Health technology assessment: decentralized and fragmented in the US compared to other countries

This paper presents the results of the first comprehensive international survey to catalogue health technology assessment (HTA) activities. By 1995, there were formal HTA programs in 24 countries established mostly in the late 1980s and early 1990s. European countries generally have one or two federal or provincial HTA programs each, Canada has an extensive network of federal and regional organizations coordinated by a central body and the US has 53 HTA organizations, the vast majority of which are in the private sector. While the commitment of the US government to HTA has been erratic, the private sector has been witness to an expansion of HTA activities by insurance companies, hospitals, medical/device manufacturers, consulting firms and health professional societies. In contrast to other developed countries, the current state of technology assessment in the US is decentralized, fragmented and duplicative. We conclude by discussing the importance of a US HTA agency at the national level.     

Predictors of disability in elderly finnish men—A longitudinal study

Factors predicting disability in late life were studied in 716 men from eastern or southwestern Finland in connection with the 25-year follow-up. of the East-West Study, which is part of the Seven Countries Study, in 1984. In middle-aged men, low forced vital capacity, occurrence of diabetes, presence of intermittent claudication, high diastolic blood pressure, higher age and lower educational level showed the greatest predicting power for future disability 15–25 years later. In later middle age, low forced vital capacity, presence of intermittent claudication, cerebrovascular disease or coronary heart disease and higher age were the most powerful predictors for disability 10 years later. In order to lower disability in old age, it is important to prevent deterioration of ventilatory function and cardiovascular diseases in middle-aged populations and to treat chronic diseases adequately.     

New directions in health care and disability: the need for a shared understanding of human functioning

Objective: Human ‘functioning’ is about how people live on a day‐to‐day basis. This paper sets out the case for adopting a common language about functioning that would improve population health information and information sharing across health and community service systems. Approach: Modern health systems recognise the importance of human functioning in addition to diagnosis and disease prevention. ‘Functioning’ is important in the context of chronic disease, mental health, healthy ageing, and the right of people with disabilities and their carers to participate in society. We outline major directions in the health system and their relationship to the concept of functioning. Conclusions and implications: The concept of functioning has not been used explicitly and consistently in Australian health and human service systems, which nevertheless deal with the 20% of the population who experience difficulties in functioning. The International Classification of Functioning, Disability and Health (ICF) is the international standard for definition, classification, information and measurement of functioning. While it has been partially implemented in Australia, it should be used more broadly, across health and community services, as the basis for information on functioning. This is an intended parallel to the use of the ICD as the standard classification and code list for disease monitoring and related health information systems. Monitoring health status and planning interventions and resources require information about people's functioning in their daily lives as well as their diseases. Such information should be based on the international standards developed for this purpose.     

A prospective study of the reliability and convergent validity of three physical activity measures in a field research trial

This investigation sought to determine the test-retest reliability and convergent validity of three commonly used physical activity measures. The Stanford Physical Activity Recall, the Caltrac Activity Monitor, and a daily physical activity log were administered to 45 subjects over a 3-week period. The results indicated high levels of test-retest reliability for the Stanford and the daily log; low test-retest reliability was obtained for the Caltrac. Convergent validity was also high between the Stanford and daily log but was low for both of these measures with the Caltrac: These results suggest that the Stanford Physical Activity Recall may be the self-report measure of choice for large studies due to its high reliability and convergent validity with a more time-consuming daily log, as well as its cost- and time-efficiency. Based on the results, it is recommended that the Caltrac activity sensors not be used for field studies of physical activity until the logistical problems of their use in clinical trials are solved.     

Rapid collaborative health impact assessment: a three-meeting process

A three-meeting process for collaborative health (inequality) impact assessment [H(I)IA] of a proposed new road is described in which local residents worked with professionals to produce a jointly agreed evidence-based report. Collaborative H(I)IA provided a forum for people to express fears that they believed had been ignored, and for planners to understand the concerns of the community and the health impacts of developments on the most vulnerable. The report has been passed to those who will influence the future of the road development plan and a decision is awaited.     

Exploring the influence of depressive symptoms on physical disability: A cohort study of elderly in Beijing,China

OBJECTIVES: This study examined the influence of depressive symptoms on the prevalence of physical disability in a cohort study of Beijing elderly (1992--2000) and analyses the role of some confounding variables in this relationship. METHODS: A cohort of 1828 elderly aged 55 and older who were initially free of any physical disability was followed up for 8 years. Baseline depression was assessed by the Center for Epidemiological Studies Depression Scale. Disability on activities of daily living (BADL and IADL) was measured in 1994, 1997, and 2000 respectively. RESULTS: The cumulative percentages of persons who developed BADL disability and IADL disability during each follow-up interview was significantly greater among depressed than non-depressed individuals. Compare with the 1525 non-depressed individuals, the 303 depressed individuals had a relative risk (95% confidence interval) of 2.52 (2.02, 4.82) for BADL disability and 4.98 (2.46, 10.09) for IADL disability, respectively. Although adjustment for confounding factors reduced the risk to 2.20 (1.33, 3.62) and 4.29 (2.08, 8.86), the detrimental effect of depression on disability remained significant. The items of IADL which connected physical activity had higher impairment among depressed individuals. CONCLUSIONS: Depression in elderly persons may increase the risk for prevalent disability. It is very important for elders to prevent and reduce depression for improving the quality of their life and physical function.     

Physical activity for individuals living with a physical disability in Quebec: Issues and opportunities of access

BackgroundIndividuals living with a physical disability have reported difficulty in meeting their healthy living and leisure needs which could be a result of poor accessibility.ObjectiveThis qualitative study aimed to understand the relative accessibility of physical activity from the perspective of individuals living with a physical disability in Quebec, Canada.MethodsTwenty semi-structured interviews were conducted with current, past, non-members, and staff members of an adapted physical activity program. A qualitative approach with an inductive thematic analysis was used to interpret the data.ResultsWe identified five overarching themes focusing on participants’ experiences related to access: (i) physical activity opportunities; (ii) social interactions; (iii) relationships; (iv) infrastructure; (v) policies and public services. Participants highlighted that access to physical activity programming is shaped by a complex interaction of these overarching themes and their sub-themes.ConclusionsAccess to physical activity opportunities for individuals living with a physical disability cannot be understood in isolation from the broader public policies, infrastructure, social interactions, and relationships that shape their experiences. Policy makers and other health and recreational professionals must consider these broader factors when recommending or creating physical activity opportunities for individuals with physical disabilities.     

The lifestyle assessment questionnaire: an instrument to measure the impact of disability on the lives of children with cerebral palsy and their families

Suitable measures of health and morbidity are less readily available for children than they are for adults. We present a measure, which is used to describe the impact of impairment and disability on the lives of children with cerebral palsy and their families. The development of this measure involved data collected from 691 children with cerebral palsy contained within the North-East England Cerebral Palsy Register and born between 1960 and 1985. Uniquely, multidimensional scaling techniques were used to derive dimensions analogous with those described in the International Classification of Impairments, Disabilities, and Handicaps. We present the analyses undertaken to test the properties of the tool, which show that it is a reliable and valid measure of the disadvantages experienced by children with cerebral palsy.     

The RAI-PC: an assessment instrument for palliative care in all settings

Large numbers of persons in most types of healthcare settings have palliative care needs that have considerable impact on their quality of life. Therefore, InterRAI, a multinational consortium of researchers, clinicians, and regulators that uses assessment systems to improve the care of elderly and disabled persons, designed a standardized assessment tool, the Resident Assessment Instrument for Palliative Care (RAI-PC). The RAI-PC can be used for both the design of individual care plans and for case mix and outcomes research. Some elements of this instrument are taken from the resident assessment instrument (RAI) mandated for use in all nursing homes in the United States and widely used throughout the world. The RAI-PC can be used alone or in counjunction with the other assessment tools designed by the InterRAI collaboration: the RAI for homecare (RAI-HC), for acute care (RAI-AC), and for mental health care (RAI-MH). The objective of this study was to field test and carry out reliability studies on the RAI-PC. After appropriate approvals were obtained, the RAI-PC instrument was field tested on 151 persons in three countries in more than five types of settings. Data obtained from 144 of these individuals were analyzed for reliability. The reliability of the instrument was very good, with about 50 percent of the questions having kappa values of 0.8 or higher, and the average kappa value for each of the eight domains ranging from 0.76 to 0.95. The 54 men and 95 women had a mean age of 79 years. Thirty-four percent of individuals suffered pain daily. Eighty percent tired easily; 52 percent were breathless on exertion; and 19 to 53 percent had one or more other symptoms, including change in sleep pattern, dry mouth, nausea and vomiting, anorexia, breathlessness at rest, constipation, and diarrhea. The number of symptoms an individual reported increased as the estimated time until death declined. The "clinician friendly" RAI-PC can be used in multiple sites of care to facilitate both care planning and case mix and outcomes research.     

Characterization of grit in arable birds to improve pesticide risk assessment

To describe the grit in bird gizzards, we examined the gizzard content of some 200 birds of varying size and diet (e.g., granivores and nongranivores). Grit use (frequency, size, amount, and shape) was characterized for 27 bird species that forage, at least part of the year, on arable land in the Netherlands. Three different groups could be recognized: the nongranivores with predominantly small "grit" particles (the result of inadvertent ingesting soil while foraging), the granivores with larger grit particles (the result of intentionally selecting soil particles), and the group in between (omnivores), which shows features of both other groups. Sample calculations made in this article show a probability of 3-277 in 1000 times for unintentionally consuming one granule. Therefore, attention should also be paid to nongranivorous birds when assessing the hazard or risk of the use of granular pesticide formulations. A risk assessment model is presented in the Appendix.     

The Toronto breast self-examination instrument (TBSEI): Its development and reliability and validity data

The Toronto Breast Self-Examination Instrument (TBSEI) was developed out of the need for a self-administered survey that is reliable and valid. This article describes the development of the TBSEI, its dimensions, and reliability and validity data to support its continued use. To analyze the reliability and validity properties of the three TBSEI scales, we surveyed 729 Toronto, Ontario women. The TBSEI was found to have good face and content validity, internal consistency reliability (0.91, 0.69, 0.85), and test-retest reliability (0.89). Age norms for each of the three scales are also provided. These results are consistent with previous research findings in breast cancer and breast self-examination research.     

Act now: The effects of the 2008 Spanish disability reform

The 2008 reform of the Spanish disability system reduced the benefits for individuals who have a short contributory history relative to their age. It also unintentionally introduced an incentive for individuals to apply for disability in the present. We use a lifecycle model and an empirical analysis to understand the overall impact of the reform. Our baseline estimates suggest that men and women who were affected by the reform were 46% and 22% more likely to be on permanent partial disability following the reform, respectively, and 55% and 46% more likely to be on total disability, respectively.     

Reliability and physiologic correlates of the Harvard alumni activity survey in a general population

The reliability of the Harvard Alumni Activity Survey (HAAS) and its association with physiologic measures was assessed in a large sample of men and women aged 25–65 years residing in the Boston metropolitan area in 1987. Reliability was estimated by comparing HAAS energy expenditure reports (kcal/week) from two separate interviews conducted 7–12 weeks apart. The test-retest reliability coefficient was 0.58 for the entire sample, but was considerably higher (r = 0.69) for those whose activity patterns had not changed from one interview to the next. HAAS self-reports were compared to two physiologic measures known to be affected by physical activity: high density lipoprotein cholesterol (HDLC) and body mass index (BMI). The natural logarithm of weekly HAAS expenditures was positively correlated with HDLC (r = 0.14, p < 0.01) and negatively correlated with BMI (r = 0.13, p < 0.01) for all respondents. These statistically significant associations persisted when adjusted for other covariates influencing physiologic status. The reliability coefficients and physiologic correlations for the HAAS in this sample are comparable to those reported for physical activity instruments requiring more intensive data collection and scoring procedures.     

临床常用10项生化指标测量不确定度的评定

摘要:目的 探讨测量不确定度在临床生化检验中的应用。方法 使用日立7600型全自动生化分析仪及其配套校准品和质控品,所使用的试剂为四川迈克品牌产品,以生化检验中的几个常规检测项目为例,探讨测量不确定度在临床生化检验中的应用,其中总蛋白（TP）采用双缩脲终点法,白蛋白（ALB）采用溴甲酚绿法,丙氨酸氨基转移酶（ALT）、γ-谷氨酰转移酶(γ-GGT)采用速率法,总胆红素（TBiL）采用化学氧化法,血糖（GLU）采用己糖激酶法,总甘油三酯（TG）采用GPO-PAP法、总胆固醇（TC）采用胆固醇氧化酶法,尿素氮（UREA）采用脲酶紫外速率法,肌酐（CREA）采用肌氨酸氧化酶法。结果 各指标相对扩展不确定度为:ALB为6.90%,TP为9.79%,ALT为11.50%,γ-GGT为12.50%,TBiL为17.16%,GLU为8.52%,TC为8.73%,TG为9.84%,UREA为9.99%,CREA为6.36%。结论 通过对测量不确定度的评定,提高了检测质量,增强了检测结果的可比性与使用价值,客观上有效的反映了本室检测结果的准确性与分散性。     

Socio-economic status and risk factors for cardiovascular disease: A multicentre collaborative study in the international clinical epidemiology network (INCLEN)

As part of a multicentre collaborative study of risk factors for cardiovascular disease (CVD) in the International Clinical Epidemiology Network (INCLEN), each of 12 Centres in 7 countries examined the relationship between CVD risk factors and socio-economic variables.

Each Centre (three in Thailand, two each in China, Chile and Brazil and one each in the Philippines, Indonesia and Colombia) examined approx. 200 men aged 35–65 drawn at random from a population within their locality (not designed to be necessarily representative of the general population). Standardized measures of CVD risk factors included body mass index (BMI), blood pressure, blood cholesterol and cigarette smoking habits. Education, occupation and current income were grouped into ordinal categories of socio-economic status according to standard protocol guidelines, and comparisons were made between risk factor levels within each of these categories. Many of these populations had higher levels of education (as a marker of socio-economic status) than would the general population of their country.

For both BMI and blood cholesterol there were a number of centres which showed positive associations with socio-economic status. These were predominately in China or urban or rural South East Asia. For blood pressure and cigarette smoking the associations with socio-economic status tended to be negative, more in line with the direction of association seen in the “Developed” World.

The high risk factor levels found in these populations, particularly the alarming prevalence of cigarette smoking in Asia and the high cholesterol levels in Latin America and Urban S.E. Asia suggest that CVD will emerge as a major public health problem in the Developing World. As this happens, knowledge of the patterns of association between risk and socio-economic status is likely to be important in both understanding the reasons for the patterns of disease and directing efforts at prevention.     

A community-based evaluation of disability resources and inclusion practices in rural Botswana

BackgroundCommunity-based approaches to enhance the inclusion of persons with disabilities have proven effective; however, not much is known about cultural and contextual factors that influence the capacity of policy implementation and inclusion practices in rural Botswana.ObjectiveThe study evaluated local disability education and health resources in rural Botswana to develop a deeper understanding of cultural and contextual factors impacting inclusion practices.MethodResearchers used socio-demographic and qualitative research methods to conduct a comprehensive community-based needs assessment. Sampling techniques included maximum variation and snowball sampling. Thirty-two individuals participated in the study. Data were collected between June and August of 2019 through participant observation, in-depth interviews, and focus group discussions. An inductive thematic analysis was conducted by examining participants’ attitudes, perceptions, and experiences of community members with disabilities.ResultsFour primary themes emerged identifying factors that affect people living with disabilities in the rural community: (1) culture of vulnerability, (2) determinants of disability, (3) educational resources for persons with disabilities, and (4) effective systems integration. Findings suggested that while policies associated with disability at the government level are in place, disparities among rural communities’ hindered local responses to managing the needs of persons with disabilities.ConclusionsSocial, environmental, and physical barriers prevent the full implementation of policies that advocate for the rights of persons with disabilities in Botswana's rural settings. Increasing awareness of cultural and contextual factors may help community stakeholders facilitate inclusive practices in Botswana.     

Evaluating child disability programmes: the role of commissioners

The paper briefly reviews the role of a health care commissioner in planning and evaluating children's disability services, an area with a strong statutory framework but a paucity of guidance. It also explores how different aspects of evaluation apply to commissioning.