Translation and validation of the Hirschsprung and anorectal malformation quality of life (HAQL) questionnaire in a Danish Hirschsprung population

BACKGROUND

Hirschsprung's disease (HD) may result in an impaired quality of life (QoL) due to bowel problems, postoperative complications and other health-related issues. The Hirschsprung and Anorectal Malformation Quality of Life (HAQL) questionnaire is a disease-specific instrument developed in the Netherlands to measure the QoL in patients with HD and anorectal malformations. The aim of this study was to translate, culturally adapt and validate HAQL in a Danish Hirschsprung population.

MATERIAL AND METHODS

Translation and cultural adaptation were performed according to international guidelines. Invitations to participate in the validation were sent to 401 patients operated for HD during the period from 1985 to 2012. A total of 156 patients completed the translated and culturally adapted Danish versions of HAQL and 35 parents of children and adolescents completed the corresponding parent questionnaire. Reliability was evaluated in terms of internal consistency using Cronbach's α and test-retest reliability using Intraclass Correlation Coefficient for the retest step. Known groups comparison was performed with comparison of mild HD (defined as recto-sigmoidal HD) and serious HD (defined as more proximal disease).

RESULTS

The internal consistency of the dimensions was overall satisfactory for adults and adolescents but more problematic for children, where Cronbach's α was less than 0.7 in 60% of the dimensions. For both children and adolescents, the α-value was unsatisfactory for social functioning, emotional functioning, and body image. The test-retest reliability was overall good. The known groups comparison was only able to demonstrate a significant difference between mild and severe HD within one dimension.

CONCLUSIONS

The translated version of the HAQL questionnaires provides an overall reliable instrument for evaluating disease-specific QoL in a Danish HD population, but it is important to acknowledge the limitations of the questionnaire, especially in children and adolescents.

Angle-resolved photoemission spectroscopy of tetragonal CuO: evidence for intralayer coupling between cupratelike sublattices

We investigate by angle-resolved photoemission the electronic structure of in situ grown tetragonal CuO, a synthetic quasi-two-dimensional edge-sharing cuprate. We show that, in spite of the very different nature of the copper oxide layers, with twice as many Cu in the CuO layers of tetragonal CuO as compared to the CuO(2) layers of the high-T(c) cuprates, the low-energy electronic excitations are surprisingly similar, with a Zhang-Rice singlet dispersing on weakly coupled cupratelike sublattices. This system should thus be considered as a member of the high-T(c) cuprate family, with, however, interesting differences due to the intralayer coupling between the cupratelike sublattices.

Nocturnal 6-hydroxymelatonin sulfate excretion in female workers exposed to magnetic fields

The objective of this study was to determine whether daytime occupational exposure to extremely low frequency magnetic fields (MFs) suppresses nocturnal melatonin production. Sixty female volunteers were recruited. Thirty-nine worked in a garment factory, and 21 office workers served as a reference group. Exposure assessment was based on the type of sewing machine used and MF measurements around each type of machine. Eye-level MF flux density was used to classify the operators to higher (>1 microT) and lower (0.3-1 microT) exposure categories. A third group of factory workers had diverse MF exposures from other sources. The reference group had average exposure of about 0.15 microT. Urine samples were collected on Friday and Monday for three consecutive weeks. Melatonin production was assessed as urinary 6-hydroxymelatonin sulfate (6-OHMS) excretion. The ratio of Friday morning/Monday morning 6-OHMS was used to test the hypothesis that melatonin production is suppressed after 4 days of occupational MF exposure with significant recovery during the weekend. Possible chronic suppression of melatonin production was evaluated by studying exposure-related differences in the Friday values by multivariate regression analysis. The Monday/Friday ratios were close to 1.0, suggesting that there is no increase in melatonin production over the weekend. The average 6-OHMS excretion on Friday was lower among the factory workers than in the reference group, but no monotonous dose-response was observed. Multivariate regression analysis identified MF exposure, smoking, and age as significant explanatory variables associated with decreased 6-OHMS excretion.

EMF exposure assessment in the Finnish garment industry: evaluation of proposed EMF exposure metrics

Recently published studies indicate that having worked in occupations that involve moderate to high electromagnetic field (EMF) exposure is a risk factor for neurodegenerative diseases, including Alzheimer's disease. In these studies, the occupational groups most over-represented for EMF exposure comprised seamstresses, dressmakers, and tailors. Future epidemiologic studies designed to evaluate the possibility of a causal relationship between exposure to EMF and a neuro degenerative disease endpoint such as incidence of Alzheimer's disease, will benefit from the measurement of electromagnetic field metrics with potential biological relevance. Data collection methodology in such studies would be highly dependent upon how the metrics are defined. In this research the authors developed and demonstrated (1) protocols for collecting EMF exposure data suitable for estimating a variety of exposure metrics that may have biological relevance, and (2) analytical methods for calculation of these metrics. The authors show how exposure might be estimated under each of the three prominent EMF health-effects mechanism theories and evaluate the assertion that relative exposure ranking is dependent on which mechanism is assumed. The authors also performed AC RMS magnetic flux density measurements, confirming previously reported findings. The results indicate that seamstresses, as an occupational group, should be considered for study of the possible health effects of long-term EMF exposure.

Adult leukemia risk and personal appliance use: a preliminary study

The hypothesis that use of personal electric appliances may be associated with increased risk of acute nonlymphocytic leukemia in adults was tested using interview data from a previously completed case-control study of 114 cases and 133 controls conducted between 1981 and 1984. Cases were obtained from a population-based cancer registry in western Washington state, and controls were obtained from the same area by random digit dialing. Of 32 electrical home appliances for which data on use were available for adult acute nonlymphocytic leukemia cases and controls, three motor-driven personal appliances (electric razors, hair dryers, and massage units) were selected a priori because their use represents exposure to higher peak magnetic fields than that from most other home appliances. When compared on an "ever used" versus "never used" basis, use of one or more of these appliances was not associated with increased risk of leukemia in the population studied (odds ratio (OR) = 0.71, 95% confidence interval (CI) 0.41-1.24). When the appliances were considered individually, massage units were more likely to have been used by cases than by controls (OR = 3.00, 95% CI 1.43-6.32), while hair dryers were more likely to have been used by controls than cases (OR = 0.38, 95% CI 0.22-0.66). There was a nonsignificant tendency for electric razor use to differentiate the cases from controls (OR = 1.33, 95% CI 0.80-2.23). When reported daily time of use was stratified, there was no overall increased risk with increased time of use except for electric razors (p < 0.05). In addition to the analysis of appliance use data from the case-control study, the authors obtained several models of these motor-driven personal appliances and characterized the magnetic fields they produce. Magnetic field flux density, or the B-field, and spectral measurements showed that partial body exposure from such appliances may exceed 0.5 mTesla (root mean squared) at rates-of-change exceeding 10 Tesla/sec. These epidemiologic data must be interpreted cautiously because the number of cases is limited and because of proxy reporting of appliance use for deceased cases. Nevertheless, the authors believe these data indicate that peak magnetic field exposure from personal appliances warrants further investigation as a possible risk factor for acute nonlymphocytic leukemia in adults.

Magnetic-field flux density and spectral characteristics of motor-driven personal appliances

Flux density and spectral measurements were carried out on magnetic fields generated by several types of motor-driven personal appliances used near the body. Among the units tested were several for which the average flux densities, as determined at the surfaces of the appliance, exceeded 0.4 mT. Time-rates-of-change (dB/dt) for several units exceeded 1000 T/s, and several units exhibited high-frequency components in the low-MHz range. Use of such appliances, although normally of short duration, can represent exposure to magnetic fields of relatively high flux density, which may also have high-frequency components. Compared to other household and commercial sources of magnetic fields, those generated by certain motor-driven personal appliances may represent a significant contribution to time-weighted average exposure and may represent an important source of local induced currents in the body. Furthermore, high-frequency transients that represent only a minor contribution to time-weighted average exposure may generate significant instantaneous induced currents.

Abused and neglected elderly: what can the family physician do?

Family abuse involving children and spouses is estimated to occur with one Canadian child or spouse in 10. The same figures probably apply to elderly persons cared for by a family member. This paper defines and describes abuse and neglect of the elderly, reviews the stress factors that often underlie it and profiles high-risk candidates for giving and receiving abuse. It provides guidance in detecting the occurrence of abuse of the elderly and suggests means of handling such occurrences in a humane, sensible and protective way.

Family physicians and teaching hospitals: a litany of woes

Retreat of family physicians from caring for their patients in teaching hospitals has been partly imposed and partly passively accepted. Confusion of patient, family doctor and consultant relationships has resulted. Town/gown and family physician/specialist communication problems disrupt a proper model of care. Family physicians need to take individual and group action to initiate change, but little action has been evident. Everyone is the loser. We should reinstitute a model in which family physicians are the closest professionals to their patients, wherever they are in the health care system. Demonstrating the value of family physician coordination of care and continuity of care will positively affect the current financial `loss leader' status of this work.

Rubella prevention in family practice with RA27/3 vaccine

The literature reveals serious shortcomings in rubella immunization programs since the introduction of rubella vaccine in 1969. Current programs may be supplemented by immunizing susceptible women in the childbearing years. Family physicians are in an ideal position to add this service for their practice populations. Existing methods in two practices were assessed by chart review and found to be disorganized. Testing of immunity was haphazard and incomplete, only occasionally being followed by immunization when indicated. A method of approaching this problem in the context of provision of service in everyday practice was established and evaluated. It is concluded that preventive measures are more successful if proposed during routine patient visits for other reasons. The distribution of rubella HI antibody titers in women from ages 12 to 40 years in this practice are displayed, along with the success rate of vaccination with RA27/3 vaccine (Almevax) and the frequency and nature of adverse effects. The superiority of response to this vaccine is demonstrated, as is the practicability of inclusion of Rubella HI testing and vaccination in the daily provision of care in a family practice.

Group B beta haemolytic streptococci in the female genital tract: a study of four clinic populations

The carrier rate of group B beta-haemolytic streptococci (GBS) was assessed in pregnant and non-pregnant women attending four clinics. Multiple sites were sampled and standard methods were used to isolate GBS. Colonization rates were highest in patients attending a venereal disease clinic but were not associated with other sexually transmitted diseases. Higher colonization rates were detected when multiple sites were sampled. Serotypes II and III occurred most frequently.