The relation of reported symptoms to social, individual, and behavioral indicators of ill-health: is the number of reported symptoms a unique general dimension of ill-health?

Concordance Between Respondent Self-reports and Medical Records for Chronic Conditions

Researchers have frequently relied on case identification using clinician-based screening as the standard. This study evaluates a self-administered screening questionnaire developed for use in the Veterans Health Study. We compared concordance between elderly patients' reports of selected chronic illnesses and the medical record. The purpose of this study was to determine the feasibility of using a self-report screening questionnaire for case identification in an outcomes study of elderly respondents. Reports of the presence of selected chronic illnesses were compared in a sample of patients (N=402) receiving outpatient care between 2 data sources, patient self-report and medical record, to determine overall concordance in 5 common chronic conditions (hypertension, adult-onset diabetes mellitus, chronic low-back pain, osteoarthritis of the knee, and chronic lung disease). Discordance between the 2 data sources varied by condition. Differences in reporting were small for diabetes and hypertension, intermediate for chronic lung disease, and larger for osteoarthritis of the knee and chronic low-back pain, where the chart did not identify substantial proportions of cases reported in the questionnaire. Use of patient-reported screening questionnaires, which are self-administered, is a valid, cost-efficient method to identify some chronic illnesses. Using medical records alone may result in underestimation of some symptom-based conditions.

Background morbidity of headache in an adult general population. Results of the Austrian SERMO (Self-Reported Morbidity) study

STUDY OBJECTIVE

To assess period and point prevalence of headache in Austria and the influence of sociodemographic factors and seasonal variations.

DESIGN

Data for the prevalence of headache were drawn from the database of seven representative surveys in the SERMO study (Self-Reported Morbidity Study). The aims of the SERMO study are to describe and monitor the characteristics of background morbidity in the Austrian population. The study is based on face-to-face interviews. Headache/migraine was one of 36 disorders the interviewed persons were asked about.

SETTING

The representative samples of the Austrian general population were selected by the "quota-procedure". Thus each cross sectional sample is representative for the entire Austrian population.

PARTICIPANTS

The study population consisted of 7,162 Austrian people over 15 years of age.

RESULTS

About one fifth (20.1%) of the Austrian adult population reported having headaches during the year (prevalence 26.4% in women vs. 13.0% in men, p<0.001). Period prevalences varied from 19.6% in August to 23.1% in October 1995. Mean point prevalence in the general population was 5.7% (3.6% in men vs. 7.7% in women, p<0.001). The highest point prevalence (8.0%) was observed among people over 60. Whereas period prevalence showed no trend with age or education, we found increasing point prevalence with age and lower levels of education. In general, significantly more people with self-reported headache suffered from stress (39.1% vs. 33.7%, p<0.001) and chronic diseases (33.6% vs. 23.2%, p<0.001) and took drugs regularly (all kinds of medication: 44.3% vs. 26.8%, p<0.001).

CONCLUSIONS

Headache is one of the most commonly experienced symptoms in Austria. The most common concomitant disease in the study population as a whole was hypertension. People with headache had a higher prevalence of hypertension, rheumatic diseases, venous diseases, diabetes and a higher consumption of drugs. Therefore, headache, as one aspect of multimorbidity or a symptom of other diseases, could be an indicator of impaired well-being and poor health.

The association between exposure to a rear-end collision and future health complaints

Different symptoms, together with neck pain, have been attributed to persons with persistent complaints after a previous motor vehicle crash (MVC) and are sometimes referred to as the "late whiplash syndrome." A cohort study was conducted to determine whether exposure to a rear-end collision, with or without whiplash injury, is associated with future health complaints. The results regarding future neck or shoulder pain have previously been described, and the objective of the present report was to focus on outcomes other than neck pain. Included in the study were persons 18 to 65 years of age and covered by traffic insurance at one of the largest insurance companies in Sweden. Claim reports were collected from the period November 1987 to April 1988. Drivers exposed to a rear-end collision were divided into two subgroups: those with reported whiplash injury (n = 232) and those without reported whiplash injury (n = 204). For comparison, 3688 subjects who were unexposed to MVCs were selected, with consideration taken to the age and gender distribution in the exposed subgroups. The prevalence of different health complaints among the study subjects was estimated according to a mailed questionnaire at follow-up in 1994, 7 years after the rear-end collision. When exposed subjects with whiplash injury were compared to unexposed subjects, increased relative risks in the range of 1.6-3.7 were seen for headache, thoracic and low back pain, as well as for fatigue, sleep disturbances and ill health. No corresponding increased risks were found among the exposed subjects without reported whiplash injury. We conclude that rear-end collisions resulting in reported whiplash injuries seem to have a substantial impact on health complaints, even a long time after the collision. There is a need to identify factors that predict a non-favorable outcome in order to improve clinical management.

The patient-specific index: asking patients what they want

The Patient-Specific Index is used to assess the outcome of total hip arthroplasty by evaluating the preferences of the individual patient. The purpose of this study was to determine the reliability, validity, and responsiveness of this index and to compare different methods of combining patients' ratings of the severity and importance of their complaints, to obtain Patient-Specific Index summary scores. All patients who were scheduled to have a total hip arthroplasty performed by one surgeon at a single institution were eligible for the study. The patients completed the Harris hip score form, the McMaster-Toronto Arthritis (MACTAR) Patient Preference Disability Questionnaire, the Short Form-36, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the Patient-Specific Index. With use of the Patient-Specific Index, patients rated the severity and importance of each complaint. These ratings were summed in four different ways to derive severity-importance scores. The questionnaires were completed twice (two weeks apart) before the total hip arthroplasty and twice (two weeks apart) six months after the total hip arthroplasty by a subset of the patients. The seventy-eight participating patients had a mean age of 62.2 years (range, twenty-five to eighty-seven years) at the time of the operation. Forty-three patients (55 per cent) were men, and sixty-three (81 per cent) had osteoarthrosis. The inter-rater and intra-rater test-retest random-effects intraclass correlation coefficients of the Patient-Specific Index were 0.77 or greater (greater than 0.75 is considered excellent). Construct validity was shown by correlations of the Patient-Specific Index with other scales. The additive versions of the Patient-Specific Index (with a responsiveness statistic of 3.3 or greater and a standardized response mean of 1.6 or greater) were more responsive than the other scales. We concluded that the Patient-Specific Index is reliable, valid, and responsive. The additive versions were the most responsive and are recommended for future applications. Such indices need to be tested in studies of patients who have osteoarthrosis of the hip and other musculoskeletal diseases, to ensure generalizability of the results.

The relation of self-reported back pain to psychosocial, behavioral, and health-related factors in a working population in Switzerland

Back pain causes a considerable loss of working days as well as health care costs and therefore represents a major public health problem in industrialized countries. Psychosocial factors have received increasing attention from researchers studying the causal factors of non-specific back pain. However, most studies focus on few dimensions, like individual or work-related factors. We studied the simultaneous association of various factors representing psychosocial, behavioral, and health-related dimensions to self-reported back pain. Data from the Berne Workplace Health Project on 850 employed men and women was analyzed. Back pain was operationalized by a dichotomized variable (having suffered moderately to severely from back pain in the preceding four weeks). The theoretical model guiding the underlying project was a general demand-resource model. Variables that--according to that model--were hypothesized to be related to back pain as well as more specific factors--like physical work load--were analyzed by stepwise logistic regression analysis. In men, there was a statistical trend (P < 0.1) for several work-related factors (low job discretion, high job demands, low job satisfaction). In women, dissatisfaction with salary was the only work-related factor associated with back pain. There was no significant association between private context factors, like poor social network or high demands/low control, and back pain. Only in men, the likelihood of back pain increased with age, while only in women, back pain was associated with emotional problems (individual factors). Among the behavioral factors, smoking was associated to back pain in men, while in women none of the behavioral factors was significant. In both men and women reporting more than two functional symptoms and a history of intestinal problems were associated to back pain. All of our findings were in the expected direction, i.e., it was invariably unfavorable categories of explanatory variables that were associated with higher prevalence of back pain. However, most associations seem to be quite unspecific. There is a need for theoretically guided research aiming at the development of a more complex process model of back pain.