Selecting a measure of health-related quality of life.

Quality of life is becoming recognized increasingly as an important outcome measure which needs to be considered by social workers. However, there does not appear to be a clear consensus about the definition of quality of life. In addition, social workers are likely to experience difficulties choosing and applying an appropriate instrument with which to measure quality of life because of the many available instruments purporting to assess quality of life. This paper discusses the definition of health-related quality of life and explains the main measurement properties of an instrument that must be appraised when considering whether or not an instrument is appropriate. The paper will assist social workers to make an informed choice about measures of health-related quality of life.

Generic, disease-specific and individualised approaches to measuring health-related quality of life among people with heart disease - a comparative analysis.

Increasing emphasis is being placed on the evaluation of health-related quality of life. However, there is no consensus on the definition of this concept and as a result there are a plethora of existing measurement instruments. Head-to-head comparisons of the psychometric properties of existing instruments are necessary to facilitate evidence-based decisions about which instrument should be chosen for routine use. Therefore, an individualised instrument (the modified Patient Generated Index), a generic instrument (the Short Form 36) and a disease-specific instrument (the Quality of Life after Myocardial Infarction questionnaire) were administered to patients with ischaemic heart disease (n=117) and the evidence for the validity, reliability and sensitivity of each instrument was examined and compared. The modified Patient Generated Index compared favourably with the other instruments but none of the instruments examined provided sound evidence for sensitivity to change. Therefore, any recommendation for the use of the individualised approach in the routine collection of health-related quality of life data in clinical practice must be conditional upon the submission of further evidence to support the sensitivity of such instruments.

Impact of cough across different chronic respiratory diseases: comparison of two cough-specific health-related quality of life questionnaires

Background: Cough is a prominent symptom across a range of common chronic respiratory diseases and impacts considerably on patient health status.

Methods: We undertook a cross-sectional comparison of scores from two cough-specific health-related quality of life (HRQoL) questionnaires, the Leicester Cough Questionnaire (LCQ), and the Cough Quality of Life Questionnaire (CQLQ), together with a generic HRQoL measure, the EuroQol. Questionnaires were administered to and spirometry performed on 147 outpatients with chronic cough (n = 83), COPD (n = 18), asthma (n = 20), and bronchiectasis (n = 26).

Results: There was no significant difference in the LCQ and CQLQ total scores between groups (p = 0.24 and p = 0.26, respectively). Exploratory analyses of questionnaire subdomains revealed differences in psychosocial issues and functional impairment between the four groups (p = 0.01 and p = 0.05, respectively). CQLQ scores indicated that chronic coughers have more psychosocial issues than patients with bronchiectasis (p = 0.03) but less functional impairment than COPD patients (p = 0.04). There was a significant difference in generic health status across the four disease groups (p = 0.04), with poorest health status in COPD patients. A significant inverse correlation was observed between CQLQ and LCQ in each disease group (chronic cough r = - 0.56, p < 0.001; COPD r = - 0.49, p = 0.04; asthma r = - 0.94, p < 0.001; and bronchiectasis r = - 0.88, p < 0.001). There was no correlation between cough questionnaire scores and FEV1 in any group, although a significant correlation between EuroQol visual analog scale component and FEV1 (r = 0.639, p = 0.004) was observed in COPD patients.

Conclusion: Cough adversely affects health status across a range of common respiratory diseases. The LCQ and CQLQ can each provide important additional information concerning the impact of cough.

‘Care just changes your life’: Factors impacting on the mental health of children and young people in care in Northern Ireland.

This paper represents one element of a research project carried out into the mental health needs of children and young people with experiences of care in Northern Ireland. Focusing exclusively on qualitative data collected from 51 young people in care and aftercare, it discusses in the first instance how the challenges and difficulties faced by young people can manifest themselves in feelings and behaviours that may exemplify poor mental well-being. In doing so it provides an understanding of mental health in the context of these young people’s lives. Through offering a more detailed account of some of the specific issues that put these young people at increased risk, it highlights areas for further work and consideration as a means of protecting them against these risks. These include: dealing with experiences prior to care; easing and ‘‘normalising’’ the experience of living in care; and enhancing ‘‘safety nets’’ after care. A key objective of the research is to inform policy and practice through the accounts of children and young people. It is argued that more work needs to be done to find creative ways of enhancing the day-to-day experiences of young people while in care and when leaving care.

Devotional Culture in Late Medieval England and Europe: Diverse Imaginations of Christ’s Life

Christ’s life, as related through the Gospel narratives and early Apocrypha, was subject to a riot of literary-devotional adaptation in the medieval period. This collection provides a series of groundbreaking studies centring on the devotional and cultural significance of Christianity’s pivotal story during the Middle Ages.

The collection represents an important milestone in terms of mapping the meditative modes of piety that characterize a number of Christological traditions, including the Meditationes vitae Christi and the numerous versions it spawned in both Latin and the vernacular. A number of chapters in the volume track how and why meditative piety grew in popularity to become a mode of spiritual activity advised not only to recluses and cenobites as in the writings of Aelred of Rievaulx, but also reached out to diverse lay audiences through the pastoral regimens prescribed by devotional authors such as the Carthusian prior Nicholas Love in England and the Parisian theologian and chancellor of the University of Paris, Jean Gerson.

Through exploring these texts from a variety of perspectives — theoretical, codicological, theological — and through tracing their complex lines of dissemination in ideological and material terms, this collection promises to be invaluable to students and scholars of medieval religious and literary culture.

Verteporfin Photodynamic Therapy Cohort Study Report 2: Clinical Measures of Vision and Health-Related Quality of Life

Purpose: To quantify decreases in health-related quality of life (HRQoL) for given deterioration in clinical measures of vision; to describe the shape of these relationships; and to test whether the gradients of these relationships change with duration of visual loss.

Measuring health-related quality of life after stroke: A brief tool.

Routine assessment of health-related quality of life (HRQoL) can be time consuming and burdensome for a person with stroke. Therefore the aim of this study was to develop and test a brief instrument for assessing HRQoL among people with stroke. The Quality of Life after Stroke Scale (QLASS) was constructed from items within the Quality of Life Index-Stroke Version and the Chronic Respiratory Disease Questionnaire. It was administered to 92 people with stroke at three points in time: immediately after discharge from hospital, 6 months and 12 months later. Results suggest that the QLASS has 19 items which represent three factors: emotional functioning, mastery and fatigue which correlate with valid measures of health status and activities of daily living. The QLASS is proposed as a brief, valid HRQoL tool for use among people with stroke.