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Development of the quality of life questionnaire for elderly hypertensive patients
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RISK FACTORS FOR FOREARM FRACTURE IN POSTMENOPAUSAL WOMEN IN CHENGDU, CHINA. Liangzhi Xu, M. Phillips, J. Porteous, S. Zheng. CEU, West China University of Medical Sciences, Chengdu, China. Objectives: Osteoporotic forearm fractures are a major cause of disability in elderly women, so preventing these accidents is an important public health objective. This is the first study that assesses the risk factors for forearm fracture in postmenopausal women in China. Design: Case-control study. Setting: All 5 districts in Chengdu with a total population of 2,322,964. P a r t i c i p a n t s : 210 postmenopausal women with new forearm fractures sequentially identified in the 8 hospitals that manage almost all fractures in Chengdu and 210 age and urban district matched postmenopausal community controls without a history of fractures. M a i n O u t c o m e Measure(s): Forearm fractures were diagnosed by X-ray. Results: Cases were wealthier, more educated, less active and more likely to live above the first floor; they had lower daily calcium (Ca) intakes, weaker grip strengths, shorter periods of breast feeding their children, longer irregular menstruation before the age of 45, more falls in the prior year and more first or second degree relatives who had fractures. After adjusting fi~r b~dy mass index, smoking, drinking, income, education and occupation, some fi~ctors remained significantly different between the cases and controls: Ca intake (OR = 0.40; 95% CI 0.28-0.57), present activity level (OR 0.87, 95% CI 0.78-0.97), activity level befi~re the age of 40 (OR = 0.81, 95% CI 0.72-0.90), better vision (OR = 0.34, 95% CI 0.140.84), living above the 1st floor (OR - 5.54, 95% CI 3.17-9.67), history of respiratory system diseases (OR - 2.48, 95% CI 1.22-5.02), irregular menses befi)re the age of 45 (OR = 2.09, 95% CI 1.08-4.02), and having first or second degree relatives with fractures (OR = 2.61, 95% CI 1.225.60). Conclusions: Among postmenopausal women in urban China, higher Ca intake, a high activity level and better vision are protectors, while respiratory system disease, irregular menses before the age of 45, living above the 1st floor, and having relatives with fractures are risk factors for forearm fracture. Educational programs in elderly women should attempt to change these factors.
DEVELOPMENT OF THE QUALITY OF LIFE QUESTIONNAIRE FOR ELDERLY HYPERTENSIVE PATIENTS. Wei Xu. CEU, Shanghai Medical University, Shanghai, China. O b j e c t i v e : To develop and validate an instrument suitable for measuring the quality of life (QOL) in Chinese elderly hypertensive patients. Design: A cross-sectional survey. Setting: Outpatient department of Zhong Shan Hospital, a teaching hospital. P a r t i c i p a n t s : 96 elderly hypertensive patients. I n t e r v e n t i o n s : None. M a i n O u t c o m e M e a s u r e ( s ) : A pool of items were selected from literature review, interviews with patients and physicians. The preliminary questionnaire was administered to the patients. Items reduction was done by item analysis and factor analysis, which also acted to identify domains. These domains were assessed for reliability (internal consistency reliability, test-retest reliability, split-half reliability), and for construct validity based on clinical hypotheses and comparison with the Medical Outcomes Short-Form 36 (SF-36) related components. Results: A 22-item self-administered questionnaire called EH-22 was developed. It comprised 3 domains: physical health, mental health and social function. Domain scores were reproducible after 2 weeks (r = 0.749~0.821) and were internally reliable (Cronbach c~ = 0.787~0.819). In an exploratory principal axes factor analysis, 76.8% of the common variance was explained by 3 factors that correlated with the initial domains. Construct validity was demonstrated by moderate correlation with the SF-36 related components (r = 0.38~0.68). Patients with moderate or newly diagnosed hypertension responded with higher (worse) scores than those with mild or non-newly diagnosed hypertension. Conclusions: EH-22 is valuable in the measurement of quality of life in the Chinese elderly hypertensive patients.
CARE OF ADULTS
ASSESSMENT OF CATARACT BLINDNESS AND OUTCOMES IN CATARACT SURGERY IN SHUNYI COUNTY. Jialiang Zhao, Ruifang Sui, Lifing Jia, Leon Ellwein. CEU, Peking Union Medical College Hospital, Beijing, China. O b j e c t i v e : Estimate the prevalence of blindness and cataract surgery in a rural county of China with an active eye care program. Design: Cluster sampling was used in randomly selecting participants. Setting: 28 randomly selected villages in Shunyi County, suburb of Beijing city, China. P a r t i c i p a n t s : 5,555 individuals aged 50 years or older were enumerated. 91.5% of them were examined. I n t e r v e n t i o n s : Visual acuity measurement, eye examination with slit lamp and ophthalmoscope were performed. The survey was preceded by a pilot study where operational methods were refined and quality assurance evaluations carried out. M a i n O u t c o m e s M e a s u r e ( s ) : Blindness prevalence, the principle cause for blindness, surgical coverage of cataract blindness. Results: Blindness prevalence (presenting visual acuity < 6/60 in both eyes) was estimated as 2.8% (95% CI: 2.3-3.2) with cataract as the principal cause, fi~llowed by retinal abnormalities, corneal scar/opacities and refractive errors. The cataract burden is highest among the elderly, t;emales, and the illiterate. These population subgroups have both a higher rate of cataract development and a lower surgical coverage. Surgical coverage of cataract blindness within the examined population as a whole was 47.8%. Conclusions: Blindness, and cataract blindness in particular, continues as a significant problem in China. The elderly, females, and the illiterate appear to be disproportionately affected.
RISK FACTORS FOR FOREARM FRACTURE IN POSTMENOPAUSAL WOMEN IN CHENGDU, CHINA. Liangzhi Xu, M. Phillips, J. Porteous, S. Zheng. CEU, West China University of Medical Sciences, Chengdu, China. Objectives: Osteoporotic forearm fractures are a major cause of disability in elderly women, so preventing these accidents is an important public health objective. This is the first study that assesses the risk factors for forearm fracture in postmenopausal women in China. Design: Case-control study. Setting: All 5 districts in Chengdu with a total population of 2,322,964. P a r t i c i p a n t s : 210 postmenopausal women with new forearm fractures sequentially identified in the 8 hospitals that manage almost all fractures in Chengdu and 210 age and urban district matched postmenopausal community controls without a history of fractures. M a i n O u t c o m e Measure(s): Forearm fractures were diagnosed by X-ray. Results: Cases were wealthier, more educated, less active and more likely to live above the first floor; they had lower daily calcium (Ca) intakes, weaker grip strengths, shorter periods of breast feeding their children, longer irregular menstruation before the age of 45, more falls in the prior year and more first or second degree relatives who had fractures. After adjusting fi~r b~dy mass index, smoking, drinking, income, education and occupation, some fi~ctors remained significantly different between the cases and controls: Ca intake (OR = 0.40; 95% CI 0.28-0.57), present activity level (OR 0.87, 95% CI 0.78-0.97), activity level befi~re the age of 40 (OR = 0.81, 95% CI 0.72-0.90), better vision (OR = 0.34, 95% CI 0.140.84), living above the 1st floor (OR - 5.54, 95% CI 3.17-9.67), history of respiratory system diseases (OR - 2.48, 95% CI 1.22-5.02), irregular menses befi)re the age of 45 (OR = 2.09, 95% CI 1.08-4.02), and having first or second degree relatives with fractures (OR = 2.61, 95% CI 1.225.60). Conclusions: Among postmenopausal women in urban China, higher Ca intake, a high activity level and better vision are protectors, while respiratory system disease, irregular menses before the age of 45, living above the 1st floor, and having relatives with fractures are risk factors for forearm fracture. Educational programs in elderly women should attempt to change these factors.
DEVELOPMENT OF THE QUALITY OF LIFE QUESTIONNAIRE FOR ELDERLY HYPERTENSIVE PATIENTS. Wei Xu. CEU, Shanghai Medical University, Shanghai, China. O b j e c t i v e : To develop and validate an instrument suitable for measuring the quality of life (QOL) in Chinese elderly hypertensive patients. Design: A cross-sectional survey. Setting: Outpatient department of Zhong Shan Hospital, a teaching hospital. P a r t i c i p a n t s : 96 elderly hypertensive patients. I n t e r v e n t i o n s : None. M a i n O u t c o m e M e a s u r e ( s ) : A pool of items were selected from literature review, interviews with patients and physicians. The preliminary questionnaire was administered to the patients. Items reduction was done by item analysis and factor analysis, which also acted to identify domains. These domains were assessed for reliability (internal consistency reliability, test-retest reliability, split-half reliability), and for construct validity based on clinical hypotheses and comparison with the Medical Outcomes Short-Form 36 (SF-36) related components. Results: A 22-item self-administered questionnaire called EH-22 was developed. It comprised 3 domains: physical health, mental health and social function. Domain scores were reproducible after 2 weeks (r = 0.749~0.821) and were internally reliable (Cronbach c~ = 0.787~0.819). In an exploratory principal axes factor analysis, 76.8% of the common variance was explained by 3 factors that correlated with the initial domains. Construct validity was demonstrated by moderate correlation with the SF-36 related components (r = 0.38~0.68). Patients with moderate or newly diagnosed hypertension responded with higher (worse) scores than those with mild or non-newly diagnosed hypertension. Conclusions: EH-22 is valuable in the measurement of quality of life in the Chinese elderly hypertensive patients.
CARE OF ADULTS
ASSESSMENT OF CATARACT BLINDNESS AND OUTCOMES IN CATARACT SURGERY IN SHUNYI COUNTY. Jialiang Zhao, Ruifang Sui, Lifing Jia, Leon Ellwein. CEU, Peking Union Medical College Hospital, Beijing, China. O b j e c t i v e : Estimate the prevalence of blindness and cataract surgery in a rural county of China with an active eye care program. Design: Cluster sampling was used in randomly selecting participants. Setting: 28 randomly selected villages in Shunyi County, suburb of Beijing city, China. P a r t i c i p a n t s : 5,555 individuals aged 50 years or older were enumerated. 91.5% of them were examined. I n t e r v e n t i o n s : Visual acuity measurement, eye examination with slit lamp and ophthalmoscope were performed. The survey was preceded by a pilot study where operational methods were refined and quality assurance evaluations carried out. M a i n O u t c o m e s M e a s u r e ( s ) : Blindness prevalence, the principle cause for blindness, surgical coverage of cataract blindness. Results: Blindness prevalence (presenting visual acuity < 6/60 in both eyes) was estimated as 2.8% (95% CI: 2.3-3.2) with cataract as the principal cause, fi~llowed by retinal abnormalities, corneal scar/opacities and refractive errors. The cataract burden is highest among the elderly, t;emales, and the illiterate. These population subgroups have both a higher rate of cataract development and a lower surgical coverage. Surgical coverage of cataract blindness within the examined population as a whole was 47.8%. Conclusions: Blindness, and cataract blindness in particular, continues as a significant problem in China. The elderly, females, and the illiterate appear to be disproportionately affected.