Reliability and validity of the adapted Finnish version of the early onset scoliosis questionnaire (EOSQ-24)

BACKGROUND

EOSQ-24 is a disease specific patient-reported outcome score used to assess the quality of life in patients with early-onset scoliosis. The aim of this study was to translate and cross-culturally adapt the English version of the EOSQ-24 to Finnish language and to assess the reliability and validity of the translation.

METHODS

Cross-cultural adaptation and cross-cultural validation were performed to the Finnish translation of the EOSQ-24. Patients and/or their caretakers were then recruited to assess the psychometric properties of the translation. We assessed the internal consistency, test-retest reliability, floor and ceiling effects, and discriminative abilities. One-hundred-and-three patients filled the questionnaire.

RESULTS

EOSQ-24 was successfully translated into Finnish. The translation showed excellent internal consistency (Cronbach alpha 0.94), satisfactory item-total correlations ranging from 0.6 to 0.9, and moderate to strong inter item correlations. Test-retest reliability ranged from 0.7 to 0.96 indicating good to excellent agreement. Patients with neuromuscular and syndromic scoliosis reported lower EOSQ-24 scores when compared to patients' idiopathic and congenital scoliosis. There was a significant negative correlation between major curve and EOSQ-24 scores in patients with idiopathic early onset scoliosis.

CONCLUSION

The internal consistency and test-retest reliability of the measure were found to be satisfactory. A marked ceiling effect was observed, indicating a potential source of error.

Surgical and Health-related Quality of life Outcomes in Children With Congenital Scoliosis During 5-year Follow-up. Comparison to Age and Sex-matched Healthy Controls

BACKGROUND

Congenital spinal anomalies represent a heterogeneous group of spinal deformities, of which only progressive or severe curves warrant surgical management. Only a limited number of studies have investigated the impact of surgery on the health-related quality of life and very limited data exists comparing these outcomes to healthy controls.

METHODS

A single surgeon series of 67 consecutive children with congenital scoliosis (mean age at surgery 8.0 y, range: 1.0 to 18.3 y, 28 girls) undergoing hemivertebrectomy (n = 34), instrumented spinal fusion (n = 20), or vertical expandable prosthetic titanium rib procedure (n = 13) with a mean follow-up of 5.8 years (range: 2 to 13 y). The comparison was made to age and sex-matched healthy controls. Outcome measures included the Scoliosis Research Society questionnaire both pre and postoperatively, radiographic outcomes, and complications.

RESULTS

The average major curve correction was significantly better in the hemivertebrectomy (60%) and instrumented spinal fusion (51%) than in the vertical expandable prosthetic titanium rib group (24%), respectively ( P < 0.001). Complications were noted in 8 of 67 (12%) children, but all patients recovered fully during follow-up. Pain, self-image, and function domains improved numerically from preoperative to final follow-up, but the pain score was the only one with a statistically significant change ( P = 0.033). The Scoliosis Research Society pain, self-image, and function domain scores remained at a significantly lower level at the final follow-up than in the healthy controls ( P ≤ 0.05), while activity scores improved to a similar level.

CONCLUSIONS

Surgery for congenital scoliosis improved angular spinal deformities with a reasonable risk of complications. Health-related quality of life outcomes improved from preoperative to final follow-up, but especially pain and function domains remained at a significantly lower level than in the age and sex-matched healthy controls.

LEVEL OF EVIDENCE

Level III, therapeutic.

Heavy metal solubility in podzolic soils exposed to the alkalizing effect of air pollutants

The heavy metal content of pine forest soil was studied near the boundary between Russia and Estonia, an area characterized by large amounts of acidic and basic air pollutants, mainly sulfur dioxide and calcium. Alkalization dominates the processes in soil, since sulfur is adsorbed only in small quantities, and calcium is much better adsorbed. In addition to Ca, great amounts of Al, Fe, K, and Mg are accumulated in the humus layer due to air pollution. The heavy metal content has increased. The exchangeable content of heavy metals was in many cases much higher in polluted alkaline soils than in non-polluted acidic soils, even the ratio of exchangeable to total metal content being higher in alkaline plots. To avoid a dangerous increase in soluble heavy metal content, it is important to decrease not only the large sulfur emissions of local pollutant sources, but also the alkaline pollutants. A similar concern must be taken into account when liming of acidic forest soils is planned.

Biomonitoring of the distribution of dust emissions by means of a new SEM/EDX technique

A new application of the Scanning Electron Microscope (SEM) equipped with an Energy Dispersive X-ray Microanalyzer (EDX) has been developed to study the distribution of airborne dust emissions. This technique makes it possible to identify the particles and measure the amount of dust deposition on the surface of the biomonitoring material. Pine bark or needles and moss can easily be used as the study material. A map indicating pollution levels and distribution can be drawn on the basis of the measured data.

The use of SEM/EDX for studying the distribution of air pollutants in the surroundings of the emission source

A new application of SEM/EDX-methods to study the distribution of air pollutants in the surroundings of an emission source is described. An energy dispersive X-ray microanalyzer (EDX) connected to a scanning electron microscope (SEM) was used to measure the amount of several elements on the surface of Scots pine bark. To test this method, bark samples were collected near a limestone quarry and plant. The results indicated that the pollutant gradient in the surroundings of the emission source was clearest, when this new method was used. The coefficient of determination (R2) for calcium on pine bark was as high as 0.99, whereas in the same study line, measurements of total Ca content of pine needles and soil humus yielded R2 values of 0.46 and 0.74, respectively.

The effects of simultaneous large acidic and alkaline airborne pollutants on forest soil

The effects of air pollutants on soil were studied in Scots pine (Pinus sylvestris L.) forests near the boundary of Russia and Estonia. The study area is characterized by large amounts of acidic and basic pollutants, mainly sulphur dioxide (SO(2)) and calcium (Ca). Several variables were measured in different horizons of the podzolic soil polluted by emissions from local sources in areas of several thousands of square kilometers. Alkalinization dominates the processes in the soil, since sulphur is absorbed only in small quantities and Ca is much better absorbed. Ca content in humus horizon may rise even to 100 000 mg kg(-1) and the pH of originally very acidic soil may rise to 8.3. Total aluminum (Al) content was high in the heavily polluted plots, since emissions contain much Al. On the other hand, the exchangeable Al was very low in these alkaline sites. A larger quantity of exchangeable Al occurred farther from the pollutant sources, even though total Al in these plots was low. These plots had acidic soils in which Al is in exchangeable form. Due to the neutralizing effect of acidic and basic pollutants, forest damage in the study area was not as serious as might be supposed. Complicated pollutant situations must be taken into consideration when pollution-caused environmental protection measures are planned. It is not reasonable to reduce only SO(2) emissions, but necessary to lower the basic emissions at the same time.

Ecological condition of forests around the eastern part of the Gulf of Finland

The effects of air pollutants on forests around the eastern part of the Gulf of Finland were studied by measurement of the sulphur and calcium content of pine needles and evaluation of the ecological conditions of pine forests. Several parameters for pine trees and their needles were chosen as well as the species composition and condition of epiphytic lichens. Very high pine needle S- and Ca-contents were measured in the vicinity of the Narva and Slantsy plants. In this region both the acid and basic pollutant load is massive, partly neutralizing each other. It is suggested that the total load will, sooner or later, cause unexpected environmental damage. Wide 'lichen desert' areas were detected around Narva and Slantsy. Near the margins of these areas extraordinary epiphytes on pines were observed namely Xanthoria parietina (L.) Th.Fr. and red-coloured green alga Trentepohlia umbrina. They are regarded as indicators of alkaline pollution. The lowest pine needle S- and Ca-contents of the study area were measured in south-eastern Finland. The condition of pine forests and their needles was, however, better on the neighbouring Karelian Isthmus although the species number of epiphytic lichens was very low and the condition of the lichens was poor. It is suggested that these most sensitive indicators of air pollutants are damaged by pollutants from St Petersburg and Narva. Vast virgin forests of the Karelian Isthmus act as pollutant sinks reducing the effect of pollutants on trees. On the Finnish side intensive forest management has been carried on for many decades making forests and trees more sensitive to pollutants.

Photosynthesis and starch metabolism of chloroplasts during prolonged illumination

The starch metabolism of the chloroplasts in the leaves of Stellaria media was studied by means of electron microscopy. During the night the starch grains diminished in size but did not disappear entirely. In the light they grew due to photosynthesis. After prolonged illumination of the plant the grains almost filled up the chloroplasts. However, after an illumination of 26-27 hr a sudded disintegration took place. This was apparently caused by the increased activity of β-amylase observed in an earlier investigation to occur at this time in the chloroplasts. After the disintegration the starch grains of the chloroplasts showed irregular changes.The rate of photosynthesis and respiration was measured by an infra-red gas analyser. During prolonged illumination Stellaria media showed a rather intensive and constant rate of assimilation. The role of starch disintegration and β-amylase synthesis in making possible this constant assimilation has been discussed.