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BACKGROUND: Health is a fundamental aspect of many scientific disciplines and its definition and measurement is the analytical core of many empirical studies. Comprehensive measures of health, however, are typically precluded in survey research due to financial and temporal restrictions. Self-rated health (SRH) as a single indicator of health, on the other hand, exhibits a lack of measurement invariance by age and is biased due to non-health influences. In the three-item Minimum European Health Module (MEHM), SRH is complemented with questions on chronic health conditions and activity limitations, thus providing a compromise between single indicators and comprehensive measures. METHODS: Using data from the German Ageing Survey (2008 & 2014; n = 12,037), I investigated the feasibility to combine the MEHM into a generic health indicator and judged its utility in comparison to SRH as a benchmark. Additionally, I explored the option of an extended version of the MEHM by adding information on multimorbidity and the presence and intensity of chronic pain. RESULTS: The analyses showed that both versions of the MEHM had a good internal consistency and each represented a single latent variable that can be computed using generalized structural equation modeling. The utility of this approach showed great promise as it significantly reduced age-specific reporting behavior and some non-health biases present in SRH. CONCLUSIONS: Using the MEHM to measure generic (physical) health is a promising approach with a wide array of applications. Further research could extend these analyses to additional age groups, other countries, and establish standardized weights for greater comparability.

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OBJECTIVES: Patient-Reported Outcomes Measurement Information System-Global Health (PROMIS-GH) is a widely used generic measure of health status. This study aimed to (1) assess the psychometric properties of the Hungarian PROMIS-GH and to (2) develop general population reference values in Hungary. METHODS: An online cross-sectional survey was conducted among the Hungarian adult general population (n = 1700). Respondents completed the PROMIS-GH v1.2. Unidimensionality (confirmatory factor analysis and bifactor model), local independence, monotonicity (Mokken scaling), graded response model fit, item characteristic curves and measurement invariance were examined. Spearman's correlations were used to analyse convergent validity of PROMIS-GH subscales with SF-36v1 composites and subscales. Age- and gender-weighted T-scores were computed for the Global Physical Health (GPH) and Global Mental Health (GMH) subscales using the US item calibrations. RESULTS: The item response theory assumptions of unidimensionality, local independence and monotonicity were met for both subscales. The graded response model showed acceptable fit indices for both subscales. No differential item functioning was detected for any sociodemographic characteristics. GMH T-scores showed a strong correlation with SF-36 mental health composite score (rs = 0.71) and GPH T-scores with SF-36 physical health composite score (rs = 0.83). Mean GPH and GMH T-scores of females were lower (47.8 and 46.4) compared to males (50.5 and 49.3) (p < 0.001), and both mean GPH and GMH T-scores decreased with age, suggesting worse health status (p < 0.05). CONCLUSION: This study established the validity and developed general population reference values for the PROMIS-GH in Hungary. Population reference values facilitate the interpretation of patients' scores and allow inter-country comparisons.

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OBJECTIVES: The Munich Breathlessness Service (MBS) significantly improved control of breathlessness measured by the Chronic Respiratory Questionnaire (CRQ) Mastery in a randomized controlled fast track trial with waitlist group design spanning 8 weeks in Germany. This study aimed to assess the within-trial cost-effectiveness of MBS from a societal perspective. METHODS: Data included generic (5-level version of EQ-5D) health-related quality of life and disease-specific CRQ Mastery. Quality-adjusted life years (QALYs) were calculated based on 5-level version of EQ-5D utilities valued with German time trade-off. Direct medical costs and productivity loss were calculated based on standardized unit costs. Incremental cost-effectiveness ratios (ICER) and cost-effectiveness-acceptance curves were calculated using adjusted mean differences (AMD) in costs (gamma-distributed model) and both effect parameters (Gaussian-distributed model) and performing 1000 simultaneous bootstrap replications. Potential gender differences were investigated in stratified analyses. RESULTS: Between March 2014 and April 2019, 183 eligible patients were enrolled. MBS intervention demonstrated significantly better effects regarding generic (AMD of QALY gains of 0.004, 95% confidence interval [CI] 0.0003 to 0.008) and disease-specific health-related quality of life at nonsignificantly higher costs (AMD of €605 [95% CI -1109 to 2550]). At the end of the intervention, the ICER was €152 433/QALY (95% CI -453 545 to 1 625 903) and €1548/CRQ Mastery point (95% CI -3093 to 10 168). Intervention costs were on average €357 (SD = 132). Gender-specific analyses displayed dominance for MBS in males and higher effects coupled with significantly higher costs in females. CONCLUSIONS: Our results show a high ICER for MBS. Considering dominance for MBS in males, implementing MBS on approval within the German health care system should be considered.

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PURPOSE: The aims of this study were to investigate (1) the extent to which response shift occurs among patients with coronary artery disease (CAD) after coronary revascularization, (2) whether the assessment of changes in health-related quality of life (HRQoL), controlled for response shift, yield more valid estimates of changes in HRQoL, as indicated by stronger associations with criterion measures of change, than without controlling for response shift, and (3) if occurrences of response shift are related to patient characteristics. METHODS: Patients with CAD completed the SF-36 and the Seattle Angina Questionnaire (SAQ7) at baseline and 3 months after coronary revascularization. Sociodemographic, clinical and psychosocial variables were measured with the patient version of the New York Heart Association-class, Subjective Significance Questionnaire, Reconstruction of Life Events Questionnaire (RE-LIFE), and HEXACO personality inventory. Oort's Structural Equation Modeling (SEM) approach was used to investigate response shift. RESULTS: 191 patient completed questionnaires at baseline and at 3 months after treatment. The SF-36 showed recalibration and reprioritization response shift and the SAQ7 reconceptualization response shift. Controlling for these response shift effects did not result in more valid estimates of change. One significant association was found between reprioritization response shift and complete integration of having CAD into their life story, as indicated by the RE-LIFE. CONCLUSION: Results indicate response shift in HRQoL following coronary revascularization. While we did not find an impact of response shift on the estimates of change, the SEM approach provides a more comprehensive insight into the different types of change in HRQoL following coronary revascularization.

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BACKGROUND: Generic health literacy measurement (GHLM) is an important tool to identify individuals with limited health literacy and can assist the design of tailored interventions for improving public health literacy. However, there is no consensus on measuring generic health literacy. The present study aims to review current GHLM used for adults in the literature. METHODS: A scoping review was undertaken to map the available measurements designed to assess generic health literacy. RESULTS: The review identified 19 GHLM for adults. Most of them applied a multidimensional definition of health literacy with a focus on individuals' abilities to access, appraise, understand, and apply health information and services. Nutbeam's conceptual model and Sørensen's integrated model were widely used among the identified measures as the theoretical foundation. While the social determinants of health (SDH) were acknowledged in the two models, it remains unmentioned in many of the identified measures based on the Nutbeam's model and needs further development in the measure based on the Sørensen's model. A total of 39 different domains were assessed in the 19 measurements: prose was identified in 8 measurements and was the most prominent domain; followed by numeracy (n = 7) and interactive (n = 7). SDH related domains such as social support (n = 3), social capital (n = 1) were seldom included in the identified measurements. CONCLUSIONS: Although current GHLM adopted a multidimensional construct, they mainly focused on individuals' abilities and SDH has not been well-developed in the assessment. Further research is required to advance the measuring of the interaction between SDH and health literacy.

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Objective The goal of this American College of Phlebology Patient Reported Outcome Venous Registry analysis was to examine the clinical efficacy of compression stockings using short-form 6D questionnaire (SF-6D). Method SF-6D scores were modeled over time using linear mixed effects model. Changes of SF-6D score from baseline to the last encounter were examined using a paired t-test. Analysis of variance was used to compare changes from baseline in SF-6D scores between C classifications. All analyses were conducted using SAS software, version 9.4 (SAS Institute, Cary NC). Results Baseline mean SF-6D score was 0.83 and at follow-up, 0.85. Mean SF-6D change was +0.02 points (P = .001) over an average time period of 5.5 months. Patients' SF-6D scores were estimated to increase by +0.03 points (P = .005) per year of usage of compression stockings. SF-6D score changes across C classifications did not demonstrate significant differences (P = .265). Conclusion There was an improvement of SF-6D score in the registry participants who used circular knit compression stockings.

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OBJECTIVE: We sought to assess the disutility associated with diabetes in the kidney transplant population. METHODS: We enrolled 233 kidney transplant recipients age 18-74 from a Midwestern hospital outpatient department. Recipients with multiple or multi-organ transplants, those with laboratory evidence that suggests acute cellular damage (creatinine-kinase > 200 U/L), or a diagnosis of acute renal failure or acute rejection were excluded from the analysis (n = 33). Participants health-related quality of life (HRQOL) were evaluated using the Euro-QoL-5 Dimension (EQ-5D), Health Utility Index Mark III (HUI-III), and the Short Form-6D (SF-6D), which was calculated from the generic section (SF-12) of the Kidney Disease Quality of Life 36 (KDQOL-36). We estimated health utilities associated with diabetes using general linear modeling after adjusting for demographic, socioeconomic, and clinical characteristics. RESULTS: The adjusted health disutilities associated with diabetes were clinically and statistically significant: EQ-5D (Δ = 0.05; p < 0.01), HUI-III (Δ = 0.09; p < 0.01), and SF-6D (Δ = 0.04, p < 0.01). There was no difference between diabetic patients with good glycemic control (mean serum glucose <126 mg/dL in the three months prior to enrollment) and patients with poor glycemic control. CONCLUSIONS: Among kidney transplant patients between the ages of 18-74, non-diabetics have significantly higher HRQOL scores on the EQ-5D, HUI-III, and SF-6D compared with patients with diabetes.

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PURPOSE: The desired outcome in schizophrenia treatment has evolved from symptom management to maximization of quality of life and functional recovery. The aim of this study was to assess the relationship between a specific well-being measure, the Subjective Well-being under Neuroleptic Scale - short version (SWN-K), and the SF-36 Health Survey as a generic quality of life measure. PATIENTS AND METHODS: A multicenter, cross-sectional study was conducted with clinically stable outpatients diagnosed with schizophrenia. Spearman's rank correlation was used to assess the associations between the SWN-K total score, its five subscales, and the SF-36 domains. RESULTS: Ninety-seven patients were included in the study. The mean age was 35 years (standard deviation = 10) and 72% were male. All correlations among domains were positive and most were statistically significant. The bodily pain domain of the SF-36 presented the lower correlations with the SWN-K (rho range 0.10-0.25), whereas the other seven domains correlated significantly (rho range 0.49-0.60, all P < 0.001). The largest correlations were obtained between the SWN-K and the SF-36 domains of general health (rho = 0.53), mental health (rho = 0.60), and vitality (rho = 0.54). CONCLUSION: The positive but nevertheless moderate correlations observed between a specific well-being instrument and a generic quality of life scale supports the inclusion of diagnosis-specific tools for outcome assessment of patients with schizophrenia.

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BACKGROUND: The aim of this study was to investigate the association between the two most commonly used generic and disease specific health-related quality of life (HRQoL) measures in patients with chronic lung disease due to SM: Medical Outcomes Study Short Form 36-Item (SF-36) and St George's Respiratory Questionnaire (SGRQ). METHODS: This is a secondary analysis of Iranian Chemical Warfare Victims Health Assessment Study (ICWVHAS) during October 2007 in Isfahan, Iran. In that survey, conducted in an outpatient setting, 292 patients with chronic lung disease due to SM were selected from all provinces in Iran. The total score and sub scores of correlations of SGRQ and SF-36 were assessed. Correlation of quality-of-life scores were evaluated using Pearson's coefficient. RESULTS: Samples were 276 patients who were selected for our analysis. No significant correlation was found between the total score or sub scores of SF-36 and the total score or sub scores of SGRQ (p > 0.05). CONCLUSIONS: In patients with chronic lung disease due to SM, the SF-36 and SGRQ assess different aspects of HRQoL. Therefore applying both of them together, at least in the research setting is suggested.

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BACKGROUND AND OBJECTIVE: It is recommend that health-related quality of life (HRQL) should be measured as well as conventional clinical indices in order to obtain a complete picture of a patient's health status. In patients with bronchial asthma, frequent symptoms and management related burdens may result in reduced HRQL. In Korea, asthma-specific quality of life (QOL) questionnaire has been developed and broadly applied in clinical practice. But little is known about the impact of asthma on generic HRQL. In this study, we evaluated the generic HRQL in adult asthmatic patients by using the Nottingham Health Profile (NHP). METHODS: Two-hundred three subjects with age over 40 years were enrolled in this study; 77 hospital out-patients with asthma, 63 with stable ischemic heart disease (IHD), 26 hospitalized patients with unstable IHD such as unstable angina or acute myocardial infarct (MI), and 37 healthy controls. All subjects were asked to answer the NHP by self-administration method. The NHP was composed of two parts. Part I consisted of 38 items in six domains and part II 7 items. Six domains of part I were physical mobility (8 items), pain (8 items), social isolation (5 items), emotional reaction (9 items), energy level (3 items) and sleep (5 items). RESULTS: Although patients with unstable IHD had most significant problems in all area of the NHP part I and II, bronchial asthmatics had similar or more restriction to patients with stable IHD. Patients with asthma also had significantly more problems of generic HRQL than healthy controls. Patients with more severe asthma suffered from more pain and loss of energy than mild asthmatics. In similar severity of asthma, patients with lower economic state had more restriction, especially in pain and emotional reaction. Patients with asthma experienced difficulties with daily activities in the NHP part II in order of holidays, work, home relationships, homework, hobbies, social life, sex life, and had more problems with their home work and home relationships than patients with stable IHD. CONCLUSION: Patients with bronchial asthma had similar or more restriction to patients with stable IHD in generic HRQL. To improve outcome measurement of asthma treatment, generic HRQL should be measured as well as asthma-specific QOL and clinical indices.

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