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Health Outcomes (health + outcome)
Kinds of Health Outcomes Terms modified by Health Outcomes Selected AbstractsEfficacy and Safety of a Once-Yearly Intravenous Zoledronic Acid 5 mg for Fracture Prevention in Elderly Postmenopausal Women with Osteoporosis Aged 75 and OlderJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2010Steven Boonen MD OBJECTIVES: To determine the efficacy of once-yearly intravenous zoledronic acid (ZOL) 5 mg in reducing risk of clinical vertebral, nonvertebral, and any clinical fractures in elderly osteoporotic postmenopausal women. DESIGN: A post hoc subgroup analysis of pooled data from the Health Outcome and Reduced Incidence with Zoledronic Acid One Yearly (HORIZON) Pivotal Fracture Trial and the HORIZON Recurrent Fracture Trial. SETTING: Multicenter, randomized, double-blind, placebo-controlled trials. PARTICIPANTS: Postmenopausal women (aged ,75) with documented osteoporosis (T -score ,,2.5 at femoral neck or ,1 prevalent vertebral or hip fracture) or a recent hip fracture. INTERVENTION: Patients were randomized to receive an intravenous infusion of ZOL 5 mg (n=1,961) or placebo (n=1,926) at baseline and 12 and 24 months. MEASUREMENTS: Primary endpoints were incidence of clinical vertebral and nonvertebral and any clinical fracture after treatment. RESULTS: At 3 years, incidence of any clinical, clinical vertebral, and nonvertebral fracture were significantly lower in the ZOL group than in the placebo group (10.8% vs 16.6%, 1.1% vs 3.7%, and 9.9% vs 13.7%, respectively) (hazard ratio (HR)=0.65, 95% confidence interval (CI)=0.54,0.78, P<.001; HR=0.34, 95% CI=0.21,0.55, P<.001; and HR=0.73, 95% CI=0.60,0.90, P=.002, respectively). The incidence of hip fracture was lower with ZOL but did not reach statistical significance. The incidence rate of postdose adverse events were higher with ZOL, although the rate of serious adverse events and deaths was comparable between the two groups. CONCLUSION: Once-yearly intravenous ZOL 5 mg was associated with a significant reduction in the risk of new clinical fractures (vertebral and nonvertebral) in elderly postmenopausal women with osteroporosis. [source] Inter-State Disparities in Health Outcomes in Rural India: An Analysis Using a Stochastic Production Frontier ApproachDEVELOPMENT POLICY REVIEW, Issue 2 2005Vinish Kathuria In an era of reforms in the health sector and with the role of government in health provision diminishing, emphasis is shifting to making the sector efficient. This article analyses the performance of the rural public health systems of 16 major States in India, using stochastic production frontier techniques and panel data for the period 1986-97. The results show that States differ not only in capacity-building in terms of health infrastructure created, but also in efficiency in using these inputs. There is scope for health systems to re-orient their strategies in order to provide the best health in the most efficient way or at the lowest possible cost. [source] Inferences for Selected Location Quotients with Applications to Health OutcomesGEOGRAPHICAL ANALYSIS, Issue 3 2010Gemechis Dilba Djira The location quotient (LQ) is an index frequently used in geography and economics to measure the relative concentration of activities. This quotient is calculated in a variety of ways depending on which group is used as a reference. Here, we focus on a simultaneous inference for the ratios of the individual proportions to the overall proportion based on binomial data. This is a multiple comparison problem and inferences for LQs with adjustments for multiplicity have not been addressed before. The comparisons are negatively correlated. The quotients can be simultaneously tested against unity, and simultaneous confidence intervals can be constructed for the LQs based on existing probability inequalities and by directly using the asymptotic joint distribution of the associated test statistics. The proposed inferences are appropriate for analysis based on sample surveys. Two real data sets are used to demonstrate the application of multiplicity-adjusted LQs. A simulation study is also carried out to assess the performance of the proposed methods to achieve a nominal coverage probability. For the LQs considered, the coverage of the simple Bonferroni-adjusted Fieller intervals for LQs is observed to be almost as good as the coverage of the method that directly takes the correlations into account. El cociente de localización (LQ) es un índice de uso frecuente en las disciplinas de Geografía y Economía para medir la concentración relativa de actividades. El cálculo del cociente se realiza de una variedad de formas, dependiendo del grupo que se utilice como referencia. El presente artículo aborda el problema de realizar inferencias simultáneas con tasas que describen proporciones individuales en relación a proporciones globales, para el caso de datos en escala binomial. Este problema puede ser caracterizado como uno de tipo de comparaciones múltiples (multiple comparison problem). Salvo el estudio presente, no existen precedentes de métodos diseñados para realizar inferencias de LQ que estén ajustados para abordar comparaciones múltiples. Las comparaciones están correlacionadas negativamente. Los cocientes pueden ser evaluados simultáneamente para verificar la propiedad de unidad (unity), y se pueden construir intervalos de confianza simultáneos para un LQ basado en la desigualdad de probabilidades existentes y por medio del uso directo de la distribución asintótica conjunta (asymtotic joint distribution) de los test o pruebas estadísticas asociadas. El tipo de inferencias propuestas por los autores son las adecuadas para el análisis de encuestas por muestreo. Para demostrar la aplicación del LQ desarrollado por el estudio, se utilizan dos conjuntos de datos del mundo real. Asimismo se lleva a cabo un estudio de simulación para evaluar el desempeño de los métodos propuestos con el fin de alcanzar una probabilidad de cobertura nominal (nominal coverage). Para los LQs seleccionados, la cobertura de los intervalos de confianza simples Fieller-Bonferroni ajustados para LQ, producen resultados casi tan buenos como la cobertura de métodos que toma en cuenta las correlaciones directamente. [source] Worldwide-Schizophrenia Outpatient Health Outcomes (W-SOHO): baseline characteristics of pan-regional observational data from more than 17,000 patients,INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 11 2009J. Karagianis Summary Objective:, To describe the Worldwide-Schizophrenia Outpatient Health Outcomes (W-SOHO) patient population at study entry, focusing on illness burden and prescribing practices across regions. Methods:, The SOHO study was a 3-year, prospective, observational study designed to assess costs and outcomes associated with antipsychotic use in outpatients initiating or changing antipsychotic (with an emphasis on olanzapine compared with other antipsychotics). SOHO was conducted in 10 European countries and 27 other countries as Intercontinental SOHO (IC-SOHO). Data from all countries have been pooled to produce the W-SOHO dataset. Main outcomes measures:, Clinical Global Impression-Schizophrenia (CGI-SCH) severity scores, psychotropic medication use, adverse events, social interaction, housing and employment status, self-perceived health state (EuroQoL EQ-5D scale and Visual Analogue Scale, EQ-VAS), and reasons for initiation/change of antipsychotic. Results:, The W-SOHO database comprises 17,384 patients from six regions; East Asia (n = 1223), Central and Eastern Europe (n = 2175), Northern Europe (n = 4291), Southern Europe (n = 5788), Latin America (n = 2566), North Africa and the Middle East (n = 1341). Overall, patients were 38 ± 13 years old (mean ± SD), moderately ill (mean CGI-SCH overall score of 4.4 ± 1.0) with a median duration of illness of 7 years (interquartile range 1,16 years); 43% were female, 10% were receiving antipsychotic medication for the first time. Adverse events were prevalent across all regions; on average, 50% (range 41,59%) of patients taking antipsychotics exhibited extrapyramidal symptoms at baseline, and 62% (34,67%) of patients reported sexual dysfunction in the previous month. On average, only 19% (16,23%) of patients were in paid employment and as many as 69% were living in dependent housing. Conclusions:, Despite inherent diversity in these patients and the health care systems supporting them, there are striking cross-regional similarities in baseline characteristics for most measures. Not all countries are represented; regional comparisons may not be valid outside of the countries studied. [source] Cognitive Impairment Improves the Predictive Validity of the Phenotype of Frailty for Adverse Health Outcomes: The Three-City StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2009José Alberto Ávila-Funes MD OBJECTIVES: To determine whether adding cognitive impairment to frailty improves its predictive validity for adverse health outcomes. DESIGN: Four-year longitudinal study. SETTING: The French Three-City Study. PARTICIPANTS: Six thousand thirty community-dwelling persons aged 65 to 95. MEASUREMENTS: Frailty was defined as having at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low physical activity. Subjects meeting one or two criteria were prefrail and those meeting none as nonfrail. The lowest quartile in the Mini-Mental State Examination (MMSE) and the Isaacs Set Test (IST) was used to identify subjects with cognitive impairment. The predictive validity of frailty for incident disability, hospitalization, dementia, and death was calculated first for frailty subgroups and then rerun after stratification according to the presence or absence of cognitive impairment. RESULTS: Four hundred twenty-one individuals (7%) met frailty criteria. Cognitive impairment was present in 10%, 12%, and 22% of the nonfrail, prefrail, and frail subjects, respectively. Those classified as frail scored lower on the MMSE and IST than those classified as prefrail and nonfrail. After adjustment, frail persons with cognitive impairment were significantly more likely to develop disability in activities of daily living (ADLs) and instrumental ADLs over the following 4 years. The risk of incident mobility disability and hospitalization was marginally greater. Incident dementia was greater in the groups with cognitive impairment irrespective of their frailty status. Conversely, frailty was not a significant predictor of mortality. CONCLUSION: Cognitive impairment improves the predictive validity of the operational definition of frailty, because it increases the risk of adverse health outcomes in this particular subgroup of the elderly population. [source] Health Literacy for Improved Health Outcomes: Effective Capital in the MarketplaceJOURNAL OF CONSUMER AFFAIRS, Issue 2 2009NATALIE ROSS ADKINS Improving consumers' health literacy addresses many of the rising problems in healthcare. We empirically support a reconceptualization of health literacy as a social and cultural practice through which adults leverage a range of skills as well as social networks to meet their needs. Pierre Bourdieu's "theory of practice" guides this reconceptualization and facilitates articulation of the array of strategies used in the complex healthcare marketplace. We focus on the low literate consumers' alternative forms of capital and the providers' recognition and support. The findings, from an emergent research design consisting of depth interviews with low literate consumers and healthcare providers, suggest a critical, reflective approach that enhances health literacy, empowers consumers to become partners in their own healthcare programs, and improves health outcomes. [source] Partner Violence and Mental Health Outcomes in a New Zealand Birth CohortJOURNAL OF MARRIAGE AND FAMILY, Issue 5 2005David M. Fergusson This study examines the prevalence and extent of domestic violence and the consequences of domestic violence for mental health outcomes in a birth cohort of New Zealand young adults studied at age 25 years. A total of 828 young people (437 women and 391 men) were interviewed about the domestic violence victimization and violence perpetration in their current or most recent partner relationship. Key findings of the study were (a) domestic conflict was present in 70% of relationships, with this conflict ranging from minor psychological abuse to severe assault; (b) men and women reported similar experiences of victimization and perpetration of domestic violence; and (c) exposure to domestic violence was significantly related to increased risks of major depression (p < .05) and suicidal ideation (p < .005) even after extensive control for covariates. [source] Adolescent Dating Violence: Prevalence, Risk Factors, Health Outcomes, and Implications for Clinical PracticeJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2 2003Nancy Glass PhD, RN assistant professor The goal of this synthesis is to provide a comprehensive assessment of the literature associated with dating violence in adolescence. Previous research findings on the prevalence, risk factors associated with victimization and perpetration, and potential health outcomes of dating violence are discussed. The importance of designing developmentally and culturally competent dating violence prevention and intervention strategies in the clinical setting is emphasized. This review is intended to assist health care professionals to develop interventions in their clinical settings to prevent and reduce adolescent dating violence. [source] Demonstrating Successful Aging Using the International Collaborative Study for Oral Health OutcomesJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 4 2000Kathryn A. Atchison DDS Abstract As the lifespan increases and people are faced with 15 to 20 years of "old age," we ask what one considers successful aging with respect to oral health. We propose a comprehensive combination of outcome variables, maintenance of teeth, manageable periodontal condition, positive perceived oral health, satisfaction with their access to and receipt of dental services, and minimal functional problems, that together comprise a definition of successful aging. The International Collaborative Study for Oral Health Outcomes provides a data set for exploring the oral health of a diverse sample of older adults in US and international sites using the modified Andersen Behavioral Model. The percent of adults who report no natural teeth ranged from 16 percent in San Antonio to 59 percent in New Zealand. Seventy percent or more of the adults from each site rated their oral health as good/fair or better except in Poland. The current cohort of older adults is faring better on some indicators than others; nevertheless, ethnic minorities and poorer countries still demonstrate inequities. Dentistry must attempt to educate individuals early in their lifespan that a combination of personal oral health practices and current dental techniques offers the potential for successful oral health throughout one's lifetime. [source] Same-Sex Activity Among Women May Be a Marker for Adverse Sexual and Reproductive Health OutcomesPERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 4 2007D. Hollander No abstract is available for this article. [source] Fitness: The Ultimate Marker for Risk Stratification and Health Outcomes?PREVENTIVE CARDIOLOGY, Issue 1 2007Barry A Franklin PhD First page of article [source] Struggling to Survive: Sexual Assault, Poverty, and Mental Health Outcomes of African American WomenAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 1 2010Thema Bryant-Davis A substantial body of research documents the mental health consequences of sexual assault including, but not limited to, depression, posttraumatic stress disorder, substance use, and suicidality. Far less attention has been given to the mental health effects of sexual assault for ethnic minority women or women living in poverty. Given African American women's increased risk for sexual assault and increased risk for persistent poverty, the current study explores the relationship between income and mental health effects within a sample of 413 African American sexual assault survivors. Hierarchical regression analyses revealed that after controlling for childhood sexual abuse there were positive relationships between poverty and mental health outcomes of depression, posttraumatic stress disorder, and illicit drug use. There was no significant relationship between poverty and suicidal ideation. Counseling and research implications are discussed. [source] Exercise and Cancer Survivorship: Impact on Health Outcomes and Quality of Life.PSYCHO-ONCOLOGY, Issue 8 2010Amanda Daley., Edited by John Saxton No abstract is available for this article. [source] Sexual Function in F-111 Maintenance Workers: The Study of Health Outcomes in Aircraft Maintenance PersonnelTHE JOURNAL OF SEXUAL MEDICINE, Issue 6 2009Anthony Brown MPH ABSTRACT Introduction., In Australia, four formal F-111 fuel tank deseal/reseal (DSRS) repair programs were implemented over more than two decades, each involving different processes and using a range of hazardous substances. However, health concerns were raised by a number of workers. The "Study of Health Outcomes in Aircraft Maintenance Personnel" was commissioned by the Australian Department of Defence to investigate potential adverse health outcomes as a result of being involved in the deseal/reseal processes. Aim., To compare measures of sexual function in F-111 aircraft fuel tank DSRS maintenance workers, against two appropriate comparison groups. Methods., Exposed and comparison participants completed a postal questionnaire which included general questions of health and health behavior, and two specific questions on sexual functioning. They also completed the International Index of Erectile Function (IIEF) questionnaire. Logistic regression was used to explore exposure status and outcome while adjusting for potential confounders. Main Outcome Measures., The three outcomes of interest for this study were the proportion of participants with erectile dysfunction (ED) according to the IIEF, the proportion with self-reported loss of interest in sex, and the proportion with self-reported problems with sexual functioning. Results., Compared with each of the comparison groups, a larger proportion of the exposed group reported sexual problems and were classified as having ED according to the IIEF. In logistic regression, the odds of all three outcomes were higher for exposed participants relative to each comparison group and after adjustment for potentially confounding variables including anxiety and depression. Conclusions., There was a consistent problem with sexual functioning in the exposed group that is not explained by anxiety and depression, and it appears related to DSRS activities. Brown A, Gibson R, Tavener M, Guest M, D'Este C, Byles J, Attia J, Horsley K, Harrex W, and Ross J. Sexual function in F-111 maintenance workers: The study of health outcomes in aircraft maintenance personnel. J Sex Med 2009;6:1569,1578. [source] Psychological Functioning, Nonadherence and Health Outcomes After Pediatric Liver TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2007E. M. Fredericks The present study empirically assessed the relationships between adherence behaviors and HRQOL, parent and child psychological functioning and family functioning, and investigated the relationship between adherence behaviors and health outcomes in children who were within 5 years of their liver transplantation. Participants included 38 children (mean = 8.5 years, range 28 months to 16 years) and their parent/guardian(s). HRQOL and psychological functioning were examined using well-validated assessment measures. Measures of adherence included the rate of clinic attendance and standard deviations (SDs) of consecutive tacrolimus blood levels, which were collected and evaluated retrospectively. Measures of child health status included the frequency of hospital admissions, liver biopsies, episodes of rejection and graft function for the year prior to study participation. Results indicated that nonadherence was related to lower physical HRQOL, more limitations in social and school activities related to emotional and behavioral problems, parental emotional distress and decreased family cohesion. Nonadherence was also related to frequency and duration of hospitalizations, liver biopsies and rejection episodes. These results suggest that empirically based assessment of HRQOL, parenting stress and family functioning may help identify patients at risk for nonadherence, and may allow for the need-based delivery of appropriate clinical interventions. [source] Modeling Data with Excess Zeros and Measurement Error: Application to Evaluating Relationships between Episodically Consumed Foods and Health OutcomesBIOMETRICS, Issue 4 2009Victor Kipnis Summary Dietary assessment of episodically consumed foods gives rise to nonnegative data that have excess zeros and measurement error. Tooze et al. (2006,,Journal of the American Dietetic Association,106, 1575,1587) describe a general statistical approach (National Cancer Institute method) for modeling such food intakes reported on two or more 24-hour recalls (24HRs) and demonstrate its use to estimate the distribution of the food's usual intake in the general population. In this article, we propose an extension of this method to predict individual usual intake of such foods and to evaluate the relationships of usual intakes with health outcomes. Following the regression calibration approach for measurement error correction, individual usual intake is generally predicted as the conditional mean intake given 24HR-reported intake and other covariates in the health model. One feature of the proposed method is that additional covariates potentially related to usual intake may be used to increase the precision of estimates of usual intake and of diet-health outcome associations. Applying the method to data from the Eating at America's Table Study, we quantify the increased precision obtained from including reported frequency of intake on a food frequency questionnaire (FFQ) as a covariate in the calibration model. We then demonstrate the method in evaluating the linear relationship between log blood mercury levels and fish intake in women by using data from the National Health and Nutrition Examination Survey, and show increased precision when including the FFQ information. Finally, we present simulation results evaluating the performance of the proposed method in this context. [source] Health outcomes associated with methamphetamine use among young people: a systematic reviewADDICTION, Issue 6 2010Brandon D. L. Marshall ABSTRACT Objectives Methamphetamine (MA) use among young people is of significant social, economic and public health concern to affected communities and policy makers. While responses have focused upon various perceived severe harms of MA use, effective public health interventions require a strong scientific evidence base. Methods We conducted a systematic review to identify scientific studies investigating health outcomes associated with MA use among young people aged 10,24 years. The International Classification of Diseases (ICD-10) was used to categorize outcomes and determine the level of evidence for each series of harms. Results We identified 47 eligible studies for review. Consistent associations were observed between MA use and several mental health outcomes, including depression, suicidal ideation and psychosis. Suicide and overdose appear to be significant sources of morbidity and mortality among young MA users. Evidence for a strong association between MA use and increased risk of human immunodeficiency virus (HIV) and other sexually transmitted infections is equivocal. Finally, we identified only weak evidence of an association between MA use and dental diseases among young people. Conclusions Available evidence indicates a consistent relationship between MA use and mental health outcomes (e.g. depression, psychosis) and an increased risk of mortality due to suicide and overdose. We found insufficient evidence of an association between MA use and other previously cited harms, including infectious diseases and dental outcomes. As such, future research of higher methodological quality is required to further investigate possible associations. Current interventions should focus attention upon MA-related health outcomes for which sound scientific evidence is available. [source] The meta-analysis of the Italian studies on short-term effects of air pollution (MISA): old and new issues on the interpretation of the statistical evidencesENVIRONMETRICS, Issue 3 2007Pierantonio Bellini Abstract The second meta-analysis of the Italian studies on short-term health effects of air pollution, known as MISA-2, was based on daily time series of indicators of both pollution and of health outcomes. It covered 15 cities during 1996,2002 for a total population of approximately nine millions. Health outcomes included mortality for natural causes, for respiratory diseases and for cardiovascular conditions, as well as hospital admissions for respiratory, cardiac and cerebrovascular diseases. Pollutants considered in univariate analyses were sulphur dioxide (SO2), nitrogen oxide (NO2), carbon monoxide (CO), suspended particulate matter (SPM) measuring less than 10,µm diameter (PM10) and ozone (O3, limited to the summer period). Results, including risk estimates, have been largely confirmatory of findings obtained in previous large meta-analytic studies carried out in North America and in Europe. A full report in Italian is available. The present contribution summarises the results of MISA-2 and addresses three major issues regarding their interpretation: robustness of the causal inferential process, the role of specific air pollutants and the reliability of risk estimates. The former issue is stressed according to Bradford Hill's criteria and the conclusion is reached that at least for the association of air pollution with an increase in mortality the evidence for causality is strong. Assessing the role of each air pollutant is problematic: there is some evidence that the effects of PM10 are partly confounded by other pollutants, but PM10 may not be the best indicator of the role of air SPM (routine measures of PM2.5 have not been introduced in Italy). As for risk estimates, the per cent increase in risk of mortality for unit increase in PM10 concentration, measured in MISA-2, is remarkably similar to estimates in other studies and there is indication for linearity of the dose,response relationship. Copyright © 2007 John Wiley & Sons, Ltd. [source] Cost-effectiveness analysis of general anaesthesia versus local anaesthesia for carotid surgery (GALA Trial)BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2010M. Gomes Background: Health outcomes and costs are both important when deciding whether general (GA) or local (LA) anaesthesia should be used during carotid endarterectomy. The aim of this study was to assess the cost-effectiveness of carotid endarterectomy under LA or GA in patients with symptomatic or asymptomatic carotid stenosis for whom surgery was advised. Methods: Using patient-level data from a large, multinational, randomized controlled trial (GALA Trial) time free from stroke, myocardial infarction or death, and costs incurred were evaluated. The cost-effectiveness outcome was incremental cost per day free from an event, within a time horizon of 30 days. Results: A patient undergoing carotid endarterectomy under LA incurred fewer costs (mean difference £178) and had a slightly longer event-free survival (difference 0·16 days, but the 95 per cent confidence limits around this estimate were wide) compared with a patient who had GA. Existing uncertainty did not have a significant impact on the decision to adopt LA, over a wide range of willingness-to-pay values. Conclusion: If cost-effectiveness was considered in the decision to adopt GA or LA for carotid endarterectomy, given the evidence provided by this study, LA is likely to be the favoured treatment for patients for whom either anaesthetic approach is clinically appropriate. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Cost-effectiveness and quality-of-life analysis of physician-staffed helicopter emergency medical services,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2009A. N. Ringburg Background: The long-term health outcomes and costs of helicopter emergency medical services (HEMS) assistance remain uncertain. The aim of this study was to investigate the cost-effectiveness of HEMS assistance compared with emergency medical services (EMS). Methods: A prospective cohort study was performed at a level I trauma centre. Quality-of-life measurements were obtained at 2 years after trauma, using the EuroQol,Five Dimensions (EQ-5D) as generic measure to determine health status. Health outcomes and costs were combined into costs per quality-adjusted life year (QALY). Results: The study population receiving HEMS assistance was more severely injured than that receiving EMS assistance only. Over the 4-year study interval, HEMS assistance saved a total of 29 additional lives. No statistically significant differences in quality of life were found between assistance with HEMS or with EMS. Two years after trauma the mean EQ-5D utility score was 0·70 versus 0·71 respectively. The incremental cost,effectiveness ratio for HEMS versus EMS was ,28 327 per QALY. The sensitivity analysis showed a cost-effectiveness ratio between ,16 000 and ,62 000. Conclusion: In the Netherlands, the costs of HEMS assistance per QALY remain below the acceptance threshold. HEMS should therefore be considered as cost effective. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Outcomes for children's health and well-beingCHILDREN & SOCIETY, Issue 3 2003Zarrina Kurtz Health outcomes are implicit in the government's major policies on reducing poverty, unemployment and social exclusion, and in environmental regeneration, as well as in explicitly targeted policies for modernising the National Health Service. The impact of policies in childhood are regarded as a key feature in determining socioeconomic outcomes in many domains, among which mental health plays a particularly important part. But although early intervention is recognised as crucial in the achievement of socioeconomic and health policy aims, outcomes in children and for children have only recently received full recognition. This article outlines the impact that government policies may have on health outcomes for children. However, the assessment of changes in health status is difficult and mostly relies on proxy measures. The evidence that any changes can be related to policy is extremely limited and mostly based on small-scale and locally specific projects. What can be learnt from these and from collective analysis of linked projects, such as those funded through the CAMHS Innovation Grant, is discussed. Because of the attention paid by the government to evidence-based policy, outcomes in all domains will become known before long for major national children's policy initiatives such as the Sure Start programme, highlighting the crucial and continuing need for evaluation of the ways in which policies are implemented. Copyright © 2003 John Wiley & Sons, Ltd. [source] Health outcomes of children fathered by patients treated with radioiodine for thyroid cancerCLINICAL ENDOCRINOLOGY, Issue 6 2009Jérôme-Philippe Garsi Summary Context and objectives, Radiation is known to be mutagenic. The present study analyses birth outcomes and the health of offspring from men previously exposed to 131I treatment for thyroid carcinoma. Methods, Data on 493 pregnancies (356 from 173 untreated fathers, 23 from 17 patients who have undergone surgery alone and 114 from 63 fathers who received 131I) were obtained by interviewing male patients treated for thyroid carcinoma who had not received significant external radiation to the testes. Among these pregnancies, 73 were conceived from fathers who had received more than 370 MBq. Results, The mean activity for the 114 pregnancies fathered by 63 patients was 3993 MBq leading to an estimated radiation dose of 9·2 cGy to the testes (MIRD committee coefficient). No significant differences between untreated and treated fathers were found for any adverse outcome. Conclusion, There was no evidence that exposure to radioiodine affects the outcome of subsequent pregnancies and offspring, whatever the event considered. As our study is underpowered, the question of whether testicular irradiation, fractionated or not, is linked to impaired fertility or consequences on offspring remains to be established. [source] Psychological effects of prevention: do participants of a type 2 diabetes prevention program experience increased mental distress?DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 1 2009Katrin E. Giel Abstract Objective To evaluate the mental health outcome of a lifestyle intervention for the prevention of type 2 diabetes and to exclude possible harmful psychological effects. Background There is little empirical data on potential harmful effects of prevention programs. However, information, education, diagnostic procedures, phenotyping and risk assessment may cause or intensify psychological distress such as anxiety, depression or somatization in vulnerable individuals. Methods The Tuebingen Lifestyle Intervention Program (TULIP) for the prevention of type 2 diabetes has assessed mental health outcome in the participants after 9 months of program participation using the Symptom Checklist-90-R (SCL-90-R). The 24-months lifestyle intervention TULIP comprises regular exercise and changes in nutrition and assesses both, a broad range of somatic parameters as well as psychometric variables. For an interim analysis of psychological outcome, complete data sets of the SCL-90-R assessed at baseline and after 9 months of intervention were available for 195 participants (125 females, 70 males; age: 46.1 ± 10.6 years). Data on somatization, anxiety, depression and overall psychological distress were compared to baseline levels. Results SCL-90-R scores of the TULIP-participants did not significantly differ from the German healthy reference population. Compared to baseline, a significant decrease in SCL-90-R scores was found for anxiety, depression and overall psychological distress at re-assessment after 9 months. Conclusion The interim analysis on mental health outcome of a type 2 diabetes prevention program comprising extensive phenotyping and risk assessment rules out adverse psychological effects, suggesting rather beneficial changes concerning symptoms of anxiety, depression and overall psychological distress. Copyright © 2009 John Wiley & Sons, Ltd. [source] Not all roads lead to Rome,a review of quality of life measurement in adults with diabetesDIABETIC MEDICINE, Issue 4 2009J. Speight Abstract Aims Quality of life (QoL) is recognized widely as an important health outcome in diabetes, where the burden of self-management places great demands on the individual. However, the concept of QoL remains ambiguous and poorly defined. The aim of our review is to clarify the measurement of QoL in terms of conceptualization, terminology and psychometric properties, to review the instruments that have been used most frequently to assess QoL in diabetes research and make recommendations for how to select measures appropriately. Methods A systematic literature search was conducted to identify the ten measures most frequently used to assess QoL in diabetes research (including clinical trials) from 1995 to March 2008. Results Six thousand and eight-five abstracts were identified and screened for instrument names. Of the ten instruments most frequently used to assess ,QoL', only three actually do so [i.e. the generic World Health Organization Quality of Life (WHOQOL) and the diabetes-specific Diabetes Quality of Life (DQOL) and Audit of Diabetes-Dependent Quality of Life (ADDQoL)]. Seven instruments more accurately measure health status [Short-Form 36 (SF-36), EuroQoL 5-Dimension (EQ-5D)], treatment satisfaction [Diabetes Treatment Satisfaction Questionnaire (DTSQ)] and psychological well-being [Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Well-Being Questionnaire (W-BQ), Problem Areas in Diabetes (PAID)]. Conclusions No single measure can suit every purpose or application but, when measures are selected inappropriately and data misinterpreted, any conclusions drawn are fundamentally flawed. If we value QoL as a therapeutic goal, we must ensure that the instruments we use are both valid and reliable. QoL assessment has the proven potential to identify ways in which treatments can be tailored to reduce the burden of diabetes. With careful consideration, appropriate measures can be selected and truly robust assessments undertaken successfully. [source] Characterization and comparison of health-related utility in people with diabetes with various single and multiple vascular complicationsDIABETIC MEDICINE, Issue 10 2006C. Ll. Abstract Aims To characterize and compare health-related utility in a large cohort of patients treated in hospital with diabetes and with single and multiple comorbidities. Methods The study was conducted in Cardiff and the Vale of Glamorgan, UK. Health-related utility was measured using the EQ5Dindex, a standardized instrument for measuring health outcome. Patients from the Health Outcomes Data Repository (HODaR) were surveyed by postal questionnaire 6 weeks post discharge for in-patients and during clinics for patients attending as out-patients between January 2002 and July 2005. Patients with diabetes were identified by a previous history of in-patient admission with diabetes or as an out-patient with diabetes recorded as a coexisting diagnosis. Results, We identified 4502 patients with diabetes. Mean ages were 65.4 and 64.2 years for males and females, respectively. Of these, 2003 (45%) had no recorded vascular complication. Overall, the EQ5Dindex was 0.584 (sd 0.325) for males and 0.533 (sd 0.351) for females. For those without any vascular complications the mean EQ5Dindex was 0.735 (sd 0.288). In a general linear model, the presence of single and multiple complications had a detrimental impact on the EQ5Dindex. Conclusion The results of this study provide an indication of the true impact of diabetes in terms of health-related utility. There was a decrease in the mean EQ5Dindex for those with vascular complications. Economic models of diabetes that have used additive or multiplicative methods to assess utility in individuals with several complications may be unreliable, and direct measurements, such as this, are recommended. [source] Occupational exposure to methyl tertiary butyl ether in relation to key health symptom prevalence: the effect of measurement error correctionENVIRONMETRICS, Issue 6 2003Aparna P. Keshaviah Abstract In 1995, White et al. reported that methyl tertiary butyl ether (MTBE), an oxygenate added to gasoline, was significantly associated with key health symptoms, including headaches, eye irritation, and burning of the nose and throat, among 44 people occupationally exposed to the compound and for whom serum MTBE measurements were available (odds ratio (OR),=,8.9, 95% CI,=,[1.2, 75.6]). However, these serum MTBE measurements were available for only 29 per cent of the 150 subjects enrolled. Around the same time, Mannino et al. conducted a similar study among individuals occupationally exposed to low levels of MTBE and did not find a significant association between exposure to MTBE and the presence of one or more key health symptoms among the 264 study participants (OR,=,0.60, 95% CI,=,[0.3, 1.21]). In this article, we evaluate the effect of MTBE on the prevalence of key health symptoms by applying a regression calibration method to White et al.'s and Mannino et al.'s data. Unlike White et al., who classified exposure using actual MTBE levels among a subset of the participants, and Mannino et al., who classified exposure based on job category among all participants, we use all of the available data to obtain an estimate of the effect of MTBE in units of serum concentration, adjusted for measurement error due to using job category instead of measured exposure. After adjusting for age, gender and smoking status, MTBE exposure was found to be significantly associated with a 50 per cent increase in the prevalence of one or more key health symptoms per order of magnitude increase in blood concentration on the log10 scale, using data from the 409 study participants with complete information on the covariates (95% CI,=,[1.00, 2.25]). Simulation results indicated that under conditions similar to those observed in these data, the estimator is unbiased and has a coverage probability close to the nominal value. The methodology illustrated in this article is advantageous because all of the available data were used in the analysis, obtaining a more precise estimate of exposure effect on health outcome, and the estimate is adjusted for measurement error due to using job category instead of measured exposure. Copyright © 2003 John Wiley & Sons, Ltd. [source] Primary Headache in Italian Early Adolescents: The Role of Perceived Teacher UnfairnessHEADACHE, Issue 3 2009Massimo Santinello BA Background., The impact of perceived teacher unfairness on headache incidence has previously been insufficiently investigated. Objective., The aims of the study are to analyze the prevalence of headache among Italian early adolescents as well as to examine the role of perceived teacher unfairness and classmate social support in predicting this health outcome. Methods., Data were taken from the "Health Behaviour in School Aged Children," a cross-sectional survey investigating health behaviors among early adolescents in selected European countries. Headache, perceived teacher unfairness, and classmate social support were measured through a self-administered questionnaire filled out by a representative sample of 4386 (48.4% males) Italian students (11, 13, and 15 years old). Covariates included demographic characteristics (age, gender) and socioeconomic status (parental educational attainment), and other confounding psychological factors (eg, family empowerment, bullying). Results., Prevalence of frequent headaches (at least once a week) was about 40%. Girls were more likely to report frequent headaches compared with boys. Prevalence of frequent headaches increased with age. After adjusting for age and gender, teacher unfairness showed a significant association with frequent headache (P < .001). This relationship remained significant even after additional adjustment for several psychosocial factors. Classmate social support seems to act as a protective factor, but not as a buffering mechanism against the negative effects of teacher unfairness. Conclusions., Italian early adolescents show a quite high prevalence of frequent headache. Results show that characteristics of the school setting, such as teacher unfairness and classmate social support, can be significant predictors of frequent headache among early adolescents. Longitudinal research is needed to delineate causal relationships between school factors and recurrent headache. [source] Cost-effectiveness acceptability curves , facts, fallacies and frequently asked questionsHEALTH ECONOMICS, Issue 5 2004Elisabeth Fenwick Abstract Cost-effectiveness acceptability curves (CEACs) have been widely adopted as a method to quantify and graphically represent uncertainty in economic evaluation studies of health-care technologies. However, there remain some common fallacies regarding the nature and shape of CEACs that largely result from the ,textbook' illustration of the CEAC. This ,textbook' CEAC shows a smooth curve starting at probability 0, with an asymptote to 1 for higher money values of the health outcome (,). But this familiar ,ogive' shape which makes the ,textbook' CEAC look like a cumulative distribution function is just one special case of the CEAC. The reality is that the CEAC can take many shapes and turns because it is a graphic transformation from the cost-effectiveness plane, where the joint density of incremental costs and effects may ,straddle' quadrants with attendant discontinuities and asymptotes. In fact CEACs: (i) do not have to cut the y -axis at 0; (ii) do not have to asymptote to 1; (iii) are not always monotonically increasing in ,; and (iv) do not represent cumulative distribution functions (cdfs). Within this paper we present a ,gallery' of CEACs in order to identify the fallacies and illustrate the facts surrounding the CEAC. The aim of the paper is to serve as a reference tool to accompany the increased use of CEACs within major medical journals. Copyright © 2004 John Wiley & Sons, Ltd. [source] The effect of traumatic bereavement on tsunami-exposed survivors,JOURNAL OF TRAUMATIC STRESS, Issue 6 2009Kerstin Bergh Johannesson Fourteen months after the 2004 tsunami, mental health outcome was assessed in 187 bereaved relatives, 308 bereaved friends, and in 3,020 nonbereaved Swedish survivors. Of the bereaved relatives, 41% reported posttraumatic stress reactions and 62% reported impaired general mental health. Having been caught or chased by the tsunami in combination with bereavement was associated with increased posttraumatic stress reactions. Complicated grief reactions among relatives were almost as frequent as posttraumatic stress reactions. The highest levels of psychological distress were found among those who had lost children. Traumatic bereavement, in combination with exposure to life danger, is probably a risk factor for mental health sequelae after a natural disaster. [source] An investigation of the impact of posttraumatic stress disorder on physical healthJOURNAL OF TRAUMATIC STRESS, Issue 1 2000Amy W. Wagner Abstract In a large sample of Gulf War veterans (N = 2301) we examined the relations between PTSD symptoms assessed immediately upon returning from the Gulf War and self-reported health problems assessed 18,24 months later. PTSD symptomatology was predictive of self-reported health problems over time for both men and women veterans, even after the effects of combat exposure were removed from the analysis. Female veterans reported significantly more health problems than male veterans, however, there was no interactive effect of gender and PTSD on health problems. These findings provide further support for the theory that psychological response to stressors impacts health outcome. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||