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Alain Leplège

Publications and source records attributed to Alain Leplège.

7 recordsLinked to original sources
PubMed2006

A new condition specific quality of life measure for the blind and the partially sighted in Sub-Saharan Africa, the IOTAQOL: methodological aspects of the development procedure.

In Mali, blind and partially sighted people represent 1.2% of the population. Good quality and low cost ophthalmologic care is available, but, unfortunately, is insufficiently taken advantage of. In order to contribute to the analysis of this situation a valid and reliable questionnaire was needed to take the patient's perspective into account. Because of face validity concerns, it was not possible to merely translate an existing questionnaire. Thus we decided to develop a new questionnaire directly in one of the main languages of Mali: Bambara. This involved the setting of a study team composed of social and health science specialists, the majority of whom were native Bambara speakers. The overall project consisted in the iteration of three main steps (1) Conceptual clarification and operationalization of this concept. (2) Qualitative steps: qualitative interviews, focus groups and content analysis. (3) Quantitative steps: statistical analysis of an initial try-out survey (143 participants) and a validation survey (420 participants). This approach yields satisfying results. Indeed, the final version of the IOTAQOL has good psychometric properties. Thus, this interviewer administered instrument can be used to measure health-related quality-of-life in Mali and the methodology that we used could serve as a basis for similar projects.

Adolescent↗
PubMed2005

Methodological issues in determining the dimensionality of composite health measures using principal component analysis: case illustration and suggestions for practice.

During the early steps of the construction of composite health measures, principal component analysis (PCA) is commonly used to identify 'latent' factors that underlie observed variables and to determine the dimensionality of the instruments. The determination of the number of components to retain is critical to PCA: it markedly influences the factorial model identified and further conditions the validity of the constructed instrument. However, many researchers developing composite health measures seem to be unaware of the importance of this determination. The purposes of the paper are to illustrate (1) the variability of the factorial models obtained by using different published rules (n = 10) for determining the number of components to retain in PCA applied to two quality-of-life datasets, and (2) the value of a careful and diversified approach to the problem of the number of components to retain in PCA that we suggest, instead of the unsatisfactory 'rule-of-thumb' that many researchers use. This involves: (1) using robust rules (including parallel analysis and minimum average partial procedure) to generate a set of possible values for the number of components to retain, (2) repeating the analysis across samples, (3) comprehensively assessing the models obtained, and (4) considering complementary methods to PCA and especially confirmatory factor analysis.

Factor Analysis, Statistical↗
PubMed2004

Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project.

CONTEXT: Few studies and no international comparisons have examined the impact of multiple chronic conditions on populations using a comprehensive health-related quality of life (HRQL) questionnaire. OBJECTIVE: The impact of common chronic conditions on HRQL among the general populations of eight countries was assessed. DESIGN: Cross-sectional mail and interview surveys were conducted. PARTICIPANTS AND SETTING: Sample representatives of the adult general population of eight countries (Denmark, France, Germany, Italy, Japan, The Netherlands, Norway and the United States) were evaluated. Sample sizes ranged from 2031 to 4084. MAIN OUTCOME MEASURES: Self-reported prevalence of chronic conditions (including allergies, arthritis, congestive heart failure, chronic lung disease, hypertension, diabetes, and ischemic heart disease), sociodemographic data and the SF-36 Health Survey were obtained. The SF-36 scale and summary scores were estimated for individuals with and without selected chronic conditions and compared across countries using multivariate linear regression analyses. Adjustments were made for age, gender, marital status, education and the mode of SF-36 administration. RESULTS: More than half (55.1%) of the pooled sample reported at least one chronic condition, and 30.2% had more than one. Hypertension, allergies and arthritis were the most frequently reported conditions. The effect of ischemic heart disease on many of the physical health scales was noteworthy, as was the impact of diabetes on general health, or arthritis on bodily pain scale scores. Arthritis, chronic lung disease and congestive heart failure were the conditions with a higher impact on SF-36 physical summary score, whereas for hypertension and allergies, HRQL impact was low (comparing with a typical person without chronic conditions, deviation scores were around -4 points for the first group and -1 for the second). Differences between chronic conditions in terms of their impact on SF-36 mental summary score were low (deviation scores ranged between -1 and -2). CONCLUSIONS: Arthritis has the highest HRQL impact in the general population of the countries studied due to the combination of a high deviation score on physical scales and a high frequency. Impact of chronic conditions on HRQL was similar roughly across countries, despite important variation in prevalence. The use of HRQL measures such as the SF-36 should be useful to better characterize the global burden of disease.

Adult↗
PubMed2002

From visual function deficiency to handicap: measuring visual handicap in Mali.

BACKGROUND/AIMS: Blindness is a major public health problem in developing countries, even though most could be prevented by relatively simple hygienic and medical interventions. Relatively few patients use the quality health care services available, despite their low cost, due to problems of access or socio-cultural barriers. This health services research project stressed the need for measurement of subjective self-perceived health. The objectives of this study were twofold: a) To translate, adapt and integrate the cultural context found in Mali and validate two instruments for measuring, respectively, perceived vision and quality of life. b) To study the relationship between these variables and visual deficiencies by gender. METHODS: The perceived vision and quality of life questionnaires were based on a translation of the Aravind questionnaire, adapted to Mali. The resulting perceived vision questionnaire comprises 13 questions, grouped according to five subscales (global vision, visual perception, sensory adaptation, visual field and depth perception). Furthermore, the 13 questions on quality of life were grouped into four subscales (personal care, mobility, social life and psychological). For both questionnaires, a global score could be computed. These two questionnaires were administered to a representative sample of 203 subjects with impaired vision, aged over 40, in a rural area in Mali. RESULTS: The acceptability of the questionnaires was good (1% missing data). The convergent validity was adequate for all but one subscale (psychological). The discriminate validity is acceptable for three of the six subscales where measurement can be made (visual perception, personal care, mobility). The Cronbach alpha coefficients indicate good reliability for the global scores. CONCLUSIONS: Analysis of mean results confirms the validity of the International Classification of Disease (ICD) definition of blindness (seeing less than 0.05 results in a steep decrease in quality of life). Moreover, blindness affects the quality of life of women more severely than that of men; this may be related to the availability of social support.

Adult↗
PubMed1992

Some problems with cost-benefit analysis in health care.

...Arnold's article is very ambitious. He suggests rules that could be followed in order to decide whether health care should be rationed. He notes that explicit assessments of costs and benefits using the same monetary unit are rarely used. The main reason, it seems to me, is that the method of cost-benefit analysis is relatively difficult to apply in the context of health care. Arnold does not address the difficulties that are related to his approach. Thus, my impression is that the interest of his provocative article lies more in its ability to foster a useful debate than in the methodology itself. In this brief commentary, I will merely list some of the theoretical problems that occurred to me while reading this article....

Clozapine↗
PubMedDate not supplied

Quality of life scale and impact of a topical treatment on symptoms of gastro-esophageal reflux without severe esophagitis.

OBJECTIVE: Restoring a normal quality of life (QOL) should be the goal of treatments of gastro-esophageal reflux (GER) without severe esophagitis. In this analysis, carried out within the frame of a clinical study comparing a topical anti-inflammatory gel to a placebo, we assessed the relevance of the MOS SF-36 questionnaire in patients suffering from GER without severe esophagitis, and compared the scores of the studied patients to those of a representative sample of the French general population. PATIENTS AND METHODS: The patients had to suffer from GER symptoms for at least 2 months, with no or mild (< or =grade 1) esophagitis endoscopy. They were randomized to be given a 4 week treatment either with a topical gel containing gaïazulene and dimeticone or a placebo gel. Patients were asked to complete a symptom diary during the study, which allowed the calculation of mean symptom scores. The MOS SF-36 questionnaire was administered at baseline (d0) and after 4 weeks of treatment (d28). RESULTS: Two hundred and thirty three patients were enrolled in the study. At baseline, QOL scores were impaired in both groups. After 4 weeks of treatment: the treated patients displayed better improvement in all MOS SF-36 domains compared with the placebo group. The QOL profile in the treated group reached the level of the French reference population, while it remained impaired in the placebo group. CONCLUSION: This analysis evidenced the relevancy of the MOS SF-36 questionnaire to assess the impact of GER without severe esophagitis on QOL. Moreover, it demonstrated the capacity of the studied topical treatment to restore a normal QOL to the patients.

Administration, Topical↗