Integration ... whether PHOs will survive.

BACKGROUND: The use of quality of life (QoL) instruments in menorrhagia research is increasing but there is concern that not enough emphasis is placed on patient-focus in these measurements, i.e. on issues which are of importance to patients and reflect their experiences and concerns (clinical face validity). The objective was to assess the quality of QoL instruments in studies of menorrhagia. STUDY DESIGN: A systematic review of published research. Papers were identified through MEDLINE (1966-April 2000), EMBASE (1980-April 2000), Science Citation Index (1981-April 2000), Social Science Citation Index (1981-April 2000), CINAHL (1982-1999) and PsychLIT (1966-1999), and by manual searching of bibliographies of known primary and review articles. Studies were selected if they assessed women with menorrhagia for life quality, either developing QoL instruments or applying them as an outcome measure. Selected studies were assessed for quality of their QoL instruments, using a 17 items checklist including 10 items for clinical face validity (issues of relevance to patients' expectations and concerns) and 7 items for measurement properties (such as reliability, responsiveness, etc.). RESULTS: A total of 19 articles, 8 on instrument development and 11 on application, were included in the review. The generic Short Form 36 Health Survey Questionnaire (SF36) was used in 12/19 (63%) studies. Only two studies developed new specific QoL instruments for menorrhagia but they complied with 7/17 (41%) and 10/17 (59%) of the quality criteria. Quality assessment showed that only 7/19 (37%) studies complied with more than half the criteria for face validity whereas 17/19 (90%) studies complied with more than half of the criteria for measurement properties (P = 0.0001). CONCLUSION: Among existing QoL instruments, there is good compliance with the quality criteria for measurement properties but not with those for clinical face validity. There is a need to develop methodologically sound disease specific QoL instruments in menorrhagia focussing both on face validity and measurement properties.

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PubMed2002

[Occupational physician's role regarding return to work of workers with acquired disability].

Occupational physicians are expected to play important roles in helping workers with an acquired disability return to work. However, the key elements to develop a successful program to help these workers return to work are still unclear. In this study, we searched the literature referring to occupational physicians' role in the return-to-work process of the workers with acquired disability. Many of these studies mentioned the following; occupational physicians should start co-operating with the treating physician right after the appearance of the disability and exchange medical and occupational health information with each other. When a disabled worker wishes to return to work, the occupational physician in charge should carefully evaluate his/her work ability, and fitness for the work. We also performed a hearing survey at 15 diverse institutions and organizations that are generally aimed at promoting employment, social welfare and medical service for disabled persons located in at least a 5 million population prefecture in Japan. Among them, the Local Occupational Center for the Disabled functions as the practical gateway for employment, and the Health and Welfare Center is the principal window for the social welfare of the disabled. However, their services are sometimes limited to only those who have become jobless and not for those returning to their original work. We considered that occupational physicians should also communicate positively with the organizations to promote successful returning of the workers with acquired disability to their former work.

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