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1.
Stud Health Technol Inform ; 264: 1065-1069, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438088

RESUMO

Social media presents a rich opportunity to gather health information with limited intervention through the analysis of completely unstructured and unlabeled microposts. We sought to estimate the health-related quality of life (HRQOL) of Twitter users using automated semantic processing methods. We collected tweets from 878 Twitter users recruited through online solicitation and in-person contact with patients. All participants completed the four-item Centers for Disease Control Healthy Days Questionnaire at the time of enrollment and 30 days later to measure "ground truth" HRQOL. We used a combination of document frequency analysis, sentiment analysis, topic analysis, and concept mapping to extract features from tweets, which we then used to estimate dichotomized HRQOL ("high" vs. "low") using logistic regression. Binary HRQOL status was estimated with moderate performance (AUC = 0.64). This result indicates that free-range social media data only offers a window into HRQOL, but does not afford direct access to current health status.


Assuntos
Mídias Sociais , Coleta de Dados , Nível de Saúde , Humanos , Qualidade de Vida , Semântica
2.
Ther Adv Cardiovasc Dis ; 13: 1753944719870084, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441375

RESUMO

Reduced functional ability and exercise tolerance in patients with heart failure (HF) are associated with poor quality of life and a worse prognosis. The 6-minute walking test (6MWT) is a widely available and well-tolerated test for the assessment of the functional capacity of patients with HF. Although the cardiopulmonary exercise test (a maximal exercise test) remains the gold standard for the evaluation of exercise capacity in patients with HF, the 6MWT (submaximal exercise test) may provide reliable information about the patient's daily activity. The current review summarizes the value of 6MWT in patients with HF and identifies its usefulness and limitations in everyday clinical practice in populations of HF. We aimed to investigate potential associations of 6MWD with other measures of functional status and determinants of 6MWD in patients with HF as well as to review its prognostic role and changes to various interventions in these patients.


Assuntos
Tolerância ao Exercício , Insuficiência Cardíaca/diagnóstico , Teste de Caminhada , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aptidão Cardiorrespiratória , Feminino , Nível de Saúde , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Volume Sistólico , Função Ventricular Esquerda , Adulto Jovem
3.
Genome Biol ; 20(1): 152, 2019 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375147

RESUMO

Jacob and Speed did not identify even a single example of a '150-gene-set' that was statistically significant at classifying Alzheimer's disease (AD) samples, or age in independent studies. We attempt to clarify the various misunderstandings, below.


Assuntos
Doença de Alzheimer , Envelhecimento Saudável , Cognição , Nível de Saúde , Humanos , RNA
5.
Stud Health Technol Inform ; 264: 1478-1479, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438190

RESUMO

The health concept has evolved throughout history. The people health level is determined by the perception that each individual has of it. It is a dynamic process over time, so the variations can be see from one moment to another. In this way, knowing the health of the patients you care for will facilitate decision-making in the treatment of care. To know the level of health of the people, a technological tool is presented that calculates the people health level through the Health Variables and Nursing Outcomes Classification (NOC) labels.


Assuntos
Tomada de Decisões , Nível de Saúde , Humanos
6.
BMJ ; 366: l4414, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391187

RESUMO

OBJECTIVES: To examine the association between the Life Simple 7 cardiovascular health score at age 50 and incidence of dementia. DESIGN: Prospective cohort study. SETTING: Civil service departments in London (Whitehall II study; study inception 1985-88). PARTICIPANTS: 7899 participants with data on the cardiovascular health score at age 50. EXPOSURES: The cardiovascular health score included four behavioural (smoking, diet, physical activity, body mass index) and three biological (fasting glucose, blood cholesterol, blood pressure) metrics, coded on a three point scale (0, 1, 2). The cardiovascular health score was the sum of seven metrics (score range 0-14) and was categorised into poor (scores 0-6), intermediate (7-11), and optimal (12-14) cardiovascular health. MAIN OUTCOME MEASURE: Incident dementia, identified through linkage to hospital, mental health services, and mortality registers until 2017. RESULTS: 347 incident cases of dementia were recorded over a median follow-up of 24.7 years. Compared with an incidence rate of dementia of 3.2 (95% confidence interval 2.5 to 4.0) per 1000 person years among the group with poor cardiovascular health, the absolute rate differences per 1000 person years were -1.5 (95% confidence interval -2.3 to -0.7) for the group with intermediate cardiovascular health and -1.9 (-2.8 to -1.1) for the group with optimal cardiovascular health. Higher cardiovascular health score was associated with a lower risk of dementia (hazard ratio 0.89 (0.85 to 0.95) per 1 point increment in the cardiovascular health score). Similar associations with dementia were observed for the behavioural and biological subscales (hazard ratios per 1 point increment in the subscores 0.87 (0.81 to 0.93) and 0.91 (0.83 to 1.00), respectively). The association between cardiovascular health at age 50 and dementia was also seen in people who remained free of cardiovascular disease over the follow-up (hazard ratio 0.89 (0.84 to 0.95) per 1 point increment in the cardiovascular health score). CONCLUSION: Adherence to the Life Simple 7 ideal cardiovascular health recommendations in midlife was associated with a lower risk of dementia later in life.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Demência/epidemiologia , Nível de Saúde , Estilo de Vida Saudável , Adulto , Idoso , Doenças Cardiovasculares/sangue , Demência/prevenção & controle , Feminino , Seguimentos , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
7.
S D Med ; 72(5): 206-213, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31454473

RESUMO

INTRODUCTION: Individual health is influenced by multiple, potentially correlated factors including healthcare availability, community context, and socioeconomic factors. To measure the health changes at county-levels across North Dakota, South Dakota, and Minnesota, a measure of relative health, health index, was developed incorporating multiple indicators from domains of health conditions, health behaviors, and social determinants. METHODS: We combined data from all 206 counties in the aforementioned three states for the years 2008-2012 from multiple data sources. We performed factor analysis that accounted for a hierarchical structure of the overall health index comprising of 15 indicators. RESULTS: A hierarchical structure is identified in which three intermediate factors are connecting the health index with 15 health indicators. The grouping results of the 206 counties based on health index values demonstrate the existence of a gradient in health conditions in the Northern Plains. CONCLUSIONS: The health status of urban areas was generally better than that of rural areas in the Northern Plains during this study period. The developed index adds stability to the estimates of the population characteristics, especially in rural, sparsely populated counties.


Assuntos
Comportamentos Relacionados com a Saúde , Nível de Saúde , Indicadores Básicos de Saúde , Humanos , Minnesota , North Dakota , South Dakota
8.
Medicine (Baltimore) ; 98(26): e16060, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261513

RESUMO

The purpose of this study was to investigate the association between objectively-measured lifestyle factors and health factors in patients with knee osteoarthritis (OA).In this cross-sectional study, 52 patients with knee OA were examined. Lifestyle factors were measured using a wearable smartwatch (step counts, walking distance, calorie consumption, sleep hours) and by self-report (eating speed). Body mass index (BMI), waist circumference, blood pressure, muscle strength of knee extensor and hip abductor, knee pain, symptoms, daily living function, sports recreation function, quality of life by knee injury and OA outcome score (KOOS) were measured to obtain data on health factors. Correlations and regression analysis were used to analyze the relationship between lifestyle factors and health factors.KOOS subscales (pain, symptom, daily living function) and hip abductor strength were positively correlated with daily step count, which was the only independently contributing lifestyle factor. Additionally, knee pain duration and diastolic blood pressure were negatively correlated with daily step count. BMI and waist circumference showed no correlation with physical activity data, but were negatively correlated with sleep duration and eating speed.The findings of this study contribute to expanding the knowledge on how lifestyle habits of older patients with knee OA contribute to their health status. Daily step counts were associated with knee OA-related pain, symptom, function in daily living, duration of knee pain, blood pressure, and strength of hip abductor. BMI and waist circumference were associated with sleep duration and eating speed.


Assuntos
Nível de Saúde , Estilo de Vida , Osteoartrite do Joelho/epidemiologia , Acelerometria , Idoso , Artralgia/epidemiologia , Artralgia/etiologia , Artralgia/fisiopatologia , Pressão Sanguínea , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos Transversais , Exercício , Comportamento Alimentar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Sono , Circunferência da Cintura
9.
J Zoo Wildl Med ; 50(2): 362-368, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31260201

RESUMO

Colloid osmotic pressure (COP) is an important component of the forces that manage capillary filtration and is determined by circulating plasma proteins. Patients affected by conditions resulting in hypoproteinemia often suffer severe hemodynamic derangements, including decreased COP. Because chronically debilitated sea turtles (CDT) present with severe hypoproteinemia, the objectives of this study were to 1) determine differences in plasma COP and blood analyte data (packed cell volume [PCV], sodium, chloride, plasma protein fractions) in CDT at admission compared with data from apparently healthy rehabilitated turtles at time of release (HRT) admitted from various stranding causes, and 2) to investigate correlations of COP with these selected blood analytes. COP, PCV, and most plasma protein fractions (excluding pre-albumin and γ-globulins) were significantly lower in CDT upon admission as compared with HRT. Sodium and chloride did not significantly differ between CDT and HRT. A significant increase was observed with PCV and all plasma protein fractions as COP increased. Of all protein fractions tested, albumin contributed the most toward COP (r2 = 0.88, P < 0.001). The results of this study suggest that COP is significantly lower in CDT as compared with HRT, providing insight into the complexity of this critical clinical condition and a small step in advancing the understanding of associated hemodynamic imbalances. Although COP analysis is not readily available as a diagnostic test, this preliminary baseline data suggests that additional research studies are warranted, given the potential for optimization of fluid therapy during rehabilitation of CDT.


Assuntos
Coloides , Pressão Osmótica/fisiologia , Plasma/química , Tartarugas/sangue , Animais , Proteínas Sanguíneas , Doença Crônica , Hidratação , Nível de Saúde , Valores de Referência
10.
Stud Health Technol Inform ; 262: 188-189, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349298

RESUMO

Road accidents are one of the major causes of loss of life, injuries and damage of property. The aim of this paper is to assess the overall health status (physical and psychological) of road accident victims and to propose a Health IT system to managing the assessment procedure. A prospective observational study was conducted among 474 people attended to the emergency department, after a road accident. 30% of the participants were 18-28 years old. After the road accident, most patients (67.1%) did not develop depression and 3 and 6 months after the accident, depression levels were higher. In contrast, the patients' QoL showed improvement over time. As road accidents seems to be a high risk incidents that can affect the health status of people, an Health IT system is suggested to contribute on the management of the assessment of the patients' health status.


Assuntos
Acidentes de Trânsito , Sistemas de Informação em Saúde , Nível de Saúde , Adolescente , Adulto , Serviço Hospitalar de Emergência , Humanos , Estudos Prospectivos , Adulto Jovem
11.
Health Qual Life Outcomes ; 17(1): 119, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299967

RESUMO

BACKGROUND: The purpose of this study is to evaluate the reliability and validity of the multiple happiness questionnaire (MHQ) in new-generation migrant workers (NGMW), to compare the difference of well-being and Health-Related Quality of Life (HRQOL) in NGMW with first-generation migrant workers (FGMW) and urban workers (UW), and to explore the relationship between well-being and HRQOL and analyze influential factors to well-being in NGMW in Zhejiang province, China. METHODS: By stratified sampling, 542 NGMW, 226 FGMW and 200 UW had completed the questionnaires in 2018. Cronbach's alpha coefficient (a) for internal consistency of the multiple happiness questionnaire (MHQ) was used. Factor analysis was applied for construct validity. Scores of well-being and HRQOL were compared between NGMW and control groups. Spearman's correlation was performed to clarify the relationship between well-being and HRQOL in NGMW. Multiple linear regression analytical methods were used to adjust confounding effects and to identify the variables that were associated with well-being. RESULTS: MHQ had good internal consistency (Cronbach's alpha overall was 0.960, subscales ranged from 0.754 to 0.957) and structural validity based on factor analysis. Except for life satisfaction and altruism commitment, there was a positive correlation between well-being and HRQOL in NGMW. There were significant differences in psychological well-being (PWB), health concern, subjective vitality, physical component summary (PCS) and mental component summary (MCS) between NGMW and FGMW. Compared to UW, NGMW's general well-being (GWB), subjective well-being (SWB), life satisfaction, positive relation and altruism commitment scores were lower and their negative affect was higher. The GWB score was related to MCS, PCS, self-reported social status, marital status, age and monthly income. CONCLUSION: The results suggest that the MHQ is a reliable and valid measure for well-being in NGMW. There is a significant difference in well-being and HRQOL between NGMW and control groups. Well-being is higher in NGMW than in FGMW, but is lower than in UW. Well-being is related with HRQOL and may be affected by MCS, PCS, self-reported social status, marital status, age and monthly income in NGMW.


Assuntos
Qualidade de Vida , Inquéritos e Questionários/normas , Migrantes/psicologia , Adulto , China , Análise Fatorial , Feminino , Felicidade , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto Jovem
12.
N C Med J ; 80(4): 240-243, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31278188

RESUMO

Social media's ubiquitous influence is changing the landscape of health-related practices. Health organizations and individuals continue to utilize social media for health with mixed results. We discuss current perspectives and challenges of using social media for improving health outcomes. We conclude this paper by highlighting five specific areas that warrant further investigation to better harness social media for health.


Assuntos
Promoção da Saúde , Mídias Sociais , Nível de Saúde , Humanos
13.
N Engl J Med ; 381(2): 111-120, 2019 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-31291514

RESUMO

BACKGROUND: Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD). METHODS: We performed a multicenter, open-label, randomized, controlled trial involving patients with a diagnosis of COPD in their primary care clinical record who consulted a clinician at 1 of 86 general medical practices in England and Wales for an acute exacerbation of COPD. The patients were assigned to receive usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual-care group). The primary outcomes were patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks after randomization (to show superiority) and COPD-related health status at 2 weeks after randomization, as measured by the Clinical COPD Questionnaire, a 10-item scale with scores ranging from 0 (very good COPD health status) to 6 (extremely poor COPD health status) (to show noninferiority). RESULTS: A total of 653 patients underwent randomization. Fewer patients in the CRP-guided group reported antibiotic use than in the usual-care group (57.0% vs. 77.4%; adjusted odds ratio, 0.31; 95% confidence interval [CI], 0.20 to 0.47). The adjusted mean difference in the total score on the Clinical COPD Questionnaire at 2 weeks was -0.19 points (two-sided 90% CI, -0.33 to -0.05) in favor of the CRP-guided group. The antibiotic prescribing decisions made by clinicians at the initial consultation were ascertained for all but 1 patient, and antibiotic prescriptions issued over the first 4 weeks of follow-up were ascertained for 96.9% of the patients. A lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs. 69.7%, for a difference of 22.0 percentage points; adjusted odds ratio, 0.31; 95% CI, 0.21 to 0.45) and during the first 4 weeks of follow-up (59.1% vs. 79.7%, for a difference of 20.6 percentage points; adjusted odds ratio, 0.30; 95% CI, 0.20 to 0.46). Two patients in the usual-care group died within 4 weeks after randomization from causes considered by the investigators to be unrelated to trial participation. CONCLUSIONS: CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm. (Funded by the National Institute for Health Research Health Technology Assessment Program; PACE Current Controlled Trials number, ISRCTN24346473.).


Assuntos
Antibacterianos/uso terapêutico , Proteína C-Reativa/análise , Prescrição Inadequada/prevenção & controle , Testes Imediatos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Idoso , Biomarcadores/sangue , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/sangue
14.
Medicine (Baltimore) ; 98(28): e16149, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305397

RESUMO

This study aims to test the moderation and mediation effects of self-acceptance and self-reported health on self-worth's impact on subjective well-being among elderly Chinese rural empty-nester elderly, and confirm whether self-report health is a moderating variable between self-worth and subjective well-being.This cross-sectional study was performed from May 2017 to April 2018; the participants were 365 empty-nest elderly adults from rural areas of Chifeng City in Inner Mongolia.Data were collected with the General information questionnaire, Self-worth questionnaire for adults, Self-acceptance Questionnaire, and Memorial University of New Found land Scale of Happiness. For the analyses, correlations, regressions, and structural equation models were used. Bootstrapping was performed to confirm the mediation effect. Multiple regression analysis was performed to confirm the moderation effect.Self-worth showed significant correlations with self-acceptance and subjective well-being (all P < .01). Bootstrapping indicated that the mediating role of self-acceptance was statistically significant. And self-reported health moderated the self-worth and subjective well-being association.Self-acceptance partially mediated the relationship between self-worth and subjective well-being of the rural empty-nest elderly and self-reported health moderated self-worth and subjective well-being association. Consequently, to improve the subjective well-being of the rural empty-nest elderly, self-acceptance and personal health should be the focus.


Assuntos
Nível de Saúde , Autoimagem , Idoso , Idoso de 80 Anos ou mais , Comportamento , China , Estudos Transversais , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Rural , Inquéritos e Questionários
15.
J Forensic Leg Med ; 66: 120-128, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31299484

RESUMO

PURPOSE: A series of studies suggest that non-Hispanic White women have significantly more injuries than non-Hispanic Black women after sexual assault and consensual sexual intercourse. One explanation for this difference is that the degree of skin protection may vary as skin mechanics and skin pigmentation vary. The aim of the study was to determine the association among genital-anal injury, skin color, skin viscoelasticity and skin hydration in women following consensual sexual intercourse when controlling for age, smoking history, body mass index (BMI), sun exposure, and health status. PROCEDURES: We employed a prospective cohort study design to enroll women 21 years of age or older at two study sites. They underwent two data collection sessions, baseline and follow-up after consensual sexual intercourse. Baseline genital-anal injury identification occurred with a standard forensic examination (direct visualization, nuclear staining with toluidine blue contrast, and colposcopy examination) and measurements of other variables (skin color, skin viscoelasticity, skin hydration, age, smoking history, body mass index [BMI], sun exposure, and health status). Participants were then asked to have consensual sexual intercourse with a male partner of their choice and to return for a second forensic examination for injury detection. Genital-anal injury was regressed on skin color, skin viscoelasticity, skin hydration, age, smoking history, BMI, sun exposure, and health status. FINDINGS: We enrolled 341 participants, 88 non-Hispanic White (25.8%), 54 non-Hispanic Black (15.8%), 190 Hispanic/Latina (55.7), and 9 Other Identities (2.6%). At baseline the genital-anal injury prevalence was 57.77% and at follow-up after consensual sexual intercourse, injury prevalence was 72.73%. External genital injury prevalence was associated with increased L* (lightness) values (Adjusted Odds Ratio [AOR] = 1.98, 95% Confidence Interval [CI] = 1.03, 4.04) and decreased skin elasticity (AOR = 0.96, 95% CI = 0.93, 0.99) at baseline. Increased skin hydration was associated with a significantly higher frequency of external, internal, anal, and total genital-anal injuries (Adjusted Rate Ratio [ARR] > 1.27) at follow-up. Also at the follow-up examination, Hispanic/Latina participants had significantly lower external genital and total genital-anal injury prevalence and frequency as compared to non-Hispanic White participants (AOR < 0.40). CONCLUSIONS: Our findings provide qualified support for the importance of skin color during the forensic examination. Women with lighter skin tones may have skin that is more easily injured than women with darker tones. In contrast, external genital injuries may be more easily identified in women with light as compared to dark skin, a situation that is important in both the health care and criminal justice systems. Additionally, women with decreased viscoelasticity and increased hydration may be more easily injured. These findings support the need to develop forensic procedures that are effective in people across the range of skin colors and to interpret forensic findings considering the innate properties of the skin.


Assuntos
Canal Anal/lesões , Coito , Elasticidade/fisiologia , Genitália Feminina/lesões , Fenômenos Fisiológicos da Pele , Pigmentação da Pele/fisiologia , Adulto , Canal Anal/fisiopatologia , Fenômenos Biomecânicos/fisiologia , Estudos de Coortes , Colposcopia , Grupos de Populações Continentais , Feminino , Medicina Legal , Genitália Feminina/fisiopatologia , Nível de Saúde , Humanos
16.
Health Qual Life Outcomes ; 17(1): 111, 2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31255183

RESUMO

BACKGROUND: Self-rated health (SRH) is a health measure used in studies of older adults. The objective of this study is to analyze SRH as a predictor of mortality in the institutionalized older population and the characteristics of those who do not provide information about their SRH on health questionnaires. METHODS: This is a 15-year follow-up study of older adult residents in nursing or care homes in of Madrid, Spain. SRH was measured on a 5-point Likert type scale. The association between answering the SRH question and socio-demographic and health characteristics was evaluated through prevalence ratio (PR), estimated by Poisson regression models. Survival rates associated with SRH were studied through a multivariate Cox regression. RESULTS: The sample has a mean age of 83.4 (standard deviation, SD = 7.3), with 75.7% women. Twelve percent did not answer the SRH item. Those who did not answer showed a higher probability of disability (Barthel index, PR = 0.76, 95% confidence interval = 0.67-0.86) and/or dementia (PR = 8.03, 3.38-19.03). A trend for higher mortality was observed in those persons who did not respond (adjusted hazard ratio HR = 1.26, 0.75-2.11). The mortality rate was 32% higher for those who declared poor SRH in comparison with those who reported good SRH (adjusted HR = 1.32, 1.08-1.6). CONCLUSIONS: There is an elevated number of people who do not respond to the SRH item, mainly those with disabilities and cognitive deterioration. Lack of response to SRH is a good indicator of 15-year mortality for persons institutionalized in care or nursing homes.


Assuntos
Nível de Saúde , Qualidade de Vida , Autorrelato/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Seguimentos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Casas de Saúde/estatística & dados numéricos , Modelos de Riscos Proporcionais , Espanha , Análise de Sobrevida
17.
Health Qual Life Outcomes ; 17(1): 112, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262318

RESUMO

BACKGROUND: Health economists have shown a growing interest in deliberation and multi-criteria decision analysis (MCDA) as possible pathways to transparently integrate value judgments in cost-utility analyses. In line with these developments, this study piloted a consensus process to derive a German value set for the Short-Form Six-Dimension (SF-6D). In a conference setting, a group was tasked to deliberate on scores and weights for the SF-6D from the perspective of a self-determined and independent life. METHODS: The one-day consensus conference was based on a deliberative process in combination with the MCDA method MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique). According to MACBETH, participants were asked to qualitatively rate pairwise comparisons of SF-6D health states. The scoring within each dimension was conducted in parallel group sessions. Final agreement on the scores as well as weights for the SF-6D dimensions were derived in a subsequent plenary assembly. Results were analyzed using the software M-MACBETH and qualitative content analysis. RESULTS: A total of 34 participants were recruited. While each of the 6 small groups presented a consented score, the plenary assembly reached consensus on all dimensions apart from pain. Concerning dimension weights, some participants favored prioritizing pain and mental health. Others disputed that trade-offs between dimensions and thus assigning weights were not acceptable in a context where this may involve withholding care from someone. As a consequence, no consensus on a value set was reached. Participants identified the group size of the plenary session and the applied weighting procedure as main obstacles to the process. CONCLUSIONS: This pilot study presents a consensus-based approach for valuing health-related quality of life. However, further research is needed on deliberative processes that yield quantifiable results. Future conferences should explore smaller group sizes, longer durations of the deliberative process and alternatives to the additive value function applied in MACBETH.


Assuntos
Técnicas de Apoio para a Decisão , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Conferências de Consenso como Assunto , Análise Custo-Benefício , Feminino , Pesquisa sobre Serviços de Saúde , Nível de Saúde , Humanos , Masculino , Projetos Piloto , Adulto Jovem
18.
Health Qual Life Outcomes ; 17(1): 114, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266505

RESUMO

BACKGROUND: Joint replacement, an increasingly common procedure amongst older adults, can substantially improve health-related quality of life (HRQoL). However, differential item functioning (DIF) may affect the accurate interpretation of differences in HRQoL amongst patients with different demographic and health status characteristics but the same underlying (i.e., latent) level of the investigated construct. This study tested for DIF in pre-operative SF-12 physical health (PH) and mental health (MH) sub-scale items amongst patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: Data were from a population-based joint replacement registry from the Canadian province of Manitoba. TKA and THA patients who had surgery between 2009 and 2015 and completed a pre-operative assessment were included. DIF was tested using the multiple indicators multiple causes (MIMIC) method with sex, age group, body weight status, and presence of multiple comorbid conditions (i.e., multimorbidity) as covariates. Analyses were stratified by joint type. RESULTS: The study cohort included 8820 patients; 42.1% underwent THA, 57.3% were female, 32.7% were 70+ years, and 52.8% were obese. For each sub-scale, four of the six items exhibited DIF in both THA and TKA groups. Differences in the covariate effect estimates for DIF and No-DIF models on the MH latent variable were largest for age and body weight status for the THA group, and for sex and multimorbidity for the TKA group. All of the differences were small for PH. Multimorbidity had the strongest association with PH and age and sex had the strongest association with MH in the DIF models. CONCLUSIONS: Demographic and health status characteristics influenced SF-12 PH and MH item responses in joint replacement populations, although the size of the effects were not large for PH. We recommend testing and adjusting for DIF effects to ensure comparability of HRQoL measures in joint replacement populations.


Assuntos
Artroplastia de Quadril/psicologia , Artroplastia do Joelho/psicologia , Multimorbidade , Qualidade de Vida , Idoso , Canadá , Estudos de Coortes , Feminino , Nível de Saúde , Humanos , Masculino , Manitoba , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Inquéritos e Questionários
19.
Graefes Arch Clin Exp Ophthalmol ; 257(9): 1981-1988, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31338586

RESUMO

PURPOSE: Vision of the elderly may be affected by typical age-related diseases like cataract and macular degeneration. Little is known about the effect of aging on visual difficulties and vision-related quality of life. This study was conducted to compare the ophthalmological health status of younger and older individuals within a large cohort study of residents of a greater metropolitan area (Berlin Aging Study II [BASE-II]). METHODS: A total of 1655 participants (805 men) aged 60 years and older and 494 participants (232 men) aged between 22 and 48 years from the Berlin Aging Study II were included in the analysis. The subjects were examined during a 2-day clinical examination period. History of ocular diseases, vision-related quality of life using the visual function questionnaire (VFQ- 25), refraction, distance and near visual acuity, tonometry, and color vision were provided. RESULTS: Older subjects performed significantly worse concerning distance and near visual acuity, color vision, and vision-related quality of life compared to young subjects. Intraocular pressure showed no significant difference between groups. Individuals are often unaware of existing eye diseases. CONCLUSION: The prevalence of ocular diseases and the impairment of vision increases with age. Although 98% of elderly subjects have reported to suffer from any ocular disease, subjective quality of life seems to be affected to a lesser extent.


Assuntos
Envelhecimento , Oftalmopatias/epidemiologia , Nível de Saúde , Qualidade de Vida , População Urbana , Acuidade Visual , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Berlim/epidemiologia , Oftalmopatias/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Adulto Jovem
20.
J Stroke Cerebrovasc Dis ; 28(9): 2525-2529, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31256983

RESUMO

OBJECTIVES: Physician-staffed helicopter transport is faster than ground transport and allows for prompt medical care of patients in rural areas. In this study, we evaluated the relationship between helicopter transport and the prognosis of patients with acute cerebral infarction in rural Japan. METHODS: This retrospective, observational study included 546 patients with acute cerebral infarction attending Aomori Prefectural Central Hospital, which serves a rural region of Japan. Patients were separated into 2 transport groups: physician-staffed helicopter emergency medical services and ground emergency medical services. Patients were assessed for stroke severity, treatment, and prognosis. RESULTS: Of the 546 patients, 11.2% were transported by physician-staffed helicopter emergency medical services and 88.8% by ground emergency medical services. Although the distance transported was significantly longer in the physician-staffed helicopter emergency medical services group, the time from onset to reaching our hospital was similar between the groups. National Institutes of Health Stroke Scale on admission and final prognosis were significantly worse with physician-staffed helicopter emergency medical services than with ground emergency medical services. Multivariate analysis showed no association between transport system and prognosis. CONCLUSIONS: In this study, patients transported by physician-staffed helicopter emergency medical services had more severe stroke symptoms and poorer functional outcomes than those transported by ground emergency medical services. However, the transport time was shorter for physician-staffed helicopter emergency medical services; thus, physician-staffed helicopter emergency medical services may be useful for reducing transport time for patients in rural Japan.


Assuntos
Resgate Aéreo , Infarto Cerebral/terapia , Serviços de Saúde Rural , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Infarto Cerebral/diagnóstico , Infarto Cerebral/fisiopatologia , Avaliação da Deficiência , Feminino , Nível de Saúde , Humanos , Japão , Masculino , Recuperação de Função Fisiológica , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
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