US norms for six generic health-related quality-of-life indexes from the National Health Measurement study.

BACKGROUND: A number of indexes measuring self-reported generic health-related quality-of-life (HRQoL) using preference-weighted scoring are used widely in population surveys and clinical studies in the United States. OBJECTIVE: To obtain age-by-gender norms for older adults on 6 generic HRQoL indexes in a cross-sectional US population survey and compare age-related trends in HRQoL. METHODS: The EuroQol EQ-5D, Health Utilities Index Mark 2, Health Utilities Index Mark 3, SF-36v2 (used to compute SF-6D), Quality of Well-being Scale self-administered form, and Health and Activities Limitations index were administered via telephone interview to each respondent in a national survey sample of 3844 noninstitutionalized adults age 35-89. Persons age 65-89 and telephone exchanges with high percentages of African Americans were oversampled. Age-by-gender means were computed using sampling and poststratification weights to adjust results to the US adult population. RESULTS: The 6 indexes exhibit similar patterns of age-related HRQoL by gender; however, means differ significantly across indexes. Females report slightly lower HRQoL than do males across all age groups. HRQoL seems somewhat higher for persons age 65-74 compared with people in the next younger age decade, as measured by all indexes. CONCLUSIONS: Six HRQoL measures show similar but not identical trends in population norms for older US adults. Results reported here provide reference values for 6 self-reported HRQoL indexes.

Changes in adherence to highly active antiretroviral therapy medications in the Multicenter AIDS Cohort Study.

OBJECTIVES: To characterize the determinants of changes in adherence to antiretroviral therapy and examine whether there are persistent lower adherers. DESIGN: A cohort study with repeated measurements. METHODS: Self-reported 100% adherence was defined as taking all doses and numbers of pills over a 4-day period as prescribed for current HIV medications. Independent predictors of changing adherence (< 100% to 100% and 100% to < 100%) were determined by logistic regression, correcting for correlated repeated measures for 597 HIV-positive men reporting the use of highly active antiretroviral therapy (HAART) between October 1998 and October 2000. RESULTS: Of the 942 visit-pairs with initial 100% adherence, 106 (11.3%) reduced adherence to less than 100%, and 836 (88.7%) remained 100% adherent at the next 6-month visit. No recent outpatient visits, younger age, depression, less than college educated, and later in calendar time predicted decreasing adherence. Among 186 visit-pairs starting with less than 100% adherence, 133 (71.5%) improved adherence to 100% and 53 (28.5%) remained less than 100% adherent at the next visit. The determinants of improving adherence included not being African-American, not using recreational drugs, and having had more than three HAART regimens. Lower adherence was not a random event; it was significantly correlated across visits within the individual. CONCLUSION: Characteristics associated with improving and lowering adherence differed and should be considered in developing interventions to enhance adherence and optimize effective therapies.

Guidelines for childhood obesity prevention programs: promoting healthy weight in children.

These guidelines for obesity prevention programs encourage a health-centered, rather than weight-centered, approach that focuses on the whole child, physically, mentally, and socially. The emphasis is on living actively, eating in normal and healthful ways, and creating a nurturing environment that helps children recognize their own worth and respects cultural foodways and family traditions. It is recognized that obesity, eating disorders, hazardous weight loss, nutrient deficiencies, size discrimination, and body hatred are all interrelated and need to be addressed in comprehensive ways that do no harm.