Positive Health Measures Research Articles

Addressing the Need for Better Measures of Positive Health.

Addressing the Need for Better Measures of Positive Health.

P052 VALIDITY AND INTERPRETABILITY OF PROMIS PEDIATRIC PATIENT-REPORTED OUTCOMES FOR CHILDREN WITH INFLAMMATORY BOWEL DISEASE

Abstract Introduction Patient-Reported Outcome Measurement Information System (PROMIS) instruments were developed using rigorous psychometric methods to assess health and quality of life across the life course. In two studies, we aimed to evaluate the clinical validity of PROMIS measures for children with inflammatory bowel disease (IBD) and to increase the interpretability of scores on these measures. Methods Study 1 recruitment and clinical data collection took place within 14 pediatric gastroenterology practices located across the United States. PROMIS Pediatric measures of Pain Interference, Fatigue, Psychological Stress Experiences, Global Health, and Life Satisfaction were completed by 1,049 children and youth (8–24 years old) with IBD and linked to an IBD registry that included disease activity measures. Study 2 utilized baseline data from a large, multi-center clinical trial to compare the effectiveness of anti-TNF monotherapy versus combination therapy with methotrexate. A total of 199 participants (8–20 years old) across 35 sites completed PROMIS Pediatric measures of Pain Interference, Fatigue, and Positive Affect. PROMIS measures were scored on a T-score metric (mean = 50; standard deviation = 10). Scores on symptom measures were classified as “severe” if they were at or above the 95th percentile, and scores on positive health measures were classified as “poor” if they were at or below the 5th percentile, relative to the United States general population of children ages 8–17. Results For nearly all domains across both studies, PROMIS scores were significantly associated with clinical measures of IBD severity. PROMIS measures indicated worse health and/or functioning with corresponding increases in disease activity (inactive to mild to moderate/severe). Comparisons between inactive and mild IBD groups resulted in medium or large effect sizes (Cohen’s d = 0.5 – 0.96) for Pain Interference, Fatigue, Psychological Stress, Global Health, and Life Satisfaction (Table 1). Proportions of children with IBD who were classified as “severe” or “poor” were higher than in the general population and increased with increasing levels of IBD severity (Table 2). Conclusions These studies support the clinical validity of PROMIS instruments for assessing the lived experiences of children with IBD. Effect sizes associated with differences between inactive and mild IBD translate to 5–10 points on the PROMIS T-scale, suggesting that 5–10 points is a clinically important difference between group average scores. To aid interpretation of an individual’s score, percentiles derived from the general population may be used to determine whether the score falls within the range of severe/poor scores for the measure.

Prospective associations between cannabis use and negative and positive health and social measures among emerging adults

BackgroundIn light of on-going policy changes related to cannabis use in the United States, it is important to examine possible associations between cannabis use and subsequent behaviors of public health interest. This study identified prospective associations between cannabis use during first-year post high-school and a wide range of positive and negative health and social measures one year later. MethodsData were from Waves 4 (Time 1; 1st year after high-school) and 5 (Time 2; one year later) of the NEXT Generation Health Study, a national sample of emerging adults in the United States (n = 1915; mean age = 20.2; 61% female). Multinomial logistic regressions adjusting for pertinent covariates were conducted to examine odds of substance use, nutrition, physical activity, sedentary behaviors, school performance, family relations, mental health, driving behaviors and health perceptions at Time 2. ResultsCompared with non-use, frequent use (20+ times in the past year) at Time 1 was associated with Time 2 negative health and social measures, including risky driving behaviors (AOR = 1.78, CI-1.45–2.19), depressive symptoms (AOR = 1.68, CI-1.43–1.98), unhealthy weight control behaviors (AOR = 1.55, CI-1.31–1.84), psycho-somatic symptoms (AOR = 1.55, CI-1.30–1.83), and low school achievement (AOR = 1.46, CI-1.23–1.75). Frequent users relative to non-users had a lower probability of being overweight and obese (AOR = 0.75, CI-0.60–0.92).Regarding positive measures frequent users relative to non-users had a higher probability of meeting recommendation of physical activity (AOR = 1.28, CI-1.09–1.51), but a lower probability of consuming fruits and vegetables (AOR = 0.82, CI-0.70–0.96) or attending college/university (AOR = 0.57, CI-0.44–0.75). Findingson occasional cannabis use (1–19 times in the past year) were more similar to frequent cannabis use for negative than positive health and social measures. ConclusionResults demonstrate complex prospective patterns in which significant prospective associations with most adverse measures were found for both occasional and frequent users, and with few significant associations of positive health measures mostly among occasional cannabis users.

HEALTH RELATED FITNESS (H-RF) OF OBESE AND OVERWEIGHT CHILDREN FROM MALOPOLSKA REGION – PART I. girls

Aim of research. Basing on the results of the researches conducted on 3221 girls from Małopolska in years 1996-2005 some hypothesis were verified about ontogenetic period ap-pearance of: the negative influence of too low and too high fatness level on the positive health measures level, and the similar structure of the physical efficiency analyzed referring to health and the similar strength of the correlation connection between its elements and the height-weight index (Quetelet II) sorted in groups according to BMI level. Methods. The results of the positive health indexes were analyzed such as: the basic somat-ic features, antropometric indexes, the oxygen efficiency (VO2 max), motor ability tested on Eurofit and MTSF tests. Basing on the average value and the standard aberration of BMI all tested girls were divided into 3 groups: 8-10, 13-14, 17-18. In every group the range and the trend of the considering features differentiations were discerned and only in two groups (above and below the range of 1 SD BMI) the concentration analysis was conducted where the strength of the correlation connection between the elements of the physical efficiency structure, tested according to the relation of health and BMI level, were estimated. Results. The researches confirmed the accepted hypothesis about the negative influence of low and high fatness level, tested by BMI indexes, on the selected indexes of the positive health. The results of the concentration analysis and the Pearson’s correlation between BMI index and the physical efficiency’s elements tested referring to health show the reason to claim there are similar connections between the elements of the physical efficiency and the hierarchic structure in the group of individuals of low and high fatness. The statistically es-sential correlations only between efficiency’s morphologic components and BMI were found. Conclusion. The conducted researches confirmed: 1. The negative influence of too low and too high level of fatness on the level of the health positive indexes, 2. The statistically essen-tial correlation connections only between BMI and the somatic features which measure a body’s fatness, 3. The poor relations between BMI level and the positive health measures such as: physical efficiency, motor ability, 4. The similar structure of the physical efficiency tested referring to health in groups of lower and higher level of fatness.

Is workplace health promotion research in the Nordic countries really on the right track?

The aims of this scoping review of research on workplace health promotion interventions in the Nordic countries were to investigate: how the studies defined health; whether the studies intended to change the workplace itself (the settings approach); and whether the research focus regarding their definitions of health and use of settings approaches has changed in the past five-year period versus previous times. Using scientific literature databases, we searched for intervention studies labelled as "health promotion" in an occupational setting in the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) published from 1986 to 2014. We identified 63 publications and qualitatively analysed their content regarding health outcomes and their use of settings approaches. The reviewed studies focused primarily on preventing disease rather than promoting positive measures of health. In addition, most studies did not try to change the workplace but rather used the workplace as a convenient setting for reaching people to change their behaviour related to lifestyles and disease prevention. Participatory and non-participatory settings approaches to promote well-being and other positive health measures have been used to a minor degree. The recent studies' definitions of health and use of settings approaches did not differ much from the studies published earlier. workplace health promotion in the nordic countries should more often include positive health measures and settings approaches in intervention research it is important to anchor workplace health promotion among important stakeholders such as unions and employers by arguing that sustainable production is dependent on workers' health.

Evaluation of aging in place model with home care services and registered nurse care coordination in senior housing

A state-sponsored evaluation of aging in place (AIP) as an alternative to assisted living and nursing home has been underway in Missouri. Cost, physical, and mental health assessment data reveal the cost-effectiveness and positive health measures of AIP. Findings of the first four years of the AIP evaluation of two long-term care settings in Missouri with registered nurse care coordination are compared with national data for traditional long-term care. The combined care and housing cost for any resident who received care services beyond base services of AIP and who qualified for nursing home care has never approached or exceeded the cost of nursing home care at either location. Both mental health and physical health measures indicate the health restoration and independence effectiveness of the AIP model for long-term care.

Mindfulness meditation practise as a healthcare intervention: A systematic review

Background Mindfulness may be viewed as a supra-cognitive state of consciousness focussed on the decentred, objective and compassionate observation of transient mental and physical phenomena that may be attained through meditation practices. Mindfulness meditation is thought to be beneficial in the management of various physical and mental health conditions. Objective To assess the effectiveness of mindfulness meditation practice as a healthcare intervention. Methods Systematic computerised and hand literature searches for randomised controlled trials and evaluation using methodological quality criteria. Results The higher quality studies analysed in this review have demonstrated replicated statistically significant improvements in spirituality and positive health measures and decreases in depressive relapse, depressive recurrence and psychological distress. Conclusions Despite the lack of specific, reliable and validated mindfulness measures, mindfulness shows potential as a positive healthcare intervention and continued investigation is warranted. Further research using improved methodology and utilising specific mindfulness outcome measures in trials with long-term follow up, larger populations and a wider demographic range is recommended.

How Positive Psychosocial Work Factors may Promote Self-Efficacy and Mental Health among Psychiatric Nurses

Most research on workplace health promotion has focused on modifying lifestyles and preventing disease, and not so much on how the workplace itself affects positive health measures. This cross-sectional study investigated the relationships between psychosocial work factors and psychiatric nurses’ health, measured as generalised selfefficacy, caring efficacy and mental health. A specific objective was to investigate whether the work factors correlated differently with the different health measures, and whether efficacy mediated the effect of work factors on mental health. Both personal control and social support correlated positively with the two efficacy measures. Social support was a more important predictor of caring efficacy than control. Control was the most important psychosocial work factor positively associated with the psychiatric nurses’ mental health. Both efficacy measures correlated positively with mental health, but neither mediated the effect of the psychosocial work factors on mental health.

Health Systems Governance for Health Equity: Critical Reflections

This article addresses several issues pertinent to health systems governance for health equity. It argues the importance of health systems using measures of positive health (well-being), discriminating in favour of historically less advantaged groups and weighing the costs of health care against investments in the social determinants of health. It cautions that the concept of governance could weaken the role of government, with disequalizing effects, while emphasizing the importance of two elements of good governance (transparency and participation) in health systems decision-making. It distinguishes between participation as volunteer labour and participation as exercising political rights, and questions the assumption that decentralization in health systems is necessarily empowering. It then identifies five health system roles to address issues of equity (educator/watchdog, resource broker, community developer, partnership developer and advocate/catalyst) and the implications of these roles for practice. Drawing on preliminary findings of a global research project on comprehensive primary health care, it discusses political aspects of progressive health system reform and the implications of equity-focused health system governance on health workers' roles, noting the importance of health workers claiming their identity as citizens. The article concludes with a commentary on the inherently political nature of health reforms based on equity; the necessary confrontation with power relations politics involves; and the health systems governance challenge of managing competing health discourses of efficiency and results-based financing, on the one hand, and equity and citizen empowerment, on the other.

The California Wellness Foundation's grant making in work and health.

The California Wellness Foundation's grant making in work and health.

CHANGING RESPONSIBILITIES IN MILK AND FOOD TECHNOLOGY

Among the challenging possibilities for improving milk and food practices are: pinpointing sanitation efforts on genuine health hazards; establishment of standards of nutrient quality in foods; assumption by private enterprise of more responsibility for food sanitation; application of modern science to the reclamation of community food wastes; bringing up to date the epidemiology of food-borne disease and adjusting control measures accordingly.Hydroponic famring, photosynthesis of algae in sewage oxidation ponds to produce cottle feed—and thus beefsteak—; radiation sterilization of food; complete meals in sealed packages; and the application of positive health measures such as fluoridation of drinking water and enrichment of food are but examples of the rapid change in our technology.