Estimating a preference-based index for a menopause specific health quality of life questionnaire

BACKGROUND: The aim of the study was to develop a menopause-specific, preference-based healthrelated quality-of-life (HRQoL) index reflecting both menopausal symptoms and potential sideeffects of Hormone Replacement Therapy (HRT). METHODS: The study had three phases: the development of a health state classification, a prospective valuation survey and the estimation of a model to interpolate HRQoL indices for all remaining health states as defined by the classification. A menopausal health state classification was developed with seven dimensions: hot flushes, aching joints/muscles, anxious/frightened feelings, breast tenderness, bleeding, vaginal dryness and undesirable androgenic signs. Each dimension contains between three and five levels and defines a total of 6,075 health states. A sample of 96 health states was selected for the valuation survey. These states were valued by a sample of 229 women aged 45 to 60, randomly selected from 6 general practice lists in Sheffield, UK. Respondents were asked to complete a time trade-off (TTO) task for nine health states, resulting in an average of 16.5 values for each health state. RESULTS: Mean health states valued range from 0.48 to 0.98 (where 1.0 is full health and zero is for states regarded as equivalent to death). Symptoms, as described by the classification system, can be rank-ordered in terms of their impact (from high to low) on menopausal HRQoL as follows: aching joints and muscles, bleeding, breast tenderness, anxious or frightened feelings, vaginal dryness, androgenic signs. Hot flushes did not significantly contribute to model fit. The preferred model produced a mean absolute error of 0.053, but suffered from bias at both ends of the scale. CONCLUSION: This article presents an attempt to directly value a condition specific health state classification. The overall fit was disappointing, but the results demonstrate that menopausal symptoms are perceived by patients to have a significant impact on utility. The overall effect is modest compared to the more generic health state descriptions such as the EQ-5D. The resultant algorithm generates a preference-based index that can be used economic evaluation and that reflects the impact of this condition

Incomplete block designs with blocks of two plots

Various workers have shown that considerable economies in experimentation can be achieved by the use of identical twins, halves of leaves and halves of plants. The basic statistical principle enabling these economies is that of incomplete block designs. These make possible the comparison of treatments within pairs of identical twins, pairs of half-leaves or whatever grouping is used, so that experimental error arises only because of differences between individuals within the pairs. Extensive use of these natural groupings is possible only when the possible incomplete block designs have been enumerated. The purpose of this bulletin is to present what is essentially a complete array of incomplete block designs with blocks of two plots. The balanced incomplete block design requires (n-1) replications, where n is the number of treatments. Any design using a lesser number of replications must necessarily be unbalanced. Designs are presented which require (n-2), (n-3), ... , three replications, whenever such is possible, for any number of treatments between 6 and 12. These designs have been extracted from a pool of designs formed by (a) the class of partially balanced incomplete block designs with two classes of associates and (b) the class of circulant designs. The design chosen to cover each situation is the design which has the highest efficiency factor among all the designs in the pool applicable to the given situation. The tabulation of material necessary for the analysis of the respective designs is made to facilitate computations. The computations are exemplified by the inclusion of a worked example covering both the intrablock and interblock analysis

A health/media literacy intervention improves adults’ interpretations of sugar-sweetened beverage advertising

Although excessive sugar-sweetened beverages (SSB) intake is linked to numerous adverse health consequences, media literacy interventions rarely address the influences of food and beverage marketing with a specific focus on adults. This randomized controlled trial study investigated (1) whether media literacy education modifies adults’ perceptions of SSB advertising and (2) whether changes are moderated by health literacy. Results from the multilevel mixed-effects regression analyses with the intention-to-treat last-observation-carried-forward method showed that compared to MoveMore (a matched-contact comparison condition), SIPsmartER (an intervention condition) participants significantly enhanced their skillsets across media literacy domains (i.e., authors/audiences, messages/meanings, representation/reality) between baseline and 6-month follow-up. Baseline health literacy status did not moderate media literacy outcomes. Both low and high health literate participants improved their outcomes, suggesting that this media literacy intervention benefited adults regardless of their health literacy level. Results demonstrate the importance of cultivating critical analyses and strengthening adults’ resistance toward SSB advertising

Predicting sugar-sweetened behaviours with theory of planned behaviour constructs: Outcome and process results from the SIPsmartER behavioural intervention

Objective Guided by the theory of planned behaviour (TPB) and health literacy concepts, SIPsmartER is a six-month multicomponent intervention effective at improving SSB behaviours. Using SIPsmartER data, this study explores prediction of SSB behavioural intention (BI) and behaviour from TPB constructs using: (1) cross-sectional and prospective models and (2) 11 single-item assessments from interactive voice response (IVR) technology. Design Quasi-experimental design, including pre- and post-outcome data and repeated-measures process data of 155 intervention participants. Main Outcome Measures Validated multi-item TPB measures, single-item TPB measures, and self-reported SSB behaviours. Hypothesised relationships were investigated using correlation and multiple regression models. Results TPB constructs explained 32% of the variance cross sectionally and 20% prospectively in BI; and explained 13–20% of variance cross sectionally and 6% prospectively. Single-item scale models were significant, yet explained less variance. All IVR models predicting BI (average 21%, range 6–38%) and behaviour (average 30%, range 6–55%) were significant. Conclusion Findings are interpreted in the context of other cross-sectional, prospective and experimental TPB health and dietary studies. Findings advance experimental application of the TPB, including understanding constructs at outcome and process time points and applying theory in all intervention development, implementation and evaluation phases

Simulated reductions in consumption of sugar-sweetened beverages improves diet quality in Lower Mississippi Delta adults

Although the effects of replacing sugar-sweetened beverages (SSBs) with water on energy intake and body weight have been reported, little is known about how these replacements affect diet quality.To simulate the effects of replacing SSBs with tap water on diet quality and total energy intake of Lower Mississippi Delta (LMD) adults.Retrospective analysis of cross-sectional dietary intake data using a representative sample of LMD adults (n=1,689). Diet quality was measured using the Healthy Eating Index-2005 (HEI-2005) scores that were computed using the population ratio method. The effects of substituting SSBs with water on diet quality were simulated by replacing the targeted items’ nutrient profile with tap water's profile.Simulating the replacement of SSBs with tap water at 25, 50, and 100% levels resulted in 1-, 2.3-, and 3.8-point increases, respectively, in the HEI-2005 total score. Based on a mean daily intake of 2,011 kcal, 100% substitution of SSBs with tap water would result in 11% reduction in energy intake.Replacing SSBs with water could substantially improve the diet quality of the LMD adult population and potentially lead to significant weight loss overtime. Prioritizing intervention efforts to focus on the replacement of SSBs with energy-free drinks may be the most efficacious approach for conveying potentially substantial health benefits in this and similar disadvantaged populations

Identifying predictors of attitudes towards local onshore wind development with reference to an English case study

The threats posed by climate change are placing governments under increasing pressure to meet electricity demand from low-carbon sources. In many countries, including the UK, legislation is in place to ensure the continued expansion of renewable energy capacity. Onshore wind turbines are expected to play a key role in achieving these aims. However, despite high levels of public support for onshore wind development in principle, specific projects often experience local opposition. Traditionally this difference in general and specific attitudes has been attributed to NIMBYism (not in my back yard), but evidence is increasingly calling this assumption into question. This study used multiple regression analysis to identify what factors might predict attitudes towards mooted wind development in Sheffield, England. We report on the attitudes of two groups; one group (target) living close to four sites earmarked for development and an unaffected comparison group (comparison). We found little evidence of NIMBYism amongst members of the target group; instead, differences between general and specific attitudes appeared attributable to uncertainty regarding the proposals. The results are discussed with respect to literature highlighting the importance of early, continued and responsive community involvement in combating local opposition and facilitating the deployment of onshore wind turbines. (C) 2009 Elsevier Ltd. All rights reserved

A hybrid actuator disc - full rotor CFD methodology for modelling the effects of wind turbine wake interactions on performance

The performance of individual wind turbines is crucial for maximum energy yield, however, their performance is often reduced when turbines are placed together in an array. The wake produced by the rotors interacts with downstream turbines, resulting in a reduction in power output. In this paper, we demonstrate a new and faster modelling technique which combines actuator disc theory, modelled using wind tunnel validated Computational Fluid Dynamics (CFD), and integrated into full rotor CFD simulations. This novel hybrid of techniques results in the ability to analyse performance when simulating various array layouts more rapidly and accurately than using either method on its own. It is shown that there is a significant power reduction from a downstream turbine that is subjected to the wake of an upstream turbine, and that this is due to both a reduction in power in the wind and also due to changes in the aerodynamics. Analysis of static pressure along the blade showed that as a result of wake interactions, a large reduction in the suction peak along the leading edge reduced the lift generated by the rotor and so reduced the torque production and the ability for the blade to extract energy from the wind