The value of studies of quality of life in chronic respiratory tract diseases in the framework of holistic medicine

Quality of Life (QOL) is a new area of research evaluating the psychical, functional and psychological components of human life. According to current understanding of health issues the measurement of morbidity or mortality does not estimate the health status and describe the influence of illness on human life. The theoretical framework of Health Related Quality of Life is largely based on a multidimensional perspective of human as physical, psychological and social functioning and well-being, along the WHO definition of health. QOL assessment could be carried out using different psychological methods. There are several questionnaires developed to assess the quality of life in patients. The measurement instruments are generic (used in wide range of health related issues), domain specific (concerning some important outcome such as social support, coping), and disease specific which are used to assess patients with particular health problems. QOL assessment could be used as the measurements in pharmacoeconomics and clinical trials. Polish QOL Initiative Group produce Polish version of existing questionnaires--for example The Asthma Quality of Life Questionnaire was registered in Polish language version. Quality of Life researches facilitate doctors to understand patient's perceiving of the health state and help them to live a fulfilling life.     

An eighteen-year follow-up study of Israeli prisoners of war and combat veterans

Up to now, the quality of life of children and adolescents with psychiatric disorders has rarely been investigated. Not many suitable instruments are available. A new one is the "Inventory for the Assessment of the Quality of Live in Children and Adolescents" presented here. Objectives and underlying conceptual assumptions are discussed, followed by an explanation of the instrument itself (questionnaires, rating scales, etc.). Finally, experiences with the application of the instrument are reported together with initial empirical results from a clinical sample and a sample of high school students. These indicate that the instrument usefully assesses clinically relevant information about the quality of life of the patients. A broader empirical analysis of this method is being prepared.     

Measuring the quality of life of children and adolescents with asthma--The Pediatric Asthma Quality of Life Questionnaire

Quality of life becomes more and more important in evaluating the effects of treatments. At the moment, different questionnaires to measure quality of life in children and adolescents with asthma are available. The Paediatric Asthma Quality of Life Questionnaire (PAQL) was developed by Juniper and co-workers in Canada and has already been translated into German. It is a self- or interviewer-administered instrument for children and adolescents between age 7 and 17. The PAQL contains 23 items in three domains: activity limitation, symptoms, and emotional function. The empirical results suggest that the PAQL is reliable and sensitive to clinical change. Problems associated with the administration are discussed.     

Beyond unfavorable thinking: The Illness Cognition Questionnaire for chronic diseases.

The literature on chronic diseases recognizes the role of illness cognition as a mediator between stress and illness. Few conceptualizations and instruments, however, give an indication of both unfavorable and favorable ways of adjusting to an uncontrollable long-term stressor, such as a chronic disease. The authors propose 3 generic illness cognitions that reflect different ways of reevaluating the inherently aversive character of a chronic condition: helplessness as a way of emphasizing the aversive meaning of the disease, acceptance as a way to diminish the aversive meaning, and perceived benefits as a way of adding a positive meaning to the disease. A self-report instrument, the Illness Cognition Questionnaire, was developed to assess these cognitions across different chronic diseases. The results support the reliable and valid assessment of these illness cognitions in patients with rheumatoid arthritis and multiple sclerosis and indicate the maladaptive function of helplessness and the adaptive function of acceptance and perceived benefits for the long-term physical and psychological health of patients with a chronic disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health assessment in the rheumatic diseases of childhood

Assessment of children and adults with rheumatic diseases, both in clinical practice and controlled clinical trials in rheumatology, has traditionally focused on the measurement of disease activity. More recently emphasis has been placed on the need to incorporate estimates of physical, social, and mental functioning into health assessment. Thus there has been a tremendous growth in the development of measurement instruments that evaluate health status, functional status, disability, and quality of life. This type of measurement has become essential, particularly for clinical trials in adults with rheumatic diseases, for which the AIMS (Arthritis Impact Measurement Scales), the HAQ (Health Assessment Questionnaire), and the MACTAR (McMaster-Toronto arthritis) patient preference questionnaire have been the most widely used. In the past few years, similar measures have been developed for application in children with rheumatic diseases. These include the CHAIMS (Childhood Arthritis Impact Measurement Scales), the CHAQ (Childhood Health Assessment Questionnaire), the JAFAR (Juvenile Arthritis Functional Assessment Report), the JASI (Juvenile Arthritis Self-report Index), the JAQQ (Juvenile Arthritis Quality of Life Questionnaire), and the CAHP (Childhood Arthritis Health Profile). In this review, the development and measurement properties of these childhood instruments are discussed, with particular emphasis on their potential roles as supported by recent literature.     

Reliability of mental status instruments administered to nursing home residents.

Compared the reliability of 8 mental status instruments (e.g., the Short Portable Mental Status Questionnaire) administered to 36 nursing home elderly (mean age 84.86 yrs) referred for psychological assessment. Test–retest, split-half, and internal consistency methods were employed to determine the reliability of each instrument. Most of the instruments were found to have acceptable reliability using all 3 methods, and in general all the instruments were of equal value with regard to reliability. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of an instrument for assessing the quality of life of people with diabetes. Diabetes-39

OBJECTIVES: The aim of this 2-year research project was to develop an instrument specifically designed to assess the quality of life of people with diabetes. METHODS: The project was divided into two phases. In the first phase, information from a detailed literature review, from existing quality-of-life instruments, and from interviews with health professionals and people with diabetes was used to develop an initial instrument of 92 items considered to address important aspects of patients' lives. This questionnaire was mailed to 1,000 people with diabetes, and data from the 516 respondents were used to select the most important and useful items. Fifty items were excluded, leaving 42 items that constituted the pilot instrument. During phase 2, the pilot instrument was used to assess the quality of life of 427 diabetic patients who completed the revised questionnaire. After analyzing this data, three additional items were dropped. The final instrument consists of 39 items and covers five dimensions of patients' lives: Energy and Mobility, Diabetes Control, Anxiety and Worry, Social Burden, and Sexual Functioning. RESULTS: The results of validity and reliability tests conducted to date testify to the relevance of the 39-item questionnaire (Diabetes-39) as a valid discriminative instrument, one which shows significant correlations with an overall quality-of-life assessment, the pattern of diabetes severity, and comorbidity. Further, the results from Diabetes-39 correlate well with the results from the established generic quality-of-life instrument, the Medical Outcomes Study 36-Item Short-Form Health Survey. CONCLUSIONS: Validation of a quality-of-life instrument, however, is an ongoing process. Further research is required to corroborate these early findings and to ensure that this is an instrument that can capture data of greatest relevance to the diabetic patient and that is responsive to change in quality of life.     

Assessing noninstitutionalized asthma and COPD patients' priorities and perceptions of quality of health care: the development of the QUOTE-CNSLD instrument

Patient judgments on the quality of health care services have become increasingly important. This research describes the development and empirical testing of an instrument that measures quality of health care services from the perspective of noninstitutionalized patients. The instrument was developed in close collaboration with noninstitutionalized patients with chronic nonspecific lung diseases (asthma and COPD), rheumatic diseases, and disabled and elderly patients. Four instruments were developed with a common generic part and four disease-specific parts. This article focuses on the psychometric properties and the practical use of outcomes for quality assurance policies of the instrument for patients with chronic nonspecific lung diseases.     

The effects of substrate and fluid provision on thermoregulatory, cardiorespiratory and metabolic responses to prolonged exercise in a cold environment in man

We propose a method for selecting quality-of-life instruments for use in phase III trials using the convergent validity of patient responses collected in phase I and II clinical trials. Two generic and two disease-specific instruments were administered to patients with breast cancer undergoing peripheral blood progenitor cell mobilization and transplantation. They included the visual analog scale from the EuroQoL EQ5D instrument, the SF-36, the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C30, and the Functional Assessment of Cancer Therapy instrument. No single instrument was found to have superior convergent validity in all domains, but the EORTC-QLQ-C30 seemed to perform better than the SF-36.     

Development of an instrument to assess stress levels and quality of life in children with asthma

The purpose of this study was to develop and evaluate a new instrument, About My Asthma (AMA), to assess stressors affecting quality of life in children with asthma. The AMA is a 55-item, 4-point Likert-type scale. Concurrent validity was established by comparing the AMA with the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). Increased levels of stress measured by the AMA correlated with a decreased quality of life measured by the PAQLQ. We conclude that the AMA is a valid and reliable instrument to measure the quantity and type of stressors experienced by children who have asthma.     

Quality-of-life measures in asthma--do they matter to the GP?

Asthma is a condition which incurs a great cost to the National Health Service, to the economy and above all to the patient in terms of loss of quality of life. Treatments for asthma need to be evaluated for their cost-effectiveness. Traditional outcome measures, such as airflow measurements have their limitations, especially in mild to moderate asthma. Quality-of-life measurements represent the impact of asthma on the everyday lives of asthmatics across the whole disease spectrum. Disease specific quality-of-life questionnaires, such as the Asthma Quality-of-Life Questionnaire (AQLQ), provide reliable instruments in reflecting disease severity, but also in detecting changes in quality of life produced by different asthma treatments. Quality-of-life measures are becoming increasingly important and are end-points of therapeutic asthma trials in primary care, but should be used in conjunction with more surrogate markers of asthma severity such as peak flow.     

Evaluation of indicated preventive intervention (secondary prevention) mental health programs for children and adolescents

Evaluated the outcomes of 130 indicated preventive interventions (secondary prevention) mental health programs for children and adolescents that seek to identify early signs of maladjustment and to intervene before full-blown disorders develop. Results indicate such programs significantly reduce problems and significantly increase competencies. In particular, behavioral and cognitive-behavior programs for children with subclinical disorders (mean ESs in the 0.50s) appear as effective as psychotherapy for children with established problems and more effective than attempts to prevent adolescent smoking alcohol use, and delinquency. In practical terms, the average participant receiving behavioral or cognitive-behavior intervention surpasses the performance of approximately 70% of those in a control group. Of particular interest was the high mean effect (0.72) achieved by programs targeting incipient externalizing problems which are customarily the least amenable to change via traditional psychotherapeutic efforts when they reach clinical levels. Priorities for future research include greater specification of intervention procedures, assessment of treatment implementation, more follow-up studies, and identifying how different participants respond to early intervention.     

Overview of health-related quality-of-life measures for pediatric patients: application in the assessment of pharmacotherapeutic and pharmacoeconomic outcomes

Health-related quality of life (HRQOL) is an important dimension in assessing health care. Several methodologic considerations are related to the manner in which these data are obtained in children. Few multidimensional generic measures of quality of life (QOL) have been developed for children and adolescents. Most published research concerns the development of tools to be used in a disease-specific manner for clinical trials. Although several authors point out numerous advantages in assessing HRQOL in clinical practice, several barriers must be overcome for this to occur. In the current era of economic restraint, HRQOL measures must be integrated into pharmaco-economic analyses to assess fully the impact of a drug on health care resources and outcomes.     

Randomized comparison of four tools measuring overall quality of life in patients with advanced cancer

PURPOSE: We report on a clinical trial developed to compare four different instruments that provide overall quality-of-life (QOL) scores, ranging from a simple, one-item instrument to more detailed instruments. Two issues addressed were (1) Will QOL tools suffer from missing data when used in a community-based cooperative group setting?, and (2) Are there additional data generated by a more detailed multiitem instrument over that provided by a single-item global QOL question? MATERIALS AND METHODS: A four-arm randomized trial was designed to compare four instruments that provide overall QOL scores in patients with advanced colorectal cancer. Patients and physicians completed the single-item Spitzer Uniscale (UNISCALE) at baseline and monthly. Patients were randomly assigned to complete, in addition, either the 22-item Functional Living Index-Cancer (FLIC), the five-item Spitzer QOL index (QLI), a picture-face scale (PICT), or nothing else. RESULTS: A total of 128 patients were randomized. Greater than 90% complete QOL data were obtained. There was strong correlation, concordance, and criterion-related validity among all four patient-completed tools. The UNISCALE had a greater decrease over time than did the FLIC (P=.005), which suggests a greater sensitivity; the UNISCALE was similar to the QLI and the PICT in this regard. Physicians provided lower UNISCALE scores than patients. Results supported the hypothesis that QOL is prognostic for survival. CONCLUSION: Patients can effectively complete QOL tools in a cooperative group setting with proper education of health care providers and patients. A simple single-item tool (UNISCALE) appears to be appropriate to obtain a measure of overall QOL.     

A step in the right direction: A resource for collaboration on health-related issues.

Reviews the book, Health-related disorders in children and adolescents edited by L. Phelps (see record 1998-07780-000). This edited text provides an overview of 96 medical conditions that place children at risk of developing psychological or educational problems. The central feature of this book is that it is intended as a reference tool for professionals who collaborate with medical professionals. Increasingly, there have been many vehicles for school psychologists to collaborate with medical professionals, including comprehensive school health care programs and school-based health clinics, and community-based coordinated services that provide children and youth comprehensive care. In this regard, school psychologists are likely to encounter increasing numbers of children who experience health disorders, along with more traditional areas of practice including mental health and educational issues. Although not a purely medically oriented text, Phelps has taken a perspective that school psychologists work within the context of a multidisciplinary team of professionals who are likely to provide services for these children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Appraisal of dental anxiety and fear questionnaires: a review

This article reviews and assesses six dental anxiety and fear questionnaires. The construct aimed at by the questionnaires, the data collected, their reliability, validity and normative scores are considered. Some attention is given to the correlations between the questionnaires, their ambiguity, the presence of manuals, and whether the questionnaires tap the three segments distinguishable on theoretical ground in dental anxiety/fear. All questionnaires are open to criticism. In the final assessment Kleinknecht's Dental Fear Survey is preferred to Corah's Dental Anxiety Scale. The latter, however, appears useful in getting a quick impression of anxiety and in evaluative studies. Three recently developed questionnaires, Stouthard's Dental Anxiety Inventory, Weiner's Fear Questionnaire and Morin's Adolescents' Fear of Dental Treatment Cognitive Inventory are considered promising, but for the last two instruments more data, in particular with regard to their validity, are needed. It is concluded that in dental anxiety research more than one questionnaire should be used and that it may be worthwhile to include other, non-anxiety questionnaires as well.     

Anxious children in adulthood: a prospective study of adjustment

OBJECTIVE: To prospectively examine psychosocial functioning in young adulthood for children and adolescents with anxiety disorders. METHOD: This 8-year prospective study compared psychosocial functioning in young adults (mean age 22 years) who had histories of early-onset anxiety disorders, comorbid anxiety and depressive disorders, or no history of psychiatric illness (NPI). Follow-up interviews assessed subjects' residential, educational, occupational, and marital status; utilization of mental health services; and psychological status RESULTS: Anxious subjects without histories of depression were less likely than NPI controls to be living independently. Anxious-depressed subjects were less likely than controls to be working or in school; more likely than purely anxious subjects to utilize mental health services; and more likely than both anxious and control subjects to report psychological problems, most frequently depression. CONCLUSIONS: Overall, results suggest that children with anxiety disorders are relatively well adjusted in young adulthood. However, a history of comorbid depression is prognostic of a more negative outcome.     

Assessment of problem situations in the family

Goal of the study is the analysis of the German version of Barkle's Home Situations Questionnaire. The analysis is accomplished in a clinical sample of N = 76 children at the age of six to ten years with the diagnosis of a hyperkinetic disorder according to ICD-10 or an Attention deficit-/hyperactivity disorder according to DSM-III-R and in a representative sample of N = 263 children aged seven to ten years. Parents of hyperkinetic children experience many family situations with their child as very problematic which is essentially more often than parents in the representative sample. Analyses of the factorial structure of the questionnaire yielded no clear and well interpretable solutions. The instrument has a good internal consistency. The HSQ-D scores correlate significantly with other parent questionnaires for the assessment of behaviour problems, the highest correlations were found with scales for the assessment of hyperkinetic behaviour problems and social problems. In the clinical practice the instrument has proven helpful within symptom-specific assessment of children with hyperkinetic and oppositional behavior disorders and for the planning of interventions.     

Developing outcome measures for ambulatory care--an application to asthma and diabetes

Increasing emphasis is now being placed on the assessment of patient outcomes, both in evaluating medical interventions and in quality assurance initiatives. Clinicians, purchasers, managers and researchers need outcome measures that are valid, reliable and responsive. This paper describes the theory and practice underlying the development of outcome measures for two chronic conditions, asthma and diabetes, for application in ambulatory settings. Existing generic and condition-specific health status and health-related quality-of-life measures were administered to almost 1300 patients. The psychometric properties of these measures were examined to identify those that were of adequate validity and reliability in these population groups. Step-wise regression procedures were then used to identify a core set of scales that best predicted patients' general health perceptions, which could be used in measuring general health outcomes for each of these groups. These core sets consist of up to 40 items, spanning physical function, energy and vitality, emotional well-being and condition-specific aspects of health such as symptom control. Further analysis is being carried out to assess the responsiveness to change of these core item sets.