Health measurement instruments and their applicability to military veterans: a systematic review.

INTRODUCTION: Accurate measurement of health status is essential to assess veterans' needs and the effects of interventions directed at improving veterans' well-being. We conducted a systematic review to identify instruments that measure subjective health status, considering four components (ie, physical, mental, social or spiritual well-being). METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we searched CINAHL, MEDLINE, Embase, PsycINFO, Web of Science, JSTOR, ERIC, Social Sciences Abstracts and ProQuest in June 2021 for studies reporting on the development or evaluation of instruments measuring subjective health among outpatient populations. We assessed risk of bias with the Consensus-based Standards for the Selection of Health Measurement Instruments tool and engaged three veteran partners to independently assess the clarity and applicability of identified instruments. RESULTS: Of 5863 abstracts screened, we identified 45 eligible articles that reported health-related instruments in the following categories: general health (n=19), mental health (n=7), physical health (n=8), social health (n=3) and spiritual health (n=8). We found evidence for adequate internal consistency for 39 instruments (87%) and good test-retest reliability for 24 (53%) instruments. Of these, our veteran partners identified five instruments for the measurement of subjective health (Military to Civilian Questionnaire (M2C-Q), Veterans RAND 36-Item Health Survey (VR-36), Short Form 36, Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF) and Sleep Health Scale) as clear and very applicable to veterans. Of the two instruments developed and validated among veterans, the 16-item M2C-Q considered most components of health (mental, social and spiritual). Of the three instruments not validated among veterans, only the 26-item WHOQOL-BREF considered all four components of health. CONCLUSION: We identified 45 health measurement instruments of which, among those reporting adequate psychometric properties and endorsed by our veteran partners, 2 instruments showed the most promise for measurement of subjective health. The M2C-Q, which requires augmentation to capture physical health (eg, the physical component score of the VR-36), and the WHOQOL-BREF, which requires validation among veterans.

Suggested curriculum guidelines on complementary and alternative medicine: recommendations of the Society of Teachers of Family Medicine Group on Alternative Medicine.

BACKGROUND AND OBJECTIVES: The widespread use of alternative and complementary therapies by the public provides a new challenge to medical education. No standardized curriculum is available for medical educators in this field. Providing an adequate background on these therapies and reliable, useful information to our learners was a task addressed by the Society of Teachers of Family Medicine (STFM) Group on Alternative Medicine over the past 2 years. METHODS: The group met at conferences and communicated via e-mail to develop a consensus of recommended knowledge, skills, and attitudes in complementary and alternative medicine for incorporation into the family practice residency training curriculum. CONCLUSION: This article suggests guidelines as developed by this STFM group to assist programs wishing to include formal training in complementary and alternative medicine in residency training.

Use of death certificates for mesothelioma surveillance.

Data from the Massachusetts Cancer Registry and death certificates were linked for mesothelioma cases reported to the registry from 1982 through 1987 to determine the extent to which the cause of death information that is given on the death certificate is useful in identifying mesothelioma cases for disease surveillance. Only 12 percent of all persons reported with mesothelioma who had died were detected using underlying cause of death codes for cancers of the peritoneum and pleura, which are commonly used to identify mesothelioma cases. The rate increased to 83 percent when death certificates were reviewed manually for any mention of mesothelioma. Surveillance using only the coded cause of death data currently available will result in a large underascertainment of mesothelioma cases.