Gulf War Veterans Measuring Health (1999) / Chapter Skim
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3 Measuring Health
3 Measuring Health
Pages 38-54
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From page 38... ...
The work of this committee represents an effort to move ahead with a more general and prospectively oriented approach for ensuring systematic study of the current and future health of Gulf War veterans. This chapter reviews the key aspects of defining and measuring health that have served to guide the committee in developing recommendations for future research.
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From page 39... ...
The new definition of health necessitated development of new indicators that would measure complete physical, mental, emotional, and social well being. A frequently used approach relies on measures of physical and psychological functioning, that is, an individual's functional status or the extent to which an individual can function normally and carry on his or her typical daily activities.
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From page 40... ...
The five main concepts of health, with selected domains and subdomains, are briefly described below. Death and Duration of Life The mortality-based measures most frequently used in prior studies of Gulf War veterans include the total death rate, condition-specific death rates, and infant mortality.
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From page 41... ...
MEASURING HEALTH TABLE 3-1 Core Concepts and Domains of Heals 41 Concepts and Domains Def~nitions/Indicators Death and Duration of Life Impairment Symptoms and subjective complaints Signs Self-reported disease Physiological measures Tissue alterations Diagnoses Functional Status Social function Limitations in usual roles Integration Contact Intimacy and sexual function Psychological function Affective Cognitive Physical function Activity restrictions Fitness Health Perceptions General health perceptions Satisfaction with health Opportunity Social or cultural disadvantage Resilience Mortality; survival; years of life lost Reports of physical and psychological symptoms, sensations, pain, health problems, or feelings not directly observable Physical examination: observable evidence of defect or abnormality Patient listing of medical conditions or impairments Laboratory data, records, and their clinical interpretation Pathological evidence Clinical judgments after "all the evidence" Acute or chronic limitations in usual social roles (major activities) of child, student, worker Participation in the community Interaction with others Perceived feelings of closeness; sexual activity and/or problems Psychological attitudes and behaviors, including distress and well being Alertness; disorientation; problems in reasoning Acute or chronic reduction in physical activity, mobility, self-care, sleep, communication Performance of activity with vigor and without excessive fatigue Self-rating of health; health concern/worry Satisfaction with physical, psychological, social function Disadvantage because of health; stigma; societal reaction Capacity for health; ability to withstand stress; physiological reserves SOURCE: Adapted from Patrick and Erickson, 1993.
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From page 42... ...
In assessing the health of a population, health status surveys frequently ask respondents to report whether or not they have or have had heart disease, cancer, respiratory disease, or other specific diagnosable condition. Some of these reports will reflect information conveyed to the respondent by a physician.
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From page 43... ...
The subdomain of affective functioning is assessed using general measures of distress, measures of specific mood states, and diagnosable conditions such as depression and anxiety. The subdomain of cognitive functioning refers to matters such as impaired thought and concentration, memory, and the ability to carry out intellectual functions essential to normal routines of living (e.g., remembering names and telephone numbers, performing tasks on the job)
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From page 44... ...
Subjective health status is often assessed on the basis of a self-rating of health as excellent, very good, good, fair, or poor. Such judgments are considered ratings because they reflect individual differences in evaluating health.
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From page 45... ...
This approach recognizes that people adjust differently to life situations altered by disease or treatment. Application to Studies of Gulf War Veterans Studies of Gulf War veterans conducted to date have measured specific components within the wide range of domains and subdomains of health-related quality of life just described.
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From page 46... ...
Life-style and health behavior includes individual activities and exposures, such as smoking, drinking, drug use, diet, and exercise factors often referred to as risk behaviors. Illness behavior includes an individual's coping behaviors and information seeking in the face of a potential or actual health threat.
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From page 47... ...
47 t / s ~ o I C'0 l I .o o5 s C~ tn O >` a)
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From page 48... ...
In developing programs for Gulf War veterans, these points may be especially relevant for both policymakers and clinicians.
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From page 49... ...
Physiological measures (e.g., blood pressure, serum glucose) rely on direct testing or observation of biologic material such as blood or tissue samples or of physiological processes such as cardiac function.
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From page 50... ...
. talon monitoring Represents net impact Useful for cost-effective ness Single instrument Contribution of domains to overall score possible Wide range of relevant outcomes possible May be expensive and measures not available for many POW conditions May not be reproducible and may be expensive Not available for many conditions or relevant to subjective reports Difficult to establish validity as no gold standard or criterion exists May be difficult to interpret; trends may not be responsive to change May not be possible to disaggregate contribution of domains to the overall score May not be responsive to change May not be responsive to change Length may be a problem May not have overall score Cannot relate different outcomes to common measurement scale May need to adjust for multiple comparisons May need to identify major outcome
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From page 51... ...
, measures that are responsive to small changes in health status are important. For health status surveys, generic measures may be particularly useful in comparing levels of health with extant norms and reference values.
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From page 52... ...
Because many of the symptoms and subjective complaints of Gulf War veterans cannot be measured solely with physiological or physical tests, or observable markers such as death, the committee views self-report measures as essential to complement evidence from physiological measurement, physical examination, and perfo~mance-based measurements such as treadmill or timed walking tests. There are strong arguments for taking the individual or patient's point of view into account when assessing health-related quality of life.
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From page 53... ...
The committee believes that the data contained in completed surveys of health status will form the basis for hypothesis generation and subsequent in-depth studies of targeted subgroups or promising therapeutic interventions. Data Collection Instruments Numerous books describe the process for developing reliable, valid instruments that measure health-related quality of life.
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From page 54... ...
Applied originally in the field of educational testing (for instance, in licensing examinations for health professionals) , IRT or CAT techniques are taking hold in the health status assessment arena as well.
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