Dimensions Of Health Status Research Articles

Multilevel analysis of covariation in socioeconomic predictors of physical functioning and psychological well-being among older people in rural Vietnam

BackgroundThere remains a lack of research on co-variation of multiple health outcomes and their socio-economic co-patterning, especially among the elderly. This papers aims to 1) examine the effects of different socio-economic factors on physical functioning and psychological well-being among older adults in a rural community in northern Vietnam; and 2) investigate the extent to which the two outcomes variables co-vary within individuals.MethodsWe analyzed the data from the WHO/INDEPTH study on global ageing and adult health conducted on 8535 people aged 50 years old and over in Bavi district of Vietnam in 2006. A multivariate response model was constructed to answer our research questions. The model treats the individual as a level two unit and the multiple measurements observed within an individual as a level one unit.ResultsLower physical functioning and psychological well-being were found in 1) women; 2) older people; 3) people with lower education level; 4) people who were currently single; 5) respondents from poorer household; and 6) mountainous dwellers compared to that in those of other category(ies) of the same variable. Socioeconomic factors accounted for about 24% and 7% of variation in physical functioning and psychological well-being scores, respectively. The adjusted correlation coefficient (0.35) indicates that physical functioning and psychological well-being did not strongly co-vary.ConclusionsThe present study shows that there exist problems of inequality in health among older adults in the study setting. This finding highlights the importance of analyzing multiple dimensions of health status simultaneously in inequality investigations.

Main dimensions of health status among the Chinese elderly

To analyze the dimensions of health status among the Chinese elderly. Through unbalanced sampling method, 16 219 elderly aged above 65 were sampled from 22 provinces of China. The activities of daily living (ADL), physical performance, cognitive function, self-reported health and life satisfaction were investigated. We conducted comparative dimensions of health analysis across age, genders and rural/urban residences. Among the male elderly aged 65-, 70-, 80-, 90- and 100-, 98.8% (730/739), 95.2% (1445/1518), 89.1% (1913/2147), 76.3% (1447/1897) and 51.6% (329/638) were ADL independent, respectively. The corresponding percentages among the female counterparts were 98.1% (654/667), 94.9% (1291/1361), 87.2% (1851/2124), 70.0% (1888/2699) and 46.8% (1136/2428), respectively (gender difference in ADL: chi(2) = 293.00, P < 0.01). Among the urban elderly aged 65-, 70-, 80-, 90- and 100-, the percentages were 98.0% (561/572), 93.6% (1090/1165), 85.5% (1413/1653), 69.3% (1311/1892) and 37.4% (434/1161) respectively. The corresponding percentages among the rural counterparts were 98.7% (823/834), 96.0% (1646/1714), 89.8% (2351/2618), 74.9% (2024/2704) and 54.1% (1031/1905) respectively (urban/rural difference in ADL: chi(2) = 85.97, P < 0.01). Among the male elderly aged 65-, 70-, 80-, 90- and 100-, 96.5% (713/739), 90.0% (1364/1516), 72.1% (1547/2145), 49.2% (929/1890) and 35.0% (218/623) had good cognitive function. The corresponding percentages among the female counterparts were 94.1% (627/666), 81.9% (1113/1359), 57.2% (1211/2116), 32.4% (870/2688), 17.5% (418/2395) respectively (gender difference in cognitive function: chi(2) = 893.89, P < 0.01). Among the urban elderly aged 65-, 70-, 80-, 90- and 100-, the percentages were 97.0% (555/572), 87.9% (1023/1164), 68.5% (1129/1648), 43.6% (820/1881) and 23.0% (258/1124) respectively. The corresponding percentages among the rural counterparts were 94.2% (785/833), 85.0% (1454/1711), 62.3% (1629/2613), 36.3% (979/2679) and 20.0% (378/1894), respectively (urban/rural difference in cognitive function: chi(2) = 57.92, P < 0.01). Among the male elderly aged 65-, 70-, 80-, 90- and 100-, the self-reported good health were 56.3% (416/739), 50.7% (770/1518), 46.0% (988/2148), 42.7% (809/1897) and 43.1% (175/638). The corresponding percentages among the female counterparts were 48.7% (325/667), 46.1% (627/1361), 43.0% (914/2124), 39.3% (1061/2699) and 34.5% (838/2428). The male elderly of each age group reported better health than the female counterparts (chi(2) = 233.91, P < 0.01). Among the male elderly aged 65-, 70-, 80-, 90- and 100-, 56.2% (415/739), 56.0% (850/1518), 55.7% (1194/2418), 52.9% (1003/1897) and 50.5% (322/638) self-reported satisfied life. The corresponding percentages among the female counterparts were 54.9% (366/667), 55.8% (759/1361), 53.9% (1144/2124), 50.6% (1365/2699) and 43.4% (1054/2428). The elderly aged 65- have no significant gender difference in self-reported life (chi(2) = 0.51, P = 0.916), while the male elderly aged 70 and above reported more satisfied life than the female counterparts (chi(2) = 218.25, P < 0.01). Percentages of good physical performance and normal cognitive function dropped dramatically as age increased, but percentages of reporting good health and satisfied life decreased very slowly as age increased. Rural elderly were significantly more active in daily living than urban elderly. Female elderly were seriously disadvantaged in ADL, physical performance, cognitive function and self-reported health as compared with their male counterparts.

Health Outcomes and Socio-Economic Status Among the Elderly in China: Evidence from the Charls Pilot

We are concerned in this paper with measuring health outcomes among the elderly in Zhejiang and Gansu provinces, China, and examining the relationships between different dimensions of health status and measures of socio-economic status (SES). We use the China Health and Retirement Longitudinal Study (CHARLS) pilot data to document health conditions among the elderly in Gansu and Zhejiang provinces, where the survey was fielded. We use a very rich set of health indicators that include both self-reported measures and biomarkers. We also examine correlations between these health outcomes and two important indicators of socioeconomic status (SES): education and log of per capita expenditure (log pce), our preferred measure of household resources. While there exists a very large literature that examines the relationships between SES and health measures, little has been done on Chinese data to see whether correlations reported in many other countries are replicated in China, particularly so for the aged. In general education tends to be positively correlated with better health outcomes, as it is in other countries. However, unmeasured community influences turn out to be highly important, much more so than one usually finds in other countries. While it is not yet clear which aspects of communities matter and why they matter, we set up an agenda for future research on this topic. We also find a large degree of under-diagnosis of hypertension, a major health problems that afflicts the aged. This implies that the current health system is not well prepared to address the rapid aging of the Chinese population, at least not in Gansu and Zhejiang.

Health Outcomes and Socio-Economic Status Among the Elderly in China: Evidence from the CHARLS Pilot

This paper is concerned with measuring health outcomes among the elderly in Zhejiang and Gansu provinces, China, and examining the relationships between different dimensions of health status and measures of socio-economic status (SES). The authors use the China Health and Retirement Longitudinal Study (CHARLS) pilot data to document health conditions among the elderly in Gansu and Zhejiang provinces, where the survey was fielded. They use a very rich set of health indicators that include both self-reported measures and biomarkers. They also examine correlations between these health outcomes and two important indicators of socioeconomic status (SES): education and log of per capita expenditure (log pce), their preferred measure of household resources. While there exists a very large literature that examines the relationships between SES and health measures, little has been done on Chinese data to see whether correlations reported in many other countries are replicated in China, particularly so for the aged. In general education tends to be positively correlated with better health outcomes, as it is in other countries. However, unmeasured community influences turn out to be highly important, much more so than one usually finds in other countries. While it is not yet clear which aspects of communities matter and why they matter, they set up an agenda for future research on this topic. They also find a large degree of under-diagnosis of hypertension, a major health problems that afflicts the aged. This implies that the current health system is not well prepared to address the rapid aging of the Chinese population, at least not in Gansu and Zhejiang.

Gender Differences in Sleep Disruption among Retail Food Workers

As women pursue careers while retaining primary responsibility for family life, discretionary time is an emerging arena of gender inequality in contemporary life. This study examines gender inequality in waking role obligations and the implications for differences in sleep disruption. Drawing on a sample of 583 retail food workers, who regularly worked nights and rotating schedules, we find in our multivariate modeling that women experience significantly more sleep disruption than do men. A decomposition analysis shows that almost one-half of the gender gap in sleep disruption is accounted for by gender differences in health status and various dimensions of work-family context. By implication, the remainder of the gender gap in sleep disruption is attributable to differences in responsibility for work-family obligations. Given the need for more research on how work-family conflict affects health and well-being, further research on sleep patterns is warranted.

Is religiosity a protective factor? Social epidemiological study of adolescent psychological health

One of the important tasks of epidemiological analyses is mapping protective factors for health promotion. Religiosity is a protective factor which has an impact on all of the three dimensions of health status, among others, it goes together with a longer lifetime, better indicators of health status indicators and quality of life, less anxiety, depression and suicide, more effective coping strategies. In relation to adolescent health, less investigation has been available thus far. The main goal of the present study was to investigate the relationship between religiosity and psychological health among adolescents. Regarding religiosity, religious affiliation, religiousness (subjective level of religiosity) and religious participation were assessed. Among health status indicators, occurrence of depressive symptomatology, level of satisfaction with life and self-perceived health were determined. Data collection of the questionnaire survey was going on among 881 high school students in Szeged (age range between 14-20 years, mean = 16.6 years, S.D. = 1.3 years of age, 44.6% of the sample was female). Associations between health status indicators (as dependent variables) and religiosity factors (as independent variables) were assessed using Odds Ratios calculated by logistic regression analyses. Our findings suggest that youth's religiosity had the least effect on depressive symptomatology, whereas youth defined themselves as religious and those who actually participated at religious events perceived their own health better and they were more satisfied with their life. Girls tended to belong more to a religious community and their religiosity was more associated with life satisfaction and self-perceived health. Religiosity is a determinant factor in adolescent psychological health except for depression. Further research is needed to analyze protective factors related to adolescents' health status.

What is the Relationship Between Patients’ And Clinicians’ Reports of the Outcomes of Elective Surgery?

To identify studies in which patients' and clinicians' reports of health status and complications of one of four elective operations - hip and knee replacement, varicose vein surgery and groin hernia repair - are reported, and to describe the associations that have been reported between clinicians' and patients' reports. Systematic search of several bibliographic databases and review of citations of articles meeting inclusion criteria. A narrative summary of the findings was conducted. Most of the 62 studies of health status identified were for hip (23) or knee (33) disease. The literature on complications was even more limited with 12 studies of surgical site infection, one for urinary tract infection and none for lower respiratory tract infections. Procedure-specific complications were restricted to one for arthroplasties and three for hernia repair. Despite considerable variation in the findings of studies, some clear patterns emerge, albeit they are largely based on arthroplasty. Patients' and clinicians' views of health status generally correlate moderately (0.5-0.6) when both are reporting on the same dimension of health status. Inevitably this is confined to disability, though patients' and clinicians' reports of symptoms are also moderately correlated. In contrast, comparisons of different dimensions, such as patients' reports of disability and clinicians' reports of impairment, result in poor correlation (0.3). There is huge variation in the way postoperative complications are measured which limits the extent to which an overview can be undertaken. Despite that, moderate to strong correlations have been reported between patients' and clinicians' views of complications. Patients' views of their level of disability reflect clinicians' views and can be relied upon to assess this dimension of health status. In addition, patients are the 'gold standard' judges of symptoms and quality of life. Given these findings, clinicians, provider managers, commissioners and politicians can be confident that patients' reports provide an accurate indication of the outcome of elective surgery.

Different pathways in social support and quality of life between Korean American and Korean breast and gynecological cancer survivors

The purpose of this study was to investigate: (1) how social support influences quality of life (QOL) and (2) whether or not the pathways for predicting QOL outcomes differ between Korean American and Korean survivors of breast and gynecological cancer. To identify multiple dimensions of health status and psychosocial outcomes, two standardized QOL and psychological distress measures were administered to 51 Korean Americans and 110 Koreans. Social support was measured by items assessing functional social support and social network structures. Hierarchical multiple regression and path analyses were employed to investigate the effects of social support on outcomes and to compare between Korean Americans and Koreans. The findings indicate that functional social support directly influences QOL and psychological distress, and social network structures are directly and/or indirectly associated with outcomes. Moreover, the two groups showed different pathways from social support to outcomes. This study provides practical research information by illuminating the relationships between social support components influencing QOL for Korean American and Korean survivors. This study may increase the utility and efficacy of the research and interventions to enhance cancer survivors' social participation and to diminish barriers to follow-up care, considering the different living conditions between the United States and Korea.

A six-year descriptive analysis of hospitalisations for ambulatory care sensitive conditions among people born in refugee-source countries

BackgroundHospitalisation for ambulatory care sensitive conditions (ACSHs) has become a recognised tool to measure access to primary care. Timely and effective outpatient care is highly relevant to refugee populations given the past exposure to torture and trauma, and poor access to adequate health care in their countries of origin and during flight. Little is known about ACSHs among resettled refugee populations. With the aim of examining the hypothesis that people from refugee backgrounds have higher ACSHs than people born in the country of hospitalisation, this study analysed a six-year state-wide hospital discharge dataset to estimate ACSH rates for residents born in refugee-source countries and compared them with the Australia-born population.MethodsHospital discharge data between 1 July 1998 and 30 June 2004 from the Victorian Admitted Episodes Dataset were used to assess ACSH rates among residents born in eight refugee-source countries, and compare them with the Australia-born average. Rate ratios and 95% confidence levels were used to illustrate these comparisons. Four categories of ambulatory care sensitive conditions were measured: total, acute, chronic and vaccine-preventable. Country of birth was used as a proxy indicator of refugee status.ResultsWhen compared with the Australia-born population, hospitalisations for total and acute ambulatory care sensitive conditions were lower among refugee-born persons over the six-year period. Chronic and vaccine-preventable ACSHs were largely similar between the two population groups.ConclusionContrary to our hypothesis, preventable hospitalisation rates among people born in refugee-source countries were no higher than Australia-born population averages. More research is needed to elucidate whether low rates of preventable hospitalisation indicate better health status, appropriate health habits, timely and effective care-seeking behaviour and outpatient care, or overall low levels of health care-seeking due to other more pressing needs during the initial period of resettlement. It is important to unpack dimensions of health status and health care access in refugee populations through ad-hoc surveys as the refugee population is not a homogenous group despite sharing a common experience of forced displacement and violence-related trauma.

Mind—Body—Spirit Practice and Perceived Self-Efficacy for Mental Health Promotion: An Exploratory Study

An increasing number of adults are exploring community-based alternative and complementary health care as a method for stress reduction and health promotion. This study explores the multidimensional impact of mind—body—spirit (MBS) practice on psychological wellbeing (mind), health (body), and spirituality and altruistic behaviors (spirit). It describes the benefits and challenges of holistic MBS practices and presents MBS as a possible intervention. The study's respondents included 357 adults who regularly practiced MBS techniques of yoga, meditation, and tai chi. Hierarchical regression analysis was performed to determine the relative importance of three categories of predictors (demographics, MBS practice, self-efficacy) on outcome variables (health status, depression, life satisfaction, spiritual experiences, and altruistic behaviors). The findings of this study suggest that MBS practice variables can influence certain dimensions of health status. In particular, perceived MBS self-efficacy became the ...

A Health Profile of Community-Living Nonagenarians in Canada

Due to increasing life expectancy over time, persons who live into their ninety, known as nonagenarians, are an important and growing segment of the Canadian population. In 2001, there were 130,325 nonagenarians (compared to 3,795 centenarians), and it is estimated that they will top 400,000 by 2026. This paper provides a health profile and an exploratory analysis of selected social determinants of health for community-living nonagenarians, using the 2001 Canadian Community Health Survey (Statistics Canada, 2003). Perceived health, selection of prevalent chronic illnesses, and several health behaviours are examined. One dominant pattern is the tendency for male nonagenarians to be in better health than their female counterparts. This finding is consistent with research on centenarians and is discussed in terms of a mortality selection effect. Other key findings include the strength of sense of belonging, income, and physical activity as potential social determinants of health, connected to particular dimensions of health status.

Religion, spirituality, and depressive symptoms in patients with HIV/AIDS

Depression has been linked to immune function and mortality in patients with chronic illnesses. Factors such as poorer spiritual well-being has been linked to increased risk for depression and other mood disorders in patients with HIV. We sought to determine how specific dimensions of religion, spirituality, and other factors relate to depressive symptoms in a contemporary, multi-center cohort of patients with HIV/AIDS. Patients were recruited from 4 medical centers in 3 cities in 2002 to 2003, and trained interviewers administered the questionnaires. The level of depressive symptoms was measured with the 10-item Center for Epidemiologic Studies Depression (CESD-10) Scale. Independent variables included socio-demographics, clinical information, 8 dimensions of health status and concerns, symptoms, social support, risk attitudes, self-esteem, spirituality, religious affiliation, religiosity, and religious coping. We examined the bivariate and multivariable associations of religiosity, spirituality, and depressive symptoms. We collected data from 450 subjects. Their mean (SD) age was 43.8 (8.4) years; 387 (86.0%) were male; 204 (45.3%) were white; and their mean CD4 count was 420.5 (301.0). Two hundred forty-one (53.6%) fit the criteria for significant depressive symptoms (CESD-10 score > or = 10). In multivariable analyses, having greater health worries, less comfort with how one contracted HIV, more HIV-related symptoms, less social support, and lower spiritual well-being was associated with significant depressive symptoms (P<.05). A majority of patients with HIV reported having significant depressive symptoms. Poorer health status and perceptions, less social support, and lower spiritual well-being were related to significant depressive symptoms, while personal religiosity and having a religious affiliation was not associated when controlling for other factors. Helping to address the spiritual needs of patients in the medical or community setting may be one way to decrease depressive symptoms in patients with HIV/AIDS.

Improved perceived health status persists three months after a special sports camp for children with congenital heart disease

Although summer and sports camps for children with congenital heart disease are organized in many countries and regions, empirical data on the effects of such camps is limited. The aim of the present study was to investigate changes in the perceived health status and habitual physical activities in children attending a special sports camp. In this longitudinal study, 25 children with congenital heart disease who participated in a three-day multi-sports camp were included. The perceived health status was measured using the Child Health Questionnaire-Child Form, CHQ-CF87, completed by the child at the start of the camp (T1), at the end of the camp (T2), and 3 months after the camp concluded (T3). Habitual physical activities were assessed by means of a modified version of the Baecke questionnaire, which was completed by one of the parents at T1 and T3. During the sports camp, we observed significant improvements in the children's perception of their physical functioning, role-physical functioning, general health, role-emotional functioning, self-esteem, mental health, and general behavior. For physical functioning, role-emotional functioning, and family activities, high scores persisted three months after the sports camp concluded. The habitual physical activities (sport and leisure time) of the children remained unchanged. In conclusion, we propose that a special sports camp for children with congenital heart disease may improve specific dimensions of subjective health status. Our study confirms a previous report on the benefits of such camps for afflicted children. If these findings can be further corroborated in other settings, participation in sport camps should be advocated as a simple, noninvasive means to promote healthier children.

Functional assessment of pediatric pain patients: Psychometric properties of the Functional Disability Inventory

The Functional Disability Inventory (FDI; Walker LS, Greene JW. The functional disability inventory: measuring a neglected dimension of child health status. J Pediatr Psychol 1991;16:39–58) assesses activity limitations in children and adolescents with a variety of pediatric conditions. This study evaluated the psychometric properties of the FDI in pediatric pain patients. Participants included 596 patients with chronic abdominal pain, ages 8–17, and a subset of their parents ( n = 151) who completed the FDI and measures of pain, limitations in school activities, and somatic and depressive symptoms at a clinic visit. Test–retest reliability was high at 2 weeks (child report, .74; parent-report, .64) and moderate at 3 months (child report, .48; parent report, .39). Internal consistency reliability was excellent, ranging from .86 to .91. Validity was supported by significant correlations of child- and parent-report FDI scores with measures of school-related disability, pain, and somatic symptoms. Study results add to a growing body of empirical literature supporting the reliability and validity of the FDI for functional assessment of pediatric patients with chronic pain.

Measurement of Outcome: A Proposed Scheme

The need to demonstrate that health care has an influence on health status is increasingly pressing. Such demonstrations require tools of measurement which are unfortunately not available. Development of instruments has been hampered by a lack of consensus on appropriate frames of reference, and there appears to be little agreement on what should be measured and what relative importance should be ascribed to different dimensions of health status. An approach that does not require the assignment of numerical values or weights to various aspects of health status and is applicable to all age groups within the population and to the whole spectrum of health problems rather than to specific medical diagnoses would seem desirable. A scheme that is based upon the development of a “profile” rather than a single “index” for describing health status is proposed in this paper. The model is a conceptual framework whose usefulness will depend upon efforts of a large number of researchers from many disciplines to develop instruments which can be incorporated in it.Although the problems in development of the scheme are complex, I hope that it will focus attention on the relevant dimensions and facilitate improved coordination of efforts to produce ways to demonstrate what health care contributes to health.

Quality of Life in Patients with Thalassemia Intermedia Compared to Thalassemia Major

The impact of thalassemia major and thalassemia intermedia and their associated complications on quality of life (QOL) is largely unknown. Determining the degree of health impairment as perceived by the patient is essential information needed to recommend suitable therapy. The objective of this study was to evaluate QOL in transfusion-independent patients with thalassemia (non-Tx) compared with that in transfused patients (Tx) and to identify the factors that affect QOL in thalassemia. A convenient sample of 48 thalassemia patients (29 Tx and 19 non-Tx) with mean age of 14.6 years (SD = 7.5 years) were selected during a comprehensive visit to complete a Dartmouth Primary Care Cooperative Information Chart System (COOP) questionnaire. Patients rated QOL from excellent (1) to poor (5) on five dimensions of health status. Scores of 4 or 5 represent major limitations. These results were augmented by a brief medical history and chart review. Forty-one percent of Tx patients and 47% of non-Tx patients reported severe impairments in 1-6 and 1-2 domains, respectively. The most commonly reported affected domains were feelings such as anxiety, depression, and concern of overall health status or indications of recent deterioration in health. In contrast with previous beliefs, transfusion-independent thalassemia patients also suffer serious impairment in QOL. Presented data suggest that all patients with thalassemia undergo QOL assessment so that interventions focused on affected domains can be implemented.

Agreement Between Patient and Proxy Responses of Health‐Related Quality of Life After Hip Fracture

To examine agreement between patient and proxy respondents on health-related quality of life (HRQL) over time during the 6-month recovery after hip fracture. Prospective longitudinal cohort study. A healthcare region serving Edmonton, Alberta, and the surrounding area. Two hundred forty-five patients aged 65 and older, were treated for hip fracture, and had Mini-Mental State Examination scores greater than 17; 245 family caregivers participated as proxy respondents. Primary outcome was HRQL (Health Utilities Mark 2 and Mark 3). Interviews were completed within 5 days after surgery and at 1, 3, and 6 months. Agreement was evaluated using intraclass correlation coefficients (ICCs). Agreement was considered moderate to excellent for HRQL. ICC values ranged from 0.50 to 0.85 (P<.001) for physically based observable dimensions of health status and from 0.32 to 0.66 (P<.01) for less-observable dimensions. Agreement improved with time. Time and the number of days between patient and proxy interviews were significant factors in accounting for patient-proxy differences. Although proxy and patient responses are not interchangeable, proxy responses provide an option for assessing function and health status in patients who are unable to respond on their own behalf.

The Validity of QALYs under Non‐Expected Utility

This paper examines applications of non-expected utility in the health domain. The most widely used utility model in health economics, the time-linear QALY model, assumes (i) separability of quality of life and life duration, and (ii) linearity of the utility for life duration. We perform new tests, which are robust to violations of expected utility, of these two assumptions. The data support separability, but show that the utility for life duration is concave rather than linear. The finding of concave utility may not be surprising in itself. The contribution of this paper is to demonstrate this empirically without being invalidated by violations of expected utility. It has by now been widely recognised that expected utility is not valid as a descriptive theory of decision under uncertainty. The descriptive violations of expected utility have led to the emergence of several non-expected utility theories. The increasing importance of non-expected utility makes it necessary to reassess applications that were previously based on expected utility. Examples of such reassessments include Karni and Safra (1989), Crawford (1990) and Dekel et al. (1991) for game theory, Machina (1995) and Wakker et al. (1997) for insurance theory and Cubitt and Sugden (1998) for the evolution of preferences. See Starmer (2000) for a review. The present paper examines applications of non-expected utility in the health domain. We focus on the main utility model in health economics, the quality-adjusted life-years (QALY) model, and present new theoretical foundations for, and empirical tests of this model under non-expected utility. QALYs provide a simple way to combine the two dimensions of health, life duration and health status, into a single utility index. They are intuitively appealing, which facilitates communication to policy makers, and analytically tractable, which explains their widespread use in practical studies. A disadvantage of QALYs is that they only represent individual preferences over health under strong assumptions. If these assumptions do not hold, then the use of QALYs may lead to incorrect policy recommendations. To gain insight into the validity of QALYs, it is necessary to assess the restrictiveness of the assumptions that the QALY model imposes. In the most common version of the QALY model, the time-linear QALY model, the utility of the health outcome of spending t years in health state q is equal to tV(g), where V is a utility function over health states. That is, in the time-linear QALY model the utility for duration is linear. It is well known that under expected utility, linearity of utility implies risk neutrality. As it turns out, risk neutrality with

Do Patients Consistently Report Comorbid Conditions Over Time?

Comorbidity is an important dimension of patient health status. However, limited attention has been given to assessing the reliability of patient-reported data on comorbid conditions. We sought to evaluate the consistency of self-report of 12 comorbid conditions at 3 distinct time points and examine the sociodemographic, clinical, health status, and survey factors associated with reliability. We undertook a longitudinal cohort analysis of survey and medical record abstract data obtained from a population-based sample of 3095 prostate cancer survivors. Consistent and inconsistent response patterns were assessed using descriptive statistics and regression modeling. More than half of the cohort demonstrated consistent responses to all comorbid condition questionnaire items. Arthritis had the highest (13%) and liver disease the lowest (1%) proportion of inconsistent responses. Older age, lower income, and poorer general and mental health status were significant predictors of inconsistent responses. Subset analyses of the 4 most prevalent comorbid conditions (ie, arthritis, diabetes, hypertension, and depression) showed that respondents who reported that they were limited by, or taking prescription medicine for, the condition were more likely to provide consistent responses than those neither limited nor taking medicine. Response consistencies of 92% or better were obtained for 11 of the 12 conditions. Men with a relatively recent prostate cancer diagnosis are generally able to provide reliable reports of their concomitant health conditions. To increase the likelihood of obtaining reliable data, investigators should consider ascertaining condition severity and current medical management when querying subjects about comorbid conditions in surveys.

P39 Evaluation of patient oriented outcome using SF‐36 in halitosis therapy

Objective To evaluate the patient oriented outcome of medical interventions, Medical Outcome Study Short Form‐36 (SF‐36) is a widely used, self‐administered questionnaire. The SF‐36 has eight dimensions of health status consisting of Physical Function (PF), Role‐ Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), SF (Social Function), Role‐ Emotion (RE) and Mental Health (MH). Furthermore, each dimensional score and two summary scores about physical and mental regions can be calculated by the algorithm. The aim of this study was to examine the application of SF‐36 to the clinical parameter of halitosis.Subjects and methods Seventy patients visiting our special clinic for halitosis were the subjects. In this study, we defined the healed persons as follows. They received our therapy two or more times, and the duration was over 2 months. After our therapy, they declared that the oral malodor of themselves could not bother them. In addition, they accepted to receive the general dental check‐up regularly after the initial therapeutic period. The SF‐36 was filled by the subjects at the first visit of our clinic and the first time of the regular check‐up. The content of our therapy was mainly involved measurement of oral malodor, supporting for oral self‐care, professional oral cleaning and counseling. All management concerning SF‐36 was performed according to the manual of SF‐36, version 1.2, Japanese edition.Results and discussion Among all 70 subjects, GH, VT, SF, RE, MH and mental summary scores were significantly lower than national averages. Among the healed persons (n = 17), only SF score significantly rose after receiving our therapy. These results suggest that the consciousness of the improvement in social function could be an important outcome of halitosis therapy. In conclusion, measuring health related QOL using SF‐36 might be useful for evaluating the efficacy of halitosis therapy.