Journal of chronic diseases最新文献

To assess the impact of medical care on children we have developed a conceptual model based on both theoretical considerations and empirical research. Child health is viewed as the ability to participate fully in developmentally appropriate activities and requires physical, psychological, and social energy. The medical system influences health through interventions addressing these domains.

Many methodologie issues are unique to the measurement of medical care processes and outcomes for children. Problems in measuring the process of medical interviews include developing systems that capture the dynamics of interactions, assess the cognitive appropriateness and metaphorical interpretation of language, and reflect the emotional impact of certain incidents. Issues that confound measurement of children's views include position bias, acquiescence response bias, and limited understanding of negatively worded items. Further, the concordance between parent and children reports or health constructs varies widely, which suggests the need to include children's reports to obtain a comprehensive view of their health.

The COOP Project, a primary care research network, has begun development of a Chart method to screen function quickly. The COOP Charts, analogous to Snellen Charts, were pretested in two practices on adult patients (N = 117) to test feasibility, clinical utility, and validity. Patients completed questionnaires containing validated health status scales and sociodemographic variables. Practice staff filled out forms indicating COOP Chart scores and clinical data. We held debriefing interviews with staff who administered the Charts, The results indicate the Charts take 1–2 minutes to administer, are easy to use, and produce important clinical data. The patterns of correlations between the Charts and validity indicator variables provide evidence for both convergent and discriminant validity. We conclude that new measures are needed to assess function in a busy office practice and that the COOP Chart system represents one promising strategy.

This paper analyzes the mortality of Mexican Americans and Puerto Ricans residing in the Chicago metropolitan area. In a comparison of these two groups with nonHispanic whites in the same area, it was found that Hispanic mortality is unusually low for the two leading causes of death in the mainstream U.S. population. Explanations discussed include underdiagnosis, underreporting of illness, the “healthy migrant” thesis and possible return migration of elderly ill.

The accuracy of routinely collected mortality data for ischemic heart disease (IHD) as indicators of death from acute myocardial infarction (AMI) was assessed in ages 25–64 years, according to the WHO criteria defined in 1983. Cases were identified from computer records (linked for individuals) of all death certificates and hospital discharges in Western Australia between 1971 and 1982. Where the official cause was IHD about 90% of deaths fulfilled the WHO criteria for definite or possible AMI. Up to 10% of fatal cases of definite or possible AMI were coded to other causes in the official death statistics, however it appeared that variations in this figure with changes in coding practices could cause appreciable bias in the estimation of secular trends in IHD mortality. This problem could largely be overcome by reviewing fatal events where the death certificate was coded to one of a limited number of other ICD rubrics.

The impact of disease and treatment on patients' lives is frequently measured by endpoints such as health status, well being and quality of life. The objective of this paper is to introduce a new but related outcome concept termed “reintegration to normal living” and to compare it to the quality of life. The concept of “reintegration” is closely allied to functional performance. Like quality of life, it is important to measure when therapeutic goals cannot include a cure but are directed at controlling the disease process or fostering compensation for impairment. A Reintegration to Normal Living (RNL) Index has been developed. Although more limited in conceptual focus, its content is similar to global quality of life measures. It is internally consistent, demonstrates content and construct validity, can be completed by patients or significant others and is sensitive to changes in patient status. The degree of reintegration achieved by patients after an incapacitating illness is seen as contributing to the quality of their lives.

Clinical trials are commonly performed in surgery to assess the efficacy of one or more treatments. Many therapies result in only partial or temporary improvement, rather than cure. Others sharply affect the quality of patients' lives or of their deaths. For most interventions, it is important to document effects on quality of life as well as morbidity and mortality rates. Yet, a review of the literature reveals that very few surgical trials consider quality of life variables as outcome measures. Surgical investigators in areas like cancer, inflammatory bowel disease, end stage renal disease, and cardiac disease have examined quality of life issues extensively using a variety of scales and indices. However, most studies on quality of life are hampered by poor design and inadequate methods of assessment. Failure to evaluate quality of life variables prevents the recognition and full use of potentially beneficial therapies and the rejection of potentially harmful ones.