我国老年人健康自评影响因素分析

健康自评是研究对象对自身健康的主观感受,是调查中经常运用的变量。健康自评能够反映健康状态的主观和客观两个方面,因此健康自评可以作为评价老年人健康状况的一个重要指标。采用2002年全国老年调查数据,做不同老年人群体的健康自评的差异性分析并进一步探究影响因素。旨在回答我国老年人健康自评的影响因素,对老年人自身和政策制定者提供参考依据。健康的生活方式对健康自评有积极的影响,身体的健康和健康自评有很强的相关性,老年人的社会人口学特征对健康自评影响十分有限。     

Subjective Indicators in the Health Sector and Their Usefulness in Policy Making

A considerable literature produced in the field of social sciences focused in the last 20 years on the importance of subjective indicators of wellbeing as an element of great significance in the analysis of public policies and quality of services, in addition to objective indicators. The health sector is characterized by a particular propensity and special consideration of the role of patients and other persons involved in the care process (family, doctors, nurses, etc.), and therefore of subjective elements. Since the end of the 1980s several studies considered the incongruences between health demand and health service supply and introduced in the debate the need to produce better evaluation methodologies, based on the interaction between objective an subjective data. The consequence was that subjective assessment by users and operators is now an integral part of any health service evaluation activity. The paper shows the evolution of scientific approaches to health services assessment, and the nature of subjective indicators mostly utilized in recent Italian experiences. Special attention is dedicated to an interesting attempt to enlarge the evaluation approach, aim of which is to contribute to the assessment of the social impact of administrative actions and public services stimulating the contribution of social parties and independent experts and involving public authorities and policy-makers.     

老年人健康状况主观评价分析

本文采用主观评价方法,对广东不同群体老年人健康状况的主客观评价进行了对比分析,目的在于探寻不同群体老年人对健康状况的主观评价是否存在差异,以及差异产生的原因.结果显示老年人对自身健康状况的评价与其客观的健康状况有着密切的联系;老年人健康状况评价的主客观指标并非完全一致;不同性别、年龄、职业、收入和医疗状况的老年人对其健康状况的主观评价存在较大差异.本研究的结果对于加快医疗制度改革具有一定启发意义.     

The Relative Contribution of Health Status and Quality of Life Domains in Subjective Health in Old Age

To analyze the influence of different health status dimensions and quality of life (QoL) domains on older adults’ subjective health, and to assess the role that residential satisfaction plays in these relationships. A QoL survey was conducted on a representative sample of the community-dwelling older adult population in Madrid province (Spain). Logistic regression models were applied to studying: the health status dimensions associated with satisfaction with health; the relationship between satisfaction with health and other QoL domains; and, the influence of these domains on satisfaction with life. Sociodemographic and residential characteristics were included in all the models. The determinants of satisfaction with health in the first model were: mobility, usual activities, morbidity, and satisfaction with neighborhood. QoL domains associated with health were: leisure activities, neighborhood, and finances. Satisfaction with life was explained by these three domains, along with age, family and health. In sum, leisure, neighborhood, and finances showed a positive effect on satisfaction with health and with life.     

Birth Intervals and Health in Adulthood: A Comparison of Siblings Using Swedish Register Data

A growing body of research has examined whether birth intervals influence perinatal outcomes and child health as well as long-term educational and socioeconomic outcomes. To date, however, very little research has examined whether birth spacing influences long-term health. We use contemporary Swedish population register data to examine the relationship between birth-to-birth intervals and a variety of health outcomes in adulthood: for men, height, physical fitness, and the probability of falling into different body mass index categories; and for men and women, mortality. In models that do not adjust carefully for family background, we find that short and long birth intervals are clearly associated with height, physical fitness, being overweight or obese, and mortality. However, after carefully adjusting for family background using a within-family sibling comparison design, we find that birth spacing is generally not associated with long-term health, although we find that men born after very long birth intervals have a higher probability of being overweight or obese in early adulthood. Overall, we conclude that birth intervals have little independent effect on long-term health outcomes.     

Psychometric Evaluation of the Tagalog and German Subjective Happiness Scales and a Cross-Cultural Comparison

The Subjective Happiness Scale (SHS) has recently been developed as a more complete measure for the assessment of molar subjective happiness. In the present study, we report on the translation and validation of German and Tagalog versions of the SHS and conduct an initial cross-cultural examination of subjective happiness. In Study 1, 960 participants in Austria completed a German version of the SHS, which showed a unidimensional structure, good internal consistency, and good convergent validity with other measures of subjective well-being. In Study 2, 182 participants in the Philippines completed a Tagalog version of the scale, which likewise had a unidimensional structure, high internal consistency, and good convergent validity. Finally, the results of Study 3 indicate that there were significant cross-cultural differences in subjective happiness. Specifically, participants in individualist Austria and Britain had higher SHS scores than their counterparts in collectivist Malaysia and the Philippines. Limitations of these studies are discussed.     

政府支出对医疗服务健康公平影响的比较和启示

医疗服务公平和人民的健康是各国卫生系统向其国家居民提供医疗服务所应实现的两个重要目标。但以英美日为例的发达国家根据世界卫生统计年鉴中的医疗服务公平性排名确有明显差距,因此,高收入和高政府医疗卫生支出与医疗卫生服务公平和健康公平性并没有必然关系。本文通过比较分析美日英国的政府间医疗卫生支出责任划分的结构发现高政府医疗卫生支出比例是提高医疗服务筹资公平性的前提,中央承担社会医疗保险责任是实现医疗服务筹资公平性的保证,政府特别是中央政府出资的长期护理有助于提高国民健康水平,地方政府的参与更有助于提高一国医疗系统机构数量特别是医院的数量。     

The Predictive Validity of Subjective Mortality Expectations: Evidence From the Health and Retirement Study

Several recent studies suggest that individual subjective survival forecasts are powerful predictors of both mortality and behavior. Using 15 years of longitudinal data from the Health and Retirement Study, I present an alternative view. Across a wide range of ages, predictions of in-sample mortality rates based on subjective forecasts are substantially less accurate than predictions based on population life tables. Subjective forecasts also fail to capture fundamental properties of senescence, including increases in yearly mortality rates with age. To shed light on the mechanisms underlying these biases, I develop and estimate a latent-factor model of how individuals form subjective forecasts. The estimates of this model’s parameters imply that these forecasts incorporate several important sources of measurement error that arguably swamp the useful information they convey.     

人口与计划生育目标管理责任制过程评价式考核体系初探

随着人口与计划生育工作综合改革的不断深入,现行人口与计划生育目标管理责任制考核模式的弊端逐渐显现出来,本文综合运用政府绩效管理、业务流程重组、激励与沟通等理论和实证分析方法,对广东省人口与计划生育目标管理责任制考核模式进行探索,从理念构建、流程构建和组织构建等三个层次,构建责任制过程评价式考核的新体系,并提出了具体政策建议.     

A Comparison of Normalized and Non-Normalized Multiplicative Subjective Importance Weighting in Quality of Life Measurement

Social Indicators Research - In quality of life (QOL) studies, importance weighting generally refers to the incorporation of perceived importance as a weighting factor into measures of QOL....     

Quality Assessment of the Oncology Health Service in a Public Hospital

Quality assessment is a crucial issue in the strategic management of the public health sector. The objective of this study is to investigate the patients’ perception of the health system quality and explore the relationships between doctors and long-term cancer patients. The data under study have been collected during a survey conducted with long-term cancer patients who follow an oncological therapy in a Public Hospital. In the study, exploratory factorial analysis is developed and two structural equation models are proposed. The first model describes the service quality as perceived by the patients, which is influenced by four important factors, namely tangible aspects, reliability, empathy (doctor–patient human relations) and hospital organization. The second model describes the relationship between doctors and long-term cancer patients, which is influenced by three factors, that is reliability, empathy and hospital organization. The discussion highlights the contribution that the results of the study may make to the investigation of the possible strategies for improving health care service quality.

     

LGBT Health in the Midlands: A Rural/Urban Comparison of Basic Health Indicators

Research into the health and wellbeing of rural lesbian, gay, bisexual, and transgender (LGBT) populations is limited. A community-based participatory research (CBPR) approach was used to develop an online survey for LGBT Nebraskans. The 770 participants replied to an array of questions on social determinants of health and basic health outcomes. Only significant differences in having health insurance were found between urban and rural participants. Social determinants of health were explored. Results of this study suggest that regional culture may be more salient to health for lesbian, gay, bisexual, and transgender persons living in the Midwest than rural or urban residence.     

Quality of Life in Europe: Objective and Subjective Indicators A Spatial Analysis Using Classification Techniques

Social Indicators Research -     

Subjective Well-being in a Multicultural Urban Population: Structural, and Multivariate Analyses of the Ontario Health Survey Well-being Scale

The validity of a scale, from the OntarioHealth Survey, measuring the subjective senseof well-being, for a large multiculturalpopulation in Metropolitan Toronto, is examinedthrough principal components analysis withoblique rotation. Four factors are extracted. Factor 1, is a stress and strain factor, andconsists of health worries, feeling exhaustedand worn out, and feeling tense. Factor 2,interpreted as a sense of control, consists ofno health worries, and ability to handlefeelings. Factor 3, interpreted as positiveaffect, consists of having an interesting life,feeling cheerful and light-hearted, feelingloved, feeling relaxed and full of vitality. Factor 4 is interpreted as a despondency factorconsists of feeling lonely, having a boringlife, inability to control feelings and feelinglow. The statistic of multiple discriminantanalysis between the variables, sex, age, andethnic groupings, as independent discriminatingvariables and the four factor scores asdependent variables, is calculated. Theresults show that the observed mean variance inthe well-being factor scores cannot beexplained by the respondents being eitherfemale or male, or being a certain age or bybelonging to specific cultural groupings. These results are discussed in relation toother studies on the dimensions of subjectivewell-being.     

The Relevance of Objective and Subjective Social Position for Self-Rated Health: A Combined Approach for the Swedish Context

The study investigates the health effects of subjective class position stratified by objective social position. Four types of subjective class were analysed separately for individuals with manual or non-manual occupational background. The cross-sectional analysis is based on the Swedish Level-of-Living Survey from 2000 and includes 4,139 individuals. The dataset comprises information on perceived class affinity and occupational position that was combined to conduct logistic regression models on self-rated health. An inverse relationship between self-rated health and the eight combinations of objective and subjective social position was found. Lower socio-economic position was associated with poor health. The largest adverse health effects were found for lower subjective social position in combination with lower occupational position. When the covariates education, father’s occupational position and income were added to the model, adverse effects on health remained only for females. Subjective social position helps to explain health inequalities. Substantial gender differences were found. It can be assumed that subjective class position captures a wide range of perceived inequalities and therefore complements the measure of occupational position.     

Subjective Health-Related Quality of Life in Homeless and Vulnerably Housed Individuals and Its Relationship with Self-Reported Physical and Mental Health Status

Although the association between homelessness and objective indicators of poor health is well-established, little research has focused on the subjective health-related quality of life of homeless and vulnerably housed (HVH) individuals. This study examined the subjective health-related quality of life of HVH individuals, using the Multiple Discrepancies Theory (MDT) Scale for Health of the Quality of Life for Homeless and Hard-to-House Individuals (QoLHHI) Inventory, and its association with self-reported functional health status, as measured by the SF-12, and self-reported physical and mental health conditions in a sample of 100 HVH individuals recruited in Vancouver, Toronto and Ottawa. Our findings indicate that physical and mental health conditions are highly prevalent among HVH individuals and that the SF-12 Physical and Mental Component Summary scores are substantially lower compared to US population norms. The MDT Health items were not statistically significantly associated with physical or mental health conditions and only showed correlations of small to moderate magnitude with the SF-12 Component Summary Scales. These findings suggest that the QoLHHI MDT Scale for Health can provide information about HVH individuals’ subjective health experiences that is different from, and can serve as a valuable complement to, health status information for use in research and evaluation studies, as well as for policy purposes to make informed decisions based on subjective health-related quality of life data from HVH individuals.     

How Bullying Involvement is Associated with the Distribution of Parental Background and With Subjective Health Complaints Among Swedish Boys and Girls

This study aimed to analyze how bullying involvement is associated with the distribution of parental background and with subjective health complaints (SHC) among Swedish boys and girls. Data were collected from the World Health Organization, Health Behavior in School-aged Children (WHO/HBSC) survey, measurement years 1997/1998, 2001/2002 and 2005/2006. A total of 11,972 boys (50.6 %) and girls (49.4 %) in grades five, seven and nine participated in the study. The adolescents were categorized in subgroups according to parental background: Swedish (80.1 %), mixed (10.5 %) and foreign (9.7 %). Multivariate logistic regressions were used to estimate remaining risk of SHC in the categories of bullying involvement. The frequencies of bullying involvement once or more were: none involved (74.8 %), victims (10.6 %), bullies (10.3 %) and bully/victims (4.4 %). Six out of ten involved in bullying were boys. Boys of foreign background were more involved as bullies compared to boys of mixed or Swedish background. Girls of foreign background were more involved in all three categories of bullying than girls of mixed or Swedish background. Increased risk of SHC was estimated among all adolescents involved in bullying, with highest OR in the category of bully/victims, OR 3.95 (CI 3.13–4.97) for the boys and OR 4.51 (CI 4.51–6.40) for the girls. The multivariate models were stable even after adjustment for socio-demographics. There are some associations between bullying involvement and parental background. Regardless of parental background, family affluence, family structure and gender, all adolescents involved in bullying are at increased risk of SHC.     

Subjective Quality of Life in Zhuhai City,South China: A Public Survey Using the International Wellbeing Index

The study of subjective quality of life and its connotations in the People’s Republic of China is at a preliminary stage. Although there is an emerging body of literature on this topic, there are few datasets representative of the general public, particularly in Mainland China. This paper reports the findings of a public survey (N = 449) conducted in Zhuhai City, South China using the International Wellbeing Index (IWI). There were four main aims: (1) to judge whether residents were satisfied with their lives; (2) to compare the data with recent findings from Hong Kong and Macau; (3) to investigate the equivalence of the IWI in terms of its psychometric properties; and (4) to determine the applicability of the ‘Theory of Homeostasis Wellbeing’. The data indicated a moderate level of personal (PWI score = 64.4.) and national (NWI score = 57.4) wellbeing, consistent with recent findings from Hong Kong and Macau. The PWI score was within the normative range for non-Western countries, which indicates that the residents were, on the whole, satisfied with their lives. Although previously reported objective measures of quality of life in Zhuhai are lower than in Hong Kong and Macau, this is not reflected in this study’s subjective measures. This finding was interpreted in terms of the ‘Theory of Subjective Wellbeing Homeostasis’, and the specific situation in Zhuhai, as there seems to be an absence of factors (i.e., no harsh economic or social situation) which could drive subjective wellbeing below normal. Last, that the IWI demonstrated good psychometric performance in terms of its reliability, validity, and sensitivity, and concurred with previous published reports, it seems that the scale’s robustness generalises to Chinese samples.     

Subjective Happiness of Lebanese College Youth in Lebanon: Factorial Structure and Invariance of the Arabic Subjective Happiness Scale

The present study evaluated the subjective happiness of Lebanese college youth using a multi-item rather than a single-item subjective happiness measure. An Arabic translation of the Subjective Happiness Scale (SHS) was administered to 273 Lebanese college youth from state- and private-run higher institutions of learning, as was the Arabic Adult Parental Acceptance-Rejection Questionnaire (Arabic PARQ). The reliability and validity of the Arabic SHS was tested in terms of factor analysis, internal consistency, and correlation with Arabic PARQ scores, as was the factorial invariance and relation of the scale across age, sex, marital status, birth order, and college campus. The Arabic SHS showed a reliable unitary structure similar to those found in other cultures, and factorial invariance across sex, marital status, birth order and college campus. While age, sex, marital status and birth order were independent of happiness scores, college students attending the private university reported greater happiness than those from the state-run academic setting. It was concluded that the Lebanese Arabic SHS is a reliable and valid measure of global subjective happiness, its factor structure is similar across other translated versions of the scale, and its scores are independent of age, sex, marital status and birth order.     

Subjective Well-Being and Life Satisfaction in the Kingdom of Tonga

This paper describes an initial attempt to assess the subjective well being of a sample of 227 Tongans via self-report. Using items adapted from the Subjective Well Being Inventory (SUBI; Nagpal and Sell, 1985; Sell and Nagpal, 1992), participants rated their level of overall life satisfaction along with their perceptions of well-beingin a number of other more specific life domains. Results indicated that mean ratings of global life satisfaction were generally positive. A factor analysis of the remaining domain-specific well-being items indicated that items loaded on to one of two factors dealing with overall positive or negative evaluations of these life areas. Importantly, these scale items stressed the importance of social and kin relations in contributing to overall well-being. In terms of demographic variables, mature respondents reported greater levels of overall life satisfaction and well-being as compared to youthful respondents. Implications and directions for future research are discussed.