Health measurement in the third era of health

On social health: history, conceptualization, and population patterning

We propose a psychologically-informed concept of social health to join physical and mental components in a more comprehensive assessment of human health. Although there is an extensive literature on the importance of social relationships to health, a theoretical framework is needed to coalesce this work into a codified conceptualisation of social health, defined here as adequate quantity and quality of relationships in a particular context to meet an individual's need for meaningful human connection. Informing this novel conceptualisation, we outline eight key propositions to guide future research and theory on social health, including five propositions focused on the conceptualisation of social health and three focused on its population patterning. The former five propositions include that social health is an outcome in its own right, that health interventions can have divergent effects on social versus physical and mental aspects of health, that social health has independent effects on quality of life, that it is a dynamic and contextual construct, and that it is embedded and encoded in the human body (and mind). The utility of the social health concept is further revealed in its significance for understanding and addressing population health concerns, such as health inequalities experienced by marginalised groups.

Feeling too low to be active: Physical inactivity mediates the relationship between mental and physical health

BACKGROUND

Physical inactivity is one of the most influential and pervasive risk factors for health problems. Therefore, public health experts call for interventions to promote physical activity across the lifespan. This study aimed to examine the role of mental health in physical inactivity and the subsequent role of physical activity in various aspects of physical health.

METHODS

Data were collected in the third wave of the European Health Interview Survey (EHIS) in Slovenia. A nationally representative sample of 9,900 people (49.6% male) aged 15 years or more (M = 49.2; SD = 18.9 years) provided self-reports on depression (PHQ-8), subjective well-being (MHC-SF), physical (in)activity, bodily pain, long-standing activity limitations, their general health status, and possible chronic diseases.

RESULTS

The results of a path analysis showed that depression had a positive effect and well-being had a negative effect on physical inactivity, which in turn contributed to the likelihood of severe bodily pain, activity limitations, poor self-rated health, and multimorbidity. Depression and well-being contributed to health-related outcomes directly and indirectly through physical inactivity.

LIMITATIONS

Because of the cross-sectional design, this study is limited in its ability to draw causal conclusions. All health data were self-reported.

CONCLUSIONS

Results suggest that high levels of depression and low levels of subjective well-being may be an early warning sign of physical health problems. Interventions aimed at preventing or reducing mental health problems and promoting positive mental health may benefit not only mental health per se, but also prevent physical inactivity and, consequently, physical health problems.

Improving the Experience of Providing Care in Community-Based Pharmacies

This study applied a human factors and ergonomics approach to describe community-based pharmacy personnel perspectives regarding how work environment characteristics affect the ability to perform the duties necessary for optimal patient care and how contributors to stress affect the ability to ensure patient safety. Data were obtained from the 2021 APhA/NASPA National State-Based Pharmacy Workplace Survey, launched in the United States in April 2021. Promotion of the online survey to pharmacists and pharmacy technicians was accomplished through social media, email, and online periodicals. Responses continued to be received through the end of 2021. A data file containing 6973 responses was downloaded on 7 January 2022 for analysis. Qualitative thematic analysis was applied for developing operational definitions and coding guidelines for content analysis of the data. The patterns of responses for the dependent variables were compared among community-based practice setting types (chain, supermarket/mass merchandiser, and independent) and work positions (manager, staff pharmacist, technician/clerk, and owner). Chi-square analysis was used for determining statistically significant differences. The findings showed that personnel working in community-based pharmacies reported undesirable work environments and work stress that affected their ability to perform assigned duties for optimal patient care and ensure patient safety. Four work system elements were identified that were both facilitators and barriers to the ability to perform duties and ensure patient safety: (1) people, (2) tasks, (3) technology/tools, and (4) organizational context. Acknowledging local contexts of workplaces, giving adequate control, applying adaptive thinking, enhancing connectivity, building on existing mechanisms, and dynamic continuous learning are key elements for applying the HFE (human factors ergonomics) approach to improving the experience of providing care in community-based pharmacies.

Quality of life in health Iranian elderly population approach in health promotion: A systematic review

BACKGROUND

The quality of life (QOL) is essential in all different stages of life; however, It is more important for older people as it can be effective in promoting their health. Therefore, the present study aimed to review the literature on the QOL in the Iranian elderly population.

MATERIALS AND METHODS

The study was carried out as a systematic review. For this purpose, all databases were searched in March 2021. The keywords used for the search were "quality of life, elderly, older adults, aging, seniors, and Iran" along with the Persian equivalents. PRISMA protocol was used to screen articles. After removing duplicate and irrelevant items, two evaluators appraised the articles separately based on a researcher-made checklist derived from the SBEM and STROBE Statement standard checklists.

RESULTS

The initial search yielded 3734 studies on the QOL in the Iranian elderly population. After screening and assessing the studies based on inclusion and exclusion criteria, 22 articles remained in the study. Most of the studies (cross-sectional) were conducted in Tehran using a 36-item Short-Form Health Survey to assess the QOL. The studies investigated sociodemographic determinants, physical and health-related behaviors, and spirituality and psychological determinants of the QOL. The sociodemographic determinants were the most common factors under study. The results showed that the role of gender and socioeconomic status was the strongest among the sociodemographic characteristics. A significant association was found between the QOL in the Iranian elderly population and factors such as depression and religious confrontation.

CONCLUSION

In addition to chronic diseases, diseases of the oral and dental, as well as an unhealthy diet, should be considered in the elderly. Therefore, attention should be paid to all social, physical, and psychological variables that affect the QOL of older people.

A holistic approach to campus well-being: Steps to Leaps at Purdue University

In response to the increasing demand of mental health solutions, Purdue University launched the Steps to Leaps initiative in 2019 to promote student well-being. It provided the tools and resources to build students’ resilience skills and establish lifelong habits to help them realize their personal definitions of success. Working collaboratively with students, faculty, and front- line staff, the initiative identified five pillars, to address these concerns: well-being, leadership/professional development, impact, networks and grit. This article briefly outlined the program implementation and provides relevant theoretical frameworks in a case study format. It then summarized twelve key lessons learned from the two years of practice and concluded with a community perspective.

Measuring population health: association of self-rated health and PROMIS measures with social determinants of health in a cross-sectional survey of the US population

BACKGROUND

Self-reported health-related quality of life is an important population health outcome, often assessed using a single question about self-rated health (SRH). The Patient Reported Outcomes Measurement Information System (PROMIS) is a new set of measures constructed using item response theory, so each item contains information about an underlying construct. This study's objective is to assess the association between SRH and PROMIS scores and social determinants of health (SDoH) to evaluate the use of PROMIS for measuring population health.

METHODS

A cross sectional survey of 4142 US adults included demographics, 7 PROMIS domains with 2 items each, the PROMIS-preference (PROPr) score, self-rated health (SRH), 30 social determinants of health (SDoH), and 12 chronic medical conditions. SDoH and chronic condition impact estimates were created by regressing the outcome (PROMIS domain, PROPr, or SRH) on demographics and SDoH or a single chronic condition. Linear regression was used for PROMIS domains and PROPr; ordinal logistic regression was used for SRH.

RESULTS

Both SRH and PROPr detected statistically significant differences for 11 of 12 chronic conditions. Of the 30 SDoH, 19 statistically significant differences were found by SRH and 26 statistically significant differences by PROPr. The SDoH with statistically significant differences included those addressing education, income, financial insecurity, and social support. The number of statistically significant differences found for SDoH varies by individual PROMIS domains from 13 for Sleep Disturbance to 25 for Physical Function.

CONCLUSIONS

SRH is a simple single question that provides information about health-related quality of life. The 14 item PROMIS measure used in this study detects more differences in health-related quality of life for social determinants of health than SRH. This manuscript illustrates the relative costs and benefits of each approach to measuring health-related quality of life.

Content analysis of the official curriculum of undergraduate degree in Iran's medical sciences universities from the perspective of social health: A qualitative study

BACKGROUND

Social health is considered as an important part of good health both individually and socially. The purpose of this study was to examine the content of the official medical sciences curriculum in undergraduate degrees from a social health perspective.

MATERIALS AND METHODS

This qualitative content analysis study was conducted in 2019 at the Isfahan University of Medical Sciences using a deductive approach based on Hsieh and Shannon's directed content analysis. For this purpose, official curricula in the fields of Public Health, Occupational Health, Environmental Health, Nursing, Midwifery, Nutrition Sciences, and Health Services Management were analyzed using MAXQDA 12.

RESULTS

The results showed that a total of 136 codes related to the components of social health were identified in the topics of undergraduate medical sciences majors. Most to least relevant topics belonged to the fields of Public Health (61 codes), Midwifery (22 codes), Nursing (16 codes), Occupational Health (12 codes), Environmental Health and Nutrition Sciences (each 10 codes), and Health Services Management (5 codes), respectively. Among the components of social health, only the component related to access to insurance and health services was mentioned in all seven disciplines. However, the components of poverty and inequality were only included in three disciplines (Public Health, Nursing, Midwifery).

CONCLUSION

Regarding insufficient focus on social health in curricula, revision of educational curricula is suggested from the perspective of social health, particularly in areas such as poverty and inequality, unemployment, population, violence, and gender discrimination.

Cross-sectional validation of the PROMIS-Preference scoring system by its association with social determinants of health

PURPOSE

PROMIS-Preference (PROPr) is a generic, societal, preference-based summary score that uses seven domains from the Patient-Reported Outcomes Measurement Information System (PROMIS). This report evaluates construct validity of PROPr by its association with social determinants of health (SDoH).

METHODS

An online panel survey of the US adult population included PROPr, SDoH, demographics, chronic conditions, and four other scores: the EuroQol-5D-5L (EQ-5D-5L), Health Utilities Index (HUI) Mark 2 and Mark 3, and the Short Form-6D (SF-6D). Each score was regressed on age, gender, health conditions, and a single SDoH. The SDoH coefficient represents the strength of its association to PROPr and was used to assess known-groups validity. Convergent validity was evaluated using Pearson correlations between different summary scores and Spearman correlations between SDoH coefficients from different summary scores.

RESULTS

From 4142 participants, all summary scores had statistically significant differences for variables related to education, income, food and financial insecurity, and social interactions. Of the 42 SDoH variables tested, the number of statistically significant variables was 27 for EQ-5D-5L, 17 for HUI Mark 2, 23 for HUI Mark 3, 27 for PROPr, and 27 for SF-6D. The average SDoH coefficients were - 0.086 for EQ-5D-5L, - 0.039 for HUI Mark 2, - 0.063 for HUI Mark 3, - 0.064 for PROPr, and - 0.037 for SF-6D. Despite the difference in magnitude across the measures, Pearson correlations were 0.60 to 0.76 and Spearman correlations were 0.74 to 0.87.

CONCLUSIONS

These results provide evidence of construct validity supporting the use of PROPr monitor population health in the general US population.

Determinants affecting medication adherence in the elderly: A qualitative study

OBJECTIVE

Due to high rates of irrational use of medicines and low rates of medication adherence among older Iranian patients, this study aimed to explore the determinants of medication adherence in the elderly.

METHODS

This qualitative study was conducted in 2019 via 20 semi-structured interviews with a purposeful sample of elderly people and health-care personnel. Transcript data were analyzed applying thematic analysis. MAXQDA10 was used for thematic analysis and presenting a thematic map.

RESULTS

Two main themes appeared as the main determinants of medication adherence: individual determinants and external determinants. Other results show that there were six sub-themes and 23 main categories in this regard. The sub-themes were as follows: consumption disorder, consumption acceptance, delinquency, forgetfulness, sociocultural factors, and others' impacts.

CONCLUSIONS

Different individual and external factors can affect elderly people's medication adherence. Considering the significance of this issue for the health of elderly people and the whole community, positive changes are needed to manage the medication-adherence process. Basic and scientific planning, appropriate interventions, and comprehensive collaboration among all health-system levels are required for implementing such changes.

Equity at the ballot box: Health as a resource for political participation among low-income workers in two United States cities

Objective: The purpose of this study is to identify health resources associated with propensity to vote at the local-level among low-wage workers in two United States. cities. Literature confirms individuals of lower income have a lower propensity of turning out to vote, yet few studies have focused on low-income populations to identify the variation in factors associated with voting within this group. Furthermore, few studies have investigated health and voter turnout at the local-level. In this study, we examine factors related to political participation at the local-level within a low-wage sample, examine mental, physical, behavioral, and social health and their association with voter turnout, and assess if these relationships differ by city.

Methods: We use cross-sectional survey data from a sample of 974 low-wage workers in Minneapolis, MN and Raleigh, NC. We computed descriptive statistics and employed a logistic regression to predict their likelihood of local voter turnout, with the key independent variables being health resources, such as self-rated health, body mass index (BMI), mental disability, smoking status, and health insurance status. We employed a logistic regression fully interacted with a city indicator variable to assess if these associations differed by city.

Results: In both cities, less than 50 percent of respondents reported voting in the last election for mayor or city council. About three-quarters of the sample reported food or housing insecurity and the majority of respondents reported utilizing some government assistance, such as supplemental nutrition programs. BMI greater than 30 was significantly associated with lower likelihood of voter turnout compared to those of lower BMI status (marginal effect = −0.10, p = 0.026). Never smoking or quitting was significantly associated with higher likelihood of voter turnout compared to those who reported being a current smoker (marginal effect = 0.10, p = 0.002). Those with health insurance were significantly more likely to report voting compared to those without any insurance (marginal effect = 0.10, p = 0.022). These results did not significantly differ by city.

Conclusions: Our research suggests low-wage workers face significant health burdens which may impact their propensity to vote at the local-level, and these associations do not significantly vary by city despite demographic and political differences between two jurisdictions.

BIM for Healthy Buildings: An Integrated Approach of Architectural Design based on IAQ Prediction

The relationship between users and the built environment represents a fundamental aspect of health. The factors that define the properties linked to health and well-being are increasingly becoming part of building design. In these terms, building information modelling (BIM) and BIM-based performance simulation take on a priority role. Among the key features for the design of Healthy Buildings, indoor air quality (IAQ) plays a central role. There are numerous indoor pollutants with significant health effects; volatile organic compounds (VOCs) are to be mentioned among these. The paper presents the proposal of an integrated workflow in the BIM process for the check and control of VOC emissions from building materials and their concentration in confined environments. The workflow is developed through the systematisation of IAQ parameters for the open BIM standard, the integration in the BIM process of a numerical model for the prediction of the VOCs concentration in the indoor environment, and the development of model checkers for performance verification. The results show a good adhesion between the numerical model and the implementation in BIM, providing the designer with a rapid control instrument of IAQ in the various phases of the building design. The present study is the first development focused on TVOC, but implementable concerning other aspects of IAQ, as needed for the effectiveness of performance building-based design for health and wellness issues.

Post-traumatic stress, social, and physical health: A mediation and moderation analysis of Syrian refugees and Jordanians in a border community

OBJECTIVES

This study examined the mediating or moderating relationship of social health on physical health and post-traumatic stress symptoms among displaced Syrians and Jordanians at high risk for physical and mental health ailments. Frequency of mental health symptoms stratified by demographic factors was also explored. We hypothesized social health would mediate and/or moderate the relationship between physical and post-traumatic stress symptoms (PTSS).

METHODS

This cross-sectional study includes 598 adults between 18 and 75 years old recruited from three health centers in the city of Irbid, Jordan, 20 km away from the Syrian border. Post-traumatic stress symptoms (PTSS) were measured through the primary care post-traumatic stress disorder checklist. Physical and social health were assessed through the Duke Health Profile. One-way ANOVA and independent samples T-tests examined mean scores of social health, PTSS, physical health stratified by age, gender, nationality, education level, and trauma exposure. Bivariate correlations explored the relationship between social health, PTSS, and physical health. PROCESS macro tested social health as a moderator and mediator on the association of the physical health and PTSS.

RESULTS

Social health moderated and mediated the relationship between physical health and PTSS. Males reported (t = 2.53, p < .05) better physical health scores than females. Those who had less than a high school education reported lower social health (F = 13.83, p < .001); higher PTSS (F = 5.83, p < .001); and lower physical health (F = 5.76, p < .01) than more educated individuals. Syrians reported significantly higher PTSS (F = 4.13, p < .05) than Jordanians, however, there was no significant differences between nationality for physical or social health. Social health was positively associated with better physical health (r = 0.10, p < .01) and negatively with PTSS (r = -.293, p < .01).

CONCLUSIONS

Our results support our primary hypothesis suggesting social health mediates and moderates PTSS and physical health. Secondary findings illustrate gender, educational, and income differences in physical health and PTSS.

CLINICAL TRIALS REGISTRY

NCT03721848.

RE-AIM Evaluation Plan for Washington State Innovation Models Project

The State of Washington received a State Innovation Models (SIM) $65 million award from the federal Centers for Medicare & Medicaid Services to improve population health and quality of care and reduce the growth of health care costs in the entire state, which has over 7 million residents. SIM is a "complex intervention" that implements several interacting components in a complex, decentralized health system to achieve goals, which poses challenges for evaluation. Our purpose is to present the state-level evaluation methods for Washington's SIM, a 3-year intervention (2016-2018). We apply the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework to structure our evaluation. We create a conceptual model and a plan to use multiple and mixed methods to study SIM performance in the RE-AIM components from a statewide, population-based perspective.

Psychometric properties of Hindi version of child oral impact on daily performances (C-OIDP) index amongst school children in North India

Aim

To assess validity and reliability of Hindi version of Child Oral impact on daily performances (C-OIDP) index among school children in North India.

Material and methodology

Descriptive cross sectional study was conducted amongst 250, 11-12 year old school children in primary schools of Rishikesh, Uttarakhand, India. The study was done in two phases: first phase included assessment of Psychometric and linguistic properties of hindi version of C-OIDP index which was then pilot tested on study subjects. Phase two comprised of the actual main study which included the re-assessment of Hindi C-OIDP index on the entire study population. The pilot study comprised of 40 school children while the main study was conducted on 250 school children.

Results

The inter-item correlation coefficient ranged from 0.1 to 0.786 while corrected item total correlation coefficient ranged from 0.176 (smiling) to 0.843 ((cleaning). The standardised Cronbach's Alpha coefficient was 0.88. Moreover, the alpha coefficients didn't increase upon deleting any of the items. Weighted kappa was 0.85 & ICC was 0.9. Children with higher scores were less satisfied with their mouth (p- 0.001) in case of concurrent validity.

Conclusion

Hindi Child Oral Impact on Daily Performances index can be used as a valid and reliable instrument in measuring OHRQoL. of Paediatric North Indian population.

Work, Health, Safety and Well-Being: Current State of the Art

This introductory chapter will present a review of the current state of the art in relation to employee health, safety and well-being (HSW). The work environment and the nature of work itself are both important influences on HSW. A substantial part of the general morbidity of the population is related to work. It is estimated that workers suffer 270 million occupational accidents and 160 million occupational diseases each year. The chapter will first define HSW. It will then review the current state of the art by outlining key HSW issues in the contemporary world of work, identifying key needs. It will then discuss the evolution of key theoretical perspectives in this area by linking theory to practice and highlighting the need for aligning perspectives and integrating approaches to managing HSW in the workplace.

Yes, health is important, but as much for its importance via social life: The direct and indirect effects of health on subjective well-being in chronically ill individuals

There is an increasing evidence that health-related quality of life, income, and social relationships are important to our subjective well-being (SWB). Little is known, however, about the specific indirect pathways that link health to SWB via social relationships and income. On the basis of a unique data set of 7 disease groups from 6 OECD-countries (N = 6,173), we investigate the direct and indirect effects of health on SWB by using structural equation modeling. Three alternative measures of health are used: For generic instruments (EQ-5D-5L; SF-6D), the total indirect effect was stronger (0.226; 0.249) than its direct effect (0.157; 0.205). For the visual analogue scale, the direct effect was stronger (0.322) than its total indirect effect (0.179). Most of the indirect effect of improved health on SWB transmitted through social relationships. The effect via income was small. Nevertheless, the presence of unmeasured confounders may bias the estimates. An important lesson for researchers is to include meaningful items on social relationships when measuring the benefits from improved health. An important lesson for policy makers is that social isolation appears to be more detrimental to overall well-being than ill health. Hence, the Health and Care Services should facilitate social arenas for people with chronic conditions.

Medical innovation and the sustainability of health systems: A historical perspective on technological change in health

New medical technology challenges the sustainability of healthcare systems in several countries. Drawing on secondary sources of data, the aim of this article is to generate a better understanding of the historical Research & Development dynamics that have contributed to shape today’s medical innovation ecosystem. We describe key technological achievements along three historical periods – the 1950s, the 1980s and the 2000s – and situate them within their broader political, social, cultural and economic contexts. Our analyses bring forward self-reinforcing dynamics between technology, medical specialization, individualization of disease and the concentration of resources in academic teaching centres. We argue that the way medical innovation has been financed, designed and commercialized since the 1950s has engendered path dependency, which exacerbates the sustainability challenges healthcare systems are now facing. We conclude on the need for innovation design principles that could protect the sustainability of healthcare systems.

Wellness among US adolescents ages 12-17 years

BACKGROUND

Wellness is a multidimensional construct related to an individual's physical, emotional, intellectual and social well-being. We present estimates of wellness among US adolescents aged 12-17 years and explore how demographic characteristics are associated with wellness.

METHODS

All respondents aged 12 to 17 years (n = 34,601) from the 2011-2012 National Survey of Children's Health were included in the sample. Survey items were coded to operationalize an overall wellness score, comprised of four subdimensions (physical, intellectual, emotional and social).

RESULTS

The mean adjusted overall wellness score was 30.2 (out of 40). Mean raw subdimensions scores were: social = 3.14 (out of 4), emotional = 4.79 (out of 6), intellectual = 4.80 (out of 8) and physical = 6.57 (out of 8). Older adolescents, those with special health needs, those in lower income families and those whose mother or father report fair-poor mental health status had lower wellness scores.

CONCLUSIONS

US adolescents have wellness scores towards the upper or higher end of our scale. Several adolescent and family characteristics were associated with either lower overall wellness and/or lower wellness on multiple subdimensions. Assessing wellness during critical developmental periods of adolescence is a first step towards promoting behaviours that support increased wellness into adulthood.

Correlates of wellness among youth with functional disabilities

BACKGROUND

The literature is more informative on the impediments to wellness among youth with functional limitations and less instructive on the state of wellness for this population.

OBJECTIVE

To explore overall wellness, and each sub-dimension of wellness, in a national sample of youth with functional limitations and to determine how demographic characteristics are associated with wellness.

METHODS

Using a previously validated screening instrument, we identify youth with functional limitations aged 12 to 17 represented in the 2011/12 National Survey of Children's Health. Survey items were coded to operationalize an overall wellness score comprised of four sub-dimensions of wellness (i.e., physical, intellectual, emotional, and social).

RESULTS

The mean overall wellness score was 26.7 (out of 40) and had an approximate normal distribution. Mean raw scores for each sub-dimension were as follows: social = 2.79 (out of 4; 69.7%); emotional = 4.09 (out of 6; 68.2%); intellectual = 3.79 (out of 8; 47.4%); and physical = 6.30 (out of 8; 78.7%). Lower wellness scores were associated with older age among youth, increasing number of chronic health conditions, lower income, single mother homes, and youth whose mother reported fair or poor mental health status (all p < 0.05). Higher wellness scores were positively associated with mother's education (p < 0.001).

CONCLUSIONS

Program planners should consider interventions that target youth with functional limitations shown to be at particular risk for lower overall wellness and promote family involvement and comprehensive supports, including maternal educational attainment, mental health screening, and referral.

Development of a scale for measuring social health of Iranians living in three big cities

BACKGROUND

Social health is considered as a significant dimension of health and, hence, its assessment is vital in health planning. Within this context, this study aimed to develop a valid and reliable scale for measuring individual's social health in Iran. To do so, an exploratory sequential mixed method was used.

METHODS

To establish the item pool and primary scale, 30 interviews with experts and other stakeholders, and a primary review of relevant literature and similar questionnaires were conducted. Then, a survey with 800 respondents from three cities in Iran was undertaken to assess the validity and reliability of the scale.

RESULTS

In the qualitative stage of this study, after careful consideration, forty questions were remained for the next step. Considering the correlation of the score of each question with the total score of the questionnaire, seven questions were omitted. For this questionnaire with 33 remaining questions, Cronbach's alpha for internal consistency was estimated to be 0.86. The reliability coefficient for 100 samples (taken after 7 to 10 days from the first round of sampling) was 0.91. Considering the factor analysis, three factors were recognized. These factors were named as "family", "community" and "friends and relatives". Cronbach's Alpha for internal consistency of community, friends and relatives, and family factors were estimated to be 0.91, 0.77 and 0.78 respectively. The corresponding value of the reliability indicator, intraclass correlation coefficient (ICC), for community, friends and relatives, and family were calculated 0.69, 0.80 and 0.67 respectively.

CONCLUSION

We developed a measurable scale for social health at an individual level in the Iranian community with an acceptable level of validity and reliability. The new developed scale is able to provide an opportunity to measure Iranians' social health at an individual level. Such an indicator of individual health can be used in evaluating the performance of social health policies and providing a platform for evidence-based policy-making in the social health context.

Lifecourse health development: past, present and future

During the latter half of the twentieth century, an explosion of research elucidated a growing number of causes of disease and contributors to health. Biopsychosocial models that accounted for the wide range of factors influencing health began to replace outmoded and overly simplified biomedical models of disease causation. More recently, models of lifecourse health development (LCHD) have synthesized research from biological, behavioral and social science disciplines, defined health development as a dynamic process that begins before conception and continues throughout the lifespan, and paved the way for the creation of novel strategies aimed at optimization of individual and population health trajectories. As rapid advances in epigenetics and biological systems research continue to inform and refine LCHD models, our healthcare delivery system has struggled to keep pace, and the gulf between knowledge and practice has widened. This paper attempts to chart the evolution of the LCHD framework, and illustrate its potential to transform how the MCH system addresses social, psychological, biological, and genetic influences on health, eliminates health disparities, reduces chronic illness, and contains healthcare costs. The LCHD approach can serve to highlight the foundational importance of MCH, moving it from the margins of national debate to the forefront of healthcare reform efforts. The paper concludes with suggestions for innovations that could accelerate the translation of health development principles into MCH practice.

Lifecourse health development: past, present and future

During the latter half of the twentieth century, an explosion of research elucidated a growing number of causes of disease and contributors to health. Biopsychosocial models that accounted for the wide range of factors influencing health began to replace outmoded and overly simplified biomedical models of disease causation. More recently, models of lifecourse health development (LCHD) have synthesized research from biological, behavioral and social science disciplines, defined health development as a dynamic process that begins before conception and continues throughout the lifespan, and paved the way for the creation of novel strategies aimed at optimization of individual and population health trajectories. As rapid advances in epigenetics and biological systems research continue to inform and refine LCHD models, our healthcare delivery system has struggled to keep pace, and the gulf between knowledge and practice has widened. This paper attempts to chart the evolution of the LCHD framework, and illustrate its potential to transform how the MCH system addresses social, psychological, biological, and genetic influences on health, eliminates health disparities, reduces chronic illness, and contains healthcare costs. The LCHD approach can serve to highlight the foundational importance of MCH, moving it from the margins of national debate to the forefront of healthcare reform efforts. The paper concludes with suggestions for innovations that could accelerate the translation of health development principles into MCH practice.

Mental, social, and physical well-being in New Hampshire, Oregon, and Washington, 2010 Behavioral Risk Factor Surveillance System: implications for public health research and practice related to Healthy People 2020 foundation health measures on well-being

BACKGROUND

Well-being is now accepted as one of four cross-cutting measures in gauging progress for Healthy People 2020. This shift to population indicators of well-being redresses notions of health that have focused on absence of illness (negative health) as a primary or sufficient indicator of positive functioning. The purpose of this study was to estimate mental, social, and physical well-being in three US states using new measures piloted on the 2010 Behavioral Risk Factor Surveillance Survey System (BRFSS). Baseline estimates were provided for states overall, and within states for demographic subgroups, those with chronic health conditions or disabilities, and those with behavioral risk factors.

METHODS

Ten validated questions designed to assess mental (e.g., satisfaction with life, satisfaction with life domains, happiness), physical (e.g., satisfaction with energy level), and social dimensions (e.g., frequency of social support) of well-being were selected with state input for inclusion on BRFSS. 18,622 individuals responded to the BRFSS surveys administered by New Hampshire (N = 3,139), Oregon (N = 2,289), and Washington (N = 13,194). Multivariate adjusted proportions of positive responses to well-being items were examined.

RESULTS

After adjustment for confounders, about 67% of adults in these states had high levels of well-being, including >80% reporting experiencing happiness. Most adults were satisfied with their work, neighborhood, and education, but significant differences were seen in subgroups. Well-being differed by demographic characteristics such as marital status, health behaviors, chronic conditions, and disability status, with those who reported a disability and smokers consistently experiencing the worst well-being.

CONCLUSIONS

Well-being is accepted as one of four cross-cutting measures in gauging progress for Healthy People 2020. Well-being differs by important sociodemographic factors and health conditions (e.g., age, employment, smoking, disability status). These findings provide baseline estimates for the three states to use in gauging improvements in well-being and can serve as a model for other state-level or national surveillance systems. These findings also assist states in identifying vulnerable subgroups who may benefit from potential interventions such as those in the National Prevention Strategy that focus on enhancing well-being where such disparities exist.

Quality and cost improvement of healthcare via complementary measurement and diagnosis of patient general health outcome using electronic health record data: research rationale and design

In this evolving 'third era of health', one of the US Health Care Reform Act's goals is to effectively facilitate the primary care physician's ability to better diagnose and manage the health outcome of the outpatient. That goal must include research on the complementary quantitative-qualitative assessment and rating of the patient's health status. This paper proposes an overview of the rationale and design of a research program for a balanced measurement and diagnostic clinical decision support system (CDSS) of the changing general health status of the patient -including disease- using electronic health record (EHR) data. The rationale, objectives, health metric-diagnostic tools architecture, simulation-optimization, and clinical trials are outlined. Resources, time frames, costs, feasibility, healthcare benefits and data-integration of the project are delineated. The basis and components of the research program to achieve an automated-CDSS to complement physician's clinical judgment, calculating a mathematical 'health equation' from each patient's EHR database, assisting physician-patient collaboration to diagnose, and improve general health outcomes is described. Use of multiple dimensional index, ways of classification, and causal factors' assessments, to arrive at the EHR-based CDSS algorithm-software providing a general health level and state rating of the patient are proposed. Its application could provide a compass for the general practitioner's best choice and use of the myriad of healthcare educational and technological options available with lower costs for everyday clinical practice and research. It could advance the approaches and focus of the 'eras of diseases', to the promising 'era of health', in an integrated, general approach to 'health.'

Framing the evidence for health smart homes and home-based consumer health technologies as a public health intervention for independent aging: a systematic review

INTRODUCTION

There is a critical need for public health interventions to support the independence of older adults as the world's population ages. Health smart homes (HSH) and home-based consumer health (HCH) technologies may play a role in these interventions.

METHODS

We conducted a systematic review of HSH and HCH literature from indexed repositories for health care and technology disciplines (e.g., MEDLINE, CINAHL, and IEEE Xplore) and classified included studies according to an evidence-based public health (EBPH) typology.

RESULTS

One thousand, six hundred and thirty-nine candidate articles were identified. Thirty-one studies from the years 1998-2011 were included. Twenty-one included studies were classified as emerging, 10 as promising and 3 as effective (first tier).

CONCLUSION

The majority of included studies were published in the period beginning in the year 2005. All 3 effective (first tier) studies and 9 of 10 of promising studies were published during this period. Almost all studies included an activity sensing component and most of them used passive infrared motion sensors. The three effective (first tier) studies all used a multicomponent technology approach that included activity sensing, reminders and other technologies tailored to individual preferences. Future research should explore the use of technology for self-management of health by older adults; social support; and self-reported health measures incorporated into personal health records, electronic medical records, and community health registries.

The meanings of recovery from addiction: evolution and promises

OBJECTIVE

To review the evolution of the paradigm of recovery in addiction and its implications.

METHOD

A systematic literature review was conducted using the MEDLINE and PsychInfo databases over the past 10 years and key references from the retrieved literature.

FINDINGS

The historical evolution of the concept of recovery has been shaped by several driving forces, including consumer experience, the need to better define our treatment outcome and parallel elaboration of the concepts of health, quality of life, and chronic disorders. Similarities and differences with the concept of "recovery" in mental health and other biomedical fields are identified.The empirical basis is growing in support of various proposed attributions and features of recovery along with the temporal benchmarks involved. The various forms of recovery, such as "natural," "transformational," or "medication-assisted," describe a choice of pathways to a common goal.The management implications are far-reaching and call for system shifts from acute stabilization to sustained recovery, including the growth of alternative institutions, and roles complementary to mutual help. Tools for the sustenance of recovery, including educational kits, recovery workbooks, and e-recovery initiatives, are developing.

CONCLUSIONS

Although first-person accounts of recovery abound, a more systematic empirical investigation of the concept has just begun, including demographic and cultural differences. Management implications are derived from the experience with other "mainstream" chronic disorders with treatment providing stabilization and initiation of recovery and a range of long-term resources becoming available to sustain it.

It’s time to make the profession of health about health

Most professional health publications and presentations are not about health, but about how to avoid, prevent, or treat disease or infirmity. Better health cannot be attained by simply avoiding, preventing, or treating problems. Health efforts, therefore, should be directed toward creating physical, mental, and social wellbeing. To guide these efforts, salutogenesis, a theoretical framework about the origins or creation of health, is needed to complement the traditional pathogenesis framework that focuses on the origins and causes of disease. Salutogenic strategies are necessary to help health professionals promote positive health enhancement by making their practices about health.

A need for holistic approach to the occupational health developing (in Serbia)

Countries in transition, such as Serbia, have been going through obligatory system reforms, including the reform of the healthcare system. As a rule, occupational health becomes marginalized by the authorities who decide on medical care. In spite of the fact that this branch of medicine cares for working population that mostly carries the burden of transition, when material situation equals the existential minimum, its potentials are not recognized. On the other hand, the World Health Organization makes a remark that such population's health is undermined now more than ever, and adopts a binding global plan for member countries and their experts in occupational health to take urgent measures for overall working people's health according to their needs. It seems that former work method of biomedicine specialists could not realize such ambition. This paper discusses the possibilities of occupational health future orientation toward holistic medicine, for the sake of workers' well-being and better quality of their lives, then creation of more humane society and vocational affirmation. Health promotion at workplace and salutogenic concept may have crucial roles. This concept is a huge challenge for academic public and vocational practitioners in poor countries in transition that are already burdened with the current economic and financial crisis. Each in their own way, helped by self-education and education, without big material investments, together they may take their countries to the road of health, the road still rarely taken, yet more secure.

Coming to consensus on health literacy measurement: an online discussion and consensus-gauging process

Health literacy continues to experience the normal growing pains of an emerging field of inquiry and practice. The evolving concept of health literacy requires the development of new measurement tools to adequately study interventions and identify best practices. This article describes a multistage process of engaging the largest known international group of health literacy professionals in an online discussion about health literacy measurement. The goal was to gather input and identify important themes in the discussion using both quantitative and qualitative evaluation methods to gauge the strength of any consensus about health literacy measurement and start to identify topics that should be considered and addressed by those working to develop new tools to measure health literacy.

Social paediatrics and early child development: Part 1

Diseases of modernism, rather than infectious diseases and chronic medical conditions, increasingly cause childhood morbidity and mortality. Thus, the goal of enhancing life outcomes for all children has become imperative. Paediatricans may begin with a renewed interest in social paediatrics - the care of the disadvantaged child in Canada, requiring a focus on all the complex factors that impact families and the community. New paediatricians need the tools to impact both social determinants of health and political policies to support health for all. Such interest is as old as the field of paediatrics (social medicine began with the great pathologist, Virchow, in the 1800s). The new neuroscience of experience-based brain and biological development has caught up with the social epidemiology literature. It is now known from both domains that a child's poor developmental and health outcomes are a product of early and ongoing socioeconomic and psychological experiences. In the era of epigenetics, it is now understood that both nature and nurture control the genome. Future paediatricians need to understand the science of experience-based brain development, and the interventions demonstrated to improve life trajectories. A challenge is to connect the traditional population health approach with traditional primary care responsibilities. New and enhanced collaborative interdisciplinary networks with, for example, public health, primary care, community resources, education and justice systems are required.

Evaluation of selected lipid parameters and blood pressure in ethnically-homogenous population of middle-aged persons, depending on gender, age and body mass

The study is a retrospective analysis of data obtained from a cardiovascular disease prevention program financed by the National Health Fund (Poland). The aim of the study was to evaluate the population to demonstrate the prevalence of favourable and unfavourable lipid parameters and blood pressure values depending on age and BMI. A total of 2,616 subjects were included in the study (811 men and 1805 women aged between 35 and 55 years of age) who perceived themselves as completely healthy individuals and in whom no cardiovascular disease or diabetes mellitus had been diagnosed. We evaluated blood pressure values, body weight, height, BMI, fasting glucose, total cholesterol, triglycerides, HDL and LDL in the serum of venous blood. The above-mentioned parameters were compared in women and men depending on BMI and age. It was demonstrated that the epidemiological situation of women in the analysed age group, regardless of the studied parameter and method of its evaluation, is much more favourable than that of men. We have demonstrated that evaluation of the analysed lipid parameters and blood pressure should be performed with consideration to gender and age. Otherwise conclusions may be obtained which are not satisfied by 75-95% of the population in a given age group. Obesity was highlighted as a factor triggering further lipid disturbances and blood pressure increase.

Valuation of health states in the US study to establish disability weights: lessons from the literature

The metric of disability-adjusted life years (DALYs) has become the global standard of measuring burden of disease. DALYs are comprised of years of life lost due to premature mortality and years of healthy life lost due to living with disability. In order to calculate the second part of the DALY equation, disease specific disability weights have to be established, i.e. measures for the decline of health associated with these disease states, which vary between zero for perfect health and one for death. Although these disability weights are key for estimating DALYs, there have not been many comprehensive studies with empirical determinations of them. This article describes a systematic review on the state of the art with respect to empirically determining disability weights. Based on this review, a multi-method approach is outlined, which has also been implemented in a US study to measure burden of disease. This approach involves the use of psychometric methodology as well as economic trade-off methods for determining the value of health states. It is conceptualized as a disaggregated approach, where the disability weight of any health state can be calculated if the attributes of this health state are known. The US study received the collaboration of experts from more than 20 institutes of the National Institutes of Health and of the Centers for Disease Control and Prevention. First results will be available by the end of this year.

Monitoring progress toward CDC's health protection goals: health outcome measures by life stage

OBJECTIVES

From 2004 through 2005, as part of a major strategic planning process called the Futures Initiative, the Centers for Disease Control and Prevention (CDC) developed a set of Health Protection Goals to make the best use of agency resources to achieve health impact. These goals were framed in terms of people, places, preparedness, and global health. This article presents a goals framework and a set of health outcome measures with historical trends and forecasts to track progress toward the Healthy People goals by life stage (Infants and Toddlers, Children, Adolescents, Adults, and Older Adults and Seniors).

METHODS

Measurable key health outcomes were chosen for each life stage to capture the multidimensional aspects of health, including mortality, morbidity, perceived health, and lifestyle factors. Analytic methods involved identifying nationally representative data sources, reviewing 20-year trends generally ranging from 1984 through 2005, and using time-series techniques to forecast measures by life stage until 2015.

RESULTS

Improvements in measures of mortality and morbidity were noted among all life stages during the study period except Adults, who reported continued declining trends in perceived health status. Although certain behavioral indicators (e.g., prevalence of nonsmokers) revealed steady improvements among Adolescents, Adults, and Older Adults and Seniors, prevalence of the healthy weight indicator was declining steadily among Children and Adolescents and dramatically among Adults and Older Adults and Seniors.

CONCLUSION

The health indicators for the Healthy People goals established a baseline assessment of population health, which will be monitored on an ongoing basis to measure progress in maximizing health and achieving one component of CDC's Health Protection Goals.

Don't wanna go through that madness no more: quality of life satisfaction as predictor of sustained remission from illicit drug misuse

Individuals who have developed a clinical dependence on drugs and/or alcohol often report that they sought help because they were "sick and tired of being sick and tired." Quality of life (QOL) remains the missing measurement in the addictions arena. The few studies conducted to date show that QOL is typically poor during active addiction and improves as a function of remission. An intriguing question bears on the role of QOL in subsequent remission status. Reasoning that higher life satisfaction may "increase the price" of future use and thus enhance the likelihood of sustained remission, this exploratory study tests the hypotheses that QOL satisfaction prospectively predicts sustained remission, and that motivational constructs mediate the association. Inner city residents (N = 289, 53.6% male, mean age 43) remitting from chronic and severe histories of dependence to crack and/or heroin were interviewed three times at yearly interval beginning in April 2003. Logistic regression findings generally support our hypotheses: Controlling for other relevant variables, baseline life satisfaction predicted remission status 1 and 2 years later and the association was partially mediated by motivation (commitment to abstinence) although the indirect effect did not reach statistical significance. Findings underline the importance of examining the role of QOL satisfaction in remission processes. Limitations of this exploratory study are discussed, including the use of a single-item global life satisfaction rating; suggestions for future studies are discussed including the need to embrace QOL as a bona fide clinical outcome and to use comprehensive standardized QOL measures that speak to individual dimensions of functioning. Implications are noted, especially the need for the addiction field to continue moving away from the pathology-focused model of care toward a broader model that embraces multiple dimensions of positive health as a key outcome.

What is recovery? A working definition from the Betty Ford Institute

There is an unknown but very large number of individuals who have experienced and successfully resolved dependence on alcohol or other drugs. These individuals refer to their new sober and productive lifestyle as "recovery." Although widely used, the lack of a standard definition for this term has hindered public understanding and research on the topic that might foster more and better recovery-oriented interventions. To this end, a group of interested researchers, treatment providers, recovery advocates, and policymakers was convened by the Betty Ford Institute to develop an initial definition of recovery as a starting point for better communication, research, and public understanding. Recovery is defined in this article as a voluntarily maintained lifestyle composed characterized by sobriety, personal health, and citizenship. This article presents the operational definitions, rationales, and research implications for each of the three elements of this definition.