General Population Participants Research Articles

Developing a preference-based utility scoring algorithm for the Psoriasis Area Severity Index (PASI)

Introduction: It is challenging to identify health state utilities associated with psoriasis because generic preference-based measures may not capture the impact of dermatological symptoms. The Psoriasis Area Severity Index (PASI) is one of the most commonly used psoriasis rating scales in clinical trials. The purpose of this study was to develop a utility scoring algorithm for the PASI.Methods: Forty health states were developed based on PASI scores of 40 clinical trial patients. Health states were valued in time trade-off interviews with UK general population participants. Regression models were conducted to crosswalk from PASI scores to utilities (e.g. OLS linear, random effects, mean, robust, spline, quadratic).Results: A total of 245 participants completed utility interviews (51.4% female; mean age = 45.3 years). Models predicting utility based on the four PASI location scores (head, upper limbs, trunk, lower limbs) had better fit/accuracy (e.g. R2, mean absolute error [MAE]) than models using the PASI total score. Head/upper limb scores were more strongly associated with utility than trunk/lower limb. The recommended model is the OLS linear model based on the four PASI location scores (R2 = 0.13; MAE = 0.03). An alternative is recommended for situations when it is necessary to estimate utility based on the PASI total score.Conclusions: The derived scoring algorithm may be used to estimate utilities based on PASI scores of any treatment group with psoriasis. Because the PASI is commonly used in psoriasis clinical trials, this scoring algorithm greatly expands options for quantifying treatment outcomes in cost-effectiveness analyses of psoriasis therapies. Results indicate that psoriasis of the head/upper limbs could be more important than trunk/lower limbs, suggesting reconsideration of the standard PASI scoring approach.

The Interaction with Disabled Persons Scale: translation and cross-cultural validation into Greek

Aim Cross-cultural adaptation of the Interaction with Disabled Persons Scale (IDPS) into Greek. Methods The IDPS was forward and back-translated by two bilingual physiotherapists and a Greek-English translator, respectively. Greek-speaking health professionals provided modifications in order to develop the final version of the Scale. Health professionals filled in the Greek version of the IDPS and the Caring Behaviors Inventory (for criterion validity). The factors of the Greek IDPS were extracted as well. After 8–10 days, the scale was re-distributed to the same health professionals (test–retest reliability) and to a general population sample (discriminant validity). Results Eighty-seven health professionals (36 ± 7.6 years) and 80 general population participants (44 ± 11.6 years) participated. There was a trend for the Greek IDPS variability to predict the variability of the Caring Behaviors Inventory (r 2 = 0.05; p = 0.054), but the coefficient of determination was low. An explanatory factor analysis extracted four factors explaining 66.66% of the total variance, confirmed by reliability analysis. The health care professionals had a significantly lower score than the general population in the Greek IDPS (mean difference: −11.0; confidence interval: −7.3 to −14.7), indicating familiarisation with the management of people with disability. The scale reliability and internal consistency were excellent; ICC(2,1) = 0.92 (confidence interval: 0.87–0.95) and Cronbach’s α = 0.96 respectively. No ceiling or floor effects were observed. Conclusions Substantial validity and reliability were observed for the Greek IDPS to assess Greek health professionals’ attitudes towards people with disabilities. Implications for rehabilitation The Greek IDPS version was shown to be comprehensible, and has demonstrated a sufficient amount of validity and reliability for assessing the perceptions and attitudes of Greek health professionals towards people with disabilities. Exploring attitudes towards people with disabilities in Greek-speaking populations, especially health professionals, with a scale such as the Greek IDPS is very important as it can help promote positive changes in approaches towards disability.

Health state utilities associated with attributes of migraine preventive treatments based on patient and general population preferences

PurposeWhile previous studies have estimated health state utilities associated with migraine severity and frequency, migraine treatments vary in other ways that may have an impact on patients’ quality of life, preference, and utility. The purpose of this study was to estimate utilities associated with migraine treatment attributes including route of administration and treatment-related adverse events (AEs).MethodsIn time trade-off interviews, migraine patients and general population participants in the UK valued health state vignettes drafted based on literature, medication labels, and clinician interviews. All respondents valued migraine health states varying in route of administration. Each participant also valued eight health states (randomly selected from a total of 15) that added the description of an AE to a migraine health state.ResultsA total of 400 participants completed interviews (200 general population [49.0% female; mean age = 43.6 years]; 200 migraine patients [74.5% female; mean age = 45.8 years]). In the general population sample, mean utilities of health states without aura were 0.79 with daily oral medication, 0.78 with one injection per month, and 0.72 with 31–39 injections once every 3 months. The greatest disutilities (i.e., decreases in utility) were for AEs associated with oral medications (e.g., − 0.060 [fatigue] and − 0.098 [brain fog]). Differences among health states followed the same pattern in the patient sample as in the general population sample.ConclusionsUtilities estimated from the general population sample may be used to represent route of administration and AEs in cost-utility models. Results from the patient sample indicate that these treatment characteristics have an impact on patient preference.

Health state utilities associated with post-surgical Staphylococcus aureus infections

IntroductionSurgical site infections (SSIs) are among the most common and potentially serious complications after surgery. Staphylococcus aureus is a virulent pathogen frequently identified as a cause of SSI. As vaccines and other infection control measures are developed to reduce SSI risk, cost-utility analyses (CUA) of these interventions are needed to inform resource allocation decisions. A recent systematic review found that available SSI utilities are of “questionable quality.” Therefore, the purpose of this study was to estimate the disutility (i.e., utility decrease) associated with SSIs.MethodsIn time trade-off interviews, general population participants in the UK (London, Edinburgh) valued health states drafted based on literature and clinician interviews. Health states described either joint or spine surgery, with or without an SSI. The utility difference between otherwise identical health states with and without the SSI represented the disutility associated with the SSI.ResultsA total of 201 participants completed interviews (50.2% female; mean age = 46.2 years). Mean (SD) utilities of health states describing joint and spine surgery without infections were 0.79 (0.23) and 0.78 (0.23). Disutilities of SSIs ranged from − 0.03 to − 0.32, depending on severity of the infection and subsequent medical interventions. All differences between corresponding health with and without SSIs were statistically significant (all p < 0.001).ConclusionThe preference-based SSI disutilities derived in this study may be used to represent mild and serious SSIs in CUAs assessing and comparing the value of vaccinations that may reduce the risk of SSIs.

Biased interpretation in perfectionistic concerns: an experimental investigation

ABSTRACTBackground and objectives: Perfectionism is associated with the development and maintenance of several disorders. Given the importance of perfectionism understanding the biased information processes that underpin it is critical. The present study tested the hypothesis that heightened concern over mistakes subscale scores of the Frost Multidimensional Perfectionism Scale are characterized by a tendency to impose emotionally negative interpretations on perfectionism-relevant situations.Method and design: Seventy-six non-clinical, general population participants’ were presented with interpretations of scenarios where a protagonist was described as achieving well above what was required, but fell short of their own high standard. Using a within-subjects, quasi-experimental design, we assessed interpretations of these scenarios by examining the degree to which participants rated test sentences as being likely implications of the original scenarios.Results: A generalized linear mixed model revealed higher concern over mistakes scores were associated with an increased tendency to rate negative target test sentences as being similar to the original perfectionism-relevant scenarios, and a reduced tendency to rate positive target test sentences as being similar to these original scenarios.Conclusions: The findings provide support for the cognitive–behavioral model of perfectionism. These findings support the inclusion of strategies in cognitive–behavioral treatment of perfectionism to reduce interpretation bias.

Prevalence and characteristics of psoriasis in Denmark: findings from the Danish skin cohort

BackgroundWide-ranging psoriasis prevalence estimates have been reported, possibly due to methodological differences.ObjectivesTo assess the prevalence of psoriasis in Denmark and to validate the use of questionnaire-based data to identify patients...

Postural Abnormality in Parkinson's Disease: A Large Comparative Study With General Population.

Postural abnormalities in Parkinson's disease (PD) patients and unimpaired elderly are not well differentiated. Factors related to postural abnormality associated with PD are controversial. We assessed differences in postural change between PD patients and unimpaired elderly and elucidated factors related to abnormal posture in PD patients. We measured the dropped head angle (DHA), anterior flexion angle (AFA), and lateral flexion angle (LFA) of the thoracolumbar spine of an unprecedented 1,117 PD patients and 2,732 general population participants (GPPs) using digital photographs. Two statistical analyses were used for elucidating factors related to these angles. In GPPs, age was correlated with DHA, AFA, and LFA. DHAs, AFAs, and LFAs of PD patients and age-matched GPPs were 21.70° ± 14.40° and 13.13° ± 10.79°, 5.98° ± 12.67,°and - 3.82° ± 4.04°, and 0.86° ± 4.25° and 1.33° ± 2.16°, respectively. In PD patients, factors related to DHA were age, male sex, and H & Y stage during ON time. Factors related to AFA were age, duration of disease, H & Y stage during ON and OFF times, pain, vertebral disease, and bending to the right. A factor related to LFA was AFA. DHA and AFA of GGPs correlated with age and were larger in PD patients than those with in GPPs. Some PD patients showed angles far beyond the normal distribution. Thus, factors associated with disease aggravation affected postural abnormality in PD patients.

Dual sensory impairment among a cohort of older adults living in Ireland: A nested case-control study of the Irish Longitudinal Study on Ageing cohort

Background: Little information is available on the implications of hearing loss, visual impairment and dual sensory impairment among older adults with an intellectual disability (ID) living in Ireland and this paper aims to address the health concerns associated with sensory impairment among this population. Methods: A representative sample of 753 persons aged 40 years and older at all levels of ID and full range of residential circumstances from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA) participants were matched with general older population TILDA participants on age, sex and geographic location within Ireland. Demographic data on samples included age, sex, visual impairment (yes/no), hearing impairment (yes/no) and dual sensory impairment (yes/no). For those with intellectual disability (ID) data was also gathered on level of intellectual disability, residence, needing assistance with activities of daily living (ADL) and instrumental activities of daily living, self-rated health, loneliness, doctor’s diagnosis of endocrine disease and of dementia and doctor’s report of two or more chronic health conditions. Bivariate analysis of associations between visual, hearing and dual sensory impairment with the measures of physical and mental health was completed and logistic regression analysis to generate adjusted odds ratios for associations between sensory impairment and physical and mental health conditions. Results: As compared to the matched general population participants, in participants with ID dual sensory impairment was more often associated with poor self-rated health, limitations with two or more ADLs, loneliness and multimorbidity. People with ID were 4.4 times more likely to be multimorbid if they were visually impaired compared with an odds ratio of 2.4 in TILDA participants. Conclusion: Previous studies found significant associations between hearing and visual impairment among older populations. Analysis here also suggests the burden of sensory impairment increases both with ID and then with level of ID

PND122 - HEALTH STATE UTILITIES ASSOCIATED WITH FAMILIAL CHYLOMICRONEMIA SYNDROME (FCS), A RARE GENETIC DISORDER

Familial Chylomicronemia Syndrome (FCS) is a rare genetic disorder resulting in increased triglyceride levels, which often leads to pancreatitis, fatty deposits on the skin, abdominal pain, fatigue, and impaired cognition. There are no currently approved therapies for FCS, but treatments are in development. As treatments are introduced, cost-utility analyses will be needed to examine their value, and these models will require health state utilities representing FCS. Therefore, the purpose of this study was to estimate utilities for various severity levels of FCS and an associated episode of acute pancreatitis. In time trade-off interviews, general population participants in the United Kingdom valued five health state vignettes drafted based on literature review, clinician input, and interviews with patients with FCS. Four health states described variations of FCS (high or low triglycerides, with or without history of acute pancreatitis [AP]). The fifth health state, describing an acute pancreatitis episode, was added to one of the other health states to evaluate its impact on utility. A total of 208 participants completed interviews (50.0% male; mean age = 45.5y; 105 from London; 103 from Edinburgh). Mean (SD) utilities were 0.80 (0.21) for low triglyceride levels without history of AP, 0.74 (0.23) for low triglycerides with history of AP, 0.60 (0.33) for high triglycerides without history of AP, and 0.46 (0.42) for high triglycerides with history of AP. The disutility (i.e., utility decrease) of AP was -0.25 when added the low triglyceride health state and -0.20 when added to the high triglyceride health state. Among these FCS health states, symptoms typically linked to higher triglycerides and history of AP were associated with lower utility. The health state utilities estimated in this study would be useful in models examining cost-effectiveness of treatments for FCS.

Anxiety and Depression among Hypertensive Outpatients in Afghanistan: A Cross-Sectional Study in Andkhoy City.

There is a relationship between mental and physical health. Depression and anxiety are linked with the development of several chronic diseases. The purpose of the present study was to determine the prevalence and factors associated with anxiety and depression among adult hypertensive outpatients in Afghanistan. Methods. Two hundred thirty-four consecutive hypertensive patients from December 2015 to August 2016 were recruited to complete the Hospital Anxiety and Depression Scale (HADS) questionnaire, which has scores for classifying the participants having anxiety and depression symptoms. Results. Of the total 234 patients, 81 (34.6%) were males and 153 (65.4%) were females. The mean age was 54.6 ± 12.7 for the hypertensive patients with anxiety and 63.8 ± 15.0 for the hypertensive patients with depression while this figure was 49.5 ± 10.2 for the adult participants in general population in Kabul city (Saeed, 2013). The prevalence of anxiety and depression (42.3% vs. 58.1%) among hypertensive persons is compared with the same mental disorders among Afghan refugees (39.3% vs. 22.1%) in Dalakee Refugee Camp (in Iran) (Hosseini Divkolaye and Burkle, 2017). Of the total participants, 99 had anxiety (42.3%), 136 had depression (58.1%), and 66 had (28.2%) comorbid anxiety-depression. Multivariate analysis was used. For anxiety age, female gender, smoking, diabetes mellitus, and 2 or more chronic diseases had a significant association. For depression, age and diabetes mellitus had a significant association, and for comorbid anxiety, depression, age, diabetes mellitus, and 2 or more chronic diseases had a significant association. Conclusion. This study shows that anxiety and depression are highly prevalent among hypertensive patients in an outpatient clinic in Afghanistan. There was an association between some sociodemographic and clinical characteristics and anxiety and depression. More studies are needed on a national level to inform the development of strategies for the prevention and control of psychological distress among patients with chronic diseases in Afghanistan.

Which Spanish Living Kidney Donors Fear Post Donation Kidney Failure?

PI15/00550 - Characterization of the fear of kidney failure in the living kidney donor. Background The impact of fearing the failure of the non-donated kidney is unknown in Spanish donors. For this reason, we aimed at assessing the validity of the Spanish version of the Fear of Kidney Failure Questionnaire (FKF), along with characterizing living donors with higher fear of kidney failure. Methods 205 living kidney donors (LKDs) were randomly selected and stratified by year of donation (2005-2015). 139 general population participants without history of, or a current renal disease and/or without first-degree relatives suffering a renal disease were recruited as comparison group. Reliability of the FKF was assessed. The FKF criterion validity was evaluated by calculating its linear relationship with anxiety, depression, and fear-related personality dimensions. Divergent validity was verified by assessing whether the FKF was unrelated to personality dimensions non-relevant for fear states. LKDs were grouped by Cluster Analysis of the FKF scores. Clusters were compared on demographic and clinical variables to describe those LKDs with higher scores in the FKF, which were further characterized by calculating the most specific logistic regression model. Results The internal consistency of the FKF was acceptable for the whole sample (α=0.95), and the LKDs (α=0.91) and general population (α=0.94) subsamples. Temporal stability of the FKF was acceptable (ICC=0.93). Factor analysis showed that the FKF was composed by a single factor explaining 83.5% of variance. Both for the whole sample and the LKDs and general population subsamples, the FKF was positively correlated with depressive and anxiety symptoms, and neuroticism (convergent validity). The FKF was unrelated to extroversion, openness to experience and conscientiousness (divergent validity). Fear of Kidney Failure in the general population subsample almost doubled the mean of the LKDs subsample. The FKF Cluster Analysis classified LKDs in three groups: absence of fear (68%), moderate fear (20%), and high fear of kidney failure (12%). Groups did not differ in demographics or donation outcomes. No differences were observed between groups in regret for having donated. However, higher FKF scorers were somewhat less satisfied with the experience of donation. This subgroup also showed a higher percentage of potential cases of depressive (16%) and anxiety disorders (20%), a worse quality of life, and higher scores in neuroticism. A higher percentage of these donors (20%) were followed both by the Nephrologist and the Family Doctor. Multivariate logistic regression showed that, once controlled the effect of presenting a potential depressive or anxiety disorder, FKF higher scorers were best characterized by higher scores in neuroticism. Conclusions Post donation fear of kidney failure is infrequent in Spanish LKDs. However, a subgroup of them, best characterized by a higher neuroticism, shows elevated FKF scores, a worse quality of life, and might present with anxiety and depressive disorders. This work has been funded by the project PI15/00550, integrated in the Plan Nacional I+D+I and co-funded by ISCIII-Subdirección General de Evaluación and European Regional Development Fund (ERDF).

Health State Utilities Associated with Attributes of Weekly Injection Devices and Subdermal Implant for Treatment of Type 2 Diabetes

Cost-utility analyses include health utilities to compare medical treatments. Health utilities, ranging from 0 to 1, represent the strength of a patient’s preference for a drug profile or health-related outcome. Recently glucagon-like peptide-1 (GLP-1) receptor agonists have been used for management of glycemic control in type 2 diabetes (T2DM). Many GLP-1 drugs have similar modes of administration. In contrast, ITCA 650 is an investigational product which is an implantable device that, following subdermal placement, provides continuous delivery of exenatide for 3 or 6 months. The study’s purpose was to estimate health utilities associated with treatment processes of GLP-1s for use in economic models. During a UK-based pilot study, 19 general population (general population) participants completed time trade-off (TTO) interviews to value health states (often called vignettes or scenarios) which were based on literature review, instructions for use, and clinician interviews. A follow-up pilot study was conducted in both general population and T2DM participants to value modified health states. Participants were recruited to ensure equal distribution across gender and education levels. A total of 20 general population and 18 T2DM patients completed face-to-face interviews (general population mean age= 50.7; T2DM mean age = 56.2). Mean utilities (SD) for ITCA-650 were 0.93 (0.06) for T2DM patients and 0.91 (0.11) for the general population. Mean utility scores for injection health states ranged from 0.83-0.92 for T2DM and 0.82-0.91 for general population. Results are higher than others found in the literature for diabetes treatment processes (range: 0.85 to 0.88). A main study with 200 participants will be conducted in early 2018. Results may be useful in cost-utility models comparing the value of treatment processes for patients with T2DM. Findings suggest the TTO method may be used to quantify preferences among different treatment processes. Disclosure A.M. Rentz: Other Relationship; Self; Intarcia Therapeutics, Inc., Servier. K. Cutts: None. K. Washington: None. M. Beillat: None. K. Yu-Isenberg: Employee; Self; Intarcia Therapeutics, Inc..

N-Terminal Pro-B-Type Natriuretic Peptide Is Not a Significant Predictor of Stroke Incidence After 5 Years - The Ohasama Study.

N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been used for risk stratification in heart failure or acute coronary syndrome, but the beyond 5-year predictive value of NT-proBNP for stroke remains an unsettled issue in Asian patients. The aim of the present study was to clarify this point.Methods and Results:We followed 1,198 participants (33.4% men; mean age, 60.5±11.1 years old) in the Japanese general population for a median of 13.0 years. A first stroke occurred in 93 participants. Referencing previous reports, we stratified participants according to NT-proBNP 30.0, 55.0, and 125.0 pg/mL. Using the NT-proBNP <30.0 pg/mL group as a reference, adjusted HR for stroke (95% CI) in the NT-proBNP 30.0-54.9-pg/mL, 55.0-124.9-pg/mL, and ≥125.0-pg/mL groups were 1.92 (0.94-3.94), 1.77 (0.85-3.66), and 1.99 (0.86-4.61), respectively. With the maximum follow-up period set at 5 years, the hazard ratio of the NT-proBNP≥125.0-pg/mL group compared with the <30.0-pg/mL group increased significantly (HR, 4.51; 95% CI: 1.03-19.85). On extension of the maximum follow-up period, however, the association between NT-proBNP and stroke risk weakened. NT-proBNP was significantly associated with an elevated stroke risk. Given, however, that the predictive power decreased with the number of years after NT-proBNP measurement, NT-proBNP should be re-evaluated periodically in Asian patients.

The Prevalence of Attention Deficit/Hyperactivity Disorder (ADHD) Among Adolescents in Stationary Rehabilitation

ADHD in adulthood is assumed to be a positive predictor for many comorbid diseases and impairments affecting all domains of life, particularly career performance. Participation in social and professional life is limited for populations which qualify for rehabilitation programs, and thus the prevalence of ADHD is presumably also higher in these populations. To estimate the prevalence of ADHD in a population undergoing rehabilitation, 1010 people aged 18 to 75 years were screened for the presence of ADHD in adulthood. Additional impairments were measured and compared to a group of non ADHD participants. As expected a higher prevalence of ADHD was found in the population undergoing rehabilitation than in the general population (10.5%) Participants with ADHD who had recently begun rehabilitation seemed to have more impairments than non ADHD-participants. Participants with ADHD who were near the end of rehabilitation were more severely impaired in their capacity to reintegrate into their previous occupation, but not for the general employment market. Adult ADHD should be more closely investigated, especially in rehabilitation programs. Affected clients not only had more severe impairments, but more often had a profession that did not fit their capability.

Physical employment standard for Canadian wildland firefighters: examining test–retest reliability and the impact of familiarisation and physical fitness training

To assess the impact of repeat performances (familiarisation) plus exercise training on completion time for the Ontario Wildland Firefighter (WFF) Fitness Test circuit (WFX-FIT), normally active general population participants (n = 145) were familiarised to the protocol then randomised into (i) exercise training, (ii) circuit only weekly performances or (iii) controls. At Baseline, the WFX-FIT pass rate for all groups combined was 11% for females and 73% for males, indicating that the Ontario WFX-FIT standard had a possible adverse impact on females. Following test familiarisation, mean circuit completion times improved by 11.9% and 10.2% for females and males, respectively. There were significant improvements in completion time for females (19.8%) and males (16.9%) who trained, plus females (12.2%) and males (9.8%) who performed the circuit only, while control participants were unchanged. Post training, the pass rate of the training group was 80% for females and 100% for males.Practitioner Summary: This paper details the impact of familiarisation plus exercise training as accommodation to mitigate potential adverse impact on initial attack wildland firefighter test performance. The results underscore the importance of test familiarisation opportunities and physical fitness training programmes that are specific to the demands of the job.

Criterion Validity of the German Version of the CES-D in the General Population

The "Center of Epidemiologic Studies - Depression scale" (CES-D) is a well-known screening tool for depression. Until now the criterion validity of the German version of the CES-D was not investigated in a sample of the adult general population. 508 study participants of the Austrian general population completed the CES-D. ICD-10 diagnoses were established by using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Receiver Operating Characteristics (ROC) analysis was conducted. Possible gender differences were explored. Overall discriminating performance of the CES-D was sufficient (ROC-AUC 0,836). Using the traditional cut-off values of 15/16 and 21/22 respectively the sensitivity was 43.2 % and 32.4 %, respectively. The cut-off value developed on the basis of our sample was 9/10 with a sensitivity of 81.1 % und a specificity of 74.3 %. There were no significant gender differences. This is the first study investigating the criterion validity of the German version of the CES-D in the general population. The optimal cut-off values yielded sufficient sensitivity and specificity, comparable to the values of other screening tools.

Risks associated with antiretroviral treatment for human immunodeficiency virus (HIV): qualitative analysis of social media data and health state utility valuation

PurposeDespite benefits of antiretroviral therapies (ART), people with HIV infection have increased risk of cardiovascular disease, kidney disease, and low bone mineral density. Some ARTs increase risk of these events. The purpose of this study was to examine patients’ perspectives of these risks and estimate health state utilities associated with these risks for use in cost-utility models.MethodsQualitative thematic analysis was conducted to examine messages posted to the POZ/AIDSmeds Internet community forums, focusing on bone, kidney, and cardiovascular side effects and risks of HIV/AIDS medications. Then, health state vignettes were drafted based on this qualitative analysis, literature review, and clinician interviews. The health states (representing HIV, plus treatment-related risks) were valued in time trade-off interviews with general population participants in the UK.ResultsQualitative analysis of the Internet forums documented patient concerns about ART risks, as well as treatment decisions made because of these risks. A total of 208 participants completed utility interviews (51.4% female; mean age 44.6 years). The mean utility of the HIV health state (virologically suppressed, treated with ART) was 0.86. Adding a description of risk resulted in statistically significant disutility (i.e., utility decreases): renal risk (disutility = −0.02), bone risk (−0.03), and myocardial infarction risk (−0.05).ConclusionsPatient concerns and treatment decisions were documented via qualitative analysis of Internet forum discussions, and the impact of these concerns was quantified in terms of health state utilities. The resulting disutilities may be useful for differentiating among ARTs in economic modeling of treatment for patients with HIV.

Spanish Validation of the Flourishing Scale in the General Population

Well-being research and its measurement have grown in the last two decades. The objective of this study was to adapt and validate the Flourishing Scale in a sample of Spanish adults. This was a cross-sectional study using a non-probabilistic sample of 999 Spanish general adult population participants. The psychometric properties of the scale were analysed from an exploratory and confirmatory perspective. Exploratory factor analysis showed a one-factor solution explaining 42.3% of the variance; an internal consistency of .846; temporal reliability correlation of .749; convergent validity with the Satisfaction with Life Scale of .521 and criterion validity with positive and negative affect (PANAS), pessimism and optimism (LOT-R) ranging from .270 to .488. Confirmatory factor analysis testing the one-factor solution showed a χ2 of 65.57 df = 20; CFI of .982, RMSEA of .06, average variance extracted index of .518 and composite reliability index of .841. Results showed that the Spanish version of the FS is a reliable and valid method for measuring high levels of well-being.

Abstract P177: Self-Reported Blood Pressure is Comparable to Measured Blood Pressure in a Study of General Population Participants

Background: Blood pressure (BP) is an established risk factor for several chronic diseases. Clinical measurement of BP is the preferable method to assess BP, but may not be feasible in large-scale epidemiologic studies. Self-reported BP has been widely collected as an alternative. It has not been well-studied whether self-reported BP is comparable to measured BP, particularly in the general population. Method: We conducted a cross-sectional analysis in a large, mail-based randomized controlled trial - VITamin D and OmegA-3 TriaL (VITAL) - to compare BP levels assessed using different methods. Participants of VITAL were women aged ≥55 years and men aged ≥50 years, free of cardiovascular disease and cancer. Among a total of 21,025 VITAL participants who reported BP in multiple categories on the baseline questionnaire, 1,955 also had seated BP measured at baseline clinic-based or home-based visits, and 269 also completed assessment of 24 hour ambulatory BP (24-hr ABP) monitoring. We included 264 VITAL participants who had all three BP measures in analysis, converted the self-reported BP levels to ordinal variable by using the median of each category, and examined the associations between the different BP measurements with estimation of correlation and linear regression. Results: The 264 VITAL participants were on average aged 63.8 years, 59% women, 23.5% African-Americans, 54.9% with post-college education, and 6.4% with a history of hypertension. The mean (SD) of self-reported BP, seated BP, and 24-hr ABP were 120.1 (9.1), 120.2 (12.5), and 128.2 (11.3) mmHg for systolic BP (SBP) and 73.0 (6.3), 72.3 (9.8), and 76.9 (7.9) mmHg for diastolic BP (DBP), respectively. Spearman correlation coefficients (Spearman r) between BP measured using three different methods ranged from 0.37 (self-reported vs. seated) to 0.49 (seated vs. 24-hr ambulatory) for SBP and from 0.30 (seated vs. 24-hr ambulatory) to 0.34 (self-reported vs. seated) for DBP (all P&lt;0.0001). The age-adjusted regression coefficients (β coefficients) and 95% confidence intervals (CI) of self-reported BP in relation to measured BP were 0.55 (95% CI: 0.39-0.71) and 0.33 (95% CI: 0.15-0.51) for seated SBP and DBP, and 0.47 (95% CI: 0.33-0.61) and 0.46 (95% CI: 0.32-0.60) for 24-hr ambulatory SBP and DBP, respectively. The β coefficients of seated BP in relation to 24-hr ABP were also statistically significant, of 0.42 (95% CI: 0.33-0.52) and 0.19 (95% CI: 0.10-0.29) for 24-hr ambulatory SBP and DBP, respectively. The β coefficients were generally similar across subgroups of participants by age, gender, and ethnicity, and were consistently stronger among those with higher education. Conclusion: In this large, mail-based study of older men and women from general US population, self-reported BP correlates reasonably well with both seated BP and 24-hr ABP. Self-reported BP can be used to estimate measured BP in large-scale epidemiologic studies.

A Content Analysis of Psychological Resilience Among First Responders and the General Population

The current study examined how first responders and the general population described the concept of resilience. Categories of resilience were coded a priori using Stemler’s content analysis. For the general population, positive coping was the most frequently occurring category followed by social support and adaptability. The next most frequently occurring terms were societal resources and personal competence. Consistent with the general population, first responders described resilience most frequently with positive coping. Social support was the next most frequently occurring category, followed by personal competence, perseverance, emotional regulation, and physical fitness. Although both the general population and first responder participants highlighted the importance of having a support network, first responders suggested that dealing with traumatic experiences was more of an individual process, and seeking professional help was not common practice. Implications for mental health professionals and future directions for research are offered.