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1.
Qual Life Res ; 27(2): 447-454, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29149441

RESUMO

PURPOSE: To examine the longitudinal construct validity in the assessment of changes in depressive symptoms of widely used utility and generic HRQL instruments in teens. METHODS: 392 teens enrolled in the study and completed HRQL and diagnostic measures as part of the baseline interview. HRQL measures included EuroQol (EQ-5D-3L), Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3), Quality of Well-Being Scale (QWB), Pediatric Quality of Life Inventory (PEDS-QL), RAND-36 (SF-6D), and Quality of Life in Depression Scale (QLDS). Youth completed follow-up interviews 12 weeks after baseline. Sixteen youth (4.1%) were lost to follow-up. We examined correlations between changes in HRQL instruments and the Children's Depression Rating Scale-Revised (CDRS-R) and assessed clinically meaningful change in multi-attribute utility HRQL measures using mean change (MC) and standardized response mean (SRM) among youth showing at least moderate (20%) improvement in depression symptomology. RESULTS: Spearman's correlation coefficients demonstrated moderate correlation between changes in CDRS-R and the HUI2 (r = 0.38), HUI3 (r = 0.42), EQ-5D-3L (r = 0.36), SF-6D (r = 0.39), and PEDS-QL (r = 0.39) and strong correlation between changes in CDRS-R and QWB (r = 0.52) and QLDS (r = - 0.71). Effect size results are also reported. Among multi-attribute utility measures, all showed clinically meaningful improvements in the sample of youth with depression improvement (HUI2, MC = 0.20, SRM = 0.97; HUI3, MC = 0.32, SRM = 1.17; EQ-5D-3L, MC = 0.08, SRM = 0.51; QWB, MC = 0.11, SRM = 0.86; and SF-6D, MC = 0.12, SRM = 1.02). CONCLUSIONS: Findings support the longitudinal construct validity of included HRQL instruments for the assessment of change in depression outcomes in teens. Results of this study can help inform researchers about viable instruments to include in economic evaluations for this population.


Assuntos
Depressão/diagnóstico , Qualidade de Vida/psicologia , Adolescente , Depressão/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Inquéritos e Questionários
2.
Med Care ; 54(12): 1089-1097, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27261639

RESUMO

PURPOSE: To provide empirical evidence on the performance of common measures in assessing health-related quality of life (HRQL) in depressed and nondepressed youth. These measures can be used in research trials, cost-effectiveness studies, and to help develop policy for treating youth depression. BACKGROUND: Depression is one of the most common mental disorders among adolescents, with a chronic, episodic course marked by considerable impairment. Data on HRQL for teens with depression could more fully demonstrate the burden of depression and help to evaluate the comparative effectiveness of teen depression services, which in turn can be used to inform public and clinical policies. METHODS: We collected data on depression and HRQL from 392 depressed and nondepressed teens aged 13-17. RESULTS: Generic mental health, disease-specific, and generic preference-based measures of HRQL all do a reasonable job of distinguishing teens with and without depression and between teens with differing levels of depression. Generic mental health and disease-specific measures provide valuable information on burden of disease and perform well. For the purpose of economic evaluation, the HUI-3 and EQ-5D perform somewhat better than other preference-based measures. These results can aid future research on teens with depression by helping to guide which HRQL instruments are most useful in this population and can help to quantify the burden of depression in teens for policy and clinical planning.


Assuntos
Depressão/psicologia , Psicologia do Adolescente , Qualidade de Vida , Adolescente , Depressão/diagnóstico , Feminino , Humanos , Entrevista Psicológica , Masculino , Escalas de Graduação Psiquiátrica , Psicologia do Adolescente/estatística & dados numéricos , Qualidade de Vida/psicologia , Inquéritos e Questionários
3.
Health Qual Life Outcomes ; 13: 90, 2015 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-26122041

RESUMO

BACKGROUND: Patients with chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT) who require dialysis are at increased risk for cardiovascular events and bone fractures. To assist in economic evaluations, this study aimed to estimate the disutility of these events beyond the impact of CKD and SHPT. METHODS: A basic one-year health state was developed describing CKD and SHPT requiring dialysis. Further health states added acute events (cardiovascular events, fractures, and surgical procedures) or chronic post-event effects. Acute health states described a year including an event, and chronic health states described a year subsequent to an event. General population participants in Canada completed time trade-off interviews from which utilities were derived. Pairwise comparisons were made between the basic state and event, and between comparable health states. RESULTS: A total of 199 participants (54.8% female; mean age = 46.3 years) completed interviews. Each health state had ≥130 valuations. The mean (SD) utility of the basic health state was 0.60 (0.34). For acute events, mean utility differences versus the basic state were: myocardial infarction, -0.06; unstable angina, -0.05; peripheral vascular disease (PVD) with amputation, -0.33; PVD without amputation, -0.11; heart failure, -0.14; stroke, -0.30; hip fracture, -0.14; arm fracture, -0.04; parathyroidectomy, +0.02; kidney transplant, +0.06. Disutilities for chronic health states were: stable angina, -0.09; stroke, -0.27; PVD with amputation, -0.30; PVD without amputation, -0.12; heart failure, -0.14. CONCLUSIONS: Cardiovascular events and fractures were associated with lower utility scores, suggesting a perceived decrease in quality of life beyond the impact of CKD and SHPT.


Assuntos
Hiperparatireoidismo Secundário/psicologia , Qualidade de Vida/psicologia , Diálise Renal/psicologia , Insuficiência Renal Crônica/psicologia , Adulto , Idoso , Feminino , Fraturas Ósseas/psicologia , Humanos , Hiperparatireoidismo Secundário/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/psicologia , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Acidente Vascular Cerebral/psicologia
4.
BMC Health Serv Res ; 15: 173, 2015 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-25896804

RESUMO

BACKGROUND: Cost-utility models are frequently used to compare treatments intended to prevent or delay the onset of cardiovascular events. Most published utilities represent post-event health states without incorporating the disutility of the event or reporting the time between the event and utility assessment. Therefore, this study estimated health state utilities representing cardiovascular conditions while distinguishing between acute impact including the cardiovascular event and the chronic post-event impact. METHODS: Health states were drafted and refined based on literature review, clinician interviews, and a pilot study. Three cardiovascular conditions were described: stroke, acute coronary syndrome (ACS), and heart failure. One-year acute health states represented the event and its immediate impact, and post-event health states represented chronic impact. UK general population respondents valued the health states in time trade-off tasks with time horizons of one year for acute states and ten years for chronic states. RESULTS: A total of 200 participants completed interviews (55% female; mean age = 46.6 y). Among acute health states, stroke had the lowest utility (0.33), followed by heart failure (0.60) and ACS (0.67). Utility scores for chronic health states followed the same pattern: stroke (0.52), heart failure (0.57), and ACS (0.82). For stroke and ACS, acute utilities were significantly lower than chronic post-event utilities (difference = 0.20 and 0.15, respectively; both p < 0.0001). CONCLUSIONS: Results add to previously published utilities for cardiovascular events by distinguishing between chronic post-event health states and acute health states that include the event and its immediate impact. Findings suggest that acute versus chronic impact should be considered when selecting scores for use in cost-utility models. Thus, the current utilities provide a unique option that may be used to represent the acute and chronic impact of cardiovascular conditions in economic models comparing treatments that may delay or prevent the onset of cardiovascular events.


Assuntos
Síndrome Coronariana Aguda , Nível de Saúde , Insuficiência Cardíaca , Qualidade de Vida , Acidente Vascular Cerebral , Síndrome Coronariana Aguda/economia , Adulto , Idoso , Doença Crônica , Feminino , Insuficiência Cardíaca/economia , Humanos , Entrevistas como Assunto , Londres , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Projetos Piloto , Pesquisa Qualitativa , Escócia , Acidente Vascular Cerebral/economia , Adulto Jovem
5.
Health Qual Life Outcomes ; 12: 48, 2014 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-24716709

RESUMO

BACKGROUND: The purpose of this study was to examine the effect of caregiver status on time trade-off (TTO) and standard gamble (SG) health state utility scores. Respondents were categorized as caregivers if they reported that either children or adults depended on them for care. METHODS: This study was a secondary analysis of data from three studies in which general population samples rated health state descriptions. Study 1: UK; four osteoarthritis health states. Study 2: UK; three adult ADHD health states. Study 3: US; 16 schizophrenia health states. All three studies included time trade-off assessment. Study 1 also included standard gamble. Descriptive statistics were calculated to examine willingness to trade in TTO or gamble in SG. Utilities for caregivers and non-caregivers were compared using t-tests and ANCOVA models. RESULTS: There were 364 respondents including 106 caregivers (n = 30, 47, and 29 in Studies 1, 2, and 3) and 258 non-caregivers. Most caregivers were parents of dependent children (78.3%). Compared to non-caregivers, caregivers had more responses at the ceiling (i.e., utility = 0.95), indicating less willingness to trade time or gamble. All utilities were higher for caregivers than non-caregivers (mean utility difference between groups: 0.07 to 0.16 in Study 1 TTO; 0.03 to 0.17 in Study 1 SG; 0.06 to 0.10 in Study 2 TTO; 0.11 to 0.22 in Study 3 TTO). These differences were statistically significant for at least two health states in each study (p < 0.05). Results of sensitivity analyses with two caregiver subgroups (parents of dependent children and parents of any child regardless of whether the child was still dependent) followed the same pattern as results of the primary analysis. The parent subgroups were generally less willing to trade time or gamble (i.e., resulting in higher utility scores) than comparison groups of non-parents. CONCLUSIONS: Results indicate that caregiver status, including being a parent, influences responses in time trade-off health state valuation. Caregivers (i.e., predominantly parents) were less willing than non-caregivers to trade time, resulting in higher utility scores. This pattern was consistent across multiple health states in three studies. Standard gamble results followed similar patterns, but with less consistent differences between groups. It may be useful to consider parenting/caregiving status when collecting, interpreting, or using utility data because this demographic variable could influence results.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Cuidadores/psicologia , Osteoartrite/psicologia , Pais/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Atitude Frente a Saúde , Cuidadores/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Nível de Saúde , Humanos , Entrevistas como Assunto , Masculino , Estado Civil , Pessoa de Meia-Idade , Osteoartrite/terapia , Esquizofrenia/terapia , Fatores Sexuais , Fatores de Tempo
6.
Qual Life Res ; 23(3): 805-13, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24081869

RESUMO

PURPOSE: The objective of this study is to evaluate the longitudinal construct validity of the Health Utilities Index Mark 2 (HUI2) and Health Utilities Index Mark 3 (HUI3) using a convergent/divergent validity approach in patients recovering from hip fracture, with the Functional Independence Measure (FIM) as the comparator. METHODS: A total of 278 patients with a primary diagnosis of hip fracture were interviewed 3-5 days after surgery and then at 1 and 6 months using the HUI2, HUI3 and the FIM and a Likert-type rating of hip pain. A priori hypotheses were formulated. Convergent and divergent correlations between HUI2, HUI3 and FIM change scores for the baseline to 1-month and baseline to 6-month intervals were examined. RESULTS: Overall HUI2 detected continued gain in health-related quality of life between 1 and 6 months after fracture, as the change increased from 0.20 to 0.29 units. The correlation between change in the overall HUI2 score and total FIM score was moderate (r = 0.50) over the 6-month interval, but larger than the observed correlation over the 1-month interval (r = 0.36). The correlation between change in overall HUI3 score and total FIM over the 1-month interval was small (r = 0.32), and the correlation between change in overall HUI3 score and total FIM was moderate (r = 0.37) over the 6-month interval. All hypotheses for the divergent correlations were supported. CONCLUSIONS: Weaker correlations were reported for change over 1 month as compared to change over the 6 months after fracture. Findings supported the longitudinal construct validity of the overall HUI2 and HUI3 for the assessment of recovery following hip fracture, particularly for change over the 6 months following fracture.


Assuntos
Indicadores Básicos de Saúde , Fraturas do Quadril/psicologia , Avaliação de Resultados da Assistência ao Paciente , Psicometria/normas , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Alberta , Feminino , Seguimentos , Fraturas do Quadril/reabilitação , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Masculino , Entrevista Psiquiátrica Padronizada , Medição da Dor , Estudos Prospectivos , Psicometria/métodos , Reprodutibilidade dos Testes , Autocuidado/psicologia , Inquéritos e Questionários , Fatores de Tempo
7.
J Gen Intern Med ; 28(2): 292-8, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23054920

RESUMO

Older adults often have multiple chronic conditions that may decrease additional life expectancy. Research evaluating the benefits and harms of screening must include consideration of competing morbidities and patient heterogeneity (beyond age), potentially increased harms of screening, and patient preferences. Other areas in need of additional research include the lack of evidence for older adults on the harms of screening tests; the overdiagnosis of disease; the burden of disease labeling; the effects of inaccurate test results; the harms of disease treatment; and harms related to prioritization of healthcare (e.g., for a particular patient, lifestyle counseling may be more important than screening). Nontraditional outcomes, such as the effects on family caregivers, are also relevant. Studies comparing trajectories of quality-adjusted survival with and without screening to assess net benefit are typically lacking. There is little evidence on the preferences of older adults for deciding whether to be screened, the process of being screened, and the health states associated with being or not being screened. To enhance the quality and quantity of evidence, older adults need to be enrolled in screening trials and clinical studies. Measures of functional status and health-related quality of life (HRQL) need to be included in trials, registries, and cohort studies. This article addresses these challenges, and presents a framework for what research is needed to better inform screening decisions in older adults.


Assuntos
Detecção Precoce de Câncer/normas , Serviços de Saúde para Idosos/normas , Fatores Etários , Idoso , Pesquisa Biomédica/métodos , Pesquisa Biomédica/tendências , Detecção Precoce de Câncer/efeitos adversos , Humanos , Avaliação de Resultados em Cuidados de Saúde/métodos , Preferência do Paciente , Guias de Prática Clínica como Assunto
8.
Qual Life Res ; 21(5): 813-25, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21842378

RESUMO

PURPOSE: The objective of the paper is to describe trajectories of health-related quality of life (HRQL) associated with categories of body mass index (BMI): underweight, normal weight, overweight, obese class I, and obese classes II and III. METHODS: Data come from the longitudinal Canadian National Population Health Survey. Analyses are based on data for 3,864 men and 4,745 women who were 40+ in 1998/1999 and followed through 2006/2007. HRQL was measured with the Health Utilities Index Mark 3. Multi-level growth modeling was used. RESULTS: HRQL declined with age. For men, there was a large HRQL decrement for being underweight; trajectories for all other BMI categories were very similar. For women being underweight was associated with higher HRQL at younger ages but lower at older ages. Otherwise, for women, HRQL was ordered from highest to lowest: normal, overweight, obese class I, and obese classes II and III. CONCLUSIONS: Given that excess weight is a risk factor for mortality and the development of chronic conditions, the HRQL results for men are surprising. The HRQL results for women may reflect both the importance of body image on mental health and the health effects of excess weight.


Assuntos
Adaptação Psicológica , Índice de Massa Corporal , Identidade de Gênero , Qualidade de Vida/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Feminino , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Psicometria , Fatores de Risco , Fatores Sexuais , Estatística como Assunto , Estresse Psicológico
9.
Value Health ; 12(2): 340-5, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-18657096

RESUMO

OBJECTIVE: Assess within-subject agreement and compare discriminative abilities between the SF-6D and the Health Utilities Index Mark 3 (HUI3) in patients with chronic kidney disease (CKD). METHODS: The HUI3 and Short Form-36 were self-completed by 185 CKD patients enrolled in a prospective study of incident patients with stage 4 and 5 CKD. RESULTS: The mean preference-based score for the SF-6D was 0.67 +/- 0.13 compared to 0.58 +/- 0.26 for the HUI3 (P < 0.01). There was a strong association between SF-6D and HUI3 scores (Pearson correlation coefficient 0.55, 95% CI 0.43-0.65) and moderate agreement with an intraclass correlation coefficient of 0.44. The HUI3 was better able to capture more severe burden of illness with fewer floor effects. The SF-6D was better at capturing differences among patients at the top range of the scale with fewer ceiling effects. Both the HUI3 and SF-6D were able to discriminate between patient groups differing in disease severity defined as predialysis versus dialysis dependent and depressive symptoms using a Beck Depression Inventory II score of >or=14 as the cutoff. The HUI3 was better able to discriminate greater depressive symptoms. CONCLUSION: The SF-6D and the HUI3 generate different preference-based scores for patients with CKD and any comparison between their scores should be made with caution. The HUI3 appears more suitable for measuring the health of populations with greater disability such as patients with CKD. It remains to be determined whether these differences will remain when one compares within-instrument differences in preference scores over time.


Assuntos
Falência Renal Crônica/diagnóstico , Índice de Gravidade de Doença , Perfil de Impacto da Doença , Adaptação Psicológica , Idoso , Intervalos de Confiança , Progressão da Doença , Feminino , Nível de Saúde , Humanos , Falência Renal Crônica/economia , Falência Renal Crônica/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Psicometria , Qualidade de Vida , Estatística como Assunto , Estresse Psicológico , Inquéritos e Questionários
10.
Health Qual Life Outcomes ; 7: 80, 2009 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-19725975

RESUMO

BACKGROUND: The heterogeneity evident among home care clients highlights the need for greater understanding of the clinical and social determinants of multi-dimensional health-related quality of life (HRQL) indices and of potential sex-differences in these determinants. We examined the relative contribution of social and clinical factors to HRQL among older home care clients and explored whether any of the observed associations varied by sex. METHODS: The Canadian-US sample included 514 clients. Self-reported HRQL was measured during in-home interviews (2002-04) using the Health Utilities Index Mark 2 (HUI2). Data on clients' sociodemographic, health and clinical characteristics were obtained with the Minimum Data Set for Home Care. The relative associations between clients' characteristics and HUI2 scores were examined using multivariable linear regression models. RESULTS: Women had a significantly lower mean HUI2 score than men (0.48, 95%CI 0.46-0.50 vs. 0.52, 0.49-0.55). Clients with distressed caregivers and poor self-rated health exhibited significantly lower HRQL scores after adjustment for a comprehensive list of clinical conditions. Several other factors remained statistically significant (arthritis, psychiatric illness, bladder incontinence, urinary tract infection) or clinically important (reported loneliness, congestive heart failure, pressure ulcers) correlates of lower HUI2 scores in adjusted analyses. These associations generally did not vary significantly by sex. CONCLUSION: For females and males, HRQL scores were negatively associated with conditions predictive or indicative of disability and with markers of psychosocial stress. Despite sex differences in the prevalence of social and clinical factors likely to affect HRQL, few varied significantly by sex in their relative impact on HUI2 scores. Further exploration of differences in the relative importance of clinical and psychosocial well-being (e.g., loneliness) to HRQL among female and male clients may help guide the development of sex-specific strategies for risk screening and care management.


Assuntos
Nível de Saúde , Serviços de Assistência Domiciliar , Qualidade de Vida , Meio Social , Inquéritos e Questionários/normas , Idoso , Idoso de 80 Anos ou mais , Canadá , Feminino , Humanos , Entrevistas como Assunto , Masculino , Fatores Sexuais , Estados Unidos
11.
J Neurosci Nurs ; 39(6): 336-41, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18186418

RESUMO

This study examined awareness of the risk factors for falling among a group of community dwelling patients with Parkinson disease (PD) using the Falls Risk Awareness Questionnaire (FRAQ). A cross-sectional survey of 28 patients who attended a Movement Disorders Clinic for treatment of PD was used. FRAQ is a 28-item self-administered survey that assesses the knowledge and perception of risk factors for falling. Demographic, medical, and medication data were gathered from both the participants and clinic charts. Twenty-three (82%) of the participants reported falls in the past; seven (30%) had fallen within the past month. Nineteen (68%) of the participants felt they were at risk for further falls. When asked to list potential risk factors for falling, only 14% could identify medication as a risk factor. Persons with PD are at substantial risk of falling, yet many appear to be unaware of common risk factors, especially medication use.


Assuntos
Acidentes por Quedas/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Doença de Parkinson , Educação de Pacientes como Assunto , Polimedicação , Alberta , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/enfermagem , Psicotrópicos/efeitos adversos , Fatores de Risco
12.
J Gerontol A Biol Sci Med Sci ; 72(1): 61-67, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-26297654

RESUMO

BACKGROUND: Cognitive impairment is common in the hip fracture patient population, yet few studies of functional recovery include this subgroup. The objective was to determine whether baseline cognition was a determinant of the rate of functional recovery over 6 months after hip fracture. METHODS: A consecutive cohort of 383 patients 65 years or older who were treated for hip fracture within a Canadian health region were grouped on cognitive status. Participants with Mini-Mental Status Examination scores <18 at 3-5 days postoperatively were classified as cognitively impaired. Primary outcome was the Functional Independence Measure. Interviews were completed within 5 days postoperatively (baseline), 1, 3, and 6 months postoperatively. Linear mixed modeling examined the pattern of recovery and the effect of cognitive status. RESULTS: Of the 383 participants, 104 (27%) had Mini-Mental Status Examination scores of less than 18. The effect size for changes in the FIM over 6 months was large for those without cognitive impairment (effect size = 2.3) and smaller for those with cognitive impairment (effect size = 0.9). After adjusting for age, gender, proxy respondent, and fracture type, participants with impaired cognition recovered more slowly, never attaining comparable levels with those without cognitive impairment. The 6-month health status for the cohort was substantially lower than the health status of age-gender-matched, community-dwelling adults. CONCLUSIONS: Patients with cognitive impairment who fracture their hips recover more slowly and achieve less functional recovery. Recovery is not uniform nor is it linear over the initial 6 months. The diversity of patient needs should be recognized postoperatively so that long-term recovery is optimized.


Assuntos
Disfunção Cognitiva/fisiopatologia , Fraturas do Quadril/psicologia , Idoso , Idoso de 80 Anos ou mais , Canadá , Disfunção Cognitiva/complicações , Estudos de Coortes , Feminino , Nível de Saúde , Fraturas do Quadril/fisiopatologia , Fraturas do Quadril/terapia , Hospitalização , Humanos , Masculino , Recuperação de Função Fisiológica , Fatores de Tempo
13.
J Clin Epidemiol ; 59(5): 472-7, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16632135

RESUMO

OBJECTIVE: To assess the cross-sectional construct validity of the Health Utilities Index mark 3 (HUI3) in type 2 diabetes using population health survey data. STUDY DESIGN AND SETTING: Data used were from 5,134 adult respondents of Cycle 1.1 (2000-2001) of the Canadian Community Health Survey (CCHS) with type 2 diabetes. Analyses of covariance models were used to assess differences in overall and single-attribute HUI3 scores between groups hypothesized a priori to differ in HRQL. The association between health-care resource use (i.e., hospitalizations and physician and emergency room visits) and overall HUI3 scores was assessed using logistic regression models. RESULTS: For overall HUI3 scores, clinically important and statistically significant differences were observed between all groups expected to differ in HRQL. Depression was the comorbidity associated with the largest deficit (-0.17; 95% confidence interval CI=-0.22, -0.12), followed by stroke (-0.15; 95% CI=-0.21, -0.10) and heart disease (-0.08; 95% CI=-0.11, -0.05). Insulin use and comorbidities were associated with clinically important deficits in pain. Overall HUI3 scores were significantly predictive of all three categories of health-care resource use. CONCLUSION: Observed differences between groups contribute further evidence of the construct validity of the HUI3 in type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Canadá/epidemiologia , Estudos Transversais , Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/psicologia , Serviços Médicos de Emergência , Feminino , Inquéritos Epidemiológicos , Hospitalização , Humanos , Insulina/uso terapêutico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Qualidade de Vida , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Fatores de Tempo
14.
Am J Public Health ; 96(9): 1649-55, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16873750

RESUMO

OBJECTIVE: We assessed which of a broad range of determinants of health are most strongly associated with health-related quality of life (HRQL) among people with type 2 diabetes. METHODS: Our analysis included respondents from the Canadian Community Health Survey Cycle 1.1 (2000-2001) who were aged 18 years and older and who were identified as having type 2 diabetes. We used regression analyses to assess the associations between the Health Utilities Index Mark 3 and determinants of health. RESULTS: Comorbidities had the largest impact on HRQL, with stroke (-0.11; 95% confidence interval [CI] = -0.17, -0.06) and depression (-0.11; 95% CI = -0.15, -0.06) being associated with the largest deficits. Large differences in HRQL were observed for 2 markers of socioeconomic status: social assistance (-0.07; 95% CI=-0.12, -0.03) and food insecurity (-0.07; 95% CI=-0.10, -0.04). Stress, physical activity, and sense of belonging also were important determinants. Overall, 36% of the variance in the Health Utilities Index Mark 3 was explained. CONCLUSION: Social and environmental factors are important, but comorbidities have the largest impact on HRQL among people with type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Nível de Saúde , Qualidade de Vida , Idoso , Canadá , Comorbidade , Depressão/etiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Apoio Social , Acidente Vascular Cerebral/etiologia
15.
Health Qual Life Outcomes ; 4: 15, 2006 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-16542446

RESUMO

BACKGROUND: Interpretations of profile and preference based measure scores can differ. Profile measures often use a norm-based scoring algorithm where each scale is scored to have a standardized mean and standard deviation, relative to the general population scores/norms (i.e., norm-based). Preference-based index measures generate an overall scores on the conventional scale in which 0.00 is assigned to dead and 1.00 is assigned to perfect health. Our objective was to investigate the interpretation of norm-based scoring of generic health status measures in a population of adults with type 1 diabetes by comparing norm-based health status scores and preference-based health-related quality of life (HRQL) scores. METHODS: Data were collected through self-complete questionnaires sent to patients with type 1 diabetes. The RAND-36 and the Health Utilities Index Mark 3 (HUI3) were included. RESULTS: A total of 216 (61%) questionnaires were returned. The respondent sample was predominantly female (58.8%); had a mean (SD) age of 37.1 (14.3) years and a mean duration of diabetes of 20.9 (12.4) years. Mean (SD) health status scores were: RAND-36 PHC 47.9 (9.4), RAND-36 MHC 47.2 (11.8), and HUI3 0.78 (0.23). Histograms of these scores show substantial left skew. HUI3 scores were similar to those previously reported for diabetes in the general Canadian population. Physical and mental health summary scores of the RAND-36 suggest that this population is as healthy as the general adult population. CONCLUSION: In this sample, a preference-based measure indicated poorer health, consistent with clinical evidence, whereas a norm-based measure indicated health similar to the average for the general population. Norm-based scoring measure may provide misleading interpretations in populations when health status is not normally distributed.


Assuntos
Atitude Frente a Saúde , Diabetes Mellitus Tipo 1/psicologia , Indicadores Básicos de Saúde , Qualidade de Vida/psicologia , Adulto , Alberta , Algoritmos , Interpretação Estatística de Dados , Diabetes Mellitus Tipo 1/complicações , Feminino , Humanos , Masculino , Psicometria , Valores de Referência , Perfil de Impacto da Doença
16.
Eur J Health Econ ; 17(8): 979-990, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26611792

RESUMO

INTRODUCTION: The purpose of this study was to examine whether the time horizon of time trade-off (TTO) and standard gamble (SG) utility assessment influences utility scores and discrimination between health states. METHODS: In two phases, UK general population participants rated three osteoarthritis health states in TTO and SG procedures with two time horizons: (1) 10-year and (2) a time horizon derived from self-reported additional life expectancy (ALE). The two time horizons were compared in terms of mean utilities and discrimination among health states. RESULTS: In Phase 1, the 10-year tasks were completed by 80 participants, 35 of whom also completed utility assessment with the ALE. In Phase 2, all 101 participants completed procedures with both time horizons. Utility scores tended to be lower with the ALE than the 10-year, a difference that was statistically significant for two health states with SG in Phase 1 (P < 0.05), two health states with TTO in Phase 2 (P < 0.01), and one health state with SG in Phase 2 (P < 0.001). In Phase 1, rates of discrimination between mild and moderate osteoarthritis health states were significantly higher with the ALE than the 10-year (TTO: P = 0.03; SG: P = 0.001). This pattern of discrimination was similar in Phase 2. DISCUSSION: Results suggest that the time horizon could influence utility scores and discrimination among health states. When designing utility evaluations, researchers should carefully consider the time horizon so that the value of health states is accurately represented in cost-utility models.


Assuntos
Artroplastia de Quadril/psicologia , Nível de Saúde , Osteoartrite do Quadril/psicologia , Dor/psicologia , Perfil de Impacto da Doença , Adulto , Idoso , Artroplastia de Quadril/economia , Análise Custo-Benefício , Feminino , Indicadores Básicos de Saúde , Humanos , Entrevistas como Assunto , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/economia , Osteoartrite do Quadril/cirurgia , Qualidade de Vida , Distribuição Aleatória , Reino Unido , Escala Visual Analógica
17.
J Am Geriatr Soc ; 53(7): 1227-33, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16108944

RESUMO

OBJECTIVES: To examine agreement between patient and proxy respondents on health-related quality of life (HRQL) over time during the 6-month recovery after hip fracture. DESIGN: Prospective longitudinal cohort study. SETTING: A healthcare region serving Edmonton, Alberta, and the surrounding area. PARTICIPANTS: Two hundred forty-five patients aged 65 and older, were treated for hip fracture, and had Mini-Mental State Examination scores greater than 17; 245 family caregivers participated as proxy respondents. MEASUREMENTS: Primary outcome was HRQL (Health Utilities Mark 2 and Mark 3). Interviews were completed within 5 days after surgery and at 1, 3, and 6 months. Agreement was evaluated using intraclass correlation coefficients (ICCs). RESULTS: Agreement was considered moderate to excellent for HRQL. ICC values ranged from 0.50 to 0.85 (P<.001) for physically based observable dimensions of health status and from 0.32 to 0.66 (P<.01) for less-observable dimensions. Agreement improved with time. Time and the number of days between patient and proxy interviews were significant factors in accounting for patient-proxy differences. CONCLUSION: Although proxy and patient responses are not interchangeable, proxy responses provide an option for assessing function and health status in patients who are unable to respond on their own behalf.


Assuntos
Fraturas do Quadril , Pacientes/psicologia , Procurador/psicologia , Qualidade de Vida , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
18.
Eur J Health Econ ; 16(9): 1005-18, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25481796

RESUMO

BACKGROUND: Cost-utility analyses are frequently conducted to compare treatments for hepatitis C, which are often associated with complex regimens and serious adverse events. Thus, the purpose of this study was to estimate the utility associated with treatment administration and adverse events of hepatitis C treatments. DESIGN: Health states were drafted based on literature review and clinician interviews. General population participants in the UK valued the health states in time trade-off (TTO) interviews with 10- and 1-year time horizons. The 14 health states described hepatitis C with variations in treatment regimen and adverse events. RESULTS: A total of 182 participants completed interviews (50% female; mean age = 39.3 years). Utilities for health states describing treatment regimens without injections ranged from 0.80 (1 tablet) to 0.79 (7 tablets). Utilities for health states describing oral plus injectable regimens were 0.77 (7 tablets), 0.75 (12 tablets), and 0.71 (18 tablets). Addition of a weekly injection had a disutility of -0.02. A requirement to take medication with fatty food had a disutility of -0.04. Adverse events were associated with substantial disutilities: mild anemia, -0.12; severe anemia, -0.32; flu-like symptoms, -0.21; mild rash, -0.13; severe rash, -0.48; depression, -0.47. One-year TTO scores were similar to these 10-year values. CONCLUSIONS: Adverse events and greater treatment regimen complexity were associated with lower utility scores, suggesting a perceived decrease in quality of life beyond the impact of hepatitis C. The resulting utilities may be used in models estimating and comparing the value of treatments for hepatitis C.


Assuntos
Vias de Administração de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hepatite C Crônica/tratamento farmacológico , Preferência do Paciente , Adulto , Análise Custo-Benefício , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Fatores Socioeconômicos , Reino Unido
19.
Stroke ; 35(2): 607-12, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-14726549

RESUMO

BACKGROUND AND PURPOSE: Proxy informants can provide information on patients who are limited in ability to self-assess health-related quality of life (HRQL) after stroke. One alternative is to exclude assessments of such patients and attenuate generalizability. The purpose of this study was to examine patient-proxy agreement on the domains and summary scores of the EQ-5D and Health Utilities Index Mark 3 (HUI3) after stroke. METHODS: An observational longitudinal cohort of 124 patients hospitalized after ischemic stroke and their family caregivers completed the HRQL measures at baseline and were followed up for 6 months. Patient and proxy agreement was assessed by use of weighted kappa or the intraclass correlation coefficient (ICC). RESULTS: At baseline, the more observable domains of HRQL demonstrated greater agreement than the more subjective components. Cross-sectional point estimates of agreement were generally acceptable (ICC >0.70) for the EQ-5D Index and HUI3 summary scores when assessed >or=1 month after baseline. Agreement between change scores was generally poor to fair (ICC <0.60), but systematic bias was not observed for the indirect preference-based summary scores between baseline and 6 months. CONCLUSIONS: Results suggest that proxy assessments obtained 6 months after stroke are more reliable than those obtained within 2 to 3 weeks after stroke. Although proxy-assessed change scores for indirect preference-based summary scores of the EQ-5D and HUI3 provided suboptimal agreement with patient assessment, limited systematic bias may support their consideration as alternatives to missing data or statistical imputation. Further research into the validity and reliability of proxy assessments is suggested.


Assuntos
Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Procurador/estatística & dados numéricos , Qualidade de Vida , Autoeficácia , Perfil de Impacto da Doença , Acidente Vascular Cerebral/diagnóstico , Idoso , Alberta , Cuidadores/estatística & dados numéricos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Variações Dependentes do Observador , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo
20.
J Natl Cancer Inst Monogr ; (33): 102-25, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15504922

RESUMO

BACKGROUND: A comprehensive review was made of the literature on the health-related quality of life (HRQL) and economic outcomes of children with acute lymphoblastic leukemia (ALL), the most common of all cancers in childhood. OBJECTIVES: The primary objectives of the review were to locate and describe measures of HRQL used in pediatrics and in pediatric oncology that might be applicable to ALL, to summarize studies that have applied HRQL measures to ALL, to identify and summarize economic evaluations of the costs and consequences of care for pediatric ALL, and to identify areas requiring further research. DATA SOURCES: To identify the HRQL literature in pediatric ALL, searches were run on the major biomedical and social science bibliographic databases. Search terms included a variety of MeSH and other thesaurus terms, text words, names of HRQL instruments, and the names of key authors in the field. The economic literature searches included most of the same databases, with the addition of the National Health Service Economic Evaluation Database and EconLit. Searches on specific authors and instruments and hand searches were also conducted. STUDY SELECTION: Only English language studies published from 1975 through 2000 were included. DATA EXTRACTION: Standardized data extraction forms were used to abstract information from HRQL and economic evaluation studies. Two reviewers independently screened the search results, and differences were resolved by consensus. DATA SYNTHESIS: A number of generic HRQL measures, both adult and pediatric, have been applied in pediatric ALL. In addition, a number of pediatric oncology-specific instruments and pediatric oncology disease-specific instruments have been developed. Most of these instruments have been used to measure the health status of patients undergoing therapy. Despite the limited numbers of patients and resources available to assess HRQL measures in children with cancer, a fairly substantial body of literature has been published. Economic studies of pediatric ALL have only recently been undertaken. Most studies focus on a particular, narrow aspect of costs associated with the disease. There are relatively few cost-effectiveness studies that compare the costs and consequences of two or more treatment options. There are no published, comprehensive economic evaluations of pediatric ALL. CONCLUSIONS: HRQL measures provide not only important information on the improvements offered by new therapies but also an outcome measure for economic evaluations. Recently developed HRQL measures and applications that include the direct assessments of children are important contributions. By the age of 7 or 8 years, children can generally provide reliable responses. Furthermore, children often provide information that is not available from parental reports (e.g., in the more subjective areas of pain and emotion). However, the use of multiple viewpoints, such as the patient, parent, and health professional perspectives, can provide valid and important complementary information. Expertise in HRQL measurement should be included in the design of most future trials. Funds for HRQL research should be made available to enhance the scope of HRQL activities by organizations such as the Children's Oncology Group. In the near future, further work to generate evidence of validity for available HRQL measures for use in children with ALL will be a high priority. Continuation of inquiries into the methods for HRQL assessment of younger children (i.e., preschoolers) is also a priority.


Assuntos
Avaliação de Resultados em Cuidados de Saúde , Leucemia-Linfoma Linfoblástico de Células Precursoras/economia , Leucemia-Linfoma Linfoblástico de Células Precursoras/psicologia , Qualidade de Vida , Criança , Nível de Saúde , Humanos
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