Healthier Group Research Articles

Characterisation of user‐defined health status in older adults with intellectual disabilities

Older adults with Intellectual Disabilities (ID) have an excess disease burden that standard health assessments are designed to detect. Older adults with ID have a broader concept of health with dimensions of well being in addition to absence of disease in line with the World Health Organization's health definition. We sought to characterise user-defined health status in a sample of older adults with ID. We administered a user-led health assessment to 57 adults with ID aged 40 years and over. Cluster analysis on user-defined health themes of participation, nutrition and hygiene/self-care identified clear separation of participants into a healthier and a less healthy group. Disease burden (P = 0.002) and medication use (P = 0.003) were greater in the less healthy group. The healthier group were taller (P = 0.005), stronger (P = 0.005) and had better vision (P < 0.001) than the less healthy group. Constipation (P = 0.014), urinary incontinence (P < 0.001) and faecal incontinence (P < 0.001) were commoner in the less healthy group. There were few significant differences between health groups on the majority of standard physical-examination items. There is considerable overlap between user-defined health and that assessed by standard instruments. In addition, user-defined health encompasses aspects of physical fitness not captured by traditional disease-based health models.

Clinical Uses of Microsatellite Instability Testing in Colorectal Cancer: An Ongoing Challenge

Clinical Uses of Microsatellite Instability Testing in Colorectal Cancer: An Ongoing Challenge

Obesity, Physical Activity, and Mortality in a Prospective Chinese Elderly Cohort

In older people, it is unclear whether obesity relates to mortality, which calls into question its etiologic role in disease and its public health relevance. This apparent lack of relationship in older people could be an artifactual result of their diverse health states. We used Cox regression analysis to determine whether the effect of body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) or physical activity on mortality varied with health status in a prospective cohort study of Chinese people 65 years or older enrolled from 1998 to 2000 at all of the 18 Elderly Health Centers of the Hong Kong Government Department of Health. Health status was categorized into 5 morbidity groups using a 12-item index covering illnesses, medications, frailty, and smoking. After a mean follow-up of 4.1 years, there were 3819 deaths in 54 088 subjects (96.5% successful follow-up). The effect of BMI on mortality varied with baseline health status (P<.001). In the healthiest group, obese people (BMI >/=25) had higher mortality (adjusted hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.02-2.33), but in the unhealthiest group they had lower mortality (HR, 0.55; 95% CI, 0.49-0.63) compared with subjects of normal weight. Daily physical activity was associated with lower mortality compared with inactivity in the unhealthiest group (HR, 0.70; 95% CI, 0.61- 0.81) but not in the healthiest group. In the elderly, the relationship between obesity and mortality varies according to the underlying health status. In those with poor health status, obesity is associated with better outcome, whereas in those with initially good health status, obesity is associated with worse outcome.

Pets and Human Health in Germany and Australia: National Longitudinal Results

The German and Australian longitudinal surveys analysed here are the first national representative surveys to show that (1) people who continuously own a pet are the healthiest group and (2) people who cease to have a pet or never had one are less healthy. Most previous studies which have claimed that pets confer health benefits were cross-sectional. So they were open to the objection that owners may have been healthier in the first place, rather than becoming healthier due to owning a pet. In both countries the data show that pet owners make about 15% fewer annual doctor visits than non-owners. The relationship remains statistically significant after controlling for gender, age, marital status, income and other variables associated with health. The German data come from the German Socio-Economic Panel in which respondents have been interviewed every year since 1984 (N = 9723). Australian data come from the Australian National Social Science Survey 2001 (N = 1246).

An Evaluation of the Nashville REACH 2010 Community Health Screening Strategy

Community-based screening is 1 of 4 strategies selected by the Nashville REACH 2010 project for reducing disparities in heart disease and diabetes among African Americans in North Nashville, Tenn. We evaluated our screening efforts by asking 4 questions: (1) Are the screening participants representative of the target population? (2) How often were screening participants with possible undiagnosed hypertension, high cholesterol, and diabetes identified? (3) How often were screening participants with an elevated risk for developing hypertension, high cholesterol, and diabetes identified? and (4) How often did we identify screening participants with known hypertension, high cholesterol, and diabetes whose disease management was suboptimal? Results from 1757 persons screened were compared to telephone surveys from 16,199 Nashville residents. Those screened were younger and healthier than the target population. Rates of potentially undiagnosed cases among African Americans were 0.8% for diabetes, 17.4% for hypertension, and 32.7% for high cholesterol. High-risk individuals were identified 13.1% of the time for diabetes, 45.3% of the time for hypertension, and 21.3% of the time for total cholesterol. Rates of poorly controlled known disease were 23.5% for diabetes, 39.0% for hypertension, and 58.2% for total cholesterol. Although we reached a younger and healthier group than the community population, community-based screenings identified many people with potential health risks. We present a model of how to organize and implement successful community-based screening.

日本版生き方の原則調査票（ＶＩＡ‐ＩＳ： Ｖａｌｕｅｓ ｉｎ Ａｃｔｉｏｎ Ｉｎｖｅｎｔｏｒｙ ｏｆ Ｓｔｒｅｎｇｔｈｓ）作成の試み

Purpose of this study was to develop the Japanese version of the Values In Action Inventory of Strengths (VIA-IS). Japanese VIA-IS was back-translated, and their items were checked by the developers of the original VIA-IS. Participants in our standardization study were 778 undergraduate students who answered a battery of self-report questionnaires. The battery consisted of the Japanese versions of VIA-IS, Subjective Happiness Scale, General Health Questionnaire, and NEO Five Factor Inventory (NEO-FFI). It was found that VIA-IS has high internal consistency and test-retest reliability. Happier people showed higher overall scores on VIA-IS and on almost all subscales both in men and women. Scores on VIA-IS were higher in the healthier group than in the unhealthy group, especially on the subscales of depression and impediment of social activities. Subscales of NEO-FFI were related to subscales of VIA-IS in a consistent way. High nomination groups showed significantly higher scores on eight subscales of VIA-IS than low nomination groups.

Obesity and Health Status in Rural, Urban, and Suburban Southern Women

Obesity has reached epidemic proportions over the past 20 years. This study investigated the differences in rates of obesity and perceptions of health status between rural, urban, and suburban Southern women based on selected socioeconomic factors. Using data from a national health survey, the reports from 4,391 women aged 40 to 64 years were included in the study. Significantly more rural women lived in poverty, reported a poorer health status, and had a greater prevalence of obesity. Urban women had the next highest obesity rate and a moderate health status. The healthiest group with the lowest obesity and poverty rates were suburban women. Obesity and poor overall health are closely related in rural women. The greatest challenge to health care providers is to provide appropriate community-based weight-management programs.

Relationship between gingival health and dental caries in children aged 7-12 years.

The purpose of this study was to investigate the relationship between gingival health and dental caries in elementary school children in Japan. The subjects were 474 children aged 7 to 12 years who attended dental check-ups at an elementary school. The Oral Rating Index for Children, which consists of five categories (+2, +1, 0, -1, -2), was used to rate the findings of the gingival health examination. The dental examination was performed using the WHO caries diagnostic criteria for DMFT. Children were divided into three groups: a healthier group (H-group) made up of those scoring +2 (excellent) or +1 (good), an equivocal group (E-group) made up of those scoring 0, and a gingival less-healthy group (L-group) made up of those scoring -2 (very poor) or -1 (poor). Overall percentages for the H-group, E-group and L-group were 48.3%, 21.5% and 30.2%, respectively. The number in the L-group increased with increasing age. The mean scores of the DT and DMFT in the H-group were significantly lower than those in the L-group (p < 0.01 and p < 0.05, respectively). The results suggest that oral hygiene instruction should be given to children in order to motivate self-care, not only to avoid dental caries but also to prevent gingivitis.

Marital Status and Long-Term Illness in Great Britain

MIKE MUROHY London School of Economics and Political Science KAREN GLASER AND EMILY GRUNDY King's College* This study investigates the relationship between health and marital status, focusing particularly on older persons, using data on reported longterm illness rates from the Samples of Anonymised Records (SARs) drawn from the British Census. Until about age 70, long-term illness rates are generally lowest for those in first marriage, followed by the remarried, with intermediate values for the widowed and divorced, and highest for the single. Beyond age 75 for both sexes, single people in the private household population report the lowest illness rates, but when the institutionalized population is included, single people at older ages no longer appear to be the healthiest group. This is because at older ages increasingly high proportions of those with longterm illness are in institutions, disproportionately so for single people, explaining why such crossovers have been found in analyses of private household populations. The health status of cohabiters is generally closer to the married than to other groups for both sexes. Key Words: Great Britain, health, marital status, older persons. In 1858 William Farr, of the English General Registrar's Office, observed that if unmarried people suffer from disease in undue proportion, the suffer still more.... Marriage is a healthy estate (Farr,1858). Since then numerous studies have lent support to Farr's conclusion. Married people have been found to have the best mental and physical health, followed by the single (never married) and then the have-been-married (Hu & Goldman, 1990; Ross, Mirowsky, & Goldsteen, 1990; Umberson, 1992; Verbrugge, 1979; Wyke & Ford, 1992). The health advantage of the married generally has been found to persist even when age, health behaviors, marital acquisition variables (material resources acquired through marriage), and other relevant sociodemographic factors are controlled for. Moreover, this advantage has been found in studies using a wide range of health indicators, including mortality, work disability, hospital admissions and length of hospital stay, and both acute and chronic limiting conditions (Lillard & Waite, 1995). However, although this topic has been extensively researched and the results of many studies are broadly consistent with Farr's pioneering analysis, a number of large, welldesigned investigations have found no statistically significant associations between marital status and mortality, morbidity, or disability in the populations studied (Lentzner, Pamuk, Rhodenhiser, Rothenberg, & Powell-Griner, 1992; Stinner, Byun, & Paita, 1990; Welin et al., 1985). Most of these latter studies have been of older populations, and a number of important questions about the relationship between health and marital status in later stages of the life span remain unanswered or unclear. MARITAL STATUS AND HEALTH AT OLDER AGES Much of the research specifically on relationships between marital status and health at older ages has been based on relatively small samples that have limited the analyses possible, or the research has considered only one group, such as the widowed. Research on some subgroups, such as cohabitors, is lacking. Some studies suggest that the relationship between health and marital status may be weaker in older age groups than for those in midlife (Litwak & Messeri, 1989). The analysis by Goldman, Korenman, and Wiseman (1995) of the U.S. Longitudinal Study of Aging, a relatively large national sample of the private household population, found that never-married women had better health outcomes than their married counterparts, a result the authors attributed to their supportive social environment. Gender Differences in Relationships Between Marital Status and Health Gender and age variations in the relationship between marital status and health also have been reported in a number of studies, although again both the extent and the reason for such variations are not wholly clear. …

Taking health status into account when setting capitation rates. A comparison of risk-adjustment methods

Objective. —To compare performance of different health status measures for risk-adjusting capitation rates. Design. —Cross-sectional study. Health status measures derived from 1 year were used to predict resources for that year and the next. Setting. —Group-network health maintenance organization in Minnesota. Participants. —Sample of 18- to 64-year-old (n=3825) and elderly (aged ≥65 years; n=1955) members enrolled in a network-model health maintenance organization in Minnesota. Main Outcome Measures. —Total expenditures in the year concurrent with the health status survey (July 1991 through June 1992) and total expenditures in the year following the survey (July 1992 through June 1993). Results. —Capitation adjustment based on demographic measures performed least well. Both self-reported health status measures and diagnoses predicted future expenditures twice as well as demographics. When predicting costs for groups of patients rather than individuals, the demographic model worked well for average groups but tended to overpredict healthier groups and underpredict sicker groups. Ambulatory Care Groups based on diagnoses performed better than self-reported health status both in the retrospective models and across healthier and sicker groups. Conclustion. —Without risk adjustment, capitation rates are likely to overpay or underpay physicians for certain patient groups. It is possible to improve prediction using health status measures for risk adjustment. When selection bias is suspected and administrative data are available, we recommend a risk-adjustment method based on diagnostic information. If diagnostic data are not available, we recommend a system based on simple self-reported measures, such as chronic conditions, rather than complex functional status measures.

GRANDPARENTS AND CHILDREN OF DIVORCE: THEIR CONTRASTING PERCEPTIONS AND DESIRES FOR THE POSTDIVORCE RELATIONSHIP

Seventy‐seven children of divorce and their selected grandparents completed questionnaires that included a demographic section, the Family Adaptability and Cohesion Evaluation Scale‐II (FACES II; Olson, Bell, & Portner, 1982) to assess their relationships, and an instrument designed to identify shared activities and desires in these areas. Partners had similar present and future perceptions of relationship and activity factors. All participants desired future increases in both areas. Grandchildren and grandparents connected emotional bonding with grandparents’ listening, keeping them safe, and gift giving; grandparents also thought a good relationship with the custodial parent was important. Most healthy and least healthy subgroups were identified. Membership in the healthiest group was related to geographic proximity, feminine gender for both partners, and being married and employed full‐time for grandparents. Grandparents who were related by blood to custodial parents, had a good relationship with them, and negotiated their role were more likely to have a healthier relationship. Helping professionals are encouraged to explore these variables as they help family members negotiate the grandparent‐grandchild relationship, use skill training to foster development in areas amenable to change, and use supportive tactics in areas of liability.

The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30.

While quality of life (QOL) assessment is becoming more common, interpreting the results remains problematic. This paper demonstrates an approach to developing clinically-based interpretations for QOL outcomes, using the QLQ-C30 as an example. The results from 14 published QLQ-C30 studies which group patients by performance status, weight loss, toxicity, extent or severity of disease are collated. Groups with lower clinical status generally have worse QOL. The largest differences are between performance status groups, and the smallest differences are between groups of patients with local disease and those with metastases. The physical and role scores have the largest ranges of means across patient groups, and show the largest differences between clinical groups, while the cognitive and emotional scores have the smallest ranges of means and differences. Sicker groups have larger score standard deviations than healthier groups. Relatively large and small means and differences, and corresponding effect sizes, are presented. Collectively, the results provide a sense of the relative sizes of means and of differences, and of the types of clinical groups which give rise to them, thereby providing clinically-based benchmarks by which to interpret QLQ-C30 results.

GROWTH OF U.S. HEALTH CARE SPENDING

The share of output allocated to health care has more than doubled since 1960. This paper models the growth in this ratio and finds that the increase in the elderly population whose medical spending is heavily subsidized is a key factor behind this growth. Technological change is a symptom of the medical market structure rather than a cause of medical spending growth. The econometric model in the analysis here is based on a micro model composed of two groups. The first group is a healthier group that makes income transfers in order to finance the sicker group's health insurance premiums. In this model, a technical constraint places an upper bound on the healing ability of the medical good. This upper bound changes through an unobservable endogenous process. Estimating the health care model involves using estimation techniques that bypass the need to make any a priori assumptions about the functional form of the regressions or about the distribution of the residuals. The results suggest that technical change cannot indefinitely induce health care spending growth if no subsidies exist that provide full health care coverage with premiums fully paid by the subsidy. If subsidies provide full coverage and pay the entire premium, then new technical discoveries can induce constantly expanding medical expenditures.

A 20-month follow-up study of 628 women with eating disorders: II. Course of associated symptoms and related clinical features

In response to a magazine article, 628 women with eating disorders completed questionnaires in 1982 and in 1984, an average of 20 months later. The majority of these respondents met simulated DSM-III criteria for normal-weight bulimia (NWB) or fell into a somewhat healthier group that we called subdiagnostic eating disorders (SDED). Five percent met simulated criteria for anorexia nervosa with bulimic features (BAN). Although at follow-up there was some improvement in eating disorders criterion symptoms and slight improvement in associated symptoms such as menstrual irregularities, depression, and self-destructive behaviors, the burden of these symptoms remained considerable. Furthermore, at follow-up the BAN group reported an increased use of alcohol and the NWB group an increased use of cigarettes.

Productivity losses due to illness, disability and premature death in different occupational groups in Finland

In this study losses due to illness, disability and premature death for the economically active population in Finland in 1975 were examined. Total losses of the employed population due to premature death, disability and illness were 503,000 workyears. In monetary terms the losses were 7.91 billion Finnish marks. Age standardized losses per 1000 economically active males were 266 years and per 1000 economically active females 233 years. Losses for males in agriculture and in industry were almost three times higher than in administration. Among females the losses in agriculture were 3.3 times greater and in industry and in services 2.5 times greater than in administration. The main reason for the differences between the total losses was the uneven distribution of invalidity pensions. Losses associated with occupation were calculated assuming that the morbidity, disability and mortality rates in all occupational groups were the same as in healthiest group (administration). If the extra mortality, disability and illnesses of occupational groups were eliminated, the savings would be 255,000 workyears or about 3.9 billion Finnish marks per year e.g. the total losses would decrease to below half of the present level.

The British-Norwegian Migrant Study -- Analysis of Parameters of Mortality Differentials Associated with Angina

The prevalence of selected cardiorespiratory symptoms was ascertained by a common mail questionnaire for 73,884 men and women in the United States, Great Britain and Norway. The study groups were identified in the early 1960's and included 30,033 British and Norwegian migrants to the United States and 43,851 non-migrants who resided in Great Britain and Norway. The main study objectives were to contrast the morbidity and mortality experience of the migrant and non-migrant groups in the light of known national differences in mortality from cardiorespiratory diseases in the early 1960's. At that time, the U.S. had the highest death rates from coronary heart disease while Great Britain had the highest rates for lung cancer and for chronic non-specific lung disease. Norway had the lowest rates for all three rubrics. The prevalence of "angina" and other symptoms was ascertained for each of the study groups. Contrary to expectation, angina was reported much more frequently by persons remaining in Britain and Norway than by migrants to the United States. Mortality rates during the five years and responding to the symptoms questionnaire were determined and mortality patterns were evaluated according to the presence or absence of angina. Angina was found to be a strong predictor of cardiovascular mortality. In the absence of angina, it was observed that migrants had similar mortality rates to non-migrants regardless of country of origin. However, the British had higher mortality rates from cardiovascular and from non-cardiovascular causes than the Norwegians. The primary determinant of angina prevalence was found to be migration status. It is believed that this differential was determined primarily by selection of those who migrate, with the migrants to the U.S. being a healthier group than their counterparts remaining in the native country.

Corn Earworm:1 Effects of Temperature Variation on a Colony2, 3

Under a constant vapor pressure deficit of 8.41 mm Hg, a holding temperature of 30.0°C produced the most rapid development of the corn earworm, Heliothis zea (Boddie). However, oviposition and fertility were greater when the larvae and pupae were held at lower temperatures. Under constant temperature conditions, adults held at 25.6° and 22.2°C were both more fecund and more fertile than those held at 28.9° and 18.9°C. Incorporation of this high temperature (28.9°C) into a fluctuating temperature regimen had no measurable effects on egg production and hatch. A high temperature of 32.2°C in a variable temperature regimen lowered egg hatch for one group of adults but had no effect on an apparently healthier group.

Patterns of sickness absence in a railway population.

This investigation was carried out in order to obtain morbidity statistics in a large industrial population with special reference to the effects of ageing. The population chosen, the “railway research population,” consisted of a sample of Scottish railwaymen, drawn from five of the eight areas in the Scottish Region of British Railways. Only certain occupational grades were studied. Information was obtained over a period of one year by means of a detailed monthly return of (<i>a</i>) sickness absence data and (<i>b</i>) job changes. Indices of sickness absence were defined. The sickness absence experience of the railway research population was compared with that of other populations. It is a healthier group than the total insured population but differs in some respects from that of London Transport. The nature of sickness absence within the railway research population was then studied. It was shown in all but one measure used that sickness tends to increase with age, the most important factor being the increase of long episodes. Examination of the frequency distribution of the duration of sickness episodes revealed that sickness absence tends to be taken in terms of weeks off rather than days off. Analysis of the daily variation in sickness absence showed that the total absence rate increased from Monday to Friday. There was a well defined tendency for sickness to start on Mondays, and in longer episodes an additional tendency to start on Fridays. This was interpreted in terms of morale, both positive and negative. Marked differences of the same order of magnitude as those due to age were noted in the sickness experience of the various grades, related to both conditions of work and responsibility. The reasons for job changes were analysed and the grades to which men were transferred were identified. The choice of suitable grades for older workers was discussed. It was concluded that working conditions might be important factors in the type of sickness absence experienced and that comparisons with other populations might be helpful in this context. More detailed work was also called for on the psychological as well as physical aspects of the work situation for both the individual and the grade.