Measuring the burden of disease

Reliability and validity of the Japanese version of the Pediatric Quality of Life Inventory Infant Scales

BACKGROUND

PedsQL Infant Scales (PedsQL-I) are used to assess parent-reported health-related quality of life for children younger than 2 years. We determined the feasibility, reliability, and validity of the Japanese version of the PedsQL-I.

METHODS

A total of 183 participants (parents) with infants aged 1-30 months were recruited from 8 day care centers and one pediatric clinic. Participants completed the PedsQL-I (infants aged 1-18 months), the PedsQL-I and the PedsQL-Toddler version (infants aged 19-30 months), and the Kessler-6 psychological distress scale (all participants). We determined feasibility, internal consistency, test-retest reliability, concurrent validity, convergent and discriminant validity, known-groups validity with regard to acute and chronic illness, and relative and transitional validity with PedsQL-Toddler for the use in infants aged 25-30 months.

RESULTS

All subscales were internally consistent (Cronbach's alpha for 1-12 months: 0.88-0.98 and for 13-24 months: 0.85-0.97); test-retest reliability was acceptable (intra-class correlation coefficients > 0.40); and all scales were concurrently valid with the PedsQL-Toddler version (Pearson's product-moment correlation coefficient for the total score = 0.74). The scales' convergent and discriminant validity were acceptable (scaling success rate > 80%). Validation for known-groups showed that the Physical Health Summary score was sensitive to acute and chronic disease, the Psychosocial Health Summary score was sensitive to neither acute nor chronic disease, and the total score was sensitive to acute disease. Relative validity showed a ratio of 1.74 for the squared t values for the total score.

CONCLUSIONS

The PedsQL-I is suitable for assessing health-related quality of life in infants aged 1-24 months in prospective studies.

High Cancer Burden in Elderly Chinese, 2005-2011

Objective: Cancer risk increases with age, creating a challenge for the Chinese health system. To inform public health policy and research, we evaluated the cancer burden in elderly Chinese. Methods: Based on the published Chinese Cancer Registry Annual Report or related literature and the China Population and Employment Statistics Yearbooks, we estimated the cancer burden of elderly Chinese, who were representative of the Chinese population. We calculated the cancer incidence, cancer-related mortality, potential years of life lost (PYLL), and disability-adjusted life years (DALYs) in 2005–2011 by age, sex, district (rural, urban), and calendar year using national cancer registry, publication, and census data. The relative ratios (RRs) were determined between the elderly (≥60 years) and young (<60 years). Results: Cancer incidence and related mortality in the elderly were 8.47 and 13.96 times, respectively, those in the young. The PYLL and DALY rates of the elderly were 1.63 and 5.00 times, respectively, those in the young. The PYLL and DALY rates for elderly men and rural districts were higher than for elderly women and urban districts. The RRs for male sex and rural districts were higher than for female sex and urban districts. RRs increased sharply from 2005 to 2011. Conclusions: The cancer burden in elderly Chinese was higher in men and rural districts than in women and urban districts, which creates considerable challenges for the Chinese health care system. Comprehensive measures for cancer prevention and treatment in the elderly are needed.

Disability adjusted life year (DALY): a useful tool for quantitative assessment of environmental pollution

Disability adjusted life year (DALY) has been widely used since 1990s for evaluating global and/or regional burden of diseases. As many environmental pollutants are hazardous to human health, DALY is also recognized as an indicator to quantify the health impact of environmental pollution related to disease burden. Based on literature reviews, this article aims to give an overview of the applicable methodologies and research directions for using DALY as a tool for quantitative assessment of environmental pollution. With an introduction of the methodological framework of DALY, the requirements on data collection and manipulation for quantifying disease burdens are summarized. Regarding environmental pollutants hazardous to human beings, health effect/risk evaluation is indispensable for transforming pollution data into disease data through exposure and dose-response analyses which need careful selection of models and determination of parameters. Following the methodological discussions, real cases are analyzed with attention paid to chemical pollutants and pathogens usually encountered in environmental pollution. It can be seen from existing studies that DALY is advantageous over conventional environmental impact assessment for quantification and comparison of the risks resulted from environmental pollution. However, further studies are still required to standardize the methods of health effect evaluation regarding varied pollutants under varied circumstances before DALY calculation.

Cardiovascular disease mortality and years of life lost attributable to non-optimal systolic blood pressure and hypertension in northeastern Iran

BACKGROUND

High blood pressure is the second most important risk factor of cardiovascular diseases (CVDs) in Iran. It is imperative to estimate the burden of CVDs that can be averted if high blood pressure is controlled at the population level. The aim of the current study was to estimate the avertable CVD mortality in the setting of Golestan Cohort Study (GCS).

METHODS

Over 50,000 participants were recruited and followed for a median of 7 years. The exposures of interest in this study were non-optimal systolic blood pressure (SBP) and hypertension measured at baseline. Deaths by cause have been precisely recorded. The Population Attributable Fraction (PAF) of deaths and Years of Life Lost (YLLs) due to CVDs attributable to exposures of interest were calculated.

RESULTS

Overall, 223 deaths due to ischemic heart disease (IHD), 207 deaths due to cerebrovascular accidents (CVA), and 460 deaths due to all CVDs could be averted if the SBP of all subjects in the study were optimal. Similarly, 5,560 YLLs due to IHD, 4,771 YLLs due to CVA, and 11,135 YLLs due to CVDs could be prevented if SBP were optimal. In all age groups, the avertable deaths and YLLs were higher due to IHD compared with CVA. Deaths and YLLs attributable to non-optimal SBP in women were less than men.

CONCLUSIONS

A very large proportion of CVD deaths can be averted if blood pressure is controlled in Iran. Effective interventions in primary and secondary health care setting are mandatory to be implemented as early as possible.

Oral cleft prevention program (OCPP)

Background

Oral clefts are one of the most common birth defects with significant medical, psychosocial, and economic ramifications. Oral clefts have a complex etiology with genetic and environmental risk factors. There are suggestive results for decreased risks of cleft occurrence and recurrence with folic acid supplements taken at preconception and during pregnancy with a stronger evidence for higher than lower doses in preventing recurrence. Yet previous studies have suffered from considerable design limitations particularly non-randomization into treatment. There is also well-documented effectiveness for folic acid in preventing neural tube defect occurrence at 0.4 mg and recurrence with 4 mg. Given the substantial burden of clefting on the individual and the family and the supportive data for the effectiveness of folic acid supplementation as well as its low cost, a randomized clinical trial of the effectiveness of high versus low dose folic acid for prevention of cleft recurrence is warranted.

Methods/design

This study will assess the effect of 4 mg and 0.4 mg doses of folic acid, taken on a daily basis during preconception and up to 3 months of pregnancy by women who are at risk of having a child with nonsyndromic cleft lip with/without palate (NSCL/P), on the recurrence of NSCL/P. The total sample will include about 6,000 women (that either have NSCL/P or that have at least one child with NSCL/P) randomly assigned to the 4 mg and the 0.4 mg folic acid study groups. The study will also compare the recurrence rates of NSCL/P in the total sample of subjects, as well as the two study groups (4mg, 0.4 mg) to that of a historical control group.

The study has been approved by IRBs (ethics committees) of all involved sites. Results will be disseminated through publications and presentations at scientific meetings.

Discussion

The costs related to oral clefts are high, including long term psychological and socio-economic effects. This study provides an opportunity for huge savings in not only money but the overall quality of life. This may help establish more specific clinical guidelines for oral cleft prevention so that the intervention can be better tailored for at-risk women.

ClinicalTrials.gov Identifier

NCT00397917

Prevalence, comorbidity, and service utilization for mood disorders in the United States at the beginning of the twenty-first century

The results of recent community epidemiological research are reviewed, documenting that major depressive disorder (MDD) is a highly prevalent, persistent, and often seriously impairing disorder, and that bipolar disorder (BPD) is less prevalent but more persistent and more impairing than MDD. The higher persistence and severity of BPD results in a substantial proportion of all seriously impairing depressive episodes being due to threshold or subthreshold BPD rather than to MDD. Although the percentage of people with mood disorders in treatment has increased substantially since the early 1990s, a majority of cases remain either untreated or undertreated. An especially serious concern is the misdiagnosis of depressive episodes due to BPD as due to MDD because the majority of depression treatment involves medication provided by primary care doctors in the absence of psychotherapy. The article closes with a discussion of future directions for research.

Reliability and validity of the Infant and Toddler Quality of Life Questionnaire (ITQOL) in a general population and respiratory disease sample

OBJECTIVE

To evaluate feasibility, internal consistency, test-retest reliability, and concurrent and discriminative validity of the Infant and Toddler Quality of Life Questionnaire (ITQOL) for parents of pre-school children with 12 scales (103-items) covering physical and psychosocial domains and impact of child health on parents, in comparison with the TNO-AZL Pre-school Children Quality of Life Questionnaire (TAPQOL).

METHODS

Parents of children from a random general population sample (2 months-4 years old; n = 500) and of an outpatient clinic sample of children with respiratory disease (5 months-[Formula: see text] years old; n = 217) were mailed ITQOL and TAPQOL questionnaires; a retest was sent after two weeks.

RESULTS

Feasibility: The response was >or=80% with few missing and non-unique ITQOL-answers (<2%) in both study populations. Some ITQOL-scales (3-4 scales) showed a ceiling effect (>25% at maximum score). Internal consistency: All Cronbach's alpha >0.70. Test-retest Intraclass Correlation Coefficients (ICCs) were moderate or adequate (>or=0.50; p < 0.01) for 10 ITQOL-scales.

VALIDITY

ITQOL-scales, with a few exceptions, correlated better with predefined parallel TAPQOL scales than with non-parallel scales. Five to eight ITQOL-scales discriminated clearly between children with few and with many parent-reported chronic conditions, between children with and without doctor-diagnosed respiratory disease and with a low and a high parent-reported medical consumption (p < 0.05).

CONCLUSIONS

This study supported the evidence that the ITQOL is a feasible instrument with adequate psychometric properties. The study provided reference ITQOL scores for gender/age subgroups. We recommend repeated evaluations of the ITQOL in varied populations, especially among very young children, including repeated assessments of test-retest characteristics and evaluations of responsiveness to change. We recommend developing and evaluating a shortened ITQOL version.

Reliability and validity of the short form of the child health questionnaire for parents (CHQ-PF28) in large random school based and general population samples

STUDY OBJECTIVES

This study assessed the feasibility, reliability, and validity of the 28 item short child health questionnaire parent form (CHQ-PF28) containing the same 13 scales, but only a subset of the items in the widely used 50 item CHQ-PF50.

DESIGN

Questionnaires were sent to a random regional sample of 2040 parents of schoolchildren (4-13 years); in a random subgroup test-retest reliability was assessed (n = 234). Additionally, the study assessed CHQ-PF28 score distributions and internal consistencies in a nationwide general population sample of (parents of) children aged 4-11 (n = 2474) from Statistics Netherlands.

MAIN RESULTS

Response was 70%. In the school and general population samples seven scales showed ceiling effects. Both CHQ summary measures and one multi-item scale showed adequate internal consistency in both samples (Cronbach's alpha>0.70). One summary measure and one scale showed excellent test-retest reliability (intraclass correlation coefficient >0.70); seven scales showed moderate test-retest reliability (intraclass correlation coefficient 0.50-0.70). The CHQ could discriminate between a subgroup with no parent reported chronic conditions (n = 954) and subgroups with asthma (n = 134), frequent headaches (n = 42), and with problems with hearing (n = 38) (Cohen's effect sizes 0.12-0.92; p<0.05 for 39 of 42 comparisons).

CONCLUSIONS

This study showed that the CHQ-PF28 resulted in score distributions, and discriminative validity that are comparable to its longer counterpart, but that the internal consistency of most individual scales was low. In community health applications, the CHQ-PF28 may be an acceptable alternative for the longer CHQ-PF50 if the summary measures suffice and reliable estimates of each separate CHQ scale are not required.

Inflammation is a crucial feature of atherosclerosis and a potential target to reduce cardiovascular events

Contrary to popular opinion, atherosclerosis is not a disease unique to modern civilization. In fact, atherosclerotic lesions have been found in the arteries of mummies dating back to 1,500 B.C., and yet our understanding of this complex process is still evolving. A fusion of basic science advances and clinical research findings has radically altered our traditional concepts about the pathogenesis and treatment of the clinical complications of atherosclerosis. Most physicians previously regarded the artery as a being merely a blood conduit that became encrusted with lipid detritus as part of the aging process. Modern-day treatment of atherosclerosis has arisen primarily from an understanding of the epidemiology of the disease rather than its pathophysiology, in that risk factors have traditionally been targeted. Our concepts of atherogenesis have evolved from vague ideas of inevitable degeneration to a much better defined scenario of molecular and cellular events. As we enhance our understanding of its fundamental mechanism, we can begin to approach atherogenesis as a modifiable rather than ineluctable process. Indeed, as we recognize now that inflammation plays a pivotal role in the process of atherosclerosis, it is noteworthy to evaluate the effect of modern therapies on this facet of the disease.

Feasibility and reliability of a mailed questionnaire to obtain visual analogue scale valuations for health states defined by the Health Utilities Index Mark 3

To establish the generalizability (external validity) of the Health Utilities Index Mark 3 (HUI3) as a single-summary score generic outcome measure in numerous countries/subgroups (including children), repeated studies of community preferences should be performed in various settings. In performing multiple HUI3 studies, a mailed questionnaire approach, if feasible and reliable, might be substituted for oral interviews. In the present study, we assessed the feasibility and reliability of a mailed questionnaire approach originally developed for the EQ-5D, for the purpose of collecting Visual Analogue Scale (VAS) valuations from parents as surrogate responders for 65 pediatric HUI3 health states and for the state of being dead. Untransformed mean VAS scores of the health states and scores converted into preliminary Standard Gamble (SG)-utilities were compared with Canadian and French multiattribute utility estimates. A random sample of 1920 parents of schoolchildren (aged 4 to 13) received a mailed questionnaire. Each parent was asked to rate 6 HUI3 health states on a 0 to 100 VAS. Response was 70%. Mean completion time was 20 minutes (SD 9). The questionnaire was rated difficult by only 9%. The current format was, however, inappropriate for valuing the state of being dead. Interrater reliability of health state valuations was.87. Spearman's rank correlations, Pearson-R correlations and intra class correlation coefficients (ICCs) between untransformed VAS valuations and Canadian/French utility estimates were > or =.87. However, preliminary SG-utilities showed diminished ICCs (.71 to.72). The data support the feasibility and reliability of mailed HUI3 valuation questionnaires to a considerable extent, but further methodological studies regarding other formats and different populations are recommended.

Reliability and validity of comprehensive health status measures in children: The Child Health Questionnaire in relation to the Health Utilities Index

This study assesses the feasibility, reliability and validity of the Child Health Questionnaire-Parent Form (CHQ-PF50), consisting of 11 multi-item scales covering the physical, emotional and social well-being of children. The Health Utilities Index mark 2 (HUI2) was selected for comparison. Parents of 467 Dutch schoolchildren (age 5-13) were sent CHQ and HUI questionnaires. A subgroup of 79 parents of children aged 10-11 were sent a retest after 2 weeks. Feasibility: 78% response with few missing/non-unique CHQ-answers (<1%). Internal consistency: Cronbach's alphas of.39-.96 (mean.72). Item-own scale correlations were higher than item-other scale correlations. Test-retest ICCs were statistically significant for all but two CHQ scales (ICCs.31-.84). Test-retest CHQ-scale means did not show statistically significant differences except for one scale ("Behavior").

VALIDITY

the CHQ-scales, with one exception, correlated better with predefined parallel HUI domains (ICCs.26-.53), than with non-parallel domains. Six CHQ scales discriminated clearly between children with and without chronic conditions and three scales discriminated between high and low medical consumption. This was at least equivalent to the discriminative ability of the HUI2 in this study. Additional studies of test-retest reliability and responsiveness to change of the CHQ in varied populations are needed. From the present study and literature data on other (clinical) populations we conclude that psychometric properties of CHQ-based health status measurement justify application in pediatric outcome studies, in addition to clinical measures.