Factors associated with severity on admission and in-hospital mortality after primary intracerebral hemorrhage in China.

BACKGROUND AND PURPOSE: Of the stroke types, intracerebral hemorrhage is the most debilitating and fatal. The aim of the current study was to determine factors that influence the severity and in-hospital mortality after primary intracerebral hemorrhage. METHODS: Data were collected retrospectively on 1268 patients with primary intracerebral hemorrhage admitted to stroke units at participating hospitals in Guangzhou between January 2005 and August 2008. Logistic regression analysis was used to determine factors associated with severity on admission and in-hospital mortality. RESULTS: Of the 1268 patients, 20·4% were reported to have a severe stroke on admission, and the in-hospital mortality rate was 12·5%. Severity on admission was strongly associated with Glasgow Coma Scale score on admission (odds ratio = 0·89, 95% confidence interval 0·85-0·94) and hematoma location. Notably, basal ganglia hemorrhages were associated with increased severity (odds ratio = 1·40, 95% confidence interval 1·03-1·90), and cerebellar hemorrhages were associated with reduced severity (odds ratio = 0·29, 95% confidence interval 0·10-0·84). In-hospital mortality was not only correlated with Glasgow Coma Scale score on admission (odds ratio = 0·79, 95% confidence interval 0·74-0·84) and basal ganglia location (odds ratio = 0·47, 95% confidence interval 0·26-0·83), but also with dysnatremia (odds ratio = 1·91, 95% confidence interval 1·08-3·40) and comorbidities such as upper gastrointestinal hemorrhage (odds ratio = 2·28, 95% confidence interval 1·33-3·91), pneumonia (odds ratio = 3·50, 95% confidence interval 2·17-5·63), urinary incontinence (odds ratio = 2·22, 95% confidence interval 1·40-3·51), and renal dysfunction (odds ratio = 2·28, 95% confidence interval 1·42-3·65). CONCLUSION: Glasgow Coma Scale score and hematoma locations were independently associated with severity on admission and in-hospital mortality after primary intracerebral hemorrhage. The study also highlights the deleterious effect of comorbidities on in-hospital mortality following primary intracerebral hemorrhage in China.

Development of short versions for the WHOQOL-OLD module.

PURPOSE OF THE STUDY: To explore short-form versions of World Health Organization Quality of Life (WHOQOL-OLD) with acceptable psychometric properties, which was developed for older adults by the WHOQOL research group, containing 24 items initially. DESIGN AND METHODS: We randomly sampled two-thirds of respondents from the data of WHOQOL-OLD field study (N = 5,566), as a developmental sample, and the remaining third as a validation sample. Three approaches (item response theory [IRT] and regression analysis [REG], classical test theory [CTT] and REG, and CTT and IRT and REG) were performed to develop three short-form scales with six items each using the developmental sample. The reliability and criterion validity of the three short-form scales were evaluated using the validation sample. RESULTS: The version 1 of short-form scales contained items 6, 11, 12, 16, 20, and 21; version 2 contained items 2, 6, 11, 12, 17, and 22; and version 3 contained items 4, 6, 17, 19, 20, and 24. The correlation coefficient between the total scores of the three versions and WHOQOL-OLD were .918, .925, and .922, respectively. The internal consistency reliability coefficients of the three versions were .681, .678, and .649, respectively. IMPLICATIONS: The three versions of short-form WHOQOL-OLD contained the best items of the original module, much shorter, and with good internal consistency and criterion validity as a whole.

[A structural equation model for the WHO health survey data].

OBJECTIVE: Based on the 2002 WHO health survey data, to explore the latent relationship among self-reported health level, the actual level of health, the social demographic characteristics and the risk factors, and to analyze the influence of the various surveillance indicators on self-reported health and the degree that the self-reported health explained the actual level of health. METHODS: Field tests for various components of the World health survey were conducted in nine countries during 2002, including India, Brazil, Burkina, Hungary, Nepal, Russia, Spain, Tunisia, and Vietnam (29 971). The survey questionnaire included a self-assessment component and anchoring vignette component. The self-assessment component data was adjusted and eliminated the affect of "cut-point bias" by using the anchoring vignette component data, and then was used to build the structural equation model on the relationship among self-reported health level, actual health level, social demographic characteristics and the risk factors. RESULTS: In the final structural equation model, "the actual level of health" = 0.80 × "the self-reported health level" + (-0.04) × "the social demographic characteristics" + (-0.08) × "the risk factors" (R(2) = 0.66), and "the self-reported health level" = (-0.70) × "the social demographic characteristics" + 0.10 × "the risk factors" (R(2) = 0.55). The standardized total effect of self-reported health to the actual level of health was 0.80, and that of the social demographic characteristics to the self-reported health and the actual level of health were -0.70 and -0.60, respectively. And the 16 items of self-reported health consisted of 8 dimensions; and sorted by the power of impact to the actual health level, they were mobility, pain and discomfort, sleep, cognition, feelings, self-care ability, visual capacity and interpersonal activities. CONCLUSION: There were significant linear correlation relationship between the actual level of health and the self-reported health, as well as between the self-reported health and the social demographic characteristics. And the self-reported 16 items used by the 2002 WHO health survey played an important role in the health evaluation of population.