SF-36 as a Predictor of Health States

Background: There are a number of claims that Medical Outcomes Study Short Form 36 (MOS SF-36) mean scores can be used to discriminate between healthy and nonhealthy persons and determine various levels of health.
Objectives: The purpose of this study was to evaluate the ability of the SF-36 to predict whether or not respondents reported health problems.
Methods: We used structural equation modeling (SEM) techniques to evaluate the SF-36 and its ability to discriminate between those who reported health problems or reported physician-determined illness and those who did not in a sample from the 1990 National Survey of Functional Health Status (NHS).
Results: The correlation between physician-determined illness and Physical Health was −.404, resulting in 16.32% shared variance. The correlation between reported health problems and Physical Health was −.360, resulting in 12.96% shared variance. These correlations are markedly lower than those to the eight first-order scales or between Physical and Mental Health ( r = .889). Mental Health could not predict physician-determined illness or reported health problems independent of Physical Health.
Conclusions: The SF-36 is relatively poor at accounting for the health status of respondents. There are significant paths but the variance accounted for in absolute and relative terms is small. Physical Health does a much better job of accounting for general mental health than it does for perceived health problems or physician-determined illness. These findings suggest that the SF-36 may not discriminate well between healthy and nonhealthy groups and that objective measures of health status may be required in conjunction with the use of the SF-36.     

Emergence of New Professional Leadership Roles within a Health Professional Group Following Organizational Redesign

Results of a survey conducted in all Ontario hospitals have shown that several new non-management professional leadership positions and a model of shared governance within a health professional group have emerged. The model was most evident in healthcare organizations with a program management structure. This article discusses the roles and activities of these advanced professional leaders and shared responsibilities for one professional group (physiotherapy) in light of the results of the survey.     

Implication of Organizational Health Policy on Organizational Attraction

This study investigated both smoking and nonsmoking undergraduates' reactions to an organization implementing a policy that either mandated or recommended that employees quit smoking. Undergraduate participants (N = 296) were randomly assigned to 1 of 2 (high vs. low severity of a smoke-free policy implementation) × 2 (high vs. low organizational assistance) conditions and indicated their organizational attraction for a hypothetical organization, imagining themselves as job applicants. The findings showed that organizational attraction was affected by the level of organizational assistance but not by the level of severity. These and other findings concerning individuals' perceived severity, perceived organizational support, smoking sensitivity, and employer control are presented in detail, and the implications thereof are discussed.     

Improving Psychosocial Health in Hemodialysis Patients After a Disaster

Twenty-two social workers implemented a cognitive-behavioral intervention with 69 patients in 22 dialysis units in Louisiana to improve psychosocial health following Hurricanes Katrina and Rita. Pre- and post-intervention questionnaires measured psychosocial status domains (general health status, social functioning, burden of kidney disease, depressed mood, anxiety, and mastery). Participants rated their general health status (p < .05) and social functioning (p < .05) significantly higher after the intervention. Participants who listened to the class Managing stress through communication and problem solving and discussed it with their social worker, had significant improvement in depressed mood score (p < .05) after completing the program, compared to participants who did not discuss this material with their social worker. Sixty-five percent had scores indicating depressed mood before the program, compared with 56% following. The more positive participants' program evaluation, the higher their quality of life (lower perceived burden of kidney disease [p = .05]).     

Catalyzing a Reproductive Health and Social Justice Movement

Objectives The maternal and child health (MCH) community, partnering with women and their families, has the potential to play a critical role in advancing a new multi-sector social movement focused on creating a women’s reproductive and economic justice agenda. Since the turn of the twenty-first century, the MCH field has been planting seeds for change. The time has come for this work to bear fruit as many states are facing stagnant or slow progress in reducing infant mortality, increasing maternal death rates, and growing health inequities. Methods This paper synthesizes three current, interrelated approaches to addressing MCH challenges—life course theory, preconception health, and social justice/reproductive equity. Conclusion Based on these core constructs, the authors offer four directions for advancing efforts to improve MCH outcomes. The first is to ensure access to quality health care for all. The second is to facilitate change through critical conversations about challenging issues such as poverty, racism, sexism, and immigration; the relevance of evidence-based practice in disenfranchised communities; and how we might be perpetuating inequities in our institutions. The third is to develop collaborative spaces in which leaders across diverse sectors can see their roles in creating equitable neighborhood conditions that ensure optimal reproductive choices and outcomes for women and their families. Last, the authors suggest that leaders engage the MCH workforce and its consumers in dialogue and action about local and national policies that address the social determinants of health and how these policies influence reproductive and early childhood outcomes.     

Multidimensional Poverty and Health Status as a Predictor of Chronic Income Poverty

Longitudinal analysis of Wave 5 to 10 of the nationally representative Household, Income and Labour Dynamics in Australia dataset was undertaken to assess whether multidimensional poverty status can predict chronic income poverty. Of those who were multidimensionally poor (low income plus poor health or poor health and insufficient education attainment) in 2007, and those who were in income poverty only (no other forms of disadvantage) in 2007, a greater proportion of those in multidimensional poverty continued to be in income poverty for the subsequent 5 years through to 2012. People who were multidimensionally poor in 2007 had 2.17 times the odds of being in income poverty each year through to 2012 than those who were in income poverty only in 2005 (95% CI: 1.23–3.83). Multidimensional poverty measures are a useful tool for policymakers to identify target populations for policies aiming to improve equity and reduce chronic disadvantage. Copyright © 2014 John Wiley & Sons, Ltd.     

卫生基本法的价值定位：医疗正义

卫生基本法的价值定位应该是医疗正义。正义的实质内容主要表现为自由、平等、秩序等价值目标。从自由角度来理解医疗正义,就是要承认和尊重公民的健康权;从平等角度来理解医疗正义,就是要合理地配置医疗资源,以确保每个公民的健康权底线内容能得以基本实现;从秩序的角度来理解医疗正义,就是要强化政府责任,以期完善医疗秩序。     

Development of Pediatric Secondary Psychosocial Care in a Health Maintenance Organization

A pediatric secondary psychosocial service was developed to provide easy access to brief, focused problem-oriented psychosocial care for children and their parents on referral from their primary care providers The intent was to support parents efforts at resolving their families' difficulties Support was provided for patients with needs beyond the realm of primary care, so as to avoid deterioration in functioning and the need for tertiary care During the first 6 months 243 children were seen for a wide range of behavioral emotional and social relationship difficulties Evaluation revealed strong support by referring providers, parents and psychosocial staff Subsequent developments and plans are discussed.     

Future issues in Children's Health Care: Addressing Psychosocial Concerns

A panel of experts, participating in a Delphi poll, identified significant issues facing psychosocial aspects of health care for children in the future In three rounds of feedback and evaluation, ten top future issues were composited in rank order chronic illness and complex health care needs, sociogenic problems, unequal access to health care, lack of financial resources for psychosocial services, increased focus on prevention, children without primary caregivers, complex ethical questions, family-centered care, training of health care professionals, and interdisciplinary integration Implications of these issues are discussed.     

Future issues in Children's Health Care: Addressing Psychosocial Concerns

A panel of experts, participating in a Delphi poll, identified significant issues facing psychosocial aspects of health care for children in the future In three rounds of feedback and evaluation, ten top future issues were composited in rank order chronic illness and complex health care needs, sociogenic problems, unequal access to health care, lack of financial resources for psychosocial services, increased focus on prevention, children without primary caregivers, complex ethical questions, family-centered care, training of health care professionals, and interdisciplinary integration Implications of these issues are discussed.     

Mental Health and High‐Cost Health Care Utilization: New Evidence from Axis II Disorders

Objective

To analyze the associations between Axis II (A2) disorders and two measures of health care utilization with relatively high cost: emergency department (ED) episodes and hospital admissions.

Data Source/Study Setting

Wave I (2001/2002) and Wave II (2004/2005) of the National Longitudinal Survey on Alcohol and Related Conditions (NESARC).

Study Design

A national probability sample of adults. Gender-stratified regression analysis adjusted for a range of covariates associated with health care utilization.

Data Collection

The target population of the NESARC is the civilian noninstitutionalized population aged 18 years and older residing in the United States. The cumulative survey response rate is 70.2 percent with a response rate of 81 percent (N = 43,093) in Wave I and 86.7 percent (N = 34,653) in Wave II.

Principal Findings

Both men and women with A2 disorders are at elevated risk for ED episodes and hospital admissions. Associations are robust after adjusting for a rich set of confounding factors, including Axis I (clinical) psychiatric disorders. We find evidence of a dose–response relationship, while antisocial and borderline disorders exhibit the strongest associations with both measures of health care utilization.

Conclusions

This study provides the first published estimates of the associations between A2 disorders and high-cost health care utilization in a large, nationally representative survey. The findings underscore the potential implications of these disorders on health care expenditures.