The long-term mental health impact of peacekeeping: prevalence and predictors of psychiatric disorder.

BACKGROUND: The mental health outcomes of military personnel deployed on peacekeeping missions have been relatively neglected in the military mental health literature. AIMS: To assess the mental health impacts of peacekeeping deployments. METHOD: In total, 1025 Australian peacekeepers were assessed for current and lifetime psychiatric diagnoses, service history and exposure to potentially traumatic events (PTEs). A matched Australian community sample was used as a comparator. Univariate and regression analyses were conducted to explore predictors of psychiatric diagnosis. RESULTS: Peacekeepers had significantly higher 12-month prevalence of post-traumatic stress disorder (16.8%), major depressive episode (7%), generalised anxiety disorder (4.7%), alcohol misuse (12%), alcohol dependence (11.3%) and suicidal ideation (10.7%) when compared with the civilian comparator. The presence of these psychiatric disorders was most strongly and consistently associated with exposure to PTEs. CONCLUSIONS: Veteran peacekeepers had significant levels of psychiatric morbidity. Their needs, alongside those of combat veterans, should be recognised within military mental health initiatives. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.

Rehabilitation following cerebral anoxia: An assessment of 27 patients.

OBJECTIVES: (1) To evaluate cognitive and emotional impairments, disability and quality-of-life for adults with cerebral anoxia institutionalized in residential care facilities. (2) To evaluate the efficacy of medication, psychotherapy, support group and therapeutic activities. METHODS: Twenty-seven persons with cerebral anoxia were recruited, on average 8 years post-injury. Only 20 went through the whole study. Over three consecutive 2-month periods, they were assessed four times to evaluate: baseline observations (T1-T2), adjustment of their medication (T2-T3); and the effect of psychotherapy, support group and therapeutic activities such as physical and artistic or cultural activities usually proposed in the facilities involved (T3-T4). Examined variables at all time points were cognitive status, anxiety and depression, anosognosia, alexithymia, disability and quality-of-life. RESULTS: All participants exhibited cognitive and emotional impairments comparable to those reported in the literature. Statistical analyses revealed good baseline stability of their condition and no significant effects of changes in medication (between T2 and T3). Conversely, following implementation of psychotherapy, support group and therapeutic activities (between T3 and T4), quality-of-life and social participation were significantly improved. CONCLUSION: Social participation and quality-of-life for persons instutionalized several years after cerebral anoxia were improved by psychotherapeutic and therapeutic activities.

Quality of Life and Social Isolation Among Caregivers of Adults with Schizophrenia: Policy and Outcomes.

Services have been increasingly directed at supporting carers of people living with mental illness but it is difficult to evaluate the impact of service change where benchmarks for carer functioning are sparse. Sixty Australian carers were assessed regarding their quality of life, psychological distress, social isolation and caregiving experience. Their scores were compared with two matched community samples and previous studies. Carers were ten times more likely to be socially isolated and quality of life was significantly less than matched community samples. Over 40 % of the carer sample met criteria for probable psychiatric disorder. Comparison of caregiving experiences with a study 15 years ago showed no improvement in negative caregiving experiences. Carers still face considerable challenges to their wellbeing as they support people living with mental illness, in spite of progress in the development of policy and services.

The comparison of quality of life among people with mild dementia in nursing home and home care--a preliminary report.

BACKGROUND: Living arrangements play an important role in determining the quality of life (QoL) of people with dementia. Although informal care (home-based) is favored, the transition to formal (institutional) care often becomes necessary, especially in the later stages of dementia. Nevertheless, there is currently no definitive evidence showing that informal or formal care provides a higher QoL for those with dementia. OBJECTIVE: To compare the QoL of people with dementia in the nursing home and home care, and identify factors that differentiate their QoL. DESIGN AND METHODS: This was a cross-sectional survey. A total of 49 people with dementia ≥60 years old were recruited from government nursing homes and hospitals (home care). Consenting participants were assessed on cognitive severity, QoL, activities of daily living (ADLs), depression, and social isolation/connectedness by the Short Mini Mental State Examination (SMMSE), the WHO-8 (the EUROHIS-QOL), Short Assessment of Quality of Life (AQoL-8), Barthel Index (BI), Cornell Scale for Depression (CSDD), and Friendship Scale (FS). RESULTS: There were significant differences in QoL, HRQoLs, ADLs, and social connectedness among people with dementia in home care (n = 19) and those in nursing homes (n = 30) (p < 0.01). No significant differences were found by socio-demographic factors, cognitive severity, or depression between the study cohorts. CONCLUSIONS: Older adults with dementia who were living at home experienced higher QoL, ADLs, and social connectedness compared with those living in institutional care. Support should be provided enabling home care and empowering caregivers to provide better care for people with dementia.

Evaluation of the dimensions of anger reactions-5 (DAR-5) scale in combat veterans with posttraumatic stress disorder.

After a traumatic event many people experience problems with anger which not only results in significant distress, but can also impede recovery. As such, there is value to include the assessment of anger in routine post-trauma screening procedures. The Dimensions of Anger Reactions-5 (DAR-5), as a concise measure of anger, was designed to meet such a need, its brevity minimizing the burden on client and practitioner. This study examined the psychometric properties of the DAR-5 with a sample of 163 male veterans diagnosed with Posttraumatic Stress Disorder. The DAR-5 demonstrated internal reliability (α=.86), along with convergent, concurrent and discriminant validity against a variety of established measures (e.g., HADS, PCL, STAXI). Support for the clinical cut-point score of 12 suggested by Forbes et al. (2014, Utility of the dimensions of anger reactions-5 (DAR-5) scale as a brief anger measure. Depression and Anxiety, 31, 166-173) was observed. The results support considering the DAR-5 as a preferred screening and assessment measure of problematic anger.

Health-related quality of life (HRQoL) changes in South Australia: comparison of burden of disease morbidity and survey-based health utility estimates.

BACKGROUND: Global research shows a clear transition in health outcomes over the past two decades where improved survival was accompanied by lower health related quality of life (HRQoL) as measured by morbidity and disability. These trends suggest the need to better understand changes in population HRQoL. This paper compares two perspectives on population HRQoL change using burden of disease morbidity estimates from administrative data and self-reports from random and representative population surveys. METHODS: South Australian administrative data including inpatient hospital activity, cancer and communicable disease registrations were used within a Burden of Disease study framework to quantify morbidity as Prevalent Years of Life lived with Disease and injury related illness (PYLD) for 1999 to 2008. Self-reported HRQoL was measured using the Assessment of Quality of Life (AQoL) in face to face interviews with at least 3000 respondents in each of South Australia's Health Omnibus Surveys (HOS) in 1998, 2004 and 2008. RESULTS: Age specific PYLD rates for those aged 75 or more increased by 5.1%. HRQoL dis-utility in this age group also increased significantly and beyond the minimally important difference threshold. Underlying increased dis-utility were greater difficulties in independent living (particularly requiring help with household tasks) and psychological well-being (as influenced by pain, discomfort and difficulty sleeping). CONCLUSIONS: Consistent with increased quantity of life being accompanied by reduced HRQoL, the analysis indicates older people in South Australia experienced increased morbidity in the decade to 2008. The results warrant routine monitoring of health dis-utility at a population level and improvement to the supply and scope of administrative data.

Measuring patient satisfaction with health care treatment using the Short Assessment of Patient Satisfaction measure delivered superior and robust satisfaction estimates.

OBJECTIVES: Reviews of patient satisfaction suggest seven dimensions, each of which should be assessed. This study reports development of a short generic patient satisfaction measure for use in routine clinical practice. STUDY DESIGN AND SETTINGS: Participants were randomly recruited from two Australian incontinence clinics. Participants completed a follow-up questionnaire including patient satisfaction items. Iterative Mokken and Rasch analyses derived the Short Assessment of Patient Satisfaction (SAPS) scale from the item bank. RESULTS: The SAPS psychometric properties illustrated the following features, namely its descriptive system covers all seven patient satisfaction dimensions, there were no misfitting items, and the scale exceeded the Loevinger H criteria for a strong unidimensional scale. The reliability of the SAPS was Cronbach α=0.86. When discriminatory function was examined, the SAPS scale was more sensitive than two other generic patient satisfaction instruments. CONCLUSION: The SAPS scale is based on a firm theoretical model of patient satisfaction and its descriptive system covers the known dimensions contributing to patient satisfaction. Its internal psychometric properties exceeded standard psychometric standards, and it discriminated at least as well as other longer patient satisfaction measures. Although it needs further validation, the study results suggest that it may be useful for assessing patient satisfaction with health care.

Measurement of costs and scales for outcome evaluation in health economic studies of Parkinson's disease.

Health economic studies in Parkinson's disease (PD) have become increasingly common in recent years. Because several methodologies and instruments have been used to assess cost and outcomes in PD, the Movement Disorder Society (MDS) commissioned a Task Force to assess their properties and make recommendations regarding their use. A systematic literature review was conducted to explore the use of those instruments in PD and to determine which should be selected for this review. We assessed approaches to evaluate cost of illness (COI), cost effectiveness, and cost utilities, which include the use of direct (standard gamble, time trade-off. and visual analogue scales) and indirect instruments to measure health status and utilities. No validated instruments/models were identified for the evaluation of COI or cost-effectiveness in patients with PD; therefore, no instruments in this group are recommended. Among utility instruments, only a few of these outcome instruments have been used in the PD population, and only limited psychometric data are available for these instruments with respect to PD. Because psychometric data for further utility instruments in conditions other than PD already exist, the standard gamble and time trade-off methods and the EQ-5D (a European quality-of-life health states instrument) and Health Utility Index instruments met the criteria for scales that are "recommended (with limitations)," but only the EQ-5D has been assessed in detail in PD patients. The MDS Task Force recommends further study of these instruments in the PD population to establish core psychometric properties. For the assessment of COI, the Task Force considers the development of a COI instrument specifically for PD, like that available for Alzheimer's disease.

Comparison of the measurement properties of the AQoL and SF-6D in critical illness.

OBJECTIVE: Multiattribute utility (MAU) instruments are short instruments measuring quality of life, health utility scores and treatment cost-effectiveness. Many studies have compared MAU instruments, but few have involved intensive care unit patients. Our aim was to compare the measurement properties of two MAUs, the assessment of quality of life (AQoL) and Medical Outcomes Study Short Form 6D (SF-6D), in a sample of patients with critical illness. METHODS: Prospective observational study conducted in an 18-bed mixed tertiary Australian ICU. Eligibility criteria were: admitted to the ICU > 48 hours, aged > 18 years, and not imminently at risk of death. Participants completed the AQoL and SF-6D on admission to the ICU as a "then-test" of pre-ICU status, and 6 months after ICU discharge. We assessed the reliability, validity, sensitivity and responsiveness of the instruments. RESULTS: Median age was 61 years (interquartile range [IQR], 49-73 years)], 60% were men, and the median Acute Physiology and Chronic Health Evaluation II score was 17 (IQR, 13-21). Cronbach's α was acceptable for the AQoL (α = 0.81) but not for the SF-6D (α = 0.65). The AQoL and SF-6D showed evidence of validity but, despite moderate agreement between their utilities, their scores were not interchangeable. This was likely due to the SF-6D's truncated scoring range. The AQoL was predictive of hospital readmission but the responsiveness and sensitivity of the instruments varied by clinical condition. CONCLUSIONS: The AQoL and SF-6D demonstrated acceptable measurement properties in the ICU population, but the findings raised questions about the reliability and predictive power of the SF-6D. Further research is required to determine the most appropriate instrument for use in measuring health utility in the ICU population.

Relationship between health-related quality of life, and acute care re-admissions and survival in older adults with chronic illness.

BACKGROUND: Australia's ageing population means that there is increasing emphasis on developing innovative models of health care delivery for older adults. The assessment of the most appropriate mix of services and measurement of their impact on patient outcomes is challenging. The aim of this evaluation was to describe the health related quality of life (HRQoL) of older adults with complex needs and to explore the relationship between HRQoL, readmission to acute care and survival. METHODS: The study was conducted in metropolitan Melbourne, Australia; participants were recruited from a cohort of older adults enrolled in a multidisciplinary case management service. HRQoL was measured at enrolment into the case-management service using The Assessment of Quality of Life (AQoL) instrument. In 2007-2009, participating service clinicians approached their patients and asked for consent to study participation. Administrative databases were used to obtain data on comorbidities (Charlson Comorbidity Index) at enrolment, and follow-up data on acute care readmissions over 12 months and five year mortality. HRQoL was compared to aged-matched norms using Welch's approximate t-tests. Univariate and multivariate logistic regression models were used to explore which patient factors were predictive of readmissions and mortality. RESULTS: There were 210 study participants, mean age 78 years, 67% were female. Participants reported significantly worse HRQoL than age-matched population norms with a mean AQOL of 0.30 (SD 0.27). Seventy-eight (38%) participants were readmitted over 12-months and 5-year mortality was 65 (31%). Multivariate regression found that an AQOL utility score <0.37 (OR 1.95, 95%CI, 1.03 - 3.70), and a Charlson Comorbidity Index ≥6 (OR 4.89, 95%CI 2.37 - 10.09) were predictive of readmission. Multivariate analysis demonstrated that age ≥80 years (OR 7.15, 95%CI, 1.83 - 28.02), and Charlson Comorbidity Index ≥6 (OR 6.00, 95%CI, 2.82 - 12.79) were predictive of death. CONCLUSION: This study confirms that the AQoL instrument is a robust measure of HRQoL in older community-dwelling adults with chronic illness. Lower self-reported HRQoL was associated with an increased risk of readmission independently of comorbidity and kind of service provided, but was not an independent predictor of five-year mortality.

Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow-up.

INTRODUCTION: The purpose of this trial was to investigate the effectiveness of an exercise rehabilitation program commencing during ICU admission and continuing into the outpatient setting compared with usual care on physical function and health-related quality of life in ICU survivors. METHODS: We conducted a single-center, assessor-blinded, randomized controlled trial. One hundred and fifty participants were stratified and randomized to receive usual care or intervention if they were in the ICU for 5 days or more and had no permanent neurological insult. The intervention group received intensive exercises in the ICU and the ward and as outpatients. Participants were assessed at recruitment, ICU admission, hospital discharge and at 3-, 6- and 12-month follow-up. Physical function was evaluated using the Six-Minute Walk Test (6MWT) (primary outcome), the Timed Up and Go Test and the Physical Function in ICU Test. Patient-reported outcomes were measured using the Short Form 36 Health Survey, version 2 (SF-36v2) and Assessment of Quality of Life (AQoL) Instrument. Data were analyzed using mixed models. RESULTS: The a priori enrollment goal was not reached. There were no between-group differences in demographic and hospital data, including acuity and length of acute hospital stay (LOS) (Acute Physiology and Chronic Health Evaluation II score: 21 vs 19; hospital LOS: 20 vs 24 days). No significant differences were found for the primary outcome of 6MWT or any other outcomes at 12 months after ICU discharge. However, exploratory analyses showed the rate of change over time and mean between-group differences in 6MWT from first assessment were greater in the intervention group. CONCLUSIONS: Further research examining the trajectory of improvement with rehabilitation is warranted in this population. TRIAL REGISTRATION: The trial was registered with the Australian New Zealand Clinical Trials Registry ACTRN12605000776606.

The revised faecal incontinence scale: a clinical validation of a new, short measure for assessment and outcomes evaluation.

BACKGROUND: The patient perspective on fecal incontinence can only be captured through the use of participant-reported measures. There are few psychometric evaluations of such measures, and these evaluations have reported some problems with existing measures. OBJECTIVE: This study clinically evaluated the new Revised Faecal Incontinence Scale which was developed to provide a short, psychometrically sound measure for epidemiological and evaluative research. DESIGN: A sample of consecutive patients was recruited and administered a questionnaire pre and posttreatment (Continence Advising, Physiotherapy and Surgery). SETTINGS: The study was conducted at 6 incontinence clinics across Australia. PATIENTS: : The sample included 61 people with fecal incontinence at baseline and 38 at follow-up. MAIN OUTCOME MEASURES: Measures included the Revised Faecal Incontinence Scale, the Wexner Continence Scale, and the St Mark's Incontinence Score. Additionally, patient and clinician ratings of severity and improvement were collected. RESULTS: The internal reliability of the Revised Faecal Incontinence Scale had a Cronbach's α = 0.78 compared with 0.65 for both the Wexner and St Mark's scales. Test-retest reliabilities were 0.80, 0.74, and 0.68. All 3 instruments were similarly responsive to change at follow-up. Correlations with other fecal incontinence measures were high and significant. LIMITATIONS: The small sample size, particularly at posttreatment, provides limitations concerning generalizability and subanalyses that could be undertaken. CONCLUSIONS: The Revised Faecal Incontinence Scale possessed evaluative discrimination between different levels of incontinence severity. In this sample it had superior internal consistency and test-retest reliability to the Wexner and St Mark's Incontinence Scales. It was at least as responsive as the Wexner and St Mark's in detecting change in incontinence status following treatment. Although ongoing clinical validation is required, these findings suggest it is a short, reliable, and valid scale that could be considered for use by researchers, epidemiologists, and clinicians.

Population norms for the AQoL derived from the 2007 Australian National Survey of Mental Health and Wellbeing.

OBJECTIVE: To provide Australian health-related quality of life (HRQoL) population norms, based on utility scores from the Assessment of Quality of Life (AQoL) measure, a participant-reported outcomes (PRO) instrument. METHODS: The data were from the 2007 National Survey of Mental Health and Wellbeing. AQoL scores were analysed by age cohorts, gender, other demographic characteristics, and mental and physical health variables. RESULTS: The AQoL utility score mean was 0.81 (95%CI 0.81-0.82), and 47% obtained scores indicating a very high HRQoL (>0.90). HRQoL gently declined by age group, with older adults' scores indicating lower HRQoL. Based on effect sizes (ESs), there were small losses in HRQoL associated with other demographic variables (e.g. by lack of labour force participation, ES(median) : 0.27). Those with current mental health syndromes reported moderate losses in HRQoL (ES(median) : 0.64), while those with physical health conditions generally also reported moderate losses in HRQoL (ES(median) : 0.41). CONCLUSIONS: This study has provided contemporary Australian population norms for HRQoL that may be used by researchers as indicators allowing interpretation and estimation of population health (e.g. estimation of the burden of disease), cross comparison between studies, the identification of health inequalities, and to provide benchmarks for health care interventions.

Back pain and social isolation: cross-sectional validation of the friendship scale for use in studies on low back pain.

BACKGROUND: Low back pain (LBP) is common, and social isolation is both a risk factor for poor recovery and a consequence. However, no studies seem to have validated social isolation measures in LBP populations. AIMS: This study assessed the validity of the Friendship Scale (FS), a brief measure of social isolation. METHODS: LBP participants were 100 consecutive consenting adult patients attending physiotherapy outpatient clinics, matched (1:2) by age and gender with a general population sample (GPS; n=200). FS validation was through factor analysis, internal consistency, sensitivity by known groups, and Rasch analysis. RESULTS: : There were significant differences between LPB and GPS on 5 of the 6 FS items. Social isolation on the FS was reported by 26% of the LBP cohort compared with 9% of the GPS. All FS items loaded on the principal component >0.60, suggesting unidimensionality. Internal consistency was α=0.81. The FS was sensitive by pain severity and study cohort. Rasch analysis showed no disordered items, although 2 items were marginally misfitting. Differential item functioning by sex was observed on 1 item; there was no other observed differential item functioning. After removal of the worst fitting item (feeling alone), the remaining items fit the Rasch model. This, however, may have been a function of study samples. CONCLUSIONS: Generally, the FS performed well, and its descriptive system contains excess capacity beyond that needed in the study population; that is, those with LBP were not particularly socially isolated, and responses indicating severe social isolation were barely reported by these participants. Overall, the FS appears to be a suitable instrument for assessing social isolation among LBP patients.

QOLIBRI overall scale: a brief index of health-related quality of life after traumatic brain injury.

BACKGROUND: The quality of life after brain injury (QOLIBRI) scale is a recently developed instrument that provides a profile of health-related quality of life (HRQoL) in domains typically affected by brain injury. However, for global assessment it is desirable to have a brief summary measure. This study examined a 6-item QOLIBRI overall scale (QOLIBRI-OS), and considered whether it could provide an index of HRQoL after traumatic brain injury (TBI). METHODS: The properties of the QOLIBRI-OS were studied in a sample of 792 participants with TBI recruited from centres in nine countries covering six languages. An examination of construct validity was undertaken on a subsample of 153 participants recruited in Germany who had been assessed on two relevant brief quality of life measures, the satisfaction with life scale and the quality of life visual analogue scale. RESULTS: The reliability of the QOLIBRI-OS was good (Cronbach's α=0.86, test-retest reliability =0.81) and similar in participants with higher and lower cognitive performance. Factor analysis indicated that the scale is unidimensional. Rasch analysis also showed a satisfactory fit with this model. The QOLIBRI-OS correlates highly with the total score from the full QOLIBRI scale (r=0.87). Moderate to strong relationships were found among the QOLIBRI-OS and the extended glasgow outcome scale, short-form-36, and hospital anxiety and depression scale (r=0.54 to -0.76). The QOLIBRI-OS showed good construct validity in the TBI group. CONCLUSIONS: The QOLIBRI-OS assesses a similar construct to the QOLIBRI total score and can be used as a brief index of HRQoL for TBI.

Construction of the descriptive system for the Assessment of Quality of Life AQoL-6D utility instrument.

BACKGROUND: Multi attribute utility (MAU) instruments are used to include the health related quality of life (HRQoL) in economic evaluations of health programs. Comparative studies suggest different MAU instruments measure related but different constructs. The objective of this paper is to describe the methods employed to achieve content validity in the descriptive system of the Assessment of Quality of Life (AQoL)-6D, MAU instrument. METHODS: The AQoL program introduced the use of psychometric methods in the construction of health related MAU instruments. To develop the AQoL-6D we selected 112 items from previous research, focus groups and expert judgment and administered them to 316 members of the public and 302 hospital patients. The search for content validity across a broad spectrum of health states required both formative and reflective modelling. We employed Exploratory Factor Analysis and Structural Equation Modelling (SEM) to meet these dual requirements. RESULTS AND DISCUSSION: The resulting instrument employs 20 items in a multi-tier descriptive system. Latent dimension variables achieve sensitive descriptions of 6 dimensions which, in turn, combine to form a single latent QoL variable. Diagnostic statistics from the SEM analysis are exceptionally good and confirm the hypothesised structure of the model. CONCLUSIONS: The AQoL-6D descriptive system has good psychometric properties. They imply that the instrument has achieved construct validity and provides a sensitive description of HRQoL. This means that it may be used with confidence for measuring health related quality of life and that it is a suitable basis for modelling utilities for inclusion in the economic evaluation of health programs.

Impact of a diabetes disease management program on diabetes control and patient quality of life.

The worldwide burden of diabetes is projected to be 5.4% of the adult population by the year 2025. Diabetes is associated with multiple medical complications that both decrease health-related quality of life (HR-QOL) and contribute to earlier mortality. There is growing evidence for the effectiveness of multidisciplinary disease management programs that incorporate self-management principles in improving patients' long-term outcomes. The aim of this project was to evaluate the effectiveness of this approach in improving: (1) glycemic control measured by HbA1c, and (2) HR-QOL measured by the Assessment of Quality of Life (AQOL), at enrollment and at 12-months follow-up. Between 2004 and 2008, a total of 967 patients were enrolled in the program; 545 (56%) of these patients had HbA1c data available at baseline and at 12 months. Mean HbA1c at enrollment was 8.6% (SD 1.9) versus 7.3% (SD 1.2) at 12 months (P<0.001). Overall, 68% of patients experienced improvements in HbA1c. At enrollment, patients reported "fair" HR-QOL, which was significantly lower than age-adjusted population norms who reported "good" HR-QOL. At 12 months, 251 (64%) patients had improved HR-QOL, 27 (7%) had no change, and 114 (29%) deteriorated. Mean utility scores improved by 0.11 (P<0.001), which is almost twice the minimum clinically important difference for the AQOL. This study confirms that a multidisciplinary disease management program for patients with poorly controlled type 2 diabetes can improve both glycemic control and HR-QOL.

Systematic review of quality of life in the management of vestibular schwannoma.

Vestibular schwannoma (VS) is a benign tumour arising from the vestibular component of the vestibulocochlear nerve. Treatment protocols range from observation to microsurgical resection (MS) or radiation therapy using focused delivery techniques: either stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT). Most reported outcome measures explore medically orientated results such as extent of resection or facial nerve function and do not give any insight into how the initial disease, the treatment or operative complications impinge upon the patient's quality of life (QoL). The primary aim of this review was to appraise the quality of research concerning the measurement of QoL in patients with VS. A systematic review was performed including trials of patients with newly diagnosed VS undergoing MS, SRT/SRS, or observation with a measure of QoL. Only trials of prospective design were included. Excluded trials included participants with recurrent disease or comorbidities, and studies reporting patients with VS in association with neurofibromatosis type 2. Each trial for inclusion was assessed for bias and underwent formal data extraction. Between 1973 and 2010, 47 unique trials were identified with eight trials of prospective design. All included studies were prospective non-randomised, observational convenience sampled trials. No randomised control trials or systematic reviews were identified. The most common QoL measure used was the Short Form Questionnaire (SF-36), although it has not been validated in VS. The included trials suggest that the treatment protocols of MS and SRS/SRT are of equal efficacy with regard to impact on QoL; however, the trials were hetereogenous and suffered from a variety of methodological deficiencies. Given this heterogeneity, no meta-analysis was able to be performed. The available literature on QoL in the treatment of VS suffers from significant methodological weaknesses making it difficult to make any assessment as to the efficacy on QoL of available treatment options for VS. Further well-designed, randomised prospective research is necessary to understand this condition, its effect on QoL and how QoL outcomes may be used alongside clinical indicators in making treatment decisions.

Quality of life in dementia patients: nursing home versus home care.

BACKGROUND: Care management providing a high quality of life (QoL) is a crucial issue in dealing with increasing numbers of dementia patients. Although the transition from informal (home-based) care to formal (institutional) care is often a function of dementia stage, for those with early dementia there is currently no definitive evidence showing that informal or formal care provides a higher QoL, particularly where informal care is favored for local cultural reasons. This paper outlines the research protocol for a study comparing formal and informal care in Malaysia. It seeks to provide evidence regarding which is more appropriate and results in higher QoL in early dementia. METHODS: This is a quasi-experimental study design involving 224 early dementia patients from both nursing home and community settings. Participants will be assessed for cognitive severity, QoL, needs, activities of daily living, depression and social isolation/connectedness by using the Mini-Mental State Examination (MMSE), Cognitive Impairment Scale - 4 items (CIS-4), EUROPE Health Interview Survey-Quality of Life (WHO8), Assessment of Quality of Life (AQoL8), Camberwell Assessment of Need for the Elderly - Short Version (CANE-S), Barthel Index (BI), Cornell Scale for Depression (CSDD), Geriatric Depression Scale - 15 items (GDS-15), and Friendship Scale (FS) respectively. CONCLUSION: This study aims to provide a better understanding of care needs in early dementia. Given population aging, the study findings will provide evidence assisting decision-making for policies aimed at reducing the burden of caregiving and preserving the QoL of dementia patients.

Changes in the prevalence of bipolar disorders between 1998 and 2008 in an Australian population.

OBJECTIVE: To identify any changes in the prevalence of bipolar disorder (BD) between 1998, 2004, and 2008. METHOD: Cross-sectional population-based surveys were conducted involving random and representative samples of South Australian adults aged ≥ 15 years. BD was assessed using the mood module of the Primary Care Evaluation of Mental Disorders instrument (PRIME-MD), a single question related to doctor-diagnosed BD and the Mood Disorder Questionnaire (MDQ), which defines bipolar spectrum disorder. RESULTS: The PRIME-MD-derived prevalence of BD increased significantly from 0.5% [95% confidence interval (CI): 0.27-0.79] in 1998 to 1.0% (95% CI: 0.61-1.31) in 2004 and 1.5% (95% CI: 1.05-1.91) in 2008, demonstrating a significant increased linear trend (χ² =13.91, df=2, p=0.002). Similarly, reported doctor-diagnosed BD increased significantly from 1.1% (95% CI: 0.75-1.51) in 1998 to 1.7% (95% CI: 1.26-2.18) in 2004 and 2.9% (95% CI: 2.28-3.48) in 2008 (Linear trend test χ²=24.55, df=2, p<0.001). The MDQ-derived diagnosis of bipolar spectrum disorder changed from 2.5% (95% CI: 1.96-3.08) in 2004 to 3.3% (95% CI: 2.66-3.94) in 2008 (χ² =3.22, df=1, p<0.10), but this difference did not attain statistical significance. Confining the analysis to those positive for BD on all three methods, there was a significant increase in the prevalence of the detection of BD using all three measures (χ² =4.43, df=1, p=0.03) between 2004 and 2008. CONCLUSIONS: There has been an increased prevalence of BD in South Australia over the last decade, but this may be related to changing diagnostic practices rather than a true increase.