Healthier Group Research Articles

Association between a lifestyle score and all-cause mortality: a prospective analysis of the Chilean National Health Survey 2009-2010.

To investigate the association between a lifestyle score and all-cause mortality in the Chilean population. Prospective study. The score was based on seven modifiable behaviours: salt intake, fruit and vegetable intake, alcohol consumption, sleep duration, smoking, physical activity and sedentary behaviours. 1-point was assigned for each healthy recommendation. Points were summed to create an unweighted score from 0 (less healthy) to 7 (healthiest). According to their score, participants were then classified into: less healthy (0-2 points), moderately healthy (3-4 points) and the healthiest (5-7 points). Associations between the categories of lifestyle score and all-cause mortality were investigated using Cox proportional hazard models adjusted for confounders. Nonlinear associations were also investigated. 2706 participants from the Chilean National Health Survey 2009-2010. After a median follow-up of 10·9 years, 286 (10·6 %) participants died. In the maximally adjusted model, and compared with the healthiest participants, those less healthy had 2·55 (95 % CI 1·75, 3·71) times higher mortality risk due to any cause. Similar trends were identified for the moderately healthy group. Moreover, there was a significant trend towards increasing the mortality risk when increasing unhealthy behaviours (hazard ratio model 3: 1·61 (95 % CI 1·34, 1·94)). There was no evidence of nonlinearity between the lifestyle score and all-cause mortality. Individuals in the less healthy lifestyle category had higher mortality risk than the healthiest group. Therefore, public health strategies should be implemented to promote adherence to a healthy lifestyle across the Chilean population.

Association between urology practice use of multiparametric MRI and genomic testing and treatment of men with newly diagnosed prostate cancer

IntroductionBiomarkers for prostate cancer, such as multiparametric MRI (mpMRI) and tissue-based genomics, are increasingly used for treatment decision-making. Using biomarkers indiscriminately and thus ignoring competing risks of mortality may lead to treatment in some men who derive little clinical benefit. We assessed the relationship between urology practice use of biomarkers and subsequent treatment in men with newly diagnosed prostate cancer. MethodsWe used a 20% random sample of national Medicare data to perform a retrospective cohort study of men with newly diagnosed prostate cancer diagnosed from 2015 through 2019. Urology practice-level use of biomarkers was characterized based on urology practice propensity to use either biomarker after diagnosis (never, below median, above the median). Noncancer mortality risk within 10 years of diagnosis was calculated for all men. Multilevel models were used to assess the relationship between practice-level biomarker use and treatment by noncancer mortality risk. ResultsBetween 2015 and 2019, 1,764 (65%) urology practices used mpMRI and 897 (33%) used genomic testing for prostate cancer. Compared with urology practices never using each biomarker, those using mpMRI above the median (56% vs. 47%, P = 0.003) and tissue-based genomics below the median (56% vs. 50%, P = 0.03) were more likely to treat men with >75% risk of noncancer mortality. Additionally, compared with urology practices never using either biomarker, use of mpMRI (72% vs. 69%, P = 0.07) or tissue-based genomics (71% vs. 70%, P = 0.65) did not impact treatment in the healthiest group (i.e., those with <25% risk of noncancer mortality). ConclusionsCompared to practices that do not use each biomarker in men with newly diagnosed prostate cancer, urology practices using mpMRI, and tissue-based genomics to a lesser extent, are more likely to treat men at very high risk of dying from competing risks of mortality within 10 years of prostate cancer diagnosis.

Correlation Analysis of Attention and Intelligence of Preterm Infants at Preschool Age: A Premature Cohort Study

Developmental delay in neurocognitive function has been reported in premature children. This cohort study prospectively followed preterm infants following birth, and herein we present the four-year longitudinal follow-up data of cognitive development at preschool age and analyze correlated factors. Term and preterm children received regular clinical evaluations and development assessments after birth, and at age 4 ± 1 years, they received the Wechsler-preschool and primary scale of intelligence, Fourth Edition (WPPSI-IV), excluding those with full-scale intelligence quotient < 70. A total of 150 participants received Conners Kiddie Continuous Performance Test (K-CPT), while 129 participants received ophthalmic evaluation. We adopted Chi-square test, ANOVA, and post hoc analysis to compare group differences. Correlations with K-CPT and WPPSI-IV were analyzed using Pearson's correlation. Group 1 consisted of 25 full-term children, group 2 had 94 preterm children with birth-weight of ≥ 1500 g, and group 3 had 159 preterm children with birth-weight of < 1500 g. Group 1 was the healthiest group and had the best performance in attention and intelligence, while group 3 had the worst physical condition and cognitive performance. The correlation analysis revealed that perinatal factors, including gestational age, birth weight, Apgar scores, and physical conditions, significantly correlated with WPPSI-IV and K-CPT variables. Gender significantly correlated with object assembly of WPSSI-IV and clinical index of K-CPT. Among vision-related variables, best corrected visual acuity correlated most with K-CPT, including clinical index, Omission, and hit reaction time standard error of K-CPT, as well as significantly correlated with information and bug search of WPPSI-IV. Preterm children at preschool age still had poorer cognitive performance than full-term children, especially those with birth BW less than 1500 g. Gender and vision are correlated with cognitive deficits. Continuous monitoring with comprehensive assessments is recommended.

The association between healthy aging index and trajectories of disability: a population-based cohort study.

Healthy aging index (HAI) could predict adverse health consequences including mortality and disability independent of age and comorbidity. We investigated the role of HAI on trajectories of disability throughout later life based on a nationally representative sample. We examined 1733 participants aged over 60years from the China Health and Retirement Longitudinal Study (CHARLS) followed for 7years/4 waves repeatedly. Systolic blood pressure [SBP], cognitive function, cystatin C, peak expiratory flow [PEF], and fasting glucose were categorized using tertile or clinical reference range, and scored as 0 (healthiest), 1 (less healthy) and 2 (least healthy) respectively to further generate HAI summary scores (range 0-10). Disability was defined as the sum of impaired activities of daily living (ADL) and instrumental activities of daily living (IADL). We used linear mixed-effects model to study the association between HAI and trajectories of disability. A total of 10.5% of participants represented in the healthiest group and 22.5% ended up as the least healthy. After adjusting for all potential confounders, disability progression was significantly faster (β = 0.27, 95% CI 0.11-0.42) in the least healthy group when comparing with the healthiest. Our findings suggest that HAI is associated with disability progression among adults aged over 60years old. It might be beneficial for future interventions to specifically target older adults with high HAI scores as a means of reducing disability.

Topical timolol enhances surgical wound healing in the lower portion of the leg in older patients with comorbidities: A retrospective review

Topical timolol enhances surgical wound healing in the lower portion of the leg in older patients with comorbidities: A retrospective review

Vaginal Cuff Dehiscence Among Gender Diverse Persons

<h3>Study Objective</h3> To compare the risk of vaginal cuff dehiscence (VCD) following total hysterectomy among gender diverse (GD) persons and cisgender women (CW) and to identify factors associated with VCD. <h3>Design</h3> This is a retrospective cohort study among adults who underwent total hysterectomy for benign indications between 2014 and 2018 with at least 6-months of postoperative follow-up. <h3>Setting</h3> All surgeries were performed within an integrated closed healthcare delivery system. <h3>Patients or Participants</h3> Adult subjects who underwent non-emergent total hysterectomy for benign indications were included. Subjects who underwent subtotal hysterectomy, concomitant vaginectomy, and hysterectomy for obstetric or oncologic indications were excluded. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> The 18,151 cohort was comprised of 282 (1.6%) GD and 17,869 (98.4%) CW. Compared to the CW group, the GD group was significantly younger (30.8 vs 48.2 years, <i>P</i><0.01) and healthier (Charlson Comorbidity Index≥1 was 5.3% vs 10.4%, <i>P</i><0.01). Hysterectomies among GD had lower blood loss (61.4 vs 128.8 mL, <i>P</i><0.01) and lower rates of perioperative wound infection (0.4% vs 0.7%, <i>P</i><0.01). The overall rate of VCD was 3.9% in the GD group and 2.5% in the CW group (<i>P</i>=0.13). In bivariate analysis, identifying as GD was not a significant risk factor for VCD (OR 1.60, 95%CI 0.87-2.95), whereas hypertension (OR 1.43, 95%CI 1.17-1.74) and laparotomy relative to laparoscopy (OR 1.78, 95%CI 1.22-2.58) were significantly associated with VCD. <h3>Conclusion</h3> VCD is a rare postsurgical complication, and a 1.6-fold increased, non-significant risk among a younger, healthier group with less intraoperative blood loss and fewer post-surgical infections suggests that our findings may represent a clinically significant difference. Hypertension and route of hysterectomy were found to be associated with VCD. We plan to analyze the data using multivariable analyses to control for confounders. We also plan to examine relationship between VCD and gender-affirming use of systemic testosterone by GD persons as a potential explanation for this clinical discrepancy in VCD.

Child Euthanasia and the Church

The creeping expansion of euthanasia around the world, but especially in the West, is a concern for any moral theologian. This expansion has already reached beyond the elderly into younger and objectively healthier groups, including children. The stance of the Catholic Church is that euthanasia is never permissible and must combat philosophies and laws that support it as fervently as possible.

Effect of nutritional status on cognitive function in adolescents

Background: Adolescents are considered to be the healthiest group among the entire population. However, due to fast food obsession, the nutritional habits of adolescent generation are changing and are unable to meet the increased nutrient requirement per unit body weight. Thus, adolescents are facing weight problems, that is, overweight/normal weight/underweight, but undernourished. Aims and Objectives: The aims of the study were (1) to assess the nutritional status using anthropometric measurements in the adolescents and (2) to correlate the anthropometric measurements with their cognitive performance. Materials and Methods: A total of 281 adolescents, height (cm), weight (Kg), and waist circumference (cm) were measured. Using these parameters, the body mass index (BMI) and waist-to-height ratio (WTHR) were calculated. Cognitive function test was carried out using Raven’s Progressive Matrices (RPM). Statistical analysis was done using Pearson correlation coefficient and Fisher’s exact type of Chi-square. Results: The gender and age distribution in the study population were not statistically significant. Gender-wise distribution of the WTHR, the BMI, and the standard RPM of the study population was statistically significant. Relation between BMI, WTHR, and RPM percentiles was not statistically significant, but regardless of the weight status, the scores were between the 25th and 50th percentile. Conclusion: With fast changing food habits among the adolescents, along with students, parents and teachers must also be made aware of importance of food containing all essential nutrients in optimum amounts for better cognitive functioning of the adolescent brain, and not merely focus on physically visible parameters such as weight and height.

Sex-specific risks of death in patients hospitalized for hyponatremia: a population-based study

PurposeSeveral studies have reported an association between hyponatremia and lethality. However, it remains elusive whether hyponatremia independently contributes to lethality. The aim of the study was to investigate associations between hyponatremia and lethality and differences in lethality between men and women hospitalized due to hyponatremia.MethodsFour registries were utilized in this population-based retrospective study: The National Patient Registry, the Cause of Death Register, the Swedish Prescribed Drug Register and the Total Population Register (NPR) from which the controls were sampled. All hospitalized patients with a first-ever principal ICD10 diagnosis of hyponatremia or syndrome of inappropriate ADH secretion in the NPR between 1 October 2005 and 31 December 2014 were defined as cases. Cox regression with adjustment for potential confounders was used.Results14,359 individuals with a principal diagnosis of hyponatremia, and 57,382 matched controls were identified. Median age was 76 years and the majority were women (72%). Median age for women and men was 79 and 68 years, respectively. Adjusted hazard ratios (and 95% CI) for lethality in those with hyponatremia compared with controls were for the entire population 5.5 (4.4–7.0) and in the subgroup free from previously known underlying disease 6.7 (3.3–13.3). Lethality in women with hyponatremia was lower compared with men: HR: 0.56 (0.49–0.64). In the healthier group the lethality remained lower for women: HR: 0.49 (0.34–0.71).ConclusionsPatients hospitalized due to hyponatremia faced an increased subsequent lethality that was independent of concomitant disease. This increase was nearly twice as large among men compared with women.

Multiple Health Behaviors Engagement in an African American Cohort: Clustering Patterns and Correlates.

We investigated class clustering patterns of four behaviors-physical activity, fruit and vegetable (F&V) intake, smoking, and alcohol use-in a faith-based African American cohort. Guided by socio-ecological models, we also examined the psychosocial and neighborhood social environmental factors associated with the clustering patterns. Participants were 1,467 African American adults recruited from a mega church in the metropolitan Houston, TX, in 2008-2009. They completed a survey and health assessment. Latent class analysis and multinomial regression analysis were conducted. Results supported a three-class model: Class 1 was characterized by low physical activity, low F&V intake, and low substance use (smoking and alcohol use). Class 2 was characterized by high physical activity, low F&V intake, and mild drinking. Class 3 seemed to be the healthiest group, characterized by high physical activity, moderate-to-high F&V intake, and low substance use. The probabilities of being included in Classes 1, 2, and 3 were .33, .48, and .19, respectively. Participants in Class 1 (vs. Class 3) reported lower physical activity norm ( p < .001) and higher smoking norm ( p = .002) and lower neighborhood social cohesion ( p = .031). Participants in Class 2 (vs. Class 3) reported higher cancer risk perception ( p < .001), lower F&V norm ( p = .022), lower physical activity norm ( p < .001), higher smoking norm ( p < .001), and lower social cohesion ( p = .047). As health behaviors are clustered together, future interventions for African Americans may consider targeting multiple health behaviors instead of targeting a single health behavior. Interventions addressing social norm and neighborhood social cohesion may enhance multiple health behaviors engagement in this population.

How Does Delayed Retirement Affect Mortality and Health?

Older Americans have been retiring later for a number of reasons, including jobs that are becoming less physically demanding, the shift from defined benefit to defined contribution pensions, and changes in Social Security’s incentives. What are the implications of working longer for workers’ mortality and health? Answering this question is complicated, because work and health are jointly determined – healthy people with lower mortality tend to work longer. Previous studies looking at the causal effect of work on mortality and health have found mixed results and have tended to focus on the effects of early retirement, not delayed retirement. A simple assumption would be that the relationship between them is symmetric. But it is unclear that that assumption is correct – after all, people who decide to keep working are likely a healthier group than those who stop early. This paper uses administrative data from the Netherlands and exploits policy variation designed to delay retirement to explore the links between work and health outcomes.

Comparative Effectiveness of Prostate Cancer Treatment Options: Limitations of Retrospective Analysis of Cancer Registry Data

Retrospective analyses of cancer registry and institutional data have consistently found better survival after radical prostatectomy versus radiation therapy, which contrasts with findings from a randomized trial. This is likely because of the inability of retrospective studies to fully account for comorbidity differences across treatment groups because of the lack of detailed data in the registries. We use a unique population-based data set with detailed data regarding comorbidities and functional limitations to assess whether this can provide valid comparisons of survival across prostate cancer treatment groups. The Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) data set results from a linkage between the SEER database and the MHOS database, which includes detailed information regarding patient-reported comorbidity and functional limitations. We analyzed 3102 patients with prostate cancer in SEER-MHOS and used latent class analysis to identify the healthiest group with minimal comorbidity burden and functional limitations. Among the healthiest group, we examined overall survival across treatments using the Kaplan-Meier method. Three distinct health groups were identified using latent class analysis; the healthiest group comprised 57% of the cohort and had a 10-year overall survival of 67%. Other health groups had higher rates of comorbidities or functional limitations. Among the healthiest group, 10-year overall survival differed across treatment groups: no local treatment (55%), external beam radiation therapy (69%), brachytherapy (76%), and radical prostatectomy (85%). Survival curves for the 3 treated groups separated at 4years of follow-up. Despite the detailed health status information available in SEER-MHOS, our retrospective analysis could not fully account for patient selection biases across prostate cancer treatment groups. These findings highlight an important limitation of retrospective studies using population-based data sets and serve as a reminder to interpret results with caution.

Health Disparities by Income in Spain Before and After the Economic Crisis.

Little is known about how health disparities by income change during times of economic crisis. We apply a decomposition method to unravel the contributions of income growth, income inequality and differential income mobility across socio-demographic groups to changes in health disparities by income in Spain using longitudinal data from the Survey of Income and Living Conditions for the period 2004-2012. We find a modest rise in health inequality by income in Spain in the 5years of economic growth prior to the start of the crisis in 2008, but a sharp fall after 2008. The drop mainly derives from the fact that loss of employment and earnings has disproportionately affected the incomes of the younger and healthier groups rather than the (mainly stable pension) incomes of the groups over 65years. This suggests that unequal distribution of income protection by age may reduce health inequality in the short run after an economic recession. Copyright © 2016 John Wiley & Sons, Ltd.

Electrocardiographic evaluation in athletes: ‘Normal’ changes in the athlete's heart and benefits and disadvantages of screening

Young athletes are considered the healthiest group in society. Although rare, there are still reports of sudden death or cardiac arrest on the playing fields. Clinical evaluation is of paramount importance for the identification of possible pathological states that confer increased risk of these events. Interpretation of the electrocardiogram of young athletes can help identify changes associated with heart disease that might preclude the participation in sports. In this context, it is essential to recognize the electrocardiographic patterns that represent the structural and electrical remodeling resulting from continued adaptation to exercise, and which thus do not increase the risk of adverse events during exercise. The European Society of Cardiology (ESC) and the American Heart Association (AHA) have issued consensus documents summarizing which electrocardiographic abnormalities should be considered ‘physiological’, resulting from adaptation to exercise (‘athlete's heart’), and which should be considered pathological and thus require further study. However, the two societies have different approaches with respect to the electrocardiographic screening of athletes. This paper provides a brief review of current evidence regarding the electrocardiographic findings considered normal and abnormal in athletes, and presents the arguments of the ESC and AHA for electrocardiographic screening in this population.

Electrocardiographic evaluation in athletes: ‘Normal’ changes in the athlete's heart and benefits and disadvantages of screening

Young athletes are considered the healthiest group in society. Although rare, there are still reports of sudden death or cardiac arrest on the playing fields. Clinical evaluation is of paramount importance for the identification of possible pathological states that confer increased risk of these events. Interpretation of the electrocardiogram of young athletes can help identify changes associated with heart disease that might preclude the participation in sports. In this context, it is essential to recognize the electrocardiographic patterns that represent the structural and electrical remodeling resulting from continued adaptation to exercise, and which thus do not increase the risk of adverse events during exercise. The European Society of Cardiology (ESC) and the American Heart Association (AHA) have issued consensus documents summarizing which electrocardiographic abnormalities should be considered ‘physiological’, resulting from adaptation to exercise (‘athlete's heart’), and which should be considered pathological and thus require further study. However, the two societies have different approaches with respect to the electrocardiographic screening of athletes. This paper provides a brief review of current evidence regarding the electrocardiographic findings considered normal and abnormal in athletes, and presents the arguments of the ESC and AHA for electrocardiographic screening in this population.

Modification of genetic influences on adiposity between 36 and 63 years of age by physical activity and smoking in the 1946 British Birth Cohort Study.

Background:Previous studies reporting on the interaction between physical activity and genetic susceptibility on obesity have been cross-sectional and have not considered the potential influences of other lifestyle behaviours. The aim of this study was to examine modification of genetic influences on changes across age in adiposity during mid-adulthood by physical activity and smoking.Methods:The sample comprised 2444 participants who were genotyped for 11 obesity variants and had body mass index (BMI), waist circumference-to-height ratio (WHtR), physical activity and smoking measures at 36, 43, 53 and 60–64 years of age. A genetic risk score (GRS) comprising the sum of risk alleles was computed. Structural equation models investigated modification of the longitudinal GRS associations by physical activity (active versus inactive) and smoking (non-smoker versus smoker), using a latent linear spline to summarise BMI or WHtR (multiplied by 100) at the age of 36 years and their subsequent rates of change over age.Results:Physical activity at the age of 36 years attenuated the GRS associations with BMI and WHtR at the same age (P-interaction 0.009 and 0.004, respectively). Further, physical activity at the age of 53 years attenuated the GRS association with rate of change in BMI between 53 and 63 years of age (by 0.012 kg m−2 per year (95% confidence interval (CI): 0.001, 0.024), P-interaction 0.004). Conversely, smoking at the age of 43 years showed a trend towards augmenting the GRS association with rate of change in WHtR between 43 and 63 years of age (by 0.012 (95% CI: 0.001, 0.026), P-interaction 0.07). Estimated GRS effect sizes were lowest at all ages in the healthiest group (e.g., active non-smokers).Conclusions:Healthy lifestyle behaviours appeared to attenuate the genetic influence on changes across age in BMI and central adiposity during mid-adulthood. An active lifestyle and not smoking may have additive effects on reducing the genetic susceptibility to obesity in adults.

Cost‐Effectiveness of Oral Bisphosphonates for Osteoporosis at Different Ages and Levels of Life Expectancy

To evaluate the cost-effectiveness of oral bisphosphonate therapy for osteoporosis in women at different ages and life expectancies. A Markov model was used to analyze oral bisphosphonate treatment for 5 years compared to no intervention. Women at each age were divided into life expectancy quartiles: the lowest 1% to 25% (sickest group), the two middle 26% to 75% (average health group), and the highest 76% to 100% of life expectancy (healthiest group). Simulations were performed for hypothetical cohorts at 5-year intervals with starting ages between 50 and 90 and for each life expectancy group and followed for up to 100 years or until death. Data sources included published fracture rates, costs, utility values, and mortality risks. Computer simulation using a societal perspective. Hypothetical cohort of women with various life expectancies beginning osteoporosis treatment between the age of 50 and 90 years. Cost per quality-adjusted life years (QALY) gained for 5 years of bisphosphonate therapy compared to no treatment. Cost-effectiveness was defined at a willingness-to-pay of $50,000. In the healthiest group, all costs were less than $18,000 per QALY. In the median quartiles of life expectancy, lifetime costs per QALY were less than $27,000 for patients at all ages; treatment became cost-saving at a starting age of 75 and remained so through a starting age of 85. Even in the sickest group, although osteoporosis treatment was not cost-saving, it remained cost-effective through a starting age of 90 with lifetime costs of less than $43,000 per QALY. Treatment with an oral bisphosphonate for 5 years was cost-effective for all women, regardless of quartile of life expectancy. Advanced age should not prevent consideration of osteoporosis treatment based on cost effectiveness, and strategies to improve care, such as nurse-led screening programs or electronic medical record tools, are needed.

Registries and Selection Bias

Outcomes researchers share a strong interest in determining what is being achieved in practice. In the quest to reveal what is actually being done in medicine, we are often in a position to use existing data about clinical practice and patient experience to answer relevant questions, rather than having to generate data de novo. Patient registries, with their size, scope, and focus on patients who represent those seen in clinical practice, have become an increasingly common source of data for outcomes researchers. There is much to like about patient registries. These organized collections of data about clinical practice are a vehicle by which we can assemble massive amounts of information about patients and use it to assess quality of care, identify patterns of care, facilitate real-world research, and improve performance. In cardiovascular medicine, registries capture information about patients with acute coronary syndromes and heart failure as well as those who undergo procedures related to cardiac catheterization, percutaneous coronary intervention, carotid stents, and internal cardioverter defibrillators. Federal agencies are turning to registries to provide information about quality and produce insights about how to best practice medicine through an emphasis on comparative effectiveness research. Outcomes research articles based on registry data are numerous, including those from NRMI, CRUSADE, GWTG-HF, …

Physical and mental health correlates of pregnancy following breast cancer

e20552 Background: The possibility and safety of pregnancy after breast cancer is an important issue for many younger breast cancer survivors and their health care providers. Current research does not indicate that survival is negatively affected by pregnancy. However, the “healthy mother bias”, suggesting that survivors who go on to become pregnant are a self-selected healthier group based on their prognosis, has led to cautious interpretation of these findings. No studies have systematically evaluated the potential for this bias. Methods: This nested case-control study includes 81 participants, age 40 or younger at diagnosis, from the Women's Healthy Eating and Living Study (WHEL) (N=3,088). Our sample includes 27 cases who went on to have a child after breast cancer and 54 controls, matched on age and stage at diagnosis, who did not. We used hierarchical linear modeling to accommodate longitudinal data with individuals nested within matched sets (cases and controls). The primary aim was to evaluate the association between summary scores of health and successful pregnancy after breast cancer. The outcome variables, physical health summary score (PHSS) and mental health summary score (MHSS), were taken from the RAND 36 item health survey (SF-36). Covariates were added for adjustment and to improve model precision. Results: Controlling for other variables in the model, mean PHSS were not different among cases compared to controls (B=0.14, p=0.96) (n=152). MHSS were marginally higher among cases (B=6.40, p=0.08), as compared to controls (n=154). This difference is considered clinically significant. Conclusions: While based on a small sample size, this preliminary study did not find evidence of a healthy mother bias based on scores of physical health. However, mental health was marginally better among those who went on to have a child, indicating that the role of mental health should be evaluated in future research. No significant financial relationships to disclose.

Comparing SF-6D and EQ-5D utilities across groups differing in health status

To compare the EQ-5D and SF-6D within socio-demographic and clinical groups in a representative sample (n = 1,005) of the Greek general population and to examine mean utility differences across groups differing in health in this population and in a highly morbid disease sample (diabetes, n = 215). Association and level of agreement between instruments were estimated with Pearson's r and the intraclass correlation coefficient (ICC), respectively. Paired-samples t-test was used to identify significant score differences, which were regarded as minimally important differences (MID) when they exceeded 0.03. The EQ-VAS was used to classify individuals into health status groups, covering the range from very poor to very good health, and the same classification was used in the diabetes sample. EQ-5D and SF-6D were in agreement and strongly correlated over the entire sample (ICC = 0.536, P < 0.001 and r = 0.662, P < 0.001), but correlation varied according to socio-demographic factors and clinical conditions. In healthier responders, EQ-5D scores were significantly higher than SF-6D scores (P < 0.001) and differences constituted MIDs. Contrarily, in individuals with clinical conditions, SF-6D scores were predominantly higher than EQ-5D. The pattern of results was replicated in the disease sample as well. The hypotheses that EQ-5D generates higher scores in healthier populations and the SF-6D in less healthier groups were confirmed. Based on the evidence provided here, EQ-5D and SF-6D measuring discrepancies generate utility differences across VAS-based health groups, which warrant further within-sample investigation.