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Biomedical subjects

C Gudex

Publications and source records attributed to C Gudex.

12 recordsLinked to original sources

Why women want prenatal ultrasound in normal pregnancy.

OBJECTIVES: To investigate women's reasons for requesting prenatal ultrasound in the absence of clinical indications. METHODS: A postal questionnaire was completed by 370 pregnant women with no apparent obstetric risk factors, who had expressed a desire to have ultrasound scanning in their current pregnancy. The women were asked to indicate, from a list of 12 items, their three most important reasons for wanting scanning. Ninety per cent of the women were in the first trimester of pregnancy, and 10% in the second trimester. RESULTS: The items most frequently identified as important reasons for ultrasound were to check for fetal abnormalities (60% of women), to see that all was normal (55%) and for own reassurance (44%). Lower income was related to wanting to see the baby (P = 0.028) and wanting an ultrasound picture (P = 0.017); higher income was related to checking that all was normal (P = 0.003) and for own reassurance (P = 0.015). Women in their first pregnancy were more likely to want themselves and the father to see the baby (P = 0.001); women who had given birth previously were more likely to want reassurance (P = 0.002), as were women with a previous miscarriage or induced abortion. Women who believed that the presence of fetal trisomy justifies abortion or who would vote for free abortion were more likely to want to know about abnormalities (P < 0.001 and P < 0.004, respectively). Women in the second trimester were more likely to want to check for abnormalities (P = 0.041) and appropriate fetal growth (P = 0.047) than those in the first trimester. CONCLUSIONS: It would appear that women in normal pregnancy have specific reasons for wanting prenatal ultrasound that are influenced by sociodemographic, obstetric and attitudinal factors.

Adult↗

Variations in population health status: results from a United Kingdom national questionnaire survey.

OBJECTIVE: To measure the health of a representative sample of the population of the United Kingdom by using the EuroQoL EQ-5D questionnaire. DESIGN: Stratified random sample representative of the general population aged 18 and over and living in the community. SETTING: United Kingdom. SUBJECTS: 3395 people resident in the United Kingdom. MAIN OUTCOME MEASURES: Average values for mobility, self care, usual activities, pain or discomfort, and anxiety or depression. RESULTS: One in three respondents reported problems with pain or discomfort. There were differences in the perception of health according to the respondent's age, social class, education, housing tenure, economic position, and smoking behaviour. CONCLUSIONS: The EQ-5D questionnaire is a practical way of measuring the health of a population and of detecting differences in subgroups of the population.

Adolescent↗

The use of generic measures of health-related quality of life in the assessment of outcome from transurethral resection of the prostate.

OBJECTIVES: To investigate the performance of the EuroQol (EQ) quality-of-life measure and the Nottingham Health Profile (NHP) in assessing the outcome of transurethral resection of the prostate (TURP) for lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO), and to determine which men experience the greatest increase in health-related quality of life (HRQL) after TURP. PATIENTS AND METHODS: A prospective cohort study was undertaken over 12 months from Arpil 1992 of 314 men who completed the EQ, the NHP and a symptom inventory before undergoing elective TURP for probable BPO (Group 1). Identical postal questionnaires were used to follow up this group at 6 weeks, 6 months and 12 months post-operatively, with response rates of 79%, 74% and 69%, respectively. Overall, 92% of patients responded at either 6 or 12 months after surgery. A group of 51 men who had not undergone operation, also with LUTS and probable BPO, were similarly followed over 6 months, before eventually undergoing TURP (Group 2). These patients differed from Group 1 in being younger, less symptomatic and having a higher baseline quality-of-life score, but the inclusion of this group from a broadly similar diagnostic category allowed outcome to be assessed over time in the absence of surgery. RESULTS: There was a significant improvement in all LUTS 6 weeks after TURP; post-micturition dribbling and storage symptoms continued to improve for up to one year. The NHP revealed pre-operative morbidity in all dimensions of the profile. At 12 months after surgery there were significant improvements in the domains of social interaction, energy, pain, emotional reactions and sleep. The EQ profile also showed morbidity in all dimensions before surgery, with significant improvement at 12 months in usual activities, mood and pain/discomfort. The EQ self-rated health and composite quality-of-life score also showed improvement with TURP which continued for 12 months after surgery. The patients in Group 2 tended to deteriorate over the 6 months of follow-up using all measures, but the changes were not significant. The EQ composite quality-of-life score also discriminated between patients on the basis of age, number of symptoms and ASA grade, suggesting that these subgroups experienced differing amounts of benefit from surgery. CONCLUSION: TURP led to significant improvement in the indices of generic HRQL as measured using the NHP and EQ; this improvement continued for 12 months after surgery and mirrored the symptomatic improvement. The EQ confirmed clinical experience, in that men who were younger, fitter and most symptomatic experienced the greatest benefit from surgery. This has not been shown previously using a quality-of-life measure. Generic HRQL measures can be incorporated easily into clinical trials and both the measures used in this study have sufficient sensitivity to be used in this population. The EQ has the advantage of generating a composite quality-of-life score which is easy to interpret and can be used in cost-utility analysis. The addition of HRQL measures leads to a more robust appraisal of the results of surgical intervention. Ultimately, patient-based outcome from TURP will be assessed using a combination of psychometrically tested disease-specific and generic measures, together with symptom scoring.

Activities of Daily Living↗

Health state valuations from the general public using the visual analogue scale.

In the clinical and economic evaluation of health care, the value of benefit gained should be determined from a public perspective. The objective of this study was to establish relative valuations attached to different health states to form the basis for a 'social tariff' for use in quantifying patient benefit from health care. Three thousand three hundred and ninety-five interviews were conducted with a representative sample of the adult British population. Using the EuroQol health state classification and a visual analogue scale (VAS), each respondent valued 15 health states producing, in total, direct valuations for 45 states. Two hundred and twenty-one re-interviews were conducted approximately 10 weeks later. A near complete, and logically consistent, VAS data set was generated with good test-retest reliability (mean ICC = 0.78). Both social class and education had a significant effect, where higher median valuations were given by respondents in social classes III-V and by those with intermediate or no educational qualifications. These effects were particularly noticeable for more severe states. The use of such valuations in a social tariff raises important issues regarding the use of the VAS method itself to elicit valuations for hypothetical health states, the production of separate tariffs according to social class and/or education and the appropriate measure of central tendency.

Activities of Daily Living↗

Valuing health states: a comparison of methods.

In eliciting health state valuations, two widely used methods are the standard gamble (SG) and the time trade off (TTO). Both methods make assumptions about individual preferences that are too restrictive to allow them to act as perfect proxies for utility. Therefore, a choice between them might instead be made on empirical grounds. This paper reports on a study which compared a "props" (using specifically-designed boards) and a "no props" (using self-completion booklets) variant of each method. The results suggested that both non props variants might be susceptable to framing effects and that TTP props outperformed SG props.

Adolescent↗

The WHO (Ten) Well-Being Index: validation in diabetes.

BACKGROUND: In a European trial in 8 countries, the subjective well-being of patients on alternative forms of treatment for insulin-dependent diabetes was compared using the 28-item WHO Well-Being Questionnaire, covering four dimensions of depression, anxiety, energy and positive well-being. The objective of the analysis reported here has been to identify the items of the WHO questionnaire which belong to an overall index of negative and positive well-being. METHODS: Adult patients at 10 study centres in 8 countries who had been on insulin for at least 2 years were invited to participate in a randomised, cross-over trial to compare insulin pump treatment with injection therapy. At each phase, patients completed questions on well-being and general health. Internal validity of the well-being index was evaluated by Cronbach's alpha and Loevinger's and Mokken's homogeneity coefficients, as well as factor analysis. External validity was evaluated by comparisons with results of the general assessment questions and by the ability to discriminate between the alternative forms of treatment. RESULTS: 358 patients had sufficient data for analysis. Ten items were found to constitute a valid index of well-being with respect to internal and external validity. Coefficients of homogeneity were acceptable and there was evidence for both concurrent and discriminant validity. CONCLUSIONS: The WHO (Ten) well-being index includes negative and positive aspects of well-being in a single uni-dimensional scale. Its advantage lies in its ability to show overall change along the continuum of well-being, thus facilitating comparisons between patient groups and treatments. It is not specific to diabetes, and therefore may be useful as a disease-independent index of well-being in a broad range of health care studies.

Adaptation, Psychological↗

Quality of life in liaison psychiatry. A comparison of patient and clinician assessment.

BACKGROUND: This exploratory study investigates the performance of the Health Measurement Questionnaire (HMQ), as compared with the Psychiatric Assessment Schedule (PAS) and the Nottingham Health Profile (NHP), and compares self- and observer-completed measures. METHOD: A total of 138 medical patients scoring over the screening threshold for probable psychiatric illness completed the HMQ, NHP and PAS, and were rated by a psychiatrist on Rosser disability and distress. RESULTS: HMQ disability correlated well with NHP and PAS physical health items, while HMQ distress correlated well with the NHP emotional reactions and PAS Index of Definition. There was significant correlation between self-report and psychiatrist ratings, the latter being more sensitive to distress. CONCLUSION: The HMQ is a useful measure of generic health status in liaison psychiatry settings.

Adolescent↗

Lay people's evaluations of health: are there variations between different subgroups?

STUDY OBJECTIVE: To elicit lay concepts of health and to see whether these are related to various sociodemographic factors, as has been suggested by previous smaller studies. DESIGN AND SETTING: A total of 196 people aged 18 and over were selected, as a representative sample of the general population, from the electoral registers of Walsall and Dudley in the West Midlands. Respondents were interviewed in their own homes in the autumn of 1989. MEASUREMENTS: Open ended and structured questions were used to elicit concepts of health. The three main stages consisted of an unprompted section in which respondents were asked to describe the features of good or poor health in themselves or others; a prompted section in which they were asked to rate 37 health statements using a series of categories from "very important" to "not at all important"; and a section in which they were asked to indicate which of six groups of statements, each representing a particular concept of health, best represented their own notions of health. RESULTS: Health was seen as multidimensional. Irrespective of whether respondents addressed health in self or health in others, or good or poor health, the biomedical dimension remained an important one. The manner by which concepts of health are elicited may provide some explanation as to why so many and varied concepts are alleged to be held by different subgroups of the population (notably different social classes). CONCLUSIONS: The differences found in this study between models of health employed by different subgroups of the general population have not been as great as has previously been suggested in the published reports. This is encouraging for those using existing health status measurements.

Adolescent↗

Adverse effects of benzodiazepines.

The growing realisation that the benzodiazepines have potential for causing serious harm has caused concern due to their wide and common use. This paper is a review of the adverse effects of benzodiazepines, and concentrates on four areas of particular concern: drug dependence with the consequent withdrawal symptoms; psychological effects while on the drugs; use by the elderly; and tolerance to the drug effects. Although the phenomenon of a benzodiazepine withdrawal syndrome is generally accepted, there is still controversy over the frequency amongst users. A number of major studies are reviewed here, and the main methodological issues are discussed. These include definition of the withdrawal symptoms, selection of subjects, and use of double-blind, placebo-controlled conditions. The studies investigating psychological impairment with benzodiazepine use deal mainly with motor performance and co-ordination, although there is a large group of studies looking at the effect of the drugs on memory. Although the studies reviewed make a considerable contribution to the understanding of the effects of benzodiazepines, they focus on physiological and specific psychological variables, rather than more global measures of functioning and behaviour. It is suggested here that this emphasis needs to change in order to obtain a clearer picture of how benzodiazepines affect quality of life. Future studies should also be prospective in design, and include clear criteria for the selection of subjects and for the definition of withdrawal symptoms.

Anxiety Disorders↗

Prioritising waiting lists.

The 'top 22' patient conditions on the general surgical waiting list at Guy's Hospital were rated independently by five general surgeons. Each surgeon estimated the peri-operative mortality rates associated with each treatment; the proportion of patients who failed to benefit; the effect of successful treatment on life expectancy and on the patients' quality of life. the mean values were used to estimate the expected net benefits (in terms of quality-adjusted life-years) from treatment one year earlier than might otherwise have been the case. These benefits were then related to the operating times and length of stay associated with each treatment; this identified which treatments offered the greatest benefit per unit of each constrained resource. Of all conditions examined anal fissures where shown to be the least resource intensive in relation to the benefits generated, whilst varicose veins and epigastric hernias proved otherwise. For the full potential of this approach to be realised it needs to be repeated in other places and in other specialties. It nevertheless offers a more rational basis for interpreting waiting list data than presently exists and by using the short-cut methods is a relatively cheap way of generating much useful data.

Data Collection↗

The time trade-off method: results from a general population study.

An important consideration when establishing priorities in health care is the likely effects that alternative allocations of resources will have on health-related quality-of-life (HRQoL). This paper reports on a large-scale national study that elicited the relative valuations attached by the general public to different states of health (defined in HRQoL terms). Health state valuations were derived using the time trade-off (TTO) method. The data from 3395 respondents were highly consistent, suggesting that it is feasible to use the TTO method to elicit valuations from the general public. The paper shows that valuations for severe health states appear to be affected by the age and the sex of the respondent; those aged 18-59 have higher valuations than those aged 60 or over and men have higher valuations than women. These results contradict those reported elsewhere and suggest that the small samples used in other studies may be concealing real differences that exist between population sub-groups. This has important implications for public policy decisions.

Adolescent↗

Time preference, duration and health state valuations.

There is increasing interest in health status measurement and the relative weights that people attach to different states of health and illness. One important issue which has been raised is the effect that the time spent in a health state may have on the way that state is perceived. Previous studies have suggested that the worse a state is, the more intolerable it becomes as it lasts longer. However, for most of these studies, it is impossible to determine how much of what was observed is attributable to the time spent in the state and how much is attributable to when it was occurring. This paper reports on a pilot study designed to test the feasibility of using the Time Trade-Off (TTO) method to isolate the effect of pure time preference from the effect of duration per se. Interviews were conducted with 39 members of the general population who were asked to rate 5 health states for durations of one month, one year and ten years. In aggregate, rates of time preference were very close to zero which suggests that the implicit assumption of the TTO method that there is no discounting may be a valid one. However, that more respondents had negative (rather than positive) rates, casts some doubt on the axions of discounted utility theory. In addition, implied valuations for states lasting for short periods were often counter-intuitive which questions the feasibility of using the TTO method to measure preferences for temporary health states.

Adult↗