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PubMed1983

Prevalence of diabetic retinopathy and distribution of its severity among patients of a university clinic of diabetes in Osaka.

We have been following longitudinal changes of diabetic retinopathy by periodic fundoscopy in patients at our out-patient clinic for diabetes mellitus. In this study, we reviewed the prevalence of diabetic retinopathy and the distribution of its severities. Funduscopic examinations for retinopathy were performed on 242 patients. They ranged in age from 13 to 84 years (52.9 +/- 0.9, mean +/- s.e.). Duration of diabetes ranged from 1 to 31 years (10.7 +/- 0.4). Forty patients were treated with diet alone, 112 with oral hypoglycemic agents and 90 with insulin administration. No retinopathy was found in 83 patients (34%), background retinopathy in 113 (47%), preproliferative retinopathy in 24 (10%) and proliferative retinopathy in 17 (7%). Five patients (2%) were blind. Twenty-seven patients (60%) of 45 with a less than 5-year duration of diabetes were apparently without retinopathy, while the incidence of proliferative retinopathy increased in proportion to the duration. Fasting plasma glucose and glycosylated hemoglobin levels were higher in the patients with proliferative retinopathy than in any other group. All of the blind patients had a long history of untreated diabetes. Whether diabetic control assessed by glycosylated hemoglobin influences the progression of retinopathy could not be demonstrated by a 2-year observation. Further analysis based on a longer duration is needed in this respect.

Adolescent↗

PubMed2005

Cystatin C and mortality risk in the elderly: the health, aging, and body composition study.

Kidney dysfunction is known to decrease life expectancy in the elderly. Cystatin C is a novel biomarker of kidney function that may have prognostic utility in older adults. The association of cystatin C with mortality was evaluated in a biracial cohort of black and white ambulatory elderly and compared with that of serum creatinine concentrations. The Health, Aging and Body Composition study is a cohort of well-functioning elderly that was designed to evaluate longitudinal changes in weight, body composition, and function. A total of 3075 participants who were aged 70 to 79 yr and had no disability were recruited at sites in Memphis, TN, and Pittsburgh, PA, between April 1997 and June 1998 with a follow-up of 6 yr. At entry, the mean cystatin C was 1.05 mg/L and the mean creatinine was 1.06 mg/dl. After 6 yr of follow-up, 557 participants had died. The mortality rates in each ascending cystatin C quintile were 1.7, 2.7, 2.9, 3.1, and 5.4%/yr. After adjustment for demographic risk factors, comorbid health conditions, and inflammatory biomarkers (C-reactive protein, IL-6. and TNF-alpha), each quintile of cystatin C was significantly associated with increased mortality risk compared with the lowest: Hazard ratios (HR; 95% confidence intervals) quintile 1, -1.0 (referent); quintile 2, -1.74 (1.21 to 2.50); quintile 3, -1.51 (1.05 to 2.18); quintile 4, -1.49 (1.04 to 2.13); and quintile 5, -2.18 (1.53 to 3.10). These associations did not differ by gender or race. Results were consistent for cardiovascular and other-cause mortality, but not cancer mortality. Creatinine quintiles were not associated with mortality after multivariate adjustment (HR: 1.0 [referent], 1.00 [0.72 to 1.39], 0.95 [0.68 to 1.32], 1.11 [0.79 to 1.57], 1.16 [0.86 to 1.58]). Cystatin C is a strong, independent risk factor for mortality in the elderly. Future studies should investigate whether cystatin C has a role in clinical medicine.

Aged↗

PubMed1992

Predictors of smoking cessation and relapse in older adults.

We examined longitudinal changes in smoking behavior among older adults in three community cohorts of the Established Populations for Epidemiologic Studies of the Elderly. Smoking prevalence declined from 15% at baseline to 9% during 6 years of follow-up. Annual smoking cessation and relapse rates were 10% and less than 1%, respectively. Interval diagnosis of myocardial infarction, stroke, or cancer increased subsequent smoking cessation but not relapse. Although smoking cessation around diagnosis is increased, primary prevention could yield greater benefits.

Aged↗

PubMed2005

Smoking and drinking habits five years after baseline in the JACC study.

BACKGROUND: Observing longitudinal changes in smoking and drinking habits is important for evaluating the risk of incidence and death from cancer or other diseases in a cohort study. METHODS: Smoking and drinking habits at baseline and about five years later among 18,312 males and 28,338 females were obtained from the baseline and interim surveys in the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study) sponsored by Monbusho (Ministry of Education, Science, Sports and Culture of Japan). Changes in smoking and drinking habits between the two surveys were observed. Odds ratios for quitting these habits at interim survey were estimated. RESULTS: Percentages of current smokers at baseline and interim surveys were 51.0% and 45.5% in males, and 5.2% and 4.8% in females, respectively. Percentages of current drinkers at baseline and interim surveys were 78.0% and 73.2% in males, and 29.5% and 23.5% in females, respectively. The number of cigarettes per day among male current smokers and the usual amount of alcohol consumed on each occasion among current drinkers decreased between the two surveys. Odds ratios for smoking cessation increased with age at baseline and decreased with the number of cigarettes per day at baseline. Odds ratios for drinking cessation increased with age at baseline and decreased with the usual amount of alcohol consumed on each occasion at baseline. CONCLUSION: The decrease in smoking and drinking habits was observed during the five-year follow-up period. Higher age and lower levels of exposure were associated with quitting smoking or drinking.

Adult↗

PubMed1987

Cognitive function and prediction of dementia in old age.

Longitudinal changes in cognitive functioning were examined for a sample of aging twins, some of whom developed dementia while others did not. Individuals who were judged to be demented at a mean age of eighty-five years had achieved lower scores on most tests twenty years prior to diagnosis, and experienced greater declines in vocabulary and forward digit span over time, than those surviving to a comparable age without dementia. These trends were observed for individuals with mild, as well as moderate-to-severe, dementia and were unrelated to physical health status or premorbid activity patterns. It is suggested that dementing illness may develop very slowly, and that the likelihood of exhibiting clinically significant dementia may vary with premorbid intellectual level.

Activities of Daily Living↗

PubMed2003

Physical fitness in persons with hemiparetic stroke.

In persons with hemiparetic stroke, assessment and promotion of fitness have so far received limited attention, partly because of the lack of appropriate measures applicable to them. Because these mobility-impaired persons are prone to inactivity, disuse and insulin resistance are likely to occur, and can aggravate the already significant health and economic consequences that stroke entails. It is therefore important to assess objectively their fitness to devize effective and efficient fitness promotion programs. Because of physical limitations, however, many persons with stroke cannot perform traditional stress testing using a treadmill or a cycle ergometer, and maximal oxygen consumption, which is regarded as a gold standard, is not a practical measure. In this article, we reviewed the current status of research on fitness in persons with hemiparetic stroke from the perspectives of evaluation, structure analysis of fitness, and longitudinal changes during a rehabilitation program. As a measure of fitness, indices obtainable with a submaximal exercise are proposed, such as anaerobic threshold and heart rate oxygen coefficient. Protocols applicable to persons with hemiparetic stroke with a variety of functional limitations have been developed (basic bedside activities, bridging activity, or single arm ergometry). The structure of their fitness is demonstrated to be described by a fitness model of healthy persons (cardiopulmonary, muscular and metabolic dimensions) if the paresis/activities of daily living dimension is added. Several studies suggest that fitness improves during a conventional stroke rehabilitation program. Studying the changes of the above four dimensions can help develop more effective fitness training programs.

Humans↗

PubMed1990

Importance of imparied insulin-gene expression in occurrence of diabetes in obese rats.

To investigate the role of the beta-cell in the occurrence of diabetes in obesity, longitudinal changes of insulin-gene expression and pancreatic insulin content were compared among genetically obese diabetic (Wistar fatty) rats, genetically obese nondiabetic (Zucker fatty) rats, and ventromedial hypothalamus (VMH)-lesioned obese rats. Plasma glucose levels were significantly elevated with age in Wistar fatty rats, whereas they were virtually unchanged in VMH-lesioned and Zucker fatty rats. Obesity and hyperinsulinemia were evident in VMH-lesioned rats 1 wk after the operation and in Zucker and Wistar fatty rats at 5 wk of age. In VMH-lesioned rats, the pancreatic preproinsulin I mRNA (pplmRNA) level and pancreatic insulin content markedly increased approximately two- to threefold (P less than 0.001) with the development of hyperinsulinemia, whereas sham-operated rats showed no significant change. In Zucker and Wistar lean rats, the pplmRNA level and pancreatic insulin content increased with age, corresponding to increases in body weight. In Zucker fatty rats, the pplmRNA level and pancreatic insulin content at 5 and 14 wk of age were significantly higher than those of lean littermates. The pplmRNA level in Zucker fatty rats at 14 wk of age reached 290% of that of their lean littermates (P less than 0.001). On the other hand, the pplmRNA level and pancreatic insulin content in Wistar fatty rats at 5 and 14 wk of age did not increase more than those of their lean littermates at the corresponding ages and were therefore significantly lower than in Zucker fatty rats, which had a higher grade of hyperinsulinemia at 14 wk of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2002

TNF-alpha is a predictor of insulin resistance in human pregnancy.

Historically, insulin resistance during pregnancy has been ascribed to increased production of placental hormones and cortisol. The purpose of this study was to test this hypothesis by correlating the longitudinal changes in insulin sensitivity during pregnancy with changes in placental hormones, cortisol, leptin, and tumor necrosis factor (TNF)-alpha. Insulin resistance was assessed in 15 women (5 with gestational diabetes mellitus [GDM] and 10 with normal glucose tolerance) using the euglycemic-hyperinsulinemic clamp procedure, before pregnancy (pregravid) and during early (12-14 weeks) and late (34-36 weeks) gestation. Body composition, plasma TNF-alpha, leptin, cortisol, and reproductive hormones (human chorionic gonadotropin, estradiol, progesterone, human placental lactogen, and prolactin) were measured in conjunction with the clamps. Placental TNF-alpha was measured in vitro using dually perfused human placental cotyledon from five additional subjects. Compared with pregravid, insulin resistance was evident during late pregnancy in all women (12.4 +/- 1.2 vs. 8.1 +/- 0.8 10(-2) mg. kg(-1) fat-free mass. min(-1). microU(-1). ml(-1)). TNF-alpha, leptin, cortisol, all reproductive hormones, and fat mass were increased in late pregnancy (P < 0.001). In vitro, most of the placental TNF-alpha (94%) was released into the maternal circulation; 6% was released to the fetal side. During late pregnancy, TNF-alpha was inversely correlated with insulin sensitivity (r = -0.69, P < 0.006). Furthermore, among all of the hormonal changes measured in this study, the change in TNF-alpha from pregravid to late pregnancy was the only significant predictor of the change in insulin sensitivity (r = -0.60, P < 0.02). The placental reproductive hormones and cortisol did not correlate with insulin sensitivity in late pregnancy. Multivariate stepwise regression analysis revealed that TNF-alpha was the most significant independent predictor of insulin sensitivity (r = -0.67, P < 0.0001), even after adjustment for fat mass by covariance (r = 0.46, P < 0.01). These observations challenge the view that the classical reproductive hormones are the primary mediators of change in insulin sensitivity during gestation and provide the basis for including TNF-alpha in a new paradigm to explain insulin resistance in pregnancy.

Adult↗

PubMed1999

Effects of maternal gestational diabetes on offspring adiposity at 4-7 years of age.

OBJECTIVE: The purpose of this study was to assess the long-term effects of maternal prenatal factors, including gestational diabetes mellitus (GDM), adiposity, and weight gain during pregnancy, on adiposity of offspring from 4 to 7 years of age. A second purpose was to investigate the relationships among childhood adiposity, blood pressure, and 2-h postprandial glucose level. RESEARCH DESIGN AND METHODS: Prospective observational study of four groups of children including large-for-gestational-age (LGA) offspring of mothers with gestational diabetes (OGDM); appropriate-for-gestational-age (AGA) OGDM; LGA control subjects; and AGA control subjects. Anthropometrics including skin-fold measurements, blood pressure measurements, and a 2-h postprandial glucose measurement were obtained at each visit. Repeated measures analysis of variance models were used to detect different patterns of longitudinal change among the groups. RESULTS: LGA OGDM were more likely to be heavier, have larger circumferences and skin-fold measurements, and have a higher BMI than AGA OGDM and control subjects, and these findings increased with increasing age. Blood pressures and postprandial glucose values were similar for OGDM and control subjects at 4-7 years. Multivariable analyses showed that infant BMI and maternal prepregnant BMI predicted 7-year BMI for OGDM, whereas for control subjects, maternal prepregnancy BMI and weight gain during pregnancy were positive predictors with a small negative contribution from birth BMI. CONCLUSIONS: We conclude that LGA OGDM have evidence of increasing body size and adiposity with increasing age and that maternal GDM and maternal prepregnant adiposity are significant predictors of their unique growth patterns.

Adipose Tissue↗

PubMed2006

Serum and synovial fluid concentrations of keratan sulfate and hyaluronan in dogs with induced stifle joint osteoarthritis following cranial cruciate ligament transection.

OBJECTIVE: To examine longitudinal changes in serum and synovial fluid concentrations of keratan sulfate (KS) and hyaluronan (HA) after cranial cruciate ligament (CCL) transection in dogs. ANIMALS: 12 clinically normal adult mixed-breed dogs. PROCEDURE: Following CCL transection in the right stifle joint, KS and HA concentrations were determined in serum and neat (undiluted) synovial fluid prior to and 1, 2, 3, and 12 months after surgery. Postsurgical dilution of synovial fluid was corrected by use of urea as a passive marker. RESULTS: Synovial fluid KS and HA concentrations decreased at 1, 2, and 3 months after surgery in operated stifle joints, compared with baseline values. Synovial fluid KS concentration decreased in unoperated stifle joints at 1 month. A decrease in synovial fluid KS concentration was found in operated stifle joints, compared with unoperated stifle joints, at 2 and 3 months, and a decrease in synovial fluid HA concentrations was also found in operated stifle joints, compared with unoperated stifle joints, at 1, 2, and 3 months. Serum KS concentrations increased from baseline values at 3 months after surgery. Hyaluronan concentrations in operated stifle joints were lower than baseline values at 1, 2, and 3 months. Urea-adjusted synovial fluid concentrations revealed that dilution did not account for the decline in biomarker concentrations. CONCLUSIONS AND CLINICAL RELEVANCE: The initial decrease and subsequent increase in synovial fluid concentrations of HA and KS may be caused by an acute inflammatory response to surgical intervention that negatively affects cartilage metabolism or an increase in production of immature proteoglycans.

Animals↗

PubMed2001

Language, cognition, and short-term memory in individuals with Down syndrome.

The developmentally emerging phenotype of language and cognition in individuals with Down syndrome is summarized on the basis of the project's prior work. Identified are a) the emerging divergence of expressive and receptive language, b) the emerging divergence of lexical and syntactic knowledge in each process, and c) the emerging divergence within cognitive skills of auditory short-term memory and visuospatial short-term memory from other visuospatial skills. Expressive syntax and auditory short-term memory are identified as areas of particular difficulty. Evidence for the continued acquisition of language skills in adolescence is presented. The role of the two components of working memory, auditory and visual, in language development is investigated in studies of narrative and longitudinal change in language skills. Predictors of individual differences during six years of language development are evaluated through hierarchical linear modelling. Chronological age, visuospatial short-term memory, and auditory-short term memory are identified as key predictors of performance at study entry, but not individual change over time, for expressive syntax. The same predictors account for variation in comprehension skill at study outset; and change over the six years can be predicted by chronological age and the change in visuospatial short-term memory skills.

Cognition Disorders↗

PubMedDate not supplied

[Longitudinal component of gastric motility: its relationship to peristaltic velocity and contractility. Cineradiographic study in man].

The aim of this study was to further characterize the gastric longitudinal motility and its relationship between the peristaltic velocity and contractility. Twelve healthy volunteers (six made sport S and six were sedentary NS; moy +/- DS; 24 +/- 2.4 years; 172 +/- 3.9 cm; 65.8 +/- 3.4 kg; n = 12) were involved and ingested 5 hours after a standard meal, 250 ml of barium sulfate suspension. A serial of 15 fluoroscopic plates (size 10 x 10 cm) was taken in 30 seconds. For each subject, the longitudinal variation delta L (cm) of gastric shape, the mean velocity V (mm/s) of gastric peristalsis and the intensity AM (p 100) of contractile wave were measured with a digitalized table connected to a computer. Compared to NS group, the S group showed significative enhanced values of the dynamic parameters (delta L: 2.9 +/- 0.4 vs 1.8 +/- 0.2 cm; V: 2.8 +/- 0.2 vs 2.3 +/- 0.2 mm/s; AM: 55.8 +/- 5.3 vs 48.3 +/- 2.8 p 100; moy +/- DS). Faster rhythms were observed in the diagram of longitudinal motility, with or without the well known gastric frequency 3 c/min. This study allows to point out longitudinal changes of the gastric shape and shows a pattern of significant augmented gastric motility. In fact, it is necessary to consider the stomach in a biomechanical system with the diaphragm and the abdominal wall. This system influenced by exercise might be studied intensively with our dynamic parameters associated with respiratory and abdominal data.

Adult↗

PubMed1993

Urinary epidermal growth factor in patients with gliomas: significance of the factor as a glial tumor marker.

Epidermal growth factor (EGF) content in urine from patients with glial tumors was examined by radioimmunoassay techniques with labeled human EGF and its rabbit EGF polyclonal antibody. There was no cross-reaction with transforming growth factor-alpha, which has a common receptor with EGF. Forty glial tumors were divided into three groups according to the clinical stage: Samples from Group A patients were obtained before therapy and/or after biopsy; in these patients a large volume of tumor was apparent on computerized tomography (CT). Group B samples were obtained after gross total removal of the tumor and/or chemo- and radiation therapy; these patients showed a small volume of residual tumor on CT. Samples from Group C patients were obtained after gross tumor total removal and/or chemo- and radiation therapy; no tumor was detected on CT scans in these patients. Urinary EGF levels in Group A samples were statistically significantly higher than in samples from healthy individuals (p < 0.001), Group B patients (p < 0.10), and Group C patients (p < 0.02). In addition, high-grade glial tumors in Group A cases showed a significantly higher level of urinary EGF than low-grade tumors in Group A patients (p < 0.05), or patients with meningioma (p < 0.02), metastatic brain tumor (p < 0.05), and cerebral infarction (p < 0.001). Longitudinal changes of urinary EGF levels in glioma patients mostly synchronized with the clinical course and therapeutic interventions. Therefore, urinary EGF, as a glial tumor marker, may be of practical value for diagnosing a malignant glioma and evaluating for the efficacy of chemo- and radiation therapy.

Adolescent↗

PubMed2006

Functional magnetic resonance imaging of the primary somatosensory cortex in piglets.

OBJECT: The piglet is an excellent model for the developing human brain, and has been used increasingly in various centers for studies of traumatic brain injury and other insults. Unlike rodent or primate models, however, there are few behavioral scales for the piglet, and the available ones are used to test general responsiveness rather than specific functional outcome. The differing behavioral repertoires of animals of different ages provide an additional challenge when age-dependent injury responses are compared. To overcome these experimental limitations of piglets in brain injury research, the authors developed a functional magnetic resonance (fMR) imaging paradigm that can be used to track recovery in the somatosensory cortex over time in anesthetized animals of different ages. METHODS: Fifteen fMR imaging studies in eight piglets were performed before and after scaled cortical impact injury to the primary somatosensory cortex subserving snout sensation. Specific anesthetic and imaging protocols enabled visualization of cortical activation, and comparison with somatosensory evoked potentials obtained before and after injury was obtained. A piglet brain template for group-level analysis of these data was constructed, similar to the fMR imaging techniques used in humans, to allow for group comparisons and longitudinal change analysis over time. CONCLUSIONS: Loss of function in a specifically traumatized cortical region and its subsequent recovery over time can now be demonstrated visually by fMR imaging in the piglet. Besides its value in understanding intrinsic recovery mechanisms and plasticity at different ages, this functional outcome measure will enable the use of the piglet model in treatment trials specifically designed for the immature brain.

Age Factors↗

PubMed1996

[Otoacoustic emissions of full-term and preterm neonates].

Transiently evoked otoacoustic emission (TEOAE), distortion product otoacoustic emission (DPOAE), and spontaneous otoacoustic emission (SOAE) were measured in 45 full-term neonates (68 ears) and 12 preterm neonates (20 ears) with ILO88 & 92. Measurements were performed in the nursery of the obstetrics ward or NICU (not sound proof room) under natural sleeping condition after nursing. No sedating agent was used. TEOAEs were rated "good response" in 61 (89.7%) of 68 full-term neonate ears. DPOAEs were rated "good response" in 40 (71.4%) of 56 full-term neonate ears. SOAEs were detectable in 25 (62.5%) of 40 full-term neonate ears. Considering the high positive rate of TEOAE in full-term neonates and the easy and noninvasive method of measurement, we concluded that TEOAE is useful for auditory screening in neonates. There was failure to detect TEOAEs in 7 ears and the measurements were all performed within 6 days after birth. Some reports claim that residual amnion in the external auditory canal or the middle ear in the first few days after birth causes slight hearing loss. Thus, we expected that making the measurements more than 7 days after birth might yield higher "good response" rates. We sometimes found that the Total Echo Powers of TEOAEs were reduced by the poor condition of the ear probe. Thus, we must be very careful in regard to this technical problem in order to perform accurate examinations. Because of its lower "good response" rate, DPOAE was not as useful for screening as TEOAE. Because of the movements or respiratory noises of the newborn infants, it was hard to detect reliable DPOAEs, particularly in the low frequency range. On the other hand, because of its frequency specificity, particurally at high frequencies, DPOAE will be useful for detecting the partial hearing impairment such as congenital high-tone hearing impairment. It would be difficult to use SOAE as a clinical test. Because it is not an evoked response, its mechanism of generation is not well understood. We expect that following longitudinal changes in SOAE in neonates may yield some information about it. We measured mainly TEOAE in preterm neonates because we had to complete the measurements as soon as possible. High Total Echo Powers of TEOAEs were recorded in most infants over 38 weeks of PCA (post conceptional age). The earliest case showed reliable TEOAE at 35 weeks PCA. In most cases that could be measured twice on different days, the Total Echo Powers of TEOAE, were higher in the second time. We therefore concluded that TEOAE might serve as an examination for monitoring the maturation of preterm neonate hearing.

Female↗

PubMedDate not supplied

Effect of implanted insulin pumps on fluorescein transcapillary escape time in type 1 diabetes mellitus.

OBJECTIVE: To determine whether significant increases in fluorescein transcapillary escape time (FTET) would occur after treatment of patients with type 1 diabetes with insulin delivered intraperitoneally by a surgically implanted pump. METHODS: Nine patients with type 1 diabetes who were otherwise healthy and had received surgically implanted insulin pumps on a study protocol were recruited to have three measurements of FTET and glycosylated hemoglobin during an 18-month period. Serum fluorescein-albumin binding was measured at the time of the final test. Control FTETs were measured in 46 patients with type 1 diabetes who did not have insulin pumps and in 15 adults without diabetes. RESULTS: In the implanted insulin pump group, 50% of the FTETs were below normal, but no significant longitudinal change in FTETs was noted in eight of the nine study patients. The mean FTETs in the implanted insulin pump group were significantly higher than those of the control patients with diabetes but without insulin pumps (mean, 88 versus 62 seconds; P<0.05) but significantly lower than those of the control subjects without diabetes (88 versus 163 seconds; P<0.001). Four of the nine patients with implanted insulin pumps had normal FTETs on all three studies. This subgroup had used insulin pumps (external + implanted) for significantly longer periods (6.2 versus 2.6 years; P<0.05) than the other five patients. These differences within the implanted pump group did not correlate with differences in glycosylated hemoglobin values or fluorescein-albumin binding; however, the glycosylated hemoglobin levels before insulin pump implantation were significantly lower than those of the other five patients. Three patients with onset of type 1 diabetes before age 10 years had the lowest FTETs. CONCLUSION: Implanted insulin pumps did not alter FTETs between 6 months and 32 months after pump implantation. Total time on insulin pumps (external and implanted) is associated with normal FTET, and onset of diabetes before age 10 years is associated with abnormal FTET.

Journal Article↗

PubMed1993

Discriminative versus evaluative assessment: some observations on goal attainment scaling.

Goal attainment scaling has been described in the rehabilitation literature as a method of evaluation designed to monitor client progress, structure team conferences, and provide information on overall program evaluation. The appropriate use of goal attainment scaling in clinical environments depends on a clear understanding of its strengths and weaknesses. The primary strength of goal attainment scaling is the ability to evaluate individualized longitudinal change. Goal attainment scaling is not a methodology designed to assess functional status. Confusion occurs when evaluation tools designed to discriminate between persons (determine status) are used to assess change in individual patients over time. This paper describes the strengths and weaknesses of goal attainment scaling as a methodology for evaluating clinical change. The process of evaluative assessment with goal attainment scaling is compared to discriminative assessment where the purpose is to distinguish between persons or to classify persons into predefined categories.

Documentation↗

PubMed1993

Measuring health-related quality of life.

Clinicians and policymakers are recognizing the importance of measuring health-related quality of life (HRQL) to inform patient management and policy decisions. Self- or interviewer-administered questionnaires can be used to measure cross-sectional differences in quality of life between patients at a point in time (discriminative instruments) or longitudinal changes in HRQL within patients during a period of time (evaluative instruments). Both discriminative and evaluative instruments must be valid (really measuring what they are supposed to measure) and have a high ratio of signal to noise (reliability and responsiveness, respectively). Reliable discriminative instruments are able to reproducibly differentiate between persons. Responsive evaluative measures are able to detect important changes in HRQL during a period of time, even if those changes are small. Health-related quality of life measures should also be interpretable--that is, clinicians and policymakers must be able to identify differences in scores that correspond to trivial, small, moderate, and large differences. Two basic approaches to quality-of-life measurement are available: generic instruments that provide a summary of HRQL; and specific instruments that focus on problems associated with single disease states, patient groups, or areas of function. Generic instruments include health profiles and instruments that generate health utilities. The approaches are not mutually exclusive. Each approach has its strengths and weaknesses and may be suitable for different circumstances. Investigations in HRQL have led to instruments suitable for detecting minimally important effects in clinical trials, for measuring the health of populations, and for providing information for policy decisions.

Chronic Disease↗