Transcultural adaptation of the Liver Disease Quality of Life instrument (LDQOL 1.0) for its use in the Spanish population

Instruments of health-related quality of life (HRQOL) help us to interpret the results of treatments and health interventions. In Spain there is no HRQOL instrument specifically designed for use in patients with liver disease or to measure the effect of interventions such as liver transplantation. The Liver Disease Quality of Life (LDQOL 1.0) questionnaire is an American instrument developed for use in these patients. The aim of this study was to produce an appropriate version of this questionnaire for use in Spain. Cultural adaptation was performed in 3 phases: a) modification for use in Spain of a Hispanic version of this questionnaire supplied by the original authors; b) back-translation to English of a new version of the questionnaire and comparison with the original version in English, and c) a pilot test in a small sample of patients. In the first phase consisting of revision of the Hispanic version, the changes were mainly linguistic due to cultural and idiomatic differences. The validated Spanish version of the SF-36 was directly incorporated and items that could be of interest to local investigators were added. Few changes were made in the second phase of the process: changes involved an item on the appearance of feces and another item on taking naps. In the final phase, various changes suggested by the patients were introduced. Before applying the new version of the LDQOL 1.0 in clinical studies in Spain, its psychometric properties (its reliability, validity and sensitivity to change) must be verified in a subsequent validation study.     

Cross-cultural adaptation to Spanish of the Vécu et Santé Perçue de l'Adolescent (VSP-A):: a generic measure of the quality of life of adolescents

BACKGROUND: Different measures of health related quality of life for use exclusively in children and adolescents have been developed over the last ten years. However, few instruments of this type have been adapted in Spain. The VSP-A is a generic health related quality of life measure for adolescents aged 11-17 developed in France. The objective of this study was to adapt the VSP-A into Spanish as a first step towards obtaining this questionnaire. METHODS: The version of the VSP-A including 39 questions was adapted following the forward-backward translation methodology, including two translations into Spanish, scoring of difficulty (0 min-10 max.) and classification of semantic and conceptual equivalence, two panel discussions with adolescents, as well as meetings of consensus with the original authors. Finally, a backward translation (translation back into the original language) was carried out into French, and the final pre-test version was administered in a pilot test. RESULTS: Most of the questions were classified as equivalent (24/39). Following the meetings with adolescents, changes were made in some questions. After the back-translation into French, three questions required some minor changes. CONCLUSIONS: The Spanish version of the VSP-A seems to be semantically and culturally equivalent to the original version and suitable for adolescents in Spain. The inclusion of easy statements in the original version, the comments of the adolescents and the involvement in the adaptation process of the original authors has offered the possibility of achieving a suitable pre-test version. The next phase of the study will involve the questionnaire's reliability and validity testing. The VSP-A is expected to be useful for measuring the health-related quality of life in health surveys or as a screening tool in schools and primary care centers in Spain.     

Kaposi's sarcoma of the head and neck in patients with AIDS

Over a 40 month period, 219 patients with AIDS were seen at St. Mary's Hospital, London. Kaposi's sarcoma, one of the criteria for diagnosing the syndrome, was the presenting feature in 62 patients. Eighty four patients developed Kaposi's sarcoma at some stage of their disease and the head and neck region was involved in 56 of them. Although Kaposi's sarcoma is rarely life threatening in AIDS, potential airway obstruction, pain or cosmetic disfigurement may justify treating the lesion. Whilst cutaneous tumours may be managed by using radiotherapy (16 Gray in four fractions over four days), this treatment produces a sever mucositis when used to treat mucosal disease; we, therefore use a combination of vincristine and bleomycin for this.     

Chondrosarcoma of the sphenoid--a case report and review

The case of 57-year-old woman is presented with a chondrosarcoma of the sphenoid. The main symptom was rapid loss of vision and in order to halt this the tumour was debulked. The literature relating to chondrosarcomas of the head and neck is reviewed. These rare tumours are not radio-sensitive and surgery represents the best form of treatment at the present time. The prognosis is poor.     

Grommets and cholesteatoma in children

Cholesteatoma in children may be a sequel to chronic exudative otitis media with tympanic membrane retraction but the role of grommets in the possible facilitation of squamous epithelial invasion into the middle ear is not yet clear. A retrospective study was made of the history and prior treatment in 25 children who underwent mastoidectomy for cholesteatoma at St. Mary's Hospital between 1975 and 1986. Thirteen patients had undergone previous middle ear aeration procedures which included myringotomy, cortical mastoidectomy and grommets. There was no difference in the site or severity of cholesteatoma in the operated and non-operated cases. Of the seven patients with a history of multiple grommets three had primarily attic, and three had primarily mesotympanic disease. The latter had greater ossicular erosion. One patient with an intact tympanic membrane had grommet insertion subsequently developed a cholesteatoma. While cholesteatoma due directly to the presence of grommets is rare, it appears that children who require multiple grommet insertions constitute a high risk group and should be very closely monitored.     

The influence of ill-health experience on the valuation of health

Social valuations for health states are potentially useful both in clinical decision-making and in health-resource allocation, but there is some evidence that the experience of illness may affect such valuations. This article compares valuations of hypothetical health states obtained from a sample of chronically ill patients, with valuations obtained from a sample of relatively healthy individuals. The instrument used to obtain these values was the EuroQOL 5D questionnaire (EQ-5D). We found that the EQ-5D values of chronically ill patients differed significantly from the values obtained from healthier individuals, particularly in the case of the more severe health states. Healthy individuals assigned negative values to some hypothetical health states, indicating that they consider them to be worse than death, whereas chronically ill patients assigned positive values to all health states. These results raise difficult questions about whose values should count when health-status measures are incorporated in clinical and economic evaluation, and in particular when deciding upon the allocation of scarce resources.     

Treatment of benign paroxysmal positional vertigo

Peripheral vestibular disorders result in vertigo, disequilibrium, and frequently nausea and vomiting. The purpose of this article is to describe the physical therapy management of one of the more common peripheral vestibular disorders--benign paroxysmal positional vertigo (BPPV). Several different approaches have been used in the treatment of BPPV. These approaches are compared, and the criteria used in choosing the appropriate approach are presented. Case studies are used to illustrate the different treatment approaches.