Measuring quality of life in mental health: Are we asking the right questions?

Measuring quality-adjusted-life years using generic preference-based quality of life measures is common practice when evaluating health interventions. However, there are concerns that measures in common use, such as the EQ-5D and SF-6D, focus overly on physical health and therefore may not be appropriate for measuring quality of life for people with mental health problems. The aim of this research was to identify the domains of quality of life that are important to people with mental health problems in order to assess the content validity of these generic measures. Qualitative semi-structured interviews were conducted with 19 people, recruited from UK mental health services, with a broad range of mental health problems at varying levels of severity. This complemented a previous systematic review and thematic synthesis of qualitative studies on the same topic. Seven domains important to quality of life for people with mental health problems were identified: well-being and ill-being; relationships and a sense of belonging; activity; self-perception; autonomy, hope and hopelessness; and physical health. These were consistent with the systematic review, with the addition of physical health as a domain, and revealed a differing emphasis on the positive and negative aspects of quality of life according to the severity of the mental health problems. We conclude that the content of existing generic preference-based measures of health do not cover this domain space well. Additionally, because people may experience substantial improvements in their quality of life without registering on the positive end of a quality of life scale, it is important that the full spectrum of negative through to positive aspects of each domain are included in any quality of life measure

The selection of search sources influences the findings of a systematic review of people’s views: a case study in public health

Background For systematic reviews providing evidence for policy decisions in specific geographical regions, there is a need to minimise regional bias when seeking out relevant research studies. Studies on people’s views tend to be dispersed across a range of bibliographic databases and other search sources. It is recognised that a comprehensive literature search can provide unique evidence not found from a focused search; however, the geographical focus of databases as a potential source of bias on the findings of a research review is less clear. This case study describes search source selection for research about people’s views and how supplementary searches designed to redress geographical bias influenced the findings of a systematic review. Our research questions are: a) what was the impact of search methods employed to redress potential database selection bias on the overall findings of the review? and b) how did each search source contribute to the identification of all the research studies included in the review? Methods The contribution of 25 search sources in locating 28 studies included within a systematic review on UK children’s views of body size, shape and weight was analysed retrospectively. The impact of utilising seven search sources chosen to identify UK-based literature on the review’s findings was assessed. Results Over a sixth (5 out of 28) of the studies were located only through supplementary searches of three sources. These five studies were of a disproportionally high quality compared with the other studies in the review. The retrieval of these studies added direction, detail and strength to the overall findings of the review. All studies in the review were located within 21 search sources. Precision for 21 sources ranged from 0.21% to 1.64%. Conclusions For reducing geographical bias and increasing the coverage and context-specificity of systematic reviews of people’s perspectives and experiences, searching that is sensitive and aimed at reducing geographical bias in database sources is recommended

Ψηφιακές ιστορίες Κυπρίων πολιτών που βίωσαν την τουρκική εισβολή του 1974

Έχουν περάσει πολλά καλοκαίρια από εκείνο το μαύρο καλοκαίρι του 1974. Τα σημάδια έντονα βαθιά στις ψυχές όλων όσων έζησαν τότε, γιατί πόνεσαν θρήνησαν, γιατί θυμούνται και γιατί δεν ξέχασαν. Σημάδια που δεν επουλώθηκαν παρόλα τα 47 χρόνια. Δεν μπόρεσαν να σβήσουν τον πόνο, την αδικία, την αθλιότητα, την αγριότητα, τη βαρβαρότητα. Έζησαν έναν εφιάλτη, μαρτύρησαν και μαρτυρούν βουβά. Δεν ξέχασαν γιατί τα άδικα δεν ξεχνιούνται, δεν ξέχασαν γιατί πονούν! Ιστορίες που δεν ξεδιπλώθηκαν, δε βγήκαν από τη σφαίρα της βίωσης, δεν πέρασαν στην ατμόσφαιρα της αφήγησης, που έμειναν μυστικές. Πολλά τα δάκρυα που δε φανερώθηκαν. Σ’ αυτές τις ανείπωτες ιστορίες θα διεισδύσει η παρούσα διπλωματική έρευνα, ώστε αυτές να αποκτήσουν ήχο και εικόνα. Μέσω των ιστοριών αυτών θα γίνει και παράλληλη προσπάθεια ώστε οι συμμετέχοντες να εκφράσουν ελεύθερα τα συναισθήματά τους. Θα αποτελούνται από τέσσερις βασικές ομάδες: Μια ομάδα προσφύγων, μια ομάδα στρατιωτών που πολέμησαν, μια τρίτη ομάδα από ανθρώπους που βίωσαν τον Αττίλα εντός του πεδίου μάχης και μια τέταρτη ομάδα όπως βίωσε τον πόλεμο (εκτός του πεδίου μάχης) στην υπόλοιπη Κύπρο. Επιπροσθέτως, θα γίνει μια μικρή συνέντευξη σε τρεις νέους ανθρώπους οι οποίοι βίωσαν τον πόλεμο, μέσα από τις αφηγήσεις των γονιών τους και των παππούδων τους, και από αυτών που έμαθαν από το σχολείο μέσω των δασκάλων τους. Σκοπός να ανακαλύψουμε μέσα από τις απαντήσεις τους τι σημαίνουν για αυτούς οι έννοιες: πόλεμος, «Δεν ξεχνώ», κατεχόμενα, διχοτόμηση κ.λπ., όπως επίσης και την εκπαιδευτική διάσταση της διαδικασίας. Βασικός στόχος της έρευνας, είναι να συγκριθούν τα συναισθήματα των βασικών τεσσάρων κατηγοριών μέσα από τις αφηγήσεις τους, όπως και των νέων μέσα από τις απαντήσεις τους και περαιτέρω υποερωτήματα: εσωτερικά διλήμματα που προκύπτουν για τη νέα γενιά που βαδίζει σε μια διελκυστίνδα ανάμεσα στην υποχρέωση και το παρελθόν και το παρόν. Η νέα γενιά από τη μια είναι υποχρεωμένη να βαδίζει μπροστά και η παλιά που δεν ξεχνά, προσπαθεί να βαδίζει με τα τραύματα του παρελθόντος.Many summers have passed since that black summer of 1974. The scars run deep in the souls of all those who lived then because they remember, because they have not forgotten. Scars that have not healed despite 47 years. They could not erase the pain, the injustice, the misery, the cruelty, the brutality. They have lived a nightmare; have become martyrs and are now deafeningly silent. Furthermore, they did not forget because the unjust is not forgotten, they did not forget because they still hurt! Stories that did not unfold, that did not leave the realm of experience, that did not pass into the atmosphere of the narrative, that remained secret. There were many tears that were not shown. It is into these untold stories that this thesis research will penetrate, so that they can acquire sound and image. Through these stories, a parallel effort will be made, so that the participants can freely express their feelings. The stories will consist of four main groups: A group of refugees, a group of soldiers who fought, a third group of people who experienced Attila on the battlefield and a fourth group who experienced it off the battlefield in the rest of Cyprus. In addition, there will be a short interview with three young people who experienced the war from the stories of their parents, their grandparents, from what they learned and heard from school. The purpose of this study is to fully understand what war, "I will not forget," occupied areas, division, and other topics mean to them via their responses, as well as the educational aspect of the process. The research's major objective is to compare the feelings of the four main groups through their narratives, as well as the responses and sub-questions of the young people like internal difficulties that occur for the new generation as it walks a tightrope between obligation, the past, and the present. On the one hand, the younger generation is obligated to go on, while on the other hand the older generation, who does not forget, attempts to walk with the scars of the past

Discriminatory ability of calcaneal quantitative ultrasound in the assessment of bone status in patients with inflammatory bowel disease

A high incidence of bone disease in patients with inflammatory bowel disease (IBD) requires frequent monitoring of skeletal status and, for that reason, evaluation of radiation-free technology is an issue of interest. Our objective was to appraise the parameters of calcaneal quantitative ultrasound (QUS): broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (QUI), and establish their t-score values to investigate discriminatory ability of QUS in IBD patients with metabolic bone disease. The study included 126 patients (Crohn's disease [n = 94] and ulcerative colitis [n = 32]), and 228 age- and sex-matched healthy volunteers. Bone status was evaluated on the same day by calcaneal QUS and dual-energy x-ray absorptiometry (DXA) at spine (L1-L4) and total hip. All QUS measurements were lower in patients compared with healthy controls (BUA p < 0.001; SOS p < 0.001; QUI p < 0.001) and correlated significantly but inversely with disease duration (r = -0.3, p = 0.002). There was no difference with respect to type of disease (Crohn's disease or ulcerative colitis) or corticosteroid therapy. All three QUS t-scores were significantly lower in patients who had previously sustained fragile fractures (n = 28) than in those without fracture in their history (n = 98) (t-scores: BUA -2.0 vs. -1.3, p = 0.008; SOS -2.1 vs. -1.4, p = 0.02: QUI -2.3 vs. -1.5, p = 0.009). Axial DXA was not significantly different between the fracture and nonfracture patients (-1.7 vs. -1.2, p = 0.1), whereas total hip DXA showed a discriminatory power between the two (-1.6 vs. -0.7, p = 0.001). Patients with t-score < -1.0 scanned by DXA were classified as bone disease. The sensitivity of QUS to identify bone disease was 93% and specificity 63%. The sensitivity of QUS to detect osteopenia was 84% and 72% for osteoporosis. Alternatively, lower negative QUS t-score cutoff </= -1.8 identified 83% of osteoporosis at lumbar spine and 100% at total hip. All three QUS variables had t-scores less than -1.8 when osteoporosis was detected at both spine and hip. However, the subgroup of IBD patients with QUI t-score cutoff </= -1.8 still included 26% of individuals with normal bone status. Calcaneal QUS measurements may identify patients with IBD who are at a higher risk of fracture independently of DXA measurements. However, QUS showed poor agreement with bone status scanned by DXA and a low discriminatory power between osteopenia and osteoporosis

Temperature dependence of mobilities and carrier concentrations in semi-insulating GaAs

The temperature behavior of electron and hole mobilities and carrier concentrations was measured in p-type Cr doped semi-insulating GaAs. The above quantities were determined by measuring at a given temperature the photomagnetoresistance and photo-Hall effect vs magnetic field intensity. A minimum of hole concentration is observed at 210-225 K. The electron concentration either remains constant below 190-200 K or it rises again at lower temperatures. The mobilities of both carriers show a maximum at almost the same temperatures with those where the behavior of n and p changes. We try to explain the above on the basis of radiative recombination and impurity conduction. © 1980