Psychometric properties of the PROMIS® pediatric scales: precision,stability, and comparison of different scoring and administration options

Objectives

The objectives of the present study are to investigate the precision of static (fixed-length) short forms versus computerized adaptive testing (CAT) administration, response pattern scoring versus summed score conversion, and test–retest reliability (stability) of the Patient-Reported Outcomes Measurement Information System (PROMIS^®) pediatric self-report scales measuring the latent constructs of depressive symptoms, anxiety, anger, pain interference, peer relationships, fatigue, mobility, upper extremity functioning, and asthma impact with polytomous items.

Methods

Participants (N = 331) between the ages of 8 and 17 were recruited from outpatient general pediatrics and subspecialty clinics. Of the 331 participants, 137 were diagnosed with asthma. Three scores based on item response theory (IRT) were computed for each respondent: CAT response pattern expected a posteriori estimates, short-form response pattern expected a posteriori estimates, and short-form summed score expected a posteriori estimates. Scores were also compared between participants with and without asthma. To examine test–retest reliability, 54 children were selected for retesting approximately 2 weeks after the first assessment.

Results

A short CAT (maximum 12 items with a standard error of 0.4) was found, on average, to be less precise than the static short forms. The CAT appears to have limited usefulness over and above what can be accomplished with the existing static short forms (8–10 items). Stability of the scale scores over a 2-week period was generally supported.

Conclusion

The study provides further information on the psychometric properties of the PROMIS pediatric scales and extends the previous IRT analyses to include precision estimates of dynamic versus static administration, test–retest reliability, and validity of administration across groups. Both the positive and negative aspects of using CAT versus short forms are highlighted.     

Association between residents’ perception of the neighborhood’s environments and walking time in objectively different regions

Objective The purpose of this study is to delineate the association between residents’ perception of the neighborhood’s environments and walking time in objectively different regions in Japan. Methods Two regions were selected as high and low walkable regions on the basis of differences in their residential density, mixed land use and street connectivity. The subjects in this study were participants in a health promotion program focused on walking sponsored by local governments. A questionnaire was sent to the participants asking about how their perception of the neighborhood’s environment related to walking, and the time spent walking per week. There were 237 residents from the high walkable region and 195 from the low walkable region who completed the study survey. Results The high walkable region had a larger residential density, a high mixed land use and a higher street connectivity than the low walkable region. Walking time, and the scores of the perception of the neighborhood’s environment for the high walkable region residents were significantly higher than those for the low walkable region residents. Thus, residents’ perception of the neighborhood’s environment generally reflected the actual physical environmental characteristics. Residents in the high walkable region whose scores for accessibility and aesthetics were high, spent significantly more walking time. Residents in the low walkable region whose scores for accessibility, safety, convenience and aesthetics were high, spent significantly more walking time. Conclusion The study results suggested that the neighborhood’s environment may influence daily walking time. The perceptions of the neighborhood’s environmental factors that correlate with walking times differ between the different regional physical environments. Therefore, to promote physical activity, the consideration of environmental factors unique to residents’ neighborhood’s environments is needed.     

Agreement between web-based and paper versions of a socio-demographic questionnaire in the NutriNet-Santé study

Objectives  

Web-based studies nowadays raise a major interest as they can improve all steps involved in observational studies. Our objective was to compare the web-based version of the NutriNet-Santé self-administered socio-demographic and economic questionnaire with the traditional paper version.     

Assessing responsiveness over time of the PROMIS® pediatric symptom and function measures in cancer,nephrotic syndrome,and sickle cell disease

Quality of Life Research - Previous studies provided evidence for the validity of the PROMIS Pediatric measures in cross-sectional studies. This study evaluated the ability of the PROMIS Pediatric...     

Comparison between spontaneous sedimentation method and Paratest® for the diagnosis of intestinal parasitic infections

Correct diagnosis of parasitic infections is essential for the treatment of individuals avoiding indiscriminate use of anthelmintics which increases drug resistance. In a comparative study between the spontaneous sedimentation technique and Paratest^®, 140 stool samples were analyzed for the detection of parasites. The prevalence was 12.7% obtained by the spontaneous sedimentation method but only 5.7% using Paratest^®. Paratest^® has shown a high proportion of false-negative results, lower sensitivity and negative predictive values compared with the spontaneous sedimentation method. Further optimization and studies of the Paratest^® method are necessary for wider use in clinical diagnosis.     

Evaluation of Cuprimine® and Syprine® for decorporation of radioisotopes of cesium, cobalt, iridium and strontium

Cuprimine? and Syprine? are therapeutics approved by the USFDA to treat copper overload in Wilson Disease (a genetic defect in copper transport) by chelation and accelerated excretion of internally-deposited copper. These oral therapeutics are based on the respective active ingredients D-penicillamine (DPA) and N,N'-bis (2-aminoethyl) -1,2-ethanediamine dihydrochloride (Trien). Cuprimine is considered the primary treatment, although physicians are increasingly turning to Syprine as a first-line therapy. Both drugs exhibit oral systemic activity and low toxicity; their biological effects and safety are established. Previous in vivo studies using a rodent animal model established the decorporation potential of Cuprimine and Syprine for (60)Co and (210)Po. Currently these studies are being expanded to evaluate the in vivo decorporation efficacy of these drugs for several additional radionuclides. In this report, results of this investigation are discussed using the radionuclides (137)Cs, (60)Co, (192)Ir and (85)Sr. Short-term 48-h pilot studies were undertaken to evaluate DPA and Trien for their in vivo decorporation potential using male Wistar-Han rats. In these studies, a radionuclide solution was administered to the animals by intravenous (IV) injection, followed by a single IV dose of either DPA or Trien. Control animals received the radionuclide alone. Results show effective decorporation of (60)Co by DPA within the time frame evaluated. DPA and Trien were also modestly effective in decorporation of (137)Cs and (85)Sr, respectively. The study did not find DPA or Trien effective for decorporation of (192)Ir. Based on these encouraging findings, further studies to evaluate the dose-response profiles and timing of the chelator administration post exposure to radionuclides are warranted.     

Nowhere to play? The relationship between the location of outdoor play areas and deprivation in Glasgow

Childhood obesity is rising and this rise has been linked to a decrease in physical activity. Access to appropriate facilities for physical activity is a key determinant of participation. This paper investigates the provision of outdoor play areas for children in relation to area deprivation in Glasgow, Scotland. Analysis of the distribution of outdoor play areas showed significantly higher mean number of play areas per 1000 child population in more deprived areas. However, despite the apparent advantage of deprived areas in terms of actual number of play areas, the quality of play areas in different types of areas may warrant further exploration.     

Are reliability, reproducibility and validity the correct terms to assess the correctness of dietary studies?

Nutritional studies often use the terms reliability, reproducibility and validity to indicate the correctness of the study. These terms do not appear to have a universal meaning to all researchers. The components of a dietary study are the input, the data collection instrument and the compiled data. Frequently the data collection questionnaire/tool/instrument is tested for reliability, reproducibility or validity. The data collection questionnaire/tool/instrument is simply a structure, a vehicle for gathering data. An argument is presented that demonstrates the reasons that such a structure cannot be tested for reliability, reproducibility or validity. The logical approach to the use of the terms reliability, reproducibility and validity is presented. Reliability refers to the input component of the study, reproducibility may or may not lead to strengthening the study and validity refers to the truthfulness of the database generated. Validity must be derived from reliable and reproducible data.     

The overdiagnosis of what? On the relationship between the concepts of overdiagnosis,disease, and diagnosis

Overdiagnosis and disease are related concepts. Widened conceptions of disease increase overdiagnosis and vice versa. This is partly because there is a close and complex relationship between disease and overdiagnosis. In order to address the problems with overdiagnosis, we may benefit from a closer understanding this relationship. Accordingly, the objective of this article is to elucidate the relationship between disease and overdiagnosis. To do so, the article starts with scrutinizing how overdiagnosis can explain the expansion of the concept of disease. Then it investigates how definitions of disease address various challenges of overdiagnosis. The article specifically investigates recent attempts to clarify the relationship between the concepts of disease and overdiagnosis. Several shortcomings are identified and lead to a closer analysis of overdiagnosis in the diagnostic process. Contrary to recent contributions to the field, it is argued that cases of overdiagnosis are not cases of disease. They are non-verified labelling of disease. It is revealed how overdiagnosis establishes an unwarranted link between indicative phenomena, such as polyps or cell changes, and harm, and thereby generates a link to disease. One implication of this study is that we should stop attributing disease language to indicative phenomena. That is, we should stop calling it “cancer screening” when we are actually searching for polyps. Another implications is that we should strive for scientific progress in differentiating phenomena that are of negative value to us from those that are not. In overdiagnosis we diagnose something that is not disease: it is over-diagnosis.     

Dietary supplementation of different doses of NUTRIOSE®FB, a fermentable dextrin, alters the activity of faecal enzymes in healthy men

BACKGROUND: It is well documented that fermentation of carbohydrates that escape digestion exert several effects supposed to be beneficial for (colonic) health, including an increase in stool volume, a shorter intestinal transit time, production of short chain fatty acids and a decrease of colonic pH (Kritchevsky 1988). NUTRIOSE FB is a dextrin that is not completely hydrolysed and absorbed in the small intestine, due to many alpha-1.6 linkages and the presence of non-digestible glucoside linkages (e. g. alpha-1.2 and alpha-1.3). To be beneficial for 'colonic' health effective NUTRIOSE FB must reach the cecum in some form. AIM OF THE STUDY: To estimate how much non digested NUTRIOSE FB is fermented and to determine the fibre-like effect of the wheat dextrin NUTRIOSE((R))FB by analysing enzymatic activity in faeces. METHODS: In a randomized, double-blind,multiple dose, placebo-controlled, combined cross-over and parallel trial, 20 healthy men (age 31.7 +/- 9.1 yrs; BMI 24.5 +/- 2.9 kg.m(-2) received different treatments. One group of ten subjects consumed on top of their diet 10, 30 and 60 g daily of NUTRIOSE FB or maltodextrin (placebo). The other group of 10 subjects consumed 15, 45 and 80 g daily. Each dose was consumed for 7 days. On the last two days of each of the 7-day period, faeces were collected in which the enzymatic activity and NUTRIOSE FB residue were analysed. RESULTS: As expected, the faecal residue of NUTRIOSE FB non-linearly increased with the dose of NUTRIOSE FB to approximately 13% of 80 g/d. Compared with the placebo, 30, 45, 60 and 80 g/d of NUTRIOSE FB increased the concentration of alpha-glucosidase significantly. All daily doses of NUTRIOSE FB (10 g/d to 80 g/d) led to significant changes in concentration of beta-glucosidase. CONCLUSIONS: The small amount of the residue of NUTRIOSE FB in the faeces suggests that approximately 87% or more of NUTRIOSE FB is digested or fermented in the gastrointestinal tract. Fermentation of NUTRIOSE FB led to an increased faecal concentration of alpha- and beta-glucosidase.     

Do social inequalities exist in terms of the prevention,diagnosis, treatment,control and monitoring of diabetes? A systematic review

The major increase in the prevalence of diabetes mellitus (DM) has led to the study of social inequalities in health-care. The aim of this study is to establish the possible existence of social inequalities in the prevention, diagnosis, treatment, control and monitoring of diabetes in Organisation for Economic Co-operation and Development (OECD) countries which have universal healthcare systems. We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for all relevant articles published up to 15 December 2007. We included observational studies carried out in OECD countries with universal healthcare systems in place that investigate social inequalities in the provision of health-care to diabetes patients. Two independent reviewers carried out the critical assessment using the STROBE tool items considered most adequate for the evaluation of the methodological quality. We selected 41 articles from which we critically assessed 25 (18 cross-sectional, 6 cohorts, 1 case-control). Consistency among the article results was found regarding the existence of ethnic inequalities in treatment, metabolic control and use of healthcare services. Socioeconomic inequalities were also found in the diagnosis and control of the disease, but no evidence of any gender inequalities was found. In general, the methodological quality of the articles was moderate with insufficient information in the majority of cases to rule out bias. This review shows that even in countries with a significant level of economic development and which have universal healthcare systems in place which endeavour to provide medical care to the entire population, socioeconomic and ethnic inequalities can be identified in the provision of health-care to DM sufferers. However, higher quality and follow-up articles are needed to confirm these results.     

Are variance components of exposure heterogeneous between time periods and factories in the European carbon black industry?

Occupational exposure to chemical agents can vary enormously within- and between-workers, even when carrying out the same jobs. When repeated measurements are available, the variance components can be estimated using random- or mixed-effects models. Pooling the variance components across the fixed effects, in mixed-effects models, reduces the complexity of the models; especially, when there are a large number of fixed effects. The analyses presented in this paper tested the assumptions of homogeneity in the variance components between factories and surveys for inhalable dust exposure in the European carbon black manufacturing industry. In total, 5296 measurements from 1771 workers were available collected during two surveys carried out between 1991 and 1995. Workers were grouped into eight job categories, and for each of these separate mixed-effects models were developed, including factory, survey and in some cases the interaction term as the fixed effects. The likelihood ratio test was used to test the assumptions of homogeneity of the variance components. Statistically significant heterogeneity of the variance components was observed for two of the eight job categories, 'Fitter/Welder' and 'Warehouseman'. The heterogeneity was due mainly to differences in variance between the factories. When estimating the probability of overexposure for all the factories combined, there was little difference between the models with and without heterogeneous variance components for 'Fitters/Welders'. For the 'Warehousemen' the probability of overexposure in the last survey changed marginally from 4% in the pooled model to 6% in the heterogeneous model. Larger differences between the models were observed when estimating the probability of overexposure for individual factories, which was due to over- or under-estimation of the variance components in the pooled models. In conclusion, for most job categories pooling of the variance components appears to be justified in this database. In addition, no large differences were found when determining the industry-wide probability of 'overexposure' when comparing the pooled with the heterogeneous models. However, when evaluating the factory-specific probability of 'overexposure' or when using the models to provide exposure estimates for epidemiological studies heterogeneity in the variance components should be investigated.     

Healthy and happy in Europe? On the association between happiness and life expectancy over time

This paper revisits the standard finding in individual-level studies that happiness leads to longevity. It does so in a cross-country time-series analysis in which the use of a random effects estimator controls for most relevant time-invariant factors. The findings suggest that happiness is negatively associated with longevity at the national level, and suggests a potential indirect transmission channel, as national happiness is negatively associated with public health expenditures. The paper concludes by discussing the implications of the results for public policy and future research.     

Health inequalities between lone and couple mothers and policy under different welfare regimes – The example of Italy,Sweden and Britain

This study examines the welfare state arrangements and social policy, living conditions and health among lone and couple mothers in three contrasting policy environments: Italy, Sweden and Britain. These countries fall into distinctive family policy categories. Data were drawn from representative national household interview surveys. The findings highlight both similarities and differences. Lone mothers had significantly worse health than couple mothers in all three countries, were more likely to suffer material disadvantage and were much more likely to be smokers. They could be considered a disadvantaged group in particular need in all three countries, irrespective of the policy regime. It is the differences between countries, however, in the experiences of lone and couple mothers that indicate that the prevailing policy regime really does matter. There were telling differences in the prevalence of lone motherhood, their composition, rates of joblessness, poverty and health status of lone mothers in relation to couple mothers in each country. These may be traced back to the main policy regimes of each country, but also partly reflect culture and traditions. The study illustrates an emerging approach to investigating the health inequalities impact of complex social policy contexts. The experiences of lone mothers as a group may serve as a ‘litmus’ test of how each family policy system is operating and offer an early warning of adverse impacts when policies change.