Quality of life assessment in the community-dwelling elderly : validation of the Assessment of Quality of Life (AQoL) instrument and comparison with the SF-36

Measurement of Health-Related Quality of Life (HRQoL) of the elderly requires instruments with demonstrated sensitivity, reliability, and validity, particularly with the increasing proportion of older people entering the health care system. This article reports the psychometric properties of the 12-item Assessment of Quality of Life (AQoL) instrument in chronically ill community-dwelling elderly people with an 18-month follow-up. Comparator instruments included the SF-36 and the OARS. Construct validity of the AQoL was strong when examined via factor analysis and convergent and divergent validity against other scales. Receiver Operator Characteristic (ROC) curve analyses and relative efficiency estimates indicated the AQoL is sensitive, responsive, and had the strongest predicative validity for nursing home entry. It was also sensitive to economic prediction over the follow-up. Given these robust psychometric properties and the brevity of the scale, AQoL appears to be a suitable instrument for epidemiologic studies where HRQoL and utility data are required from elderly populations.

Anti-tumour necrosis factor-α therapy for severe enteropathy in patients with common variable immunodeficiency (CVID)

We present three common variable immunodeficiency (CVID) patients with
severe inflammatory bowel disease of unknown aetiology, resistant to steroid
treatment, treated with infliximab.After exclusion of any infection, infliximab
was given at a dose of 5 mg/kg every 4 weeks for a 3 month induction followed
by every 4–8 weeks depending on clinical response. Two of these patients had
predominantly small bowel disease; they both showed clinical response to
infliximab with weight gain and improvement of quality of life scores. The
third patient had large bowel involvement with profuse watery diarrhea; this
patient improved dramatically within 48 hours of having infliximab
treatment. All three patients have been maintained on infliximab treatment
for between 5 and 53 months (mean 37 months) with no evidence of increased
susceptibility to infections in the patients with small bowel disease, although
the third patient developed two urinary tract infections and a herpes zoster
infection following therapy. This is the first small case series to show that
infliximab is a useful addition to current therapy in this rare group of patients
with potentially life threatening enteritis.

Diet quality in bipolar disorder in a population-based sample of women

Background : Recent epidemiological evidence has indicated a role for diet quality in unipolar depressive illness. This study examined the association between diet quality and bipolar disorder (BD) in an epidemiological cohort of randomly selected, population-based women aged 20–93 years.

Methods : An a priori diet quality score was derived from food frequency questionnaire data, a factor analysis identified habitual dietary patterns and glycemic load was assessed. Mental health was assessed using the SCID-I/NP.

Results : BD was identified in 23 women and there were 691 participants with no history of psychopathology. Compared to those with no psychopathology, those with BD had a higher glycemic load (p = 0.06) and higher scores on a ‘western’ dietary factor (p = 0.03) and the ‘modern’ dietary factor (p = 0.02). For each standard deviation increase in a ‘western’ and ‘modern’ dietary pattern and glycemic load, the odds ratios for BD were increased (‘western’ OR = 1.88, 95% CI 1.33–2.65; ‘modern’ OR = 1.72, 95% CI 1.14–2.39; GL OR = 1.56, 95% CI 1.13–2.14). Conversely, a ‘traditional’ dietary pattern was associated with reduced odds for BD (OR = 0.53 95% CI 0.32–0.89) after adjustments for overall energy intake.

Limitations : The small sample size did not allow for multivariate analyses and the cross-sectional study design precludes any determinations regarding the direction of the relationships between diet quality and BD.

Conclusion : These data are largely concordant with results from dietary studies in unipolar depression. However, clinical recommendations cannot be made until the direction of the relationship between diet quality and BD is determined. Longitudinal studies are warranted.

Quantifying urbanisation as a risk factor for non-communicable disease

Aim of this study was to investigate the poorly understood relationship between the process of urbanization and non-communicable diseases (NCDs) in Sri Lanka using a multi-component, quantitative measure of urbanicity.

NCD prevalence data were taken from the Sri Lankan Diabetes and Cardiovascular Study comprising a representative sample of people from seven of the nine provinces in Sri Lanka (n=4,485/5,000; response rate=89.7%). We constructed a measure of the urban environment for seven areas using a seven-item scale based on data from study clusters to develop an ―urbanicity” scale. The items were population size, population density, and access to markets, transportation, communications/media, economic factors, environment/sanitation, health, education, and housing quality. Linear and logistic regression models were constructed to examine the relationship between urbanicity and chronic disease risk factors.

Among men, urbanicity was positively associated with physical inactivity (OR: 3.22; 2.27 – 4.57), high body mass index (OR: 2.45; 95% CI: 1.88 – 3.20) and diabetes mellitus (OR: 2.44; 95% CI: 1.66 – 3.57). Among women, too, urbanicity was positively associated with physical inactivity (OR: 2.29; 95% CI: 1.64 – 3.21), high body mass index (OR: 2.92;95% CI: 2.41 – 3.55) and diabetes mellitus (OR: 2.10; 95% CI: 1.58 – 2.80).

There is a clear relationship between urbanicity and common modifiable risk factors for chronic disease in a representative sample of Sri Lankan adults.

The quality-of-relationship construct in IT outsourcing

This paper reports on the conceptualization and measurement of an important management controllable factor affecting the success of an information technology outsourcing (ITO) arrangement, namely Quality of Relationship (QoR). Attributes of the construct were identified from an analysis of the literature, and key attributes selected based on interviews with 29 managers in four pairs of client and supplier organizations. Construct validity of the resultant measure is assessed through comparison with qualitative interview data, and through tests of association between our measure and perceived overall ITO success. The results suggest that the ten indicators identified in the paper provide a valid measure of the quality of relationship that can be used by both client and supplier managers, and researchers, in assessing the health of an ITO relationship.

The impact of hypoglycaemia on quality of life and related patient-reported outcomes in Type 2 diabetes : a narrative review

As a common side effect of insulin treatment for diabetes, hypoglycaemia is a constant threat and can have far-reaching and potentially devastating consequences, including immediate physical injury as well as more pervasive cognitive, behavioural and emotional effects. Moreover, as a significant limiting factor in achieving optimal glycaemic control, exposure to hypoglycaemia can influence diabetes self-management.

Although hypoglycaemia is known to occur in Type 2 diabetes, its morbidity and impact on the individual are not well recognized. The aim of the current review is to examine published evidence to achieve a synthesis of the scope and significance of the potential detriment caused by hypoglycaemia to individuals with Type 2 diabetes. The implications of these observations for treatment and research have also been considered.

A narrative review was performed of empirical papers published in English since 1966, reporting the effect of hypoglycaemia on quality of life and related outcomes (including generic and diabetes specificquality of life, emotional well-being and health utilities) in Type 2 diabetes.

Research demonstrates the potential impact of hypoglycaemia on the lives of people with Type 2 diabetes, from an association with depressive symptoms and heightened anxiety, to impairment of the ability to drive, work and function in ways that are important for quality of life. Few studies consider hypoglycaemia as an explanatory variable in combination with quality of life or related primary endpoints. As a consequence, there is a pressing need for high-quality research into the overall impact of hypoglycaemia on the lives of people with Type 2 diabetes.

The quality of community reintegration planning for child molesters : effects on sexual recidivism

Research on the causal factors underlying sex offender recidivism has not considered the success or failure of the reintegration process by which the offender rejoins the community after prison. The authors developed a coding protocol to measure the quality and comprehensiveness of reintegration planning for sex offenders. The protocol was retrospectively applied to groups of recidivists and nonrecidivists who were matched on static risk level and follow-up time. The protocol demonstrated adequate reliability. Compared to nonrecidivists, recidivists had significantly lower scores relating to accommodation, employment, and the Good Lives Model secondary goods, as well as lower total reintegration plan scores. ANCOVAs showed that when IQ and level of sexual deviance were controlled for, accommodation (a place to live) was significantly related to sexual recidivism and the Good Lives Model—secondary goods was significantly related to any recidivism. These results suggest that poor reintegration planning may be a risk factor for recidivism.

Identifying the determinants of e-learning service delivery quality

In recent years, many universities and educational institutions have made considerable investments in e-learning systems. These are systems that deliver educational services via electronic channels. Service quality has been studied in previous research as a critical factor for measuring systems success. Modest attention has been paid to factors affecting the service delivery quality in the e-learning arena. The objective of this study is to identify the factors considered to impact the e-learning systems service delivery quality through a survey of stakeholders. The sample was 720 students enrolled in online courses at the University of Southern Queensland (USQ).The main finding of this study is that IT infrastructure, system quality, and information quality significantly affect service delivery quality in the e-learning systems field. IT infrastructure services were found to play a critical role in improving system quality and information quality, and this construct can be considered as a foundation of delivering high quality educational services.

The effects of website quality on adoption of e-government service : an empirical study applying UTAUT model using SEM

In today’s global age, e-government services have become the main channel for online communication between the government and its citizens. They aim to provide citizens with more accessible, accurate, real-time and high quality services. Therefore, the quality of government websites which provide e-services is an essential factor in the successful adoption of e-government services by the public. This paper discusses an investigation of the effect of the Website Quality (WQ) factor on the acceptance of using e-government services (G2C) in the Kingdom of Saudi Arabia (KSA) by adopting the Unified Theory of Acceptance and Use of Technology (UTAUT) Model. Survey Data collected from 400 respondents were examined using the structural equation modelling (SEM) technique and utilising AMOS tools. This study found that the factors that significantly influenced the Use Behaviour of e-government services in KSA (USE) include Performance Expectancy (PE), Effort expectancy (EE), Facilitating Conditions (FC) and Website Quality (WQ), while the construct known Social Influence (SI) did not. Moreover, the results confirm the importance of quality government websites and support systems as one of the main significant and influential factors of e-government services adoption. The results of this study can be helpful to Saudi’s governmental sectors to adjust their corporate strategies and plans to advance successful adoption and diffusion of e-government services (G2C) in KSA.

Construction of the descriptive system for the assessment of quality of life AQoL-6D utility instrument

Background
Multi attribute utility (MAU) instruments are used to include the health related quality of life (HRQoL) in economic evaluations of health programs. Comparative studies suggest different MAU instruments measure related but different constructs. The objective of this paper is to describe the methods employed to achieve content validity in the descriptive system of the Assessment of Quality of Life (AQoL)-6D, MAU instrument.

Methods
The AQoL program introduced the use of psychometric methods in the construction of health related MAU instruments. To develop the AQoL-6D we selected 112 items from previous research, focus groups and expert judgment and administered them to 316 members of the public and 302 hospital patients. The search for content validity across a broad spectrum of health states required both formative and reflective modelling. We employed Exploratory Factor Analysis and Structural Equation Modelling (SEM) to meet these dual requirements.

Results and Discussion
The resulting instrument employs 20 items in a multi-tier descriptive system. Latent dimension variables achieve sensitive descriptions of 6 dimensions which, in turn, combine to form a single latent QoL variable. Diagnostic statistics from the SEM analysis are exceptionally good and confirm the hypothesised structure of the model.

Conclusions
The AQoL-6D descriptive system has good psychometric properties. They imply that the instrument has achieved construct validity and provides a sensitive description of HRQoL. This means that it may be used with confidence for measuring health related quality of life and that it is a suitable basis for modelling utilities for inclusion in the economic evaluation of health programs.

Assessing the impact of diabetes on the quality of life of older adults living in a care home : validation of the ADDQoL senior

Aims  Around a quarter of UK care-home residents have diabetes. Diabetes is known to impact quality of life but existing diabetes-specific quality of life measures are unsuitable for elderly care-home residents. We aimed to develop and evaluate a new measure for use with older adults, to be particularly suitable for use with care-home residents: the Audit of Diabetes-Dependent Quality of Life (ADDQoL) Senior†.

Methods  Content and format changes were made to the 19-domain ADDQoL, informed by related measures for people with visual impairments (12 domain-specific items were retained, four items were revised/added and three items were removed). This revision was modified further following cognitive debriefing interviews with three older adults living in a care home. Psychometric evaluation of the newly developed 17-domain ADDQoL Senior was conducted using data from 90 care-home residents with diabetes who took part in a broader intervention study.

Results  The life domains most impacted by diabetes were ‘independence’ and ‘freedom to eat as I wish’. The ADDQoL Senior demonstrated good factor structure and internal consistency (Cronbach’s alpha = 0.924). Domain scores were, as expected, significantly intercorrelated.

Conclusions  The ADDQoL Senior measures the perceived impact of diabetes on quality of life in older adults, and has been found to be suitable for those living in care homes if administered by interview. The scale has demonstrated acceptability and excellent psychometric properties. It is anticipated that the number of items may be reduced in the future if our current findings can be replicated.

Linguistic and psychometric validation of the diabetes-specific quality-of-life scale in U. K. english for adults with type 1 diabetes

OBJECTIVE To develop a linguistically and psychometrically validated U.K. English (U.K./Ireland) version of the Diabetes-Specific Quality-of-Life Scale (DSQOLS) for adults with type 1 diabetes.

RESEARCH DESIGN AND METHODS We conducted independent forward and backward translation of the validated German DSQOLS. An iterative interview study with health professionals (n = 3) and adults with type 1 diabetes (n = 8) established linguistic validity. The DSQOLS was included in three Dose Adjustment for Normal Eating (DAFNE) studies (total N = 1,071). Exploratory factor analysis (EFA) was undertaken to examine questionnaire structure. Concurrent and discriminant validity, internal consistency, and reliability were assessed.

RESULTS EFA indicated a six-factor structure for the DSQOLS (social aspects, fear of hypoglycemia, dietary restrictions, physical complaints, anxiety about the future, and daily hassles). High internal consistency reliability was found for these factors and the weighted treatment satisfaction scale (α = 0.85–0.94). All subscales were moderately, positively correlated with the Audit of Diabetes-Dependent Quality-of-Life (ADDQoL) measure, demonstrating evidence of concurrent validity. Lower DSQOLS subscale scores [indicating impaired quality of life (QoL)] were associated with the presence of diabetes-related complications.

CONCLUSIONS The DSQOLS captures the impact of detailed aspects of modern type 1 diabetes management (e.g., carbohydrate counting and flexible insulin dose adjustment) that are now routine in many parts of the U.K. and Ireland. The U.K. English version of the DSQOLS offers a valuable tool for assessing the impact of treatment approaches on QoL in adults with type 1 diabetes.

What's important in defining quality of life for older people? An exploratory study of the views of older South Australians

Background
Cost-effectiveness analyses of interventions for older adults have traditionally focused on health status. There is increasing recognition of the need to develop new instruments to capture quality of life in a broader sense in the face of age-associated increasing frailty and declining health status, particularly in the economic evaluation of aged and social care interventions which may have positive benefits beyond health. 

Nutrition, management and other environmental influences on the quality and production of mohair and cashmere with particular reference to mediterranean and annual temperate climatic zones : a review

Goat fibre production is affected by genetic and environmental influences. Environmental influences which are the subject of this review include bio–geophysical factors (photoperiod, climate–herbage system and soil–plant trace nutrient composition), nutrition factors and management factors. Nutrition and management influences discussed include rate of stocking, supplementary feeding of energy and protein, liveweight change, parturition and management during shearing. While experimental data suggest affects of seasonal photoperiod on the growth of mohair and cashmere are large, these results may have confounded changes in temperature with photoperiod. The nutritional variation within and among years is the most important climatic factor influencing mohair and cashmere production and quality. Mohair quality and growth is affected significantly by rate of stocking and during periods of liveweight loss by supplementary feeding of either energy or protein. Strategic use of supplements, methods for rapid introduction of cereal grains, influence of dietary roughage on intake and the economics of supplementary feeding are discussed. Cashmere production of young, low producing goats does not appear to be affected by energy supplementation, but large responses to energy supplementation have been measured in more productive cashmere goat strains. The designs of these cashmere nutrition experiments are reviewed. Evidence for the hypothesis that energy-deprived cashmere goats divert nutrients preferentially to cashmere growth is reviewed. The influence and potential use of liveweight manipulation in affecting mohair and cashmere production and quality are described. Estimates of the energy requirements for the maintenance of fibre goats and the effect of pregnancy and lactation on mohair and cashmere growth are summarised. The effects and importance of management and hygiene during fibre harvesting (shearing) in producing quality fibre is emphasised. The review concludes that it is important to assess the results of scientific experiments for the total environmental content within which they were conducted. The review supports the view that scientific experiments should use control treatments appropriate to the environment under study as well as having controls relevant for other environments. In mediterranean and annual temperate environments, appropriate controls are liveweight loss and liveweight maintenance treatments. Mohair producers must graze goats at moderate rates of stocking to maximise animal welfare, but in so doing, they will produce heavier goats and coarser mohair. In mediterranean and annual temperate environments, seasonal changes in liveweight are large and influence both quality and production of mohair and cashmere. Mohair and cashmere producers can manipulate liveweight by supplementary feeding energy during dry seasons to minimise liveweight loss, but the economics of such feeding needs to be carefully examined. Strategic benefits can be obtained by enhancing the growth of young does prior to mating and for higher producing cashmere goats.

Effects of site of assessment and variation in wool quality traits on the tactile assessment of textural greasy wool handle

Variation in textural greasy wool handle across the fleece of Merino sheep was explored. Results demonstrate that there were significant differences across nine sites on the fleece. The inclusion of the covariates fibre diameter, fibre diameter co-efficient of variation, staple length, dust penetration, staple structure, greasy wool colour and resistance to compression, helped to explain some of the variation in textural greasy wool handle between sites such that site of assessment was no longer a significant factor (P ≤ 0.065). However, in practice, those involved with clip preparation or sheep selection based on textural greasy wool handle assessment are unlikely to have these measurements available. The results highlight the importance of nominating a site of assessment when recording textural greasy wool handle. © CSIRO 2014.