A Study of the Construct Validity of the Health Utilities Index Mark 3 (HUI3) in Patients with Schizophrenia

This study assessed the construct validity of the Health Utilities Index Mark 3 (HUI3) in patients with schizophrenia. Patients with schizophrenia recruited from a tertiary mental hospital in Singapore completed the HUI3, the Short-Form 36 Health Survey (SF-36) and the Schizophrenia Quality of Life Scale (SQLS). Patients were assessed for presence and absence of 22 common psychiatric symptoms. Construct validity was assessed using 6 a priori hypotheses. Two hundred and two patients (mean age: 37.8 years, female: 52%) completed the survey. As hypothesized, overall HUI3 utility scores were correlated with SF-36 measures (Spearman’s rho: 0.19 to 0.51), SQLS scales (Spearman’s rho: −0.56 to −0.36), and the number of psychiatric symptoms (Spearman’s rho: −0.49). The HUI3 emotion attribute was moderately correlated with SF-36 mental health (Spearman’s rho: 0.45) and SQLS psychosocial scales (Spearman’s rho: −0.43), and HUI3 pain attribute was strongly correlated with SF-36 bodily pain scale (Spearman’s rho: 0.58). The mean HUI3 overall, emotion, cognition, and speech scores for patients with schizophrenia were 0.07, 0.09, 0.04 and 0.04 points lower than respective age-, sex- and ethnicity-adjusted population norms (p<0.001 for all, ANCOVA). This study provides evidence for the construct validity of the HUI3 in patients with schizophrenia.     

Validation of the Chinese version of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) in Taiwanese patients with schizophrenia

We tested the reliability, sensitivity, and validity of a Chinese translation of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4). One hundred Taiwanese individuals with schizophrenia were recruited. The internal consistency reliability was satisfactory for both the psychosocial and vitality domains (Cronbach’s α = 0.92, 0.84). The test–retest reliability was also high (psychosocial: ICC = 0.84, vitality: ICC = 0.84) for those individuals whose psychological conditions remained stable between the two-week interval. However, the responsiveness coefficient for those with considerable changes in psychological conditions ranged from very small to moderate, suggesting either low responsiveness for the vitality domain or a complex relationship between the change of psychological conditions and quality of life, and the need to estimate responsiveness more conclusively in a future intervention study. The convergent validity was supported by moderate-to-large correlations between domains measuring related constructs of the SQLS-R4 and SF-36 (r = −0.65 to −0.67). Overall, the results of this study provide preliminary evidence for the reliability and validity of the SQLS-R4 used in Taiwanese individuals with schizophrenia. This study provides a common ground for international researchers to understand quality of life in Taiwanese patients with schizophrenia.     

A randomized validation study comparing embedded versus extracted FACT Head and Neck Symptom Index scores

Objective To evaluate the impact of administration context (embedded versus stand-alone) on the reliability and validity of the FACT Head and Neck Symptom Index (FHNSI). Methods Ninety-eight patients with head and neck cancer were randomized to one of two assessment conditions to evaluate the FHNSI’s context (items administered embedded within the FACT-H&N or as stand-alone scale) and order of administration in the battery. Results Planned comparisons on the item and scale levels revealed no systematic order or context differences. The embedded and stand-alone versions of the FHNSI showed high internal consistency (Cronbach's alpha 0.79–0.87). Correlations were high between the FHNSI versions and the physical and functional well-being scales of the FACT-H&N (0.70–0.84) and measures of pain intensity (−0.73, −0.74) and depression (−0.71, −0.74); moderate to large with the Performance Status Scale for Head and Neck subscales (PSS-HN; 0.46–0.71); and low with an anxiety measure (0.30, 0.34). Both FHNSI versions differentiated patients grouped by performance status (p < .0001, p < .0001) and global rating of change (p < .0001, p < 0.01). The FHNSI's minimally important difference range was 3–4 points. Conclusion The FHNSI is a reliable and valid symptom index, which can be administered alone or scored using items embedded within the FACT-H&N. Athanassios Argiris—Formerly of Feinberg School of Medicine, Northwestern University, Chicago, IL.     

Reliability and validity of the Pediatric Quality of Life Inventory™ (PedsQL™) Short Form 15 Generic Core Scales in Japan

Objective To assess the reliability and validity of the Japanese translation version of the Pediatric Quality of Life Inventory™ 4.0 Short Form 15 (PedsQL™ 4.0 SF15). Methods The PedsQL™ 4.0 SF15 was administered to 229 schoolchildren aged 6–13 years and 100 pediatric outpatients aged 5–18 years and their parents. Results Internal consistency reliability exceeded 0.70 for both proxy-reported and self-reported scales. Test–retest reliability demonstrated large values for parent proxy-report (range: 0.68–0.79) and moderate to large values for child self-report (range: 0.46–0.73). Parent proxy-report health-related quality of life (HRQOL) was higher than child self-report in all scales except for School Functioning. The correlations between the reports of the parents and children were moderate to high. Gender differences were observed in Social Functioning, School Functioning, and Psychosocial Health Summary, with girls reporting higher HRQOL than boys. Factor analysis indicated that four factors were extracted from the PedsQL™ 4.0 SF15 and these four factors corresponded mainly to the four scales. Known groups validity was established for proxy-report and self-report with higher HRQOL being reported for healthy children than those with psychosomatic complaints including headache and abdominal pain. Conclusion The Japanese translation version of the PedsQL™ 4.0 SF15 demonstrates good reliability and validity and could be used as a measure of HRQOL for transcultural comparisons of pediatric research in school settings and healthcare services research.     

Measuring Psychological Consequences of Screening: Adaptation of the Psychological Consequences Questionnaire into Dutch

Objective: To assess the psychometric properties of a Dutch adaptation of an originally Australian instrument measuring the psychological impact of breast cancer screening. Methods: The three subscales (emotional, physical, social) of the Psychological Consequences Questionnaire (PCQ) underwent formal linguistic and cultural translation. A total of 524 women under intensive surveillance because of increased breast cancer risk were asked to complete the questionnaire at 2 months prior to screening, at the day of the screening visit preceding the screening, and 1–4 weeks after screening. Acceptability, score distribution, internal consistency, scale structure, responsiveness to change and construct validity were analysed. Results: Response rates were high (98–94%) and there were very few missing answers and non-unique answers. All scales had Cronbach’s αs > 0.70. The physical and social subscale showed ceiling effects. The item-own scale correlations were only slightly higher than the corresponding item-other scale correlations. Factor analysis showed that the assumed three separate subscales were replicated in our study. Pre- and post-screening effect sizes for the emotional scale were larger than for the other two scales. All PCQ scales correlated with the scales of two other psychological measures (p ≤ 0.01). The emotional scale and the total PCQ score were able to differentiate between subgroups varying in affective risk perception (p ≤ 0.01). Conclusion: The Dutch PCQ is useful in measuring psychological impact among women under intensive surveillance because of high breast cancer risk.     

Reliability, validity and responsiveness of the German Short Musculoskeletal Function Assessment Questionnaire in patients undergoing surgical or conservative inpatient treatment

Objective: The patient-based evaluation of outcome is gaining increased importance. The aim of the study was to demonstrate the reliability, validity and responsiveness of the German version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA-D) in patients undergoing surgical or conservative treatment. Methods: Three hundred and thirty-two patients suffering from osteoarthritis of the hip or knee, rheumatoid arthritis or rotator cuff tear undergoing surgical or medical inpatient treatment were followed up for 12 month. Patients underwent both SMFA-D and other assessments and clinical as well as radiological examinations. Reliability, validity and responsiveness of the SMFA-D were evaluated. Results: Values of the SMFA-D subscales, Function index (M 22–49, SD 12–20, range 0–96) and Bother index (M 29–52, SD 15–23, range 0–100), showed a normal distribution. Internal consistency (0.88–0.97) and retest reliability (0.71–0.96) coefficients were satisfactory to excellent. In most cases, the SMFA-D correlated significantly with function tests, physicians’ function ratings, patients’ pain ratings and other quality-of-life questionnaires in all patient subgroups. The results support both the construct and criterion validity of the measure. Different patient groups and subgroups could be discriminated with the SMFA-D scales. The standardized response means of SMFA-D subscales were in surgical patients better than in conservatively treated patients and comparable to those of the SF-36 Physical Component Summary scale. Conclusions: The German version of SMFA is a reliable, valid and responsive questionnaire in patients with osteoarthritis of the hip or knee, rheumatoid arthritis or rotator cuff tear undergoing surgical or medical inpatient treatment. Thus, the use of the SMFA-D in these patients can be recommended.     

A new treatment satisfaction measure for asthmatics: A validation study

The Patient Satisfaction with Asthma Medication (PSAM) questionnaire was developed because no treatment satisfaction questionnaire could be identified that was comprehensive yet brief enough for use in clinical trials. Adult moderate asthmatics residing in Canada using an inhaled medication (either salmeterol, formoterol, or albuterol) self-administered the questionnaire, which also included the Asthma Quality of Life Questionnaire (AQLQ). A total of 53 asthmatics (70% female, 45% married, mean age: 47 years) completed the questionnaire. Using variable clustering, four PSAM scales were identified: Inhaler Properties, Comparison with Other Medications, Overall Perception of Medication, and Relief. Internal-consistency reliability provided evidence of reliability and lack of redundancy (Cronbach's Alpha: 0.82–0.88). Test-retest reliability was acceptable (ICC values at or near 0.70). As expected, interscale PSAM correlations were moderate to high; correlations between the PSAM and the AQLQ were low to moderate. To assess known groups validity, respondents were categorized by self-reported degree of asthma control: ‘very well controlled’ ‘somewhat controlled’, and ‘not well controlled’. Significant between-groups differences were found on all PSAM scales except Inhaler Properties. Patients categorized as ‘very well controlled’ tended to report highest PSAM scale scores. The PSAM questionnaire demonstrated reliability and validity in moderate asthmatics. Responsiveness should be assessed in future, prospective studies. This revised version was published online in June 2006 with corrections to the Cover Date.     

Blood benzene concentrations in workers exposed to oxygenated fuel in Fairbanks,Alaska

 Objective: In November 1992 residents of Fairbanks, Alaska became concerned about the potential health effects of an oxygenated fuel program during which 15% (by volume) methyl tertiary butyl ether (MTBE) was added to gasoline. To address those concerns, we earlier completed a survey of occupational exposure to MTBE. We conducted a follow-up survey of workers’ exposure to benzene from gasoline in Fairbanks. Design: Cross-sectional exposure survey. Methods: We examined blood concentrations of benzene from a convenience sample of workers taken in December 1992 during the oxygenated fuel program and from another convenience sample of workers taken in February 1993 after the program was suspended. Results: In December, the median blood benzene concentration of samples taken from four mechanics after their workshift (postshift) was 1.32  μg/l (range, 0.84–2.61 μg/l), and seven nonmechanics (drivers and other garage workers) had a median postshift blood benzene concentration of 0.27 μg/l (range, 0.09– 0.45 μg/l). In February, nine mechanics had a median postshift blood benzene concentration of 1.99 μg/l (range, 0.92–3.23 μg/l), and nine nonmechanics had a median postshift blood benzene concentration of 0.26 μg/l (range, 0.2–0.46 μg/l). Conclusion: Mechanics had higher blood benzene concentrations than did nonmechanics, but further study is needed to determine the impact of the oxygenated fuel program on exposure to benzene. Received: 6 November 1995/Accepted: 2 April 1996     

The Accumulation of Cadmium by the Yellow Pond Lily, Nuphar variegatum, in Ontario Peatlands

Cadmium concentrations of a common macrophyte, the yellow pond lily (Nuphar variegatum) were investigated from peatlands with a range in pH (4.4–6.3), alkalinity (0–181 μeq/L Ca), DOC (5.1–16.8 mg/L), and sediment organic content (20–88%). Cd concentrations in Nuphar ranged from 0.3 to 1.51 μg/g in the leaves and from 0.46 to 1.51 μg/g in the petioles, and was significantly higher in the petioles than in the leaves (p = 0.014; t-Test). Significant and negative correlations between Nuphar leaf Cd and pH (r²= 0.76; p < 0.001), alkalinity (r²= 0.41; p = 0.034), and DOC (r²= 0.46; p = 0.022) were obtained. In addition, a significant and negative correlation was found between Nuphar petiole Cd and pH (r²= 0.46; p = 0.023). These results indicate that the leaves of Nuphar found in peatlands of low pH, low alkalinity, and low DOC, and the petioles of Nuphar found in peatlands of low pH are more susceptible to accumulating potentially toxic levels of Cd. The organic content of the peatland sediments was not significantly correlated with either the leaf or petiole Cd concentration. Nuphar is an important food source for many wetland animals; any Cd that is present in these plants may be passed onto other trophic levels because diet is considered to be the major source of Cd to animals. Received: 5 December 1995/Revised: 13 June 1996     

Psychometric validation of the S-QoL Chinese (Taiwan) version for patients with schizophrenia

We translated the S-QoL into the Chinese (Taiwan) language and evaluated the score distributions of the translated S-QoL in terms of ceiling/floor effect, internal consistency, test–retest reliability, and convergent and discriminant validity. To ensure conceptual and semantic equivalence of the S-QoL, the researchers performed both forward translation and back translation, consulted professionals, and completed a pilot trial on college students. Forty-one patients with schizophrenia were recruited. No significant ceiling/floor effects (<20%) were found in subscales of the translated S-QoL. The internal consistency reliabilities were acceptable to good for the whole scale and 7 of the subscales (Cronbach’s alpha = 0.71–0.93), but not for the sentimental life subscale (Cronbach’s alpha = 0.44). The test–retest reliabilities were moderate to high (ICC = 0.64–87, P < 0.001 to <0.0001). The convergent validities were supported by satisfactory correlations among subscales measuring related constructs of the translated S-QoL and those of the SQLS-R4, WHOQoL-BREF, and RESE (r = 0.36–0.82, P < 0.05 to <0.01). Discriminant validity was demonstrated between groups with different numbers of episodes and hospitalization. The S-QoL Chinese (Taiwan) version was found to have good psychometrics and is suggested as a feasible choice of disease-specific measure for capturing HRQoL in patients with schizophrenia.     

Mother–Child Interactions and the Associations with Child Healthcare Utilization in Low-Income Urban Families

Studies have demonstrated that low-income families often have disproportionately high utilization of emergency department (ED) and hospital services, and low utilization of preventive visits. A possible contributing factor is that some mothers may not respond optimally to their infants’ health needs, either due to their own responsiveness or due to the child’s ability to send cues. These mother–child interactions are measurable and amenable to change. We examined the associations between mother–child interactions and child healthcare utilization among low-income families. We analyzed data from the Nurse-Family Partnership trial in Memphis, TN control group (n = 432). Data were collected from child medical records (birth to 24 months), mother interviews (12 and 24 months postpartum), and observations of mother–child interactions (12 months postpartum). We used logistic and ordered logistic regression to assess independent associations between mother–child interactions and child healthcare utilization measures: hospitalizations, ED visits, sick-child visits to primary care, and well-child visits. Better mother–child interactions, as measured by mother’s responsiveness to her child, were associated with decreased hospitalizations (OR: 0.51; 95% CI: 0.32, 0.81), decreased ambulatory-care-sensitive ED visits (OR: 0.65, 95% CI: 0.44, 0.96), and increased well-child visits (OR: 1.55, 95% CI: 1.06, 2.28). Mother’s responsiveness to her child was associated with child healthcare utilization. Interventions to improve mother–child interactions may be appropriate for mother–child dyads in which child healthcare utilization appears unbalanced with inadequate primary care and excess urgent care. Recognition of these interactions may also improve the care clinicians provide for families.     

The Responsiveness of Disease-Specific and Generic Health Measures to Changes in the Severity of Asthma Among Adults

The objective of the study was to compare the validity of asthma-specific and generic health outcome measures in relation to changes in the severity of asthma and to treatment. Adult patients (n = 142) participating in a randomized placebo-controlled trial at six clinics were assessed at baseline, prior to the withdrawal (placebo) or continuation of treatment with Vanceril and again after 8 weeks. The criterion measures of change in severity included pulmonary function expressed as the percent predicted FEV₁, five physician-assessed asthma severity measures (cough, chest tightness, wheezing, shortness of breath and overall condition) and two patient-assessed severity measures (night-time symptoms and overall symptoms). The 8 week change scores were estimated for all generic and specific measures and the results were compared across groups of patients who did and did not change in terms of clinical criteria of disease severity and across treatment groups. The responsiveness of each generic and specific measure was estimated independently using the relative validity (RV) methodology, which compares F-ratios for the mean change scores across measures in analyses of the same comparison groups. RV coefficients estimate how much worse each measure discriminated between comparison groups, relative to the best measure (RV = 1.0). Four standardized asthma-specific measures and a total scale score (based on the Marks questionnaire), an individualized asthma-specific scale measuring limitations in activities most important to each patient (based on the Juniper method) and two newly-developed scales measuring physical and psychosocial symptoms were used as outcome measures, generic health outcome measures included eight functional health and well-being scales as well as the physical and mental health summary scales from the SF-36 health survey. A standardized asthma-specific scale was most valid in discriminating between groups of patients who did and did not change according to all of the clinical criterion variables studied and in discriminating between treated and untreated groups. Different scales performed best, depending on the clinical criterion. The asthma-specific Marks breathlessness scale was significant in all nine comparisons (RV = 0.62–1.0) and was most valid in discriminating between groups in six of nine tests. The overall scale also performed well in all comparisons (RV = 0.58–1.0). The newly-developed physical symptoms scale was significant in discriminating between groups in eight out of nine tests (RV = 0.52–1.0) and was most valid in three of the nine, including the treatment comparison. The psychosocial impact scale discriminated significantly in eight of the nine comparisons (RV = 0.16–0.38), but was less valid than other specific measures. The asthma-specific individualized activities scale discriminated significantly in seven of the nine tests, but performed less well than the other specific measures (RV = 0.21–0.35) and was not significant in the treatment comparison. One or more SF-36 scales discriminated significantly between groups in all nine comparisons. Two of those scales (physical functioning and role-physical) were consistently more valid than the others (RV = 0.17 and 0.58, respectively) and were the only two generic scales that discriminated between groups of patients defined in terms of changes in FEV₁ (RV = 0.26–0.58). The SF-36 physical summary scale discriminated significantly between groups in all nine comparisons (RV = 0.19–0.61) and was the most valid generic measure in the treatment comparison (RV = 0.55). The SF-36 mental summary scale was significant only for the two patient-assessed changes in disease severity (RV = 0.31 and 0.32) and for physician-assessed overall severity (RV = 0.12). A comprehensive battery of generic and specific measures is likely to be most useful in understanding the impact of changes in disease severity on the functional health and well-being of adults with asthma, as well as treatment effects. The standardized asthma-specific and generic measures of physical health were most valid in relation to changes in asthma severity and in detecting treatment impact. The SF-36 physical summary and the Marks asthma-specific summary measures detected changes in asthma severity and treatment impact as well as most scales in their respective profiles. This revised version was published online in June 2006 with corrections to the Cover Date.     

Disease-specific health-related quality of life questionnaires for heart failure: a systematic review with meta-analyses

Background  Heart failure (HF) is an increasingly common condition affecting patients’ health-related quality of life (HRQL). However, there is little literature comparing HF-specific instruments. Our aim was to evaluate and compare data on the conceptual model and metric properties (reliability, validity and responsiveness) of HF-specific HRQL instruments, by performing a systematic review with meta-analyses. Methods and results  Of 2,541 articles initially identified, 421 were full-text reviewed. Ninety-four reported data on five questionnaires: Minnesota Living with Heart Failure Questionnaire (MLHFQ), Chronic Heart Failure Questionnaire (CHFQ), Quality of Life Questionnaire for Severe Heart Failure (QLQ-SHF), Kansas City Cardiomyopathy Questionnaire (KCCQ) and Left Ventricular Dysfunction (LVD-36) questionnaire. Metric properties (reliability, validity and responsiveness) were summarised using meta-analysis for pools above five estimates. Cronbach’s alpha coefficients were generally high (0.83–0.95) for overall scores and scales measuring physical health. Associations with four validity criteria (New York Heart Association [NYHA] class, six-minute walk test [6MWT] and short form-36 [SF-36] ‘Physical’ and ‘Social Functioning’) were moderate to strong (0.41–0.84), except for those between two CHFQ domains (fatigue and dyspnoea) and the NYHA (0.19 and 0.22). Pooled estimates of change from eight meta-analyses showed the MLHFQ to be highly responsive, with changes in overall score ranging from −9.6 (95% confidence interval [CI]: −4.1; −15.2) for placebo to −17.7 (95% CI: −15.3; −20.2) for pacing devices. The CHFQ and KCCQ also showed good sensitivity to change. Conclusions  Most of the questionnaires studied met minimum psychometric criteria, though current evidence would primarily support the use of the MLHFQ, followed by the KCCQ and CHFQ. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR): A Measure of Health-Related Quality of Life and Quality of Life for Patients with Pulmonary Hypertension

Objective: No outcome measures specific to pulmonary hypertension (PH) currently exist. The aim of the study was to develop health-related quality of life (symptoms and functioning) scales and a quality of life scale that would allow comprehensive, accurate and valid patient-reported outcome assessment in clinical studies. Methods: The content of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) was derived from qualitative interviews conducted with 35 patients. Item reduction was based on the analysis of responses to a postal survey (n=75) and patient interviews (n=15) designed to determine face and content validity. A final postal validation study (n=91) was performed to determine reproducibility and construct validity. Results: The questionnaire was well received by participants who found it to be relevant, comprehensible and quick and easy to complete. Rasch and factor analyses were conducted to ensure unidimensionality of the final CAMPHOR scales; Overall symptoms (made up of Energy, Breathlessness and Mood subscales), Functioning and Quality of life. The CAMPHOR scales had good internal consistency (α=0.90–0.92) and reproducibility (test–retest correlations=0.86–0.92). They also exhibited convergent, divergent and known groups validity. Conclusions: The CAMPHOR is a valuable new instrument for assessing patient-reported outcome in PH clinical trials and routine practice.     

Bronchial hyperresponsiveness and exposure in pig farmers

Objective: To study the effect of exposure on bronchial responsiveness in pig farmers. Method: A group of 196 pig farmers were tested for lung function and bronchial responsiveness to histamine in the summer of 1992. To achieve sufficient contrast in respiratory morbidity and exposure, 96 of the farmers were selected because they had chronic respiratory symptoms and the remaining 100 because they were free from any respiratory symptoms. Personal exposure to dust, endotoxins and ammonia was measured during 1 working day in the summer of 1991 and 1 day in the winter of 1992. Data on farm characteristics were gathered in the same period. Results: After adjusting for age and smoking behaviour, mild bronchial responsiveness, defined as PC₁₀≤ 16 mg/ml, was associated with the use of quaternary ammonium compounds as disinfectant [prevalence odds ratio (POR) 6.7, 95% confidence interval (CI) 1.4–32.8], use of wood-shavings as bedding (POR 13.3, CI 1.3–136.7), use of automated dry feeding (POR 2.8, CI 1.0–7.8), use of pellets as feeding material (POR 4.8, CI 1.1–21.1) and location of air exhaust via pit or roof in the confinement units (POR 2.7, CI 1.2–6.3). The association with the use of disinfectants other than quaternary ammonium compounds was not significant (POR 2.4, CI 0.7–8.4). No associations between bronchial responsiveness and measured exposure to dust, endotoxins or ammonia were discernible. Conclusion: Protective measures, designed to prevent airway disease in confinement farming, should be based on information about the operational and other characteristics of farms that are related to high exposure and health effects. Specifically, the use of quaternary ammonium compounds as disinfectant, the use of wood-shavings as bedding and the use of automated dry feeding should be discouraged. Received: 7 December 1996 / Accepted: 10 April 1997     

Responsiveness of disease-specific and generic utility instruments in prostate cancer patients

Background Preferences (utilities) for health outcomes have an important role in decisions about prostate cancer screening and treatment. The responsiveness of utility instruments has not been evaluated. Subjects Prostate cancer outpatients from the Princess Margaret Hospital, Toronto (n = 248) were allocated into three cohorts: N – newly diagnosed and treated; M – metastatic disease; O – all others. Measures We measured quality of life at 3 points within 12 months using 3 disease-specific utility instruments (Patient Oriented Prostate Utility Scales), 3 generic utility instruments (Health Utilities Index, EQ-5D, Quality of Well-Being Scale), and 3 profile scales (PORPUS-P profile, Prostate Cancer Index, QLQ-C-30). Responsiveness was assessed using measures of internal responsiveness (standardized effect size, standardized response mean) and external responsiveness (receiver operator curve analysis, mixed model regression). Results Cohort N patients showed post-treatment declines followed by improvement in global health and functional status. Disease specific instruments detected moderate (0.4–1.3) decrements followed by small increments (0.1–0.4) in standardized effect size and standardized response mean. Most instruments detected change using external responsiveness measures (all cohorts). Conclusions Disease-specific utility instruments appeared to be more responsive than generic instruments. Use of generic instruments should be supplemented with a responsive disease-specific instrument, particularly for applications in early prostate cancer.     

The Validity and Reliability of the Functional Impairment Checklist (FIC) in the Evaluation of Functional Consequences of Severe Acute Respiratory Distress Syndrome (SARS)

Severe acute respiratory distress syndrome (SARS) contributed to significant mortality and morbidity worldwide. We aimed to establish the validity, reliability and responsiveness of the functional impairment checklist (FIC) as a measurement tool for physical dysfunction in SARS survivors. One hundred and sixteeen (65 females and 51 males, mean age 45.6) patients who joined the SARS rehabilitation programme were analysed. The factor analysis yielded two latent factors. The mean FIC-symptom and FIC-disability score were 24.12 (SD ± 20.2) and 26.11 (SD ± 27.32), respectively. Based on the item-scale correlation coefficients, the Cronbach’s alpha coefficients reflecting the internal consistency reliability of scale score were 0.75 for FIC-symptom and 0.86 for FIC-disability. Test–retest reliability in 23 patients showed no statistical significant difference in the FIC scores between tests with intraclass correlation coefficient (ICC) 0.49–0.57. The FIC scales correlated both with 6 munute walking test (6MWT) distance (−0.26 and −0.38) and handgrip strength (HGS) (−0.20 and −0.27). Moreover, the FIC scales correlated with St. George’s respiratory questionnaire (SGRQ) (0.19 to 0.52) and short form 36 Hong Kong (SF-36) domains (−0.19 to −0.59). Both FIC scales correlated stronger with physical component summary (PCS) (−0.41 and −0.55) than with mental component summary (MCS) (−0.30 and −0.23). FIC reduced significantly at 6 months while the SF-36 PCS and MCS did not show any change. In conclusion, the study results indicate the FIC is reliable, valid and responsive to change in symptom and disability as a consequence of SARS, suggesting it may provide a means of assessing health related quality of life (HRQOL) outcomes in a longitudinal follow up.     

A Pilot Study Determining Hair Arsenic and Lead Levels in Residents of a Community Established on a Former Landfill in Puerto Rico

Arsenic (As) and lead (Pb) were determined in hair of 12 adult women and 27 children living in a soil–metal contaminated community in Puerto Rico. Average concentrations in residential soils ranged from 24 to 109 μg/g for As and from 42 to 1,585 μg/g for Pb. For hair–As, about 75 % of the samples were below 0.08 μg/g. Hair–Pb presented levels of health concern, with 10 % of the samples above a reference value of 5 μg/g, indicating significant exposure to Pb. Multivariate analyses revealed that children’s Pb hair levels were predicted by age and sex, while consumption of home-grown animals influenced the association with soil–Pb.     

Psychosocial work environment and burnout among emergency medical and nursing staff

Objectives: The prevalence of burnout syndrome is increasing among doctors and nurses. The aim of this study was to analyse the relationship between the psychosocial work environment and burnout syndrome among emergency medical and nursing staff in Spain. A secondary aim was to determine if the effect of this psychosocial work environment on burnout was different for doctors and nurses. Methods: A cross-sectional survey was carried out by means of a mail questionnaire among 945 emergency doctors and nursing staff of Spain. The outcome variable was three dimensions of burnout syndrome [emotional exhaustion (EE), personal accomplishment (PA), depersonalisation (DP)]. The explanatory variable was that psychosocial work environment evaluated according to Karasek and Johnson’s demand-control model. The adjusted odds ratios (OR) and their 95% confidence intervals were calculated by logistical regression. Results: The probability of high EE was greater among those exposed to high psychological demands, OR 4.66 (2.75–7.90), low job control, OR 1.65 (1.04–2.63), and low supervisors’ social support, OR 1.64 (1.01–2.59). Emotional exhaustion dimension was negatively influenced by low control only among doctors. Those exposed to low job control had a higher risk of low PA, OR 2.55 (1.66–3.94). There was no evidence of negative effect of psychosocial risk factors on the DP. Prevalence of EE and PA was higher among doctors and nurses. Conclusions: The presence of risk factors derived from work organisation within the work place (psychosocial risk factors) increases the probability of presenting burnout syndrome and, above all, EE.     

Measuring Clients’ Perception of Functional Limitations Using the Perceived Functioning &; Health Questionnaire

Background The Perceived Functioning & Health (PFH) questionnaire was developed to collect, in a standardized manner, which work activities are limited due to health conditions according to the perception of the client. In this study the questionnaire’s reliability and validity are investigated. Methods The PFH questionnaire is comprised of 147 questions, distributed over 33 scales, pertaining to the client’s psychosocial and physical work limitations. The PFH data of 800 respondents were analyzed: 254 healthy employees, 408 workers on sick leave and 138 recipients of a disability pension. Internal consistency (Cronbach’s α) for the scales was established. The test–retest reliability was examined for the data of 52 recipients of a disability pension who filled out the PFH twice within an interval of 1 month. Validation was established by taking the nature of the limitations as a criterion: mental limitations, physical limitations or a mix of both. To this end, the respondents were divided into groups distinguished on the basis of self-classification, as well as classification on the basis of disease codes given by insurance and occupational health physicians: a “healthy” group, subjects with only physical (“physical” group) or mental limitations (“mental” group) or mixed limitations (“mixed” group). The scale scores of these groups were compared and tested using analyses-of-variance and discriminant analyses. Results The scales were found to have sufficient to good internal consistency (mean Cronbach’s-α = 0.79) and test–retest reliability (mean correlation r = 0.76). Analyses-of-variance demonstrated significant differences between the scores of the mental, physical and healthy groups on most of the expected scales. These results were found both in groups defined by self-classification as well as in groups based on disease codes. Moreover, discriminant analyses revealed that the a priori classification of the respondents into three groups (mental, physical, healthy) for more than 75% of them corresponded with the classification on the basis of scale scores obtained from the questionnaire. Furthermore, limitations due to specific types of complaints (low back pain, fatigue, concentration problems) or diagnosed disorders (musculoskeletal disorders, reactive disorders, endogenous disorders) were clearly reflected in the scores of the related scales of the PFH. Conclusion The psychometric properties of the PFH with respect to reliability and validity were satisfactory. The PFH would appear to be an appropriate instrument for systematically measuring functional limitations in subjects on sick leave and in those receiving disability pensions, and could be used as a starting point in a disability claim procedure.