Objective Measures Of Health Status Research Articles

Contextual influence on poor self-rated health in patients with Chagas disease: multilevel study.

Chagas disease (CD) is recognized by the World Health Organization as one of the thirteen most neglected tropical diseases in the world. Self-perceived health is considered a better predictor of mortality than objective measures of health status, and the context in which one lives influences this predictor. This study aimed to evaluate the prevalence and individual and contextual factors associated with poor self-rated health among CD patients from an endemic region in Brazil. It is a multilevel cross-sectional study. The individual data come from a cross-section of a cohort study named SaMi-Trop. Contextual data was collected from publicly accessible institutional information systems and platforms. The dependent variable was self-perceived health. The analysis was performed using multilevel binary logistic regression. The study included 1,513 patients with CD, where 335 (22.1%) had Poor self-rated health. This study revealed the influence of the organization/offer of the Brazilian public health service and of individual characteristics on the self-perceived health of patients with CD.

The evolution of health over the life cycle

We construct a unified objective measure of health status: the frailty index, defined as the cumulative sum of all adverse health indicators observed for an individual. Using this index, we document four stylized facts on health dynamics over the life cycle and show that they are robust to other ways of constructing the index. We also compare the frailty index with self-reported health status and find significant differences in their dynamics and ability to predict health-related outcomes. Finally, we propose and estimate a stochastic process for frailty dynamics over the life cycle accounting for mortality bias. Our frailty measure and dynamic process can be used to study the evolution of health over the life cycle and its economic implications.

710-P: The Relationship between Health Literacy, Cardiovascular Disease Knowledge, and Diabetes Prevention Knowledge in Middle Eastern Patients at a Free Clinic

This study's purpose was to investigate the level of health literacy, cardiovascular disease (CVD) knowledge and diabetes prevention knowledge, as well as the relationship among them, in the Middle Eastern population. A survey was conducted among the Middle Eastern patients of a free health clinic to obtain information on the health literacy and knowledge of these patients. A total of 73 surveys were collected and analyzed in this study. Print literacy and numeracy were strongly correlated with each other (r=0.4949, P<0.0001). Both print literacy and numeracy were significantly correlated with the Diabetes Prevention knowledge score (print literacy: r=0.2764, P=0.0179; numeracy: r=0.4110, P=0.0003), but not with the CVD knowledge score. The Diabetes Prevention knowledge score had a high correlation with the CVD knowledge score (r=0.6980, P<0.0001). Furthermore, print literacy was significantly associated with self-reported health status (r=0.2637, P=0.0242). Our results support that health literacy was associated with some disease-specific knowledge and self-reported health status in the Middle Eastern population. Future research that includes measures of health behaviors and objective measure of health status could help provide more insight into the interactions between these variables in this understudied population. Disclosure C. Kawata: None. L. Jiang: None.

The Evolution of Health over the Life Cycle

We construct a unified objective measure of health status: the frailty index, defined as the cumulative sum of all adverse health indicators observed for an individual. First, we show that the frailty index has several advantages over self-reported health status, particularly when studying health dynamics. Then we estimate a stochastic process for frailty dynamics over the life cycle. We find that the autocovariance structure of frailty in panel data strongly supports a process that allows the conditional variance of frailty shocks to increase with age. Our frailty measure and dynamic process can be used by researchers to study the evolution of health over the life cycle and its economic implications.

Use of a commercial ELISA for the detection of measles-specific immunoglobulin G (IgG) in dried blood spots collected from children living in low-resource settings.

Seroepidemiological monitoring of population immunity to vaccine-preventable diseases is critical to prevent future outbreaks. Dried blood spots (DBS), drops of capillary blood dried on filter paper, are an affordable, minimally invasive alternative to venipuncture for collecting blood in field settings. However, few proven methods exist to analyze DBS for the presence of protective antibodies. This study validates a novel technique for measuring measles-specific immunoglobulin G (IgG) in capillary DBS using a commercial ELISA. The predictive performance of a new method for analyzing DBS was tested by comparing matched serum and DBS samples from 50 children. The accuracy, precision, and reliability of the procedure were evaluated, and the optimal cut points to classify positive and negative samples were determined. The method was then applied to 1,588 DBS collected during a large survey of children in Mexico and Nicaragua. Measles-specific IgG in serum samples were 62% negative, 10% equivocal, and 28% positive. In comparisons with matched serum, DBS results were 100% sensitive and 96 · 8% specific, and agreed in 46 of 50 (92%) cases. The inter-assay and intra-assay coefficients of variation from kit-provided controls were greater than desired (24.8% and 8.4%, respectively). However, in predictive simulations the average misclassification was only 3.9%. Procedures were found to be acceptable to surveyors and participants. Analyzing DBS collected in low-resources settings is a feasible and accurate means of measuring population immunity to measles and should be used to generate objective measures of health status and health system performance.

Measures of Health and Disease in Africa: Are Current Methods Giving Us Useful Information About Trends in Cardiovascular Diseases?

An enormous burst of interest in the public health burden from chronic disease in Africa has emerged as a consequence of efforts to estimate global population health. Detailed estimates are now published for Africa as a whole and each country on the continent. These data have formed the basis for warnings about sharp increases in cardiovascular disease (CVD) in the coming decades. In this essay we briefly examine the trajectory of social development on the continent and its consequences for the epidemiology of CVD and potential control strategies. Since full vital registration has only been implemented in segments of South Africa and the island nations of Seychelles and Mauritius – formally part of WHO-AFRO – mortality data are extremely limited. Numerous sample surveys have been conducted but they often lack standardization or objective measures of health status. Trend data are even less informative. However, using the best quality data available, age-standardized trends in CVD are downward, and in the case of stroke, sharply so. While acknowledging that the extremely limited available data cannot be used as the basis for inference to the continent, we raise the concern that general estimates based on imputation to fill in the missing mortality tables may be even more misleading. No immediate remedies to this problem can be identified, however bilateral collaborative efforts to strength local educational institutions and governmental agencies rank as the highest priority for near term development.

Life satisfaction and cardiovascular disease risk in Poland

IntroductionCardiovascular disease is the most common cause of death. Life satisfaction is a predictor of morbidity and mortality, irrespectively of objective measures of health status. The aim of the study was to evaluate the relationship between life satisfaction (LS) and cardiovascular disease risk (CVD) assessed with the Framingham Risk Score (FRS) in Polish adults.Material and methodsPast, present and projected LS were estimated. The FRS reflecting 10-year CVD risk was calculated from health indices and lifestyle parameters. Relationships between LS and FRS were tested by two-way analysis of variance in 489 men and 591 women, 40–50 years of age.ResultsSubjects with a reduction in LS over time had a higher FRS compared to peers with an improvement in LS. The relationship between current LS and FRS had a J-shape in men; FRS was lowest in men with an LS of 5–7 (average LS), slightly higher in men with an LS of 8–10 (highest LS), and highest in men with an LS of 1–4 (lowest LS). Among women, there was an inverse linear relationship between LS and FRS: the higher the LS, the lower FRS. There was a strong linear relationship between predicted LS and CVD risk. Highest risk was evident in subjects with low LS in whom low LS was predicted over the next five years.ConclusionsLow LS (dissatisfaction) thus has a long-term negative effect on CVD risk in Polish adults of both sexes.

Burnout and health: expanding our knowledge

Burnout and health: expanding our knowledge

“As long as I’m in good health”. The relationship between medical diagnoses and life satisfaction in the oldest-old

Life satisfaction in the elderly has usually been found to be closely related to self-rated health, and less to diagnoses and more objective measures of health status. However, few studies have examined the relative importance of various specific diagnoses in population-based samples. In this study, we investigate the relationship between life satisfaction and medical diagnoses in a non-demented sample of 392 participants aged 80 and older. Among 25 common diagnoses, only sleeping problems, urinary incontinence and stroke were significantly related to life satisfaction. Men with angina pectoris and eczema were less satisfied with life compared with men without these diagnoses, whereas women with peptic ulcer were less satisfied with life compared with women without this diagnosis. Our results confirm previous findings of a weak relationship between medically based measures of health and life satisfaction. However, health care and future studies of health and quality of life need to focus on the fact that meaning and consequences of various diseases differ among individuals and that gender may partially account for variability.

Self-rated health does not explain the socioeconomic differential in mortality: a prospective study in the EPIC-Norfolk cohort

Background:Self-rated health (SRH), a subjective measure of health, is strongly predictive of mortality, independently of objective measures of health status and existing known disease. There is a strong social gradient...

Health status and health dynamics in an empirical model of expected longevity

Expected longevity is an important factor influencing older individuals’ decisions such as consumption, savings, purchase of life insurance and annuities, claiming of Social Security benefits, and labor supply. It has also been shown to be a good predictor of actual longevity, which in turn is highly correlated with health status. A relatively new literature on health investments under uncertainty, which builds upon the seminal work by Grossman [Grossman, M., 1972. On the concept of health capital and demand for health. Journal of Political Economy 80, 223–255] has directly linked longevity with characteristics, behaviors, and decisions by utility maximizing agents. Our empirical model can be understood within that theoretical framework as estimating a production function of longevity. Using longitudinal data from the Health and Retirement Study, we directly incorporate health dynamics in explaining the variation in expected longevities, and compare two alternative measures of health dynamics: the self-reported health change, and the computed health change based on self-reports of health status. In 38% of the reports in our sample, computed health changes are inconsistent with the direct report on health changes over time. And another 15% of the sample can suffer from information losses if computed changes are used to assess changes in actual health. These potentially serious problems raise doubts regarding the use and interpretation of the computed health changes and even the lagged measures of self-reported health as controls for health dynamics in a variety of empirical settings. Our empirical results, controlling for both subjective and objective measures of health status and unobserved heterogeneity in reporting, suggest that self-reported health changes are a preferred measure of health dynamics.

Do Economic Inequalities Harm Health? Evidence from Europe

Until recently, there has been a consensus among empirical health economists that there is an association between income inequality and individual health, in line with Wilkinson's (1992) idea that the psychosocial effects of the former are detrimental to the latter. However, using US data, Mellor and Milyo (2002) (MM) found no evidence of such association and claimed that the previously reported results are statistical artifacts, arising from the use of aggregate data. This paper uses the European Community Household Panel (ECHP) to check the robustness of MM results. It replicates the MM methodology to assess the effect of country-level income inequality on individuals' health. It is shown that income inequality, whether measured at the regional or the national level, systematically harms individuals' health, regardless of their positions in the income distribution. The results are also robust to a number of aspects MM do not account for. First, random effect models are estimated to account for unobserved heterogeneity. Second, self-assessed and objective measures of health status are also considered. Third, besides the traditional aggregate measures of income inequality, a further measure is constructed reflecting first, how unequal the distribution is and second the relative position of individuals in the income distribution of their own country.

The contribution of migration to changes in the distribution of health over time: Five-year follow-up study in Northern Ireland

A number of recent studies have highlighted the potential contribution of migration to increasing inequalities in health between areas with different levels of deprivation. Some of these studies have reported that increasing inequalities between areas can, at least partly, be explained by selective migration. Both mortality and morbidity have been used as indicators of health status, but many of the studies focusing on morbidity have suffered from specific methodological problems, including the use of self-reported health measured after migration had occurred, thereby ignoring the possible effect that migration itself may have on health and the reporting of health. This study used general practice records assessed prior to movement, an arguably more objective measure of health status, from 40 general practices, to determine whether selective migration influenced the distribution of health in Northern Ireland between the years 2000 and 2005. Evidence of selective migration was found in the study, with migrants often having significantly different levels of health to non-migrants. However, overall migration within this cohort did not substantially alter the distribution of health through time, partly because the migrants out of the deprived and affluent areas were replaced by in-migrants with similar levels of health. The absence of an effect of migration in this instance should not be used, however, to conclude that migration effects are unimportant in assessing changes in inequalities through time. Rather, migration should be viewed in the context of the underlying population dynamics, which at the time of this study were characterised by a process of urban regeneration. Varying population movements, operating at different times and locations, require that the effects of migration be considered in all studies which examine changes in the spatial distribution of health.

Identificación de estados de salud y su relación con características socioeconómicas y geográficas: análisis de una encuesta poblacional en México

To estimate the effectiveness of using standardized health vignettes to adjust self-reported health taking into account household and community variables to correct for systematic bias. The national health survey "Evaluación del Desempeño 2002" (Mexican component of the World Health Survey) was used. This survey analyzed subject's health perception based on their responses to hypothetical questions referring to third parties in the vignettes within eight domains. Variations in responses were attributed to socio-demographic, socioeconomic, community, differences of the subjects. To assess those variations, an index for each domain was constructed and used as a variable in a series of linear regression models to estimate the relation between health perceptions, self-reported health, socioeconomic and socio-demographic characteristics. The health perception index derived from the vignettes showed a positive, logarithmic correlation with household expenditure for each health domain, after controlling for socio-demographic, health and community characteristics. No relationship was found between the health status described in the vignettes and self-reported health status. In no case was the explanatory power above 10%. The low explanatory power of the models, and the lack of correlation between self reported health status and the health perception index, suggest that the variability in the vignettes responses cannot be explained by differences in self-reported health status or socioeconomic and socio-demographic characteristics. These results from Mexico suggest that vignette-based methods to correct for systematic variability in perception of own health status are of limited efficacy and reinforce the importance of collecting objective measures of health status in health surveys.

Depression and Quality of Life in Patients Living 10 to 18 Years Beyond Heart Transplantation

The purpose of this study was to advance current understanding of factors that influence long-term quality-of-life (QoL) outcomes after heart transplantation, by addressing the influence of depression on perceived health status. Data were collected from all recipients (n = 137) still alive at >10 years after transplantation. They completed the Short Form Health Survey (SF-36) inventory and the Beck Depression Inventory (BDI) questionnaire, while objective measures of health status were retrieved from medical records. All instruments used had acceptable reliability and validity. Data were analyzed using descriptive statistics, general linear regression models and survival analysis. We assessed 137 patients who received transplants between November 1985 and June 1994 in Pavia and have survived 10 to 18 years after transplantation (mean 13.64 years, SD 2.25). They rated their health as good and only the physical QoL (PCS) was impaired when compared with the general population. Thirty-two percent of patients experienced mood depressive symptoms in the long term after transplantation, indicating a low perceived QoL. Higher educational qualification (p = 0.049), being unemployed and receiving a disability pension (p = 0.001), high triglycerides levels (p = 0.020) and lack of physical activity (p < 0.001) were predictors of high BDI scores. Assessment of depression levels and better understanding of risk factors for psychiatric disorders in the long term after transplantation could be of benefit in predicting negative outcomes and allowing future developments in patient management.

Are contributory behaviors related to culture? Comparison of the oldest old in the United States and in China

The purpose of this study is to examine the impact of culture on contributory behaviors within the context of family, friends, and neighbors among the oldest old in the United States and in China. The study was conducted in suburban areas of Boston in 1996 (n=465), and later in 1999 a replication of the study was conducted by Chinese researchers in urban areas of Shanghai, China (n=539). This study found some common factors such as objective measure of health status, assistance received from others, and group affiliation. However, many differences emerged in the study. The range of contributory behaviors toward friends is quite different between the two samples. Some of the correlates’ impact is also culturally specific, such as sibling support. These differences reflect variation in respondents’ social support as well as social structural differences. Findings from this study suggest that providing more opportunities for elders to participate in groups would facilitate their participation in volunteer activities and improve their overall well-being.

Subjective impact of osteoarthritis flare-ups on patients' quality of life

BackgroundClinical trials on osteoarthritis (OA) flare-ups treatment usually focus only on objective measures of health status, albeit recent literature suggestions on the importance of patients' subjectivity. Aim of the study was to evaluate the effects of OA and of its different types of medical treatment(s) on Health Related Quality of Life (HRQoL) in terms of both subjective satisfaction and functional status.MethodsAn observational study on prospective data collected from the Evaluation of Quality of life in OA (EQuO) clinical trial (April 1999-November 2000) was conducted; outpatients from 70 participating centers (Orthopedy or Rheumatology Departments in Italy) with a diagnosis of OA of the hip or knee were consecutively enrolled. Patients were observed at OA flare-ups (baseline) and at follow up 4 weeks after treatment. Patients' objective and subjective HRQoL were assessed by means of the SF-36 and the Satisfaction Profile (SAT-P, which focuses on subjective satisfaction); Present Pain at baseline and Pain Relief at follow up were also evaluated.ResultsAmong the 1323 patients, 1138 (86%) were prescribed one drug/treatment of osteoarthritis, 169 (13%) 2 drugs/treatments, and 16 (1%) 3 drugs/treatments; most of treatments involved the prescription of NSAIDs; non-coxib, COX2 selective NSAIDs were prescribed in about 50% of patients. Follow-up visits were performed after 29.0 days on average (± 7.69 SD). For all SF-36 domains, all SAT-P items and factors, the differences between baseline and follow up scores resulted statistically significant (p < 0.001), enlighting an improvement both in health status and in subjective HRQoL.ConclusionBesides the classic health status measures, the assessment of patients' subjective satisfaction provides important clues on treatments efficacy of OA within the patient-centered medicine model. In clinical practice this could lead to a better doctor-patient communication and to higher levels of treatment adherence.

Does optimism affect symptom report in chronic disease?: What are its consequences for self-care behaviour and physical functioning?

Objective The aim of the present study was to examine whether optimistic chronically ill patients [50 multiple sclerosis (MS) patients and 65 Type 1 diabetes mellitus (IDDM) patients] overestimate their health status by decreased symptom report, and to what extent such an optimistic interpretation of health status affects self-care behaviour and physical functioning. Method Hierarchical regression analyses were employed to determine the relationship of three concepts of optimistic beliefs (positive outcome expectancies, positive efficacy expectancies and unrealistic optimism) with symptom report, controlling for objective measures of health status; and whether this relationship was mediated by negative affectivity or denial. Hierarchical regression analyses were also employed to assess the impact of optimistic beliefs on self-care behaviour and physical functioning 6 months later. Results Optimistic beliefs did not affect symptom report with the exception of positive outcome expectancies relating to decreased fatigue report in IDDM patients, a relationship that was mediated by decreased negative affectivity. In addition, positive efficacy expectancies contributed to more self-care behaviours in both MS and IDDM patients. Conclusion Optimistic chronically ill patients do not tend to have a biased perception of their health status, and positive efficacy expectancies appear to encourage self-care behaviour 6 months later.

The Association Between Health and Cognitive Performance in a Population-Based Study of Older Adults: The Charlotte County Healthy Aging Study (CCHAS)

In the present study, the relationship between self-reports and objective measures of health status and measures of cognitive performance was examined. Participants consisted of 437 persons (M =72.91 years) from the Charlotte County Healthy Aging Study, a population-based sample of older adults. Cognitive performance was assessed by tests of episodic memory, perceptual speed, and attention. Health status was indexed by subjective ratings, self-reports, and objective measures. The health measures accounted for significant variance on both the Trailmaking A and B tests, accounting for a modest amount of variance (4.4% and 1.1%, respectively). The health measures were not significantly associated with performance on the measures of attention or episodic memory. The results suggest that health status is associated with processing speed to a greater degree than higher order cognitive processes.

Convergence of health ratings across nephrologists, nurses, and patients with end-stage renal disease

We evaluated a health rating for renal failure patients that was completed by patients, nurses, and nephrologists. The study was a prospective inception-cohort follow-up design. Measurements were taken before initiating dialysis ( n = 206) or at the initiation of dialysis ( n = 200) and at 18 ( n = 225), 30 ( n = 181), 42 ( n = 162), 54 ( n = 137), and 66 ( n = 112) months after initiating dialysis. Patients, nurses, and nephrologists independently rated patients' health at each measurement occasion. Objective measures of health status, abstracted from the medical record, included emergency and non-emergency admissions, smoking, diabetes mellitus, pulmonary edema, history and number of myocardial infarctions (MI), basal rales, comorbid illnesses, and uremic symptoms. Simultaneous multiple regression analyses examined the correspondence between objective measures of health status and subjective health ratings separately for each rater and measurement occasion. Health ratings were averaged and submitted to the same analyses. Raters showed good agreement (average Pearson r = .43 overall), although agreement was higher between nephrologists and nurses (average r = .64) than between health professional and patients (average r = .34 and .31, respectively). All three ratings and the combined rating corresponded significantly to objective measures of health status. Uremic symptoms, emergency hospital admissions, diabetes mellitus, and recent MI correlated uniquely and most consistently with subjective health ratings. Despite overall convergence, objective measures of health status related to the groups' ratings in a complementary fashion. The health rating is reliable and relates to the current status of the patient. Performance was superior for the combined score that incorporated ratings by patients, nurses, and nephrologists.