The Adolescent Health Review: a brief, multidimensional screening instrument.

PURPOSE: To develop a brief, multidimensional screening instrument for adolescents that addresses psychosocial domains critical to adolescent preventive health care services. METHODS: Secondary analyses were conducted on survey data obtained in 1995 from a school sample of 76,159 students in grades 9 and 12, as well as 893 adolescents from juvenile correctional facilities, 500 adolescents from chemical dependency treatment programs, and 575 adolescents from residential behavioral treatment programs. A comprehensive set of 300 survey items was used in a series of discriminant analyses to determine which items best distinguished males and females in each clinical sample from their counterparts in the school sample. RESULTS: The item selection for the Adolescent Health Review was guided both by empirical analyses and clinical judgment. The final screen is comprised of 33 demographic and clinical items that address a variety of psychosocial domains. The computerized, self-administered screen can be completed in about 3 minutes. The screen is scored automatically and produces an easy-to-read risk-assessment profile. Because screening items were drawn from a large epidemiologic survey, normative profiles are available for each age and gender subgroup. CONCLUSIONS: A brief, empirically derived screening instrument, designed to address a range of adolescent risks, offers an opportunity for information gathering that otherwise might not be incorporated into routine clinic visits.     

Patient-physician fit: an exploratory study of a multidimensional instrument.

BACKGROUND: Patients face difficulty selecting physicians because they have little knowledge of how physicians' behaviors fit with their own preferences. OBJECTIVE: To develop scales of patient and physician behavior preferences and determine whether patient-physician fit is associated with patient satisfaction. DESIGN: Two cross-sectional surveys of patients and providers. SETTING: Ambulatory clinics at a university medical center. Participants. Eight general internists, 14 family physicians, and 193 patients. MEASUREMENTS: Two instruments were developed to measure 6 preferences for physician behaviors: 1) considering nonmedical aspects of the patient's life, 2) familiarity with herbal medicine, 3) physician decision making, 4) providing information, 5) considering the patient's religion, and 6) treating what the patient perceives as his or her problem. Patients reported how they would prefer physicians to behave, and physicians reported how they preferred to behave. Patients also rated satisfaction with their physician. RESULTS: Post hoc tests found that as a group, patients scored higher than physicians in preference for the physician to provide information and lower in preference for considering nonmedical aspects of the patient's life and religious beliefs. As hypothesized, preference differences accounted for significant variance in satisfaction in overall tests (19% in the family medicine patients and 25% in internal medicine patients). Greater satisfaction was associated with fit between patient and physician preferences for physician decision making (in the internal medicine patients) and with fit in providing information and consideration of religion (in family medicine patients) CONCLUSIONS: Patients often prefer behaviors other than how their physicians prefer to behave. Preference fit is associated with enhanced patient satisfaction. Physicians should attend to whether patients want religion and other nonmedical aspects of their lives considered. Health plans may wish to provide tools to help patients choose physicians by fit.     

The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function

This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.     

The AMC Linear Disability Score (ALDS): a cross-sectional study with a new generic instrument to measure disability applied to patients with peripheral arterial disease

Background  

The AMC Linear Disability Score (ALDS) is a calibrated generic itembank to measure the level of physical disability in patients with chronic diseases. The ALDS has already been validated in different patient populations suffering from chronic diseases. The aim of this study was to assess the clinimetric properties of the ALDS in patients with peripheral arterial disease.     

The acquired immunodeficiency syndrome (AIDS): Memorandum from a WHO Meeting

An International Conference on Acquired Immunodeficiency Syndrome (AIDS), sponsored by the United States Department of Health and Human Services and the World Health Organization, was held in Atlanta on 15-17 April 1985. More than 3000 participants from 50 countries attended. This conference was followed by a meeting organized by WHO on 18-19 April where the participants reviewed the information presented at the conference and assessed its international health implications, which are described in this Memorandum.     

The Swiss Health Literacy Survey: development and psychometric properties of a multidimensional instrument to assess competencies for health

Background Growing recognition of the role of citizens and patients in health and health care has placed a spotlight on health literacy and patient education. Objective To identify specific competencies for health in definitions of health literacy and patient‐centred concepts and empirically test their dimensionality in the general population. Methods A thorough review of the literature on health literacy, self‐management, patient empowerment, patient education and shared decision making revealed considerable conceptual overlap as competencies for health and identified a corpus of 30 generic competencies for health. A questionnaire containing 127 items covering the 30 competencies was fielded as a telephone interview in German, French and Italian among 1255 respondents randomly selected from the resident population in Switzerland. Findings Analyses with the software MPlus to model items with mixed response categories showed that the items do not load onto a single factor. Multifactorial models with good fit could be erected for each of five dimensions defined a priori and their corresponding competencies: information and knowledge (four competencies, 17 items), general cognitive skills (four competencies, 17 items), social roles (two competencies, seven items), medical management (four competencies, 27 items) and healthy lifestyle (two competencies, six items). Multiple indicators and multiple causes models identified problematic differential item functioning for only six items belonging to two competencies. Conclusions The psychometric analyses of this instrument support broader conceptualization of health literacy not as a single competence but rather as a package of competencies for health.     

Global index of safety (GIS): a new instrument to assess drug safety.

There is an asymmetry between the extraordinary development of measures and tools aimed at studying the beneficial effects of the drugs and the more limited methods to assess their safety profile. The goal of our study was to develop a global measuring tool to assess drugs' safety. We conducted a survey of Spanish psychiatrists in mental health centers and outpatient treatment units to assess the severity scores that they would assign to a list of the most common adverse events (AEs) that usually occur with antipsychotic treatment. The severity scores were then applied to the list of AEs that really occurred along a naturalistic pharmacoepidemiological study on the use of different antipsychotics in the treatment of schizophrenia. The Global Index of Safety (GIS) of the experimental group treated with olanzapine (OLZ) was compared with the GIS of the control group and with the GIS of specific antipsychotics for which the number of treated patients was greater than 100. A total of 194 psychiatrists rated the severity of each AE on a scale of 1 (insignificant) to 5 (extremely severe). The individual severity was applied to the 2949 schizophrenic patients included in a pharmacoepidemiological study. A GIS was calculated for every group of patients receiving the same treatments. The GIS of the control group was higher (4.3) than that calculated from the experimental group (2.5) (P < 0.001). The GIS of the risperidone (3.6) and haloperidol (6.0) subgroups were higher than that calculated from the OLZ group (P < 0.001). The development of a GIS may facilitate the comparison of the safety of several drugs and may constitute a very valuable aid for those involved in selecting drugs.     

The clinical eating disorder rating instrument (CEDRI): A preliminary description

A new interview based clinical rating scale for use with eating disordered patients is described. Two preliminary studies of interrater reliability gave satisfactory results. The Clinical Eating Disorders Rating Instrument (CEDRI) is offered as a possible tool for both clinical and research use.     

The DSFI: a multidimensional measure of sexual functioning

The present report summarizes work to date on the Derogatis Sexual Functioning Inventory (DSFI), a multidimensional measure of human sexual functioning. We discuss the rationale for the test as well as the selection of the primary domains of measurement. Reliability coefficients for the various subtests are given, and a review section on validation studies is provided, including a factor analysis, predictive validation, and discriminant function analyses. Prototypic clinical profiles are also provided for several of the major types of sexual dysfunction.     

The weight-specific adolescent instrument for economic evaluation (WAItE): psychometric evaluation using a Rasch model approach

Quality of Life Research - The Weight-specific Adolescent Instrument for Economic evaluation (WAItE) is a 7-item condition-specific tool assessing the impact of weight status on seven dimensions of...     

Disparities in the prevalence of obesity in Boston: results from the Boston Area Community Health (BACH) survey

Objective

This study examined disparities in the prevalence of obesity to determine how future prevention and/or intervention efforts should be developed to remedy obesity.

Methods

We obtained individual information of sociodemographic characteristics, comorbid conditions, and lifestyle behaviors from the Boston Area Community Health (BACH) survey for 2002–2005. To account for the complex BACH sampling design, observations were weighted inversely to their probability of selection, and sampling weights were poststratified to the Boston population from the U.S. Census 2000. We tested all possible two- and three-way interaction terms from a multivariate logistic regression model.

Results

After controlling for individual determinants in detail and focusing on the population within a single city, the associations of sociodemographic characteristics, comorbid conditions, and lifestyle behaviors with obesity were consistent with previous findings. Notably, three two-way interaction terms were significantly associated with obesity: (1) race/ethnicity and gender, (2) gender and other people in the household, and (3) race/ethnicity and alcohol consumption.

Conclusions

Future obesity prevention and/or intervention programs in Boston need to be primarily gender- and racially/ethnically specific to minimize cost and maximize results. Additional considerations are needed to take into account the differences in age, the presence of other people in the household, and education level.In the United States, the prevalence of obesity (defined as a body mass index [BMI] of ≥30 kilograms per meter squared [kg/m²]) has continued to increase during recent decades. The prevalence of obesity grew from 22.9% to 30.5% between the 1988–1994 and 1999–2000 National Health and Nutrition Examination Surveys.¹ This increasing trend was observed across gender, age, racial/ethnic minority groups, and other sociodemographic characteristics.² Regional variations are evident in the U.S., where the prevalence of obesity was higher in the South and Midwest and lower in the Northeast and West.³ Although a recent study indicated a change in the relationship between obesity and disabilities over time,⁴ the obese population is consistently at a higher risk of cardiovascular disease, stroke, hypertension, diabetes, and other health threats.⁵ With these health complications, obese individuals are confronting an economic burden associated with higher health-care and/or medical costs.^6,7 Moreover, they face a lower life expectancy and are associated with increased mortality relative to those with a normal weight (BMI of 18.5 to <25.0 kg/m²).^8,9 A recent study showed that obesity yields a significant increase in both cardiovascular disease- and cancer-related mortality.¹⁰Because of the health implications of obesity, effective prevention and/or intervention programs are deemed necessary to remedy obesity.^11,12 Such efforts require a comprehensive understanding of health inequalities and disparities among the population. In the U.S., significant differences are already evident by gender, age, race/ethnicity, and socioeconomic status (SES) (i.e., level of education and income).^13,14 In general, women, middle-aged adults, black people, those with low educational attainment, and/or low-income individuals are more likely to be obese. Additionally, lifestyle behaviors (e.g., smoking habits, drinking patterns, and exercise routines) are known to greatly influence body weight. For instance, individuals who are cigarette smokers and moderate alcohol drinkers have a lower BMI relative to nonsmokers and non-alcohol drinkers, respectively.^15,16 Those who engage in a high level of physical activity (i.e., those in a physically active occupation and those who exercise regularly during leisure time) are also less likely to become obese.¹⁷Although these national studies are informative to a certain extent, the relationship of obesity to socio-demographic characteristics, comorbid conditions, and lifestyle behaviors is complex and dynamic. In the U.S., dramatic obesity disparities exist in the intersection among gender, race/ethnicity, and SES. For example, a higher prevalence of obesity is evident among women, racial/ethnic minority groups, and those of low SES. The underlying factors for such disparities have been associated with the differences in stress-coping strategies, occupation-related lifestyle disorders, cultural norms, as well as home and residential settings.¹⁸ Therefore, to successfully implement future obesity prevention and/or intervention efforts, identifying the target population becomes crucial to minimize cost and maximize results. Doing so requires a better understanding of the prevalence of obesity and associated disparities at greater individual detail and in a specific geographic location. Such studies can provide local authorities, decision makers, and public health professionals with insight on resource allocation.To date, only a limited number of studies have been conducted in this capacity. Hence, this study attempts to fill this gap by examining the disparities in the prevalence of obesity in Boston, Massachusetts, using a community-based epidemiologic survey.     

The AIDS Clinical Trials Information Service (ACTIS): a decade of providing clinical trials information

The AIDS Clinical Trials Information Service (ACTIS) is a central resource for information about federally and privately funded HIV/AIDS clinical trials. Sponsored by four components of the U.S. Department of Health and Human Services, ACTIS has been a key part of U.S. HIV/AIDS information and education services since 1989. ACTIS offers a toll-free telephone service, through which trained information specialists can provide callers with information about AIDS clinical trials in English or Spanish, and a website that provides access to clinical trials databases and a variety of educational resources. Future priorities include the development of new resources to target diverse and underserved populations. In addition, research needs to be conducted on the use of telephone services vs. Web-based information exchange to ensure the broadest possible dissemination of up-to-date information on HIV infection and clinical trials.