Self-rated health between psychology and biology. A response to Huisman and Deeg

In their commentary on my article “What is self-rated health and why does it predict mortality? Towards a unified conceptual model”, Martin Huisman and Dorly Deeg argue, first, that the model I suggest may exaggerate the rational elements in the process of assessment and ignore the irrational and illogical influences; and, second, that self-rated health should be best understood not as a measure of “true health”, but as a measure of people's perceptions about their health. My response to these comments attempts to clarify the nature of the model as a tool for describing the conceptual and logical structure of the evaluation, not the empirical process itself. Psychological and external influences, including “irrational” elements, can be understood as belonging to the contextual framework of evaluation. There is no question that self-rated health represents individual self-perceptions, but to explain its association with mortality it is crucial to understand its relationship to the biological and physiological states of the organism.     

Prosthetic dental restorations in Swedish samples: prevalence and agreement between self-report,clinical findings,and influence on quality of life

Objective: To determine the prevalence of dental prosthetic restorations in an adult population, to study the agreement between self-reports and clinical findings of prosthetic restorations, and to study answers from a questionnaire in relation to the prevalence of prosthetic restorations.

Material and methods: A questionnaire was sent to a sample of 10,000 adults. A further sample of 1000 individuals was invited to answer the questionnaire and also participate in a clinical study. The agreement between self-report and clinical findings was analyzed, as were the associations between prosthetic restorations and questionnaire responses, using the chi² test.

Results: A total of 40% of the sample had fixed dental prostheses (FDP), 2.7% had removable dentures. The agreement between self-report and clinical findings was 93%. 34.7% of the individuals with no prosthetic restorations were university graduates and 4% of individuals with removable complete dentures. Oral health had the greatest impact on the quality of life of younger individuals with FDP, with an OHIP-14 (Oral Health Impact Profile) score of 7.3 for the age group 20–39 years compared to 4.9 for the age group 65–89 years. Conclusion: The questionnaire method can be a cost-effective way to determine the prevalence of prosthetic restorations.     

Training total communication

ABSTRACT

Background: Many people with severe or moderate aphasia begin to use nonverbal methods of communication spontaneously, but some need special training to do so. Use of total communication, including different nonverbal techniques, is often recommended to enable communication and participation in social interaction. Emphasis has also been placed on the importance of a communication partner in facilitating interaction and co-constructing the meaning in a discussion.

Aims: The aim of the present study was to examine the way people with severe or moderate aphasia perceive they communicate, and if they and their partners perceive changes in the use of different means of communication during an intervention where the aphasic participants are stimulated to use total communication and the communication partners are guided to support the interaction and to facilitate the use of different means of communication.

Methods & Procedures: The data were collected during a regular rehabilitation course. The course was carried out in two parts (8 + 4 days) with a 3-month interval. A total of 38 aphasic respondents, mainly with severe or moderate aphasia, aged 26 to 65 years, and 38 of their partners aged 29 to 71 years participated in the study. The research involved an initial, interim, and delayed post-test questionnaire design stretched over a 9-month period. An investigator-constructed, self-assessment questionnaire called Use of Different Communication Methods (UDCM) was used. With the aphasic participants a pictorial version of the questionnaire was administered in the form of an interview. The partners completed the questionnaire independently.

Outcomes & Results: The results indicate that persons with aphasia and their partners perceive the use of different communication methods quite similarly. The participants with aphasia perceive they use mostly the remaining ability of speech they possess and spontaneous nonverbal communicative methods and in lesser degree low-tech and high-tech devices. Both parties perceived that the use of spontaneous nonverbal means of communication and low-tech devices increased during and after the intervention.

Conclusions: The results indicate that people with severe and moderate aphasia and their partners perceive that total communication, i.e., all available means of communication as for instance, limited speech, spontaneous nonverbal means of communication and low-tech devices is often in use. They also perceive that the use of these different communication methods can further be increased by training and by guiding the communication partner to facilitate and support the use of them.     

A comparison of the perceptions and aspirations of third-year physiotherapy students trained in three educational settings in Poland

Objectives

In Poland, physiotherapy is offered at three types of school: medical universities, universities of physical education, and schools that do not specialise in either the medical sciences or physical education. This study explored the knowledge of students who were completing their physiotherapy studies about working in Poland and other countries of the European Union (EU), and about their vocational plans. Students were asked, through self-assessment, about aspects of the professional skills they had gained.

Design

Quantitative questionnaire-based study of students in three university settings.

Setting

Eleven university-level schools in Poland offering studies in physiotherapy and representing three orientations: medical sciences (MS), physical education (PE) and other universities (OU).

Participants

The study sample comprised of 954 third-year Bachelor programme students.

Results

The differences in university profiles did not influence the vocational plans of the students, with more than 70% (668/954) declaring that they would look for work outside Poland: 76% (725/954) in the UK and 69% (658/954) in Germany. Most students stated that finding work as a physiotherapist is difficult in Poland (686/954,72%) and easy in other EU countries (763/954, 80%). Differences in university profiles had an effect on the students’ assessments of their professional skills, as students from universities without a long-standing tradition of training in physiotherapy declared that they were less well prepared to work as physiotherapists; the difference was statistically significant for 12 of the 16 domains examined (P < 0.05).

Conclusions

In the light of these results, an increased influx of Polish physiotherapists, trained according to European standards, into EU countries, especially the UK and Germany, is to be expected in the near future. The physiotherapists will predominantly be graduates of medical and sports-oriented state universities. It appears advisable to launch, under the auspices of an EU programme, an integrated employment information system for physiotherapists that would offer updated information on current demand in individual EU countries.     

Health-related quality of life during the last three months of life in patients with advanced cancer

Goals of work  The aim of the study was to explore the development of functioning impairments and symptom occurrence during the last months of life of advanced cancer patients. Materials and methods  Self-reported data from 116 patients who all completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire—Core 30 (EORTC QLQ-C30) at 3, 2 and 1 month before death were analysed. Main results  All functioning aspects deteriorated. For physical, cognitive and social function, the most marked changes occurred between 2 and 1 month before death. The proportion reporting serious difficulties with self-care activities increased from 14% to 43%. The most seriously affected activity could not be distinguished from the EORTC QLQ-C30 scores. Levels of fatigue, dyspnoea and appetite loss increased significantly. More than 50% of the patients had severe pain at all assessments, and only a minor number (8%) reported any improvement. Conclusions  The findings have implications for the planning of care and indicate that further research is required to improve assessment, treatment and follow-up procedures. Adequate pain treatment seems still to be a challenge. Anorexia, fatigue as well as dyspnoea are all symptoms that need further focus.     

中国中老年人自评健康与心血管疾病发病风险的关联分析

目的分析中国中老年人自评健康(SRH)与心血管疾病(CVD)发病风险的关联。方法资料来自2011至2012年启动的中国健康与养老追踪调查项目,采用与人口规模成比例的概率抽样,从28个省级行政单位的150个区(县)获取21133名研究对象,本研究最终将11701名对象纳入分析。基线调查中采用问卷调查收集研究对象的基本情况和自评健康等资料,随访中收集研究对象自报CVD发病情况。采用Cox比例风险回归模型分析SRH与CVD发病风险的关联,按年龄、性别、体重指数(BMI)等因素分层进行亚组分析,采用似然比检验分析交互作用。结果研究对象年龄为(57.9±9.7)岁,男性占48.1%(5626名)。SRH极好、很好、好、一般和不好者分别占4.2%(487名)、13.5%(1583名)、33.6%(3932名)、35.4%(4147名)和13.3%(1552名)。随访累计42104人年,期间发生CVD 590例。与SRH极好(很好)者相比,SRH好、一般和不好者CVD发病风险的HR(95%CI)分别为1.36(1.02~1.80)、1.66(1.26~2.19)和1.89(1.38~2.59)。亚组分析显示,在45~59、≥75岁组、男性组、女性组和正常BMI组中,与SRH极好(很好)者相比,SRH不好者CVD发病风险的HR(95%CI)分别为2.00(1.32~3.04)、3.87(1.04~14.46)、1.76(1.07~2.91)、1.92(1.27~2.91)和2.30(1.42~3.72)。SRH与年龄、性别、BMI不存在交互作用(P>0.05)。结论中国中老年人群SRH与CVD发病风险有关,与SRH极好(很好)者相比,SRH好、一般和不好者CVD发病风险增加。     

医学生能力成长档案袋构建及应用研究

目的 通过回溯性构建医学生能力成长档案袋,应用其分析影响自我评价能力的因素,从而探究高效建构成长档案袋的方法。方法 随机选取汕头大学医学院2015届临床医学专业本科毕业生为研究对象,采用档案资料收集和在线问卷调查相结合的方式,系统性采集调查对象从入学、院校教育、毕业后医学教育共八年的成长数据,构建成长档案袋。利用Kendall’s tau-b相关系数检验变量的相关性,采用Mann-Whitney U检验分析组间差异。结果 共回收有效问卷并有效建立成长档案袋数据126份。采集数据指标共208个,其中问卷调查数据指标79个（含能力自评36个）,问卷信度系数（Cronbach’s α）为0.984。识别了与能力自我评价相关的因素。结论 本研究为实施成长档案袋评价提供了切入点,能够促进学生的自我评价和能力发展。优化数据指标体系、建设网络平台、激发参与者参与动机、突出反思和反馈要素,将有助于提高成长档案袋构建效率和效能。     

OSTA在慢性阻塞性肺疾病患者骨质疏松风险评估中的应用

目的:探讨亚洲人骨质疏松自我筛查工具(Osteoporosis Self-assessment Tool for Asians,OSTA)在慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者骨质疏松风险评估中的应用前景。方法:根据OSTA风险分层,对33例呼吸系统疾病患者,其中COPD23例,进行相关特征的分析。结果:COPD组骨质疏松中、高风险患者所占比例较对照组高。COPD组中不同风险组间在身高差、体重、BMI,甲状旁腺激素(PTH)、同型半胱氨酸(Hcy)水平,任何重要的骨质疏松性骨折(Major osteoporotic)、髋部骨折(Hip Fracture)概率及深吸气量(IC)的差异,存在统计学意义。OSTA与下列因素的相关性存在统计学差异,其中与身高差、Major osteoporotic概率、Hip Fracture概率、PTH、Hcy呈正相关,与体重、BMI、用力肺活量(FVC)、IC呈负相关。结论:COPD患者骨质疏松的风险较高,对于尚不具备双能X线吸收测量法(DXA)检测条件的基层医院,OSTA不失为一种有效的初步筛选工具。     

Gastrointestinal Symptoms Rating Scale in Coeliac Disease Patients on Wheat Starch-based Gluten-free Diets

Background: A wheat starch-based gluten-free diet is widely adopted in the treatment of coeliac disease, even though the products contain trace amounts of gluten. The aim here was to establish whether such a diet sustains abdominal symptoms. Methods: The Gastrointestinal Symptom Rating Scale (GSRS) was applied to 58 coeliac disease patients on gluten-free diets and 110 non-coeliac controls. An estimate was made of daily dietary fibre and wheat starch-derived gluten. Psychological well-being was evaluated by a structured interview. Twenty-three coeliac patients consented to small-bowel biopsy. Results: The mean GSRS score in coeliac disease patients did not differ from that in control subjects. Poorer psychological well-being was associated with abdominal symptoms in coeliac patients, whereas the daily amount of wheat starch had no effect on GSRS score. Overall dietary compliance was good, and villous atrophy was found in only 2 out of 23 patients. The average fibre consumption, 13 g per day, was lower than recommended. Conclusions: Wheat starch-based gluten-free products are well-tolerated in coeliac disease patients, provided that their diets are otherwise strict.