The reliability and validity of the Health of the Nation Outcome Scales: validation in relation to patient derived measures

OBJECTIVE

The Health of Nation Outcome Scales (HoNOS) was developed to assess mental health outcomes. The aim of the studies is to examine the psychometric properties, reliability and validity of the HoNOS.

METHOD

Three studies were conducted within St John of God Hospitals in New South Wales, Australia. They examined the reliability and the validity of the HoNOS. The first study examined the interrater reliability of the HoNOS, before and after staff training in the use of the HoNOS. The second study examined the validity of the HoNOS with the Symptom Checklist 90 Revised (SCL90-R) and the third study examined the validity of the HoNOS with the Short-Form 36 (SF-36).

RESULTS

The first study showed an improvement in the interrater reliability (IRR) of the HoNOS due to training. However, a generally unsatisfactory IRR (range 0.50-0.65) was achieved. The second study found no correlation between the SCL90-R and the HoNOS on admission (r = 0.04) and discharge (r = 0.06). The third study found no significant correlation between the Mental Component Score of the SF-36 and the HoNOS on admission (r = -0.033) nor on discharge (r = -0.104).

CONCLUSIONS

The HoNOS has at best moderate interrater reliabilities. Further, the validity of the HoNOS is under question, that is, it does not correlate with a major measure of mental health symptoms, nor with a major measure of health status. As such, it is concluded that the psychometric properties of the HoNOS do not warrant its use as a routine measure.

An intensive treatment program for chronic posttraumatic stress disorder: 2-year outcome data

OBJECTIVE

The present study evaluates the efficacy of a closed-cohort treatment program for chronic posttraumatic stress disorder (PTSD).

METHOD

The treatment orientation was a combined approach involving cognitive behaviour therapy and pharmacotherapy. Treatment involved an inpatient phase of 4 weeks, with group and individual follow-up sessions of at least 6-month duration. The treatment population consisted largely of Australian Vietnam veterans. Standardised psychometric measures were obtained pre-treatment, on completion of the residential phase; and at 6, 12 and 24 months post discharge from the residential program.

RESULTS

The results obtained from 64 patients demonstrate significant reductions in depression, anxiety and PTSD symptoms, maintained at 2 years post discharge from the residential phase of the treatment program.

CONCLUSIONS

This paper presents encouraging findings for treatment with this troubled population.

Radiolabelled 5'-iodo-2'-deoxyuridine: a promising alternative to [18F]-2-fluoro-2-deoxy-D-glucose for PET studies of early response to anticancer treatment

We investigated the potential of radiolabelled 5-iodo-2'-deoxyuridine (IUdR) as a pharmacodynamic probe for use with positron emission tomography (PET) in studies of early proliferative response to anticancer treatment. Using the hormone-responsive rat mammary carcinoma OES.HR1, we used a multiple radiotracer method to examine treatment-induced changes in 24 h tumour retention of [131I]IUdR, uptake of [3H]2-deoxy-D-glucose ([3H]DG) together with [99mTc]hexylmethylpropylene amineoxine ([99mTc]HMPAO) uptake as a measure of blood flow. Radiotracer data were compared with macroscopic changes in tumour growth, and cell proliferation as determined by DNA histogram flow cytometry. From 4 days after tumour growth arrest induced by oestrogen ablation, a sustained fall in tumour cell proliferation was demonstrated, which was associated with reduced tumour uptake of each tracer. Whereas reduced levels of tumour [3H]DG could be accounted for by changes in blood flow, this was not the case for [131I]IUdR, which was found to be closely related to percentage S-phase cells within tumour (r = 0.73, p < 0.002). It was also estimated that residual levels of radioiodide may contribute significantly, to the low levels of retained radioactivity associated with responding tumours at 24 h following IUdR administration, suggesting that metabolite correction methods should be implemented as part of IUdR PET imaging protocols. We conclude that [124I]IUdR is a promising alternative to [18F]fluorodeoxyglucose ([18F]FDG) for the early assessment by PET of tumour response to treatments directed at targets associated with cell proliferation.

The selection of female urinals: results of a multicentre evaluation

Female urinals are designed to enable women to empty their bladders while not on the toilet and are therefore potentially useful in preventing incontinence. However, there is little published information to guide product selection. Therefore, an evaluation of these products was undertaken by the Continence Products Evaluation Network (funded by the Medical Devices Agency). All 13 reusable female urinals available in the UK in March 1997 were evaluated. Each urinal was evaluated by 28-32 community-based women. Preliminarily, each subject tested all urinals by trying to place them in one or two of their preferred positions, to establish if the urinals were suitable for full testing. Each of the urinals that were selected for full testing were then used for 1 week each. During this week the subjects kept a diary to record leakage or spillage when using the urinal. At the end of the week a product evaluation form was filled in to record product performance. The results from full testing indicate that all urinals were successful for some subjects. However, some urinals were found to be successful for all four main positions (e.g. Petal Female Urinal) while others were successful mainly in one or two positions (e.g. Bridge Saddle Pan and Subaseal). Many urinals were successful in the standing/crouching and sitting on the edge (of chair or bed) positions, while comparatively few urinals were successful in the lying position. It was found that the chances of finding a suitable urinal increased with levels of independence. This means that subjects with higher levels of dependency found fewer urinals to be suitable for their needs when used without assistance. The results of this evaluation provide guidance for product selection. However, it is recommended that continence specialists keep samples of the full range of female urinals to enable women to experiment with urinals in order to find one that best suits their needs.

The double-stranded RNA-binding domains of Xenopus laevis ADAR1 exhibit different RNA-binding behaviors

We have cloned cDNAs encoding two versions of Xenopus double-stranded RNA adenosine deaminase (ADAR1). Like ADAR1 proteins from other species Xenopus ADAR1 contains three double-stranded RNA-binding domains (dsRBDs) which are most likely required for substrate binding and recognition of this RNA-editing enzyme. Analysis of mammalian ADAR1 identified the third dsRBD in this enzyme as most important for RNA binding. Here we analyzed the three dsRBDs of Xenopus ADAR1 for their in vitro RNA-binding behavior using two different assays. Northwestern assays identified the second dsRBD in the Xenopus protein as most important for RNA binding while in-solution assays demonstrated the importance of the third dsRBD for RNA binding. The differences between these two assays are discussed and we suggest that both the second and third dsRBD of Xenopus ADAR1 are important for RNA binding in vivo. We show further that all three dsRBDs can contribute to a cooperative binding effect.

Infant feeding practices in Barbados predict later growth

This longitudinal study was designed to examine reciprocal relationships between feeding practices and infant growth over the first 6 mo of life. The following three hypotheses were tested: 1) early feeding practices predict later infant growth; 2) early infant growth predicts later feeding practices; and 3) these relationships occur after controlling for related background variables. The sample included 226 healthy, well-nourished infants born at the Queen Elizabeth Hospital, Bridgetown, Barbados. Assessments were made at birth, 7 wk, and 3 and 6 mo of age. Factor analysis of a feeding practices questionnaire for those mothers who attended all three postnatal visits yielded five uncorrelated factors. Three of these factors, preference for breast-feeding, feeding intensity and feeding difficulty, declined with infant age. Two of these factors, father helps and relatives help, increased with infant age. Several background variables, including maternal age, anthropometry and reproductive history, and reliance on outside sources of information were correlated with infant growth. Multivariate analyses confirmed all three hypotheses. The group of feeding practices (particularly the preference for breast-feeding) at 7 wk predicted increases in infant lengths at subsequent ages. Conversely, infant weights at 3 and 6 mo predicted subsequent feeding practices, especially feeding intensity. These reciprocal relationships remained even after statistically controlling for the influence of the background variables. Implications for public policy include the need for comprehensive programs advocating breast-feeding and supporting the general health of mothers and infants.

The role of bradykinin in the regulation of blood flow to hindlimb muscle groups of the anaesthetized cat

1. Male cats were anaesthetized with alphaxalone-alphadolone and breathed spontaneously following tracheotomy, Using coloured microspheres, muscle blood flow was measured at rest and during two periods of contraction elicited by simultaneous stimulation of the left sciatic and femoral nerves at 3 Hz for 10 min. In one group, the hindlimb blood flow was allowed to increase during muscle contraction and in another group the perfusion of the hindlimb was limited by a stenosis on the left external iliac artery. 2. In the absence of flow restriction, soleus muscle blood flow increased from 18.9 +/- 3.8 to 30.4 +/- 3.3 ml min-1 (100 g tissue)-1 (n = 6; P < 0.02) and gastrocnemius muscle blood flow increased from 24.8 +/- 5.9 to 61.6 +/- 12.8 ml min-1 (100 g tissue)-1 (n = 6; P < 0.01) during contraction. The bradykinin (BK) antagonists HOE 140 (1 mg kg-1, i.v.) did not affect the response in either the soleus (37.7 +/- 7.3 ml min-1 (100 g tissue)-1; n = 6; n.s.) or the gastrocnemius (62.9 +/- 7.9 ml min-1 (100 g tissue)-1; n = 6; n.s.) muscles. 3. In the stenosis group, soleus muscle blood flow increased from 9.8 +/- 2.3 to 22.9 +/- 4.9 ml min-1 (100 g tissue)-1 (n = 6; P < 0.01) and gastrocnemius muscle blood flow increased from 15.8 +/ 3.4 to 36.4 +/- 5.5 ml min-1 (100 g tissue)-1 (n = 6; P < 0.01) during contraction. Following administration of HOE 140, functional hyperaemia in the soleus muscle was unaffected (blood flow, 17.8 +/- 2.2 ml min-1 (100 g tissue)-1, n = 6; n.s.) white blood flow in the gastrocnemius muscle was reduced to 21.8 +/- 6.0 ml min-1 (100 g tissue)-1 (n = 6; P < 0.05). 4. The results show that BK does not contribute ot functional hyperaemia associated with twitch contraction at 3 Hz when blood flow is unrestricted, but may contribute up to 40% of the vasodilation of predominantly glycolytic muscle groups such as the gastrocnemius when flow is restricted. BK plays no role in hyperaemia associated with twitch contraction of oxidative muscle groups such as the soleus.

The relationship between a patient's spirituality and health experiences

BACKGROUND AND OBJECTIVES

The relationship between spirituality and health is a new frontier in medicine. This study is a preliminary investigation into the relationship between a patient's experience of overall health, physical pain, and intrinsic spirituality.

METHODS

We used a stratified, random sample of 462 patients at a family practice residency clinic. The Index of Core Spiritual Experiences (INSPIRIT) measured intrinsic spirituality, and Dartmouth Primary Care Cooperative Charts measured overall health and pain. Pearson correlations tested the association between health, pain, and spirituality. Patient scores on the INSPIRIT were then placed into three groups (high, medium, and low levels of intrinsic spirituality). ANOVA tested for significant differences in health and pain.

RESULTS

We collected information from 442 of the patients surveyed (95%). We found significant correlation between patient health and spirituality. Significant differences were also found in both overall health and physical pain, based on the three levels of spirituality. Gender differences were only significant for overall health, not for patient pain.

CONCLUSIONS

Our results suggest an association between intrinsic spirituality and a patient's experience of health and pain. Assessment of spirituality may be important for family physicians to consider as a supplement to patient interviews.

Infant sensitivity to deviations in dynamic facial-vocal displays: the role of eye regard

Do young infants appreciate the intentionality of adult interactors? In view of recent speculation that infants are innately sensitive to eye direction and that communicative intent is conveyed in part by attentional cues, the reactions of 3- and 5-month infants were compared to video episodes of normally responsive women who either appeared or did not appear to make eye contact. Across three experiments, lack of eye contact was achieved by either averting the eyes (E), averting the head and eyes (H&E), closing the eyes (ECL), or averting the head alone (H). Three-month-olds smiled less at H&E, H, and ECL, but not at E, relative to frontal faces, indicating sensitivity to head but not to eye orientation. By contrast, 5-month-olds smiled less at H&E, E, and ECL, but not at H, indicating sensitivity to both head and eye orientation. The implications of the data for mentalist views of infant social behavior are discussed.

Infant sensitivity to deviations in dynamic facial-vocal displays: the role of eye regard

Do young infants appreciate the intentionality of adult interactors? In view of recent speculation that infants are innately sensitive to eye direction and that communicative intent is conveyed in part by attentional cues, the reactions of 3- and 5-month infants were compared to video episodes of normally responsive women who either appeared or did not appear to make eye contact. Across three experiments, lack of eye contact was achieved by either averting the eyes (E), averting the head and eyes (H&E), closing the eyes (ECL), or averting the head alone (H). Three-month-olds smiled less at H&E, H, and ECL, but not at E, relative to frontal faces, indicating sensitivity to head but not to eye orientation. By contrast, 5-month-olds smiled less at H&E, E, and ECL, but not at H, indicating sensitivity to both head and eye orientation. The implications of the data for mentalist views of infant social behavior are discussed.

Improving the performance of small incontinence pads: a study of "wet comfort"

PURPOSE

The wet comfort of small, disposable incontinence pads has been found to correlate strongly with overall acceptability. This study examined the relationship between pad properties (absorption capacity, strike-through, and wetback) and wet comfort.

DESIGN

A group of women with light incontinence were asked to report on the wet comfort of a series of experimental pads made up to the same design geometry but in different combinations of materials.

METHODS

Three different pad variants were selected, and two experiments were conducted. Experiment 1 used a single-blind design in which 20 testers were supplied with a random mix of the three unlabeled pad variants. All pads were saved for weighing and scored for overall performance, wet comfort, and absorbency. In experiment 2, subjects used each pad variant in turn for 1 week and at the end of each week compared that pad with the one used the previous week.

MAIN OUTCOME MEASURES

Absorption capacity, wetback, and strike-through properties for each pad variant were measured in the laboratory setting, and wet comfort was measured by a written tool completed by participants during clinical trials.

RESULTS

Data analysis from experiment 1 revealed statistically significant differences among pad variants, particularly when assessed for absorbency. Differences for wet comfort were less marked and only achieved significance when those with ratings of good or OK for wet comfort were compared with those with a score of poor. In experiment 2, no statistically significant differences were found for wet comfort.

CONCLUSIONS

Overall, the improvement in wet comfort achieved by a substantial increase in absorption capacity and reduction in wetback were disappointing. The relatively small sample and the design specifications of the pad may have masked differences. Cost considerations mean that more evidence is needed to justify the inclusion of more expensive materials and production stages in the manufacture of small pads.

Quality of life outcomes after intensive care. Comparison with a community group

OBJECTIVE

Compare the health related quality of life of intensive care patients with a community sample.

DESIGN

Self-completed questionnaire posted to a consecutive sample of 238 patients 16 months after discharge from an intensive care unit (ICU) and to a random community sample (n = 242).

SETTING

The Liverpool Hospital is the main referral and teaching hospital in a community of 620,000 people. It has a ten-bed general ICU.

PATIENTS AND PARTICIPANTS

All patients admitted to the ICU over 8 months with a length of stay > or = 24 h and a sample drawn from the community telephone directory.

MEASUREMENTS AND MAIN RESULTS

The self completed questionnaire contained physical and psychosocial health and quality of life (QOL) scales. Analysis of variance indicated that ICU patients were more physically ill and anxiously depressed than the community sample. Sixty-three per cent of patients had not attained full health, were functionally impaired and had a poorer QOL than those patients who had returned to full health and the community. Psychosocial health (apart from anxious depression) was related to the level of perceived physical health rather than to whether or not they had been admitted to the ICU. Those subjects not in full health had poorer interpersonal relationships, less positive attitudes about life, more anxious depression and more suicidal depression.

CONCLUSIONS

ICU patients following discharge have worse perceived health and more anxiety than others in the community. Sixty-three per cent of patients had a poorer QOL and functional health than those who returned to full health and those in the community.

The effects of selective cholinergic basal forebrain lesions and aging upon expectancy in the rat

The effects of selective cholinergic cell loss within the basal forebrain (BF) were determined using a task that requires shifting of attention between two visual stimuli. Discriminability between two stimuli and response bias were determined in young and old F-344 rats given BF injections of IgG-192 saporin (100 ng). The lesion reduced ChAT activity in the frontal and parietal cortices, hippocampus, and olfactory bulbs. The lesion did not significantly alter Na+/K(+)-ATPase activity in cortex, hippocampus, or olfactory bulbs, or endogenous levels of neuropeptide Y and neurokinin B within the BF. The BF lesions impaired both stimulus discriminability and response bias in young and old rats. The BF lesions had a significantly greater effect upon stimulus discriminability and response bias in aged rats, compared to young rats, only when the stimulus duration was very brief, i.e., when the task was most difficult to solve. At longer stimulus durations, aging and lesions showed no interaction. The results suggest that the selective loss of cholinergic cells in the BF, but not normal aging, impairs the ability to discriminate between independent sensory stimuli. The loss of these cells confers a response bias in simple operant tasks involving motor responses to reward-related visual stimuli.

A multicentre comparative evaluation of catheter valves

Catheter valves are an alternative to leg bags for urine drainage, but no studies have yet been published which have compared the performance of different valves. This study was undertaken to evaluate the performance of the seven catheter valves available on the UK market in April 1996. The study was carried out by the Continence Products Evaluation (CPE) Network funded by the Medical Devices Agency (Department of Health). Each valve type was tested for 1 week by 19-36 cognitively unimpaired and manually dextrous subjects recruited from 11 test centres. At the end of each week, subjects completed an evaluation form (based on a three-point rating scale) to record product performance. The same catheter valves were also tested for ease of opening/closing by 33 subjects (mostly catheter users) who had some manual impairment. Performance scores varied widely between products. It was found that, to be successful, a valve needs to be easy to manipulate, leak-free, comfortable and inconspicuous. Prescribers need to be aware of the strengths and limitations of different valves for appropriate product selection.

Effect of the potassium channel opener ZM260384 on skeletal muscle function during restricted blood flow in the anaesthetized cat

The aim of the present experiment was to determine whether the potassium channel opener 2-(2,2-bis(difluoromethyl)-6-nitro-3,4-dihydro-2H-1, 4-benzoxazine-4-yl)pyridine-N-oxide (ZM260384) was capable of accelerating the decline in skeletal muscle function during restricted blood flow in vivo. Cats (3.0-4.5 kg body weight) were anaesthetized with alphaxalone-alphadalone and breathed spontaneously following tracheotomy. Isometric tension was measured in the extensor digitorum longus-anterior tibialis (EDL-TA) muscle group. Ischaemia was induced by perfusing the hindlimb with the animal's own blood at a rate of 12.5 ml min-1 using a roller pump and stimulating the common peroneal nerve to induce repetitive submaximal tetanic contractions in the EDL-TA. The number of stimulation voltage increments required each minute to maintain a constant level of submaximal mechanical output and the time to exhaustion were used as indices of the rate of tension decline. The rate of tension decline in the ischaemic EDL-TA in the presence of ZM260384 at 3 mg kg-1, a maximally hypotensive dose predicted to be within the dose range required to exert direct effects on skeletal muscle, was measured and compared with the rate of tension decline in the presence of ZM260384 at 0.03 mg kg-1, also maximally hypotensive dose but below the predicted dose range for skeletal muscle effects. The number of voltage increments per minute was 1.93 +/- 0.07 and 1.48 +/- 0.14 (P < 0.05) in the presence of 3 and 0.03 mg kg-1 ZM260384, respectively. Time to exhaustion was 17.5 +/- 4.2 and 7.2 +/- 0.8 min (P < 0.05) in the presence of 3 and 0.03 mg kg-1 ZM260384, respectively. Given that there was no difference between these two groups in any haemodynamic variable measured, the results of the present study suggest that ZM260384 (3 mg kg-1) increases the rate of isometric force loss in ischemic skeletal muscle in vivo.