Temporal changes in the nature of disability: U.S. Army soldiers discharged with disability, 1981-2005

BackgroundWe sought to (1) document and describe the relative proportion of disabilities by major type over the study period, (2) describe the population at risk for different types of disability, and (3) document and describe the type of compensation (an indicator of severity) awarded for different types of disability and any temporal changes in these associations.MethodsTime-series, logistic regression analyses, and direct standardization of rates were used to study 108,119 active-duty Army soldiers discharged with permanent disability between 1981 and 2005.ResultsOf all disability, 91% is captured within the top five most prevalent types of disability: musculoskeletal (72%, n = 77,418), neurological (6%, n = 6,896), mental health (5%, n = 5,075), cardiovascular system (4%, n = 4,429), and respiratory (4%, n = 4,202). Musculoskeletal disability rates are increasing rapidly (+2.5% per year); neurological and cardiovascular disability rates are decreasing (−1.3% and −10.0% annually, respectively), and respiratory and mental health disability rates did not change significantly. Demographic risk factors vary by disability type. At greatest risk for musculoskeletal disability were female soldiers, soldiers who were between the ages of 21 and 35 years, white, in lower- to mid-level enlisted ranks with relatively short service tenure, and soldiers without a college education. Compensation awards also varied by disability type: Overall, 77% (n = 83,320) received separation with severance pay, 15% (n = 16,107) received a permanent disability retirement, and 8% (n = 8,692) received separation without benefits. Separation with severance pay was the largest and fastest growing disability disposition for all disabilities and for musculoskeletal disability specifically.ConclusionsDemographic risk factors vary by type of disability and by compensation award. Musculoskeletal disability rates are rapidly increasing as is separation with severance pay—particularly among white, young, lower ranking female soldiers.     

US general population norms for telephone administration of the SF-36v2

ObjectiveUS general population norms for mail administration of the Medical Outcomes Study 36-Item Short Form Version 2 (SF-36v2) were established in 1998. This article reports SF-36v2 telephone-administered norms collected in 2005–2006 for adults aged 35–89 years.Study Design and SettingThe SF-36v2 was administered to 3,844 adults in the National Health Measurement Study (NHMS), a random-digit dial telephone survey. Scale scores and physical and mental component summary (PCS and MCS) scores were computed.ResultsWhen compared with 1998 norms (mean = 50.00, standard deviation [SD] = 10.00), SF-36v2 scores for the 2005–2006 general population tended to be higher: physical functioning (mean = 50.68, SD = 14.48); role limitations due to physical health problems (mean = 49.47, SD = 14.71); bodily pain (mean = 50.66, SD = 16.28); general health perceptions (mean = 50.10, SD = 16.87); vitality (mean = 53.71, SD = 15.35); social functioning (mean = 51.37, SD = 13.93); role limitations due to emotional problems (mean = 51.44, SD = 13.93); mental health (mean = 54.27, SD = 13.28); PCS (mean = 49.22, SD = 15.13); MCS (mean = 53.78, SD = 13.14). PCS and MCS factor scoring coefficients were similar to those previously reported for the 1998 norms. SF-36v2 norms for telephone administration were created.ConclusionThe higher scores for NHMS data are likely due to the effect of telephone administration. The 2005–2006 norms can be used as a reference to interpret scale and component summary scores for telephone-administered surveys with the SF-36v2.     

Rasch analysis supports the use of the depression, anxiety, and stress scales to measure mood in groups but not in individuals with chronic low back pain

ObjectiveChronic pain is a common problem that is associated with mood disorders such as depression. The Depression, Anxiety, and Stress Scales (DASS-21) questionnaire is commonly used to help measure disordered mood. In this study, we used Rasch analysis to analyze the clinimetric properties of the DASS-21 in a chronic low back pain sample.Study Design and SettingA Rasch analysis was conducted on data collected as a part of a randomized hospital-based placebo-controlled trial. DASS-21 questionnaires were completed by the 154 enrolled participants.ResultsThe DASS-21 subscales fit the Rasch model. No differential item functioning was detected for age, gender, pain severity, or disability. Reliability for individual use was supported for the depression subscale (Person Separation Index [PSI] = 0.86) but group use only for the anxiety (PSI = 0.74) and stress (PSI = 0.82) subscales. A DASS-21 aggregate score of “negative affect” lacked fit to the Rasch model (χ² = 191.48, P < 0.001).ConclusionThis is the first study that used Rasch analysis to demonstrate that the DASS-21 subscales demonstrate adequate measurement properties for research involving groups with chronic pain. Only the DASS-21 depression subscale demonstrated adequate reliability for use with individuals with chronic pain. The use of a single DASS-21 aggregate score as a measure of “negative affect” was not supported.     

Peer influence on youth's snack purchases: a laboratory analog of convenience store shopping

ObjectiveThis paper reports the results of two experiments using a laboratory analog to examine the influence of taxes and subsidies on youth's snack food purchases when alone (Experiment 1) and when in the presence of a same-gender peer (Experiment 2).MethodAdolescents (12–14-years-old) completed a purchasing task, during which prices of snack foods were manipulated, either alone in Experiment 1 (N = 37) or in the presence of an unfamiliar peer in Experiment 2 (N = 52).ResultsIn both experiments, purchases of unhealthy snacks decreased and purchases of healthy snacks increased when the price of unhealthy snacks were taxed (increased). In Experiment 1 (alone), participants did not purchase more healthy snacks when the price of these snacks were subsidized (decreased). However, in Experiment 2 (when participants were in the presence of a peer), participants purchased more healthy snacks when these snacks were subsidized.ConclusionTaxes and subsidies affect adolescents' snack purchasing, as does the presence of peers. The results of this study highlight factors that influence healthy and unhealthy snack purchasing behavior in young adolescents.     

Worldwide prevalence of physical inactivity and its association with human development index in 76 countries

ObjectiveTo describe the worldwide prevalence of physical inactivity and to analyze its association with development level of each country.MethodsPooled analysis of three multicenter studies, conducted between 2002 and 2004, which investigated the prevalence of physical inactivity in 76 countries, and comprised almost 300,000 individuals aged 15 years or older. Each study used the International Physical Activity Questionnaire to assess physical inactivity. The level of development of each country was analyzed by the Human Development Index (HDI).ResultsThe crude worldwide prevalence of physical inactivity was 21.4% (95%CI 18.4–24.3), being higher among women (mean = 23.7%, 95%CI 20.4–27.1) than men (mean = 18.9%, 95%CI 16.2–21.7). It ranged from 2.6% (in Comoros) to 62.3% (in Mauritania), with a median equal to 18%. After weighting for the total population of each country, the worldwide prevalence of physical inactivity was 17.4% (95%CI 15.1–19.7). There was a positive association between HDI and prevalence of physical inactivity (rho = 0.27). Less developed countries showed the lowest prevalence of physical inactivity (18.7%), while physical inactivity was more prevalent among the most developed countries (27.8%).ConclusionsOne out of five adults around the world is physically inactive. Physical inactivity was more prevalent among wealthier and urban countries, and among women and elderly individuals.     

Using item response theory improved responsiveness of patient-reported outcomes measures in carpal tunnel syndrome

ObjectiveTo compare responsiveness based on item response theory (IRT) with that based on conventional scoring for two patient-reported outcomes measures in carpal tunnel syndrome (CTS); the short disabilities of the arm, shoulder, and hand (QuickDASH) measure, and the 6-item CTS symptoms scale (CTS-6).Study Design and SettingProspective cohort study of patients with CTS undergoing carpal tunnel release at one orthopedic department. Of 455 consecutive patients, 343 completed the QuickDASH and the CTS-6 before and within 1 year after surgery. IRT-based and conventional scores were compared in subgroups according to global rating of change in hand status and treatment satisfaction. The effect size (ES) and the area under the receiver operating characteristic (ROC) curve were used as measures of responsiveness.ResultsThe mean value for the IRT-based QuickDASH estimate was ?0.09 (standard deviation [SD] = 1.13) preoperatively and ?2.14 (SD = 1.79) postoperatively (ES = ?1.8) and for the CTS-6 estimate was 0.29 (SD = 1.36) preoperatively and ?3.87 (SD = 2.3) postoperatively (ES = ?3.1), indicating very large improvement. The ES for the QuickDASH and CTS-6 were very large (?2.4 and ?3.8), respectively, in the group with the largest perceived improvement and decreased with lower perceived improvement. The ES was consistently larger with IRT-based scoring than conventional scoring. The AUC for the QuickDASH and CTS-6 exceeded 0.85.ConclusionIRT-based scoring showed high responsiveness for the QuickDASH and CTS-6, and the ES were larger than those estimated using conventional scoring.     

Problem solving, treatment adherence, and weight-loss outcome among women participating in lifestyle treatment for obesity

ObjectiveThis study examined whether improvements in problem-solving abilities mediate the relation between treatment adherence and weight-loss outcome in the behavioral treatment of obesity.Method272 women (mean ± SD age = 59.4 ± 6.2 years, BMI = 36.5 ± 4.8) participated in a 6-month lifestyle intervention for obesity. Body weight and problem-solving skills (as measured by the Social Problem Solving Inventory—Revised) were assessed pre- and posttreatment. The completion of self-monitoring logs during the intervention served as the marker of treatment adherence.ResultsAt posttreatment, participants lost 8.4 ± 5.8 kg, an 8.8% reduction in body weight. Changes in weight were associated with increased problem-solving skills and with higher levels of treatment adherence. Improvements in problem-solving skills partially mediated the relation between treatment adherence and weight-loss outcome. Moreover, participants with weight reductions ≥ 10% demonstrated significantly greater improvements in problem-solving skills than those with reductions < 5%.DiscussionImprovements in problem-solving skills may enable participants to overcome barriers to adherence and thereby enhance treatment-induced weight losses.     

Physical activity and adolescent smoking: A moderated mediation model

BackgroundResearch has found that physical activity (PA) protects adolescents from smoking initiation and progression, although it is not clear whether all PA is equally protective. Moreover, it is unclear whether the protective effects are direct or indirect through mediating mechanisms (e.g., self-concept, depression symptoms).PurposeThe purpose of this study was to assess a sequential mediation model in which moderate and vigorous PA (MVPA) and interscholastic sport participation decrease the likelihood of smoking one year later, indirectly in a sequential pathway through sport competence beliefs (SCB) and depressive symptoms (DS). We were also interested whether interscholastic sport participation or MVPA is most protective, and if males and females differ in the indirect effects.MethodsParticipants were 384 adolescents (55% male, 96% Caucasian) drawn from a public high school in the North East region of the United States, taking part in a two-year prospective study (grades 10–11) evaluating the relationship between 10th grade physical activity and 11th grade smoking in adolescents. We employed a two-group (male versus female) structural equation model (SEM) to test sequential mediation pathways for significance.ResultsOnly interscholastic sport participation (β_{interscholastic sport–SCB–DS–smoking} = −0.05, 95%CI = −0.10, −0.01), not MVPA, had a significant negative sequential indirect effect on adolescent smoking through SCB and DS, but only for males, not females.ConclusionsThe results suggest the effects of interscholastic sport participation on adolescent smoking may depend upon how competent youth feel after participation. Thus, in addition to prescribing organized activity participation, such as interscholastic sport, smoking prevention initiatives could focus on how youth interpret activity experience. Further, the sex difference found suggests that more research is needed to understand what type of organized activity, if any, is most protective for females against smoking.     

Rates and correlates of influenza vaccination among HIV-infected adults in the HIV Outpatient Study (HOPS), USA, 1999-2008

BackgroundWe sought to describe rates of vaccination among HIV-infected adults in care and identify factors associated with vaccination.MethodsUsing data abstracted from medical records of participants in the HIV Outpatient Study (HOPS) during 8 influenza seasons (1999–2008) and negative binomial models with generalized estimating equation methods, we examined factors associated with increased prevalence of annual influenza vaccination.ResultsAmong active patients, 25.8% to 43.3% were vaccinated for influenza each year (annual mean = 35%, test for trend p = 0.71). Vaccination rates peaked in October and November of each season and decreased sharply thereafter. In multivariable analysis, patients who were male (67.2%), non-Hispanic white (70%) or Hispanic (66%), had lower HIV viral loads (73.5%), were prescribed antiretroviral treatment (72.7%), or had a greater number of clinical encounters per year (86.7%) were more likely to receive influenza vaccination.DiscussionThe decreased likelihood of vaccination among women and non-Hispanic black patients suggests the need for focused efforts to reduce disparities. Increasing patient and clinician education on the importance of universal vaccination, and ensuring that vaccination activities continue in HIV clinics during the later months of the influenza season may improve influenza vaccine coverage.     

The HIV epidemic among industrial male miners in Guinea: prevalence, associated factors and trends from 2001 to 2007

BackgroundTo estimate HIV prevalence, associated factors and trends from 2001 to 2007 among male miners in Guinea.MethodsTwo hundred and eighty-six male miners in 2001 and 579 in 2007 were tested for HIV and interviewed about their lifestyles and sexual practices. Investigations were conducted in the five mining companies operating in the country. A standard questionnaire was used for collecting data and SAS Windows 9.2 version (SAS Institute, Cary, North Carolina, USA) for statistical analysis.ResultsMedian age was 45 years in 2001 and 39 years in 2007 (P = 0.001). HIV prevalence was 4.5% (95% Confidence Interval [95% CI]: 2.1–7.0) in 2001 and 6.4% (95% CI: 4.4–8.4) in 2007. In multivariate analysis, HIV prevalence was associated with history of sexually transmitted infections (STIs) (Prevalence Ratio [PR] = 2.21; P = 0.03), and with paying for sex (PR = 6.01; P = 0.04), whereas it was significantly higher in divorced, separated or widowed men. HIV prevalence increased but not significantly between 2001 and 2007, whereas casual sex (P = 0.03) and counseling activities against HIV (P < 0.0007) decreased.ConclusionHIV prevalence is high in this population and, although not statistically significant, the increase observed between 2001 and 2007 is worrying in a context where the population of miners became younger over time. Prevention of HIV/AIDS has to be reinforced among miners in Guinea.     

Hearing, mobility, and pain predict mortality: a longitudinal population-based study

ObjectiveMeasures of health-related quality of life (HRQL), including the Health Utilities Index Mark 3 (HUI3) are predictive of mortality. HUI3 includes eight attributes, vision, hearing, speech, ambulation, dexterity, cognition, emotion, and pain and discomfort, with five or six levels per attribute that vary from no to severe disability. This study examined associations between individual HUI3 attributes and mortality.Study Design and SettingBaseline data and 12 years of follow-up data from a closed longitudinal cohort study, the 1994/95 Canadian National Population Health Survey, consisting of 12,375 women and men aged 18 and older. A priori hypotheses were that ambulation, cognition, emotion, and pain would predict mortality. Cox proportional hazards regression models were applied controlling for standard determinants of health and risk factors.ResultsSingle-attribute utility scores for ambulation (hazard ratio [HR] = 0.10; 0.04–0.22), hearing (HR = 0.18; 0.06–0.57), and pain (HR = 0.53; 0.29–0.96) were statistically significantly associated with an increased risk of mortality; ambulation and hearing were predictive for the 60+ cohort.ConclusionFew studies have identified hearing or pain as risk factors for mortality. This study is innovative because it identifies specific components of HRQL that predict mortality. Further research is needed to understand better the mechanisms through which deficits in hearing and pain affect mortality risks.     

The effect of a smoke-free campus policy on college students' smoking behaviors and attitudes

ObjectiveTo evaluate the impact of a smoke-free campus policy on college students' smoking behaviors and attitudes.MethodsThe current study utilized repeated cross-sectional surveys with a nested 4-wave longitudinal cohort design. Data were collected from undergraduate students at two large matched public universities in Indiana before and after one of the campuses went smoke-free in January 2008. Baseline data were collected in fall 2007 (n = 3266) and follow-up data were collected in fall 2009 (n = 3207). In addition, volunteers provided longitudinal follow-up data at four different time points.ResultsIn the cross-sectional analyses, students exposed to the smoke-free campus policy demonstrated significant favorable changes in smoking behavior (16.5% to 12.8%, p < 0.001), perceptions of peer tobacco use (73.6% to 66.8%, p < 0.001), and smoking norms (45.5% to 40.4%, p < 0.001) compared to students on the control campus. In the longitudinal analyses, students exposed to the smoke-free campus policy demonstrated these changes plus significant favorable changes in attitudes toward regulation of tobacco (83.2% to 89.9%, p < 0.01).ConclusionsThe implementation of a smoke-free campus policy may be an effective intervention for reducing tobacco use among college students.     

The standardized and mini versions of the PAQLQ are valid, reliable, and responsive measurement tools

ObjectiveThe Paediatric Asthma Quality of Life Questionnaire (PAQLQ) is a validated tool developed to assess the impact of symptoms on quality of life. Here we assess the validity, reliability and responsiveness of two new simpler versions of this questionnaire: the Standardised PAQLQ and the MiniPAQLQ.Study Design and SettingParticipants included 42 children with asthma, who completed the PAQLQ, PAQLQ(S), MiniPAQLQ, Asthma Control Questionnaire, and Health Utilities Index at baseline, one, five and nine weeks. Concordance between questionnaires was examined using intraclass correlation coefficients (ICC), bias by paired Student's t-tests and closeness of association by Pearson correlation coefficients.ResultsCorrelation coefficients for each of the corresponding domains of the PAQLQ with the PAQLQ(S) were strong (r > 0.97), and moderate to strong (r = 0.50–0.94) with the MiniPAQLQ. Reliability was strong for both the PAQLQ(S) (ICC > 0.89) and MiniPAQLQ (ICC > 0.91). The responsiveness index values for the PAQLQ(S) (0.96) and the MiniPAQLQ (1.05) were both higher than that of the original PAQLQ (0.90). Cross sectional and longitudinal correlation coefficients were similar for all three instruments.ConclusionThe PAQLQ(S) and the MiniPAQLQ are valid, reliable and responsive to change. They can be used with confidence for long-term monitoring in clinical trials.     

Using short information leaflets as recruitment tools did not improve recruitment: a randomized controlled trial

ObjectiveTo assess if the type of patient information leaflet (PIL) received at an initial invitation to participate in a randomized trial influences the number of patients recruited.Study Design and SettingA randomized controlled trial was used to compare the effects of short or full PILs on recruitment in a primary care setting. Patients invited to take part in the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy study through a database mail out were randomly allocated to receive one of two types of PIL.ResultsThe type of PIL received with the initial invitation did not influence recruitment. Of those receiving the short PIL, 5.4% were recruited compared with 5.1% in the full PIL group. The difference in proportions between the groups was not statistically significant (mean difference = 0.3%; 95% confidence interval [CI] = ?1.5%, 2.2%; P = 0.75). Secondary analyses on the numbers of ineligible patients showed a statistically significant difference between the groups in favor of the full PIL group, which yielded fewer ineligible patients (P = 0.04; mean difference = 1.4%; CI = 0.03%, 2.8%).ConclusionProviding patients with shorter PILs when inviting them to participate in research does not affect the numbers who are subsequently recruited and yields more ineligible patients. Therefore, it is recommended to use the full PIL as a recruitment tool.     

Disability,more than multimorbidity,was predictive of mortality among older persons aged 80 years and older

ObjectiveIn this study, we evaluate the impact of disability and multimorbidity on the risk of all-cause death in a population of frail older persons living in community.Study Design and SettingWe analyzed data from the Aging and Longevity Study in the Sirente geographic area, a prospective cohort study that collected data on all subjects aged 80 years and older (n = 364). The main outcome measure was all-cause mortality over 4-year follow-up.ResultsA total of 150 deaths occurred. Sixty-seven subjects (44.6%) died in the nondisabled group compared with 83 subjects (55.3%) in the disabled group (P < 0.01). Thirty-nine subjects (31.7%) died among subjects without multimorbidity compared with 111 subjects (46.0%) with two or more diseases (P < 0.01). When examining the combined effect of multimorbidity and disability, the effect of disability on the risk of death was higher than that of multimorbidity. After adjusting for potential confounders, relative to those without disability and multimorbidity, disabled subjects showed an increased risk of death when multimorbidity was associated (hazard ratio [HR] = 3.91; 95% confidence interval [CI] = 1.53–10.00) and in absence of multimorbidity (HR = 2.36; 95% CI = 0.63–8.83).ConclusionOur results show that disability exerts an important influence on mortality, independently of age and other clinical and functional variables.     

Screen time, physical activity and mental health among urban adolescents in China

ObjectiveTo test the association between screen time (ST), physical activity (PA) and self-reported psychological problems among urban adolescents aged 11 to 16 years.MethodsIn 2010, total 5003 boys and girls were analyzed from 4 junior high schools in Bengbu city of China. The Depression Self-rating Scale for Children, Screen for Child Anxiety Related Emotional Disorders and School Life Satisfaction Rating Questionnaire were administered to obtain information on current mental health. Self-reported ST, PA and dietary intake were also assessed. Logistic regression analyses were used to explore the effects of ST and PA on psychological problems.ResultsApproximately 26.1% of adolescents were exposed to ST for more than 2 h/day. High ST was a risk factor for depressive symptoms (odds ratio (OR) = 1.52, 95% confidence interval (CI): 1.31–1.76), anxiety symptoms (OR = 1.36, 95%CI: 1.18–1.57) and school life dissatisfaction (OR = 2.07, 95%CI: 1.79–2.38). Sufficient vigorous PA (VPA) was a protective factor for depressive symptoms (OR = 0.78, 95%CI: 0.67–0.91) and school life dissatisfaction (OR = 0.73, 95%CI: 0.62–0.85). The combination of high ST and insufficient VPA was associated with the highest prevalence of various psychological problems.ConclusionsHigh ST and insufficient VPA interact to increase depressive, anxiety symptoms and school life dissatisfaction among Chinese adolescents.     

An assessment of the effectiveness of growth monitoring and promotion practices in the Lusaka district of Zambia

ObjectiveWe evaluated the effectiveness of the growth monitoring and promotion (GMP) program in Zambia.MethodsA 3-mo prospective study of growth outcomes was undertaken at randomly selected health facilities and community posts within the Lusaka district. Children <2 y old (n = 698) were purposively sampled from three health facilities (n = 459) and four community posts (n = 77) where health workers had undergone training in GMP and three health facilities where staff had not received training (n = 162). Qualitative data on knowledge, attitudes, and practices of GMP were collected from health facility managers (n = 6), health workers (n = 35), and mothers whose children attended all follow-up visits (n = 27).ResultsAnthropometric status of children in all groups deteriorated, with children at community posts having the worst outcomes (change in weight-for-age Z-score ?0.8 ± 0.7), followed by trained (?0.5 ± 0.6) and untrained (–0.3 ± 0.47; P < 0.05) health facilities. A similar trend was seen for weight for length. The overall dropout rate was 74.1%. Weight-for-age Z-scores were higher at 1- and 2-mo follow-up visits for children who did not complete the study at trained health facilities and community posts compared with those who remained in the study. Mothers/caregivers identified GMP as important in attending the under-five clinic, associated their child's weight with overall health status, and expressed a willingness to comply with health workers' advice. However, health care providers were poorly motivated, inadequately supervised, and demonstrated poor practices.ConclusionsThe GMP program in Lusaka is functioning suboptimally, even in facilities with trained staff.     

Correlates of moderate-to-vigorous physical activity among preschoolers during unstructured outdoor play periods

ObjectiveQuantify moderate-to-vigorous physical activity (MVPA) and its correlates in preschool children during outdoor unstructured play periods using direct observation.MethodsCross-sectional data consisting of 204 observation periods collected from 51 four- and five-year-old children using the Observation System for Recording Physical Activity in Children — Preschool (OSRAC-P) at a preschool in southern California, autumn and spring 2009–2010. Gender and BMI classification and OSRAC-P environmental codes were related to observed MVPA in multiple logistic regression models.ResultsLess than 21% of intervals were spent in MVPA overall. Boys and normal weight children engaged in higher intensity levels than their respective counterparts. More MVPA was associated with normal weight (OR = 2.49–3.25, R² = 3%), location (grass, playground, looping cycle path; OR = 3.21–4.90, R² = 4–12%), play context (ball/objects, wheel, open space; OR = 2.78–8.51, R² = 9%), and group composition (solitary, one-on-one; OR = 1.34–2.08, R² = 1%).ConclusionOpen spaces located in playgrounds and grass fields, and activity-genic portable equipment, manipulative objects, and riding vehicles are some design and equipment features that appear to foster MVPA. Lowering play space density and engaging children through teacher prompts and teacher-arranged activities may further increase MVPA on playgrounds.