Measuring quality of life for an economic evaluation of aphasia: First steps

Health economists typically use the Quality Adjusted Life Year (QALY) when conducting economic evaluations of healthcare investments. We have begun investigating methods to obtain QALYs for aphasia by developing a pictographic version of the Time Trade-Off methodology (picTTO) in an attempt to circumvent language barriers. A convenience sample of 50 adults with aphasia participated in reliability and validity testing of the picTTO. Analysis suggests that while the picTTO itself has face validity, results demonstrated poor to moderate test-retest reliability which we plan to improve by optimizing the study design

Service evaluation of weight outcomes as a function of initial BMI in 34,271 adults referred to a primary care/commercial weight management partnership scheme

Peer reviewedPublisher PD

Health-related quality of life in childhood epilepsy: Moving beyond 'seizure control with minimal adverse effects'

Childhood epilepsy is one of the most important and prevalent neurological conditions in the developing years. Persons with childhood onset epilepsy are at a high risk for poor psychosocial outcomes, even without experiencing co-morbidities. The goal of management of children with epilepsy should be to enable the child and the family to lead a life as free as possible from the medical and psychosocial complications of epilepsy. This comprehensive care needs to go beyond simply trying to control seizures with minimal adverse drug reactions. Seizure frequency and severity is only one important outcome variable. Other factors such as social, psychological, behavioural, educational, and cultural dimensions of their lives affect children with epilepsy, their families and their close social networks. A number of epilepsy-specific health-related quality of life (HRQL) scales for children have been developed with the aim to include and measure accurately the impact and burden of epilepsy. Their target populations, details of the origin of the items, and psychometric properties vary significantly. Their strengths and weaknesses will be identified more clearly through their continued use in the clinical setting and in research studies. Only a few studies to date have utilized these or generic HRQL measures to assess the HRQL of specific populations with epilepsy. Future research needs to develop theory driven models of HRQL and identify measurable factors that have important correlations with outcomes. Since biomedical variables like seizure frequency and severity have only moderate correlations with HRQL, other independent factors including the child's resilience, co-morbid conditions, parental well-being, family factors and societal/cultural variables may play a major role. We also need to learn what encompasses comprehensive patient care, define the goals of management and evaluate the impact of different interventions. Future studies need to include the children's own perspectives of their HRQL in addition to parental reports. Finally, clinicians need to familiarize themselves with outcome measures, be able to evaluate them, and use them routinely in their day-to-day practice

Transitions in Hearing Impairment and Psychological Distress in Older Adults

Objective: Although previous research has demonstrated an association between hearing impairment (HI) and psychological distress, less work has explored the effect of transitions in hearing status on distress over time, or the explanatory pathways that may explain this association.Method: We use 2 waves of data from the Canadian National Population Health Survey to examine the effect of HI transitions on changes in distress during 6 years, and to test the potential mediating effects of psychosocial factors and chronic stressors.Results: Experiencing a decline in hearing was associated with increased distress at Wave 4, net of Wave 1 distress, although the significance of the relation was reduced to trend level following adjustment for sociodemographic variables (P < 0.06). The introduction of mastery and self-esteem further reduced the size of the effect of reporting a decline in hearing in the fullmodel.Conclusions: The association between declines in HI and psychological distress during a 6-year period did not reach a traditional level of statistical significance, and we discuss potential explanations for this finding. Mastery and self-esteem may be important explanatory variables in the HI–distress association and should be considered in future research

Patient empowerment within a coronary care unit: insights for health professionals drawn from a patient satisfaction survey

The aim of this exploratory study was to investigate coronary care patients’ perceptions of their care and interventions related to empowerment and strengthening patient choice. The study, conducted in one acute National Health Service (NHS) Trust in Cambridgeshire, England, and completed in 2002, employed a prospective survey design. The research used a self-completion, pilot, postal questionnaire, including closed, open and scaled questions as the main method of data collection. From a total of 200 eligible patients, an unselected, consecutive sample of 142 in-patients consented to participate, of whom 103 returned the questionnaire—–a response rate of 73%. In contrast to much published literature, this study demonstrated that empowerment issues involving the rights of coronary care patients to be primary decision makers, managers of their illnesses and ultimate arbiters of their treatment and care were of minimal concern to all but a few. Almost 90% of patients were content to entrust their care exclusively to health professionals based on their confidence in the clinical expertise of the medical and nursing staff. Findings suggested that, while respondents were well-satisfied with their care, the ethos of patient empowerment was of peripheral concern and readily abdicated in the face of acute illness

Panic disorder in later life: Results from a national survey of Canadians

Background: At present, our understanding of the risk markers associated with panic disorder among older, community dwelling older adults is limited. To address this gap, we examined the prevalence, risk markers, and comorbidity of panic disorder defined using DSM-IV criteria among older adults.Method: Using data drawn from a large, nationally representative sample of Canadians, we estimated lifetime and 12-month prevalence of panic disorder, and examined demographic predictors and patterns of comorbidity of current panic disorder in adults aged 55 years and older (n = 12,792).Results: The 12-month and lifetime prevalence estimates of panic disorder in this sample were 0.82% and 2.45% respectively, and one-fifth of these cases reported a first onset after the age of 55 years. In multivariate models, the risk of panic disorder decreased with older age and was significantly lower among widowed respondents. Physical limitations in daily activities as well as the presence of other psychiatric disorders (major depression, and social phobia) were also significantly associated with panic disorder in this sample.Conclusions: Consistent with previous research on panic disorder, the prevalence of the disorder decreased with age among older adults. Potential explanations for the age effect and the clinical implications of the mental health comorbidities with panic disorder are discussed

Reliability and validity of the RS14 in orphaned and separated adolescents and youths in western Kenya

Purpose: The 14-item Resilience Scale (RS14) is a tool designed to measure psychological resilience. It has been used effectively in diverse populations. However, its applicability is largely unknown for Sub-Saharan adolescent populations and completely unknown for orphaned and separated adolescents and youths (OSAY), a highly vulnerable population for whom resilience may be critical. This study assesses the RS14\u27s psychometric properties for OSAY in Uasin Gishu County, Kenya. Methods: Survey responses from a representative sample of 1016 OSAY (51.3% female) aged 10-25 (mean = 16; SD = 3.5) living in institutional and home-based environments in Uasin Gishu County were analyzed. The RS14\u27s psychometric properties were assessed by examining internal consistency reliability, confirmatory factor analyses, and convergent validity using correlations between resilience and each of social support and depression. Sub-analyses were conducted by age and sex. Results: Resilience scores ranged from 14-98 (mean = 66; SD = 19) with no sex-based significant difference. Resilience was higher for those aged ≥18 (mean = 69; range = 14-98) versus age \u3c18 (mean = 65; range = 14-98). Internal consistency was good (Cronbach\u27s α = .90). Confirmatory factor analysis indicated a 1-factor solution, though the model fit was only moderate. Resilience was positively correlated with social support in all ages (.22; p \u3c .001) and negatively correlated with depression in individuals age \u3c18 (-.22; p \u3c .001). The relationship between resilience and depression in individuals age ≥18 was statistically significant only in females (-.17; p = .026). Conclusion: This study demonstrates reasonable evidence that the RS14 is both valid and reliable for measuring psychological resilience in the population of OSAY in western Keny