A multicenter international prospective study of the validity and reliability of a COVID-19-specific health-related quality of life questionnaire.

PURPOSE: To develop and validate a health-related quality of life (HRQoL) questionnaire for patients with current or previous coronavirus disease (COVID-19) in an international setting. METHODS: This multicenter international methodology study followed standardized guidelines for a four-phase questionnaire development. Here, we report on the pretesting and validation of our international questionnaire. Adults with current or previous COVID-19, in institutions or at home were eligible. In the pretesting, 54 participants completed the questionnaire followed by interviews to identify administration problems and evaluate content validity. Thereafter, 371 participants completed the revised questionnaire and a debriefing form to allow preliminary psychometric analysis. Validity and reliability were assessed (correlation-based methods, Cronbach's α, and intra-class correlation coefficient). RESULTS: Eleven countries within and outside Europe enrolled patients. From the pretesting, 71 of the 80 original items fulfilled the criteria for item-retention. Most participants (80%) completed the revised 71-item questionnaire within 15 min, on paper (n = 175) or digitally (n = 196). The final questionnaire included 61 items that fulfilled criteria for item retention or were important to subgroups. Item-scale correlations were > 0.7 for all but nine items. Internal consistency (range 0.68-0.92) and test-retest results (all but one scale > 0.7) were acceptable. The instrument consists of 15 multi-item scales and six single items. CONCLUSION: The Oslo COVID-19 QLQ-W61© is an international, stand-alone, multidimensional HRQoL questionnaire that can assess the symptoms, functioning, and overall quality of life in COVID-19 patients. It is available for use in research and clinical practice. Further psychometric validation in larger patient samples will be performed.

The effectiveness of counselling interventions in reducing HbA1c concentrations in patients with type 2 diabetes: a modelling study.

BACKGROUND: The burden of type 2 diabetes is increasing rapidly in the occupied Palestinian territory. Different counselling interventions have been applied worldwide to reduce HbA1c concentrations in patients with type 2 diabetes. Achieving good glycaemic control is important for prevention of complications of type 2 diabetes. The aim of this modelling study was to assess the effectiveness of different counselling interventions in improving glycaemic control in patients with type 2 diabetes. METHODS: The scientific literature was reviewed to identify relevant interventions that can reduce HbA1c concentrations in patients with type 2 diabetes. We included articles describing interventions tested at the primary health-care level and targeting patients with type 2 diabetes. Based on WHO's "Best Buys", and taking into consideration their feasibility, acceptability, and potential effectiveness, we identified different forms of counselling interventions at the primary health-care level. The effect of each identified intervention on HbA1c concentrations and the duration of this effect were collected in predefined tables. A regression line was plotted to find an estimate of the effect of each intervention through calculating the correlation between the changes in HbA1c from each intervention versus the duration of the intervention. The unstandardised ß-coefficient was identified for each intervention to predict its effectiveness in reducing HbA1c concentrations. FINDINGS: We identified three main effective counselling interventions at the primary health-care level: (1) individual counselling intervention by multidisciplinary teams of health-care professionals, which provided individual counselling sessions depending on the patients' glycaemic control status; (2) the community health-worker intervention, which provided a set of home counselling visits for patients with uncontrolled type 2 diabetes; and (3) short message service (SMS)-based intervention (sending patients a number of counselling SMS weekly). All interventions were effective in reducing mean HbA1c concentrations in patients with type 2 diabetes. The SMS-based intervention was the most effective (ß=0·65, R2=0·10), followed by the community health-worker intervention (ß=0·27, R2=0·28) and the individual counselling intervention (ß=0·14, R2=0·01). INTERPRETATION: We compared the effectiveness of a set of interventions that are considered relativity low cost and applicable at the level of primary health care (the "Best Buys"). Implementing at least one of these effective interventions within the Palestinian health-care system could help improve glycaemic control and eventually reduce the prevalence of complications associated with type 2 diabetes. Controlling HbA1c concentration will not only reduce the epidemiological burden of type 2 diabetes and its complications but it will also reduce the economic burden within Palestinian health-care system. FUNDING: Eastern Mediterranean Regional office of WHO.

Sources of Human Insecurity in Post-War Situations: The Case of Gaza.

This paper explores classical and war-related factors associated with human insecurity reports in the Gaza Strip following the winter 2008-09 Israeli attack. A cross-sectional survey was conducted six months after the Israeli attack with adults from 3017 households. Results demonstrate that persons with greater human capital and socioeconomic resources were somewhat protected from human insecurity associated with the attack and siege. Results also underscore the significance of including both classical and war-related factors in assessing human insecurity in conflict, and the link between individual and communal/national security. While it is important to intervene by supporting Gazans with food and aid, interventions should also address the violence of war and ongoing siege as one of the causes of human insecurity.