apartments as “mere parasites … which would deprive children of the privilege of quiet and open spaces for play, enjoyed by those in more favored localities,” In effect, he held that the state's police power could be used to create different levels of health, safety and genera1 welfare for different classes of people. One level was adequate for the poor and another level could be enforced at the behest of the rich who could afford to buy homes in single-family, low-density districts. Even Justice Douglas, a most unlikely bedmate for Justice Sutherland, reflected the same attitude when he wrote recently.