Representative Sample Of General Population Research Articles

Validity of the EuroQoL (EQ-5D) Instrument in a Greek General Population

Objectives The main purpose of this study was to assess the construct validity of the Greek EQ-5D instrument in measuring health-related quality of life, as well as to address the issues of concurrent validity, internal consistency reliability, and sensitivity. Methods A stratified, representative sample (n = 1388) of the Greek general population was approached for interview (response rate 72.4%). The survey included the EQ-5D, the SF-36, and questions on sociodemographic and clinical characteristics of the sample. Results The EQ-5D dimensions, the EQ visual analog scale, and the UK-based utility index were capable of distinguishing between groups of respondents, in the expected manner, on the basis of sex, age, education, socioeconomic status, self-reported health problems, and health services utilization, thus providing evidence of construct validity. Convergent and divergent validity of the EQ-5D descriptive system were supported by expected relationships with SF-36 scale and summary scores. Additionally, reporting a problem in a given EQ dimension was generally associated with lower SF-36 scores, supporting concurrent validity. Internal consistency reliability and sensitivity were also satisfactorily demonstrated. Conclusions The results provide initial support for the construct validity of the EQ-5D in Greece, and, in conjunction to future studies addressing test–retest reliability and responsiveness, they support administering the instrument in health status studies, which in turn can contribute to transnational comparisons.

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.

Comparison between exploratory factor-analytic and SEM-based approaches to constructing SF-36 summary scores

To compare the two higher order factor structures of the Short-Form 36 (SF-36) Health Survey, using exploratory factor analytic methods and structural equation modeling (SEM). Two population data sets were used. A stratified representative sample (n = 1,005) of the Greek general population was approached for interview. This survey containing the SF-36 was used to obtain component score coefficients from principal components analysis and orthogonal rotation. These coefficients were then used in the second data set (n = 1,007) of the Greek adult general population to compute scores for the physical component summary and the mental component summary of the SF-36. The second data set was also used to obtain factor scores for physical and mental health measures, applying SEM. Exploratory factor analysis supported the existence of two principal components that are the basis for summary physical and mental health measures. SEM showed that models assuming that physical and mental health are correlated provided a better fit to the data than models assuming independence between physical and mental health. However, all eight dimensions of SF-36 should be included in the construction of summary scores. These results confirm the multidimensional structure of the SF-36, the correlational equivalence between standard summary measures and SEM-based second-order factor scores, and underscore the feasibility of multinational comparisons of health status using this instrument.

Properties of the Cigarette Dependence Scale and the Fagerström Test of Nicotine Dependence in a representative sample of smokers in Norway

To compare the properties of four measures of dependence to nicotine/tobacco, the 12-item Cigarette Dependence Scale (CDS-12), the six-item Fagerström Test of Nicotine Dependence (FTND) and two shorter versions of the same measures. In a cross-sectional telephone survey of smokers in a representative general population sample in Norway, we compared the measures. We assessed (i) internal consistency reliability with Cronbach's alpha; (ii) compared item scores; and (iii) tested the validity of the questionnaires. Test-retest reliability was assessed in a smaller convenience sample. Among 1265 respondents (64%), 290 (23%) were daily smokers and included in further analysis. Their mean age was 42 years [standard deviation (SD) 15] and 46% were female. They smoked on average 13 cigarettes per day (SD 6). Internal consistency reliability was 0.61 for the FTND (n = 267) and 0.81 for the CDS-12 (n = 266). Score distributions suggested a floor effect for the FTND. Test-retest reliability was 0.90 for the FTND and 0.97 for the CDS-12 (n = 31). The correlation between the scale scores and a question about the maximum willingness to pay for a cigarette after not smoking all day was 0.36 (P < 0.001) for the FTND (n = 262) and 0.45 (P < 0.001) for the CDS-12 (n = 263). There was little difference in the associations of the two scales or their abbreviated versions with external variables. Telephone administration was acceptable for both questionnaires, and we have established population reference values for the four scales. The questionnaires were associated with each other and showed similar properties. The findings support the construct validity of the scales.

Major depression in Kunming: Prevalence, correlates and co-morbidity in a south-western city of China

Background Kunming is a major city in south-western China. However, until recently, no epidemiological studies have been conducted to provide a profile of major depression in south-western China. Method A representative sample of the Kunming general population composed of 5033 individuals aged 15 years or older was interviewed from November 2005 to January 2006 using the World Health Organization Composite International Diagnostic Interview Version 2.1 (CIDI, version 2.1) for assessment. Results The weighted prevalence of major depression were 1.96% (lifetime), 1.09% (12-month) and 0.93% (30-day). The correlates for reported lifetime MDD include having higher educational level, living in urban districts, being unemployed, and being divorced/widowed/separated. Major depression was significantly comorbided with DSM-IV anxiety disorders and somatization. Conclusions The findings show a low prevalence rate of major depression in Kunming city. Close attention to public health approaches are required to address the relationships between social isolation, urban population, unemployed and high educational people. Resolving methodological problems may lead to more accurate prevalence estimates in future epidemiological studies.

The epidemiology of fractures in England

Introduction:Fractures are a considerable public health burden in the United Kingdom but information on their epidemiology is limited.Objective:This study aims to estimate the true annual incidence and lifetime prevalence of...

Prevalence of the Child Behavior Checklist‐pediatric bipolar disorder phenotype in a German general population sample

In children with pediatric bipolar disorder (PBD), a consistent pattern of elevations in inattention/hyperactivity, depression/anxiety, and aggression has been identified on the Child Behavior Checklist (CBCL-PBD profile). In Germany, no epidemiological study has included PBD to date. To estimate the six-month prevalence of the CBCL-PBD profile in Germany in a large normative general population sample, and to examine subjects with CBCL-PBD profile with regard to symptoms assumed to coexist with PBD (e.g., suicidality, decreased need for sleep, and hypersexuality). We studied a nationwide representative general population sample of 2,856 children and adolescents aged 4-18 years. A total of 21 subjects [0.7% of the sample; 95% confidence interval (CI) = 0.5-1.1] met the criteria for the CBCL-PBD phenotype. CBCL-PBD subjects were more pervasively disturbed than clinical controls (n = 118; 4.1% of total sample; 95% CI = 3.4-4.9), demonstrated in significantly more social problems and delinquent behavior, and showed significantly higher rates of suicidality, decreased need for sleep and hypersexual behavior. The prevalence of CBCL-PBD subjects in the general German population compares to rates of PBD in US and Dutch epidemiological samples. Regardless of whether these subjects are affected by 'real' PBD or 'severe, pervasive ADHD' with pronounced emotional dysregulation, they constitute a group of seriously disturbed children and adolescents. The high rate of suicidality among CBCL-PBD subjects emphasizes the need for the identification and adequate treatment of children meeting this profile.

Prevalencia y factores de riesgo de las ideas, planes e intentos de suicidio en la población general española. Resultados del estudio ESEMeD

Suicide is a public health problem and it is increasing in Spain. The objective of this study is to analyze the prevalence and risk factors of suicide related outcomes (ideation, plan and attempt) using data from the ESEMeD-Spain project.This is a face-to-face household survey carried out in a probability representative sample of the adult general population of Spain. 5,473 subjects were interviewed using the Composite International Diagnostic Interview (CIDI 3.0), developed by the World Mental Health Survey Initiative.Lifetime prevalence of suicide ideation and attempts was 4.4% and 1.5%, respectively. Risk of suicide related outcomes was significantly higher among women (odds ratio [OR] = 2.3-2.7), younger cohorts (OR = 21.3-86), and lower education levels (OR = 5.3-6.4). Having a mental disorder was associated to an increased risk in all diagnostic categories, but especially in major depressive episode (OR = 5.3-6.8). Risk of suicide attempt was higher during the first year since the onset of ideation (OR = 30.2), decreasing thereafter.The prevalence of suicide related outcomes is low when compared with other countries. Results identified groups with higher risk (women, young, subjects with a mental disorder, psychiatric comorbidity and recent suicidal ideation) in which suicide prevention could show benefits.

Validity of SF-12 summary scores in a Greek general population

BackgroundThe 12-item Health Survey (SF-12) was developed as a shorter alternative to the SF-36 for use in large-scale studies, particularly when overall physical and mental health are the outcomes of interest instead of the typical eight-scale profile. The main purpose of this study was to assess the validity of the Greek version of the SF-12.MethodsA stratified representative sample (N = 1005) of the Greek general population was interviewed. The survey included the SF-36, the EQ-5D and questions on socio-demographic and health-related characteristics. SF-12 summary scores were derived using the standard US algorithm. Factor analysis was used to confirm the hypothesized component structure of the SF-12 items. Construct validity was investigated with "known groups" validity testing and via convergent and divergent validity, which in turn were assessed by the correlations with the EQ-5D dimensions. Concurrent validity was assessed by comparisons with SF-36 summary scores.ResultsSF-12 summary scores distinguished well, and in the expected manner, between groups of respondents on the basis of gender, age, education, socio-economic status, self-reported health problems and health services utilization, thus providing evidence of construct validity. Effect size differences between SF-36 and SF-12 summary scores were generally small (<0.2), supporting concurrent (criterion) validity. Significantly lower mean PCS-12 and MCS-12 scores were observed for respondents reporting chronic conditions compared to those without (P < 0.001). Convergent and divergent validity were supported by expected relationships with the EQ-5D. Reporting a problem in an EQ dimension was associated with lower SF-12 summary scores, supporting concurrent validity. Sensitivity of the Greek SF-12 and replication of the original measurement and conceptual model were demonstrated.ConclusionThe results provide evidence on the validity of the Greek SF-12 and, in conjunction to future studies addressing test-retest reliability and responsiveness, support its use in Greek health status studies as a brief, yet valid, alternative to the SF-36.

Tendencias de la obesidad, diabetes mellitus, hipertensión e hipercolesterolemia en España (1997-2003)

To evaluate the trend in the prevalence in Spain of obesity, diabetes mellitus, hypertension and hypercholesterolemia. The Spanish National Health Surveys (ENS) of 1997, 2001, 2003, which select representative samples of the Spanish general population were used. In total, 49,113 participants of both sexes were included. Self-reported data about weight and height were used to estimate the body mass index. The prevalence of diabetes, hypertension and hypercholesterolemia was estimated. Linear trend chi2 tests and multivariate logistic regression models adjusted for age, sex and educational level, were estimated. A significant increasing temporal trend for the prevalence of obesity, diabetes, hypertension and hypercholesterolemia was found for the studied period (1997-2003) according to the ENS. We found that the increased trend in obesity prevalence was restricted to younger participants with a significant interaction. The prevalence of obesity, diabetes mellitus, hypertension and hypercholesterolemia has increased in Spain between 1997 and 2003.

Diabetes Mellitus is the Main Risk Factor for Early Cardiovascular Mortality among General Population in Spain: Drece follow up Project

Mediterranean diet countries held the paradox of very low cardiovascular mortality and high levels of cardiovascular risk factors. The aim is to describe evolution and relationship of main cardiovascular risk factors, diet, and mortality during 1991–2004 in Spain. The Diet and Cardiovascular Risk in Spain project is a general population based follow up cohort study started in 1991. It is composed of 4783 individuals from 15 to 60 ages in the inception, and it is a representative sample of the Spanish nationwide general population. Vital status and cause of death was provided by the National Institute of Statistics. Mortality rates and risk factors were estimated by Poisson and Cox regression, hazard ratio (HR), procedures respectively. There were 125 deaths (70930 person-years). Causes of death were: 53 (42,4%) cancer, 31 (24,8%) circulatory system, and 24 (19%) cardiovascular. Mean age for all causes death was 56.6 years, for cancer 58.32 years, and for cardiovascular 59.04 years. Risk factors for all causes mortality were: Creatinine >1.5 mgr/dl, HR 3.78 (95%CI:1.52–9.40); Diabetes Mellitus HR 2.80 (95%CI:1.74–4.46); Male Sex HR 2.39 (95%CI:1.61–3.55); Age HR 1.08 (95%CI:1.07–1.10); and Gammaglutamyl transpeptidase HR 1.001 (1.000–1.003). For cancer deaths: Age HR 1.12 (95%CI: 1.09–1.16); and Tobacco HR 1.33 (95%CI: 1.14–1.54). For cardiovascular diseases: Creatinine >1.5 mg/dl, HR 19.40 (95%CI: 5.45–69.12); Diabetes Mellitus HR 9.82 (95%CI:4.19–23.04); and Age HR 1.10 (95%CI:1.05–1.15). We found a mortality profile where cancer is the most frequent cause of death following recent trends in western countries but we emphasize the role of Diabetes Mellitus and Creatinine (probably as diabetes kidney damage surrogate variable) as early and strong risk factors for cardiovascular mortality and therefore for all causes death. No diet pattern or other cardiovascular risk factors were significantly associated. Diabetes emerges as a priority target for action in Mediterranean diet countries.

Quality of life, work ability, and self employment: a population survey of entrepreneurs, farmers, and salary earners

Objectives:Self employment is increasing but it is not yet known how its different forms affect health, quality of life, and work ability. We compared the work ability, subjective quality of...

Population level of unmet need for mental healthcare in Europe

The high prevalence of mental disorders has fuelled controversy about the need for mental health services. To estimate unmet need for mental healthcare at the population level in Europe. As part of the European Study of Epidemiology of Mental Disorders (ESEMeD) project, a cross-sectional survey was conducted of representative samples of the adult general population of Belgium, France, Germany, Italy, The Netherlands and Spain (n=8796). Mental disorders were assessed with the Composite International Diagnostic Interview 3.0. Individuals with a 12-month mental disorder that was disabling or that had led to use of services in the previous 12 months were considered in need of care. About six per cent of the sample was defined as being in need of mental healthcare. Nearly half (48%) of these participants reported no formal healthcare use. In contrast, only 8% of the people with diabetes had reported no use of services for their physical condition. In total, 3.1% of the adult population had an unmet need for mental healthcare. About 13% of visits to formal health services were made by individuals without any mental morbidity. There is a high unmet need for mental care in Europe, which may not be eliminated simply by reallocating existing healthcare resources.

Origin of the Comorbidity of Anxiety Disorders and Alcohol Dependence: Findings of a General Population Study

A representative general population sample (n = 7,076) was used to study retrospectively and prospectively the nature of the relationship between co-morbid alcohol dependence and anxiety disorders. Four different models were tested: (1) anxiety disorders increase the risk of alcohol dependence; (2) alcohol dependence increases the risk of anxiety disorders; (3) family history or childhood traumatisation increase the risk of both alcohol dependence and anxiety disorders, and (4) comorbid conditions are a separate psychopathological entity. The data show that alcohol dependence does not precede the onset of anxiety disorders, that anxiety disorders do precede the onset of alcohol dependence, that family history is not very likely to be the third factor explaining the elevated comorbidity, and that in women childhood trauma might be partially responsible for the association between both disorders. The data are inconsistent with regard to comorbidity as a distinct psychopathological entity. These findings are of great importance for treatment planning in patients with alcohol dependence and comorbid anxiety disorders.

Thresholds for health and thresholds for illness: panic disorder versus subthreshold panic disorder

There is increasing evidence that subthreshold forms of psychopathology are both common and clinically relevant. To enable classification of these subthreshold forms of psychopathology, it may be useful to distinguish not only a threshold for illness but also for health. Our aim was to investigate this with regard to panic. Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), which is based on a large representative sample of the adult general population (18-65 years) of The Netherlands (n=7076). The Composite International Diagnostic Interview was used as a diagnostic instrument. By defining two thresholds, three groups were formed: panic disorder, subthreshold panic disorder and no-panic. These groups were compared using multinomial regression analysis, chi2 and analysis of variance. The 12-month prevalence of panic disorder was 2.2% while that of subthreshold panic disorder was 1.9%. Symptom profiles and risk indicators associated with panic disorder and subthreshold panic disorder were similar, and half of the risk indicators were more strongly associated with panic disorder than with subthreshold panic disorder. Subthreshold panic disorder occupied an intermediate position between panic disorder and no-panic with regard to the number of symptoms, the percentage of subjects with co-morbidity, and functioning. Subthreshold panic disorder is common, and seems clinically relevant, but is milder than panic disorder. These results thus support the use of a double threshold in panic. Further research should focus on the positioning of the thresholds, the course of subthreshold panic disorder and its treatment options.

Double depression: its morbidity and management in a community setting.

Double depression, the combination of major depression and dysthymia, is associated with poor health-related quality of life (HRQoL) and increased health service utilization. To determine the prevalence of double depression, its associated morbidity and use of health services and antidepressants. A random and representative sample of the South Australian general population was interviewed. The mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD), the Short-Form Health Status Questionnaire (SF-36) and Assessment of Quality of Life (AQoL) instruments were administered, and data relating to health service utilization, antidepressant use and role functioning were collected. Double depression was present in 3.3% of the population. The use of health services was significantly higher in this group than those with no depression, or dysthymia or major depression alone. Only 15.2% had attended a community health service, 18.2% had seen a psychiatrist, 10.1% a psychologist, 16.2% a social worker and 9.1% any other counsellor in the last month. While 41.4% were currently taking an antidepressant, the average doses of the two most commonly prescribed antidepressants were below the maximum recommended doses, and the use of antidepressant augmentation strategies was also minimal. While double depression is associated with increased morbidity and use of health services, the optimum use of both pharmacological and nonpharmacological treatments is clearly lacking in this community sample.

Prävalenz von auf eigenen Angaben basierenden muskuloskelettalen Schmerzen der österreichischen Bevölkerung

The objective of this study was to document the prevalence of musculoskeletal pain in the Austrian population, to analyze the specific pain of affected individuals and to compare the characteristics of the group of persons with pain to those without pain. Representative samples of the Austrian general population were selected by the "quota procedure". 500 persons, aged 15 years and older were questioned in face-to-face interviews. 36.4% of all questioned individuals had experienced pain in the musculoskeletal system within the last three weeks, primarily in the region of the spine. Most of the very severe pain was located in the neck area (22%). The groups of persons with and without pain differed significantly in age, occupation, occupational group, region of residence within Austria, and family status. In a regressive analysis higher age remained the only significant variable. In seeking treatment, of significant importance were higher pain intensity and higher education level, and longer time since pain onset. The high prevalence of musculoskeletal pain in the Austrian population, particularly in the advanced age group not only requires targeted and high quality treatment of the affected persons, but also attention to appropriate preventive measures.

The structure of alcohol dependence in the community

Background Although dependence on alcohol appears to be a reliable unitary construct, abuse has not found a similar level of support as a separate construct. This paper describes a confirmatory factor analysis of the DSM-IV alcohol abuse and dependence criteria in a general population sample. Methods Data from alcohol drinkers ( n = 7746) were obtained from a cross-sectional study of a large, representative sample of the Australian general population. One- and two-factor solutions for the DSM-IV criteria for abuse and dependence (assessed by CIDI-Auto) were compared using confirmatory factor analysis. Results Approximately 74% of Australians had used alcohol 12 or more times in the past year and 19% met at least one DSM-IV alcohol abuse or dependence criterion. Overall 6% met criteria for an alcohol use disorder (1.9% abuse, 4.1% dependence). More men than women met criteria for an alcohol use disorder and the prevalence of alcohol use disorders decreased with increasing age. Both one- and two-factor solutions from the confirmatory factor analyses provided an adequate fit to the data for the overall sample. The correlation between the abuse and dependence factors in the two-factor model was extremely high (0.95). Conclusion Alcohol abuse and dependence criteria were most parsimoniously described by a single continuous construct incorporating all eleven abuse and dependence criteria.

A nationwide perspective on asthma in older Australians

WHAT WE NEED TO KNOW: What is the prevalence of impaired lung function among older people in Australia? How can we differentiate between asthma and other causes of breathlessness in population-based health surveys of older people? What are the effects of ageing on people with asthma? WHAT WE NEED TO DO: Improve existing survey measures and accuracy of diagnosis. Incorporate measures of spirometric function into health surveys of representative samples of the general population. Use spirometry in the diagnostic work-up of older patients with dyspnoea.

Psychosocial aspects of chronic widespread pain and fibromyalgia

Purpose. To study the impact on health status as measured by SF-36 in groups of subjects having chronic musculoskeletal pain with different degree of generalization: No chronic pain (NCP), chronic regional pain (CRP), chronic widespread pain (CWP), CWP with a stricter ‘Manchester’ definition (CWP-M), and clinically defined fibromyalgia (FM). The study also examines the association between psychosocial and lifestyle background variables, and these pain-groups.Method. A cross-sectional study with a postal survey to 3928 subjects, constituting a representative sample of the adult general population, followed by clinical examination in a selected group of subjects with CWP. CWP and FM were diagnosed according to ACR 1990 fibromyalgia criteria. Health status was measured by SF-36 Health Survey.Results. Patients with CWP, CWP-M, and FM were found to present with more severe impairment of health status than the other two population groups. Several psychosocial factors, such as belonging to a lower socio-economic group, being an immigrant, living in a compromised housing area, having lower educational level, experiencing lower social support and having a family history of chronic pain, were associated with the populations with CWP and FMConclusions. The spectrum of impact on health and association to background variables, with respect to a stricter definition of CWP, indicates that these factors are important to attend to in the understanding and management of CWP and FM.