Lower Physical Health Status Research Articles

Health-related quality of life in a binational population with diabetes at the Texas-Mexico border

To examine physical and mental health domains of health-related quality of life (HRQL) in a binational adult population with type 2 diabetes at the Texas-Mexico border, and to explore individual and social correlates to physical and mental health status. Adults 18 years and older with type 2 diabetes residing in the South Texas Lower Rio Grande Valley and in Reynosa, Tamaulipas, Mexico, were recruited using a convenience sampling technique and interviewed face-to-face with a structured survey. HRQL was measured using physical and mental health summary components of the Medical Outcomes Study Short Form. HRQL correlates included demographic characteristics, health factors, access to healthcare, and family support. Samples characteristics were compared using the Student's t-test or Mann-Whitney U test. Associations between dependent and independent variables were examined using unadjusted and adjusted (multiple variable) logistic regression models. There were no significant differences between Valley and Reynosa respondents in physical or mental health status scores. Valley participants with lower socioeconomic status and those perceiving their supportive relative's level of diabetes-related knowledge as "low" were more likely to report worse physical health than those lacking those characteristics. In the Reynosa group, lower physical health status was associated with duration of diabetes and insulin use. Both sample populations with clinical depressive symptoms were more likely to have worse physical and mental health than those without such symptoms. HRQL is an important outcome in monitoring health status. Understanding the levels and influences of HRQL in U.S.-Mexico border residents with diabetes may help improve diabetes management programs.

Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area

BackgroundGiven the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors.MethodsData was obtained from a representative sample (N = 1426) residing in the broader Athens area (response rate 70.6%). Perceived health-related quality of life (HRQOL), as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a) last-month visits to public sector physicians, b) last-month visits to private sector physicians, c) last-year visits to hospital emergency departments and d) last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models.ResultsHealth care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector). Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care.ConclusionThis study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.

Dysphagia After Anterior Cervical Decompression and Fusion

In Brief Study Design. Retrospective analysis of the incidence and prevalence of dysphagia after anterior cervical decompression and fusion (ACDF). Objectives. To examine the incidence and prevalence of dysphagia after ACDF, determine possible associated patient and procedural characteristics, and examine dysphagia’s impact on long-term health status and function. Summary of Background Data. Dysphagia is a common early complaint after ACDF, but the risk factors associated with its development are not understood. Methods. Telephone surveys (Cervical Spine Outcomes Questionnaire) and clinical assessments (Oswestry Neck Disability Scale and SF-36) were used to evaluate 454 patients who had undergone ACDF at one of 23 nationwide sites for individual and procedure characteristics that might contribute to dysphagia. Results. Of the 454 patients, 30% reported dysphagia at the 3-month assessment (incident cases). The incidence of new complaints of dysphagia at each follow-up point was 29.8%, 6.9%, and 6.6% at 3, 6, and 24 months, respectively. Dysphagia persisted at 6 and 24 months in 21.5% and 21.3% of patients, respectively. The risk of dysphagia increased with number of surgical vertebral levels at 3 months: 1 level, 42 of 212 (19.8%); 2 levels, 50 of 150 (33.3%); 3+ levels, 36 of 92 (39.1%). Patients reporting dysphagia at 3 months had a significantly higher self-reported disability and lower physical health status at subsequent assessments. Conclusion. Duration of preexisting pain and the number of vertebral levels involved in the surgical procedure appear to influence the likelihood of dysphagia after ACDF. We examined the occurrence of dysphagia after anterior cervical decompression with fusion in a cohort of 454 patients enrolled in the CSRS Outcomes Study. Dysphagia was common, occurring in 30% of individuals 3 months after surgery and persisting in 21% of individuals at 24 months postoperatively. Dysphagia negatively affected overall health status.

Effects of chronic widespread pain on the health status and quality of life of women after breast cancer surgery

BackgroundMost research and treatment of post-breast cancer chronic pain has focused on local or regional pain problems in the operated area. The purpose of this pilot study was to compare and contrast the pain characteristics, symptom impact, health status, and quality of life of post-breast cancer surgery women with regional chronic pain versus those with widespread chronic pain.MethodsA cross-sectional, descriptive design compared two groups of women with chronic pain that began after surgery: regional pain (n = 11) and widespread pain (n = 12). Demographics, characteristics of the surgery, as well as standardized questionnaires that measured pain (Brief Pain Inventory (BPI), Short Form McGill Pain Questionnaire (MPQ-SF)), disease impact (Fibromyalgia Impact Questionnaire (FIQ), Functional Assessment of Cancer Therapy-Breast (FACT-B)), health status (Medical Outcomes Short Form (SF-36)) and quality of life (Quality of Life Scale (QOLS)) were gathered.ResultsThere were no significant differences between the groups on any demographic or type of surgery variable. A majority of both groups described their pain as aching, tender, and sharp on the MPQ-SF. On the BPI, intensity of pain and pain interference were significantly higher in the widespread pain group. Differences between the two groups reached statistical significance on the FIQ total score as well as the FACT-B physical well-being, emotional well-being and breast concerns subscales. The SF-36 physical function, physical role, and body pain subscales were significantly lower in the widespread pain group. QOLS scores were lower in the widespread pain group, but did not reach statistical significance.ConclusionThis preliminary work suggests that the women in this study who experienced widespread pain after breast cancer surgery had significantly more severity of pain, pain impact and lower physical health status than those with regional pain.

The elderly and AIDS: Coping with the impact of adult death in Tanzania

The elderly are one of the key groups of survivors who may be adversely affected by the death of prime-age adults from AIDS. We use a longitudinal survey of households from Northwestern Tanzania in 1991–94 to compare the activities and welfare of the elderly in households before and after the death of a prime-age adult with that of the elderly in households that did not have an adult death. The elderly in households that had an adult death were more educated, more likely to engage in wage employment and spent less time farming than the elderly in households that did not have a death during the survey. Time spent by the elderly in household chores rose following an adult death and participation in wage employment fell; there was no evidence of increased participation in farm work. The physical well-being of the elderly, as measured by body mass index (BMI), was lower prior to an adult death and higher afterward. Finally, the elderly with the lowest BMI are those in poor households that did not have an adult death during the survey. Thus, policymakers should be concerned about the adverse impacts of adult deaths on the physical well-being of the elderly—primarily during the period of illness prior to a prime-age adult death—but they should also focus on the larger groups of poor elderly with much lower physical health status.

Customary physical activity and psychological wellbeing: a longitudinal study.

to assess longitudinal relationships between habitual levels of physical activity and indices of psychological wellbeing in older people. baseline assessment with 4- and 8-year follow-ups. 1042 people originally aged 65 and over randomly sampled from general practitioner lists in Nottingham, UK. logistic regression analysis of selected T1 (1985) and T2 (1989) variables, with depression at T2 as dependent; multiple regression analyses of selected T1, T2 and T3 (1993) variables, with life satisfaction at T2 (model 1) or T3 (model 2) as dependent. questionnaire-assessed levels of physical activity; 14-item Symptoms of Anxiety and Depression scale; 13-item Life Satisfaction Index; health, demographic and social activity variables. in the logistic regression model, depression at T2 was most strongly associated with depression [odds ratio (OR) = 7.13; 95% confidence interval (CI) = 3.25-15.64; P < 0.001] and lower physical health status (OR = 1.26 per unit change in score; 95% CI = 1.17-1.42; P < 0.001) at T1. Lower levels of outdoor/leisure activities at T1 were also associated with some increased risk of depression 4 years later (OR = 0.92 per hour of activity; 95% CI = 0.85-0.99; P < 0.05). Similar predictive patterns emerged from the multiple regression analyses where, in both models, earlier levels of life satisfaction, social engagement and health accounted for most of the explained variance in life satisfaction (R2 = 0.42 for model 1; R2 = 0.35 for model 2). Again, however, earlier levels of physical activity (as walking and housework) did contribute significantly, although modestly, to longitudinal changes in morale. while the results provide some support for the conclusion that physical activity contributes independently to the promotion and maintenance of psychological wellbeing in later life, this contribution is, at best, extremely modest.