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.     

A questionnaire suitable for general practice for detection of the health status and quality of life of patients with hemato-oncologic diseases: psychometric properties. The Study G "Quality of Life" of the International Society for Chemo- and Immunotherapy (I.G.C.I.)

In the evaluation of therapeutic measures it is important to consider the consequences of the proposed treatment on the subjective quality of health and the subjective quality of life. Since no adequate instrument existed to provide such assessments, a short, theoretically based questionnaire was developed and psychometrically tested. The construction phase was based on data of 104 adults with haemato-oncological diseases, leading to the design of a questionnaire which was tested using data of a further 292 patients. The validity of the "questionnaire for attitudes towards quality of health and quality of life" was assessed by comparing it with physicians' ratings and by correlation with the results of an extensive questionnaire. The reliability was satisfactory; the questionnaire met with high acceptance by patients, physicians and health care personnel. It complies with the requirements of clinical trials where the objective is to measure quality of health and quality of life.     

Investigating the relationship between pain and discomfort and quality of life, using the WHOQOL

The aim of this study was to examine the impact of pain on quality of life and its components in a representative sample of 320 well people, and patients selected from all major categories of illness. Quality of life was assessed using a new, multidimensional, multilingual, generic profile designed for cross-cultural use in health care, i.e. the WHOQOL. Within the WHOQOL, pain and discomfort is one of 29 areas or facets of quality of life, grouped into six domains. It was found that pain and discomfort made a significant impact on perceptions of general quality of life related to health. Furthermore, the presence of pain affected perceptions of five of the six domains of quality of life; the domain of spirituality, religion and personal beliefs being the exception. When quality of life is assessed, negative feelings are most closely associated with reports of pain and discomfort than any other facet. But quality of life surrounding pain and discomfort is more fully explained by the inclusion of six additional facets; the availability of social care, mobility, activities of daily living, positive mood and to a lesser extent, sleep and dependence on medication. Together, these seven facets represent criteria against which the success of pain treatments may be evaluated. As predicted, those who were pain-free had significantly better quality of life than those in pain. A longer duration of pain is associated with increasingly poorer quality of life. Intense affective pain is particularly detrimental to a good quality of life. The psychometric properties of the pain and discomfort facet of the WHOQOL and WHOQOL-100 were assessed. Internal consistency (reliability), discriminant and criterion/concurrent validity were found to be good to excellent, justifying the use of this instrument with a range of chronic and acute pain patients.     

The contribution of job and leisure satisfaction to quality of life.

Examined the relationships between job and leisure satisfaction and their contributions to the perception of quality of life. Data were collected from a national probability sample of 1,297 adult Americans interviewed in May 1972. The magnitude of the correlations between job and leisure satisfaction measures was low; however, both accounted for meaningful variation in perceived quality of life for the total sample. Separate analyses for demographic subgroups were also performed. They indicated that job satisfaction and leisure satisfaction contributed relatively little to the life quality of minorities and other often "disadvantaged" subgroups compared to "advantaged" workers. Implications of the results for the application of motivational stategies in the work setting are discussed. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term validity of a personal history item scoring procedure.

The proposed "Uniform Guidelines on Employee Selection Procedures" suggest the need to evaluate the life span of selection instrument scoring procedures under changing labor market and job situations. The present study investigated the long-term validity of a personal history item scoring key developed on a 1933 sample of 10,111 life insurance agents and reevaluated on a 1939 sample of 857 agents and a 1969–1971 sample of 14,738 agents. Results, presented in expectancy table format, indicate that over the 6-yr and 38-yr cross-validation periods, little, if any, validity was lost. This was true despite drastic labor market and economic changes as well as dramatic changes in the job itself. The apparent conflict of these results with those reported in other long-term validity studies is attributed to the impact of scoring key confidentiality, test maintenance, and adequate developmental sample size. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of life in chronic venous insufficiency (CVI). Results of a study with the newly developed Tübingen Questionnaire for measuring quality of life of patients with chronic venous insufficiency

Across the boundaries of the medical specialties we have realized how important the concepts of quality of life and disease-related coping behavior are to understand the patients' subjective perception of the medical condition and its treatment. Although standardized instruments are already available for different medical indications and even in the related fields of peripheral vascular and cardiac diseases, phlebology still lacks standardized concepts for evaluating quality of life and/or disease-related coping behavior in patients with chronic venous insufficiency (CVI). We report on a newly developed instrument specifically designed for recording quality of life in patients with CVI. It not only meets the requirements of psychometric standards, but has also proven its applicability in clinical use. The "Tübingen Questionnaire for measuring Quality of Life in patients with CVI (TLQ-CVI)" and the results of a study on quality of life in 142 patients with various stages of chronic venous insufficiency are presented. It was possible to distinguish between Stage I/II and Stage III CVI patients with respect to parameters such as "leg complaints" and "day-to-day fears and worries". These convey clinically relevant insights into the patient's subjective perception of the disease and how they cope. The information gathered provides a set of reasonable target scores for clinical studies presently being carried out at various study centers in Germany incorporating the TLQ-CVI.     

Development of the multidimensional index of life quality. A quality of life measure for cardiovascular disease

OBJECTIVES: The purpose of this study was to design a multidimensional measure of health-related quality of life appropriate for patients with cardiovascular disease that was psychometrically sound, brief, and easy to administer. METHODS: Qualitative interviews conducted with healthy subjects and patients with cardiovascular diseases identified nine major quality of life domains. Based on the responses of 129 cardiovascular disease patients recruited from hospitals and clinics, a criterion-based approach was used to select 35 questionnaire items that best tapped these domains. Psychometric properties of the Multidimensional Index of Life Quality (MILQ) were tested with a sample of 348 patients with various cardiovascular diseases. RESULTS: Cronbach's alpha was 0.76 or higher for eight of the nine MILQ domains. Test-retest reliability coefficients were 0.73 or greater in all but two domains. Individual domain scores as well as a weighted overall quality of life index were correlated highly with self-assessed health and the number of heart-related symptoms. CONCLUSIONS: The Multidimensional Index of Life Quality is a psychometrically reliable and valid instrument for measuring quality of life in patients with cardiovascular diseases. The MILQ also may be a suitable measure for other types of chronic diseases.     

Validation of a hand-held lactate device in determination of blood lactate in critically injured patients

OBJECTIVES: Admission blood lactate is an accurate predictor of injury severity and mortality in trauma patients. The purpose of this study was to evaluate a portable lactate analyzer in a clinical setting by patient care staff. DESIGN: A prospective, single-operator control solution and patient sample study, using two test devices and a reference device. SETTING: An urban Level I trauma center. PATIENTS: A convenience sample of 47 trauma patients. INTERVENTIONS: Intra-assay precision was demonstrated by performance of consecutive analyses of two lactate control solutions (high and low lactate control concentrations) by medical students and physicians. Split sample, simultaneous testing of the portable lactate analyzer was then performed on 66 whole blood specimens from a convenience sample of 47 trauma patients admitted to an urban Level 1 trauma center over 4 mos. Samples were tested simultaneously tested on two portable lactate analyzers and a reference instrument. MEASUREMENTS AND MAIN RESULTS: Acceptable intra-assay precision was achieved. Regression analysis for two test instruments demonstrated a slope of 0.920, an intercept of 0.323, an r2 of .982, and an SEM of 0.496. Regression analysis for test instrument "A" vs. the reference instrument showed a slope of 0.861, an intercept of 0.209, an r2 of .977, and an SEM of 0.598. Regression analysis for test instrument "B" vs. the reference instrument demonstrated a slope of 0.929, an intercept of -0.095, an r2 of .983, and an SEM of 0.506. CONCLUSIONS: Good correlation with a low SEM was obtained over a wide range of clinically relevant lactate values. Use of point of care lactate analysis will decrease analytic time, making an important diagnostic parameter immediately available in the critical care setting.     

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.     

Expression of fas antigen in the normal mouse brain

In this paper, the first of a series dealing with the development of a methodology for assessing quality of ambulatory care, a sample of 270 outpatients from the same health center were presented with a list of 12 questions. Although different versions of the questionnaire were tested, we found a high degree of agreement between the results. The findings indicate that the parameter "satisfaction" lends itself readily to measurement, thus becoming a useful instrument for guiding active intervention.     

The quality of life of people with mental retardation: in search of an adequate approach

There is a lack of instruments that measure the quality of life of people with mental retardation. These types of instruments could be used in order to give an indication of the quality of care they receive. At the moment we are developing an instrument that measures quality of life. Our first task is to find an adequate definition of 'quality of life'. In this article an attempt is made to define this term as it relates to people with mental retardation. Starting from literature in the field of disabilities, reflections in the social sciences and philosophical analysis, a combined approach is adopted, according to which quality of life consists of specific objective and subjective factors.     

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.     

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.     

Health professionals, disability, and assisted suicide: An examination of relevant empirical evidence and reply to Batavia (2000).

Prominent disability rights groups have adopted positions opposing the legalization of assisted suicide. That physicians and other health professionals would assist in suicides of persons with incurable conditions while offering suicide prevention to "healthy" individuals is, they maintain, evidence of social discrimination and an unwarranted devaluation of the quality of life of people with disabilities. This article examined empirical literature relevant to the question: Is there evidence that disability affects life in a manner that justifies an exception to the general practice of preventing rather than endorsing suicide? Research findings are discussed in terms of their bearing on the disability rights opposition to physician-assisted suicide and the need for research addressing the dynamics of death requests of persons with disabilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A proposal for evaluating cognition in assertiveness.

This article presents the development process and initial psychometric features of an instrument for evaluating cognition in assertiveness. This is an essential social skill for adolescent development and seems to encompass emotional, behavioral, and cognitive aspects. The instrument was created by combining both empirical and theoretical methods for item construction, aiming to evaluate the cognitive realm of assertiveness. A sample of 996 adolescent students was used to test for reliability and validity. Results indicate good psychometric properties. The instrument is composed of 4 subscales: Outer Emotional Support, Functional Personal Ability, Interpersonal Management, and Affective Personal Ability. The Assertive Interpersonal Schema Questionnaire may potentially be a useful tool in the diagnosis of, understanding of, and development of a treatment plan for individuals with persistent difficulties in social events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Can a personality construct be validated empirically?

Compared previous studies in which H. A. Murray's needs constructs were measured by the Personality Research Form, Adjective Check List, and/or Edwards Personal Preference Schedule. Analysis shows that the pattern of correlations between one Murray need and other needs, as obtained by one standard measuring instrument, typically has substantial incongruities with the pattern obtained for another such instrument, even when both instruments are administered to the same sample. It is argued that the validation of a construct cannot employ just any standardized test designed to measure it. Construct validation requires the empirical testing of statements derived from the abstract conceptualization about relationships between specified observables. Given the characteristics of standard instruments and of available formulations for common personality concepts, the optimal strategy is the concurrent development of a fresh conceptualization and of measuring operations which form an integrated whole. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating health-related quality of life in patients with facial acne: development of a self-administered questionnaire for clinical trials

Although psychosocial aspects of skin diseases are well known, disease-specific questionnaires validated for use in clinical trials are not available to assess the impact of facial acne on health-related quality of life or to evaluate therapeutic change. Development of such an instrument was undertaken and included item generation, reduction and pilot-testing phases. By interviewing acne subjects and dermatologists and literature review, 168 possible items were identified. Next, 165 acne subjects identified which items affected them and rated importance on a 5-point scale. Reduction to a brief questionnaire was performed by evaluating patient-perceived importance and factor analysis; four domains were identified (self-perception, role-emotional, role-social, acne symptoms). After pilot-testing for comprehension in acne subjects, further revisions were made to improve clarity and applicability. The resulting instrument takes 10 minutes to complete, and consists of 24 questions assessing how acne affected certain aspects of patients' lives during the past week on a 7-point scale. Thus, an instrument with excellent content validity was developed to assess health-related quality of life in patients with facial acne, and is comprised of statistically meaningful items of importance to patients. Other measurement characteristics are being assessed in a recently initiated study to evaluate test-retest reliability and responsiveness to therapy.     

External review for promotion and tenure in schools of nursing

A literature review conducted for a 1989 article on assessing the quality of life in surgical studies revealed that quality of life was more often mentioned than measured. Few authors reported the use of known, standardized scales. The objective of this study was to determine if and to what extent this situation has changed. A MEDLINE search of surgical studies published between 1989 and 1995 produced over 277 abstracts of surgical studies containing the words "quality of life." The abstracts were studied in three time periods: 1989-1990, 1991-1992 and 1993-1995. Findings indicated that the use of the term "quality of life" increased markedly over the study period, and studies using standardized measures escalated from 27.4% in 1989-1990 to 48.3% in 1993-1995. Those abstracts not stating how quality of life was assessed decreased from 48.4% in the early period to 21.7% in the last period. Of the abstracts reporting studies that used quality of life measures, 33% came from cancer studies, 21.7% from cardiovascular or respiratory studies, 14.8% from gastroenterology studies, 13.4% from nephrology studies and 6.1% from orthopedic studies. Surgical investigators selected a variety of global measures of quality of life as well as disease-specific instruments. The abstracts also revealed that surgeons are using quality-of-life assessment to monitor patients over time, to help select patients for surgery, to determine the effect of surgical treatment and for making policy decisions. Notwithstanding the limitations of this project, there is evidence in the literature that surgeons are increasingly willing to assess the impact of the surgical interventions by quality-of-life measures and are becoming more familiar with the diverse measures used to assess quality of life.     

Psychobehavioral treatment in cardiac rehabilitation

This article reviews the empirical evidence for the use of behavioral and psychological therapies in the rehabilitation of patients with coronary disease. Exercise training, Type A modification, psychological counseling, smoking cessation, and dietary modification are considered. It is concluded that psychobehavioral therapies offer considerable promise to coronary patients in improving quality and quantity of life.