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.     

Differences between Eastern European immigrants of German origin and the rest of the German population in health status, health care use and health behaviour: a comparative study using data from the KORA-Survey 2000

Summary. Differences between Eastern European immigrants of German origin and the rest of the German population in health status, health care use and health behaviour: a comparative study using data from the KORA-Survey 2000Objectives: To identify differences in health status, health care use and health behaviour between Eastern European immigrants of German origin and the rest of the German population in order to develop new concepts for preventive programs.Methods: Using data from the KORA-Survey 2000 (Cooperative Health Research in the Region of Augsburg), immigrants of German origin were compared to the rest of the German population with multiple regression models controlling for sex, age, living with partner, years of education and occupation. Tests of trend were performed for the groups classified according to the year of immigration.Results: Compared to other Germans, immigrants of German origin consider their health status more often as poor. They were more likely to be obese (OR = 1.95) and have hyperlipidemia (total-cholesterol/HDL-C > 4: OR = 1.71). They were less likely to use cancer screening (OR = 0.41) or to perform sport activities (OR = 0.47). All these differences decrease with the length of residence in Germany.Conclusions: Concerning their health status, Eastern European immigrants of German origin were identified as a high risk group. They should be considered for specific preventive programs and health care interventions, especially during the first years of immigration.

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Unterschiede zwischen Aussiedlern und der übrigen deutschen Bevölkerung bezüglich Gesundheit, Gesundheitsversorgung und Gesundheitsverhalten: eine vergleichende Analyse anhand des KORA-Surveys 2000

Zusammenfassung. Fragestellung: Bis zum Jahre 2000 sind ca. 4 Mio. Aussiedler nach Deutschland eingereist. Trotzdem ist diese Bevölkerungsgruppe in der Public-Health-Forschung bisher wenig beachtet worden. Ziel dieser Studie ist es, Unterschiede bezüglich Gesundheit, Gesundheitsversorgung und Gesundheitsverhalten zwischen Aussiedlern und Nicht-Aussiedlern zu ermitteln, um auf dieser Basis Konzeptionen für Präventionsmassnahmen in der Gesundheitsversorgung entwickeln zu können.Methodik: Anhand des KORA-Surveys 2000 (Kooperative Gesundheitsforschung in der Region Augsburg) wurde eine vergleichende Analyse von Aussiedlern und den übrigen Studienteilnehmern durchgeführt. Die Zielgrössen sind den drei Bereichen Gesundheit, Gesundheitsversorgung und Gesundheitsverhalten zugeordnet. Es wurden unter Berücksichtigung von Geschlecht, Alter, Zusammenleben mit Partner, Ausbildungsdauer und Beschäftigung multiple Regressionsmodelle berechnet. Mittels Trendtest wurden Unterschiede nach der Aufenthaltsdauer untersucht.Ergebnisse: Im Vergleich zum Rest der Studienpopulation schätzen Aussiedler ihre eigene Gesundheit als schlechter ein (OR = 0,68). Sie sind eher übergewichtig (OR = 1,95) und haben häufiger ein ungünstiges Lipidverhältnis (OR = 1,71) (Gesamtcholesterin/ HDL-C>4). Ausserdem nehmen sie weniger an Krebsvorsorgeuntersuchungen teil (OR = 0,41) und sind weniger sportlich aktiv (OR = 0,47). Die beobachteten Unterschiede sind am deutlichsten bei den Aussiedlern, die vor höchstens fünf Jahren nach Deutschland übergesiedelt sind.Schlussfolgerung: Aussiedler sind eine Risikogruppe, die bei Präventions- und Versorgungsmassnahmen berücksichtigt werden sollten. Dies gilt insbesondere für Aussiedler, die sich erst seit kurzem in Deutschland aufhalten.

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Résumé. Différences entre les immigrants de lEurope de lEst dorigine allemande et le reste de la population allemande: état de santé, utilisation des services de santé, et comportement en matière de santé. Une analyse comparative basée sur les données du KORA-Survey 2000Objectifs: Jusquen 2000, environ 4 millions de personnes ont immigré en Allemagne. Ce groupe a fait lobjet de très peu de recherches en santé publique. Lobjectif de cet article est de mettre en évidence les différences sur le plan de létat de santé, de lutilisation des services de santé et du comportement en matière de santé entre les immigrants dEurope de lEst dorigine allemande et le reste de la population allemande, afin de pouvoir développer de nouvelles pratiques de prévention.Méthodes: Sur la base de lenquête KORA 2000 (Kooperative Gesundheitsforschung in der Region Augsburg), une analyse comparative a été menée entre les immigrants et les autres participants de létude,à laide de modèles de régressions multiples tenant compte du sexe, de lâge, du fait que la personne vit seule ou en couple, du nombre dannées de formation et de lactivité professionnelle. Les différences selon les dates dimmigration ont été examinées au moyen de tests de tendance.Résultats: Les immigrants de lEurope de lEst dorigine allemande estiment leur santé plus mauvaise. Ils tendent à être plus en surpoids (OR = 1,95) et à avoir un rapport lipidique défavorable (cholestérol total/cholestérol HDL > 4) (OR = 1,71). Ils utilisent moins les services de dépistage du cancer (OR = 0,41) et ils font moins de sport (OR = 0,47). Ces différences sont particulièrement nettes chez les personnes arrivées en Allemagne depuis moins de cing ans.Conclusions: Les immigrants de lEurope de lEst dorigine allemande représentent un groupe à haut risque. Il faut leur prêter une attention particulière lors de la mise en place de services de soins et de programmes de prévention, particulièrement lorsque ces personnes résident depuis peu de temps en Allemagne.

     

Validating and norming of the Greek SF-36 Health Survey

The main objective of this study was to validate the Greek SF-36 Health Survey and to provide general population normative data. The survey was administered to a stratified representative sample (n=1426) of the general population residing in the broader Athens area and the response rate was 70.6. Statistical analysis, according to documented procedures developed within the IQOLA Project, was performed. The missing value rate was very low, ranging from 0.1 to 1.3 at the item level. Multitrait scaling analysis confirmed the hypothesized scale structure of the SF-36. Cronbachs coefficient met the criterion for group analysis in all eight scales. Known group comparisons yielded consistent support of construct validity of the SF-36. Significant statistical differences in mean scores were observed in relation to demographic and social characteristics such as gender, age, education and marital status.     

A questionnaire to assess the generic and disease-specific health outcomes of patients with chronic hepatitis C

A 69-item questionnaire measuring generic functioning and well-being and disease-specific health outcomes was developed and tested using the pre-treatment data from patients with chronic hepatitis C (CHC) participating in two randomized trials of interferon -2b (n = 157). The questionnaire included all eight scales from the SF-36 and measures of nine other generic and disease-specific health concepts. Psychometric tests confirmed the assumptions underlying the construction and scoring of all generic and disease-specific scales. Cross-sectional tests of known groups validity showed that CHC patients scored worse on the generic scales than patients with other chronic conditions and worse than a healthy general population. The generic and disease-specific scale scores were lower in the presence of physical findings of CHC, as hypothesized, but only the physical functioning and bodily pain scales were linked to cirrhosis or extreme alanine aminotransferase (ALT) ratios. This instrument will be useful in studies of health outcome among patients with CHC, a condition whose health burden appears to have been underestimated in studies to date.     

Validity of the St George's respiratory questionnaire at acute exacerbation of chronic bronchitis: Comparison with the Nottingham health profile

The purpose of the study is to compare a generic and a specific quality of life (QoL) instrument in the assessment of QoL in chronic bronchitis. Data from 320 patients were collected at acute exacerbation of chronic bronchitis (AECB), and from 230 patients during a subsequent stable phase (non-AECB), utilising both the specific St George's respiratory questionnaire (SGRQ) and the generic Nottingham health profile (NHP). Patients (maximum n = 200) reported significantly poorer QoL at AECB than at non-AECB for all domains except the SGRQ symptom domain (SRM = 0.02). The SGRQ was more sensitive than the NHP to QoL differences between patients. The correlations between the scores across the two assessments were generally higher for the SGRQ, with the correlations between the NHP and SGRQ being lower at AECB, suggesting that the instruments are measuring different constructs at AECB, with the SGRQ being less responsive to QoL change. Indeed, the NHP was generally more responsive to QoL change in terms of risk and clinical factors, with the SGRQ symptom domain appearing particularly non-responsive. In conclusion, this study suggests that the condition-specific SGRQ, and particularly its symptom domain, is less responsive than the generic NHP to QoL change accompanying AECB. This reflects the construct of the symptom domain which measures chronic bronchitis symptoms over the previous year.     

Stability of time trade-off utilities for health states associated with the treatment of prostate cancer

Background: Patients diagnosed with localized prostate cancer face several treatment options. Patient preferences for treatment side effects often dominate the decision making process. We proposed to learn more about the nature of patient preferences, or utilities, for these side effects. Methods: Two hundred and fifteen men were consecutively enrolled from three institutions for assessment after prostate needle biopsy. Baseline and 6 month follow-up assessments were done using the University of California, Los Angeles Prostate Cancer Index (UCLA PCI), and a laptop utility assessment application, U-Titer II. Patient utility was assessed for current pelvic functions as well as hypothetical pelvic dysfunctions. We calculated stability of utility scores and correlations between utility scores and UCLA PCI scores. Results: Utility scores for current pelvic functions exhibited a significant ceiling effect. Utility scores for current pelvic functions and hypothetical impaired states were stable after 6 months in patients with negative biopsies. In patients who underwent treatment, utility for current sexual function decreased by 0.13 units (p < 0.00) and utility for current urinary function decreased by 0.09 units (p < 0.01). Utility for hypothetical stress urinary incontinence rose in men with a >25-point drop in UCLA PCI score. Conclusion: Utilities for some current pelvic functions decreased in tandem with UCLA PCI scores in men who experienced >25-point changes in these scores. Utilities for some hypothetical pelvic dysfunctions rose as men began to actually experience functional changes in those areas.     

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.     

Evaluation of patient's Health-Related Quality of Life using a modified and shortened version of the Living With Asthma Questionnaire (ms-LWAQ) and the medical outcomes study, Short-Form 36 (SF-36)

Objective: The specific objectives of this study were to: 1) study the effect of moderate-to-severe asthma on patient's Health-Related Quality of Life (HRQoL) as measured by the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) and 2) evaluate the construct validity of a modified and shortened version of the Living With Asthma Questionnaire (ms-LWAQ) using the SF-36 as a concomitant measure of HRQoL. Methods: Cross-sectional, telephone or mail surveys of asthmatic patients enrolled in two central Florida managed care organizations. Results: All subscales of the SF-36 and four subscales of the ms-LWAQ demonstrated adequate reliability in this population (Cronbach >0.72). The subscales of the SF-36 most affected by patient's asthma were: general health perceptions, vitality and physical role functioning. These three subscales were correlated with four subscales of the ms-LWAQ: consequences, seriousness, affect and leisure. Six of the eight SF-36 subscales and all of the ms-LWAQ subscales were associated with patient's emergency department and hospital utilization. Conclusion: The ms-LWAQ and SF-36 are valid as useful measures of asthma patient's HRQoL in this cross-sectional study. Severity of disease, as measured by health care utilization, was significantly associated with HRQoL.     

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.     

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.     

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.     

Levels of β-HCH,HCB, p,p′-DDE,p,p′-DDT and PCBs in human milk from a continental town in Croatia,Yugoslavia

Summary Concentrations of -HCH, HCB, p,p-DDE, p,p-DDT and PCBs were determined by gas chromatography in 50 human milk samples collected from the general population during 1981/1982 in a continental town in Croatia (Yugoslavia). The samples were collected between one and 22 weeks after delivery from mothers breast-feeding one child only. The mothers' age was 18 to 31 years, and they were nursing their first or second child. All 50 samples contained -HCH, HCB, p,p-DDE and PCBs, whereas p,p-DDT was present in 37 samples. The concentrations of -HCH, HCB, p,p-DDE, p,p-DDT and PCBs expressed on a whole milk basis were (median in g/kg): 11, 7.1, 67, 7.3 and 22 respectively, and expressed on a fat basis (median in mg/kg): 0.28, 0.21, 1.9, 0.18 and 0.62 respectively. The fat content was 3.7% (median). PCBs were present in a mixture containing penta-, hexa- and heptachlorobiphenyls.     

Critical evaluation of polychlorinated biphenyl toxicity in terrestrial and marine mammals: Increasing impact of non-ortho and mono-ortho coplanar polychlorinated biphenyls from land to ocean

Residues of potentially toxic non-ortho chlorine substituted coplanar 3,3,4,4-tetra-,3,3,4,4,5-penta-, 3,3,4,4,5,5-hexachlorobiphenyl and their mono- and di-ortho analogs (2,3,4,4,5-penta-, 2,3,3,4,4-penta-, 2,3,3,4,4,5-hexa-and 2,2,3,3,4,4-hexa-, 2,2,3,4,4,5-hexa-chlorobiphenyl) were determined in humans, dogs, cats (terrestrial), a finless porpoise (Neophocoena phocoenoides-coastal), Dall's porpoises (Phocoenoides dalli,dalli), Baird's beaked whales (Berardius bairdii) and killer whales (Orcinus orca-open ocean). Among the coplanar polychlorinated biphenyl (PCB) congeners, the concentration of the di-ortho congeners was the highest and the non-ortho congeners was the lowest. However, all three coplanar PCBs occurred at significantly higher levels than toxic polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs). The relative bioconcentration and metabolic capacity of terrestrial and marine mammals to these chemicals, suggest that the toxic threat of coplanar PCBs increases from land to ocean, but the reverse is true for PCDDs and PCDFs. The toxic threat of coplanar PCBs to higher aquatic predators such as cetaceans was principally assessed by 2,3,7,8-T₄CDD Toxic Equivalent Analysis which is based on the induction of arylhydrocarbon hydroxylase (AHH) and ethoxyresorufinO-deethylase (EROD). Analysis indicates, in particular, that the bioaccumulation of toxic 3,3,4,4,5-penta- and 2,3,3,4,4-pentachlorobiphenyls in carnivorous marine mammals is a cause for considerable concern.     

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.     

The Nottingham Health Profile: Score distribution, internal consistency and validity in asthma and COPD patients

This cross-sectional study among patients with asthma or Chronic Obstructive Pulmonary Disease (COPD) in general practice examined the psychometric properties of the Nottingham Health Profile (NHP). From 380 asthma patients and 170 COPD patients, data were obtained on the NHP, subjective measurements (i.e. sleep disturbances, problems in performing household activities, dyspnoea) and more objective measurements (peak expiratory flow rate, consultation rate, comorbidity). These data were used to compute score distributions, internal consistency (Cronbach's -coefficient) and construct validity. Score distributions were very skewed, with more than 50% of the patients achieving the best score. The internal consistency was moderate in the asthma group (mean =0.68) and acceptable in the COPD group (mean =0.74). Acceptable construct validity was found in both groups. Correlations between the NHP and the subjective measurements were, in general, statistically significant and higher than between the NHP and the more objective measurements. In conclusion, acceptable internal consistency and construct validity implies that the NHP can be used in cross-sectional studies concerning asthma and COPD patients in general practice, and in studies comparing these patients with other patient populations. Further research on the responsiveness of the NHP is needed to justify its use in longitudinal studies.     

The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): Validation of English version in Singapore

Objective: This study aimed to validate the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30, English version 3.0) in Singaporean cancer patients. Methods: In a cross-sectional study, a heterogeneous sample of cancer patients (n = 57) self-administered a questionnaire containing the QLQ-C30, the Short Form 36 Health Survey (SF-36) and assessing health and sociodemographic status. Construct validity was assessed by testing a priori hypotheses that QLQ-C30 scales would be moderately or strongly correlated with SF-36 scales measuring similar dimensions of health-related quality of life (HRQoL) and that subjects reporting mild symptoms would have better HRQoL scores than those reporting severe symptoms. Internal consistency reliability was assessed using Cronbachs . Results: Strength of Spearmans correlations between the QLQ-C30 and SF-36 scales assessing similar dimensions of HRQoL ranged from 0.35 to 0.67. Subjects with mild symptoms had better scores than those with severe symptoms for all six QLQ-C30 HRQoL scales (p < 0.05 for five scales, Mann–Whitney U tests). Cronbachs ranged from 0.19 for the cognitive functioning scale to 0.91 for the global QoL scale. Conclusion: This study provides preliminary evidence for the validity and reliability of the EORTC QLQ-C30 in English-speaking Singaporean cancer patients.     

Polychlorinated biphenyls: Photolysis of 3,4,3′,4′-tetrachlorobiphenyl and 4,4′-dichlorobiphenyl in solution

Summary The large difference in retention times for the photoproducts of 3,4,34-tetrachlorobiphenyl can be explained on the basis of their chlorine content and the effect of vicinal chlorosubstitution as observed by V. Zitko and coworkers (4).The absence of biphenyl among the photoproducts of 4,4-dichlorobiphenyl was not surprising since 4-chlorobiphenyl (max 203, 253) does not absorb at the wavelength of irradiation (>286), 4,4-dichlorobiphenyl exhibits only marginal absorption at this wavelength (max 201, 259, 286) this explains the low yield of 4-chlorobiphenyl obtained (appx. .1%). The greater reactivity at the meta position may be the result of bond weakening due to steric interactions with the chlorine atom at the para position. Rate studies may provide an answer to this problem.     

Presence of PCB,DDE and DDT in human milk in the provinces of New Brunswick and Nova Scotia,Canada

Summary PCB, p,p-DDE and p,p-DDT residue levels were measured in human milk from New Brunswick and Nova Scotia. Preliminary results indicate that the levels of p,p-DDT and p,p-DDE are higher in the former area, possibly because of the wider use of insecticide sprays in the past. It should be emphasized that because of the limited number of samples analyzed, further work must be done before a significant difference in these areas can be established.     

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.     

Health-related quality of life during the bereavement period of caregivers of a deceased elderly person

Few studies have addressed the health-related quality of life (HRQL) impact of bereavement. The objective of this study was to evaluate the HRQL of the main caregiver after the death of a close elderly relative. 142 caregivers were invited to participate in a phone interview with the SF-36. General population SF-36 norms were used to calculate the gender and age standardised physical component summary (PCS) and mental component summary (MCS) scores. A MCS below 43 was used as an indicator of possible depression. Databases of several patient studies were additionally used to facilitate interpretation of results. 130 caregivers (91.5%) participated, the majority being women (80%), middle aged (56 years), and the spouse (22%) or son/daughter (56%) of the deceased person. Caregivers SF-36 scores were lower than expected for mental health, role emotional and social functioning. Their MCS was below that expected by 0.6 SD units, whereas their PCS was above by 0.2 SD. The proportion of caregivers with possible depression was 33.8%. First-degree family relationship with the deceased (OR=4.5), and lower age of the deceased (OR=3.8) were significantly associated (p<0.02) to a possible depression. The recent death of an elderly person is associated with significant emotional health impact on the caregiver.The members of the Dying Elderly in Catalonia Study Group are: Alonso J., Camp L., Florensa E. Gómez-Batiste X., González C., Mascaró J., Pujol R., Ramon I., Rebollo P., Riquelme M., Sáiz N., Santed S., Subirats. E., Vila T. and Vilagut G.