The Demand-Control-Support model as a predictor of return to work.

The present study investigated work-related determinants of return to work. Our hypothesis was based on the strain hypothesis of the Demand-Control-Support model, which postulates a relation between job demands, job control and support at work on the one hand, and the aetiology of health complaints on the other hand. High demands were hypothesized to obstruct return to work, whereas high control and high support were thought to have a positive effect on return to work. This hypothesis was tested in a population of employees who were sick-listed for 6-8 weeks. Return to work, as operationalized by the categories (i) not working; (ii) return to work with adjustments; and (iii) full return to work, was determined 4 months after the onset of the sick leave. The hypothesis was tested by logistic regression analyses. High job demands were the least predictive of full return to work. However, the likelihood of employees with high job demands returning to work with adjustments was higher than the likelihood of them not working. Therefore, job demands might also work as a pressure to return to work (compare this with Smulders and Nijhuis, 1999). Furthermore, high skill discretion in combination with high job demands predicted working with adjustments in comparison with not working. Finally, high supervisor support was the most predictive of return to work without adjustments, and the least predictive of not working.

Longitudinal assessment of the development of diabetic polyneuropathy and associated risk factors.

AIMS: To longitudinally assess risk factors for diabetic polyneuropathy (DPN) severity, and to longitudinally assess risk factors for the change of DPN severity during 2-4 years of follow-up. METHODS: From 1995 to 1999, 486 Type 2 diabetes patients in general practice were examined annually with regard to DPN severity and its possible risk factors. DPN severity was assessed with a clinical neurological examination (CNE) which included pinprick sense, light touch sense, vibration sense and ankle jerk. Longitudinal (multivariate) linear associations of (change of) CNE score and predicting variables were analysed using multilevel analyses. RESULTS: In this population, 50% of participants were men and had a mean age of 65.4 years, almost one-third (31.7%) of the participants had a CNE score > 4 at baseline and were classified with DPN. CNE score significantly increased during follow-up. Among participants not graded with DPN at baseline, 21.3% progressed towards a CNE score > 4 after 3 years of follow-up. Longitudinal multivariate analyses showed that age, diabetes duration, HbA1c, height, body mass index and ankle-arm index together best predicted CNE score during follow-up. Change of CNE score during follow-up was best predicted by age, diabetes duration and HbA1c, with the latter being the strongest predictor. CONCLUSIONS: Although several factors are longitudinally associated with DPN, HbA1c, age and diabetes duration were the best predictors of CNE change during follow-up. Therefore, improving glycaemia remains an important amenable factor in preventing worsening of diabetic polyneuropathy.

Type 2 diabetes in older well-functioning people: who is undiagnosed? Data from the Health, Aging, and Body Composition study.

OBJECTIVE: To assess, in an older population, the prevalence of diagnosed and undiagnosed diabetes, the number needed to screen (NNTS) to identify one individual with undiagnosed diabetes, and factors associated with undiagnosed diabetes. RESEARCH DESIGN AND METHODS: Socioeconomic and health-related factors were assessed at the baseline examination of the Health, Aging, and Body Composition (Health ABC) Study, a cohort of 3,075 well-functioning people aged 70-79 years living in Memphis, Tennessee and Pittsburgh, Pennsylvania (42% blacks and 48% men). Diabetes was defined according to the 1985 World Health Organization criteria (fasting glucose > or =7.8 mmol/l or 2-h glucose > or =11.1 mmol/l) and the 1997 American Diabetes Association criteria (fasting glucose > or =7.0 mmol/l). RESULTS: The prevalence of diagnosed and undiagnosed diabetes was 15.6 and 8.0%, respectively, among all participants (NNTS 10.6), 13.9 and 9.1% among white men (NNTS 9.5), 7.8 and 7.4% among white women (NNTS 12.4), 22.7 and 9.1% among black men (NNTS 8.5), and 21.6 and 6.2% among black women (NNTS 12.6). In multivariate analyses, compared with individuals without diabetes, individuals with undiagnosed diabetes were more likely to be men and were more likely to have a history of hypertension, higher BMI, and larger waist circumference. NNTS was lowest in men (9.1), individuals with hypertension (8.7), individuals in the highest BMI quartile (6.9), and individuals in the largest waist circumference quartile (6.8). CONCLUSIONS: In approximately one-third of all older people with diabetes, the condition remains undiagnosed. Screening for diabetes may be more efficient among men and individuals with hypertension, high BMI, and large waist circumference.

Long-term effectiveness of a quality improvement program for patients with type 2 diabetes in general practice.

OBJECTIVE: To assess the long-term effectiveness of a quality improvement program on care provided and patient outcomes in patients with diabetes. RESEARCH DESIGN AND METHODS: A nonrandomized trial was performed with 312 patients with type 2 diabetes in the intervention group and 77 patients with type 2 diabetes in the reference group. The follow-up period was 42 months. The quality improvement program focused on improving both the provision of diabetes care and the patient outcomes. The program consisted of clinical practice guidelines, postgraduate education, audit and feedback, templates to register diabetes care, and a recall system. Data on the care provided were abstracted from medical records. Main outcomes on the provision of care were annual number of patient visits, blood pressure, and HbA(1c) and blood lipid levels. Main patient outcomes were blood pressure and HbA(1c) and blood lipid levels. Multilevel analysis was used to adjust for dependency between repeated observations within one patient and for clustering of patients within general practices. RESULTS: Patients in the intervention group received care far more in accordance with the guidelines than patients in the reference group. Odds ratios ranged from 2.43 (95% CI 1.01-5.82) for the measurement of urine albumin to 12.08 (4.70-31.01) for the measurement of blood pressure. No beneficial effect was found on any patient outcome. CONCLUSIONS: The quality improvement program improved the provision of diabetes care, but this was not accompanied by any effect on patient outcomes.

Factors associated with non-response in proton pump inhibitor users: a study of lansoprazole therapy.

BACKGROUND: Proton pump inhibitors (PPI) demonstrate high healing rates of 85-98% in clinical trials. Due to the limited knowledge regarding response and non-response to lansoprazole in daily practice and for the reason that resistance to PPIs is scarce, we investigated factors possibly associated with non-response. METHODS: Data were used from a prospective, open label, observational follow-up study in which 10,008 lansoprazole users were followed over time. The study was designed according to the SAMM guidelines. A matched nested case-control design was used to compare non-responding (cases) and responding (controls) lansoprazole users. Non-response was defined as worsening or non-improvement of symptoms at the first evaluation after at least 8 weeks of use, response as disappearance or improvement of symptoms within 8 weeks of use. Controls were matched for the evaluating physician. RESULTS: A total of 186 non-responders and 372 responders to PPI treatment were identified as cases and controls. Age of over 60 years, heavy smoking and previous use of PPIs were significantly more common in non-responding patients compared with responding patients. There were no differences found between the reported diagnosis regarding response. CONCLUSION: In daily clinical practice, previous use of PPIs, heavy smoking and an age > 60 years were significantly associated with non-response to treatment with lansoprazole. Previous use of PPIs in non-responding patients might suggest resistance to PPIs. The knowledge that non-response drives non-response may encourage physicians to follow PPI users with previous PPI use more closely.

Relationship between internal risk factors for development of decubitus ulcers and the blood flow response following pressure load.

The objective of this study was to investigate the extent to which internal risk factors for the development of decubitus ulcers are related to the blood flow response following the relief of a pressure load. There were 122 nursing home patients (43 men, 69 women, mean age: 81 +/- 8 years; range: 60-97). The following potential, internal risk factors for the development of decubitus ulcers were assessed: chronic disorders (diabetes mellitus, cardiovascular disease [congestive heart failure, history of myocardial infarct or angina pectoris] and cerebrovascular accident), fever, blood pressure, nutritional status, serum hemoglobin concentration, and serum urea and serum creatinine concentrations. Skin temperature response (latency time and total response time) was measured following relief of a 100 kPa test pressure. The presence of cardiovascular disease, cerebrovascular accident, poor nutritional condition, high serum urea and male gender showed a significant relationship with an impaired blood flow response. The delayed latency found showed a similarity to the so-called "no-reflow phenomenon." The association of cardiovascular disease and a cerebrovascular accident with a delay in the blood flow response may result from endothelial damage. A poor nutritional condition may be associated with a deficit of scavengers of oxygen-derived free radicals. The presence of free radicals may damage endothelium during reperfusion, thus influencing the blood flow response. The association of high serum urea with delayed vasodilatation may theoretically be explained by the association of serum urea and impaired kidney functioning, since the kidney is an important organ in the production of vasoactive substances. Serum urea can also be considered a measure for nutritional condition. Gender may function as a substitute for other, unmeasured factors that are related to blood flow response.

Randomised controlled trial of disclosure of emotionally important events in somatisation in primary care.

OBJECTIVE: To test whether a disclosure intervention improves subjective health and reduces medical consumption and sick leave in somatising patients in general practice. DESIGN: Non-blind randomised controlled trial. SETTING: 10 general practices in the Netherlands. PARTICIPANTS: 161 patients who frequently attended general practice with somatising symptoms. INTERVENTION: Patients in the intervention group were visited two to three times and invited to disclose emotionally important events in their life. Control patients received normal care from their general practitioners. MAIN OUTCOME MEASURES: Use of medical services (drugs and healthcare visits), subjective health, and sick leave assessed by self completion questionnaires after 6, 12, and 24 months. RESULTS: Of the 161 patients, 137 completed the trial (85%). Both groups were comparable at baseline. The intervention had no effect on the main outcome measures at any point. Intervention patients made one more visit to health care (95% confidence interval -4 to 6); the use of medicines did not change in both groups (-1 to 1); subjective health improved 3.6 points more in the control group (-11.2 to 4.3); and disclosure patients were on sick leave one more week (-1 to 3). Patients often had a depression or anxiety disorder for which they were not receiving adequate care. CONCLUSION: Although the intervention was well received by patients and doctors, disclosure had no effect on the health of somatising patients in general practice.

Health outcomes of asthma and COPD patients: the evaluation of a project to implement guidelines in general practice.

OBJECTIVE: To evaluate a project to implement guidelines on the management of patients with asthma or chronic obstructive pulmonany disease (COPD) in terms of the health outcomes of these patients. DESIGN: A before-and-after study of 1 year with a non-randomized but comparable reference group. SETTING: General practices in the Netherlands. STUDY PARTICIPANTS: Two-hundred and eighty patients from 14 practices in the intervention group and 90 patients from five practices in the reference group (receiving usual care). INTERVENTION: The project included a comprehensive implementation programme, involving identification of barriers, documentation of the care provided, specific education, feedback on compliance with the guidelines, and peer review. This project has been found to bring the process of care more in agreement with the guidelines. MAIN OUTCOME MEASURES: Mean peak expiratory flow rate (PEFR) as a percentage of the predicted value, number of days with a diurnal variation in PEFR > or = 15%, number of days with respiratory symptoms (all recorded by patients for a period of 14 days), and perceived health status (Nottingham Health Profile). RESULTS: After 1 year, the intervention group showed statistically significant improvements with regard to the mean PEFR, the diurnal variation in PEFR, respiratory symptoms and the pain score of the Nottingham Health Profile. Comparing the changes within the intervention group with the changes within the reference group, only a positive effect of the intervention on the mean PEFR was found. CONCLUSION: The comprehensive implementation programme improved the lung function and symptoms of asthma and COPD patients in the intervention group. However, in comparison with a reference group, the positive effect on the lung function was only small.

Systematic review of the occurrence of infantile colic in the community.

AIMS: To assess the occurrence of infantile colic in the community and the need for professional help; and to study the influences of potential determinants of infantile colic. METHODS: Surveys were identified by a systematic search in Medline (1966-98) and Embase (1988-98). Retrieved publications were checked for references. Studies selected were community based, prospective, and retrospective surveys on the occurrence of infantile colic published in English, German, French, or Dutch. Occurrence rates were calculated as percentages. Methodological quality of the surveys was assessed by two assessors independently with a standardised criteria list containing items on method of data gathering, definition of colic, and drop out rate. RESULTS: Fifteen community based surveys were identified. The methodological quality varied considerably and was generally low. Even the two most methodologically sound prospective studies yielded widely varying cumulative incidence rates of 5-19%. Referral rates or the need to seek help because of crying were consistently lower than occurrence rates for prolonged crying as such. Gender, socioeconomic class, type of feeding, family history of atopy, and parental smoking were not shown to be associated with colic. CONCLUSION: Occurrence rates of infantile colic vary greatly according to methodological quality. A considerable number of parents reporting prolonged crying do not seek or need professional help.

Determinants of albuminuria in people with Type 2 diabetes mellitus.

This study sought to identify determinants of albuminuria in people with Type 2 diabetes. In 335 primary care patients, we assessed albumin-creatinine ratio (ACR) in two 24-h urine samples, and its cross-sectional associations with protein and alcohol intake, cigarette smoking, body weight and height, glycosuria, blood pressure, hypoglycaemic and antihypertensive treatment, gender, age, age at diagnosis, diabetes duration, family history of diabetes and cardiovascular diseases, ethnic origin, and education. The prevalence of micro- or macro-albuminuria (ACR> or =2.0 mg/mmol) was 33%. Among these patients, compared to those with normo-albuminuria, there were more men, protein intake (g/kg) estimated from urinary urea as well as systolic blood pressure and glycosuria were higher, there were more smokers, men were shorter, and a family history of diabetes was less prevalent (all P<0.05). In linear and logistic regression (n=270) albuminuria was independently associated (P<0.05 unless indicated otherwise) with systolic blood pressure (OR(10 mmHg)=1.32), smoking (OR(ex/never)=2.36, OR(current/never)=4.89), glycosuria (OR(> or =7/<1 g/l)=2.41), gender (OR(men/women)=2.50), age in men (OR(10 year)=1.60) (P<0.10) and, inversely, in women (OR(10 year)=0.63) (P>0.10). On aggregation, the modifiable determinants systolic blood pressure, smoking and glycosuria explained 12% of the variation in albuminuria. These factors thus are, although to a moderate extent only, potential determinants of albuminuria. We also observed an independent, inverse association with body height (OR(0.10 m)=0.47). This is in line with the hypothesis that development in utero or during early life influences kidney function in later life.

Depression and cardiac mortality: results from a community-based longitudinal study.

BACKGROUND: Depression may be a potential risk factor for subsequent cardiac death. The impact of depression on cardiac mortality has been suggested to depend on cardiac disease status, and to be stronger among cardiac patients. This study examined and compared the effect of depression on cardiac mortality in community-dwelling persons with and without cardiac disease. METHODS: A cohort of 2847 men and women aged 55 to 85 years was evaluated for 4 years. Major depression was defined according to psychiatric DSM-III criteria. Minor depression was defined by Center for Epidemiologic Studies-Depression Scale scores of 16 or higher. Effects of minor and major depression on cardiac mortality were examined separately in 450 subjects with a diagnosis of cardiac disease and in 2397 subjects without cardiac disease after adjusting for demographics, smoking, alcohol use, blood pressure, body mass index, and comorbidity. RESULTS: Compared with nondepressed cardiac patients, the relative risk of subsequent cardiac mortality was 1.6 (95% confidence interval [CI], 1.0-2.7) for cardiac patients with minor depression and 3.0 (95% CI, 1.1-7.8) for cardiac patients with major depression, after adjustment for confounding variables. Among subjects without cardiac disease at baseline, similar increased cardiac mortality risks were found for minor depression (1.5 [95% CI, 0.9-2.6]) and major depression (3.9 [95% CI, 1.4-10.9]). CONCLUSION: Depression increases the risk for cardiac mortality in subjects with and without cardiac disease at baseline. The excess cardiac mortality risk was more than twice as high for major depression as for minor depression.

Prescribing patterns in patients using new antidepressants.

AIMS: To study possible selective prescribing ('channelling') we compared characteristics of patients using the SSRI sertraline with patients using longer available SSRIs. METHODS: An observational cohort study in 1251 patients being prescribed an SSRI. RESULTS: In contrast to other studies, we found no evidence for channeling of sertraline. Sertraline was mainly prescribed for the labelled indication (depressive disorder), while older SSRIs were more often prescribed also for other indications. Time on the market was inversely associated to the proportion of patients treated for depressive disorder. CONCLUSIONS: We found no evidence for channeling of sertraline compared with prescribing patterns of older SSRIs.

Indicators of childhood adversity in somatisation in general practice.

OBJECTIVE: To identify medical and psychosocial indicators of childhood adversity in somatising patients in primary care. DESIGN: Retrospective questionnaires and interviews. SETTING: Primary health care in The Netherlands. SUBJECTS: Three-hundred-and-seventy-four somatising frequent attenders in 27 general practices between 20 and 45 years of age. MAIN OUTCOME MEASURES: Major problems in childhood. RESULTS: The questionnaire on childhood problems reflected acceptable validity against a structured interview in 77 patients (correlation 0.69); however, the item "abuse" was underreported in the questionnaire. Four out of five patients reported one or more major childhood problems. Childhood adversity was indicated independently by chronic difficulties in present relations and by genital-sexual symptoms of patients. CONCLUSION: When GPs want to take a more active approach towards somatisers they may show interest in the childhood and life story of patients, especially when patients are known with chronic difficulties in relations and genital-sexual symptoms.

Determinants of an incorrect inhalation technique in patients with asthma or COPD.

OBJECTIVE: To determine the prevalence of an incorrect inhalation technique and to examine its determinants among primary care patients with asthma or chronic obstructive pulmonary disease (COPD). DESIGN: Cross-sectional study. SETTING: 28 general practitioners in The Netherlands. SUBJECTS: 558 asthma and COPD patients, aged 16-75 years. MAIN OUTCOME MEASURES: Inhalation technique was assessed using a standardised inhaler-specific checklist. Pulmonary function assessment and questionnaires were used to collect data about inhaler, patient and disease characteristics. RESULTS: Overall, 24.2% of the patients made at least one essential mistake in their inhalation technique. The type of inhaler appeared to be the strongest independent determinant of an incorrect inhalation technique. Compared to patients using the Diskhaler, patients using the Rotahaler/Spinhaler, Turbuhaler, Metered Dose Inhaler (MDI) or Cyclohaler/Inhaler-Ingelheim were at significantly higher risk of making inhalation mistakes (odds ratios (OR) were 16.08, 13.17, 11.60 and 3.27, respectively). Other significant determinants of an incorrect inhalation technique were low emotional quality of life (OR = 1.73) and being treated in a group practice (OR = 2.26). CONCLUSIONS: An incorrect inhalation technique is common among pulmonary disease patients in primary care. Our study suggests that especially patients using the Rotahaler/Spinhaler, Turbuhaler or MDI, patients with emotional problems and patients in a group practice are at increased risk for an incorrect inhalation technique.

Changes in depression and physical decline in older adults: a longitudinal perspective.

BACKGROUND: The impact of chronicity and changes in depression on physical decline over time in older persons has not been elucidated. METHODS: This prospective cohort study of 2121 community-dwelling persons aged 55-85 years uses two measurement occasions of depression (CES-D scale) over 3 years to distinguish persons with chronic, remitted, or emerging depression and persons who were never depressed. Physical function is assessed by self-reported physical ability as well as by observed performance on a short battery of tests. RESULTS: After adjustment for baseline physical function, health status and sociodemographic factors, chronic depression was associated with significantly greater decline in self-reported physical ability over 3 years when compared to never depressed persons (odds ratio (OR)=2.83, 95% confidence interval (CI)=1.86-4. 30). In the oldest old, but not in the youngest old, chronic depression was also significantly predictive of greater decline in observed physical performance over 3 years (OR=2.22, 95% CI=1.43-3. 79). Comparable effects were found for older persons with emerging depression. Persons with remitted depression did not have greater decline in reported physical ability or observed performance than persons who were never depressed. CONCLUSIONS: Our findings among community-dwelling older persons show that chronicity of depression has a large impact on physical decline over time. Since persons with remitted depression did not have greater physical decline than never depressed persons, these findings suggest that early recognition and treatment of depression in older persons could be protective for subsequent physical decline.

Improving general practice care of patients with asthma or chronic obstructive pulmonary disease: evaluation of a quality system.

CONTEXT: During the past decade, several guidelines on the management of chronic obstructive pulmonary disease and asthma have been developed. However, strategies for implementing these guidelines have not been systematically evaluated. OBJECTIVE: To test a quality system intended to improve general practitioners' compliance with recently established guidelines. DESIGN: Before-after study with concurrent controls. UNIT OF ANALYSIS: 19 general medical practices in the Netherlands (14 intervention practices and 5 control practices). INTERVENTION: A quality system with five components: identification of barriers, documentation, education, feedback, and peer review. PATIENTS: Outpatients 16 to 70 years of age with asthma or chronic obstructive pulmonary disease. MEASUREMENTS: The number of consultations for respiratory symptom monitoring, measurement of peak expiratory flow rate, prescription of anti-inflammatory agents, monitoring of medication compliance and inhalation technique, and influenza vaccination. RESULTS: The percentage of patients who had two or more consultations per year increased significantly in the intervention practices (median, 27% of patients before the intervention vs 82% of patients after the intervention; P < 0.01), as did the percentage of patients who had at least one measurement of peak expiratory flow rate (median, 10% of patients before the intervention vs 84% of patients after the intervention; P < 0.01). The percentage of patients who received a prescription for anti-inflammatory agents did not increase significantly. No significant changes were seen in the control practices. Physicians in the intervention practices were more likely to monitor medication compliance and inhalation technique. No difference was found in frequency of influenza vaccination. CONCLUSION: The quality system improved guideline compliance in some areas but not in others.

Adherence to protein restriction in patients with type 2 diabetes mellitus: a randomized trial.

OBJECTIVE: To describe the extent to which diet counselling can decrease protein intake, and to identify predictors of adherence. DESIGN: (1) Randomized trial; (2) observational longitudinal study. SUBJECTS: (1) 125 type 2 diabetic patients in primary care; (2) 59 patients in the experimental group. INTERVENTION: For a period of 12 months, dieticians provided guidance on protein restriction (experimental group, n=59) or the usual dietary advice (control group, n=66). OUTCOME MEASURES: Adherence was estimated primarily from urinary urea excretion (UUE), but also from food-frequency questionnaires (FFQ). RESULTS: After 6 months protein intake was, according to the UUE and the FFQ, respectively, 8 g/day (95% CI -2, 13) (8%) and 15 g/day (95%-CI 9, 22) (16%) lower in the experimental than in the control group. After 12 months these differences were smaller. Linear regression analysis indicated that protein restriction was greater in patients who were well satisfied with their pre-existing diet (r=0.32, bper 1/10=3.6 (1, 6) g), in patients who were less overweight (r=0.32, bper kg.m-2=1.1 (0.2, 2. 0) g), and in patients living alone (r=0.22, b=7.7 (-2, 17) g). These combined factors explained only 11% of variation in adherence. Adherence was not predicted by the number of barriers reported by the patients or by coinciding changes in diet satisfaction. CONCLUSIONS: The diet counselling resulted in a very moderate degree of protein restriction only. Predictors of adherence could be identified, but only a few, and their predictive power was limited.

'Numbness of the feet' is a poor indicator for polyneuropathy in Type 2 diabetic patients.

AIMS: To identify neuropathic sensory symptoms associated with a clinical neurological examination (CNE) and to investigate whether these symptoms could be used as a diagnostic or screening tool for diabetic polyneuropathy in general practice. METHODS: Five hundred and eighty-eight patients with Type 2 diabetes, recruited from 26 general practices in the Netherlands, underwent a CNE and completed a diabetes symptom checklist that included 10 items on neuropathic sensory symptoms. Linear regression analyses were performed to assess the association between neuropathic symptoms and CNE. Receiver operating characteristic (ROC) curves were created to assess the diagnostic properties of neuropathic symptoms. RESULTS: In this population, with a mean age of 66.8 years, 32% were identified with diabetic polyneuropathy according to the CNE. Variables that showed the strongest association with CNE score were age (beta = 0.41), symptoms of sensory alteration (beta = 0.27), and the item 'numbness of the feet' (beta = 0.35) in particular. ROC curves showed that prediction of diabetic polyneuropathy from these symptoms was unsatisfying. The sensitivity and specificity of daily symptoms of 'numbness of the feet' were 28% and 93%, respectively, in patients <68 years, and 22% and 92%, respectively, in patients > or =68 years. CONCLUSIONS: Identification of neuropathic sensory symptoms is not useful as a diagnostic or even a screening tool in the assessment of diabetic neuropathy in daily practice. Therefore, the results reported in this paper mandate an annual foot examination by the general practitioner.

Clinimetric properties of a parent report on their offspring's quality of life.

The objective of this study was to assess the reproducibility, construct validity, and responsiveness of the parent report version of the "How are you" (HAY), a quality of life questionnaire for children with a chronic disease. The reproducibility of the HAY was assessed by comparing the scores of two measurement cycles of children with stable asthma. Construct validity was evaluated by testing the differences between scores of the HAY of parents of children with and without asthma and by investigating the correlations between the HAY and instruments supposed to correlate with the HAY. Responsiveness was investigated in parents of children whose clinical status changed clinically relevant between two measurements. The HAY showed acceptable reproducibility. Also the HAY detected anticipated differences in quality of life between parents of asthmatic and healthy children. It furthermore showed acceptable ability to measure change in health status of children with asthma. The parent report version of the HAY shows acceptable reproducibility, supportive evidence for construct validity, and good responsiveness. The measurement of quality of life of asthmatic children and changes therein can truly rely on parental report.

Reproducibility, construct validity, and responsiveness of the "How Are You?" (HAY), a self-report quality of life questionnaire for children with asthma.

This study assesses the reproducibility, construct validity, and responsiveness of a new self-report quality of life questionnaire, the "How Are You?" (HAY), for 8-12-year-old children with asthma, which contains both a generic and a disease-specific part. Two hundred twenty-eight children with asthma completed the HAY and the Child Attitude Toward Illness Scale (CATIS), while their parents monitored the actual asthma status; 80 children were measured three times in order to assess reproducibility and responsiveness; 296 healthy children completed the generic section of the HAY. Significant differences were found between children with asthma and healthy children, and among asthmatic children differing in actual asthma status. Reproducibility was adequate and supportive evidence was found for construct validity. Responsiveness was demonstrated by significant score changes for most dimensions in clinically changed children. The HAY seems useful for both discriminative and evaluative research in children with asthma.