A systematic review of the quality of liver biopsy specimens

Characteristics for an optimal liver biopsy specimen were recently defined as 20 to 25 mm long and/or containing more than 11 complete portal tracts (CPTs). A systematic review of percutaneous liver biopsy (PLB) and transjugular liver biopsy (TJLB) series yielded only 32 PLB studies in which these characteristics were evaluated: mean ± SD length, 17.7 ± 5.8 mm and number of CPTs, 7.5 ± 3.4; and 15 TJLB studies: mean ± SD length, 13.5 ± 4.5 mm and number of CPTs, 6.8 ± 2.3. Studies of sampling heterogeneity and intraobserver and interobserver variability also used inadequate specimens by present standards. Only 11 (5.3%) of 207 therapeutic studies for chronic hepatitis B and C documented length and/or number of CPTs. Of the current 12 studies evaluating noninvasive fibrosis tests, only 8 documented length or number of CPTs, and only 1 documented length and number of CPTs. New studies are needed based on adequate liver biopsy samples to provide reliable estimation of grading and staging in chronic liver disease.

Impact of chronic plantar heel pain on health-related quality of life

Background: Chronic plantar heel pain (CPHP) is common and is thought to have a detrimental impact on health-related quality of life. However, no study has used normative data or a control data set for comparison of scores. Therefore, we describe the impact of CPHP on foot-specific and general health-related quality of life by comparing CPHP subjects with controls.

Methods: Foot Health Status Questionnaire scores were compared in 80 subjects with CPHP and 80 sex- and age-matched controls without CPHP.

Results: The CPHP group demonstrated significantly poorer foot-specific quality of life, as evidenced by lower scores on the foot pain, foot function, footwear, and general foot health domains of the Foot Health Status Questionnaire. The group also demonstrated significantly poorer general health-related quality of life, with lower scores on the physical activity, social capacity, and vigor domains. In multivariate analysis, CPHP remained significantly and independently associated with Foot Health Status Questionnaire scores after adjustment for differences in body mass index. Age, sex, body mass index, and whether symptoms were unilateral or bilateral had no association with the degree of impairment in people with CPHP.

Conclusion: Chronic plantar heel pain has a significant negative impact on foot-specific and general health-related quality of life. The degree of negative impact does not seem to be associated with age, sex, or body mass index.

Improving the quality of diabetes care in general practice

Objective: The evidence treatment gap for patients with type 2 diabetes.
Design: A summary of convenience sample of seven general practices.
Setting: Metropolitan and rural Victoria, Australia.
Participants: 561 patients of general practices (75% from rural general practices).
Main outcome measures: Demographic data, duration of diabetes, diabetes complications, HbA1c and lipid levels, blood pressure and score on PHQ-9.
Results: Patients with depression show more severe, progressive and intensively treated diabetes. The prevalence of depression in diabetes is about twice that of the general population.
Conclusion: Australian guidelines for diabetes should recommend screening for depression.

Predicting time trade-off health state valuations of adolescents in four Pacific countries using the assessment of quality-of-life (AQoL-6D) instrument

Objectives: Pacific Obesity Prevention in Communities (OPIC) is a community-based intervention project targeting adolescent obesity in Australia, New Zealand, Fiji, and Tonga. The Assessment of Quality of Life Mark 2 (AQoL-6D) instrument was completed by 15,481 adolescents to obtain a description of the quality of life associated with adolescent overweight and obesity, and a corresponding utility score for use in a cost–utility analysis of the interventions. This article describes the recalibration of this utility instrument for adolescents in each country.

Methods: The recalibration was based on country-specific time trade-off (TTO) data for 30 multiattribute health states constructed from the AQoL-6D descriptive system. Senior secondary students, in a classroom setting, responded to 10 health state scenarios each. These TTO interviews were conducted for 24 groups, comprising 279 students in the four countries resulting in 2790 completed TTO scores. The TTO scores were econometrically transformed by regressing the TTO scores upon predicted scores from the AQoL-6D to produce country-specific algorithms. The latter incorporated country-specific “corrections” to the Australian adult utility weights in the original AQoL.

Results: This article reports two methodological elements not previously reported. The first is the econometric modification of an extant multi-attribute utility instrument to accommodate cultural and other group-specific differences in preferences. The second is the use of the TTO technique with adolescents in a classroom group setting. Significant differences in utility scores were found between the four countries.

Conclusion: Statistical results indicate that the AQoL-6D can be validly used in the economic evaluation of both the OPIC interventions and other adolescent programs.

Volunteering and quality of life of the older age population

The contribution of volunteers to society and economy is substantial. The participation in voluntary work is on the increase, particularly by the over 55 age group. Given the aging of the Australian population, this growth has an important social consequence. The aim of this conceptual study is to review the influences of older age Australian volunteering practice, its growth pattern and the types of voluntary work undertaken. The study uses the expectancy theory of motivation to argue that volunteers participate for the perceived benefits they get from their interaction with others, by experiencing self-esteem from being useful, being connected, gaining self-satisfaction, and by focusing on giving. It reviews the issue of quality of life (QOL) in relation to voluntary social engagement and suggests that there is an association between the older age group voluntarism and improvement in their QOL. The role of policy makers in further motivating larger participation by the older age groups and the social benefits emerging from this strategy is briefly reviewed.

The economic impact of progressive neurological illness on quality of life in Australia

The current study examined the impact of financial costs and self-reported economic pressure on the quality of life of patients with progressive neurological illness. Participants were 423 people from four illness groups in Australia. Participants completed measures of: 1. quality of life, 2. income, 3. expenses, 4. economic pressure, 5. social support, 6. relationship satisfaction, and 7. severity of illness. There was a strong negative association between quality of life and economic pressure (but not income or expenses) for all groups. Subjective assessment of economic pressure was strongly associated with quality of life for people with motor neurone disease and multiple sclerosis. Implications of these results for assisting people with progressive neurological illnesses to cope with the financial changes that occur due to their illness are discussed.

Influence of grain supplements during winter on liveweight, mohair growth and mohair quality of weaner Angora goats

To identify methods to improve growth and mohair production of weaned Angora goats (mean liveweight 18-20 kg) during their first winter, two supplementary feeding experiments using whole-grain barley and lupins were conducted on a farm in southern New South Wales, in a region where weaner illthrift had been reported. Experiment 1 was a 2×2 + 1 factorial with 16 replicate goats; two feeding levels (115 or 230 g/day of whole-barley grain)× two periods of feeding (4 or 8 weeks) + Control (grazing only). Experiment 2 had five treatments × 13 replicate goats; three treatments fed 230 g/day of whole-barley grain for periods of 2 or 3 months and two treatments fed a 50:50 mixture of lupin and barley grain at 350 g/day for 2 or 4 months. Goats were individually fed and then all returned together for grazing. There were no effects of feeding in Experiment 1 and variations of feeding 230 g/day of barley in Experiment 2 provided no benefit. Feeding lupin/barley for 4 months increased liveweight (gain 59 g/day), mohair production, mohair fibre diameter and the incidence of medullated fibre. About 25% of this ration was not eaten by eight goats, reducing treatment average intake to 295 g/day. By the end of spring, there was no difference in treatment liveweights. Regression constants indicated that for each 1 μm increase in mean fibre diameter, greasy fleece weight increased 35 g and for each 1 kg increase in pre-shearing liveweight, greasy fleece weight increased 26 g. The results show that Angora weaner goats can grow during winter, provided their energy and protein needs for growth are met. Improved pasture management and higher levels of supplementary feeding to weaned Angoras are indicated compared with current practices on farms in Australia.