Relevance of a subjective quality of life questionnaire for long-term homeless persons with schizophrenia.

BACKGROUND: Increasing numbers of programs are addressing the specific needs of homeless people with schizophrenia in terms of access to housing, healthcare, basic human rights and other domains. Although quality of life scales are being used to evaluate such programs, few instruments have been validated for people with schizophrenia and none for people with schizophrenia who experience major social problems such as homelessness. The aim of the present study was to validate the French version of the S-QoL a self-administered, subjective quality of life questionnaire specific to schizophrenia for people with schizophrenia who are homeless. METHODS: In a two-step process, the S-QoL was first administered to two independent convenience samples of long-term homeless people with schizophrenia in Marseille, France. The objective of the first step was to analyse the psychometric properties of the S-QoL. The objective of the second step was to examine, through qualitative interviews with members of the population in question, the relevance and acceptability of the principle quality of life indicators used in the S-QoL instrument. RESULTS: Although the psychometric characteristics of the S-QoL were found to be globally satisfactory, from the point of view of the people being interviewed, acceptability was poor. Respondents frequently interrupted participation complaining that questionnaire items did not take into account the specific context of life on the streets. CONCLUSIONS: Less intrusive questions, more readily understandable vocabulary and greater relevance to subjects' living conditions are needed to improve the S-QoL questionnaire for this population. A modular questionnaire with context specific sections or specific quality of life instruments for socially excluded populations may well be the way forward.

Experimental violation of a Bell's inequality with efficient detection.

Local realism is the idea that objects have definite properties whether or not they are measured, and that measurements of these properties are not affected by events taking place sufficiently far away. Einstein, Podolsky and Rosen used these reasonable assumptions to conclude that quantum mechanics is incomplete. Starting in 1965, Bell and others constructed mathematical inequalities whereby experimental tests could distinguish between quantum mechanics and local realistic theories. Many experiments have since been done that are consistent with quantum mechanics and inconsistent with local realism. But these conclusions remain the subject of considerable interest and debate, and experiments are still being refined to overcome 'loopholes' that might allow a local realistic interpretation. Here we have measured correlations in the classical properties of massive entangled particles (9Be+ ions): these correlations violate a form of Bell's inequality. Our measured value of the appropriate Bell's 'signal' is 2.25 +/- 0.03, whereas a value of 2 is the maximum allowed by local realistic theories of nature. In contrast to previous measurements with massive particles, this violation of Bell's inequality was obtained by use of a complete set of measurements. Moreover, the high detection efficiency of our apparatus eliminates the so-called 'detection' loophole.

Haplogroup-associated differences in neonatal death and incidence of low birth weight at elevation: a preliminary assessment.

OBJECTIVE: We sought to assess reproductive fitness differences between mitochondrial deoxyribonucleic acid haplogroups at high altitude. STUDY DESIGN: This study considers differences in outcomes of conception, birth weight, and neonatal mortality rates for 62 women classified according to haplogroups (B or non-B). RESULTS: The number of low-weight births (<2500 g) for the non-B group was significant (P =.019). Mothers in the non-B group reported more spontaneous abortions (P =.171) and stillbirths (P =.301). The difference in conceptions per woman between groups was significant (P =.036). However, no difference in infants alive at 1 month of age was evident. Neonatal death was significant (P =.017). The odds of an unsuccessful outcome among mothers in the B group was compared with mothers in the non-B group and was significant (P =.029). The chance of an adverse outcome, that is, fetal or infant death before 1 month, for mothers in the B group was between 11.1% and 88.7% lower than for mothers in the non-B group. CONCLUSIONS: The neonatal mortality rate for the non-B group was significantly elevated relative to the B group. The molecular basis for these observations is not clear.

Outcomes of cataract extraction with multifocal intraocular lens implantation: functional status and quality of life.

OBJECTIVE: The authors measured functional status after bilateral implantation of a multifocal versus a monofocal intraocular lens (IOL). METHODS: A retrospective, case-control study was done on 100 subjects implanted bilaterally with a silicone-optic foldable zonal progressive IOL under United States Food and Drug Administration Investigational Device Exemption protocol and 103 control subjects implanted bilaterally with a monofocal IOL of similar design who were matched on age and postoperative corrected distance acuity. The Cataract TyPE specification, a 17-item functional status instrument, was modified, validated, and administered via telephone interview. The measures of vision, functional status, and quality of life were compared between patients and controls. RESULTS: The instrument was valid (Cronbach's alpha = 0.94) and correlated moderately (Pearson's r= 0.34) with Snellen acuity. Multifocal subjects were more likely than monofocal controls to never wear spectacles (41% vs. 11.7%; P < 0.001). Multifocal subjects rated their vision without spectacles significantly better than those with monofocal IOLs (9.0 vs. 7.9; P < 0.001). The difference was most significant in rating of near vision without spectacles (7.8 vs. 5.0; P < 0.001). Multifocal subjects reported less limitation in specific visual tasks without spectacles (0.3 vs. 0.8; P < 0.001, where 1.0 represents "slightly" limited). This difference was consistently observed in subscales related to distance vision activities (0.1 vs. 0.4; P < 0.001), near vision activities (0.6 vs. 1.4; P < 0.001), and social activities (0.1 vs. 0.6; P < 0.001). CONCLUSIONS: In this study, subjects with bilateral multifocal IOLs reported better overall vision, less limitation in visual function, and less spectacle usage than monofocal controls.

Disease chronicity and quality of care in hospital readmissions.

The study described in this article examined disease chronicity and quality of care and their relationship to hospital readmissions during a 3-month period. Results showed that readmissions due to disease chronicity were significantly more prevalent than for other categories. Illnesses, including pulmonary disease, heart failure, and cancer, ranked as leading causes for readmission, whereas readmissions due to quality of care or complications most often resulted from a previous admission for surgery. This study's findings demonstrate that using readmission rates alone as indicators of poor care can be misleading.

Health, income, and activities of retired physicians.

Driven to retire mainly by changes in the health care delivery system, physicians nevertheless find it difficult to reduce their professional activities as they grow older. Retired physicians in a seven-county region of upstate New York were surveyed to discover how they were faring in retirement and to elicit information of possible value to doctors planning to retire. Good health and adequate income were the prime factors in successful retirement, along with active involvement in postretirement activities, especially nonmedical ones. Three quarters of respondents found annual incomes between $25,000 and $50,000 to be comfortable. All agreed that private investments must make up at least a third of this amount, supplementing Social Security, pensions, individual retirement accounts, and Keogh plan distributions. There was diversity of opinion on remaining active in medical affairs after retirement. A large majority of those who found retirement better than anticipated advised a clean break with medicine. Most of their colleagues who rated retirement about as expected or not as good as anticipated counseled continued involvement in professional activities.

Quality assessment in the pediatric trauma care system.

The goal of the pediatric trauma care system is to prevent death, disability, and suffering of injured children. Quality assessment (QA), the evaluation of clinical performance and quality, is essential not only for formal accreditation processes, but also for day-to-day trauma center operation. QA involves three basic types of performance measures: input, process, and outcome. Input measures are inventories of the resources of a given institution, such as the availability of a surgeon on a 24-hour-a-day in-house basis. They give baseline descriptions of facilities and do not monitor performance directly. Process measures attempt to verify that the system is using its resources appropriately in response to demands, which at Children's Hospital of Pittsburgh (CHP), involves tracking all admitted patients from injury to discharge with the assistance of a system of audit screens to help identify problem cases. The methodology of the Major Trauma Outcome Study (MTOS) provides basic outcome data by identifying unexpected survivors and deaths. However, the few cases identified (four of 316 patients submitted to MTOS; 1.3%) limit conclusions regarding trauma center performance. Performance measures, when applied to admitted trauma patients, allow timely recognition of individual complications and problem trends. QA provides necessary data for important clinical decisions and resource allocations that affect trauma center operation.

Comparing state-only expenditures for AIDS.

The State AIDS Policy Center at the Inter-governmental Health Policy Project (IHPP) at George Washington University surveyed all 50 states to determine state AIDS (acquired immunodeficiency syndrome) expenditures, without Medicaid or federal funds, for fiscal 1984-88. During this period, state-only expenditures increased 15-fold, to $156.3 million. Between fiscal 1986-1988, the distribution of state funding for AIDS patient care and support services doubled from 16 to 35 per cent and the number of states supplementing federal funds for testing and counseling increased from eight to 20. Five states continue to account for the largest AIDS appropriations. Of these, California leads in funding research; New York, Florida, and New Jersey have directed funds to provide care and services to IV (intravenous) drug users, prisoners, and children. The average state expenditure per diagnosed AIDS case is $3,323 and an increasing number of states with relatively low case loads are appropriating funds beyond this level. Across states, AIDS expenditures per person average $.65 and $.21 for education, testing and counseling--below the level recommended by the Institute of Medicine for AIDS prevention activities. Some jurisdictions support AIDS activities indirectly by shifting resources, often from their STD (sexually transmitted disease) programs--this trend deserves continuing review given the rise in STD cases and their relationship to diagnosed AIDS.