Secondary preventive health behavior

A comprehensive model of secondary preventive health behavior, defined as the use of physician services for preventive care, is constructed which specifies the interrelationships among people's health beliefs, their health status, their accessibility to care, their sociodemographic characteristics, and their use of services. The model is tested by applying path analysis to a household survey of adult residents of Washtenaw County, Michigan. The results support the contention that many factors influence secondary preventive utilization, some principally directly and some largely indirectly through their effects on other variables. Accessibility to care, health status, health beliefs, and sex all directly influence use, while education and age have indirect effects. Income has indirect effects on use which, because they are in opposing directions, cancel each other out.

[Activity, social situation subjective state of health in old age (author's transl)]

1. People of advanced age in rural and urban areas do not differ from each other as regards their subjective state of health. The percentage of women with a poor subjective state of health is higher than of men. The subjective state of health does not correlate with age, however 2. There are significant correlations between a person's health and material situation 3. People with a secure material situation, higher education and close family ties derived the greatest emjoyment from life 4. Physical activity during leisure-time increased in proportion to a person's material situation and education level. The correlation index between physical activity and the employment of life is also high 5. We found that both rural and urban dwellers with an aim in life are more content with their lives.

The effect of a group practice on rural health attitudes and behavior

The opportunity to join a group practice has been identified as a successful inducement for physicians to locate in rural areas. Less is known of the effects of group practice on the health attitudes, behavior and status of the rural communities in which they are established. A random survey of households was conducted in 1972 in a rural Midwestern area, prior to the establishment of a community-sponsored multispecialty primary care group practice, and again on the same households in 1977, after establishment of this group practice (a total of 292 households representing 829 persons). Perceived access to health services before the establishment of the group practice did not significantly predict use of the group practice. Neither previous use of medical services nor health status measured by several indices was associated with eventual use of the group practice. The apparent impact on the community of the group practice was a significant improvement in access to physician services, shown by shorter average travel time to the place of primary care and a 62 per cent improvement in the ability to make a same-day appointment. Furthermore, a significant shift in the distribution of physician services was noted over the study period. The introduction of physician assistants significantly decreased the prior positive attitudes toward them. Despite improvement in access to care, no changes in population health status or receipt of preventive services were noted. Current users of the group practice appear similar to those utilizing conventional medical care sources in regard to access to services, use of services, as well as health status, attitudes and costs.

Oral cytologic patterns and nutritional status: some relationships in alcoholic subjects

Exfoliative cytologic preparations from the cheeks of 790 alcoholic patients were evaluated for relationships between microscopic features and selected indicators of nutritional status. Significant associations were observed between the cell/nucleus ratio, degree of cornification, relative concentrations of leukocytes and microorganisms, and poor dietary patterns, as well as body weight statua and serum albumin and blood hemoglobin levels. Microscopic examination, as an adjunct to gross inspection of the mouth, may be of value in the clinical assessment of nutriture.

A postal screening questionnaire in preventive geriatric care

A postal questionnaire was introduced as a screening procedure for a comprehensive geriatric assessment programme in general practice. It had a response rate of 81 per cent, a sensitivity of 0.95, a specificity of 0.68, and a predictive value of 0.91. The use of this screening procedure could reduce the workload of an assessment programme by one fifth.

Recall antigen response in pediatric cancer patients receiving parenteral hyperalimentation

Delayed hypersensitivity was evaluated in 24 pediatric cancer patients who received intravenous hyperalimentation (IVH). Hypersensitivity, as analyzed by skin test antigens, was recorded before and after IVH therapy. With the exception of malnourished patients, tumor response, nutritional status, and delayed hypersensitivity were not correlated in the way suggested by similar studies in adult patients. However, hypersensitivity was correlated with nutritional status post-IVH.

The relationship between medical resources and measures of health: some additional evidence

The relationship between an area's medical resources and physiological measures of individual health status is examined. Variables such as age, sex, race, education, and income are controlled for. The physiological measures include diastolic blood pressure, serum cholesterol concentration, electrocardiogram, chest X-ray, varicose veins, and periodontal disease. Although additional education and income were associated with fewer abnormal chest X-rays and less periodontal disease, the physiological measures were little affected by additional medical resources. The results are consistent with the view that what the individual does (or does not) do for himself affects health more than do additional medical resources.

Health effects of traffic noise

In 57 test persons having worked 1 day under traffic noise (Leq = 85 dB(A) and 1 day without noise (Leq < 50 dB(A), blood pressure and pulse frequency were measured at 1 h intervals and total urine was collected during working hours. Additionally, blood was sampled at the end of each working day. Psychological parameters were assessed by means of questionnaires. Statistically significant reactions to noise were found in the following fields: 1. Ergnomics--decrease of working quality; 2. Psychology--increase of psychical tension; 3. Blood circulation--increase of blood pressure and pulse frequency; 4. Biochemistry--increase of epinephrine, cAMP, urine and serum Mg, protein, cholesterol plus decrease of erythrocyte Na, and renin. Hypothetical mechanisms of the action of traffic noise are discussed.

Health and early retirement decisions

Health and economic considerations have consistently played important roles in retirement decisions. Increases in early retirement benefits by some employers have increased the incentive to retire early, thus inducing a change in the health and economic relationships. During the three months following implementation by a large manufacturing firm of a labor contract which included substantial improvement in early retirement benefits, structured interviews were conducted with 45 employees who had chosen early retirement and 35 eligible employees who had chosen to continue working. Data are presented on the relationship between health and retirement decisions, and on the differences between early retirees and non-retirees in regard to perceived health status, job satisfaction, potential for continued employment, leisure involvement, and morale. Implications for the primary care physician's interactions with workers who face early retirement are discussed.

Health diaries

A health diary is a prospective procedure to obtain reports of morbidity (illness and injury), disability and health actions. Health diaries have been used for 3 purposes: in methodologic studies to compare reporting levels for retrospective and prospective procedures; as memory aids to improve recall of health events in a later, retrospective interview; and as a primary data source. This article presents an inventory and description of studies which have used health diaries. It reviews evidence from the studies on the following topics: 1) levels of reporting compared to retrospective interviews; 2) recall error; 3) validity of health reports; 4) value of diary data for a broad view of symptoms and health behavior, for individual-level analysis and for studies of health dynamics; 5) respondent cooperation; 6) conditioning effects (sensitization and fatigue); 7) quality of diary data; 8) survey costs; 9) complexity of data collection and processing; and 10) complexity of data analysis. Overall health diaries have well-documented advantages with respect to content--the rich information they provide about individual health. High respondent cooperation and high-quality data can be achieved if staff members devote ample time and energy to retaining diary-keepers and monitoring their records. Researchers must weight the advantages of health diary information against the money costs, staff activities, and statistical computing resources necessary to collect and analyze it.

Use of a monthly health review to ascertain illness and injuries

A Monthly Health Review was developed to monitor symptoms, illnesses and injuries among Air Traffic Controllers. Return rate of the mailed check-list exceeded 90 per cent. Diagnoses were generated from symptom clusters by computer algorithms. Telephone interview by physicians, laboratory analyses for serum pepsinogen I, and analyses of relations between symptom clusters and degree of disability all served to support the validity of the methodology. Such a system can provide inexpensive surveillance of morbidity in suitable populations.

Regionalization in the Veterans Administration health care system: rhetoric and realities

Criticisms of the Veterans Administration health care system have centered in part on the ability of the system to reallocate resources in response to the changing needs of veterans. VA hospitals use traditional budgeting and planning processes; new programs and projected increases in workload are added to the previous year's budget to yield the budget for the succeeding year. Since these activities occur on an individual institution bases, there is little effort to plan cooperatively between hospitals or to reassess the fundamental allocation of resources based on veteran needs. Over the past two years, the VA has devised a program of regionalized budgeting and planming. The publicity surrounding VA regionalization reflects the idealized potential of shared resources and joint planning within each of the newly created VA medical districts. The reality of the program, however, when examined on a national basis and illustrated by an in-depth study of five hospitals in one district, indicates that there has been little use of resource allocation methodology and that few planning resources have been allocated to this effort. As a result, the district program is a collation of individual hospital budgets, and plans to yield the district budget and plans. Regionalization is unlikely to succeed in any meaningful manner within the VA unless further changes occur in district resource allocation methods.

Prevalence of prior hysterectomy in the Seattle-Tacoma area

Hysterectomy is the most common major surgical procedure performed in the United States. The frequency of hysterectomy among women in the general population is of interest because it affects the population at risk for uterine diseases and because the procedure itself carries significant personal and socioeconomic consequences. We studied factors related to the occurrence of hysterectomy by interviewing a representative sample of women ages 35-74 (n= 1087) in two urban Washington counties during 1976-1977.One-third of the women studied had had a hysterectomy. Later birth cohorts were at higher risk. The ageadjusted prevalence of prior hysterectomy was negatively associated with education and age at first childbirth; it was positively associated with parity, history of irregular menses, and history of a variety of other health conditions. Contrary to expectation, income was negatively associated with hysterectomy rates in one county and showed no association in the other. Part of the income effect was due to confounding by age at first childbirth, which was a surprisingly strong predictive factor. WE CONCLUDE THAT: 1) despite economic predictions based on the discretionary nature of the procedure, hysterectomies are not necessarily more common among high-income women; 2) age at first childbirth may be a more important risk factor for uterine disease than previously thought; and 3) estimates of hysterectomy frequency based on clinic populations may be misleading. (Am J Public Health 70:40-47, 1980.)

Health status and school achievement of children from Head Start and Free School Lunch Programs

School health records of 332 children through the eighth grade were examined in a retrospective comparative analysis of physical health status and school achievement of children from Head Start and Free School Lunch Programs. The objective was to determine if nutrition early in the lives of children as a part of a comprehensive health and education program such as Head Start produces greater or different benefits for disadvantaged children than nutrition intervention later through free lunches when the child enters school. Cross-sectional longitudinal, and case-study approaches were used in the analysis. A group of no-food-program disadvantaged children and a group of advantaged children served as comparisons. Results showed that advantaged children performed better on all parameters of school achievement and health status compared with the disadvantaged children, regardless of the form of intervention. Measures of school achievement of Head Start and Free Lunch children did not differ from those of the disadvantaged comparison group, but there were significant differences in measures of health status between the disadvantaged groups. Fewer boys from Project Head Start fell below the 25th percentile for height compared with boys in the Free Lunch Program. Head Start children also scored higher in physical fitness and had fewer reported absences from school due to illness.

Functional disability of elderly family medicine patients in acute care hospital and nursing homes

This report describes the functional impairments of elderly patients from a family medicine program who were admitted either to an acute care hospital or long-term care facilities over the course of a year. Assessments were performed in the areas of social and economic resources, mental health, physical health, and the ability to perform routine activities needed for independent living. The presence of significant functional impairment in many of the areas suggests the need for the family physician to develop skills in working as a member of a health care team in order to design and implement a comprehensive treatment plan for elderly patients admitted either to hospitals or long-term care facilities.

The role and responsibility of schools in affecting dental health status--a potential yet unrealized

In summary, the schools' role in affecting dental health status for children remains as a potential yet unrealized. Schools have a tremendous capacity to be supportive of programs involving preventive health and preventive dentistry for children. In order to activate such potential, there must develop stronger national and regional health planning and initiatives. Such initiatives must proceed on the basis of sound evaluation support for methods of improving dental health, must seek involvement and integration of the health and educational system, and must seek to finance and refinance school health efforts under the rubric of health care expenditures.

Low-income widows and other aged singles

Based on data collected in a nationwide survey in late 1973, this report describes the living conditions, health, social activity, and attitudes of unmarried older persons at low to middle income levels--that is, below $5,000 per year. Although most previous research has focused on the special situation of widows, the current findings indicate that lower income widowers and divorced/separated/never-married persons generally experience many of the same problems as the widows and respond to them in a remarkably similar fashion. Old age without a spouse or adequate income seems to dictate the same material and social hardship regardless of whether the spouse was lost to death, divorce, or separation, or was never acquired in the first place.

Comparison of anthropometric measures of nutritional status in preschool children in five developing countries

Weight, height, and arm circumference were measured in 7304 children 1 to 5 years old in Columbia, Costa Rica, the Dominican Republic, India, and Pakistan. Previously developed indices using these measures were applied to assess nutritional status, and the agreement between measures was compared. Weight for age and height for age deficits increased with age while weight for height deficits diminished. Many children diagnosed as mildly malnourished by weight for age were found to have normal weights for their actual heights. Deviations from weight for age norms were frequently due to height limitations. Highest positive correlation was found between weight and height, and between weight for age and height for age. Good agreement in malnutrition diagnoses was found between a weight for height limit of 90% of standard and a weight for age limit of 75% of standard. A cut-off point of 80% of standard weight for height was too low to detect most malnourished children. An age-constant arm circumference limit of 13.5 cm identified nearly all children with severe or acute malnutrition by weight for age or weight for height.