Single index of multimorbidity did not predict multiple outcomes

BACKGROUND AND OBJECTIVES: Measurement of multimorbidity and comorbidity is important in epidemiologic and health services research. The aim of this research was to derive a generic multimorbidity index based on patient self-report, incorporating severity, for predicting a range of outcomes. METHODS: The dataset was obtained from a trial including 1,541 Veterans and war widows aged 70 years and over. The survey included sociodemographics, hospital admissions, SF-36, and information on deaths was obtained. The methods of Charlson were used to derive Multimorbidity Indices. RESULTS: All indices predicted quality of life, with decreasing quality of life for each increase in multimorbidity category. Multimorbidity scores incorporating severity significantly contributed to the prediction of mortality, hospital admission, and follow-up quality of life, regardless of adjustment for baseline quality of life. CONCLUSIONS: Our results indicate that a single index cannot predict a variety of relevant outcomes. Consequently, research undertaken to assess the impact of intervention or illness on health outcomes should use an index that is valid for predicting the specific outcome of interest.     

Pilot of a novel cervical screening intervention: interactive voice response

OBJECTIVE: This paper describes the pilot of an interactive voice response (IVR) cervical screening brief advice interface. METHOD: In September 2000, 5,000 households within Cessnock, New South Wales, were contacted by an IVR system. The system randomly selected eligible women aged 18-69, assessed their cervical screening status and provided a tailored message about cervical screening. A computer-assisted telephone interview (CATI) evaluated intervention acceptability. Participation rates, participant demographics, IVR use by women, and IVR costs were also examined. RESULTS: 549 (12%) women listened to the IVR call and 587 (59%) completed the CATI interview. IVR listeners under-represented younger and older women, and over-represented women who were married, and of Aboriginal descent. The majority of women (98%) found IVR easy to answer and 90% agreed IVR reminders were a good idea. Unscreened and older women used the system more than screened or younger women. CONCLUSIONS: The IVR call was successfully used by a large number of women to obtain information on cervical cancer screening, with higher use by recognised risk groups. IMPLICATIONS: These results suggest that an IVR reminder might be useful to increase cervical screening rates since those most at risk also used IVR the most. The potential for linking IVR to a database to issue reminders in the same manner as Pap Test Register postal reminders needs to be explored.     

Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) has a high mortality and is associated with significant morbidity. Prior outcome studies have focused predominant on short-term outcomes (6-12 months). We assessed longitudinal neurocognitive, emotional, and quality of life in ARDS survivors at hospital discharge, and 1 and 2 years after hospital discharge using neuropsychologic tests and emotional and quality-of-life questionnaires. Neurocognitive sequelae occurred in 73% (54 of 74) of ARDS survivors at hospital discharge, 46% (30 of 66) at 1 year, and 47% (29 of 62) at 2 years. ARDS survivors report moderate to severe depression (16% and 23%) and anxiety (24% and 23%) at 1 and 2 years, respectively. The ARDS survivors had decreased quality of life, with the physical domains improving at 1 year, with no additional change at 2 years. Role emotional, pain, and general health did not change from hospital discharge to 2 years. Mental health improved during the first year and declined at 2 years. ARDS results in significant neurocognitive and emotional morbidity and decreased quality of life that persists at least 2 years after hospital discharge. ARDS can cause significant long-term, brain-related morbidity manifest by neurocognitive impairments and decreased quality of life.     

The effects of alpha/theta neurofeedback on personality and mood

Alpha/theta neurofeedback has been shown to be successful both in treating addictions and in enhancing artistry in music students. How its effects are mediated are not yet clear. The present study aimed to test the hypothesis that alpha/theta neurofeedback works inter alia by normalising extreme personality and raising feelings of well being. 12 participants with high scores for Withdrawal (as measured by the PSQ) were given either alpha/theta neurofeedback or mock feedback and their personality and mood were assessed. Withdrawal scores on the PSQ-80 were not found to change in either group but significant effects were found for the Profile Of Mood States (POMS), with real feedback producing higher overall scores than mock feedback (P = 0.056). Real feedback caused participants to feel significantly more energetic (P < 0.01) than did mock feedback. Sessions of real feedback made participants feel more composed (P < 0.01), agreeable (P < 0.01), elevated (P < 0.01) and confident (P < 0.05), whilst sessions of mock feedback made participants feel more tired (P < 0.05), yet composed (P < 0.01). These findings suggest that, whilst 9 sessions of alpha/theta neurofeedback was insufficient to change personality, improvements in mood may provide a partial explanation for the efficacy of alpha/theta neurofeedback.