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.     

The Po River Delta epidemiological survey: Reference values of total serum IgE levels in a normal population sample of North Italy (8–78 yrs)

The aim of this paper was to define, for the first time in Italy, normal levels of total serum IgE in a general population sample of North Italy. Total serum IgE in 1905 subjects, living in Po Delta area (near Venice), were measured by PRIST method. Normal values were derived from 558 subjects without asthma and/or asthmatic/rhinitic symptoms, noncurrent smokers, skin prick-test negatives (normals). Cut-off values to differentiate normals from the remaining part of the sample (others), from asthmatic, and from rhinitic subjects, were established with the IgE value midway between the upper limit of the 95% confidence intervals (CI) of the geometric mean for normals and the lower limit for others, asthmatics, and rhinitics, respectively. Geometric mean of normal children–adolescents was 45 kU/L (SD: 2.6; 95% CI: 38–63). In normal adults geometric mean was 29 kU/L (SD: 3.3; 95% CI: 25–40) in males and 19 kU/L (SD: 3.8; 95% CI: 16–22) in females. The diagnostic sensitivity of IgE test was low, while the specificity was very high. A good positive predictive value in discriminating normals from others was found, on the contrary, we found a good negative predictive value in discriminating normals from asthmatics or from rhinitics. In conclusion, our results confirm that it is necessary to provide separate total serum IgE reference values for what concerns age in children–adolescents and in adults, and gender, in adults. Low level of total serum IgE are helpful to exclude allergic asthma or rhinitis.     

Going off the dole: A prudential and ethical critique of the healthfare state

The present healthfare state in the United States in neither practically nor morally justified. The nation currently fails to provide adequate access to health care for tens of millions of uninsured citizens. To suggest that the United States' half-million physicians should provide their care as charity is an inadequate solution. The transfer of assets from the haves to the have-nots through taxation in a healthfare state undermines human compassion, and fails to respect minimal moral requirements. However, alternative strategies are possible. During the next 20 years health care could come to be financed on the basis of sound quasi-libertarian moral and prudential principles. In the interim deliberate political action is required to achieve novel health policy, available and affordable job and career training, and universal employment. It is possible to achieve universal access to adequate health care while sustaining individual choice, and at the same time to reduce or virtually eliminate taxpayersubsidised health care. This approach would, in time, eliminate the healthfare state and eventually encourage and even require citizens to go off the healthfare dole.     

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.     

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.     

Frequency of consumption of selected indicator foods and serum cholesterol

The relationship between frequency of consumption of eleven indicator foods (milk, meat, liver, carrots, green vegetables, fruit, eggs, ham, fish, cheese and alcohol) and serum cholesterol was investigated in the comparison group of a case-control study of acute myocardial infarction conducted in Italy. Data were collected on 792 subjects from various Italian regions, admitted to hospital for acute conditions unrelated to any known or potential risk factor for myocardial infarction or to long-term modifications in diet. No statistically or epidemio-logically meaningful relationship emerged between serum cholesterol level and frequency of consumption of any of these foods. Cholesterol levels rose according to increasing consumption tertiles for most of the indicator foods considered. Higher values for the higher tertile of consumption were observed for meat, ham and eggs, but also for fruit, carrots and green vegetables. However, correlation coefficients between frequency of consumption of various food items and serum cholesterol level were uniformly low for all food items considered, ranging between –0.09 (for milk) and 0.19 (for ham). Although a more comprehensive diet history may lead to different indications, the present data are not suggestive of any major influence of long-term frequency of consumption of a few selected indicator foods on serum cholesterol levels.GISSI-EFRIM (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto — Epidemiologia dei Fattori di Rischio dell'Infarto Miocardico). Scientific Advisory Board: G.A. Feruglio, M.G. Franzosi, C. La Vecchia, A.P. Maggioni, A. Maseri, G. Tognoni. Participating Clinical Centers: Alba (S. Boscarino); Asti (M. Alciati); Avellino (G. Amoroso); Bari Di Venere (N. D'Amato); Barletta (M.A. Messina); Belluno (A. Darold, A. De Biasi); Biella (A. Pagliarini); Bolzano (C. Romeo); Bozzolo (E. Franzi); Brindisi (C. Andriulo); Broni (B. Albonico); Cagliari (M. Sias); Casale Monferrato (M. Pezzana); Casarano (S. Ciricugno); Caserta (R. Di Sarno); Castel San Giovanni (D. Bozzarelli); Castellammare di Stabia (R. Longobardi); Cento (L. Orselli); Chiari (C. Gentilini); Colleferro (E. Venturini); Copertino (A. Calcagnile); Crotone (R. Lumare); Desio (G. Iacuitti); Fidenza (S. Callegari); Foligno (A. Mattioli); Gallarate (G. Filippini); Genova Galliera (G. Scarsi); Grosseto (A. Cresti); Guastalla (V. Manicardi); Legnago (P. Todesco); Leno (A. Lanzini); Lodi (C. Pezzi); Lugo (T. Tognoli, M. Gobbi); Magenta (G. Ventura, R. Turato); Mantova (A. Izzo, G.P. Guerra); Matera (A. Rizzi); Menaggio (S. Silvani); Messina Policlinico (G. Di Tano); Mestre (G. Gasparini); Milano Niguarda II° divisione (C. Corsini); Milano Policlinico (M. Marconi); Mirano (A. Zanocco); Monza (F. Achilli); Napoli Cardarelli ' (F. Piantadosi, R. Giuliano, G. Sepe, S. Pezzella); Novi Ligure (L. Fasciolo); Nuoro (G. Tupponi); Palermo Cervello (A. Ledda); Palermo Benfratelli (R.G. La Malfa); Palermo Villa Sofia (A. Pizzuto); Perugia (S. Brando); Pescia (L. Iacopetti); Piombino (S. Bechi); Pisa (U. Conti); Pistoia (F. Fantoni); Putignano (A. Marco); Riccione (F. Brighi, A. Benati); Rieti (S. Orazi); Rimini (F. Bologna, D. Santoro); Roma Nuova ITOR (M. Rocchi); Roma S. Pietro (P. Giuliani); Roma Policlinico (P. De Paolis); Saluzzo (P. Allemanno, S. Reinaud); San Donà di Piave (P. Delia Valentina); Sassuolo (G. Fontana, P. Orlandi); Savigliano (V. Cravero); Savona (A. Gandolfo); Sciacca (C. Catalano); Sondrio (M. Marieni); Termoli (M. Esposito); Torino Maria Vittoria (L. Faccio, L. Mussano); Trapani (G.B. Biondo); Treviso (F. Perissinotto); Udine (C. Fresco); Vasto (E. Bottari); Voghera (G. Ferrari).     

Education,motivation for learning,and social competence of 6-year-olds in kindergarten in Denmark and the United States

On the basis of ethnological research methods, the everyday life of one Danish and one American kindergarten class in school is described. In the American kindergarten class teaching of the three Rs (reading, writing and arithmetic) is predominant, whereas play constitutes the life in the Danish classroom. The study shows that the American teacher-controlled academic practice and the children's concrete cultural background contribute to the development of motivation for learning at the age of 6 years. On the other hand, the American children are very egocentric and have difficulties in participating in group activities. In contrast, the more child-controlled practice in the Danish kindergarten develops social competence but neglects the development of motivation for learning. With comprehensive development as the educational aim, neither the American teacher-controlled academic practice nor the Danish child-controlled play approach is quite adequate, which calls for a new paradigm in early childhood education.     

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.     

Applications of computerized adaptive testing (CAT) to the assessment of headache impact

Objective: To evaluate the feasibility of computerized adaptive testing (CAT) and the reliability and validity of CAT-based estimates of headache impact scores in comparison with static surveys. Methods: Responses to the 54-item Headache Impact Test (HIT) were re-analyzed for recent headache sufferers (n = 1016) who completed telephone interviews during the National Survey of Headache Impact (NSHI). Item response theory (IRT) calibrations and the computerized dynamic health assessment (DYNHA^®) software were used to simulate CAT assessments by selecting the most informative items for each person and estimating impact scores according to pre-set precision standards (CAT-HIT). Results were compared with IRT estimates based on all items (total-HIT), computerized 6-item dynamic estimates (CAT-HIT-6), and a developmental version of a static 6-item form (HIT-6-D). Analyses focused on: respondent burden (survey length and administration time), score distributions (ceiling and floor effects), reliability and standard errors, and clinical validity (diagnosis, level of severity). A random sample (n = 245) was re-assessed to test responsiveness. A second study (n = 1103) compared actual CAT surveys and an improved static HIT-6 among current headache sufferers sampled on the Internet. Respondents completed measures from the first study and the generic SF-8 Health Survey; some (n = 540) were re-tested on the Internet after 2 weeks. Results: In the first study, simulated CAT-HIT and total-HIT scores were highly correlated (r = 0.92) without ceiling or floor effects and with a substantial reduction (90.8%) in respondent burden. Six of the 54 items accounted for the great majority of item administrations (3603/5028, 77.6%). CAT-HIT reliability estimates were very high (0.975–0.992) in the range where 95% of respondents scored, and relative validity (RV) coefficients were high for diagnosis (RV = 0.87) and severity (RV = 0.89); patient-level classifications were accurate 91.3% for a diagnosis of migraine. For all three criteria of change, CAT-HIT scores were more responsive than all other measures. In the second study, estimates of respondent burden, item usage, reliability and clinical validity were replicated. The test–retest reliability of CAT-HIT was 0.79 and alternate forms coefficients ranged from 0.85 to 0.91. All correlations with the generic SF-8 were negative. Conclusions: CAT-based administrations of headache impact items achieved very large reductions in respondent burden without compromising validity for purposes of patient screening or monitoring changes in headache impact over time. IRT models and CAT-based dynamic health assessments warrant testing among patients with other conditions.     

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.     

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.     

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.     

Definitions of healthy eating in Spain as compared to other European Member States

Study objective: To assess what healthy eating means for the European population and whether this concept differs between Spain and other European Countries. Design: A Pan-European survey was developed between October 1995 and February 1996 by the Institute of European Food Studies (Dublin). Each subject was asked to describe in his or her own words what he/she understood by healthy eating. Comparisons were made among four groups of European countries (Northern, Central, Spain, and other Mediterranean countries). Setting: The survey included participants from the 15 member states of the European Union, selecting quota-controlled samples to make them nationally representative. Subjects: The questionnaire was completed by 14,331 persons, approximately 1000 from each country. Results: The responses were grouped into 89 broad categories of similar answers concerning nutritional value and afterwards these responses were collapsed to simplify the presentation. The definition of healthy eating such as more fiber and less fat was more prevalent in other States, members of the European Union than in Mediterranean Countries, although the definition of balanced diet was more frequently mentioned in Spain than in the rest of the European Union. Conclusions: Our results show that the concept of balance and variety is more prevalent in Spaniards than in other traditional Mediterranean countries. Differences in the definitions of healthy eating among European countries could be explained, at least partially by differences in consumption patterns and in the nutrition education.     

‘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.

     

Embryotoxic and teratogenic effects in unhatched fertile eggs from hens fed polychlorinated biphenyls (PCBs)

Summary The PCBs tested with caged White Leghorn hens were Aroclors 1221, 1232, 1242, 1248, 1254, 1268, 5442 and BP-6, fed at the 20 ppm level. In addition, 1242, 1248 and 1254 were also fed at the 2 ppm level. Feeding 20 ppm Aroclors 1232, 1242, 1248 and 1254 reduced hatchability and caused teratogenic effects in the embryos. The most common abnormalities found in the unhatched embryos were edema and unabsorbed yolk. Since Aroclors 1221 and 1268 did not adversely affect embryonic development, adverse effects of the PCBs were not directly related to the degree of chlorination of the biphenyls, or to the amount of total residue.     

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.     

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.     

Patients' experiences using a computerized program with a touch-sensitive video monitor for the assessment of health-related quality of life.

This study assessed patients' experiences using a computerized program with a touch-sensitive video monitor (TSVM) for the assessment of health-related quality of life (HRQoL). A software program was developed for a computerized form of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the QLQ-C30. One hundred and seventy-eight patients completed the QLQ-C30, followed by a structured interview designed to assess perceived difficulties with the use of the TSVM. Patients were asked to evaluate the ease of use of different aspects of the TSVM system (using the touch-sensitive screen, entering the patient identification number, reading the screen and following the on-screen instructions). The majority of patients found all aspects of the TSVM system very easy to use. A few patients (1–2%) admitted finding any aspect of the TSVM use somewhat difficult and none ranked any aspect as very difficult. There were no unanswered items in the QLQ-C30. All patients found the amount of time spent on answering the questionnaire acceptable, (the mean time to complete was 6.8 min with a median of 5 min) and 96% stated they were willing to complete a similar questionnaire on a future occasion. From the patients' perspective the TSVM system appears to be a highly acceptable approach for the collection of HRQoL data in clinical practice.     

Vision-specific health-related quality of life: Content areas for nursing home residents

Nursing home residents have a high prevalence of remediable visual impairment and blindness. Future research on the effectiveness of providing eye care to nursing home residents will need to include a vision-targeted health-related quality of life (HRQOL) instrument appropriate for this population. The purpose of this study was to identify the core content areas for such an instrument. In-depth interviews on vision-related issues were conducted with 40 residents. Interviews were audio-taped, transcribed, and coded using a standardized protocol. Binocular distance and near visual acuity were assessed using the resident's walking around correction to examine whether one vision-specific HRQOL measure could address the needs of residents with good and poor vision. Overall 1070 vision-related comments were identified. Residents mentioned 315 problem comments that were grouped into 13 categories, including ocular symptoms (18% of comments), reading (15%), general vision (13%), psychological distress (12%), and activities of daily living (ADLs) (7%). Compared to published data on vision-specific content areas most relevant to community based persons, nursing home residents focused more on ocular symptoms and basic ADLs, with no mention of issues related to driving, home care, and finances. The majority of categories mentioned did not differ on the proportion of comments made by those with good and poor visual acuity, suggesting that one vision-specific HRQOL instrument would be appropriate for residents with varying levels of visual acuity. Future work will focus on developing a vision-specific HRQOL instrument for nursing home residents.     

Health-related quality of life of mothers of children with leukemia in Japan

Objective: The study compared the health-related quality of life (HRQOL) of Japanese mothers of children with leukemia to that of mothers of children without leukemia. Method: We used the Medical Outcomes Study 36-item Short-Form (SF-36) to measure the HRQOL of 97 mothers of children (average age 6.2, range 0–14) with leukemia diagnosed between 1999 and 2000, and compared their scores to those of 240 mothers of children without leukemia matched to the children with leukemia. Main results: Of the eight unadjusted domain scores of the SF-36, five were significantly low among mothers of children with leukemia compared to mothers of children without leukemia: role-physical functioning (RP), general health perception (GH), vitality (VT), social functioning (SF) and mental health (MH). Their SF-36 domain scores, when adjusted for demographic and clinical factors were also significantly low in RP, GH, VT, SF, RE and MH. The MH and SF scores in mothers of children with leukemia requiring hospital care were, respectively, approximately 20 points (1 standard deviation (SD), p < 0.0001) and 30 points (1.5 SD, p < 0.0001) lower than that of mothers of children without leukemia. Conclusion: Mothers of children with leukemia requiring hospital care have poor HRQOL, particularly with regard to mental health and social functioning, and are at a greater risk for depression. These results suggest that the current system for treating leukemic diseases of children in Japan should also include close monitoring of mothers mental health, and provision of appropriate treatment and psycho-social support.