Health behaviours and socio-economic status in Ontario, Canada

Data from the 1990 Ontario Health Survey were used to investigate the association of socio-economic status with the likelihood of meeting current recommendations for four health behaviours (smoking, fat intake, alcohol consumption, and physical activity level) in adults living in Ontario (Canada). Health behaviours were categorised as unhealthy if they did not meet current recommendations in Ontario (smoking, fat intake < 30% of dietary energy, alcohol intake < 14 units per week, low level of leisure-time physical activity). Two summary variables based on the number ofÔ unhealthyÕ behaviours were also examined: the crude number of unhealthy behaviours reported and the likelihood of reporting 3 or 4 unhealthy behaviours. Four measures of socio-economic status were used: educational achievement, household income status, source of household income, and occupational prestige. Multiple logistic and linear regression analyses were performed to explore the association of each unhealthy behaviour and of the summary variables with socio-economic status indicators (taken independently or simultaneously), controlling for demographic characteristics. Except for the positive relationship between income status and high alcohol intake, measures of unhealthy behaviours were inversely associated with the socio-economic indices, suggesting that individuals in lower socio-economic groups are at an increased risk for health problems.     

Measurement of quality of life in women with breast cancer. Development of a Life Satisfaction Questionnaire (LSQ-32) and a comparison with the EORTC QLQ-C30

The purpose was to develop and validate a new instrument suitable for measuring perceived quality of life in women with breast cancer. The instrument is to be used within conventional cancer therapy as well as in complementary care, and is called the LSQ-32 (Life Satisfaction Questionnaire). The subjects were 362 women with breast cancer in all cancer stages. Cronbach's reliability coefficient of the LSQ was 0.89. The construct validity was estimated by a principal component analysis. Six orthogonal factors were identified: (1) Quality of family relation, (2) Physical symptoms, (3) Socioeconomic situation, (4) Quality of daily activities, (5) Sickness impact and (6) Quality of close friend relation. The criterion-related validity was estimated by comparing the LSQ-32 and the EORTC QLQ-C30. The scales/items of the EORTC QLQ-C30 were represented in the LSQ-32, but the factors Quality of family relation and Quality of close friend relation were not found in the EORTC QLQ-C30. It was concluded that the LSQ-32 as well as the EORTC QLQ-C30 are valuable tools in the measurement of quality of life in women with breast cancer. The LSQ-32, however, also contains an existential factor.The study was approved on 1992 04 08 by the Research Ethical Committee, Faculty of Health Sciences, University of Linköping.     

Well-being: A philosophical basis for health services

This paper develops and defends the claim that the promotion of human well-being is a philosophical basis or rationale for health services. It first sketches a case for this thesis, then defends it against various objections arising from the contrary position, here dubbed The Sceptical View. Later sections of the paper elaborate on the meaning of well-being, the nature of well-being, and the scope of appropriate health service concern with well-being. In particular, distinctions are made between thick and thin well-being, and between well-being and its various measures. These discussions generate further defences of the philosophical centrality of human well-being to health services.     

Translation,cultural adaptation,and initial reliability and multitrait testing of the Kidney Disease Quality of Life instrument for use in Japan

Background: The Kidney Disease Quality of Life instrument (KDQOL) consists of 79 items: 36 asking about health-related quality of life (HRQOL) in general (the Medical Outcomes Study SF-36) and 43 asking about QOL as it is affected by kidney disease and by dialysis. Aim: Translation, cultural adaptation and initial reliability and multitrait testing of the KDQOL for use in Japan. Methods: Translation and cultural adaptation began with two translations into Japanese, two backtranslations into English, and discussions among the translators, the project coordinators in Japan, and the developers of the original (US-English) version. Focus-group discussions and field testing were followed by analyses of test–retest reliability, internal consistency, and convergent and discriminant construct validity. Results: All eight of the SF-36 scales met the criterion for internal consistency (Cronbach's ranged from 0.73 to 0.92) and were reproducible (intraclass correlations between test and retest scores ranged from 0.60 to 0.82). Of the 10 kidney-disease-targeted scales, only two had coefficients of less than 0.70: sleep (0.61) and quality of social interaction (0.35). One item on the quality of social interaction scale had a very weak correlation with the remainder of that scale (r = 0.10). Eliminating that item from scoring increased the coefficient of the scale from 0.35 to 0.64. All three items on the quality of social interaction scale had very strong correlations with other scales. Conclusions: First, in Japanese patients receiving dialysis the SF-36 scales are internally consistent and their scores are reproducible. Second, with the possible exception of the quality of social interaction scale, the Japanese version of the KDQOL,can provide psychometrically sound kidney-disease-targeted data on quality of life in such patients.     

Drinking patterns in French adult men

Summary.Background: Establishing patterns of alcohol consumption may be useful for investigating the relationship between alcohol and diseases.Methods: We used a hierarchical agglomerative clustering method to describe the intake of eight types of alcoholic beverages and to determine drinking patterns in a cohort of 1797 men enrolled in a French 8-year intervention study involving nutritional doses of vitamins and minerals, the SU.VI.MAX study.Results: Cluster 1, referred to as abstainers, was defined a priori and included 329 men who drank less than 5 g of alcohol per day. Six drinking patterns were defined in alcohol drinkers, with increasing mean alcohol intake: cluster 2, low drinkers, included 670 subjects, who drank little of any type of alcoholic beverage; cluster 3, high quality wines, included 584 men with a high intake of champagne, high quality wines, and high-alcohol aperitifs; cluster 4, beer and cider, included 190 subjects with a high intake of beer and cider; cluster 5, digestives, included 54 men with a specifically high consumption of digestive beverages; cluster 6, local wines, included 238 subjects with a high intake of local wines and low-alcohol aperitifs; cluster 7, table wines, included 61 men with a high intake of table wines and high-alcohol aperitifs. These clusters were significantly associated with socioeconomic and lifestyle variables such as place of residence, occupation, mean caloric intake and distribution of energy intake throughout the day, body mass index, and smoking habits.Conclusions: They will be useful in future studies of the relationship between alcohol intake and medical conditions or risk factors.     

Changes in plasma,liver, and ovary vitellogenin in landlocked atlantic salmon following exposure to sublethal cyanide

Female landlocked Atlantic salmon (Salmo salar Ouananiche) were exposed to 0.005 mg/L hydrogen cyanide (HCN) for 12 days at 7±1°C during late vitellogenesis (October). Plasma vitellogenin and liver and gonad vitellogenin levels were measured by homologous radioimmunoassay (RIA) specifically developed for this species. Results indicated that plasma vitellogenin levels increased in cyanide exposed fish. Vitellogenin levels in the liver did not change relative to control fish suggesting that the increased levels of plasma vitellogenin did not result from a change in synthesis in the liver. Vitellogenin levels declined in the gonad relative to the controls by day 12. Elevated plasma vitellogenin levels along with decreased vitellogenin in the gonads suggest that exposure of female salmon to sublethal HCN during late vitellogenesis inhibits the uptake of vitellogenin at the ovarian level.Marine Sciences Research Laboratory Contribution No. 675.     

Prospective follow-up of genital HPV infections: Survival analysis of the HPV typing data

A series of 532 women with genital HPV infections has been prospectively followed-up without treatment since 1981 for a mean of 50 (+/-21) months. The patients were examined at six month intervals by colposcopy, PAP smears and/or biopsy. HPV typing of all biopsies was completed using in situ, Southern blot and/or sandwich hybridization with DNA probes for types 6, 11, 16, 18, 31 and 33. Survival data analysis was applied to analyse the clinical course (i.e. spontaneous regression and progression) of the HPV lesions stratified by their HPV type, currently available for 458 women. Clinical progression was significantly related to the HPV type present in the lesions. The progression rate was 11.1% (6/54) for HPV 6 lesions, 14.3% (8/ 56) for HPV 11, 35.2% (32/91) for HPV 16,12.5% (4/32) for HPV 18,18.8% (6/32) for HPV 31,19.4% (6/31) for HPV 33 and 28.6% (4/14) for doubly infected lesions. The lowest progression rate, 6.1% (9/ 148), was found in lesions which remained constantly HPV DNA-negative. In the survival analysis the probability of progression varied significantly between the six HPV types (p=0.0005, overall). After grouping the viral types as HPV 6/11 (low risk), HPV 16/18 (high risk) and HPV 31/33 (intermediate risk) the overall probability of progression remained significantly different (p=0.0035, overall). In clinical regression, however, the HPV type was not an equally good predictor (p=0.1952, overall). Within groups HPV 6/11, 16/18 and 31/33 the differences were even less significant (p= 0.4759, overall). In the pairwise comparison significant differences in progression occurred when HPV type 16 was compared to HPV 6, HPV 11 or HPV DNA-negative lesions. In regression similar differences existed in comparison of HPV DNA-negative to HPV 6 or HPV 18 lesions.These data confirm the previous finding of HPV type 16 as a high risk type in cervical infections. Types 31 and 33 belong to intermediate category. Although, previously included in the high risk category, type 18 did not markedly differ from the clinical course of the low risk (HPV 6, 11) types in the study.Corresponding author.     

Towards a Theory of the Everyday: The Ordinary and the Special in Daily Living in Residential Care

This paper begins with a debate about the relative place of ordinary and special approaches to everyday living with young people in residential care and treatment. It argues for a considered approach to this distinction between the ordinary and the special, based on assessments of children's needs and stages of development, and on the purpose of their residential placement. From this beginning it enters into a broader proposal about the need for a comprehensive theory of the everyday in residential work. The argument focuses on the need for an underpinning framework for the planning and analysis of daily group care practice with young people. Finally, it explores how different assumptions and theoretical frameworks may operate in support of a programme for everyday practice which is differentiated according to the needs of the children and the task of the organisation.     

Translating the Short-Form Headache Impact Test (HIT-6) in 27 countries: Methodological and conceptual issues

The process of translating the Short-Form Headache Impact Test (HIT-6) in 27 countries and the comparability of the content of the translations is discussed. HIT-6 translations were developed using a standard forward–backward translation process, including a cognitive debriefing step and international harmonization of the translations. Prior to translating the HIT-6, modifications were made to the English-language source form, to improve translation equivalence. In general, the HIT-6 was not difficult to translate. The most difficult items included colloquial expressions such as fed up and words whose intended meaning changed in translation such as school or lie down. Subjects generally found the HIT-6 translations to be clear and relevant. The translation process resulted in questionnaires that are both culturally appropriate and comparable in content.     

Rethinking Our Understanding of the Resident Group in Group Care

The author of this article lived in two residential homes in order to understand, and create a model of, the residents' social group. By understanding the way in which the group grants power to its members and the beliefs and actions which it values, residential staff have the opportunity to identify and support positive individual and group behaviours. It is a model which starts from the group rather than imposing our adult notions of how young people should behave. The way in which the everyday activities of young people, for example their use of humour, serves to maintain group expectations, organisations and relationships, should not be overlooked but rather identified, understood and encouraged.     

Explanations for the smoking paradox in Japan

The prevalence of cigarette smoking among Japanese men has been consistently high compared with Western males over the past 30 years. However, during the same period, the incidence of and mortality rates for lung cancer have consistently been lower in Japan than in Western countries (Japanese smoking paradox). The odds ratio/relative risk of cigarette smoking for lung cancer mortality/incidence relative to the same number of cigarettes smoked per capita in Japan, were apparently lower than those in Western countries. This must be the cause driving the Japanese smoking paradox. Furthermore, low carcinogenic ingredients in Japanese cigarettes and a congenitally-related resistance to smoking-related lung carcinogenesis emerged as the main factors which have brought the Japanese smoking paradox.     

Insecticidal and neuroexcitant actions of DDT analogs on the cockroach,Periplaneta americana

The American cockroach (Periplaneta americana) was used to test 14 DDT analogs for their ability to cause a) death and b) repetitive firing in the abdominal nerve cord. P,p-DDT, p,p-DDD, p,p-methoxychlor, and o,p-DDT were all found to induce repetitive firing in the nerve cord after a twice threshold stimulus, but only p,p-DDT, p,p-DDD, and p,p-methoxychlor produced mortality within 4 days from injection of the pesticides. Also, cockroaches exposed to sublethal doses of p,p-DDT and p,p-methoxychlor were found to exhibit repetitive firing in the abdominal nerve cord three weeks after injection of the pesticide. The cause and effect relationship between neuroexcitation and lethality is therefore questioned, at least in the case of cockroaches.     

Socioeconomic status, overweight and obesity in prepuberal children: A study in an area of Northern Italy

The aim of this study was to determine whether socio-economical status (SES) is associated with overweight and obesity in prepuberal children. In an area of North-Western Italy a sample of 1420 children, aged 10–11 years, had his/her height and weight recorded, (overweight and obesity were defined, respectively, as relative body weight 120% and 140%), and parents were requested to compile a questionnaire exploring some demographic and social conditions. 23% of the sample resulted overweight or obese. Prevalence rate ratios (PRR) of overweight and obesity (together) were calculated, adjusting for parents' age, parents' area of birth, and school district. PRR for mother's lowest educational level compared to the highest was 1.59 (95% CI: 1.19–2.13), while for father's education was 1.21 (0.90–1.63). PRRs for unemployed or manual mother compared to upper non manual were respectively 1.83 (1.20–2.79) and 2.20 (1.31–3.68), while for unemployed or manual father were 2.63 (1.97–2.63), and 1.63 (1.27–2.09). The cultural resources of the mother, and the economical resources of the family seem to influence the prevalence of weight gain in prepuberal children. This should be taken into account when planning programs for the prevention or reduction of obesity in children.     

‘U’ technique and standard technique of Norplant removal

Objectives To compare the side effects and time required for Norplant removal between the U technique (using the no-scalpel vas deferens holding forceps) and the standard technique.Materials and methods A randomized controlled clinical trial was carried out of acceptors in family planning clinics in Dr Kariadi Hospital, Semarang, who wanted to have Norplant removal. The Norplant was removed by experienced doctors who had been trained for both the U technique and the standard technique. Removal time, capsule condition and complications were examined.Results From 41 clients in the U technique group and 41 clients in the standard technique group, the removal times were 2.75±1.28 and 6.57±2.93 minutes, respectively (p<0.01). One week after Norplant removal, complications were found in 5 clients, 1 from the U technique group (2.44%) and 4 from the standard technique group (9.76%). Two weeks after Norplant removal no complications were found.Conclusion The U technique was quicker and less complicated compared with the standard technique.

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ResumenObjectivos Comparar los efectos secundarios y el tiempo requerido para el retiro de Norplant con la técnica U y la técnica estándar.Materiales y métodos Un ensayo clínico controlado aleatorizado de aceptadoras en la clínica de planificación familiar Dr. Kariadi Hospital Semarang que deseaban que se retirase el Norplant. El Norplant fue retirado por médicos experimentados que habían sido adiestrados tanto en la técnica U como en la estándar. Se examinaron el tiempo de retiro, el estado de las cápsulas y las complicaciones.Resultados En 41 clientas en la técnica U y 41 clientas en la técnica estándar, el tiempo de retiro fue 2,75±1,28 y 6,57±2,93 minutos (p<0,01) respectivamente. Se detectaron complicationes después de una semana del retiro de Norplant en 5 clientas, 1 caso (2,44%) en la técnica U y 4 (9,76%) en la técnica estándar. Dos semanas después no se detectaron complicaciones.Conclusión La técnica U fue más rápida y señaló menos complicaciones que la técnica estándar.

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ResumèObjectifs Comparer les effets secondaires et le temps nécessaire pour le retrait du Norplant, entre la technique en U et la technique standard.Matériels et méthodes Un essai clinique randomisé a été effectué sous contrôle à la clinique de planning familial de l'hôpital Dr. Kariadi de Semarang sur des patientes sollicitant le retrait du Norplant. Celui-ci a été retiré par des médecins expérimentés qui avaient, été formés à la technique de retrait dite en U et à la technique standard. On a relevé les temps de retrait, l'état des implants et les complications survenues.Résultats Pour 41 patientes soumises à la technique en U et 41 patientes à la technique standard, les temps de retrait ont été respectivement de 2,75±1,28 et 6,57±2,93 minutes (p<0,01). Des complications ont été observées une semaine après le retrait de Norplant chez 5 femmes, soit 1 cas (2,44%) pour la technique en U et 4(9,76%) pour la technique standard. Deux semaines plus tard, aucune complication n'a été constatée.Conclusion La technique en U est plus rapide et entraîne moins de complications que la technique standard.

     

Measuring change over time: a comparison of results from a global single item of health status and the multi-dimensional SF-36 health status survey questionnaire in patients presenting with menorrhagia

This paper compares the sensitivity to change of a multi-item, multi-dimensional health status measure with a single global health status question, in the assessment of treatment for menorrhagia. A cohort study of patients recruited by general practitioners, was carried out, with a follow up at eighteen months. Questionnaires were administered postally at baseline and follow up. General practices in Berkshire, Buckinghamshire, Northamptonshire and Oxford-shire supplied three hundred and nine women who reported heavy menstrual bleeding, and received either drug treatment alone or both drug and surgical treatment (endometrial resection or hysterectomy) during the eighteen months between the two admini-strations of the questionnaires. A single global question was given to patients asking them to rate their overall health status as excellent, very good, good, fair or poor. The eight dimensions of the SF-36 health survey questionnaire were also given to patients to complete. The dimensions of the SF-36 indicated only small levels of improvement for patients who received drug treatment. However, on many dimensions of the SF-36, a moderate to large improvement was detected for the surgical group. However, small changes were reported in overall health status, as indicated by the single global question, for both groups. Single item measures of health status may not provide a sufficiently accurate indication of health status to be appropriate for use in longitudinal studies.     

Bioethical blind spots: Four flaws in the field of view of traditional bioethics

In this paper it is argued that bioethics has tended to emphasise: high tech areas of medicine at the expense of low tech areas such as psychiatry; problems arising in treatment at the expense of those associated with diagnosis; questions of fact at the expense of questions of value; and applied ethics at the expense of philosophical theory. The common factor linking these four bioethical blind spots is a failute to recognise the full extent to which medicine is an ethical as well as scientific discipline. Once this is acknowledged it leads to a full-field bioethics in which the different areas are mutually complementary. In particular, it paves the way for a fruitful two-way exchange between the more abstract aspects of philosophical theory and the contingencies of day-to-day clinical work. The arguments of the paper are illustrated with recent work on the abuse of psychiatry.     

Polychlorinated biphenyl-induced decrease in liver vitamin A in Japanese quail and rats

Summary Aroclor 1242 (PCB) or DDT increased liver weight and lipids and decreased liver vitamin A of male and female rats or male Japanese quail. Laying female quail did not show consistent changes, presumably due to mobilization of lipid and vitamin A for egg yolk. When egg laying was inhibited, PCB reduced liver vitamin A 50%. Aroclor 1242 reduced egg production, but had no effect on egg weight or eggshell thickness.     

An application of structural equation modeling to detect response shifts and true change in quality of life data from cancer patients undergoing invasive surgery

The objective is to show how structural equation modeling can be used to detect reconceptualization, reprioritization, and recalibration response shifts in quality of life data from cancer patients undergoing invasive surgery. A consecutive series of 170 newly diagnosed cancer patients, heterogeneous to cancer site, were included. Patients were administered the SF-36 and a short version of the multidimensional fatigue inventory prior to surgery, and 3 months following surgery. Indications of response shift effects were found for five SF-36 scales: reconceptualization of general health, reprioritization of social functioning, and recalibration of role-physical, bodily pain, and vitality. Accounting for these response shifts, we found deteriorated physical health, deteriorated general fitness, and improved mental health. The sizes of the response shift effects on observed change were only small. Yet, accounting for the recalibration response shifts did change the estimate of true change in physical health from medium to large. The structural equation modeling approach was found to be useful in detecting response shift effects. The extent to which the procedure is guided by subjective decisions is discussed.     

The New York City fire epidemic as a toxic phenomenon

Summary Reductions in the fire service in New York City from 1972 to 1976 appear to have caused a disproportionate increase in fire-fighter work load through several unexpected mechanisms of fire contagion. In turn, the work load increase has itself had a disproportionate physiologic impact: A classic dose-response relation has been observed between a composite measure of per capita structural fire work load and the percentage of the fire-fighting work force retiring under conditions of disability. After 1974, the increase in work load seems to have caused entry to the linear portion of the dose-response curve.Implications of this synergism are explored for both New York City and other American urban areas now suffering fiscal crises or planning fire service reductions.     

Development and pilot-testing of a health-related quality of life chronic generic module for children and adolescents with chronic health conditions: A European perspective

Health-related quality of life (HRQOL) assessment in children and adolescents with chronic health conditions is increasingly considered as a relevant topic. The aim of the EU-funded DISABKIDS project is to develop, test, and implement European instruments for the assessment of HRQOL of children and adolescents with disabilities and their families. The current paper describes the development and pilot testing of a chronic generic HRQOL measure. Using literature searches, expert consulting and focus groups with children/adolescents and their families, items of the instruments were developed and translated into the respective languages. A pilot test with 360 children and adolescents was conducted. Children and adolescents (8–12, 13–16years) with different chronic health conditions (asthma, epilepsy, diabetes, arthritis, atopic dermatitis, cerebral palsy, and cystic fibrosis) as well as their families were included. Data were analysed according to predefined psychometric and content criteria. Psychometric analyses resulted in a 56-item chronic generic HRQOL questionnaire with six domains (Medication, Physical, Emotion, Independence, Social Inclusion, Social Exclusion) with acceptable internal consistency.The DISABKIDS Group - The DISABKIDS Group comprises a coordinating group (Prof. Monika Bullinger, Dr. Corinna Petersen, Dr. Silke Schmidt, Institute of Medical Psychology, University Clinic Hamburg-Eppendorf) and study centres in seven countries: Prof. Michael Quittan, Dr. Nilouparak Hachemian and Dr. Othmar Schuhfried, Department of Physical Medicine and Rehabilitation, University of Vienna, Austria; Dr. Marie Claude Simeoni and Dr. Audrey Clement, Department of Public Health, University Hospital of Marseille, France; Dr. Ute Thyen. and Dipl.-Psych. Esther Müller-Godeffroy, Department of Paediatrics, Medical University of Lübeck, Germany; Dr. Athanasios Vidalis, Ass. Prof. John Tsanakas, Dr. Elpis Hatziagorou and Dr. Paraskevi Karagianni, Department of Psychiatry, Hippocratio Hospital, Greece; Dr. Hendrik Koopmann and Drs. Rolanda Baars, Department of Paediatrics, Leiden University Medical Centre, Netherlands; Dr. John Eric Chaplin, Department of Paediatrics, University Hospital Lund, Sweden; Prof. Mick Power, Dr. Clare Atherton and Dr. Peter Hoare, Department of Psychiatry, University of Edinburgh, United Kingdom.