Quality adjusted survival analysis: A neglected application of the quality of well-being scale

Abstract

Background In survival analysis, those who are alive are statistically coded as 1.0 while those who are dead are coded as 0.0. Since everyone who remains alive is given the same score, a person confined to bed with an irreversible coma is alive and is counted the same as someone who is active and asymtomatic. The Quality of Well-being (QWB) scale defines levels of wellness on the continuum between death and optimum function and integrates morbidity and mortality into the same number. This paper demonstrates the effect of including mortality in QWB estimates for male adults with HIV infection.

Method This study involves follow-up of a cohort of 386 male adults participating in the San Diego HIV Neurobehavioral Research Center (HNRC). Patients were evaluated using the QWB at enrollment and at six month intervals. All patients were classified into three stages of HIV disease according to the Center for Disease Control (CDC) classification: CDC IV (symptomatic HIV disease), CDC II or III (asymptomatic infection) and uninfected male controls.

Results QWB scores were calculated with and without mortality included for men in each CDC class who completed a one year (N = 148) or two year follow-up (N = 60). At each evaluation, there were significant differences among CDC classes and inclusion of deaths increased the variance accounted for by CDC class at each evaluation.

Conclusions HIV infection has significant impacts upon both morbidity and mortality. Survival analysis captures only the mortality dimension, while quality adjusted survival analysis using the QWB includes both dimensions. We propose quality adjusted survival analysis as a more sensitive method for assessing outcome in HIV disease and other health conditions.     

Psychometric Properties of the Short Self-Regulation Questionnaire (SSRQ) in a South African Context

Self-regulation (SR), an important construct within the psychological well-being context, involves the ability to monitor behaviour, to contrast it with reference values and to introduce adjustments where necessary. A lack of validated measures of SR in the South African context has contributed to the current caveat in our knowledge of the potential importance of this construct. This investigation aimed to establish the utility of the Short Self-Regulation Questionnaire (SSRQ; Carey, Neal & Collins, 2004) in a South African context. This short version of the original Self-Regulation Questionnaire (SRQ; Brown, Miller & Lawendowski, 1999) was completed by a group of 385 undergraduate psychology students. Factor analysis produced 7 factors, all of which showed significant positive correlations with other measures of psychological well-being. This first step toward establishing the importance of SR in non-Western cultures reflected positively on the potential use of the SSRQ in large epidemiological studies.     

General and Specific Question Sequence Effects in Satisfaction Surveys: Integrating Directional and Correlational Effects

Researchers investigate relationships between well-being variables and the antecedents to well-being by examining statistical results from survey data. A common measurement approach in survey designs is to include measures of more specific aspects (i.e., facets) and more global assessments of well-being in the same survey. Research shows, however, that the sequence of specific and general measures within the survey affects the magnitude of relationships between specific and general measures. In the current study, we extend such general-specific sequence research by offering an alternative explanation for the occurrence of such sequence effects. Specifically, we propose that having the specific measure before the more general one can shift the mean-level of the specific measure toward the extremes, thereby yielding restricted variance and, ultimately, attenuated correlations between the two measures. We test our proposal on two separate samples examining job-related well-being. Our findings show that the general-specific measure relationship is stronger and the mean-level of satisfaction is lower when the general measure is read first. Our findings suggest important theoretical implications for the study and measurement of well-being. Most importantly, our study suggests that placing general measures before specific measures could avoid sequence-related bias.     

The Growing Use of Firearms by Suicidal Older Women, 1979–1992: A Research Note

Suicide among older women (65 +) has received very little attention despite increasing numbers of suicides in this population. An examination of national mortality data from the National Center for Health Statistics for the years 1979 through 1992 shows an increasing trend in rates of suicide among older women and a declining trend among women under 65. Over the 14-year period, firearms replaced poisoning as the most prevalent method of suicide by women 65 and over. The results seem consistent with the assertion that the availability, familiarity, and cultural acceptability of firearms may play a role in the choice of suicide method among older women. Although violent death and the use of firearms are generally associated with males in our society, the trends reported here indicate that greater attention to firearm suicides among older women is warranted.     

Jacob's Blessing and the Curse of Oedipus: Sibling Rivalry and its Resolution

The present paper examines the effects of paternal relationship with sons on the sons' relationship with each other. The Biblical stories initially abound with conflict between the sons because they vie for the father's blessing and favor. The Greek stories initially show little sign of sibling rivalry because the sons band together against a threatening father. With time, paternal blessing (as exemplified by Jacob's blessing) overcomes sibling rivalry. The Greek families become more pathological with time, as the diminution of the paternal threat allows on accentuating of sibling conflict (as exemplified by the curse of Oedipus).     

Book reviews

Nietzsche and Buddhism: a study in nihilism and ironic affinities. Robert G. Morrison, 1997, Oxford, Oxford University Press x + 250 pp., hb ISBN 0 19 823556 9, £32.50

Chong Yagyong: Korea's challenge to orthodox neo‐Confucianism. Mark Sftton, 1997, Albany, NY, State University of New York Press, >xv + 232 pp., pb ISBN 0 7914 3174 6, US$15.95

Fatalism in Ancient India. Sukumari Bhattacharji, 1995, Calcutta, Sarmistha Roy for Baulmon Prakashan xxviii + 356 pp., hb Rs250, ISBN 81 86552 02 2

The Vimalakirti Sutra (from the Chinese version by Kumarajiva). Burton Watson (Trans.), 1997, New York, Columbia University Press xii+ 168 pp., hb £18.00 ISBN 0 231 10656 4

Zhouyi, the Book of Changes‐a new translation with commentary. Richard Rutt, 1996, Richmond, Curzon Press xii + 498 pp., hb (Price not given), ISBN 0 70007 0467 1     

Job-finding club: A group-assisted program for obtaining employment

Although joblessness is a major problem, no method of job-counseling has been demonstrated to be superior to usual job-finding practices. The present study describes a new type of program, which has now been evaluated experimentally in a matched-control design. The new program was conducted in a group and stressed such distinctive techniques as mutual-assistance among job-seekers, a ‘buddy’ system, family support, and sharing of job leads. In addition, the program arranged special ways of using such common practices as searching want-ads, role-playing, telephoning, motivating the job-seeker, constructing a resume and contacting friends. Within 2 months 90 per cent of the counseled job-seekers had obtained employment vs. 55 per cent of the non-counseled job-seekers. All clients who attended the program regularly obtained employment. After 3 months, 40 per cent of the non-counseled job-seekers were still unemployed. The average starting salary was about a third higher for the counseled job-seekers. The present procedure appears to be an effective method of assisting a greater proportion of the unemployed to obtain jobs and more quickly, and at a higher salary than they could obtain when they used the usual job finding procedures.