Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery

BACKGROUND

Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort.

METHODS

Participants were adults (40 years of age or older) who underwent inpatient non-cardiac surgery. The 12-item WHODAS and EQ-5DTM-3L questionnaires were administered preoperatively (in person) and 1 year postoperatively (by telephone). Responsiveness was characterized using standardized response means (SRMs) and correlation coefficients between change scores. Construct validity was evaluated using correlation coefficients between 1-year scores and comparisons of WHODAS scores across clinically relevant subgroups.

RESULTS

The analysis included 546 patients. There was moderate correlation between changes in WHODAS and various EQ-5DTM subscales. The strongest correlation was between changes in WHODAS and changes in the functional domains of the EQ-5D-3L-for example, mobility (Spearman's rho 0.40, 95 per cent confidence interval [c.i.] 0.32 to 0.48) and usual activities (rho 0.45, 95 per cent c.i. 0.30 to 0.52). When compared across quartiles of EQ-5D index change, median WHODAS scores followed expected patterns of change. In subgroups with expected functional status changes, the WHODAS SRMs ranged from 'small' to 'large' in the expected directions of change. At 1 year, the WHODAS demonstrated convergence with the EQ-5D-3L functional domains, and good discrimination between patients with expected differences in functional status.

CONCLUSION

The WHODAS questionnaire has construct validity and responsiveness as a measure of functional status at 1 year after major surgery.

0965 The Association Between Liquid Consumption and Sleep Patterns in School Children

Introduction

Liquid consumption is essential for daily function and may also play a role in sleep regulation. The aim of this study was to assess 1) the association between the frequency of liquid consumption and sleep patterns; and 2) the different types of liquids on the association between liquid consumption and sleep.

Methods

Participants included 597 children ages 9-13 years old from the China Jintan Child Cohort Study. To assess child liquid intake, children self-reported the types of liquids consumed and the frequency these liquids were consumed. To assess sleep patterns, both parents and children reported sleep patterns using the parent-reported Child Sleep Habit Questionnaire (CSHQ) and a child self-reported questionnaire. Descriptive statistics and independent sample t-tests analyses were performed to examine the differential effects of liquid consumption frequency and sleeping habits.

Results

Overall, a slight dose-dependent relationship between liquid consumption and sleep quality was observed. Less sleep problems and improved sleep quality were observed for water (bedtime resistance, sleep anxiety, night awakenings, parasomnias, sleep-disordered breathing, daytime sleepiness; p<0.05) and milk (parasomnias, sleep-disordered breathing, p<0.05) consumption. Caffeinated soda tended to increase sleep problems (sleep-disordered breathing, p<0.05). Sleep onset delay had a different pattern from that of other subscales, in which water increased sleep problems and caffeinated soda decreased sleep problems. There was some discrepancy between parent- and self-reported parasomnias, but sleep disordered breathing showed consistent patterns.

Conclusion

Children who consumed more liquid, especially water and milk, were more likely to experience less sleep problems. However, caffeinated soda consumption may be linked to increased sleep problems. Findings suggest that school children may need consume more healthy liquids for better sleep patterns. Future randomized-controlled trial studies are needed to verify these findings.

Support

This study was funded by the National Institutes of Environmental Health Sciences and the National Institutes of Health (R01-ES-018858, K02-ES-019878, and K01-ES015877).

HIV/AIDS and legal issues in England and Wales

In England and Wales, the only HIV specialist legal advice service is currently observing "a return of many of the problems that were encountered in the 1980s but which we thought had been resolved." Ignorance about HIV and about how HIV is (and is not) transmitted continues, while the many benefits from new treatments have been accompanied by complacency, misunderstanding, and new forms of discrimination. This article, by members of the Advice Centre of the Terrence Higgins Trust, which includes the HIV specialist legal advice service, provides an overview of some of the legal issues currently facing people with HIV/AIDS in the UK, from discrimination to the rights of HIV-positive parents and their children, from housing to immigration and criminal law.

Molecular and cellular actions of a structural domain of human growth hormone (AOD9401) on lipid metabolism in Zucker fatty rats

A lipolytic domain (AOD9401) of human growth hormone (hGH) which resides in the carboxyl terminus of the molecule and contains the amino acid residues 177-191, has been synthesized using solid-phase peptide synthesis techniques. AOD9401 stimulated hormone-sensitive lipase and inhibited acetyl coenzyme A carboxylase (acetyl CoA carboxylase) in isolated rat adipose tissues, in a similar manner to the actions of the intact hGH molecule. The synthetic lipolytic domain mimicked the effect of the intact growth hormone on diacylglycerol release in adipocytes. Chronic treatment of obese Zucker rats with AOD9401 for 20 days reduced the body weight gain of the animals, and the average cell size of the adipocytes of the treated animals decreased from 110 to 80 microm in diameter. Unlike hGH, synthetic AOD9401 did not induce insulin resistance or glucose intolerance in the laboratory animals after chronic treatment. The results suggest that AOD9401 has the potential to be developed into a therapeutic agent for the control of obesity.

DNA-dependent ATPase from HeLa cells is related to human Ku autoantigen

A 150-kDa DNA-dependent ATPase composed of 83/68-kDa subunits was previously reported to cofractionate with a 21S complex of enzymes for DNA synthesis from HeLa cells (Vishwanatha, J. K., & Baril, E. F. (1990) Biochemistry 29, 8753-8759). The DNA-dependent ATPase was purified to electrophoretic homogeneity from a HeLa cell homogenate by a modified procedure that involves subcellular fractionation, poly(ethylene-glycol) precipitation of the combined nuclear extract/cytosol, and chromatography on Q-Sepharose and native and denatured DNA/celluloses followed by Mono-S fast protein liquid chromatography. The purified enzyme showed equimolar amounts of 83- and 68-kDa polypeptides following polyacrylamide gel electrophoresis under denaturing conditions. Sequence analysis of peptide fragments derived from the separated 83- and 68-kDa polypeptides showed 90-100% homology with the corresponding 80- and 70-kDa subunits of human Ku protein. Immunoblot analysis of the ATPase during the course of its purification and immunoprecipitation with antibodies to the 80- and 70-kDa subunits of human Ku protein confirmed the relationship of the 83- and 68-kDa polypeptides of the human DNA-dependent ATPase to the subunits of human Ku protein. Both the 83- and 68-kDa polypeptides are phosphorylated by a DNA-dependent protein kinase that cofractionates with the ATPase. The DNA-dependent ATPase activity is up regulated by phosphorylation.