The AMC Linear Disability Score in patients with newly diagnosed Parkinson disease.

OBJECTIVE: The aim of this study was to examine the clinimetric properties of the AMC Linear Disability Score (ALDS), a new generic disability measure based on Item Response Theory, in patients with newly diagnosed Parkinson disease (PD). METHODS: A sample of 132 patients with PD was evaluated using the Hoehn and Yahr (H&Y), the Unified PD Rating Scale motor examination, the Schwab and England scale (S&E), the Short Form-36, the PD Quality of Life Questionnaire, and the ALDS. RESULTS: The internal consistency reliability of the ALDS was good (alpha = 0.95) with 55 items extending the sufficient item-total correlation criterion (r > 0.20). The ALDS was correlated with other disability measures (r = 0.50 to 0.63) and decreasingly associated with measures reflecting impairments (r = 0.36 to 0.37) and mental health (r = 0.23 to -0.01). With regard to know-group validity, the ALDS indicated that patients with more severe PD (H&Y stage 3) were more disabled than patients with mild (H&Y stage 1) or moderate PD (H&Y stage 2) (p < 0.0001). The ALDS discriminated between more or less severe extrapyramidal symptoms (p = 0.001) and patients with postural instability showed lower ALDS scores compared to patients without postural instability (p = or< 0.0001). Compared to the S&E (score 100% = 19%), the ALDS showed less of a ceiling effect (5%). CONCLUSION: The AMC Linear Disability Score is a flexible, feasible, and clinimetrically promising instrument to assess the level of disability in patients with newly diagnosed Parkinson disease.

Development of the Qualeffo-31, an osteoporosis-specific quality-of-life questionnaire.

INTRODUCTION: Vertebral deformities are a common consequence of osteoporosis and are known to decrease quality of life. The Qualeffo-41 is a quality-of-life questionnaire especially developed for measuring quality of life in patients with vertebral deformities. It consists of 41 questions arranged in five domains: pain, physical function, social function, general health perception, and mental function. The objectives of this study were: (1) to develop a shorter version of the Qualeffo-41 by removing redundant questions; and (2) to investigate the scale characteristics, reliability, and validity of this shorter version. METHODS: The study was performed using data from the Qualeffo validation study and the Multiple Outcomes of Raloxifene Evaluation (MORE) study. The analyses were performed in patients with vertebral deformities (n=579). Factor analysis on polychoric correlations and an item response theory (IRT) model, i.e., the generalized partial credit model (GPCM), were used to create a shorter version of Qualeffo-41. Using GPCM, scoring weights were computed for all items. RESULTS: Three items were removed from the data set because of too many missing values. Factor analysis identified three instead of five domains: (1) pain, (2) physical function, and (3) mental function. Five items had factor loadings <0.4 and were not included in the GPCM. After excluding several items, the domains pain (four items), physical function (18 items), and mental function (nine items) showed a good, reasonable, and excellent fit, respectively. This indicates that the mental function domain and the pain domain are more unidimensional than the physical function domain. All three domains showed a very high correlation (r > or =0.95) with the corresponding domains of the Qualeffo-41. CONCLUSIONS: Qualeffo-31 was developed, consisting of three domains with a reasonable to excellent fit to the GPCM. Although the fit to the GPCM supports the construct validity of the Qualeffo-31, validation in a new study should be performed before using it in practice.

Hepatitis A in workers exposed to sewage: a systematic review.

OBJECTIVES: To assess whether the scientific literature supports the hypothesis that workers exposed to sewage are at higher risk of hepatitis A (HA). METHODS: All original papers reporting epidemiological studies published in English, French, or German which reported on the risk of HA infection in workers exposed to sewage were eligible. They were identified by several methods and each original paper was assessed independently with a checklist by two people. Studies were classified according to the strength of their design. Non-eligible studies were also examined to assess the impact of publication bias. If the risk estimates diverged widely, causes for heterogeneity were assessed. A distinction was made between seroprevalence studies based on subclinical HA (defined only by the presence of anti-HA antibodies) and clinical HA. RESULTS: 17 eligible studies were identified. No indication of an increased risk of clinical HA could be found. For seroprevalence the studies with the strongest design suggested a slightly increased risk of subclinical HA with an odds ratio (OR) <2.5. Heterogeneity was considerable and precluded a meta-analysis. Considering non-eligible studies would still decrease the OR. CONCLUSIONS: The systematic review does not confirm an increased risk of clinical HA in workers exposed to sewage. An increased risk of subclinical HA cannot be excluded but the association between seropositivity and exposure to sewage was not strong and became still weaker if publication bias was taken into account.

A negative iodine balance is found in healthy neonates compared with neonates with thyroid agenesis.

We studied the effects of the presence or absence of the thyroid gland on the iodine metabolism and excretion in term Dutch newborns by performing a retrospective study of the urinary iodine excretion in 193 term newborns with abnormal congenital hypothyroidism screening results. Thirty-six euthyroid newborns with decreased thyroxine-binding globulin levels were compared with 157 hypothyroid patients, 54 due to thyroid agenesis and 103 due to thyroid dysgenesis. A significant difference in the urinary iodine excretion was observed between the agenesis group (mean: 28 micrograms/24 h) and the euthyroid newborns (mean: 46 micrograms/24 h, P=0.001). In conclusion, healthy, euthyroid, term newborns excreted more iodine in their urine than newborns with thyroid agenesis. These results strongly indicated the existence of a temporarily negative iodine balance: the excretion of iodine prevailed over the intake and the newborn's thyroidal iodine, stored during pregnancy, could be used for thyroxine synthesis in the postnatal period. Since healthy term neonates were able to maintain adequate plasma free thyroxine concentrations under normal TSH stimulation, the prenatally acquired iodine stores could be considered sufficiently high to compensate for the transient postnatal losses.