Measures Of Subjective Health Status Research Articles

Political Determinants of Health: Healthcare Privatization and Population Health in Europe.

The extent to which healthcare reforms affect health remains understudied. Healthcare reforms result in policy outputs that determine provision of medical services, which have consequences for the health of the population. We scrutinize this relationship between health policy outputs and population health, using an original dataset of healthcare reforms passed in 36 European countries from 1989 to 2019. Focusing more specifically on legislative changes implying privatization of healthcare delivery and finance, we ask the following question: What is the relationship between reforms that privatize healthcare provision and population health in terms of health outcomes and inequalities? We answer this question by relying on fixed effects time-series cross-section models. Health outcomes are operationalized using measures of subjective health status, unmet health needs and resulting health inequalities. Our results show that privatization of healthcare is associated with higher rates of bad subjective health and unmet health needs several years after the passing of reforms. These effects are stronger for individuals in the lower tiers of income and education, resulting in higher socio-economic inequalities. The article contributes to conceptualization of the political determinants of health as health policy outputs and a better understanding of the relationship between policy outputs and population health outcomes.

Health-Related Quality of Life in Patients With a Left Ventricular Assist Device (QOLVAD) Questionnaire: Initial Psychometrics of a New Instrument.

Patients with a left ventricular assist device are a unique and growing population who deserve their own valid, reliable instrument for health-related quality of life. We developed and tested the Health-Related Quality of Life with a Left Ventricular Assist Device (QOLVAD) questionnaire. In a prospective, descriptive study, patients from 7 sites completed the QOLVAD and comparator questionnaires. Construct validity was tested using confirmatory factor analysis. Convergent validity was tested using correlations of QOLVAD scores to well-established measures of subjective health status, depression, anxiety, and meaning/faith. Reliability and test-retest reliability were quantified. Patients (n = 213) were 58.7 ± 13.9 years old; 81.0% were male, 73.7% were White, and 48.0% had bridge to transplant. Questionnaires were completed at a median time of 44 weeks post ventricular assist device. The 5 QOLVAD domains had acceptable construct validity (root mean square error of approximation = 0.064, comparative and Tucker-Lewis fit indices > 0.90, weighted root mean square residual = 0.95). The total score and domain-specific scores were significantly correlated with the instruments to which they were compared. Internal consistency reliability was acceptable for all subscales (α = .79-.83) except the cognitive domain (α = .66). Unidimensional reliability for the total score was acceptable (α = .93), as was factor determinacy for multidimensional reliability (0.95). Total test-retest reliability was 0.875 (P < .001). Our analysis provided initial support for validity and reliability of the QOLVAD for total score, physical, emotional, social, and meaning/spiritual domains. The QOLVAD has potential in research and clinical settings to guide decision making and referrals; further studies are needed.

Validity and Reliability of the Quality of Life with a Left Ventricular Assist Device (QOLVAD) Questionnaire

Purpose A valid and reliable quality of life (QOL) measure designed for left ventricular assist device (LVAD) patients has not been established. We report second stage preliminary psychometrics for the QOLVAD Questionnaire. Methods Prospective, cross-sectional study at 7 sites. QOLVAD construct validity (overall, physical, emotional, social, cognitive and meaning/spiritual QOL) was tested using confirmatory factor analysis. Convergent validity was tested using correlations between QOLVAD scores and well-established measures of subjective health status (KCCQ12), depressive symptoms (PHQ9) anxiety (PROMIS), meaning/peace and faith (FACIT). Reliability was quantified using Cronbach's alpha (for domain scores) and factor determinacy score (multidimensional reliability). Test re-test reliability was quantified using correlations and Bland-Altman tests (enrollment vs. 1 week later). Results There were 186 LVAD patients in the overall sample: 58.5±13.8 years; 82.7% male, 77.3% white, 50% bridge to transplant. Surveys were completed at median time (25th, 75th percentile) of 44 weeks (17.5±115.5) post-VAD. The five domains of the QOLVAD had good construct validity (RMSEA = 0.07, Comparative and Tucker Lewis fit indices = 0.90, weighted and standardized root mean square residual = 1.348 and 0.09, respectively). QOLVAD scores were standardized to range from 0-100 with higher values indicating better QOL. The overall and domain specific scores were significant correlated with the various other tools to which they were compared (Table). Additionally, with the exception of the cognitive domain (α=0.60), reliability was high among all areas (range 0.79 to 0.93) as was test re-test reliability (range 0.71 to 0.94; p Conclusion While a subsequent version will focus on strengthening reliability of the cognitive domain, the existing QOLVAD is a valid, reliable measure of overall QOL with an LVAD and of physical, emotional, social and meaning/spiritual domains.

Linking health states to subjective well-being: an empirical study of 5854 rural residents in China

ObjectivesDespite a maturing literature on the association between subjective well-being (SWB) and health status of the general population in Western countries, little is known regarding the happiness–health relation in China, and rural populations in particular. This study was aimed to explore the correlation between SWB and health states of China's rural residents. Study designCross-sectional survey. MethodsData derived from a household survey conducted in 2010 with 5854 rural residents included. The single-item self-reported happiness measure used in the World Values Survey was employed to measure SWB. EQ-5D dimensions and visual analogue scale (VAS) were applied to measure subjective health status. The number of chronic diseases was used as proxy of objective health status. OLS regressions were performed to estimate the variation in SWB by health status and β coefficients were employed as effect size measures. ResultsAmong EQ-5D dimensions, anxiety/depression had the strongest negative effect on SWB. Having severe anxiety/depression problems could reduce SWB by 1.65 on a scale 1–4. Reporting severe problems in pain/discomfort could also reduce SWB by 0.41, while the impact of other dimensions was insignificant. The coefficient on VAS implied a difference in SWB of 1.60 between the worst health state and the best health state. And suffering from three chronic diseases could reduce SWB by 0.62, but the effect turned insignificant when all measures of subjective health status were entered in the regression. ConclusionsThe results from this study verify the strongly negative effect of the mental health dimension on SWB in the context of rural China. And suffering from chronic diseases has substantial negative effect on SWB even after subjective health status is controlled for. But the impact of chronic diseases on SWB could be fully captured when all measures of subjective health status are taken into account.

Effect of Electroacupuncture on Function and Quality of Life in Parkinson's Disease: A Case Report

A 56-year-old man diagnosed in 2003 as having Hoehn & Yahr stage III Parkinson's disease (PD) came to our clinic in 2012 with slurred speech, right-sided bradykinesia, erectile dysfunction, rigidity, emotional instability and depression. His PD showed progressive signs with postural instability, moderate bilateral signs, and he rated 80% on the Schwab & England Activities of Daily Living Scale. A modified protocol of electroacupuncture was administered for a period of 5 weeks, six times per week, with each session lasting for 30 min. Assessments were based on the Berg Balance Scale (BBS) and Parkinson's Disease Questionnaire-39 (PDQ-39) items, a disease-specific measure of subjective health status. He showed improvement on the BBS, suggesting improved functional status. His quality of life showed improvement particularly on the 'activities of daily living', 'cognition' and 'communication' dimensions of the PDQ-39. Acupuncture treatments in animal experiments have generated valuable mechanistic insights that could be relevant to PD, for example, demonstrating its neuroprotective potential from stimulation of various neuroprotective agents. The literature also suggests acupuncture may play a role in the improvement of motor function and quality of life in PD. Acupuncture is tolerated well by individuals with PD and should be considered as an integrative approach for their symptomatic management.

Self‐rated health status in spinocerebellar ataxia—Results from a European multicenter study

Patient-based measures of subjective health status are increasingly used as outcome measures in interventional trials. We aimed to determine the variability and predictors of subjective health ratings in a possible target group for future interventions: the spinocerebellar ataxias (SCAs). A consecutive sample of 526 patients with otherwise unexplained progressive ataxia and genetic diagnoses of SCA1 (117), SCA2 (163), SCA3 (139), and SCA6 (107) were enrolled at 18 European referral centers. Subjective health status was assessed with a generic measure of health related quality of life, the EQ-5D (Euroqol) questionnaire. In addition, we performed a neurological examination and a screening questionnaire for affective disorders (patient health questionnaire). Patient-reported health status was compromised in patients of all genotypes (EQ-5D visual analogue scale (EQ-VAS) mean 61.45 +/- 20.8). Specifically, problems were reported in the dimensions of mobility (86.9% of patients), usual activities (68%), pain/discomfort (49.4%), depression/anxiety (46.4%), and self care (38.2%). Multivariate analysis revealed three independent predictors of subjective health status: ataxia severity, extent of noncerebellar involvement, and the presence of depressive syndrome. This model explained 30.5% of EQ-VAS variance in the whole sample and might be extrapolated to other SCA genotypes.

Relationships of Self-Reported Physical Health, Sociability, and Spiritual Life with Mental Health: An Investigation According to Gender and Life Stage

To investigate the relationships of self-reported physical health, social and spiritual satisfactions with subjective mental health according to gender and life stage. Self-reported questionnaires with questions regarding subjective health status and lifestyles were sent to 1905 community residents aged 20 years or older selected by random sampling in Wakayama Prefecture, Japan. Subjective mental health, physical health, social and spiritual satisfactions as measures of subjective health status were assessed using a visual analogue scale. Multiple logistic regression analysis was used to evaluate the relationships between the subjective mental health and the other three components of the subjective health status with adjustment for life style factors related to the subjective mental health in the subjects without missing values of relevant factors (n=1,752). The subjects were divided into three life stages depending on their ages: young (20-39), middle (40-59), and old (60 or more). Overall, the poor statuses of the three components, namely, physical health, social and spiritual satisfactions, were significantly associated with poor mental health in both genders at any life stage. However, detailed analysis revealed some interesting characteristics. In young men, social dissatisfaction was strongly associated with poor mental health whereas spiritual dissatisfaction in addition to social dissatisfaction was strongly associated with poor mental health in young women. In the middle aged group, both social and spiritual dissatisfactions were strongly associated with poor mental health in both genders. On the other hand, poor physical health status was strongly associated with poor mental health in the old aged group. These results suggest the importance of the mental health interventions under consideration for each life stage and gender.

Type 2 Diabetes, Muscle Strength, and Impaired Physical Function

There is growing recognition that the complications associated with type 2 diabetes may translate into functional impairment in older people (1). This may reflect a link between the metabolic and mechanical functions of muscle. However, the possibility that the link between glucose tolerance and physical function extends to people without diabetes has not been previously considered. The objective of this study was to determine whether there is a relationship among glucose tolerance, muscle strength, and physical function in men and women with and without type 2 diabetes. A cross-sectional survey within a cohort study design was used. Information was obtained on self-reported diabetes status cross-checked with medication data, glucose, and insulin levels 2 h after an oral glucose tolerance test (for participants without a previous diagnosis of diabetes) (2), grip strength using a Jamar dynamometer (3), and physical function using the physical function component of the Medical Outcomes Study 36-item short form questionnaire. This is a measure of subjective health status widely validated in both men and women (4,5). The population-based study sample consisted of 1,391 men and women aged between 60 and 70 years and living in the …

Assessing the Health of Women in Prison: A Study from the United Kingdom

The number of women imprisoned in the United Kingdom is rising rapidly, but there is little research on their health and well-being. We could find no studies in which the researchers had used measures of subjective health status to gain a picture of the health of imprisoned women. This self-completed questionnaire study aimed to explore the usefulness of the Short Form 36 (SF-36) in a general female prison population. The scores of imprisoned women for all but 3 of the 8 dimensions were significantly lower than those for women in the social class with the worst health in the United Kingdom, confirming the very poor mental and physical health of this population.

Is cardiopulmonary bypass still the cause of cognitive dysfunction after cardiac operations?

Objective: The purpose of this study was to determine whether cognitive impairment is related to cardiopulmonary bypass. Methods: Twenty-five patients undergoing coronary artery bypass grafting without cardiopulmonary bypass were matched with 50 patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. All patients received the same anesthetic regimen, and one surgeon performed all the operations. A battery of 10 standard tests of neuropsychologic function were performed before, at discharge, and 3 months after the operation. A comprehensive multidimensional measure of subjective health status was used as the primary clinical measure of functional outcome. Results: The groups were similar with respect to age, sex, and ventricular function and differed only in the need for a circumflex artery graft. Both groups showed significant improvement in the comprehensive multidimensional measure of subjective health status at 3 months. At discharge most neuropsychologic tests had deteriorated in both groups (the same 4 tests had deteriorated significantly in both groups, and an additional test had deteriorated significantly in the cardiopulmonary bypass group). At 3 months all but one test in the cardiopulmonary bypass group had returned to or exceeded baseline performance. The same 2 tests had improved significantly in both groups, and a further test had improved significantly in the group without cardiopulmonary bypass. At no specific time point was there a significant difference between the absolute or change scores between the groups on any of the tests. Conclusions: The similar pattern of early decline and late recovery of cognitive function in patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass suggests that cardiopulmonary bypass is not the major cause of postoperative cognitive impairment. This merits consideration in deciding optimal treatment strategies in coronary revascularization. (J Thorac Cardiovasc Surg 1999;118: 414-21)

Is the SF-36 suitable for assessing health status of older stroke patients?

The Medical Outcomes Study short form 36 health survey (SF-36) is being increasingly used and recommended as a suitable measure of subjective health status. However, it is unlikely that any measure will be appropriate for all groups. We wished to determine the suitability of the SF-36 for assessing quality of life in older stroke patients. A screening questionnaire was used to identify prevalent cases of stroke from a random sample of 2000 subjects aged 45 years and over. The SF-36 was included as part of a self-completion questionnaire posted to each stroke patient. Data quality indicators were analysed. We identified 104 cases of stroke and the response rate for the SF-36 questionnaires sent was 83%. Completion rates for individual items ranged from 66 to 96%. All items in the role physical and role emotional scales had completion rates < 75%. The percentage of subjects for whom an individual scale score could be computed ranged from 67 to 96%, being lowest for the role physical and role emotional scales. Floor effects were high (> 15%) for these two scales and for the social functioning and physical functioning scales. Ceiling effects were substantial (> 15%) for the two role effect scales and for social functioning and bodily pain. This study has shown high response rates from older stroke patients to a postal questionnaire incorporating the SF-36. The poor completion rates and consequent inability to compute scores for a large proportion of responders in certain scales raises concerns about the perceived relevance of these sections. Results for the response effects suggest that, on its own, the instrument is not suitable for assessing outcome. When data quality indicators were examined, it appears that postal administration of the SF-36 is not appropriate for assessing quality of life of older stroke patients.

The reliability and validity of a symptom checklist for use in HIV infection: a preliminary analysis.

The aim of the study was to determine the reliability and validity of a self-report symptom checklist designed for use in HIV infection. One hundred and seventy-one gay men completed a 28-item symptom checklist which produces 3 dimensions: physical, cognitive and psychological. The validity of each dimension was examined by comparing scores on the checklist with indices of disease progression and previously validated psychological scales. People with more advanced HIV disease had higher scores on the physical and cognitive checklists, though the psychological scale was not related to disease stage. All the scales showed moderate correlations with measures of psychological health. Examination of individual item responses suggested that patients over-reported the presence of some symptoms. Although individual items should be interpreted with caution, the overall scores of the RSC are reliable and valid as measures of subjective health status in HIV infection. The importance of psychological factors in the reporting of symptoms suggests that symptom checklists should be interpreted in the light of adequate measures of psychological state.

Tacit models of disability underlying health status instruments

In recent years much attention has been paid to the development of measures of subjective health status yet, although statistical criteria of reliability and validity have been quite rigourously tested, there has been little consideration of the different theories of disability which underlie the design. The sociology of disability may illuminate such tacit theories. It is suggested that the development of health status questionnaires has not been one of simple rational accumulation in response to methodological advances. Through an examination of the content of health assessment questionnaires, four distinct models of disability are indentified. These are shown to influence not only the focus of the content and phrasing of the questions but also, crucially, the way that they perform and how responsive they are to change. The models (the functional, subjective distress, comparative and dependence) are illustrated and discussed in terms related to research design.

Correlates of a measure of coping in older veterans: A preliminary report

Sense of Coherence (SOC) is a specific measure of perception of coping ability which is examined here in relation to demographic characteristics and measures of physical and mental health status of older veterans (N = 240). Results suggest that the SOC is strongly correlated with measures of subjective health status. It does not uniquely contribute to that dimension but does exhibit appropriate psychometric properties to encourage its use in further research.

A new measure of health status for clinical trials in inflammatory bowel disease

We have developed a measure of subjective health status (quality of life) for patients with inflammatory bowel disease (IBD). Ninety-seven patients with IBD described problems they had experienced as a result of the disease; the 32 most frequent and important items were included in the Inflammatory Bowel Disease Questionnaire (IBDQ). Sixty-one IBD patients were evaluated twice. One month separated the evaluations, at which disease activity indices, the IBDQ, and a number of other questionnaires were administered. Reproducibility studies in 19 stable patients showed improvement in scores, but also a small within-person standard deviation. Responsiveness studies revealed large changes in scores in patients who had improved or deteriorated and suggested that the IBDQ was more responsive than a general health status measure. Responsiveness appeared greater in patients with ulcerative colitis than in those with Crohn's disease. Predicted and observed correlations between changes in IBDQ score and changes in other measures were similar. We conclude that although further testing is required, particularly in examining the relation between changes in the IBDQ and changes in the activity of Crohn's disease, the IBDQ shows promise as a measure of health status for clinical trials in IBD.

Development and testing of a new measure of health status for clinical trials in heart failure.

The authors developed a new measure of subjective health status for patients with heart failure. Eighty-eight patients with heart failure were asked about the impact of their condition on 123 items related to physical and emotional function. The most frequently chosen and important items were included in a 16-item Chronic Heart Failure Questionnaire (CHQ) that examines dyspnea during daily activities, fatigue, and emotional function. The CHQ was tested in a controlled trial of digoxin in heart failure patients in sinus rhythm. When administered serially to 25 patients in the run-in phase of the trial, the CHQ proved reproducible. Subsequently, CHQ results distinguished those who reported improvement or deterioration from those who did not. The CHQ showed moderate correlations with patient global ratings, walk test scores, and clinical assessments of heart failure. The authors conclude that the CHQ may be useful for measuring health status in clinical trials in heart failure.

A New Measure of Health Status for Clinical Trials in Inflammatory Bowel Disease

We have developed a measure of subjective health status (quality of life) for patients with inflammatory bowel disease (IBD). Ninety-seven patients with IBD described problems they had experienced as a result of the disease; the 32 most frequent and important items were included in the Inflammatory Bowel Disease Questionnaire (IBDQ). Sixty-one IBD patients were evaluated twice. One month separated the evaluations, at which disease activity indices, the IBDQ, and a number of other questionnaires were administered. Reproducibility studies in 19 stable patients showed improvement in scores, but also a small within-person standard deviation. Responsiveness studies revealed large changes in scores in patients who had improved or deteriorated and suggested that the IBDQ was more responsive than a general health status measure. Responsiveness appeared greater in patients with ulcerative colitis than in those with Crohn's disease. Predicted and observed correlations between changes in IBDQ score and changes in other measures were similar. We conclude that although further testing is required, particularly in examining the relation between changes in the IBDQ and changes in the activity of Crohn's disease, the IBDQ shows promise as a measure of health status for clinical trials in IBD.

Responsiveness and validity in health status measurement: A clarification

We present data from two studies which clarify the relationship between the responsiveness and validity of instruments designed to measure health status in clinical trials. In a controlled trial of long vs short duration adjuvant chemotherapy for women with Stage II breast cancer, the Breast Cancer Chemotherapy Questionnaire (BCQ) proved valid as a measure of subjective health status and was able to distinguish long vs short arms. Well validated measures of physical and emotional function developed by the Rand Corporation were unable to distinguish between the two groups. The Eastern Co-operative Oncology Group Criteria (ECOG) distinguished the two groups, but failed criteria of clinical sensibility as a measure of subjective health status. In a study of patients with Crohn's disease and ulcerative colitis, the Inflammatory Bowel Disease Questionnaire (IBDQ) showed small intrasubject variability over time. Gobal ratings of change showed moderate to high correlations with changes in IBDQ score, and patients who reported overall improvement or deterioration showed large changes in IBDQ score. Each of these findings support, in different ways, the reproducibility, validity, and responsiveness of the questionnaire. While the same data can at times bear on both validity and responsiveness, when assessing evaluative instruments it is useful to make a conceptual distinction between the two.

The Nottingham health profile: Subjective health status and medical consultations

The decision to consult a doctor for medical reasons may be assumed to be indicative of the perception of a health problem by the patient. A study was carried out to compare the scores of consulters and non-consulters of a general practice, on the Nottingham Health Profile, which is designed to be a standardized and simple measure of subjective health status in the physical, social and emotional domains. Data on physical activity, absence from work and overall self-rated health were also collected. Each section of the Profile showed significant differences in score between consulters and non-consulters. Significant associations were also found between scores on the Profile and both self-rated health and absence from work. The association between scores and amount of physical activity was less clear cut. Females had a lower subjective health status than did males on all sections except those reflecting pain and physical mobility problems. The age-group 40–49 had a lower subjective health status than younger and older groups and for this age group males scored higher than females on sections representing emotional, social and sleep problems. The study indicates that the Nottingham Health Profile is a valid and sensitive measure of subjective health, which may well be a better predictor of need for and utilization of health services than “hard” data such as mortality and morbidity statistics.