Total Impact Score Research Articles

Emotional Distress and Posttraumatic Stress in Children: The Impact of Direct Versus Indirect Exposure

This study examined whether familiarity with the physical environment and verbal/pictorial exposure to a tsunami also inducted posttraumatic stress symptoms in adolescents. The Impact of Event Scale (IES) and Pediatric Emotional Distress Scale (PEDS) were administered to 231 subjects (130 directly exposed and 101 indirectly exposed). The directly exposed group scored high on the IES and PEDS. A significant sex difference was observed on all three dimensions of the IES, and fearful and traumatic event-related dimensions of PEDS, with females at a higher risk compared to males. In the indirectly exposed group, no sex difference was observed for the IES (avoidance and total impact score) or the fearful, acting out, or traumatic experience related dimensions of the PEDS. Significant sex differences were observed in this group on the IES intrusion and PEDS withdrawal scores, with males higher on intrusion and females higher on withdrawal.

The Pediatric Quality of Life Inventory™ (PedsQL™) family impact module: reliability and validity of the Brazilian version

BackgroundPediatric health-related quality of life (HRQOL) has emerged as an important health outcome in clinical trials and healthcare research, for which HRQOL assessment instruments have played an important role. However, these instruments are not available in all countries or all languages. The Pediatric Quality of Life Inventory™ (PedsQL™) Family Impact Module is a multidimensional instrument developed to assess the impact of chronic medical conditions on the HRQOL of parents and family functioning. The objective of the present study was to evaluate the psychometric properties of the PedsQL™ Family Impact Module cross-culturally adapted for use in Brazil.MethodsThe PedsQL™ Family Impact Module was administered to 95 parents/guardians of children with cancer in active therapy from 2 to 18 years of age of both genders. Subjects were recruited by means of convenience samples from the Pediatric Hematology/Oncology Centers at two public hospitals. The 'in-patient' sample was defined as individuals who were hospitalized for the administration of chemotherapy. The 'out-patient' sample was defined as individuals who were receiving chemotherapy and were not hospitalized.ResultsTest-retest reliability exhibited correlation values ranging from 0.81 to 0.96 for all subscales. Internal consistency reliability was demonstrated for the PedsQL™ Family Impact Module: Total Scale Score (α = 0.89), Parent Health-Related Quality of Life Summary Score (α = 0.83) and Family Summary Score (α = 0.73). The Total Impact Score for the in-patient and out-patient samples was 67.60 and 56.43, respectively (p < 0.01). The construct validity demonstrated that the PedsQL™ Family Impact Module proved capable of distinguishing between families whose children/adolescents were hospitalized and families of children/adolescents who are being taken care of at home.ConclusionThe Brazilian version of the PedsQL™ Family Impact Module was considered reliable and valid for assessing the impact of a chronic pediatric health condition on the HRQOL of parents and family functioning. The instrument should be field tested on other chronic pediatric illnesses.

Efficacy and safety of formoterol fumarate delivered by nebulization to COPD patients

Nebulized solutions of long-acting bronchodilators provide an alternative to DPI and MDI delivery, particularly for COPD patients unable to use hand-held devices easily or correctly. The long-acting beta2-agonist, formoterol fumarate, is differentiated by its onset of significant bronchodilation within 5 min of administration. In a randomized, double-blind, double-dummy trial, COPD subjects (n=351, mean forced expiratory volume FEV1=1.3 L, 44% predicted) received nebulized formoterol fumarate (Perforomist inhalation solution; FFIS 20 microg) or DPI (Foradil Aerolizer; FA 12 microg), or placebo twice daily for 12 weeks. Efficacy was assessed with 12-h pulmonary function tests, and quality of life was assessed before and after treatment with the St. George's Respiratory Questionnaire (SGRQ). At the 12-week endpoint, FFIS significantly increased FEV1 AUC0-12h relative to placebo (p<0.0001). No evidence of tachyphylaxis was observed as indicated by maintained FEV1 AUC and reduced rescue albuterol use throughout treatment. FFIS also significantly increased peak FEV1, trough FEV1, and standardized FVC AUC0-12h compared with placebo. SGRQ assessment at Week 12 demonstrated significant and clinically meaningful improvements in total score (FFIS vs placebo, -4.9, p=0.0067), symptom, and impact scores. No significant differences in efficacy were observed between the two active treatments. Drug related AEs in the FFIS arm with a frequency > or = 1% and exceeding placebo were dry mouth, nausea, and insomnia. Nebulized FFIS provided significant improvement in respiratory status and quality of life in subjects with COPD relative to placebo and was well tolerated. The efficacy and safety profile of FFIS was comparable to FA DPI.

GIS and ordination techniques for evaluation of environmental impacts in informal settlements: A case study from Cuiabá, central Brazil

This study evaluates the environmental impacts caused by informal occupation in the city of Cuiabá, Mato Grosso, Brazil. In 10 selected districts, an assessment of 35 environmental indicators was conducted, evaluating secondary data as well as field survey results, air photo interpretation and geographical information system (GIS) analysis. A matrix approach was then applied to quantify the magnitude and relevance of 13 types of impacts on the following environmental components: surface water, soil, flora/fauna, air, land use and life quality. Impacts were analyzed in the spatial context of four main classes of municipal zoning. Redundancy analysis (RDA), a multivariate ordination method, was applied to evaluate the dependency of impacts from environmental and socio-economical factors. Total impact scores were the highest in areas devoted to environmental preservation according to municipal zoning, indicating a limited ability of authorities to control informal occupation processes and their impacts on the environment. Indicator analysis showed strong impacts along the stream network in areas susceptible to episodic flooding. RDA indicates that age and district organization have a significantly important impact in the sampled districts; they were found to be as important in ordination as environmental factors such as geo-technical units.

Health-related quality of life in the first year after a diagnosis of pediatric inflammatory bowel disease

Assessment of health-related quality of life (HRQOL) is of increasing importance in the evaluation of new therapies for inflammatory bowel disease (IBD). Available data concerning HRQOL in pediatric patients are sparse and uniformly cross-sectional. The aim of this study was to describe HRQOL and influential factors in newly diagnosed pediatric patients with Crohn's disease and ulcerative colitis during the first 12 months after diagnosis. Participants were drawn from a large, prospectively derived observational IBD registry of pediatric patients studied through 18 U.S. and Canadian centers. Patients who had completed a baseline IMPACT questionnaire and for whom there were 12 months of follow-up data available were included. In addition to description of cohort, factors that were believed to influence HLQOL were assessed during the course of the year from diagnosis. Two hundred eighteen children met inclusion criteria (77% Crohn's disease, 23 % ulcerative colitis, mean age 12.7 +/- 1.9 years). Mean total IMPACT score at baseline was 154, 181 at 6 months, and 191 at 1 year (possible range 0-238, with increasing scores representing better quality of life). Repeated measures analysis showed that age and disease severity significantly negatively affected the IMPACT scores during the course of the year. In this large prospective pediatric IBD cohort, significant improvement in HRQOL is noted during the year from diagnosis. Mean IMPACT scores varied significantly depending on the disease severity and also decreased with increasing age.

A tariff system for nervous shock: introducing the total impact score.

This study was designed to test a proposed relationship between the total impact score (devised by the authors) and the quantum of damages in compensation received by victims of criminal and political violence. In so doing, the authors sought to develop a mathematical formula which could be used to quantify damages in a simple and expeditious manner. Data on 2,191 victims of violence was collated forming three databases of information, on the incident, on the victim and on the outcomes. A tool of measurement of the psychosocial impact of the traumatic event was designed (the Total Impact Score). Information on a subsample of the 208 survivors of attempted assassination was then selected and the TIS for each individual was calculated and examined for correlations with other variables including the quantum damages awarded. The TIS was shown to have validity as a measure of the psychosocial impact of a traumatic event upon an individual. The analysis showed a significant relationship between the TIS and quantum awarded. This relationship was used to generate a mathematical formula which could be used to calculate quantum damages in any case. Compensation = £500 × (10(0037t+0.059y) -1), where t is the TIS and y is the number of years after 1985. The TIS can be taken as a valid tool for quantifying the psychosocial impact of a traumatic event or violent act. The tool consists of a checklist of readily ascertainable outcome variables each of which can be scored and a TIS calculated. From this score the amount of damages can be ascertained. The authors believe that this measurement tool represents a fair and equitable method of calculating a case's worth.

A GDP research network examines patients' perceived oral health

Objective To measure the subjective impact of oral health in a group of patients attending general dental practices in the North West of England and to investigate the attributes of dentists and practices in order to examine how such attributes might relate to patients' subjective perceptions of oral health. Design Fifteen general dental practices conducting a simultaneous survey of attending patients and 15 practitioners from these practices providing information about their attitudes to treatment, prevention and various aspects of their surgery. Setting General dental practice. Outcome measures Patient subjective impact scores. Relationships between practice and practitioner variables and patients' subjectively perceived oral health. Results Fifteen practitioners with diverse practice attributes provided data on 718 patients. The mean total oral health impact score was 18.4. Twenty two per cent of patients had experienced pain in the four weeks before the survey and 11% had been unable to chew some foods. Fifty five per cent of the surveyed population had, in the previous year, worried about the appearance of their mouth and 65% had worried about their oral health in general. Dentists' beliefs were related to patient impact scores but practice attributes were not significantly associated with patients' impacts. Conclusions Fourteen percent of the differences in patients' subjectively perceived oral health can be attributed to dentist attitudes and attributes. Further research regarding the influence of dentists' personality and professional beliefs on patients well-being needs to be undertaken.

A general dental practice research network: impact of oral health in general dental practice patients.

To measure the subjective impact of oral health in a group of patients attending general dental practices in the North West of England and to investigate the attributes of dentists and practices in order to examine how such attributes might relate to patients' subjective perceptions of oral health. Fifteen general dental practices conducting a simultaneous survey of attending patients and 15 practitioners from these practices providing information about their attitudes to treatment, prevention and various aspects of their surgery. General dental Patient subjective impact scores. Relationships between practice and practitioner variables and patients' subjectively perceived oral health. Fifteen practitioners with diverse practice attributes provided data on 718 patients. The mean total oral health impact score was 18.4. Twenty two per cent of patients had experienced pain in the four weeks before the survey and 11% had been unable to chew some foods. Fifty five per cent of the surveyed population had, in the previous year, worried about the appearance of their mouth and 65% had worried about their oral health in general. Dentists' beliefs were related to patient impact scores but practice attributes were not significantly associated with patients' impacts. Fourteen percent of the differences in patients' subjectively perceived oral health can be attributed to dentist attitudes and attributes. Further research regarding the influence of dentists personality and professional beliefs on patients well-being needs to be undertaken.

The IMPACT Questionnaire: A Valid Measure of Health‐Related Quality of Life in Pediatric Inflammatory Bowel Disease

ABSTRACTBackground and aimsIMPACT is a disease‐specific health‐related quality‐of‐life questionnaire developed for use in pediatric inflammatory bowel disease through a process of patient interviews and analysis of patient responses to an item‐reduction questionnaire. This study sought to assess the feasibility, reliability, and validity of the instrument.MethodsThe readability statistics and number of unanswered questions were assessed among 147 patients (97 CD, 50 UC) with mean age 14.4 ± 2.2 years (range 9.2–18.0 years) using the self‐administered questionnaire. Internal consistency was assessed with Cronbach's α and test‐retest reliability using intraclass correlation coefficient (ICC). Construct validity was based on a priori hypotheses. Mean total scores were compared by ANOVA among patients grouped according to disease activity and disease severity within the past year.ResultsThe readability statistic showed a Flesch‐Kincaid Grade level of 4.5. Only 0.68% of questions were left blank. Reliability was excellent with Cronbach's α = 0.96, and an ICC of 0.90 in patients with stable disease over a two‐week period (n = 32). The mean total IMPACT score for patients with quiescent disease (180 ± 32) was significantly higher (better QOL) than for those with active disease (146 ± 31 for mild, 133 ± 34 for moderate/severe) (P &lt; 0.005).ConclusionsThe IMPACT questionnaire is a valid and reliable reflection of health‐related quality of life of older children and adolescents with both ulcerative colitis and Crohn's disease.

The IMPACT questionnaire: a valid measure of health-related quality of life in pediatric inflammatory bowel disease.

BACKGROUND AND AIMS IMPACT: is a disease-specific health-related quality-of-life questionnaire developed for use in pediatric inflammatory bowel disease through a process of patient interviews and analysis of patient responses to an item-reduction questionnaire. This study sought to assess the feasibility, reliability, and validity of the instrument. The readability statistics and number of unanswered questions were assessed among 147 patients (97 CD, 50 UC) with mean age 14.4 +/- 2.2 years (range 9.2-18.0 years) using the self-administered questionnaire. Internal consistency was assessed with Cronbach's alpha and test-retest reliability using intraclass correlation coefficient (ICC). Construct validity was based on a priori hypotheses. Mean total scores were compared by ANOVA among patients grouped according to disease activity and disease severity within the past year. The readability statistic showed a Flesch-Kincaid Grade level of 4.5. Only 0.68% of questions were left blank. Reliability was excellent with Cronbach's alpha = 0.96, and an ICC of 0.90 in patients with stable disease over a two-week period (n = 32). The mean total IMPACT score for patients with quiescent disease (180 +/- 32) was significantly higher (better QOL) than for those with active disease (146 +/- 31 for mild, 133 +/- 34 for moderate/severe) (P < 0.005). The IMPACT questionnaire is a valid and reliable reflection of health-related quality of life of older children and adolescents with both ulcerative colitis and Crohn's disease.

Environmental impact assessment of a proposed info-tech complex in East Calcutta wetlands

An info-tech complex is proposed for 286 acres (116 ha) of land within the East Calcutta wetlands. The proposed site is 15 km east of Kolkata city and only 8 km south of Dum Dum airport. The site is vacant, with pockets of agricultural land and a few degrading water-logged areas. In order to assess the likely impact of the proposed development on the environment, a rapid environmental impact assessment of an area of 10 km radius from the centre of the project site was carried out. The present status of the environment with respect to ambient air, surface water, groundwater, soil, landuse, noise, and socio-economics of the core and buffer zone has been documented and correlated with 24 project activities during construction, development and operational phases. The frequency of adverse impacts is greater than that of beneficial impacts. Out of the total adverse impacts 20 are short term, reversible and have a low magnitude. The total impact score for the proposed project is ( − )468.75 and as per the Assessment Value Index Scale the environmental impact of the proposed project activities is ‘no appreciable impact.’ But there are certain sectors where the environment will be adversely impacted. Therefore, appropriate measures have been suggested to ameliorate the adverse impacts. It is envisaged that if these measures are implemented then there will be an improvement in the quality of the environment, as well as life, by 687.5 units.

Outcomes of botulinum toxin treatment for patients with spasmodic dysphonia.

Spasmodic dysphonia (SD) is a focal dystonia of the larynx. Although individuals with SD have variable degrees of difficulty in everyday communication and speaking, many report significant impairments. The impact of SD on the quality of life of people with the disorder has not been well measured. To assess the impact of SD using a voice-specific, validated outcomes instrument, the Voice Handicap Index (VHI), and to evaluate the effect of botulinum toxin treatment on quality of life. The VHI measures 3 subscales (physical, functional, and emotional) of impact of a voice disorder as well as a total impact score. The VHI was completed by 30 consecutive patients with SD before receiving botulinum toxin injection and 2 to 4 weeks after injection. Pretreatment scores on the VHI were compared with posttreatment scores. Pretreatment scores on the VHI showed significant impairment in all 3 subscales (physical, 25.5; functional, 21.4; and emotional, 20.4) and the total score (67.6). Statistically significant improvements occurred in all 3 subscale scores and the total score (P =.001) for the 22 patients who completed the posttreatment survey. Spasmodic dysphonia has a significant impact on patients' perception of quality of life as measured by the VHI. Significant improvements in all 3 subscale scores and the total score on the VHI occur after treatment with botulinum toxin.

Childhood Asthma in Low-Income Hispanic and Non-Hispanic White Families in a Rural State: The Impact-on-Family Scale

We measured the impact on family functioning reported by low-income Hispanic and non-Hispanic White parents of children (N = 415, mean age 8.7 years) with asthma living in a rural state. A number of factors were associated with impact, using the Impact-on-Family Scale (Stein & Jessop, 1985). In order of importance, the factors were number of school days missed, nighttime symptoms, number of as-needed medications, and Spanish version of the tool. These factors accounted for approximately 13 % of the variance in total impact score. There were no differences in impact score between urban and rural parents or by ethnicity. The findings indicate that perceived parental impact is not strongly associated with commonly measured demographic and morbidity measures. The relation of these data to the recommendations of the National Asthma Guidelines (National Heart, Lung, and Blood Institute, 1997) is discussed.

Pain assessment for children with sickle cell disease: Improved validity of diary keeping versus interview ratings

This paper describes the development and piloting of the Central Middlesex Hospital Children's Health Diary (CMHCHD) for children and adolescents with sickle cell disease (SCD), and examines the reliability and validity of its key outcome measures. The diary has a semi‐structured format to be completed daily, covering general well‐being, common symptoms, pain events, coping strategies and the impact of any pain/illness events. Key summary measures consisted of total pain and impact scores for the diary‐keeping period. A pilot study was carried out with 25 children with SCD, and 25 matched controls who completed the diary for a four‐week period. Compliance with the procedure was satisfactory and adequate reliability was indicated although fatigue affects were observed during the fourth week of record keeping on some variables. The pain score had satisfactory concurrent validity with higher pain scores associated with more school absence (u = 88.5, p &lt; .03) and greater disruption of daily life (u = 57, p &lt; .01) and demonstrated encouraging construct validity by identifying expected higher rates of limb pain in children with SCD compared with controls (u = 196, p &lt; .02). Parent and child interview ratings of pain frequency were not associated with quality of life measures, and could not discriminate between the clinical and non‐clinical population. Compared with both parent and child interview ratings of pain frequency, the total pain score was a more accurate predictor of the impact of pain in children's everyday life (F(47) = 10.80, p &lt; .001). In conclusion, the CMHCHD shows considerable potential both for research, improving clinical assessment, and for enhancing coping strategies of children and their families.

Scale for Evaluation of Expository Writing Instruction

The objective of expository writing courses is to teach the student to write clear, coherent prose that will be effective in accomplishing its purpose with a specific audience ( 1 ) . The methodological problem posed was to develop a reliable scale to evaluate college-level courses in expository writing. An experimental 16-item 5-point (scaled strongly disagree vs strongly agree) Writing Evaluator was administered to 1311 students enrolled in 79 expository writing courses/sections in the Department of English, University of Hawaii, at the end of the Fall semester 1982 (approx. 17 students/class). Pearson T-matrix generated for rhe 16 items was positive; average T for 120 off-diagonal r-pairs was .65 ( p < ,001). Inspection of the distribution of positive eigenvalues indicated one root greater than 1.0; remaining 15 values ranged from 0.9 to 0.2. Multiple R%as inserted as communality ( h a ) estimates and one iterative principal axis factor was extracted; rotation was unnecessary. The 16 expository writing items exhibited a narrow band of factor loadings ranging from .87 to .77, and the factor was labeled, Expository Writing Impact. The factor load~ngs were ordered: ( a ) the writing assignments were useful for developing writing skills ( .87 ) . ( b ) the instructor was able to answer questions clearly and concisely ( .85) , (c) the instructor was able to analyze and explain writing problems clearly ( .85), ( d ) classroom activities were appropriately related to improvement of writing skills ( .84) , ( e ) the instructor's attention to and comments on written work were helpful (.84), ( f ) the instructor displayed steady interest and enthusiasm (.83), ( g ) this course helped me to develop skill in organizing a piece of writing ( .83) , ( h ) I would recommend this instmctor to a friend who wanted to take a writing course ( .82) , ( i ) as a result of this course, my writing skills have improved ( .82) , ( j ) my time in this course was well spent ( .81) , ( k ) the insuuctor was able to suggest ways of solving writing problems (.80), (1) the writing assignments were clear ( .79) , ( m ) this course helped me to develop skill in writing clear, effective sentences ( .79), ( n ) this course helped me to develop skill in supporting generalizations with relevant details ( .79), ( 0 ) this course helped me to develop skill in adapting my writing to a particular purpose and audience ( .79), and (p ) the instructor was able to maintain an atmosphere which actively encouraged learning ( .77). Corrected split-half reliability for the 16 items was .96 ( f i < ,001). A Total Impact Score was computed for each of the 1311 students by summing item scores (Range = 16-80, M = 63.6. SD = 13.42). Quartile values were computed to locate relatively high and low impact classes (QI = 59.6, Ma = 66.2, Qa = 72.5). During the 1983-84 academic year, instructional improvement techniques suggested by the Conference on College Composition and Communication ( 1 ) will be introduced in expository writing courses.