Disease-specific health-related quality of life questionnaires for heart failure: a systematic review with meta-analyses

Background  Heart failure (HF) is an increasingly common condition affecting patients’ health-related quality of life (HRQL). However, there is little literature comparing HF-specific instruments. Our aim was to evaluate and compare data on the conceptual model and metric properties (reliability, validity and responsiveness) of HF-specific HRQL instruments, by performing a systematic review with meta-analyses. Methods and results  Of 2,541 articles initially identified, 421 were full-text reviewed. Ninety-four reported data on five questionnaires: Minnesota Living with Heart Failure Questionnaire (MLHFQ), Chronic Heart Failure Questionnaire (CHFQ), Quality of Life Questionnaire for Severe Heart Failure (QLQ-SHF), Kansas City Cardiomyopathy Questionnaire (KCCQ) and Left Ventricular Dysfunction (LVD-36) questionnaire. Metric properties (reliability, validity and responsiveness) were summarised using meta-analysis for pools above five estimates. Cronbach’s alpha coefficients were generally high (0.83–0.95) for overall scores and scales measuring physical health. Associations with four validity criteria (New York Heart Association [NYHA] class, six-minute walk test [6MWT] and short form-36 [SF-36] ‘Physical’ and ‘Social Functioning’) were moderate to strong (0.41–0.84), except for those between two CHFQ domains (fatigue and dyspnoea) and the NYHA (0.19 and 0.22). Pooled estimates of change from eight meta-analyses showed the MLHFQ to be highly responsive, with changes in overall score ranging from −9.6 (95% confidence interval [CI]: −4.1; −15.2) for placebo to −17.7 (95% CI: −15.3; −20.2) for pacing devices. The CHFQ and KCCQ also showed good sensitivity to change. Conclusions  Most of the questionnaires studied met minimum psychometric criteria, though current evidence would primarily support the use of the MLHFQ, followed by the KCCQ and CHFQ. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

The Validity and Reliability of the Functional Impairment Checklist (FIC) in the Evaluation of Functional Consequences of Severe Acute Respiratory Distress Syndrome (SARS)

Severe acute respiratory distress syndrome (SARS) contributed to significant mortality and morbidity worldwide. We aimed to establish the validity, reliability and responsiveness of the functional impairment checklist (FIC) as a measurement tool for physical dysfunction in SARS survivors. One hundred and sixteeen (65 females and 51 males, mean age 45.6) patients who joined the SARS rehabilitation programme were analysed. The factor analysis yielded two latent factors. The mean FIC-symptom and FIC-disability score were 24.12 (SD ± 20.2) and 26.11 (SD ± 27.32), respectively. Based on the item-scale correlation coefficients, the Cronbach’s alpha coefficients reflecting the internal consistency reliability of scale score were 0.75 for FIC-symptom and 0.86 for FIC-disability. Test–retest reliability in 23 patients showed no statistical significant difference in the FIC scores between tests with intraclass correlation coefficient (ICC) 0.49–0.57. The FIC scales correlated both with 6 munute walking test (6MWT) distance (−0.26 and −0.38) and handgrip strength (HGS) (−0.20 and −0.27). Moreover, the FIC scales correlated with St. George’s respiratory questionnaire (SGRQ) (0.19 to 0.52) and short form 36 Hong Kong (SF-36) domains (−0.19 to −0.59). Both FIC scales correlated stronger with physical component summary (PCS) (−0.41 and −0.55) than with mental component summary (MCS) (−0.30 and −0.23). FIC reduced significantly at 6 months while the SF-36 PCS and MCS did not show any change. In conclusion, the study results indicate the FIC is reliable, valid and responsive to change in symptom and disability as a consequence of SARS, suggesting it may provide a means of assessing health related quality of life (HRQOL) outcomes in a longitudinal follow up.     

Validity,reliability, and responsiveness of the Kansas City Cardiomyopathy Questionnaire in anemic heart failure patients

Background While generic health status measures quantify the impact of all patients’ diseases on their health-related quality of life, disease specific measures focus on only one of the many conditions that a patient may have. If a patient has two diseases with similar clinical manifestations, they may respond differently to a disease-specific instrument if one of their conditions improves while the other worsens or remains stable, thus undermining the instruments in that patient population. We sought empirical evidence of the reliability and validity (including responsiveness) of the Kansas City Cardiomyopathy Questionnaire (KCCQ), a disease-specific measure for heart failure (HF), among HF patients with and without anemia, a condition that has similar symptoms to HF. Methods This work used a prospective cohort study of 811 HF outpatients from 58 U.S. centers with a baseline assessment of anemia of whom 698 were followed for 3 months with serial health status measures. Results Among participants, 268 (33%) were anemic. The construct validity of the KCCQ was supported by showing similar correlations with the New York Heart Association (NYHA) classification in patients with and without anemia (P value for interaction = 0.38). The internal consistency (Cronbach’s alpha = 0.92 and 0.93 for anemic and non-anemic patients, respectively) and test–retest reliability (mean 3-month change scores in stable patients = −2.8 [SD = 1.4] and −0.5 [SD = 0.8], P = 0.14) were similar. Estimates of responsiveness were also similar. Conclusion This study provides empirical evidence that the psychometric properties of the KCCQ are similar in patients with or without anemia, a potentially confounding clinical condition in patients with heart failure.     

Psychometric evaluation of a Chinese (Taiwanese) version of the SF-36 health survey amongst middle-aged women from a rural community

To test the psychometric properties of the Chinese (Taiwanese) version of the short form 36 health survey (SF-36), 1439 women, aged 40–54 years and living in Kinmen (a Taiwanese island reflecting a predominantly rural community) were recruited to participate in this survey. The rate of unavailable data points for the 36 tested items remained consistently low, and item-discriminate validity was high (95%) for all subscales. Cronbach's α coefficient remained above the 0.70 threshold criterion for all scales except for social functioning and bodily pain. Principal components analysis supported the two major dimensions of health, physical and mental, in the internal structure of the SF-36 scales, although the dimensions did not match the hypothesized association very well. Poorer health profiles were associated with physical and mental conditions. The mental health subscores in the SF-36 test correlated highly with the associated hospital anxiety and depression score (Spearman rank correlation coefficient = −0.62). In conclusion, the reliability and validity tests performed on the data collected support the cross-cultural application of the Chinese (Taiwanese) version of the SF-36 test. This revised version was published online in June 2006 with corrections to the Cover Date.     

A Study of the Construct Validity of the Health Utilities Index Mark 3 (HUI3) in Patients with Schizophrenia

This study assessed the construct validity of the Health Utilities Index Mark 3 (HUI3) in patients with schizophrenia. Patients with schizophrenia recruited from a tertiary mental hospital in Singapore completed the HUI3, the Short-Form 36 Health Survey (SF-36) and the Schizophrenia Quality of Life Scale (SQLS). Patients were assessed for presence and absence of 22 common psychiatric symptoms. Construct validity was assessed using 6 a priori hypotheses. Two hundred and two patients (mean age: 37.8 years, female: 52%) completed the survey. As hypothesized, overall HUI3 utility scores were correlated with SF-36 measures (Spearman’s rho: 0.19 to 0.51), SQLS scales (Spearman’s rho: −0.56 to −0.36), and the number of psychiatric symptoms (Spearman’s rho: −0.49). The HUI3 emotion attribute was moderately correlated with SF-36 mental health (Spearman’s rho: 0.45) and SQLS psychosocial scales (Spearman’s rho: −0.43), and HUI3 pain attribute was strongly correlated with SF-36 bodily pain scale (Spearman’s rho: 0.58). The mean HUI3 overall, emotion, cognition, and speech scores for patients with schizophrenia were 0.07, 0.09, 0.04 and 0.04 points lower than respective age-, sex- and ethnicity-adjusted population norms (p<0.001 for all, ANCOVA). This study provides evidence for the construct validity of the HUI3 in patients with schizophrenia.     

Italian translation of the Manchester-Oxford Foot Questionnaire, with re-assessment of reliability and validity

Purpose  To cross-culturally adapt and validate the Italian version of the Manchester-Oxford Foot Questionnaire (MOXFQ) in patients affected by hallux valgus. Methods  The MOXFQ was translated into Italian and culturally adapted following the forward and backward translation method. A sample of 172 patients with hallux valgus was asked to fill in the MOXFQ and the Short-Form 36 Health Survey (SF-36). Two-week retest was performed on a random sub-sample of 40 patients. Internal consistency and test–retest reliability were assessed using Cronbach’s alpha and intraclass correlation coefficient (ICC), respectively. Construct validity was assessed with the use of Spearman’s rank correlation coefficient, using a priori hypothesized correlations with SF-36 domains. Results  The internal consistency reliability was acceptable for all MOXFQ domains (Pain, Walking/standing and Social interaction) with Cronbachs’ alpha coefficients ranging from 0.72 to 0.83. The assessment of test–retest reliability reveals satisfactory values with ICCs ranging from 0.85 to 0.92. Construct validity was supported by the presence of all the hypothesized correlation, with the exception of Italian Walking/standing domain with the SF-36 Role-Physical domain (ρ = −0.29). Conclusions  The Italian version of MOXFQ is a valid and reliable instrument for evaluating foot pain and functional status in patients affected by hallux valgus.     

A Patient-Reported Outcomes Measurement Information System Short Form for Measuring Physical Function During Geriatric Rehabilitation: Test-Retest Reliability,Construct Validity,Responsiveness, and Interpretability

ObjectivesTo study the test-retest reliability and measurement error, construct validity, responsiveness, interpretability, and floor/ceiling effects of a Patient-Reported Outcomes Measurement Information System (PROMIS) short form designed to measure physical function in geriatric rehabilitation patients (PROMIS-PF-GR).DesignProspective cohort.Setting and ParticipantsInpatient geriatric rehabilitation patients.MethodsWe evaluated the test-retest reliability by re-administering PROMIS-PF-GR 3 to 5 days after the admission measurement. The intraclass correlation coefficient (ICC) was calculated to determine test-retest reliability; an ICC of ≥0.70 was considered sufficient. Measurement error was established by calculating the standard error of measurement and smallest detectable change. Construct validity and responsiveness were determined by testing a priori formulated hypotheses (criterion: ≥75% hypothesis not rejected). Interpretability was evaluated by calculating the minimal important change using predictive modeling and a global rating as criterion for change. Floor/ceiling effects were established by calculating the percentage patients with the minimum/maximum raw score (criterion: ≤15%) at admission and discharge.ResultsA total of 207 patients participated in the study [mean ± standard deviation age (80 ± 8.3 years), 58% female]. More than one-half of patients (56%) reported to be improved during rehabilitation. The ICC was 0.79 (95% confidence interval 0.70–0.84), the standardized error of measurement was 3.8, and the smallest detectable change 10.6. None of the 4 hypotheses for construct validity were rejected; 2 out of 5 hypotheses for responsiveness were rejected. The minimal important change was 8.0 (95% confidence interval 4.1–12.5). No floor/ceiling effects were found.Conclusions and ImplicationsThe PROMIS-PG-GR showed sufficient test-retest reliability, measurement error, and construct validity. We did not find sufficient evidence for responsiveness, which may be due to the unexplained weak correlation between the PROMIS change score and the Global Rating Scale. We still recommend the use the PROMIS-PG-GR for measuring self-reported physical function in geriatric rehabilitation.     

Psychometric validation of the S-QoL Chinese (Taiwan) version for patients with schizophrenia

We translated the S-QoL into the Chinese (Taiwan) language and evaluated the score distributions of the translated S-QoL in terms of ceiling/floor effect, internal consistency, test–retest reliability, and convergent and discriminant validity. To ensure conceptual and semantic equivalence of the S-QoL, the researchers performed both forward translation and back translation, consulted professionals, and completed a pilot trial on college students. Forty-one patients with schizophrenia were recruited. No significant ceiling/floor effects (<20%) were found in subscales of the translated S-QoL. The internal consistency reliabilities were acceptable to good for the whole scale and 7 of the subscales (Cronbach’s alpha = 0.71–0.93), but not for the sentimental life subscale (Cronbach’s alpha = 0.44). The test–retest reliabilities were moderate to high (ICC = 0.64–87, P < 0.001 to <0.0001). The convergent validities were supported by satisfactory correlations among subscales measuring related constructs of the translated S-QoL and those of the SQLS-R4, WHOQoL-BREF, and RESE (r = 0.36–0.82, P < 0.05 to <0.01). Discriminant validity was demonstrated between groups with different numbers of episodes and hospitalization. The S-QoL Chinese (Taiwan) version was found to have good psychometrics and is suggested as a feasible choice of disease-specific measure for capturing HRQoL in patients with schizophrenia.     

Development of Food Literacy Assessment Tool Targeting Adults With Low Income

ObjectiveDevelop and test validity and reliability of the Food Literacy Assessment Tool (FLitT) in adults with low income.DesignFace validity was tested using cognitive interviews, content validity using expert review, and internal consistency reliability and test-retest reliability based on 2 administrations of the survey.SettingUrban choice food pantry in Cincinnati, OH.ParticipantsThere were 10 and 98 adults with low income for the cognitive interview and survey, respectivelyVariables MeasuredKnowledge, self-efficacy, and behavior required to plan and manage, select, prepare, and eat in relation to food.AnalysisCronbach α and Kuder-Richardson Formula 20 for internal consistency reliability and intraclass correlation coefficient (ICC) for test-retest reliability.ResultsCognitive interviews and expert feedback suggested modifications to improve the clarity of FLitT and offer more response options. Testing shows acceptable internal consistency in self-efficacy (Cronbach α = 0.92) and behavior (Cronbach α = 0.90) but not in knowledge (Kuder-Richardson Formula 20 = 0.51). The FLitT shows acceptable test-retest reliability for knowledge (ICC = 0.84), self-efficacy (ICC = 0.70), and behavior (ICC = 0.93).Conclusions and ImplicationsThe FLitT was developed and tested for face and content validity and internal and test-retest reliability in adults with low income. Additional research is needed to conduct a second round of face validity and test construct validity using factor analysis with a larger size.     

Cultural adaptation and application of the IBS–QOL in China: a disease-specific quality-of-life questionnaire

Background Irritable bowel syndrome (IBS) is a chronic and episodic illness characterized by altered bowel habits and associated abdominal pain. At present, IBS is one of the most common functional gastrointestinal and motility disorders affecting countries around the world. Surveys have found that patients with IBS have a significantly lower health-related quality of life. Objectives The aim of this study was to translate and examine the validity of the Irritable Bowel Syndrome–Quality of Life questionnaire (IBS–QOL) in patients suffering from IBS in China. Methods A structured procedure was used for the translation and cultural adaptation of the original English IBS–QOL into Chinese. The questionnaire was administered to 73 clinical patients with IBS and␣70 healthy individuals. Psychometric testing for reliability, validity and responsiveness followed standardized procedures. Test–retest reliability (10–20 hours) was assessed using the clinical patients. Follow-up (4 weeks) was collected for 61 clinical patients. All enrolled patients also completed the Short Form-36 Health Survey (SF-36) at the baseline visit. Responsiveness to treatment (Venlafaxine and traditional Chinese herbal medicine) was assessed by one-way ANOVA methods. Results The average length of time required to complete the questionnaire was short (5.63 min for IBS patients and 5.54 min for healthy subjects by self-administration). Internal consistency (Cronbach’s alpha) values ranged from 0.722 to 0.914 for the Chinese IBS–QOL subscales and test–retest reliability coefficients were higher than 0.920 on all subscales. The convergent and discriminate validity results comparing the Chinese translation of the IBS–QOL overall score and the SF-36 subscales confirmed our predicted hypotheses. The Chinese IBS–QOL scores are more highly correlated with social functioning, vitality and general health (SF-36) and show weaker associations with physical functioning, role physical, mental health, and bodily pain (SF-36). The Chinese translation of the IBS–QOL was responsive to treatment. Conclusion In general, the Chinese translation of the IBS–QOL, after cultural adaptation and revision, possesses good reliability, validity and responsiveness. It is a reliable and valid instrument to assess the quality of life in Chinese patients suffering from IBS and is an appropriate measure to use in further clinical trials or for related research projects in China.     

Psychometric evaluation of the Schizophrenia Quality of Life Scale (SQLS) in English- and Chinese-speaking Asians in Singapore

Objective To assess the psychometric properties of the Schizophrenia Quality of Life Scale (SQLS) in Asians with schizophrenia in Singapore. Methods A consecutive sample of outpatients with schizophrenia completed the English or Chinese version of the SQLS and the Short-Form 36 Health Survey (SF-36) twice during two different clinic visits. The patients were also assessed for presence or absence of 22 psychiatric symptoms. Results About 202 patients (English-speaking: 140) participated in the study. Correlations between SQLS scales and other measures assessing similar constructs ranged from 0.46 to 0.69 (P < 0.001 for all). For SQLS psychosocial and symptoms/side effects scales, item-to-scale correlations were >0.4, Cronbach’s alpha and intra-class correlation coefficient values were close to or exceed 0.7, and Cohen’s effect size, standardized response mean, and Guyatt’s responsiveness index values approximated or exceeded 0.2 for both SQLS language versions; however, for the energy/motivation scale, item-to-scale correlations (range: 0.08–0.51), reliability (range: 0.46–0.66) and responsiveness (range: 0.04–0.08) statistics were not satisfactory for both SQLS versions. Conclusions The SQLS psychosocial and symptoms/side effects scales are valid, reliable and responsive in Singaporean patients with schizophrenia; the appropriateness of energy/motivation scale requires further investigation.     

糖尿病患者生命质量量表研制及评价

目的对慢性病患者生命质量量表系列-糖尿病量表(QLICD-DM)测试版进行评价。方法收集2型糖尿病住院患者159例,采用自主研制的QLICD-DM测试版,于患者入院时、入院第2天和出院时进行量表测评,对量表的信度、效度、反应度进行评价。结果量表各维度的内部一致性α系数和分半系数均在0.7以上,重测信度相关系数均高于0.9;量表各条目与所属维度或维度的相关均大于该条目与其他维度或维度的相关;探索性因子分析结果显示,第1主成分主要涵盖心理状况各条目,方差贡献率达到33.919%;其次为第2主成分的糖尿病并发症条目,方差贡献率为12.006%;治疗前后患者的躯体功能、心理功能、社会功能、特异模块评分及量表总评分差异均有统计学意义(P<0.01),标准反应均数(SRM)分别为0.691、0.638、0.428、1.148、1.223。结论所研制的慢性病患者糖尿病生命质量量表具有较好信度、效度和反应度,可作为国内糖尿病患者生命质量测评工具。     

An 18-item standardized Asthma Quality of Life Questionnaire-AQLQ(S)

The purpose of the present study was to examine the validity and reliability of the Asthma Quality of Life Questionnaire-AQLQ(S) in a sample of 160 Greek patients with asthma. Following evidence for sample-specific validity, the AQLQ(S) model was examined through exploratory and confirmatory factor analysis. An 18-item AQLQ(S) with the four factors of symptoms, activity limitations, sleep, and exposure in environmental stimuli fits the data (χ²/df ratio = 2.26, NNFI = 0.92, CFI = 0.94, SRMR = 0.05). The 18-item AQLQ(S) showed a high internal consistency (Cronbach’ a coefficient ranged from 0.83 to 0.96) and high 9-week test-retest reliability (overall r = 0.88, ICC = 0.94). Responsiveness was confirmed throughout 2X2 ANOVA and 2X2 MANOVA, with respect to the total score (F = 42.30, P < 0.05), and the four AQLQ(S) factors (Wilks’ λ = 0.68, F = 17.59, P < 0.05). The cross-sectional correlations between the 18-item AQLQ(S) and the: (1) FEV1% predicted and (2) Borg scale were low and moderately high, respectively. In conclusion, the 18-item AQLQ(S) derived from exploratory and confirmatory factor analysis appeared to have sufficient construct validity, cross-sectional validity, responsiveness, satisfactory test-retest reliability and internal consistency evidence for the Greek sample of adults with asthma.     

Validity and Reliability of a Food Skills Questionnaire

ObjectiveDevelop, validate, and assess reliability of a food skills questionnaire.DesignPhase 1: Questionnaire development categorized questions into domains (Food Selection and Planning, Food Preparation, and Food Safety and Storage). Phase 2: Content validity included expert panel quantitative and qualitative feedback. Phase 3: Face validity involved pilot testing. Phase 4: Reliability assessed test-retest and inter-item reliability.SettingPhase 1: The authors developed a draft questionnaire in London, Ontario, Canada.ParticipantsPhase 2: Dietitians, home economists, academics, and chefs completed content validity (n = 17; 57% response rate). Phase 3: A convenience sample of students completed face validity (n = 20; 17% response rate). Phase 4: Randomly selected students completed test-retest reliability (time 1: n = 189, time 2: n = 165; 9% response rate).Main Outcome MeasuresLawshe content validity ratio, Lawshe content validity index, intraclass correlation coefficients (ICCs), and Cronbach α.AnalysisTest-retest reliability was evaluated using ICC, and inter-item reliability by Cronbach α coefficient.ResultsIn phase 2, Lawshe content validity index was 0.80 (90% expert panel consensus). In phase 3, 85% of respondents identified the main construct. In phase 4, Cronbach α coefficients were .67–.88 for domains and .90 for the questionnaire overall, and ICC scores ranged from 0.67–0.92 for questions, 0.86–0.93 for domains, and 0.92 for the questionnaire overall.Conclusions and ImplicationsThis questionnaire demonstrated strong content validity, face validity, test-retest reliability, and good inter-item reliability. It is appropriate for evaluating food skills in a population with basic to intermediate skills (eg, young adults).     

Measuring quality of life in early HIV disease: the modular approach

Rationale: to examine the reliability and validity of the General Health Self-assessment, a modular questionnaire for self-assessment of quality of life (QoL) in human immunodeficiency virus (HIV) clinical trials and to describe the baseline QoL of participants in a large HIV clinical trial. Design: the domains assessed include health perceptions, physical, psychological and role/social functioning, health care utilization and symptom distress. Method: 1,694 subjects with early HIV infection enrolled in the AIDS Clinical Trials Group Protocol 175 completed the scale at baseline. Results: the domains demonstrated reliability, construct and discriminant validity. A worse QoL was associated with recent hospitalization and symptomatic status. Prior antiretroviral therapy was associated with higher health perceptions and well-being. The presence of symptom distress was related to lower QoL on the other scales. There was no relationship between QoL scales and the baseline CD4 count. Women showed a lower QoL than men on all scales, while ethnicity was related to differences in health perceptions and physical and psychological functioning. Conclusions: the General Health Self-assessment shows excellent potential as a measure of QoL for HIV-infected patients in clinical trials. Further research is necessary to determine the responsiveness of the scale to clinical and immunological changes in HIV-infected individuals.     

The adaptation into Spanish of the Coddington Life Events Scales (CLES)

Aims To obtain a conceptually and psychometrically equivalent Spanish version of the Coddington Life Events Scales (CLES) for children and adolescents and to test their psychometric properties. Methods Forward and backward translations were performed. Comprehension, acceptability, and alternative translations were tested in focus groups and semi-structured interviews. An expert panel and the copyright holders of the original version were actively involved. Test–retest reliability [Intraclass Correlation Coefficient (ICC)] was assessed by administering the questionnaire on two occasions 3 months apart to children aged 12–14 years (n = 30). Construct validity was assessed by comparing children’s responses with those of their parents (n = 19). The methods replicated those of the validation of the original version. Results Of the 53 CLES items translated, ten were found to be difficult to understand. Following back-translation, seven items were modified and a final version was obtained. Test–retest ICC reliability for total scores was 0.63. The ICC between children and parents was 0.42. Both results were very similar to those reported for the original version. Conclusions These preliminary findings suggest that the Spanish version of the CLES is understandable and acceptable and that it is similar to the original in terms of validity and reliability. Although further validation is needed, it is recommended for use in research settings in Spain.     

A Chinese Mandarin translation and validation of the Myocardial Infarction Dimensional Assessment Scale (MIDAS)

Aims: To evaluate the validity, reliability, and cultural relevance of the Chinese Mandarin version of Myocardial Infarction Dimensional Assessment Scale (MIDAS) as a disease-specific quality of life measure. Methods: The cultural relevance and content validity of the Chinese Mandarin version of the MIDAS (CM-MIDAS) was evaluated by an expert panel. Measurement performance was tested on 180 randomly selected Chinese MI patents. Thirty participants from the primary group completed the CM-MIDAS for test–retest reliability after 2 weeks. Reliability, validity and discriminatory power of the CM-MIDAS were calculated. Results: Two items were modified as suggested by the expert panel. The overall CM-MIDAS had acceptable internal consistency with Cronbach’s α coefficient 0.93 for the scale and 0.71–0.94 for the seven domains. Test–retest reliability by intraclass correlations was 0.85 for the overall scale and 0.74–0.94 for the seven domains. There was acceptable concurrent validity with significant (p < 0.05) correlations between the CM-MDAS and the Chinese Version of the Short Form 36. The principal components analysis extracted seven factors that explained 67.18% of the variance with high factor loading indicating good construct validity. Conclusion: Empirical data support CM-MIDAS as a valid and reliable disease-specific quality of life measure for Chinese Mandarin speaking patients with myocardial infarction.     

Iron deficiency, general health and fatigue: Results from the Australian Longitudinal Study on Women's Health

Associations between self-reported ‘low iron’, general health and well-being, vitality and tiredness in women, were examined using physical (PCS) and mental (MCS) component summary and vitality (VT) scores from the MOS short-form survey (SF-36). 14,762 young (18–23 years) and 14,072 mid-age (45–50 years) women, randomly selected from the national health insurance commission (Medicare) database, completed a baseline mailed self-report questionnaire and 12,328 mid-age women completed a follow-up questionnaire 2 years later. Young and mid-age women who reported (ever) having had ‘low iron’ reported significantly lower mean PCS, MCS and VT scores, and greater prevalence of ‘constant tiredness’ at baseline than women with no history of iron deficiency [Differences: young PCS = −2.2, MCS = −4.8, VT = −8.7; constant tiredness: 67% vs. 45%; mid-age PCS = −1.4, MCS = −3.1, VT = −5.9; constant tiredness: 63% vs. 48%]. After adjusting for number of children, chronic conditions, symptoms and socio-demographic variables, mean PCS, MCS and VT scores for mid-age women at follow-up were significantly lower for women who reported recent iron deficiency (in the last 2 years) than for women who reported past iron deficiency or no history of iron deficiency [Means: PCS – recent = 46.6, past = 47.8, never = 47.7; MCS – recent = 45.4, past = 46.9, never = 47.4; VT – recent = 54.8, past = 57.6, never = 58.6]. The adjusted mean change in PCS, MCS and VT scores between baseline and follow-up were also significantly lower among mid-age women who reported iron deficiency only in the last 2 years (i.e. recent iron deficiency) [Mean change: PCS = −3.2; MCS = −2.1; VT = −4.2]. The results suggest that iron deficiency is associated with decreased general health and well-being and increased fatigue. This revised version was published online in June 2006 with corrections to the Cover Date.