The Impact of Postoperative Complications on Short- and Long-Term Health-Related Quality of Life After Total Mesorectal Excision for Rectal Cancer

BackgroundSurvival for rectal cancer patients has improved over the past decades. In parallel, long-term health-related quality of life (HRQoL) is gaining interest. This study focuses on the effect of complications following rectal cancer surgery on HRQoL and survival.MethodsThe TME-trial (1996-1999) randomized patients with operable rectal cancer between surgery with preoperative short-course radiotherapy and surgery. Questionnaires including the Rotterdam Symptom Checklist were sent at 6 time points within the first 24 months and after 14 years the EORTC QLQ-C30 and EORTC QLQ-CR29 questionnaires. Differences in HRQoL and survival between patients with and without complications were analyzed.ResultsA total of 1207 patients were included, of which 482 (39.9%) patients experienced complications, surgical complications occurred in 177 (14.6%) patients, non-surgical complications in 197 (16.3%) and 108 patients (8.9%) had a combination of both types of complications. Three months after surgery, patients with a combination of surgical- and non-surgical complications, especially patients with anastomotic leakage, had the worst HRQoL. Twelve months postoperative HRQoL returned to a similar level as before surgery, regardless of complications. In patients who survived 14 years, no significant differences in HRQoL were seen between patients with and without complications. However, patients with complications did have lower overall survival.ConclusionThis study shows that survival and short-term HRQoL are negatively affected by complications. Twelve months after surgery HRQoL had returned to the preoperative level regardless, of complications. Also, in patients that survived 14 years, there was no effect of complications on HRQoL detected.     

全面两孩政策下已育育龄妇女生育意愿的影响因素及其对策研究

目的：在全面两孩政策下，通过抽样调查上海市户籍已育育龄妇女二孩生育意愿，并分析其影响因素，为生育政策的实施及相关配套的完善提供参考。方法：采用目的抽样的方法，对上海市2个区4个街道的920名夫妻一方为上海市户籍家庭中15~49岁已育一孩妇女进行问卷调查，采用卡方检验、多因素Logistic回归模型进行二孩生育意愿影响因素分析。结果：回收有效问卷904份，其中有二孩生育意愿者20.7%，无意愿者57.7%，不确定者21.6%。回归分析结果显示，育龄妇女年龄、家庭年收入、夫妇类型、生育偏好和区域差异是妇女二孩生育意愿的重要影响因素。结论：全面两孩政策的实施对已生育一孩妇女的二孩生育意愿影响有限，意愿生育子女数明显低于政策允许生育子女数，除生育政策外，还有很多因素制约着人们的二孩生育意愿。全面两孩政策之后，延长产假、哺乳假和提供经济支持是最受期待的育儿支持政策。     

Brazilian versions of the Measure of Processes of Care-20 and Measure of Processes of Care-Service Providers: translation,cross-cultural adaptation and reliability

BackgroundThe Measure of Processes of Care (MPOC) questionnaires evaluate Family-Centered Practice (FCP) in services for children with developmental disorders. The MPOC-20 and MPOC-SP are completed by parents and by rehabilitation professionals, respectively, and are widely used in several countries.ObjectivesTo translate and cross-culturally adapt the MPOC-20 and MPOC-SP to Brazilian Portuguese and evaluate their reliability and internal consistency.Methodsthis study included translation, back-translation, cognitive interviews, testing of the pre-final versions, analysis of reliability and of internal consistency of the final versions. Respondents included parents and rehabilitation professionals from rehabilitation centers in four capital cities in Brazil.ResultsTranslation and cultural-adaptation procedures ensured the Brazilian versions were understandable and semantically equivalent to the original MPOC-20 and MPOC-SP. Pre-final and final versions were analyzed and vetted by the original authors. The MPOC-20 internal consistency Cronbach's alpha varied between 0.61 and 0.91 (n = 107), the test-retest reliability ICC varied between 0.44 and 0.83 and the standard error of measurement varied between 0.66 and 0.85 (n = 50). The MPOC-SP internal consistency Cronbach's alpha varied between 0.52 and 0.83 (n = 92), the test-retest reliability ICC between 0.83 and 0.90, and the standard error of measure between 0.34 and 0.46 (n = 62).ConclusionThe Brazilian versions of the MPOC-20 and the MPOC-SP are in general stable and sufficiently reliable. They are relevant to the evaluation of FCP and provide information that can improve health services and ensure better care.     

How common is repeat surgery and multi-level treatment in Degenerative Cervical Myelopathy? Findings from a patient perspective survey

Degenerative Cervical Myelopathy (DCM) is a common condition which causes significant disability and reduces health-related quality of life. The only evidence-based treatment and current management guidance is surgery to decompress the spinal cord and stop further damage in moderate to severe cases. However, this guidance is mainly informed by studies that only include first time surgery and/or single level disease, but DCM can reoccur after primary surgery and affect multiple levels of the spine. It is unclear whether patients in these subgroups; repeat surgery and multi-level DCM, differ significantly in their baseline and disease characteristics from those with single-level, single-operation disease. To investigate this, we conducted an online survey of people with DCM looking at key demographic, disease (e.g. mJOA) and treatment characteristics. We received a total of 778 respondents, of which 159 (20%) had undergone surgery for DCM. Around 75% of these respondents had a single operation and 65% at a single level. We found no statistically significant difference in key participant and disease characteristics between respondents with single-level or single-operation and those with multi-level DCM or multiple operations. These data support generalisability of research to these subgroups but also warrants further investigations as these subgroups are underrepresented in current research.     

Adaptación y validacion al español de un cuestionario específico de calidad de vida en pacientes con traqueostomía (TQOL)

Background and objectiveA long-term tracheostomy can have significant negative effects on quality of life because it causes physical, functional, sensory, psychological, social, economic, and work impairments to the life of the individual. The objective of this study was to validate in Spanish a quality-of-life questionnaire for these patients.Materials and methodsA psychometric validation study of a questionnaire in 45 patients over 18 years of age, with tracheostomy for six months, who understand Spanish and have a good understanding of the questions of the SF-36 questionnaire and a specific quality of life questionnaire for the patient with tracheostomy (TQOL-versión española). This questionnaire is a modification and cultural adaptation into Spanish of the original English instrument named Tracheostomy Specific Quality of Life Questionnaire (TQOL). The 2 questionnaires (TQOL-versión española) and the SF-36 were completed 6 months after the tracheostomy and between 30 and 50 days after the first administration. The reliability, repeatability, and construct validity of the TQOL-versión española were evaluated. The construct validity was assessed by the correlation between the results of the TQOL-versión española and the dimensions of the SF-36 questionnaire.ResultsThe reliability of the TQOL-versión española measured by Cronbach's alpha coefficient was .814, with variation between items from .783 to .817 in the sample at 6 months and from .794 in the validation sample, with variation between items from .758 to .813. There was intraclass correlation for the total score of the scale using the concordance analysis of Bland-Altman and agreement for the individual questions with the McNemar symmetry test. There was also a good correlation between the scales of the TQOL-versión española and the dimensions of the S-F36.ConclusionsThe TQOL-versión española showed good reliability, repeatability, and construct validity, therefore it is a useful tool to assess the impact on individual patients with a tracheostomy in place for more than 6 months, and to establish strategies at the healthcare and social levels to improve the quality of daily life.     

Translation and cross-cultural adaptation of the Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ)

ObjectiveTo translate and cross-culturally adapt the Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ) for use in Brazilian Portuguese. The CBBDQ is an 18-item tool covering 10 bladder and 8 bowel symptoms that was developed for use with children of 5 to 12 years of age with bowel and bladder dysfunction (BBD). The instrument has already been validated for use in Dutch and English.MethodIn the process of translation and cultural adaptation from English to Portuguese, the CBBDQ was submitted to undergo the required steps as established by the international methodological criteria: forward translation, synthesis, back-translation, expert panel review and pre-testing.ResultsNinety-three parents of children with lower urinary tract dysfunction answered the questionnaire. The mean age of the children was 7.6 ± 2.1 years and 54 were female. Internal consistency was excellent, with a Cronbach’s alpha of 0.91 to 0.96. Additionally, reliability was high, with an intraclass correlation coefficient of 0.94 (95%CI: 0.85-0.93; p < 0.0001).ConclusionThe translation and cultural adaptation of the CBBDQ enabled a quantitative evaluation of bladder and bowel symptoms to be performed in Brazilian children. The scores achieved allow the severity of BBD to be evaluated, as well as the patient’s progress during treatment. The use of this questionnaire in clinical practice and research will allow more consistent data on BBD to be obtained.     

Construction and validation of a questionnaire on the knowledge of healthy habits and risk factors for cardiovascular disease in schoolchildren

ObjectivesTo develop and analyze the reliability and validity of a questionnaire on the knowledge of healthy habits and risk factors for cardiovascular disease (CARDIOKID) to be used in schoolchildren.MethodsThe study included 145 children aged 7 to 11 years. The measured factors were the knowledge of healthy habits and risk factors for cardiovascular disease. Cronbach's alpha and intra-class correlation coefficient (ICC) were used to verify reliability, and exploratory factor analysis was used to assess the validity of the questionnaire.ResultsThe sample consisted of 60% females and 40% males. In factorial analysis, the Kaiser-Meyer-Olkin (KMO) test result was measures of sampling adequacy (MSA) = 0.81 and Bartlett's test of sphericity was X² = (66) = 458.64 (p < 0.001). In the factorial analysis with varimax rotation, two dimensions were defined. The “healthy habits” dimension was composed of five factors (ICC = 0.87 and α = 0.93) and the “cardiovascular risk factors” dimension was composed of seven factors (ICC = 0.83 and α = 0.91). In the individual factor analysis, Cronbach's alphas were between 0.93 and 0.91. Total variance was 46.87%. There were no significant differences between test and retest applications.ConclusionThe questionnaire presented satisfactory validity and reliability (internal consistency and reproducibility), allowing for its use in children.     

中国北京和日本横滨两地青少年正畸治疗认知程度的调查分析

通过调查中国北京地区和日本横滨地区青少年对错(牙合)畸形的认知情况,探讨不同地区青少年对正畸治疗的理解和认识差异.方法对中国北京地区5500名青少年和日本横滨地区4646名青少年进行关于错(牙合)畸形认知情况的问卷调查,并进行χ<'2>检验.结果北京地区回收问卷3964份(72.1%),横滨地区回收问卷3291份(70.8%).北京地区已行正畸治疗的青少年为753例(19.0%),横滨地区为467例(14.2%),差异有统计学意义(P<0.001).79.2%已行正畸治疗的横滨青少年认为做正畸治疗好,比北京(66.0%)高.不同年龄段横滨青少年对正畸治疗需较长时间的了解程度均高于同年龄段北京青少年.与北京青少年(494名,65.7%)相比,更高比例的横滨青少年(370名,78.6%)认为(牙合)畸形会对面部健康带来不利影响.结论横滨地区行正畸治疗的青少年比例比北京地区小,但更多的横滨青少年认为做正畸治疗好,高于北京青少年.横滨青少年对正畸治疗的认知程度高于北京,且横滨青少年更注重错牙(牙合)畸形对面部健康的影响.     

中国口腔颌面外科学科发展调查分析

目的 全面了解中国口腔颌面外科学科发展的现状、发现存在的问题、提出口腔颌面外科可持续发展的策略.方法 设计"口腔颌面外科学科发展问卷调查表",对地市级以上综合医院的口腔科、口腔专科医院、口腔医学院校的口腔颌面外科规模、人力资源、业务范围、医疗工作量、人才培养等项目进行问卷调查,并与5、10年前的状况进行比较.结果 多数医疗机构口腔颌面外科医师人数、病床数、门诊人次增加,业务范围扩大,医疗水平提高.部分基层医疗机构相应医疗指标有下降,超过1/3的医疗机构口腔颌面外科研究生和进修生生源下降.结论 口腔颌面外科在持续发展,但存在基层医疗机构口腔颌面外科力量有所削弱等问题,应采取相应的策略增强学科的竞争力.     

Duke Activity Status Index for Cardiovascular Diseases: Validation of the Portuguese Translation

Background

The Duke Activity Status Index (DASI) assesses the functional capacity of patients with cardiovascular disease (CVD), but there is no Portuguese version validated for CVD.

Objectives

To translate and adapt cross-culturally the DASI for the Portuguese-Brazil language, and to verify its psychometric properties in the assessment of functional capacity of patients with CVD.

Methods

The DASI was translated into Portuguese, then checked by back-translation into English and evaluated by an expert committee. The pre-test version was first evaluated in 30 subjects. The psychometric properties and correlation with exercise testing was performed in a second group of 67 subjects. An exploratory factor analyses was performed in all 97 subjects to verify the construct validity of the DASI.

Results

The intraclass correlation coefficient for test-retest reliability was 0.87 and for the inter-rater reliability was 0.84. Cronbach''s α for internal consistency was 0.93. The concurrent validity was verified by significant positive correlations of DASI scores with the VO₂max (r = 0.51, p < 0.001). The factor analysis yielded two factors, which explained 54% of the total variance, with factor 1 accounting for 40% of the variance. Application of the DASI required between one and three and a half minutes per patient.

Conclusions

The Brazilian version of the DASI appears to be a valid, reliable, fast and easy to administer tool to assess functional capacity among patients with CVD.