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This study examined the reliability and validity of a two-factor structure of the Center for Epidemiologic Studies Depression (CES-D) scale. The study was conducted in a large group of cancer patients (n = 475) and a matched reference group (n = 255). Both groups filled in a questionnaire at two points in time; patients 3 and 15 months after diagnosis. Factor analysis confirmed our hypothesis that the 16 negatively and four positively formulated items measure two relatively independent factors, i.e. Depressed Affect and Positive Affect. Therefore, these items should not be combined into an overall sumscore. In both groups, Depressed Affect proved to be a reliable and valid measure of depressive symptomatology, as indicated by its good internal consistency, its strong correlations with other measures of psychological distress and neuroticism, and its effectiveness in discriminating patients from the reference group on depressive symptomatology. In contrast, the validity of the Positive Affect factor could not be confirmed, since it was only weakly related to other measures of psychological distress and extraversion. Depressed and Positive Affect were about equally related to self-esteem, life satisfaction, and quality of life. These findings support the use of a sumscore based on the 16 negatively formulated CES-D items as a more valid measure of depressive symptomatology, in cancer patients and in healthy individuals from the general population. [ABSTRACT FROM AUTHOR]

Objective : Though health-related quality of life (HRQoL) is now commonly measured as an outcome in clinical trials, the relationships between its components remain unclear. The relation of physical symptoms, physical function, and psychological symptoms to each other and to overall quality of life is of special interest. Method : Cross-sectional data from 5279 community-dwelling elders who participated in the Groningen Longitudinal Aging Study were analyzed using structural equation modeling techniques. Three models were examined. One “Linear” model included: number of chronic medical conditions, physical symptoms, physical functioning, activity interference, social function, perceived health and overall quality of life in a simple linear progression. Another `non-linear' model included these variables, but allowed effects between non-adjacent variables. A third `non-linear' model included these variables plus anxiety and depressive symptoms. Results : The Linear Model did not satisfactorily account for the observed data [X [sup 2] (15df) = 2946.96], so the saturated Non-Linear Model, incorporating paths between non-adjacent components, is described. When anxiety and depressive symptoms were added to this Non-Linear Model, they fit best in a position mediating the relation between perceived health and overall quality of life [X [sup 2] (5df) = 136.78]. Conclusions : Overall quality of life appears to be related to symptom status as directly as it is related to functional status. Anxiety and depressive symptoms appear to mediate the relation between general health perceptions and overall quality of life. Quality of life measures should therefore include assessments of physical and psychological symptom severity as well as functional status if they are to truly reflect what matters to patients. The disability-adjusted life year (DALY) measure used by the WHO may inadequately reflect the effect of symptoms on patient's quality of life. [ABSTRACT FROM AUTHOR]

The Dartmouth COOP method consists of seven questions measuring seven domains of health status: physical fitness, feelings, daily activities, social activities, change in health status, current overall health perceptions and bodily pain. Each question has five response options and each option is accompanied by an illustration. In this paper, we present the results of a randomized study of the effects of the illustrations of the seven Dartmouth COOP charts in a low-functioning elderly sample. In addition, the subjective evaluation of the illustrations was examined. The results showed no significant differences between the outcomes obtained with the illustrated COOP charts and the unillustrated COOP charts: the mean scores, patterns of intercorrelations and associations with other measures for the research participants who filled in the illustrated COOP charts hardly differed from those obtained from the participants who filled in the unillustrated charts. Furthermore, the results showed that approximately three-quarters of the research participants considered the illustrations informative, while approximately 17% of the participants considered the pictures exaggerated. We conclude that, as long as there is no empirical support for the advantages of the COOP charts with respect to cross-cultural standardization or use in subjects who have, for example, difficulty in reading, there seems to be no need for the illustrated COOP charts. The results of our study showed that both types of COOP charts appear to be interchangeable. [ABSTRACT FROM AUTHOR]

Objective: To explore the relevance of prescription changes and related drug costs when patients are referred from primary to secondary care. Patients and methods: Secondary analysis of data derived from a study on the quality of referrals, which was performed in 1989–1990. New and non-acute referrals of ambulatory patients were studied for internal medicine, neurology, and dermatology. Diagnoses were coded according to the ICPC, and drug names were coded according to the ATC. Prescription data were collected from referral letters and questionnaires. Drugs were also coded as generic or brand name products. Cost of treatment was calculated on the basis of information in the 1989 edition of the Dutch Public Health Care Drug Compendium taking into account the price of the drug and the duration of the prescription. Potential savings were calculated for those brand name products for which substitution by a similar drug was possible. Results: Data on 289 referrals, representing 289 patients, were available for analysis. In 126 out of the 289 patients (43.6%), specialists added to or changed prescriptions initiated by the general practitioner (GP). Specialist prescribing tended to shift to more chronic use. The costs of specialist prescribing are on average 23% higher than for GP prescriptions. Although specialists had fewer opportunities for generic substitution, the potential for savings was greater than for GPs. In many cases, the specialists changed the diagnosis. Only in neurology was the relative risk of receiving a prescription increased when the diagnosis changed. Conclusion: Specialists have considerable influence on prescribing to outpatients. The number of prescriptions and the related costs increased greatly when patients were referred from primary to secondary care. The opportunities for generic substitution, and therefore for possible savings, are not fully exploited by GPs or specialists. [ABSTRACT FROM AUTHOR]