The Short-Form Headache Impact Test (HIT-6) was psychometrically equivalent in nine languages

BACKGROUND AND OBJECTIVE: This study examined the psychometric properties and equivalence of the six-item Headache Impact Test (HIT-6) across 11 languages in 14 countries. METHODS: A multicenter, international cross-sectional study conducted in a primary care setting. Data obtained from 1,171 adults from 14 countries who consulted their primary care physician for headache completed the HIT-6 questionnaire and a headache survey were included in this analysis. Item-level statistics (e.g., range of response choices used by participants), item-scale statistics (e.g., item-total correlations), scale level statistics (e.g., internal consistency reliability), and tests of differential item functioning were conducted to examine the psychometric properties of all HIT-6 translations and their comparability across translations. RESULTS: Across languages, missing data were low, item-scale correlations were high, reliability was adequate, and item-level statistics were generally comparable. We found only minor differential item functioning, suggesting that the HIT-6 translations are equivalent to the U.S. English form. CONCLUSIONS: Psychometric analyses indicate that most HIT-6 translations (Canadian English, French, Greek, Hungarian, UK English, Hebrew, Portuguese, German, Spanish, and Dutch) are comparable to U.S. English. Improvements may be needed in the Finnish and Slovakian translations and the appropriateness of using the HIT-6 in South Africa should be explored further.     

Calibration of an item pool for assessing the burden of headaches: An application of item response theory to the Headache Impact Test (HIT™)

Background: Measurement of headache impact is important in clinical trials, case detection, and the clinical monitoring of patients. Computerized adaptive testing (CAT) of headache impact has potential advantages over traditional fixed-length tests in terms of precision, relevance, real-time quality control and flexibility. Objective: To develop an item pool that can be used for a computerized adaptive test of headache impact. Methods: We analyzed responses to four well-known tests of headache impact from a population-based sample of recent headache sufferers (n = 1016). We used confirmatory factor analysis for categorical data and analyses based on item response theory (IRT). Results: In factor analyses, we found very high correlations between the factors hypothesized by the original test constructers, both within and between the original questionnaires. These results suggest that a single score of headache impact is sufficient. We established a pool of 47 items which fitted the generalized partial credit IRT model. By simulating a computerized adaptive health test we showed that an adaptive test of only five items had a very high concordance with the score based on all items and that different worst-case item selection scenarios did not lead to bias. Conclusion: We have established a headache impact item pool that can be used in CAT of headache impact.     

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.     

2015年中国31个省份与134个国家(地区)综合健康状况的对比分析

目的评价中国不同省份综合健康状况,并与其他国家(地区)相比较。方法从2015年全球疾病负担研究中收集134个国家(地区)和中国31个省份的社会人口学指数、期望寿命和健康期望寿命等数据。采用K 均值聚类法对世界各国(地区)综合健康状况进行分类,采用HemI 1.0.3软件绘制中国不同省份的社会人口学指数、期望寿命和健康期望寿命等指标的分布热点图,采用判别分析评价中国不同省份综合健康状况。结果134个国家(地区)综合健康状况由好到差分为类别1~8,中国归为类别4。中国各省份的综合健康状况总体表现为东部沿海高、西部内陆低,其中上海、北京归为类别1,浙江、江苏、广东、天津归为类别2,福建、辽宁、山东归为类别3,云南、广西、新疆、贵州归为类别5,青海、西藏归为类别6,其他16个省份归为类别4。结论中国综合健康状况处于世界中上水平,不同省份存在差异。     

Health-related quality of life associated with chronic conditions in eight countries: Results from the International Quality of Life Assessment (IQOLA) Project

CONTEXT: Few studies and no international comparisons have examined the impact of multiple chronic conditions on populations using a comprehensive health-related quality of life (HRQL) questionnaire. OBJECTIVE: The impact of common chronic conditions on HRQL among the general populations of eight countries was assessed. DESIGN: Cross-sectional mail and interview surveys were conducted. PARTICIPANTS AND SETTING: Sample representatives of the adult general population of eight countries (Denmark, France, Germany, Italy, Japan, The Netherlands, Norway and the United States) were evaluated. Sample sizes ranged from 2031 to 4084. MAIN OUTCOME MEASURES: Self-reported prevalence of chronic conditions (including allergies, arthritis, congestive heart failure, chronic lung disease, hypertension, diabetes, and ischemic heart disease), sociodemographic data and the SF-36 Health Survey were obtained. The SF-36 scale and summary scores were estimated for individuals with and without selected chronic conditions and compared across countries using multivariate linear regression analyses. Adjustments were made for age, gender, marital status, education and the mode of SF-36 administration. RESULTS: More than half (55.1%) of the pooled sample reported at least one chronic condition, and 30.2% had more than one. Hypertension, allergies and arthritis were the most frequently reported conditions. The effect of ischemic heart disease on many of the physical health scales was noteworthy, as was the impact of diabetes on general health, or arthritis on bodily pain scale scores. Arthritis, chronic lung disease and congestive heart failure were the conditions with a higher impact on SF-36 physical summary score, whereas for hypertension and allergies, HRQL impact was low (comparing with a typical person without chronic conditions, deviation scores were around -4 points for the first group and -1 for the second). Differences between chronic conditions in terms of their impact on SF-36 mental summary score were low (deviation scores ranged between -1 and -2). CONCLUSIONS: Arthritis has the highest HRQL impact in the general population of the countries studied due to the combination of a high deviation score on physical scales and a high frequency. Impact of chronic conditions on HRQL was similar roughly across countries, despite important variation in prevalence. The use of HRQL measures such as the SF-36 should be useful to better characterize the global burden of disease.     

How to measure critical health competences: development and validation of the Critical Health Competence Test (CHC Test)

Consumers’ autonomy regarding health increasingly requires competences to critically appraise health information. Critical health literacy refers to the concept of evidence-based medicine. Instruments to measure these competences in curriculum evaluation and surveys are lacking. We aimed to develop and validate an instrument to measure critical health competences (CHC test). Development and testing of the questionnaire covered three phases: (1) test construction (and feasibility, (2) first field test of scalability and items revision (3) second field test to validate the instrument. Model fit analyses were performed for both field tests for Rasch-, Mixed Rasch- and Hybrid model. Participants were secondary school and university students with and without prior training in evidence-based medicine (1. field test n = 322; with training n = 87; 2. field test n = 107; with training n = 13). The second field test resulted in Rasch scalability of all items in one person class. Mean values (±SD) of person parameters were 716.14 (±53.74) for trained students and 470.11 (±59.63) for untrained students. Reliability of the instrument was 0.91 (WINMIRA ANOVA). In conclusion the CHC instrument is a feasible, reliable and valid instrument to measure critical health literacy. The generalizability of the instrument is to be explored in ongoing studies in different educational settings.     

Income-related health inequalities in the Nordic countries: examining the role of education, occupational class, and age

Numerous studies have concluded that people's socioeconomic position is related to mortality and morbidity, but that the strength of this association varies considerably both within and between European regions. This has spurred several researchers to more closely examine educational and occupational gradients in health in the Nordic countries to clarify the causes of cross-national differences. However, comparable studies using income as an indicator of socioeconomic position are still lacking. This study uses recent and highly comparable data to fill this gap. The aim of this study is threefold. First, we ask to what extent there is an income gradient in health in the Nordic countries, and to what extent the association differs between these countries. Second and third, we examine whether differences in the attenuation of the income gradient by education and occupational class, and age-specific differences between countries, may act as explanations for differences in the income gradient between the Nordic countries. The data source are three waves of the European Social Survey (ESS, 2002/2004/2006), which included 17,801 people aged 25 and over from Denmark, Finland, Norway, and Sweden. Two subjective health measures (physical/mental self reported health and limiting longstanding illness) were analysed by means of logistic regression. The results show that, in all countries, people reported significantly better health and were less likely to suffer from longstanding illness as they had a higher income. This association is strongest in Norway and Finland and weakest in Denmark. The income gradient in health, but not country differences in this gradient, is partly explained by education and occupational class. Additionally, the strength of the income gradient in health varies between age groups. The relatively high health inequalities between income groups in Norway and Finland are already visible in the youngest age groups. The results imply that the socioeconomic gradient in health will arguably not be strongly reduced in the near future as a result of cohort replacement, as has been suggested in previous studies. Health policy interventions may be particularly important five to ten years prior to retirement and in early adulthood.     

Prevalence of chronic head, neck and low back pain and associated factors in women residing in the Autonomous Region of Madrid (Spain)

Objective

To compare the prevalence of chronic headache (CH), chronic neck pain (CNP) and chronic low back pain (CLBP) in the autonomous region of Madrid by analyzing gender differences and to determine the factors associated with each pain location in women in 2007.

Methods

We analyzed data obtained from adults aged 16 years or older (n = 12,190) who participated in the 2007 Madrid Regional Health Survey. This survey includes data from personal interviews conducted in a representative population residing in family dwellings in Madrid. The presence CH, CNP, and CLBP was analyzed. Sociodemographic features, self-perceived health status, lifestyle habits, psychological distress, drug consumption, use of healthcare services, the search for alternative solutions, and comorbid diseases were analyzed by using logistic regression models.

Results

The prevalence of CH, CNP and CLBP was significantly higher (P<0.001) in women (7.3%, 8.4%, 14.1%, respectively) than in men (2.2%, 3.2%, 7.8%, respectively). In women, CH, CNP and CBLP were significantly associated with having ≥3 chronic diseases (OR 7.1, 8.5, 5.8, respectively), and with the use of analgesics and drugs for inflammation (OR: 3.5, 1.95, 2.5, respectively). In the bivariate analysis, the factors associated with pain in distinct body locations differed between men and women.

Conclusions

This study found that CH, CNP and CLBP are a major public health problem in women in central Spain. Women have a higher overall prevalence of chronic pain than men. Chronic pain was associated with a higher use of analgesics and healthcare services.     

Implementing the European Core Health Indicators (ECHI) in the Netherlands: an overview of data availability

Background

The European Commission, together with the European Union (EU) Member States, developed a core set of indicators for monitoring public health in the EU, the European Core Health Indicators (ECHI) shortlist. From 2009 to 2012 developmental work on the ECHI indicators continued within the framework of the Joint Action for European Community Health Indicators and Monitoring (ECHIM). In this article, we give the current state of affairs on the availability of data for the ECHI indicators in the Netherlands and show what progress has been made over the past 5 years. The information provided serves as an illustration of the challenges encountered in a European country when working on harmonising national data collections with international data delivery requirements.

Methods

To assess data availability, we consulted Dutch data experts and relevant websites and reports on health monitoring activities. We compared the available Dutch data with the definitions, preferred data sources and relevant dimensions as requested by ECHI.

Results

The Netherlands can provide data for 66 of the 75 ECHI indicators for which availability could be assessed: for all of the 48 ECHI indicators that can be extracted from international databases and for 18 of the 27 indicators not available from international databases. Breakdowns by socio-economic status and region are not possible for 23 (35%) of the total of 66 indicators for which data are available and for 21 (32%) of these 66 indicators the definition is not exactly the same as requested by ECHIM. Since 2009, better estimates have become available for low birth weight, practising physicians and practising nurses.Moreover, several European initiatives to improve harmonised data collection are expected to have a positive effect on data availability for the Netherlands. Such initiatives should become sustainable in order to provide possibilities for monitoring trends. The scattered data ownership in the Netherlands complicates the coordination work for international data deliveries.

Conclusion

Data availability in the Netherlands is good. Since 2009, several Dutch and European developments in harmonising data collection have contributed or will significantly contribute to improvements in the data situation for the ECHI indicators in the Netherlands.

Electronic supplementary material

The online version of this article (doi:10.1186/s13690-014-0058-4) contains supplementary material, which is available to authorized users.     

重庆市卫Ⅵ项目健康教育基线调查结果分析──产前保健部分

对重庆市农村妇女有关妇幼保健知识、信念、行为的情况进行健康教育的基线调查，结果显示：目前抽样 地区的妇女有一定的卫生保健知识，但自我保健的意识和行为不足；不同地区有显著性差异，提示进一步健康教育的重 点地区；文化程度和经济收入是影响妇女获得知识及采取行为的重要因素，针对不同层次的人群应采取恰当的健康教育 方式。     

Reliability and validity of the child health questionnaire-child form (CHQ-CF87) in a Dutch adolescent population

Feasibility, reliability, and discriminative validity of the cross-culturally adapted Dutch version of the originally US child health questionnaire-child form (CHQ-CF87), an 87-item generic pediatric health-related quality of life instrument, were assessed. The success criterion in this first evaluation was the equivalence of psychometric properties of the adapted and the original CHQ. A total of 466 schoolchildren (9–17 years) were invited to complete the questionnaire in the classroom. Test–retest reliability was measured after 14 days in a subgroup (n = 71). Response was 96%. Four scales had ceiling effects (> 50%), as was reported in an Australian study. Cronbach -values were adequate (> 0.70), except for physical functioning (0.56). Test–retest correlations, not previously reported, were not statistically significant for two CHQ-scales, whereas average retest scores indicated better health for five scales (p < 0.01). The CHQ scales discriminated significantly (p < 0.01) between children without (n = 281) and children with two or more self-reported chronic diseases (n = 59). This is in correspondence with US and Australian reports. Conclusions: The current data support application of the Dutch CHQ-CF in predominantly healthy populations, e.g. in school settings. Given the limitations of this study and some less favorable results (score distributions, internal consistency; test–retest reliability), further evaluation of the CHQ-CF is recommended, preferably by analyses of item performance and scale validity in international data sets that include varied clinical subgroups.     

四氯化碳致大鼠肝损伤时脱氢酶活性的变化

本文从脂质过氧化角度,探讨CCl_4致大鼠肝损伤时葡萄糖-6-磷酸脱氢酶(G-6-PD)和6-磷酸葡萄糖酸脱氢酶(6-PGAD)的活性变化。实验结果表明:G-6-PD 活性染毒后12小时降低,24小时回升,48小时继续升高;而6-PGAD 活性染毒后12小时上升,24小时继续升高,48小时恢复正常。经分析认为:肝中毒肘这二种酶活性的变化与CCl_4引起脂质过氧化的损伤机理是吻合的,这两种酶活性与氧化还原循环的受阻和调节密切相关。     

电镀厂周围环境与人群血、尿、发六价铬水平调查

为了解电镀废水对人群健康的影响,对某电镀厂周围地下水、土壤、小麦,白菜、蕃茄及人群血、尿、发中ＣＲ＾６＋水平沿厂址所在区地下水流向的上、下游布点共４个地区进行采样分析。     

河南省老年人社会经济地位对精神健康的影响研究——以医疗保险和居住安排为中介变量

目的 分析河南省老年人社会经济地位与精神健康的关系.方法 使用多阶段分层整群抽样方法,以河南省18个省辖市的5 570名60岁及以上老年人为研究对象,采用有序logistic回归模型分析社会经济地位对老年人精神健康的影响,探讨医疗保险和居住安排的中介效应.结果 河南省老年人精神健康受损1 999人,受损率35.89％....     

Decentralisation and convergence in health among the provinces of Spain (1980-2001)

This study measures the process of convergence in the state of health among the provinces and regions of Spain during 1980-2001 in order to analyse the possible influence of the decentralisation of healthcare management to the regions in this period. Sigma and beta convergence models, traditionally employed in macroeconomics, have been used, taking Life Expectancy at Birth (LEB) and Infant Mortality (IM) as health indicators. The analysis was carried out at two territorial levels: provinces and regions. The results reveal that the process of decentralisation either does not affect convergence or leads to divergence in health. Indeed, in the case of IM the so-called change of role scenario seems to have occurred. Thus, certain provinces with initially poor indicators have improved, overtaking those that were originally in a better position. The final result, however, is of greater dispersion than initially.     

Assessing patient outcomes in acute exacerbations of chronic bronchitis: The measure your medical outcome profile (MYMOP), medical outcomes study 6-item general health survey (MOS-6A) and EuroQol (EQ-5D)

There is little published information on the measurement of health status or quality of life in acute exacerbations of chronic bronchitis. The measure yourself medical outcome profile (MYMOP), the medical outcomes study 6-item general health survey (MOS-6A), and EuroQoL (EQ-5D) were evaluated in 81 patients with acute exacerbations of Type-1 chronic bronchitis presenting at a single general practice centre in Glasgow. The questionnaires were administered at the first clinic visit and at a second visit within 1 week of treatment completion. Item scores for MYMOP were generally more responsive than those for the other instruments, as assessed by standardised response means and an index of responsiveness for those patients reporting minimal change between visits. Construct validity was demonstrated for the MYMOP by the gradient in score change with the patient's perceived change in clinical condition and by the relationship between score change and the physician's assessment of clinical outcome. This study demonstrated that the MYMOP is a valid and potentially useful instrument for the assessment of patient outcomes in acute exacerbations of chronic bronchitis and is more responsive than the MOS-6A or EQ-5D in this setting. The choice of instrument will vary according to the objective of the study. This revised version was published online in June 2006 with corrections to the Cover Date.     

The Short Form Health Survey (SF-36): Translation and validation study of the Iranian version

This was a large population-based study to develop and validate the Iranian version of the Short Form Health Survey (SF-36) for use in health related quality of life assessment in Iran. A culturally comparable questionnaire was developed and pilot tested. Then, the Iranian version of the SF-36 was administered to a random sample of 4163 healthy individuals aged 15 years and over in Tehran. The mean age of the respondents was 35.1 (SD=16.0) years, 52% were female, mostly married (58%) and the mean years of their formal education was 10.0 (SD=4.5). Reliability was estimated using the internal consistency and validity was assessed using known groups comparison and convergent validity. In addition factor analysis was performed. The internal consistency (to test reliability) showed that all eight SF-36 scales met the minimum reliability standard, the Cronbachs coefficients ranging from 0.77 to 0.90 with the exception of the vitality scale (=0.65). Known groups comparison showed that in all scales the SF-36 discriminated between men and women, and old and the young respondents as anticipated (all p values less than 0.05). Convergent validity (to test scaling assumptions) using each item correlation with its hypothesized scale showed satisfactory results (all correlation above 0.40 ranging from 0.58 to 0.95). Factor analysis identified two principal components that jointly accounted for 65.9% of the variance. In general, the Iranian version of the SF-36 performed well and the findings suggest that it is a reliable and valid measure of health related quality of life among the general population.     

Association of socioeconomic status with inflammation markers in black and white men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) study

Inflammatory processes are implicated in a number of diseases for which there are known socioeconomic status (SES) disparities, including heart disease and diabetes. Growing evidence also suggests SES gradients in levels of peripheral blood markers of inflammation. However, we know little about potential gender and racial/ethnic differences in associations between SES and inflammation, despite the fact that the burden of inflammation-related diseases varies by gender and race. The present study examines SES (education and income) gradients in levels of two inflammatory biomarkers, C-reactive protein (CRP) and interleukin-6 (IL-6), in a biethnic (White and Black) sample of men and women (n = 3549, aged 37–55 years) in the USA from the CARDIA Study. Health status, behavioral and psychosocial variables that may underlie SES differences in inflammatory biomarker levels were also examined. Age-adjusted CRP and IL-6 levels were inversely associated with education level in each race/gender group except Black males. Income gradients were also observed in each race/gender group for IL-6 and in White females and males for CRP. In general, differences in CRP and IL-6 levels between low and high SES groups were reduced in magnitude and significance with the addition of health status, behavioral, and psychosocial variables, although the impact of the addition of model covariates varied across race/gender groups and different SES-inflammation models. Overall, findings indicate SES gradients in levels of inflammation burden in middle-aged White and Black males and females.     

Identifying the barriers to effective breast,cervical and colorectal cancer screening in thirty one European countries using the Barriers to Effective Screening Tool (BEST)

The aim of this study was to identify barriers to effective breast, cervical and colorectal cancer screening programmes throughout the whole of the European region using the Barriers to Effective Screening Tool (BEST). The study was part of the scope of the EU-TOPIA (TOwards imProved screening for breast, cervical and colorectal cancer In All of Europe) project and respondents were European screening organisers, researchers and policymakers taking part in a workshop for the project in Budapest in September 2017. 67 respondents from 31 countries responded to the online survey. The study found that there are many barriers to effective screening throughout the system from identification of the eligible population to ensuring appropriate follow-up and treatment for the three cancers. The most common barriers were opportunistic screening, sub-optimal participation, limited capacity (including trained human resource), inadequate and/or disjointed information technology systems and complex administration procedures. Many of the barriers were reported consistently across different countries. This study identified the barriers that, in general, require further investment of resources.     

Functional Capacity Evaluations in Persons with Spinal Disorders: Predicting Poor Outcomes on the Functional Assessment Screening Test (FAST)

This study determines how performance on the simple, low exertion Functional Assessment Screening Test (FAST) relates to performance on more extensive physical and psychological testing. One hundred eighty-eight persons with chronic back disability and 17 spine healthy volunteers underwent the FAST (three 2-min static tests [kneeling, stooping, and squatting] and two 5-min tests [repetitive stooping and repetitive twisting while standing]), the Progressive Isoinertial Lifting Evaluation (PILE), trunk extension endurance, submaximal bicycle ergometry, and psychological profiles. All FAST components were completed by 88% of spine healthy subjects, but only by 19.7% (n = 37) of the back patients. Internal consistency for overall test performance was 0.82 (alpha coefficient). Back pain noncompleters had poorer performance on the PILE and trunk extension endurance despite similar cardiovascular fitness and perceived exertion during testing. They had more dysfunctional coping mechanisms, pain avoidance, depression, and self-reported disability. Since performance on nonstrenuous testing is so poor, and psychosocial variables relate strongly to test performance, extensive Functional Capacity Evaluations may not be necessary or valid in assessing the physical performance of this population of chronic back pain patients.