Health status measurement in Parkinson's disease: validity of the PDQ-39 and Nottingham Health Profile.

We assessed the feasibility and psychometric properties of two commonly used health status questionnaires in Parkinson's disease (PD): the generic Nottingham Health Profile (NHP) and the disease-specific 39-item Parkinson's disease Questionnaire (PDQ-39), from a cross-sectional postal survey of PD patients (N = 81), using traditional and Rasch measurement methodologies. Overall response rate was 88%. Both questionnaires were found feasible, although the NHP performed less well. The PDQ-39 had fewer floor effects and was better able to separate respondents into distinct groups than the NHP, whereas the latter exhibited less ambiguous dimensionality and better targeting of respondents with non-extreme scores. Reliability and validity indices were similar, and potential differential item functioning by age and gender groups was found for both questionnaires. PDQ-39 response alternatives indicated ambiguity. With few exceptions, questionnaire scales were unable to meet recommended standards fully. While preliminary, this study illustrates the need for thorough evaluation of outcome measures and has implications beyond the questionnaires used here. Although promising, both questionnaires warrant further developmental work and stronger support of measurement validity before they could be considered fully suitable for valid use in PD, in particular in earlier stages of the disease.     

Influenza vaccination: a collaborative effort to improve the health of the community.

BACKGROUND: The need to improve influenza vaccination delivery in our community became painfully clear during the winter of 1997-1998 when high rates of respiratory illness led to congestion in the emergency department and a critical shortage of hospital beds. In response, the local hospital and the Department of Health launched a collaborative program to increase influenza vaccine coverage in the community. METHODS: The partnership was designed to increase the number of citizens receiving influenza vaccine and to moderate the severity of lower respiratory tract illness during the winter season. A variety of methods were used to increase public awareness, enhance vaccine delivery, and create a relatively seamless service for the community. RESULTS: During three seasons, influenza vaccination rates increased by a relative 150%. This represented immunization of 16% of the entire community and more than 75% of residents older than 65 years. Hospital employee vaccination rates also rose from 34% to 58%. When compared with other hospitals in the county, the campaign reduced the average number of annual visits to the emergency department for all respiratory diagnoses by 34% and exacerbations of chronic obstructive pulmonary disease by 46%. CONCLUSIONS: This influenza vaccination program illustrates the potential for synergy that exists between local departments of health and community hospitals in successfully increasing vaccine delivery to the community. Furthermore, it also suggests that such efforts can be successful in reducing use of the emergency department, resulting in a positive impact on the health of the community.     

Effects of Age, Parity, and Adherence on Pelvic Muscle Response to Exercise

OBJECTIVE: To examine factors that affect pelvic muscle response to 12 weeks of pelvic muscle exercise. DESIGN: Repeated measures design in which intravaginal pressures during pelvic muscle contractions were recorded at baseline and after four exercise levels. SETTING: College of Nursing research site in Gainesville, Florida. PARTICIPANTS: Eighty-five parous, community-dwelling women, aged 35-78 years and without incontinence as a primary concern. INTERVENTIONS: A 12-week graded program of regular (three times per week, every other day) pelvic muscle exercise at home. MAIN OUTCOME MEASURES: The hypotheses were that younger age, lower parity, higher baseline intravaginal pressures, and adherence to the pelvic muscle exercise program each would result in significant improvement in maximum intravaginal pressures. RESULTS: The only factor showing significance in predicting a successful outcome was age (t = -2.29, df = 41, one-tail probability = .0136). CONCLUSIONS: Regular, graded exercise over several weeks is needed to build pelvic muscles, and some women who exercise do not improve. Although the reasons for not improving are unclear, age is a significant factor.