General Health Measures Research Articles

Evaluating the merits of using brief measures of PTSD or general mental health measures in two-stage PTSD screening.

Psychological screening of large numbers of personnel returning from deployments should be as brief as possible without sacrificing the ability to detect individuals who are experiencing serious psychological difficulties. This study focused on screening for posttraumatic stress disorder (PTSD) symptomatology in 421 deployed male members of the Australian Army while they were on deployment and again 3 to 6 months after they returned home. The first aim was to evaluate the performance of the Primary Care--Posttraumatic Stress Disorder Screen (PC-PTSD) and a 4-item version of the 17-item Posttraumatic Stress Disorder Checklist (PCL). A second aim was to evaluate the role of the Kessler-10 (K10) in psychological screening. The results indicated that the short form of the PCL was a better substitute for the full PCL than the PC-PTSD. Other results suggested that a more efficient screening process can be achieved using an initial K10 screening followed by more intensive PTSD screening for people identified as high risk. An additional advantage of an initial K10 filter is that other forms of mental illness could also be targeted in the second-stage screening.

Better Health With More Friends: The Role of Social Capital in Producing Health.

This paper estimates the effect of an individual's number of friends on own health outcomes. The identification strategy exploits the panel structure of the friendship data from the National Longitudinal Study of Adolescent Health to estimate individual fixed effects in the likelihood of friendship formation and then uses the fixed effect estimates as a control function in a model relating health outcomes to number of friends. Empirical results show that having a larger number of friends improves physical and mental health and also lowers the frequency of smoking cigarettes. Specifically, making one more friend increases an individual's general health measure by 6.6% of a standard deviation. This suggests that accumulating social capital through friendship interactions is beneficial to health.

Effects of a renal rehabilitation exercise program in patients with CKD: a randomized, controlled trial.

Patients with CKD have a high prevalence of cardiovascular disease associated with or exacerbated by inactivity. This randomized, controlled study investigated whether a renal rehabilitation exercise program for patients with stages 3 or 4 CKD would improve their physical function and quality of life. In total, 119 adults with CKD stages 3 and 4 were randomized, and 107 of these patients proceeded to usual care or the renal rehabilitation exercise intervention consisting of usual care plus guided exercise two times per week for 12 weeks (24 sessions). Physical function was determined by three well established performance-based tests: 6-minute walk test, sit-to-stand test, and gait-speed test. Health-related quality of life was assessed by the RAND 36-Item Short Form Health Survey. At baseline, no differences in self-reported level of activity, 6-minute walk test, and sit-to-stand test scores were observed between the usual care (n=48) and renal rehabilitation exercise (n=59) groups, although baseline gait-speed test score was higher in the renal rehabilitation exercise group (P<0.001). At follow-up, the renal rehabilitation exercise group but not the usual care group showed significant improvements in the 6-minute walk test (+210.4±266.0 ft [19% improvement] versus -10±219.9 ft; P<0.001), the sit-to-stand test (+26.9±27% of age prediction [29% improvement] versus +0.7±12.1% of age prediction; P<0.001), and the RAND-36 physical measures of role functioning (P<0.01), physical functioning (P<0.01), energy/fatigue levels (P=0.01), and general health (P=0.03) and mental measure of pain scale (P=0.04). The renal rehabilitation exercise regimen was generally well tolerated. A 12-week/24-session renal rehabilitation exercise program improved physical capacity and quality of life in patients with CKD stages 3 and 4. Longer follow-up is needed to determine if these findings will translate into decreased mortality rates.

Teaching social–emotional skills to school-aged children with Autism Spectrum Disorder: A treatment versus control trial in 41 mainstream schools

This study examined the effectiveness of ‘Emotion-Based Social Skills Training (EBSST)’ a manualised social–emotional intervention designed to improve emotional competence in school-aged children with Autism Spectrum Disorder (ASD). Participants were 217 children (aged 7–13 years) with ASD without Intellectual Disability attending 41 mainstream primary schools in NSW Australia. Data on emotional competence, social skills and mental health difficulties were collected using teacher and parent informant report questionnaires in a pre-test/post-test control group design. One hundred and six students took part in the treatment and 111 students were in the control group. School Counsellors delivered the 16 session treatment to groups of 3–8 students in their schools. Teachers and parents also received six sessions of EBSST in separate groups. Participants received a booster session at six months follow-up. EBSST improved teacher reported emotional competence as measured by the Emotions Development Questionnaire (EDQ). The effect size was large and improvements were sustained at 6 months follow-up. Parent reported emotional competence and more general measures of social skills and mental health were insensitive to change across informants. This study has important implications for students, teachers and parents and provides a valuable basis for further research and development of EBSST and the EDQ.

Computerised cognitive behaviour therapy for depression in adolescents: study protocol for a feasibility randomised controlled trial

IntroductionThe 1 year prevalence of depression in adolescents is about 2%. Treatment with antidepressant medication is not recommended for initial treatment in young people due to concerns over high side...

S.12.04 Deletion of contactin-4 leads to cognitive rigidity and aberrant cortex development in mice

Cognitive rigidity is a defining characteristic of various psychiatric disorders, such as autism spectrum disorders (ASD) and anorexia nervosa (AN). For instance, reversal learning is considered a core component of cognitive rigidity, a behavioral domain affected in both ASD and AN. Genetic factors that are implicated in both these disorders, such as the contactin-4 (CNTN4) gene, may be particularly relevant to understand how rigidity is mediated [1]. Here, we performed an extensive developmental behavioral and morphological characterization of Cntn4-knockout mice [2]. Cognitive rigidity was assessed in adulthood using the set-shifting task, a mouse analog of the Wisconsin Card Sorting Test. This task includes intra-dimensional (affective) and extra-dimensional (attentional) set-shifting [3]. We found that mice lacking the Cntn4 gene made significantly more errors before reaching the criterion for intra-dimensional set-shifting compared to wild type mice. In contrast, no effect was found on extra-dimensional set-shifting. Moreover, no genotype effects were detected in the longitudinal assessment of general health measures and other behavioral domains. Brain morphology analyses revealed a significant reduction of cortical layer thickness in the motor cortex, but not in nonfrontal areas, including somatosensory cortex and visual cortex. Our results in Cntn4-knockout mice confirm a specific role for this gene in the regulation of cognitive rigidity. Taken together, these findings suggest that this mouse model is highly suitable to examine neurobiological underpinnings of cognitive rigidity in neurodevelopmental disorders. Ultimately, this approach may lead to the development of therapeutic strategies with cross-diagnostic relevance.

Measuring quality of life in mental health: Are we asking the right questions?

Measuring quality-adjusted-life years using generic preference-based quality of life measures is common practice when evaluating health interventions. However, there are concerns that measures in common use, such as the EQ-5D and SF-6D, focus overly on physical health and therefore may not be appropriate for measuring quality of life for people with mental health problems. The aim of this research was to identify the domains of quality of life that are important to people with mental health problems in order to assess the content validity of these generic measures. Qualitative semi-structured interviews were conducted with 19 people, recruited from UK mental health services, with a broad range of mental health problems at varying levels of severity. This complemented a previous systematic review and thematic synthesis of qualitative studies on the same topic. Seven domains important to quality of life for people with mental health problems were identified: well-being and ill-being; relationships and a sense of belonging; activity; self-perception; autonomy, hope and hopelessness; and physical health. These were consistent with the systematic review, with the addition of physical health as a domain, and revealed a differing emphasis on the positive and negative aspects of quality of life according to the severity of the mental health problems. We conclude that the content of existing generic preference-based measures of health do not cover this domain space well. Additionally, because people may experience substantial improvements in their quality of life without registering on the positive end of a quality of life scale, it is important that the full spectrum of negative through to positive aspects of each domain are included in any quality of life measure.

Adolescent chronic pain and association to perinatal factors: linkage of Birth Registry data with the Young-HUNT Study.

The aim of this study was to examine the associations of birthweight, gestation and 5-min Apgar score with self-reported chronic nonspecific pain in a large, unselected adolescent population. The third population-based Nord-Trøndelag Health Study (HUNT) included 8200 adolescents aged 13-19 years, constituting 78.2% of adolescents in Nord-Trøndelag County. In the target age group, 13-18 years, data on pain frequency from 10 localizations were available from 7373 adolescents. Chronic nonspecific pain was defined as pain at least once a week during the last 3 months, not related to any known disease or injury. Chronic multisite pain was defined as chronic pain in at least three localizations, and chronic daily pain was defined as chronic pain almost every day. Perinatal data were retrieved from the Medical Birth Registry of Norway, and data were available for 7120 of the 7373 adolescents. Covariates included adolescent and maternal general health measures from the HUNT study. We found no consistent association between preterm birth and chronic pain and no clear association between birthweight and chronic pain complaints in adolescence. Post-term birth in boys and a low 5-min Apgar score in both sexes tended to increase the reporting of chronic pain in adolescence. Perinatal factors, and especially preterm birth and low birthweight, did not seem to have a major impact on pain complaints in adolescence.

Relationship between the shape and density distribution of the femur and its natural frequencies of vibration

It has been recently suggested that mechanical loads applied at frequencies close to the natural frequencies of bone could enhance bone apposition due to the resonance phenomenon. Other applications of bone modal analysis are also suggested. For the above-mentioned applications, it is important to understand how patient-specific bone shape and density distribution influence the natural frequencies of bones. We used finite element models to study the effects of bone shape and density distribution on the natural frequencies of the femur in free boundary conditions. A statistical shape and appearance model that describes shape and density distribution independently was created, based on a training set of 27 femora. The natural frequencies were then calculated for different shape modes varied around the mean shape while keeping the mean density distribution, for different appearance modes around the mean density distribution while keeping the mean bone shape, and for the 27 training femora. Single shape or appearance modes could cause up to 15% variations in the natural frequencies with certain modes having the greatest impact. For the actual femora, shape and density distribution changed the natural frequencies by up to 38%. First appearance mode that describes the general cortical bone thickness and trabecular bone density had one of the strongest impacts. The first appearance mode could therefore provide a sensitive measure of general bone health and disease progression. Since shape and density could cause large variations in the calculated natural frequencies, patient-specific FE models are needed for accurate estimation of bone natural frequencies.

Validation of a new questionnaire to assess the impact of Whiplash Associated Disorders: The Whiplash Activity and participation List (WAL)

Valid questionnaires for measuring functional limitations in patients with Whiplash Associated Disorders (WAD) are lacking, since existing measures are not suitable for addressing the specific limitations of these patients and because of cross contamination between theoretical constructs.The objective of this study was to evaluate dimensionality, test-retest reliability, measurement error, construct validity, and responsiveness of a new condition-specific questionnaire for WAD as well as to estimate the minimally important change score.Patients with WAD grade I or II were recruited from physical therapy practices and rehabilitation centers. Dimensionality was examined by internal consistency analysis (Cronbach's alpha) and factor analysis. Test-retest reliability was estimated by intraclass correlations and measurement error was calculated by the minimal detectable change (MDC) scores. Construct validity was investigated by testing predefined hypotheses on correlations of the WAL scores with generic health measures and by using the known group method. Responsiveness was expressed as the minimal clinically important change (MCIC) score.73 patients (53 women) were included. Cronbach's alpha was high (0.95) and unidimensionality was plausible because factor analysis showed 40.3% variance explained by one dominant factor, which was more than 4.5 times larger than the second largest factor. Test-retest reliability was excellent (0.92, 95% CI 0.87–0.95). Construct validity was supported by 14 out of 15 confirmed hypotheses and the WAL showed statistically significant differences between known groups. MDC was 16 points while the MCIC was 18 points.In conclusion, the present study suggests that the WAL has adequate measurement properties, but additional research is needed.

10 Year Outcome Following Meniscus Repair Using Inside-Out Technique: A Comparative Cohort of Patients 40 years and Older vs Patients Younger than 40

Objectives:The number of meniscus repairs being performed is increasing, as research supports the need to preserve native meniscus tissue. Although excellent short-term results have been published after meniscus repair, there are limited data available on longer outcomes in patients treated with a single type of repair. The purpose of this study was to compare failure rate and clinical outcomes 10 years following mensicus repair, using inside-out technique, by a single surgeon in patients 40 years and older and patients younger than 40 years.Methods:A prospective data registry was queried for knee arthroscopies between 1992 and 2003 for meniscus repairs performed by a single surgeon. This study was IRB approved. Patients who underwent arthroscopic meniscus repair using inside-out technique were included. Exclusion criteria included patients younger than 18 years. Repairs were considered a failure if the knee had a subsequent surgery on the same meniscus or the knee was converted to a total knee arthroplasty(TKA). If knees required subsequent surgery on the meniscus, it was documented if it was a re-repair or meniscectomy. General health measure included the SF12 physical component score (PCS) and the mental component score(MCS). Condition specific outcomes included the Lysholm score, WOMAC and IKDC score. Activity was measured by the Tegner activity scale and patient satisfaction with outcome was measure on a 1 to 10 scale with 10 being very satisfied. Outcomes and failures were compared between patients 40 years and older(40P) and patients younger than 40(40Y).Results:206 patients were met the inclusion criteria. The average age was 33 years (range, 18 to 70 years) and there were 75 females and 131 males. Sixty-four (31%) knees underwent a subsequent knee surgery; 61 patients had a second meniscus surgery on the same meniscus and three had a TKA, and were therefore considered failures. Of the 61 patients who underwent a second meniscus surgery, 47 had a meniscectomy and 14 had a meniscus repair. The average age of the failure group was 33 years (range, 18 to 65 years), with 15 over the age of 40 at time of repair. The was no difference in the number of failures between 40P group and 40Y group(p=0.975) The average time to failure was 4.9 years postoperatively (range, 0.8 months to 18.6 years). Of the remaining patients, average followup was 14 years (range, 10 to 21 years). The average PCS was 54 and the average MCS was 54. The average Lysholm at latest followup was 86, the average WOMAC was 6 and the average IKDC was 73. The median Tegner activity scale was 6 (range, 1 to 9). The median patient satisfaction with outcome was 9 (range, 1 to 10). There was no difference in any outcome measure between the 40P group and the 40Y group.Conclusion:Ten years following meniscus repair, 30% of patients required repeat surgery of the meniscus or had a TKA. Older patients did not experience increased failures. Outcomes showed excellent function, low disability and high activity level 10 years following meniscus repair.

Examining the structure of spatial health effects in Germany using Hierarchical Bayes Models

This paper uses Hierarchical Bayes Models to model and estimate spatial health effects in Germany. We combine rich individual-level household panel data from the German SOEP with administrative county-level data to estimate spatial county-level health dependencies. As dependent variable we use the generic, continuous, and quasi-objective SF12 health measure. We find strong and highly significant spatial dependencies and clusters. The strong and systematic county-level impact is equivalent to 0.35 standard deviations in health. Even 20years after German reunification, we detect a clear spatial East–West health pattern that equals an age impact on health of up to 5 life years for a 40-year old.

Using early change to predict outcome in cognitive behaviour therapy: exploring timeframe, calculation method, and differences of disorder-specific versus general measures.

Early change can predict outcome of psychological treatment, especially in cognitive behavior therapy. However, the optimal operationalization of “early change” for maximizing its predictive ability, and differences in predictive ability of disorder-specific versus general mental health measures has yet to be clarified. This study aimed to investigate how well early change predicted outcome depending on the week it was measured, the calculation method (regression slope or simple subtraction), the type of measures used, and the target disorder. During 10–15 weeks of internet-based cognitive behavior therapy for depression, social anxiety disorder, or panic disorder, weekly ratings were collected through both disorder-specific measures and general measures (Outcome Questionnaire-45 (OQ-45) and Clinical Outcomes in Routine Evaluation-10 (CORE-10)). With outcome defined as the disorder-specific measure, change at week four was the optimal predictor. Slope and subtraction methods performed equally well. The OQ-45 explained 18% of outcome for depression, 14% for social anxiety disorder, and 0% for panic disorder. Corresponding values for CORE-10 were 23%, 29%, and 25%. Specific measures explained 41%, 43%, and 34% respectively: this exceeded the ability of general measures also when they predicted themselves. We conclude that a simple calculation method with a disorder-specific measure at week four seems to provide a good choice for predicting outcome in time-limited cognitive behavior therapy.

Parent-reported measures of child health and wellbeing in same-sex parent families: a cross-sectional survey.

BackgroundIt has been suggested that children with same-sex attracted parents score well in psychosocial aspects of their health, however questions remain about the impact of stigma on these children. Research to date has focused on lesbian parents and has been limited by small sample sizes. This study aims to describe the physical, mental and social wellbeing of Australian children with same-sex attracted parents, and the impact that stigma has on them.MethodsA cross-sectional survey, the Australian Study of Child Health in Same-Sex Families, was distributed in 2012 to a convenience sample of 390 parents from Australia who self-identified as same-sex attracted and had children aged 0-17 years. Parent-reported, multidimensional measures of child health and wellbeing and the relationship to perceived stigma were measured.Results315 parents completed the survey (completion rate = 81%) representing 500 children. 80% of children had a female index parent while 18% had a male index parent. Children in same-sex parent families had higher scores on measures of general behavior, general health and family cohesion compared to population normative data (β = 2.93, 95% CI = 0.35 to 5.52, P = .03; β = 5.60, 95% CI = 2.69 to 8.52, P = <.001; and β = 6.01, 95% CI = 2.84 to 9.17, P = <.001 respectively). There were no significant differences between the two groups for all other scale scores. Physical activity, mental health, and family cohesion were all negatively associated with increased stigma (β = -3.03, 95% CI = -5.86 to -0.21, P = .04; β = -10.45, 95% CI = -18.48 to -2.42, P = .01; and β = -9.82, 95% CI = -17.86 to -1.78, P = .02 respectively) and the presence of emotional symptoms was positively associated with increased stigma (β =0.94, 95% CI = 0.08 to 1.81, P = .03).ConclusionsAustralian children with same-sex attracted parents score higher than population samples on a number of parent-reported measures of child health. Perceived stigma is negatively associated with mental health. Through improved awareness of stigma these findings play an important role in health policy, improving child health outcomes.

The EQ-5D: a new tool for studying clinical outcomes in chronic rhinosinusitis.

To describe the role and applicability of the EuroQol 5-Dimension, 5-Level (EQ-5D-5L) questionnaire for the assessment of general health-related quality of life in patients with chronic rhinosinusitis. Prospective cohort study. The EQ-5D-5L was administered to 462 patients with refractory chronic rhinosinusitis before and 3 months after sinus surgery. Preoperative and postoperative scores across each of five health dimensions were analyzed and the results compared to those obtained from two widely used chronic rhinosinusitis outcomes instruments: the Chronic Sinusitis Survey (CSS) and SinoNasal Outcomes Test-22 (SNOT-22). Three hundred and fifty patients completed the five questions and visual analog scale (VAS) of the EQ-5D at baseline and at 3 months for a response rate of 75.8%. There were no incomplete questionnaires. The frequency of patients reporting problems in the EQ-5D domains of pain/discomfort, anxiety/depression, and usual activities decreased following sinus surgery (74.3% vs. 34.4%, 48.6% vs. 31.4%, and 30.6% vs. 19.4%, respectively; all P < 0.001). The domains of mobility and self-care did not demonstrate statistically significant change. EQ-5D VAS (standard deviation) improved from 73.4 (16.9) before surgery to 82.0 (14.4) after surgery (P < 0.001). Preoperative VAS correlated with SNOT-22 scores (Pearson coefficient of 0.50; P < 0.01). Postoperative change in VAS and SNOT-22 scores demonstrated moderate correlation (Pearson coefficient of 0.36, P < 0.01). The EQ-5D is a general health measure with sensitivity to clinical change in rhinosinusitis that support its use for monitoring patient outcomes. The limited response burden and ability to directly calculate health utility make it an attractive tool for rhinosinusitis outcomes research.

Different sensitivity for oxycodone-induced conditioned place preference and sensitization of locomotor activity in adolescent and adult mice

L’infiltrat lymphocytaire bénin, ou maladie de Jessner et Kanof (MJK), est une affection rare et bénigne, de traitement difficile.Cinq patients présentaient une MJK clinique. Dans tous les cas, la biopsie cutanée montrait un infiltrat lymphocytaire dense de toute la hauteur du derme, à disposition périvasculaire et périannexielle ; les examens complémentaires écartaient les diagnostics différentiels possibles. Les patients étaient traités par laser à colorant pulsé 595 nm avec une fluence de 5,5 à 8 J/cm2 et une durée de tir de 0,5 msec, avec une régression en une séance dans trois cas et deux à trois séances dans deux cas.À notre connaissance, un seul cas de traitement de la MJK par laser à colorant pulsé a été publié jusqu’ici. Le laser à colorant pulsé est utilisé dans certaines formes de lupus cutané et de granulome annulaire. La photothermolyse sélective permet l’ablation des capillaires dilatés impliqués dans l’érythème et l’inflammation.Le laser à colorant pulsé 595 nm pourrait être une alternative intéressante, y compris en première intention, pour cette maladie affichante mais sans conséquence générale.Jessner's lymphocytic infiltration of the skin (LIS) is a chronic, benign T-cell infiltrative disorder, usually manifesting as erythematous papules or plaques on the face, neck and back.Five patients presented LIS with numerous skin lesions on the face and back characteristic of this disease. Histological examination showed a lymphocytic infiltrate in the dermis without any modification of the epidermis. Direct immunofluorescent study was negative in all cases. Response to dermocorticoids proved inconsistent or negative in all patients. An excellent outcome was achieved in all five patients with pulsed dye laser. In one case, further skin lesions appeared at 1 year and responded to the same treatment. Following a single treatment session with 6–8 J/cm2, three of five patients showed normal skin. Regression occurred in the other two cases after two to three sessions. Pulsed dye laser appeared to be the best treatment for Jessner-Kanof disease for three patients at 4–8 years of follow-up.Only one case of Jessner-Kanof disease treated by pulsed dye laser has been reported. Pulsed dye laser has been used in cutaneous lupus and annular granuloma. Selective photothermolysis allows photocoagulation of dilated vessels.Pulsed dye laser at 595 nm could offer a valuable therapeutic alternative, and even a first-line treatment with no side effects.

Is pain associated with illicit opioid use or aberrant opioid-related behaviors in opioid substitution treatment patients

Aims: The limited literature on pain in opioid treatment samples indicates that current pain is highly prevalent. Understanding the clinical implications of current pain on treatment outcomes is important, particularly in light of ageing opioid treatment cohorts. This study aims to explore correlates of pain, including aberrant behaviors related to prescribed opioid use. Methods: Data on pain, physical health and previous tried pain treatments were collected in methadone or buprenorphine patients (n=141) fromthree treatment services.Measures included basic demographics, the Brief Pain Inventory, measures of general mental and physical health and quality of life questions, pain history and previous treatments tried for pain. Univariate andmultivariate analysis were used to examine correlates of pain. Results: Forty percent of the sample reported current pain. Of those with current pain, 68% reported trying some form of treatment other thanprescribed opioids. Correlates of current painwere depression, anxiety and poorer ratings of health. Current pain was not associated with greater use of illicit opioids (prescribed opioids or heroin) norwith any aberrant opioid related behaviors. Pain levels were comparable amongst methadone and buprenorphine treatment participants. Conclusions: The high prevalence of severe mental health comorbidity amongst opioid dependent people with current pain suggests screening for pain and tailoring of treatment where pain exists is warranted. The lack of association with pain and aberrant behaviors suggests it should not be assumed that those in opioid treatment misuse medications in response to pain. Financial support: Funding for the parent study was provided by Reckitt Benkiser in the form of an united educational grant; the funders had no role in study design; in the collection, analysis and interpretation of data; or in the decision to submit the paper for presentation at CPDD.

Quality of sexual life of women using the contraceptive vaginal ring in extended cycles: Preliminary report

Objective To evaluate the quality of the sexual life of healthy women who are using a contraceptive vaginal ring (CVR) in extended cycles.Methods Fifty-two women (18 to 32 years old) seeking hormonal contraception were enrolled in this prospective study. Women were to use a CVR releasing daily 15 μg of ethinylestradiol (EE) and 120 μg of etonogestrel (ENG) for 63 days, followed by a four-day hormone-free interval, for two such extended cycles. At baseline and at the first (day 63–73) and second (day 126–134) follow-ups the Female Sexual Function Index (FSFI) and the Short Form-36 (SF-36) questionnaires were administered to investigate, respectively, sexual behaviour and the quality of life (QoL). The Female Sexual Distress Scale (FSDS) was used to verify whether sexual dysfunction caused significant personal distress to the woman.Results The FSFI and FSDS scores obtained at the first and second follow-up appointments detected an improvement with respect to the baseline score (p < 0.05). QoL measures of body pain, general health and emotional role improved at the first follow-up visit (p < 0.05); at the second one, all variables showed improvement (p < 0.05).Conclusion According to these preliminary data the CVR in extended cycles could improve the sexual function and the QoL of women.Chinese 摘 要 目的 评估在扩展周期中使用阴道避孕环健康女性的性生活质量。方法 寻求激素避孕的52名女性（18-32岁）参加了这项前瞻性研究。妇女使用阴道避孕环每天释放15μg炔雌醇和120μg依托孕烯,共63天，随后4天是无激素间歇期，持续2个这样的周期。在基础状态及第一（63-73天）和第二（126-134天）周期，用女性性功能指数（FSFI）和简化SF-36表问卷，分别对性行为和生活质量(QoL)进行调查。使用女性性障碍量表(FSDS)来证明性功能障碍是否已经引起了明显的个人困扰。结果 与基础评分相比，第一次和第二次随访时FSFI和FSDS评分明显提高（p＜0.05）。QoL评分 的身体疼痛，一般健康和情绪评分在第一次随访时明显提高；第二次随访时各项评分均明显提高。结论 根据这些初步数据，扩展周期的阴道避孕环可能会改善性功能和提高妇女的生活质量。

A systematic review, psychometric analysis and qualitative assessment of generic preference-based measures of health in mental health populations and the estimation of mapping functions from widely used specific measures

Generic preference-based measures of health like the EQ-5D and SF-6D(®) are increasingly being used in economic evaluation and outcome assessment. However, there are concerns as to whether or not these generic measures are appropriate for use in people with mental health problems. The EQ-5D and SF-36(®) (including its derivatives the SF-12(®) and SF-6D) were assessed using the psychometric criteria of validity and responsiveness using quantitative and qualitative methods. Another aim was to estimate mapping functions between the EQ-5D and SF-6D and condition-specific measures, where appropriate. Four studies were undertaken to examine the appropriateness of the measures: (1) a systematic review of quantitative evidence on validity and responsiveness; (2) a further quantitative assessment of these criteria using existing data sets; (3) a review of qualitative research on the quality of life of people with mental health problems; and (4) qualitative semistructured interviews of people with a full range of problems. A fifth study estimated mapping functions between mental health-specific measures and the EQ-5D and SF-6D. A choice of venue was offered for the interviews including the participant's own home, a room at the university or a centre frequently used by mental health services. The interviews were undertaken with 19 people with a broad range of mental health problems at varying levels of severity. The reviews included the EQ-5D and SF-36 (and the SF-12 and SF-6D). The psychometric analysis included the Hospital Anxiety and Depression Scale (HADS), Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), Generalised Anxiety Disorder Assessment (GAD-7), General Health Questionnaire (GHQ-12) and Patient Health Questionnaire (PHQ-9). (1) and (2) The EQ-5D and SF-36 achieved an adequate level of performance in depression, and to some extent in anxiety and personality disorder. Results from the psychometric analyses in schizophrenia and bipolar disorder have been more mixed. (3) A framework analysis of 13 studies identified six major themes. (4) The interview data fitted the themes from the review well and resulted in minor modifications to the themes. The final set of themes comprised: well-being and ill-being; control, autonomy and choice; self-perception; belonging; activity; hope and hopelessness; and physical health. The EQ-5D and SF-36 achieved mixed results in the quantitative testing against psychometric criteria. The qualitative analysis suggests this is because they provide a very limited coverage of themes identified by people with mental health problems. Recommendations for future work include the development of new preference-based measures in mental health that are based on, or substantially revise, an existing measure. The Medical Research Council.

Poor Health, Strain, and Substance Use

Agnew’s general strain theory is widely recognized as one of the most prominent explanations of crime and deviance. Recently, scholars have conceptualized poor health as a type of strain that is related to both offending and substance use. The current research builds on this by examining data from the 2011 National Survey on Drug Use and Health and focuses on adult respondents. An index of poor health that included eighteen different diseases or conditions that were diagnosed by a doctor in the past year and a more general measure of overall health were created to measure health strain. Results from logistic regression models showed that health strain increased risk of psychological distress and that psychological distress significantly increased the risk of various types of substance use. These findings add to the growing literature on the relationship between poor health and crime/deviance and suggest that more research is needed.