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{\it Objective.} To demonstrate how outcomes assessment can assist in describing clients receiving rehabilitation in occupational health rehabilitation clinics and to describe the preliminary assessment of internal consistency rel...
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{\it Objective.} To demonstrate how outcomes assessment can assist in describing clients receiving rehabilitation in occupational health rehabilitation clinics and to describe the preliminary assessment of internal consistency reliability and construct validity of the FOTO Industrial Outcomes Tool. {\it Methods.} 266 adults referred for acute work rehabilitation (AWR), work conditioning/hardening (WC/WH) or a Functional Capacity Evaluation (FCE) comprised the data set. Clients were treated between July 1998 and January 1999 in 15 clinics from 6 states by 46 clinicians participating in the Focus on Therapeutic Outcomes (FOTO) national rehabilitation database beta test. For AWR and WC/WH, clients completed a health status questionnaire on intake and discharge, and health status was assessed prior to the FCE. Comprehensive demographic data were collected describing the clinics, clinicians, clients and work status collected 2 weeks following discharge. {\it Results.} Internal consistency reliability coefficients for the health status scores ranged from 0.57 to 0.89. Construct validity was supported. {\it Conclusion.} Results demonstrate the power of collecting outcomes from a variety of constructs for clients receiving industrial rehabilitation services. Initial reliability and construct validity findings were adequate and support continuing data analyses.
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Objectives: The Canadian Index of Wellbeing (CIW) is an ambitious undertaking that aims to measure and track Canadians' overall "wellbeing". The Healthy Populations, one of eight CIW domains, brings together both population health...
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Objectives: The Canadian Index of Wellbeing (CIW) is an ambitious undertaking that aims to measure and track Canadians' overall "wellbeing". The Healthy Populations, one of eight CIW domains, brings together both population health outcomes and important influences on health. Methods: Indicators from eight subdomains (personal wellbeing, life expectancy/mortality, physical health conditions, functional health, mental health, lifestyle and behaviour, health care, and public health) make up the Healthy Populations domain. Following a review of worldwide literature on health and wellbeing indicators, application of a prespecified set of selection criteria, and expert external validation, ten core indicators and six secondary indicators were selected. The data sources include several national population data systems (CCHS, NPHS) and databases kept at the Canadian Institute for Health Information. Indicators were examined for trends over time, and were stratified by age, sex, income and education. A single summary measure, health domain index, was calculated and reported annually from 1994 to 2008. Results: Analysis of data over a 15-year time period found that Canadians are living longer, but with fewer years in optimal health. Diabetes rates have risen, along with obesity rates, while smoking rates are on the decline and regular physical activity is becoming more common. There were notable income and education gradients for virtually all indicators measured, and gender disparities evident for life expectancy, health-adjusted life expectancy, diabetes, and depression. A worrisome downward trend in health outcomes for Canada's youth (12-19 years) was observed. The overall health index score showed a modest rise of 6.6% from 1994 to 2008. Conclusion: The Healthy Populations domain, and its ongoing use and refinement, can be an important resource for understanding and monitoring the health of Canadians. Knowledge about the status of Canadians' wellbeing will benefit from the contextualization of these findings through evidence generated from the other CIW domains.
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OBJECTIVE: To evaluate the metric properties and practicability of valid, internationally available outcome instruments in the special setting of health resort programs. METHODS: A cohort study in a convenience sample of patients ...
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OBJECTIVE: To evaluate the metric properties and practicability of valid, internationally available outcome instruments in the special setting of health resort programs. METHODS: A cohort study in a convenience sample of patients with low back pain, upper back pain, conditions of the lower extremities, and conditions of the upper extremities was conducted. Their functioning and health were assessed before and after a health resort program by the disease-specific North American Spine Society (NASS) instruments Lumbar NASS and Cervical NASS; WOMAC Osteoarthritis Index; Disabilities of Arm, Shoulder and Hand Questionnaire; and the general instrument, Medical Outcome Study Short Form-36 (SF-36). RESULTS: Completeness on the scale level ranged between 1% and 10%. Criterion validity of condition-specific instruments was confirmed by stronger associations of the pain and function scales to the Physical Health component of the SF-36 (r = -0.59 to -0.79, p < 0.001 for all scales) than to the Mental Health component (r = -0.11, NS, to r = -0.42, p < 0.001). Reliability (Cronbach's alpha coefficient) was higher than 0.8 for all scales of condition-specific instruments and for 6 of 8 SF-36 scales. Floor and ceiling effects ranged between 0% and 7%. The condition-specific instruments demonstrated a good responsiveness with an effect size ranging between 0.28 and 0.55 and with a standardized response mean between 0.32 and 0.94. The responsiveness of most SF-36 scales was similar, but the Physical Function scale showed a lower responsiveness than the condition-specific scales. CONCLUSION: The evaluated instruments can be recommended for use in clinical trials that assess the outcome of health resort programs.
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Older adults are particularly vulnerable to deficiencies of calcium, vitamin D, and vitamin B-12. Despite the availability of fortified foods in the United States, intakes of these nutrients among the elderly remain inadequate. Di...
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Older adults are particularly vulnerable to deficiencies of calcium, vitamin D, and vitamin B-12. Despite the availability of fortified foods in the United States, intakes of these nutrients among the elderly remain inadequate. Dietary supplements may be a convenient way to improve nutritional status within this population group. This article provides practical and evidence-based recommendations regarding the use of single vitamin/mineral and multivitamin/mineral ineral (MVM) supplements in older adults and provides details on calcium and vitamin D, B-12, E, and K. Some single-nutrient supplements have shown benefits for preventing or reducing risks for chronic diseases. Although MVM supplements have not been shown to prevent several major chronic diseases, they do substantially increase vitamin and mineral intakes and blood concentrations, thus improving overall micronutrient status. Older adults who use MVM and/or vitamin/mineral supplements to foster better nutritional and health status should read labels carefully and consult their health care provider to ensure appropriate dietary supplement use.
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BACKGROUND: Differences in health literacy levels by race and education are widely hypothesized to contribute to health disparities, but there is little direct evidence.
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Purpose The aim of this study is to determine what changes occur in the health status of people with autism spectrum disorder (ASD) compared to neurotypical controls. Design/methodology/approach The authors performed a comparative...
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Purpose The aim of this study is to determine what changes occur in the health status of people with autism spectrum disorder (ASD) compared to neurotypical controls. Design/methodology/approach The authors performed a comparative analysis of data collected from 72 subjects with ASD and 75 neurotypical controls aged 3-24 years using the Rochester Health Status Survey IV (RHSS-IV). A structured individual interview was conducted to compare the health status of subjects in Macedonia. Findings A majority of people with ASD take vitamins, supplements and use recommended drug therapies compared to the neurotypical population and experience a larger number of side effects (p = 0.000). Compared to people with neurotypical development, children with ASD have a higher prevalence of oral ulcers (31.9% vs 17.3%; p = 0.039), changes in neurological health status - epilepsy (19.4% vs 2.7%; p = 0.001) and ADD/ADHD (only persons with ASD-19.4%; p = 0.000); respiratory diseases - angina (30.5% vs 8%; p = 0.000), rhinitis and/or sinusitis (40.3% vs 17.3%; p = 0.02); changes in the gastrointestinal system - constipation (31.9% vs 10.6%; p = 0.02), intestinal inflammation (19.4% vs 8%; p = 0.043), permeable intestines (only persons with ASD - 13.9%; p = 0.000) and the presence of the fungus Candida albicans (19.4% vs 4%; p = 0.043); psychiatric disorders - sleep problems (only in people with ASD - 18%; p = 0.000) and tics (6.9% vs 2.6%; p = 0.25) and skin diseases - eczema/allergic skin rash (36.1% vs 18.7%; p = 0.02). Originality/value Many children with ASD have health problems. These findings support and complement the professional literature on their mutual causality.
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BACKGROUND: Few studies have examined social inequalities in self-rated health in Japan, and the issue of gender differences related to social inequalities in self-rated health remains inconclusive.METHODS: The data derived from i...
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BACKGROUND: Few studies have examined social inequalities in self-rated health in Japan, and the issue of gender differences related to social inequalities in self-rated health remains inconclusive.METHODS: The data derived from interviews with 2987 randomly selected Japanese adults in four prefectures in Japan who completed the cross-national World Mental Health survey from 2002 through 2005. We calculated odds ratios (ORs) of having poor self-rated physical and mental health by two social class indicators independently with multivariate logistic regression models, adjusted for age, gender, marital status, and area. Stratified analyses by gender and age group were also conducted. RESULTS: The adjusted ORs of the lowest educational attainment category having poor self-rated physical and mental health were 1.42 (95% confidence interval [CI]: 1.15-1.76) and 1.37 (95% CI: 1.10-1.70), respectively. Among females, educational attainment had significant linear associations with self-rated physical and mentalhealth. Adjusted household income was also significantly associated with self-rated physical health among female respondents. No associations were found among males. While educational attainment was associated with self-rated health among the young age group, adjusted household income was associated with self-rated physical health in the middle and old age group. CONCLUSION: These results indicated social inequalities in self-rated health and prominent social inequalities in self-rated health among females in Japan. Social inequalities in self-rated health seemed to exist across age groups. However, the mechanism of social inequalities in self-rated health could be different depending on the age group.
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CONTEXT: The United States spends considerably more money on health care than the United Kingdom, but whether that translates to better health outcomes is unknown. OBJECTIVE: To assess the relative heath status of older individual...
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CONTEXT: The United States spends considerably more money on health care than the United Kingdom, but whether that translates to better health outcomes is unknown. OBJECTIVE: To assess the relative heath status of older individuals in England and the United States, especially how their health status varies by important indicators of socioeconomic position. DESIGN, SETTING, AND PARTICIPANTS: We analyzed representative samples of residents aged 55 to 64 years from both countries using 2002 data from the US Health and Retirement Survey (n = 4386) and the English Longitudinal Study of Aging (n = 3681), which were designed to have directly comparable measures of health, income, and education. This analysis is supplemented by samples of those aged 40 to 70 years from the 1999-2002 waves of National Health and Nutrition Examination Survey (n = 2097) and the 2003 wave of the Health Survey for England (n = 5526). These surveys contain extensive and comparable biological disease markers on respondents, which are used to determine whether differential propensities to report illness can explain these health differences. To ensure that health differences are not solely due to health issues in the black or Latino populations in the United States, the analysis is limited to non-Hispanic whites in both countries. MAIN OUTCOME MEASURE: Self-reported prevalence rates of several chronic diseases related to diabetes and heart disease, adjusted for age and health behavior risk factors, were compared between the 2 countries and across education and income classes within each country. RESULTS: The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer. Within each country, there exists a pronounced negative socioeconomic status (SES) gradient with self-reported disease so that health disparities are largest at the bottom of the education or income variants of the SES hierarchy. This conclusion is generally robust to control for a standard set of behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking, which explain very little of these health differences. These differences between countries or across SES groups within each country are not due to biases in self-reported disease because biological markers of disease exhibit exactly the same patterns. To illustrate, among those aged 55 to 64 years, diabetes prevalence is twice as high in the United States and only one fifth of this difference can be explained by a common set of risk factors. Similarly, among middle-aged adults, mean levels of C-reactive protein are 20% higher in the United States compared with England and mean high-density lipoprotein cholesterol levels are 14% lower. These differences are not solely driven by the bottom of the SES distribution. In many diseases, the top of the SES distribution is less healthy in the United States as well. CONCLUSION: Based on self-reported illnesses and biological markers of disease, US residents are much less healthy than their English counterparts and these differences exist at all points of the SES distribution.
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OBJECTIVE: We are interested in whether functional health enhances self-esteem, as well as whether self-esteem, worker, parent, and friend identities are related to changes in functional health over a 2-year period of study. METHO...
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OBJECTIVE: We are interested in whether functional health enhances self-esteem, as well as whether self-esteem, worker, parent, and friend identities are related to changes in functional health over a 2-year period of study. METHODS: Data were collected in 1992 and 1994 from 737 older workers living in a North Carolina metropolitan area. Functional health is derived from questions asking respondents about their difficulties performing seven activities. We use Rosenberg's (1965) 10-item scale to tap self-esteem, and identities are measured with 10 adjective pairs that cover being competent, confident, and sociable as a worker, parent, and friend. RESULT: Several findings are of interest. Better functional health is associated with greater self-esteem over 2 years, and self-esteem is positively related to changes in functional health. In addition, worker identity and some social background factors are associated with positive changes in self-esteem. DISCUSSION: The findings suggest that good health may contribute to positive self assessments, but also the less well-studied expectation that self processes are associated with positive changes in health. Individuals may be motivated by their desire to affirm a sense of self-worth and positive identities to maintain and improve their physical health.
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OBJECTIVES: To review intertemporal choices, involving decisions with a trade-off between something now and something later. These choices are common in health both at an individual and societal level. METHODS: The present value o...
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OBJECTIVES: To review intertemporal choices, involving decisions with a trade-off between something now and something later. These choices are common in health both at an individual and societal level. METHODS: The present value of an outcome, for example, the amount of money or the health outcomes in various aspects, is equivalent to the value of a future outcome discounted with the delay of time. The concept of diminishing value over time is positive discounting. Economic forecasts generally use discount rates in which the value of a future dollar is less than the value of a present dollar, and where the discount rates are similar for the individual investor and society. The value of future health is commonly thought of as similar to the value of future money. Yet, the individual may rationally choose a discount rate that is exceedingly low or even negative. This paradox is particularly relevant when considering primary and secondary prevention, where initial and continuing costs may precede beneficent outcomes by decades, making discount rate selections the dominant factor in determining decisions. CONCLUSION: We suggest that the societal perspective should also recognize that discount rates for health outcomes are largely irrelevant and that even negative discount rates have crucial relevance.
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