Nocturia: focus on etiology and consequences

Nocturia is a condition characterized by the need to awaken ≥ 1 times per night to void. Although nocturia is a multifactorial condition that can coexist with other lower urinary tract symptoms, the most common causal factor is nighttime overproduction of urine. Many people with nocturia do not seek help, accepting it as a natural consequence of aging. However, nocturia is common in men and women of all ages and has a profound impact on quality of life, especially in the young, that may be associated with increased morbidity and mortality. Nocturia as a condition deserves public health attention.

Quality of Life and Job Satisfaction of Dispensing Pharmacists Practicing in Tehran Private-sector Pharmacies

As there is no evidence of previous studies on evaluating the level of job satisfaction and the major causes of dissatisfaction among the pharmacists in Iran, this study was designed. This study is a cross-sectional descriptive analysis of pharmacists practicing in Tehran private-sector pharmacies. We selected a stratified random sampling using number of prescriptions as a variable for stratification. The questionnaire was divided into three sections containing the demographic characteristics, general health perception and job satisfaction. Of all the participants, 62% were the owners of pharmacies and 38% were pharmacists in charge (non-owner). Seventy-eight percent of respondents reported satisfaction about their psychological and physical state. Just 11% of pharmacists were financially satisfied and 49% felt relaxed at the workplace. There was no correlation between the satisfaction and owning the pharmacy or sex of respondents. Spearman›s correlation showed that the income satisfaction correlated negatively with age (p ≤ 0.001) and years of experience (p < 0.05). Moreover, the average working hours was significantly higher among men compared to women (p < 0.01) and among owners relative to non-owners (p < 0.05). Overall, general health perception and quality of life among the respondents were at satisfactory level. However, work-related satisfaction was not high enough and most interviewed pharmacists were financially dissatisfied.

The effect of combined aerobic and resistance exercises on quality of life of women surviving breast cancer

BACKGROUND

Breast cancer is one of the most common cancers amongst women in developed and developing countries. It is associated with the highest mortality rate in low to average-income countries. Breast cancer investigation amongst Iranian women reveals that the number of its incidence is yet the highest in all cancer types. Despite recent longer survival time of women with breast cancer, most of the patients suffer from long term physical and mental distress due to combined treatments. Exercise interventions are among new approaches to promote the better quality of life of the patients, which has only recently been considered by researchers. This study aimed to investigate the effect of exercise intervention on the quality of life of breast cancer survivors.

MATERIALS AND METHODS

This is a clinical trial conducted on 80 women with I-III breast cancer, at 18-55 years of age mostly two years after the completion of their treatment in Seyed al Shohada hospital in Isfahan. They were randomly divided into two groups of study and control. Exercise intervention went on for 8 weeks in the study group (three sessions a week, 60 minutes). Quality of life in both groups was measured a day before, and at the end of the eight weeks period by the instrument of the National Medical Center and Beckman Research Institute. The data were analyzed by descriptive and inferential statistical tests of X2, t-test and Mac Hammer test.

FINDINGS

Results showed that there was no significant difference in the mean score of the physical dimension of quality of life in the study group before and after intervention while the score of physical health was significantly better in the control group (p < 0.00).The mean score of mental dimension had increased in the study group, while it had decreased in the control group. The mean score of social health showed no significant difference before and after intervention. The mean score of spiritual health had significantly decreased in the control group, while it had significantly increased in the study group (p = 0.004). Generally, the total mean score of the quality of life showed no significant difference before and after intervention. However, the percentage of the quality of life score increased in the study group, but decreased in the control group.

CONCLUSIONS

The results of this study showed that exercise interventions can promote a better quality of life for the patients, and increase the total score of quality of life. Although, the total score of quality of life was not significantly different, it was concluded that exercise can promote the quality of life amongst patients with breast cancer.

Perspectives on Quality of Life in Glaucoma

Chronic diseases are invariably associated with decreased functioning ability of the individual in one form or the other depending upon the system/organ involved. Disability consequent to the disease is the major factor affecting the patient's physical and psychosocial well-being; in other words, the 'Quality of Life (QOL)'. Besides the disease itself, the treatment and its consequences are also major determinants of QOL of the patients. Globally, glaucoma, which is emerging as one of the leading causes of blindness, is one such chronic ophthalmic disease characterized by a progressive loss of visual function and a potential to cause irreversible blindness, if not treated at an early stage. Patients of glaucoma need to take lifelong medications in order to keep their intraocular pressure within limits. It's impact on the daily life of patients cannot be overexpressed and compounded by the fact that it remains asymptomatic for a considerable time after the disease has set in; has led to new imperatives in diagnosis, treatment and epidemiological and outcome studies. Assessment of the debilitating effect of glaucoma and side effects of its treatment on the emotional and physical QOL of the patient is therefore an important criterion for arriving at the treatment regimen. An extensive literature search was done on Pubmed Central, Pubmed and Google Scholar using the keywords 'glaucoma', 'quality of life in glaucoma', 'management in POAG' and 'QOL assessment tools'. Various tools available for the assessment of QOL, and their advantages and limitations have been reviewed in this article.

The burden and quality of life of caregivers of sickle cell anemia patients taking hydroxyurea versus those not taking hydroxyurea

OBJECTIVE

To assess the burden and quality of life of caregivers of patients with sickle cell anemia taking hydroxyurea versus those of patients not taking hydroxyurea.

METHODS

A cross-sectional study was performed of caregivers of outpatients with sickle cell anemia in two public hospitals in Campo Grande, MS, from January through June 2010. The World Health Organization Quality of Life-BREF Scale and the Caregiver Burden Scale were used.

RESULTS

Of the 37 caregivers in this study, 81.1% were women, 73.0% were mothers, 59.5% were married, 54.1%were mulattos, 48.6% were housewives, 54.1% had family incomes of up to one minimum wage and 75.7% had onlycompleted elementary education. The mean duration of care provided (time after diagnosis) was 16.08 ± 9.88 yearsand 89.2% reported that they provided 24-hour care. Regarding health, 27.0% of study participants reported having physical and 13.5% emotional problems. There were no significant relationships between these variables either with the different domains or the total score of the WHOQOL-BREF comparing caregivers of patients taking hydroxyurea versusthose of patients not taking hydroxyurea. There was a moderate negative linear correlation between the WHOQOL-BREF and the Caregiver Burden Scale scores (linear correlation test of Pearson: p-value = 0.003, r = -0.477). The burden of caregivers of patients who did not take hydroxyurea was significantly higher than those of patients who took the medication in terms of general tension, disappointment, environment and total score (student t-test: p-value < 0.05).

CONCLUSION

In the perception of the caregiver, looking after sickle cell anemia patients represents a moderate negative burden.

A model of genetic guidance for hemoglobinopathy patients and laboratory diagnosis of family members as educational and preventive measures

BACKGROUND

The high frequency of hemoglobinopathies in Brazil constitutes a public health problem and thus educational and preventive measures are necessary to reduce the incidence. Genetic guidance, a modality of genetic counseling, and family screening are measures that can assist in reproductive decisions and mitigate clinical, psychological and social problems of families with these disorders.

OBJECTIVE

The objective of the current study was to evaluate the effectiveness of educational and preventive measures for hemoglobinopathies using genetic guidance and laboratory screening of families.

METHODS

The diagnoses of patients with hemoglobinopathies were confirmed and then the level of knowledge about their disease was evaluated and genetic guidance was provided. Three months later, the level of assimilated information of these patients was evaluated. In addition, laboratory diagnosis of family members was carried out.

RESULTS

Diagnosis of sickle cell anemia was confirmed for most patients. Moreover, the majority of the patients who had a low level of knowledge before genetic guidance (68.8%) demonstrated a higher level of assimilated information after the process (81.8%). Almost 70% of the family members had hemoglobin changes and some had hemoglobinopathies(2.6%). They were duly informed about the results of the examinations, which made it possible to investigate further.

CONCLUSION

Genetic guidance and family screening were effective preventive and educational measures that improved the quality of life of patients, preventing complications and sequels and allowed the referral of those who may transmit altered genes for clinical diagnosis and to genetic counseling services.

Association of obesity with asthma severity, control and quality of life

BACKGROUND

The association between asthma and obesity is becoming increasingly established but the mechanism that might explain the observed differences in asthma severity, control and quality of life between obese and non-obese adult asthmatics is not clear. THE PURPOSE OF THIS STUDY WAS: 1) to determine asthma severity, control and quality of life in obese asthmatics and 2) to explore, according to the body mass index (BMI), the systemic inflammatory state of asthmatic people.

MATERIALS AND METHODS

A cross-sectional study was conducted between 2009 and 2010. Two hundred adult asthmatic patients were included. Data analysis consisted of univariate analysis with chi-square comparison test followed by a multivariate logistic regression.

RESULTS

Obesity worsens the severity of asthma. This finding was more strongly observed among women than men. Obesity and overweight are associated with a poorer control of asthma. According to BMI, obese asthmatics had 6 times more frequent emergency visits, 5 times more frequent hospitalizations for asthma related complaints, increased missed work days and greater dose of inhaled corticosteroids (1025µg/day vs. 759µg/day of beclometasone equivalent). Mean serum level of C-reactive protein (CRP) and leptin was significantly correlated with asthma severity based on GINA classification (5.75 vs. 2.81 mg/l; 20.5 vs. 5.38 ng/ml; respectively).

CONCLUSION

In summary, it appears that obesity is significantly associated with a greater asthma severity and a poorer asthma control and quality of life. Chronic systemic inflammation state may explain the relationship between obesity and asthma.

Relationship between Obesity-related Hormone Peptides and Quality of Life in Obese Women among Different Traditional Chinese Medicine Syndrome Groups

The aim of this study was to explore the relationship between obesity-related hormone peptides and quality of life in obese women among different traditional Chinese medicine (TCM) syndrome groups (證型 zhèng xíng). 260 obese women met with age between 20 and 65 years old and body mass index (BMI) ≧ 27 kg/m², were recruited. The participants filled out a questionnaire on obese TCM syndrome groups, which was designed by professional TCM doctors, and two questionnaires on quality of life (QOL), WHOQOL-BREF Taiwan version and MOS Short Form-12 (SF-12). Data of biochemical characteristics and obesity-related hormone peptides were collected at the same time. According to the responses provided, the obese subjects were classified into spleen deficiency with dampness encumbrance syndrome (脾虛濕阻證 pí xū shī zǔ zhèng; SDD), stomach heat with dampness encumbrance syndrome (胃熱濕阻證 wèi rè shī zǔ zhèng; SHD), liver depression and qi stagnation syndrome (肝鬱氣滯證 gān yù qì zhì zhèng; LDQ), dual spleen-kidney deficiency syndrome (脾腎兩虛證 pí shèn liǎng xū zhèng; SKD), yin deficiency with internal heat syndrome (陰虛內熱證 yīn xū nèi rè zhèng; YDI) and a control group. For physical conditions, SDD group had significantly higher means in weight and BMI compared with the control group. The insulin and leptin levels in SHD group were significantly higher than those in the control group. The LDQ group showed marked decrease in mental condition scores compared with the control group. This study found that obese women in the SDD group were fatter than those in the control group. SHD group might have greater influence on the regulation of obesity-related hormone peptides. The LDQ group had poor QOL than the control group. Analysis of TCM syndrome groups among obese women merits further investigation.

The impact of chronic pain-European patients' perspective over 12 months

Background and methods Pain Study Tracking Ongoing Responses for a Year (PainSTORY) is a longitudinal study generating some quantitative and limited qualitative data concerning the experiences of individual patients with non-malignant chronic pain. Research was conducted across 13 European countries and a total of 294 patients completed the full evaluation process over 12 months. Adult patients (>18 years old) scoring >4 on an 11-point numeric pain rating scale (NRS-11) for most days during an average week were eligible. Four waves of interviews (W1-W4) were conducted over 12 months and information was recorded regarding pain levels, the impact of pain, pain treatment and treatment-associated side effects. Results At 3 months, 95% of respondents rated their worst pain level over the past week as ≥4. Most respondents had felt this pain level for ≥1 year, with 47% of patients reporting NRS-11 scores of 8-10 for >2 years. At 12 months, 93% of respondents still rated their worst pain level over the past week as ≥4. The overall net percentage of respondents with ≥4 pain intensity did not change substantially over 12 months of follow up. However, 40% (119/294) of patients felt their current pain level increased and 41% (121/294) felt their current pain level decreased during this time, with just 18% (53/294) of respondents reporting no change (1% of respondents not stated). At 3 months, 30% of respondents reported being managed by a pain specialist within the last 3 months, decreasing to 13% 9-12 months later. Patients were typically taking a combination of prescribed and non-prescribed medications; approximately 10% at W1 and 14% at 12 months were prescribed a strong opioid. Among those whose current pain level decreased over the year, a slightly lower proportion of patients were taking prescription medication (78%) at 12 months than in either the group with no change to their current pain level (85%), or the group whose pain level increased over the 12 month period (87%). Pain negatively affected quality of life, with respondents reporting difficulties with daily activities, including sleeping, walking, family and social interaction. Approximately half of respondents taking prescription medication reported suffering from 'constipation and associated symptoms'. In spite of no change in pain intensity, 51% of patients were happy with their pain management at W4. Conclusions The heavy individual and societal burden of uncontrolled chronic pain is demonstrated in this study. This silent epidemic has not attracted the focus of attention that it deserves. Despite the significant negative impact on individual quality of life, patients evolve to a position where they believe that chronic pain is inevitable and untreatable. implications It is clear that there is a real need for a coordinated response by healthcare providers and planners across European countries. Minimum standards of care should be developed and implemented at national level. Healthcare professionals and students of these disciplines must be educated to recognise, assess and manage pain within a reasonable timeframe. Patients who are not responding to standard measures must have rapid and easy access to a comprehensive, inter-disciplinary pain service.

Palliative care among elderly cancer patients: Own experience

BACKGROUND

Annually, more than 27,000 persons die of cancer in the Czech Republic. It is known that in addition to the demographic aging of the Czech population, the cancer burden is increased.

AIM

These data clearly demonstrate the need for affordable and good follow-up care for patients, especially for older patients and/or patients with no other cancer treatment due to irreversible progression of tumor.

MATERIALS AND METHODS

We are talking about so-called palliative cancer care, which can be provided at different levels. One of the most common forms of palliative cancer care is hospice care.

RESULTS

Our clinic in the years 2008-2010 received a total of 446 patients. 288 of them were women and 158 men. The average age of women was 61 years (age range 20-81 years). The average age of men was 56 years (age range 18-96 years). The performance status was in the fitness category PS-0 (8%), PS-1 (54%), PS-2 (33%) and PS-3 (5%).

CONCLUSION

Currently the outpatient palliative cancer care are coming more into the forefront. This type of care allows patients to stay as long as possible at home among their close relatives. Prerequisite for a well working outpatient palliative care is cooperation with general practitioners and home health care agencies.

The 36-item short form health survey: reliability and validity in Chinese medical students

OBJECTIVE

The 36-Item Short Form Health Survey (SF-36) is widely validated and popularly used in assessing the subjective quality of life (QOL) of patients and the general public. The aim of the study is to assess the psychometric properties of the 36-Item Short Form Health Survey (SF-36) in medical students in mainland of China.

METHODS

The reliability and validity of the 36-Item Short Form Health Survey (SF-36) questionnaire were assessed by conducting a cross-sectional study of Chinese medical students in December 2011. All 1358 3(rd) year and 4(th) year medical students from 46 classes at China Medical University were investigated.

RESULTS

The overall Cronbach's α coefficient of the SF-36 questionnaire was 0.791, while the respective Cronbach's α coefficients for each of the seven dimensions were > 0.70, except where the social function dimension was 0.631. Results showed that the SF-36 questionnaire was reliable and valid.

CONCLUSION

In general, this study provides evidence that the SF-36 questionnaire is suitable measures for assess the QOL of medical students in China.

A study assessing the quality of life related to voiding symptoms and sexual functions in menopausal women

Purpose

To investigate the impact of menopause on the quality of life (QoL) of middle-aged and older women, including their general well-being, voiding-related symptoms, and sexual distress.

Materials and Methods

To assess QoL, we administered a questionnaire that included questions about voiding-related symptoms and female sexual distress and part of the Women's Health Questionnaire. The self-administered questionnaires were completed by 1,679 women in the Korea. Data for 1,262 women were available for analysis, including premenopausal (n=307), perimenopausal (n=240), and postmenopausal (n=715) groups.

Results

Voiding-related discomfort increased significantly in perimenopausal and postmenopausal women compared with premenopausal women (p<0.001). General well-being worsened as menopause progressed (p<0.001). Menopausal women who were older (p=0.014), had a hysterectomy (p=0.005), or had urinary incontinence (p=0.001) had more voiding-related symptoms. Hypertension (p=0.026), cardiac disease (p=0.013), and arthritis (p=0.001) resulted in significantly decreased general well-being. Women with a hysterectomy (p=0.017) and those with arthritis (p=0.004) had high sexual distress. In the menopausal group, employed women had better general well-being than did unemployed women.

Conclusions

Menopause negatively affected the QoL of middle-aged and older women because of decreased general well-being and increased voiding-related symptoms. General health, even in menopausal women, was important to maintain a better QoL. To preserve the QoL of women undergoing menopause, control of menopause and underlying disease should be considered.

Chronic pancreatitis

The abstract is available at the Clinical pancreatic disorder I: Acute pancreatitis. North Am J Med Sci 2011; 3: 316-319. doi: 10.4297/najms.2011.3316

Health-related quality of life outcomes after cholecystectomy

Gallbladder diseases are very common in developed countries. Complicated gallstone disease represents the most frequent of biliary disorders for which surgery is regularly advocated. As regards, cholecystectomy represents a common abdominal surgical intervention; it can be performed as either an elective intervention or emergency surgery, in the case of gangrene, perforation, peritonitis or sepsis. Nowadays, the laparoscopic approach is preferred over open laparotomy. Globally, numerous cholecystectomies are performed daily; however, little evidence exists regarding assessment of post-surgical quality of life (QOL) following these interventions. To assess post-cholecystectomy QOL, in fact, documentation of high quality care has been subject to extended discussions, and the use of patient-reported outcome satisfaction for quality improvement has been advocated for several years. However, there has been little research published regarding QOL outcomes following cholecystectomy; in addition, much of the current literature lacks systematic data on patient-centered outcomes. Then, although several tools have been used to measure QOL after cholecystectomy, difficulty remains in selecting meaningful parameters in order to obtain reproducible data to reflect postoperative QOL. The aim of this study was to review the impact of surgery for gallbladder diseases on QOL. This review includes Medline searches of current literature on QOL following cholecystectomy. Most studies demonstrated that symptomatic patients profited more from surgery than patients receiving an elective intervention. Thus, the gain in QOL depends on the general conditions before surgery, and patients without symptoms profit less or may even have a reduction in QOL.

Effects of aerobic exercise at different intensities in pre menstrual syndrome

OBJECTIVES

The purpose of this study is to analyze the potential benefits of aerobic exercises at different intensities in the management of pre menstrual syndrome.

METHODS

The study design is quasi-experimental; sixty-one female subjects were randomly allocated into three groups, Group A (mild intensity), Group B (moderate intensity) and Group C (severe intensity) and the intervention were given for 6 weeks. The study setting was general community settings. The outcome measures were menstrual symptom questionnaire, VO(2) max, forced vital capacity (FVC), maximum voluntary ventilation (MVV) and lipid profile (HDL, LDL, TGL).

RESULTS

There is significant decrease in menstrual symptoms in both Groups B and C. However, Group C improved with increased rate of perceived exertion. LDL levels did not change significantly but HDL, TGL, VO(2) max, FVC, and MVV improved significantly in Groups B and C, but remains significantly unchanged in Group A.

CONCLUSIONS

This study encourages the employment of regular, moderate intensity aerobic exercise as a potential intervention for pre menstrual syndrome.

The psychosexual aspects of hypospadias repair: A review

OBJECTIVE

To review the psychosexual effects on men after hypospadias repair.

METHODS

We reviewed all English-language publications in the MEDLINE database from the US National Library of Medicine with the search terms 'hypospadias adult', 'psychosexual hypospadias', 'psychosocial hypospadias', and 'social hypospadias'. Each term returned 1036, 35, 19 and 68 results, respectively, which were reviewed.

RESULTS

While improvements in surgical techniques have improved function, the abnormality and repair still causes a disruption in perceived quality of life for many men. After repair, many men suffer from a negative view of their genitals and some degree of sexual inhibition. However, they still maintain a satisfactory sex life.

CONCLUSIONS

Psychosexual effects of hypospadias repair they endure in adulthood, although affected men maintain satisfaction with their sexual life.

Aggressive palliative surgery in metastatic phyllodes tumor: impact on quality of life

Metastatic phyllodes tumor has very few treatment options. Phyllodes tumor in metastatic setting has limited role of surgery, radiotherapy and chemotherapy or combined treatment. Most of the patients receive symptomatic management only. We present a case of metastatic phyllodes tumor managed with aggressive margin negative resection of primary tumor leading to palliation of almost all the symptoms, which eventually led to improved quality of life and probably to improved survival. The improved quality of life was objectively assessed with Hamilton depression rating scale. Surgery may be the only mode of palliation in selected patients that provides a better quality of life and directly or indirectly may lead to improved survival.

Quality of life in gynecologic cancer survivors compared to healthy check-up women

Objective

The primary objective of this study was to compare quality of life of disease-free patients after therapy for gynecologic malignancies at follow-up in comparison with healthy check-up patients. Our second objective was to assess correlation between demographic data, disease and treatment factors and quality of life scores.

Methods

Patients completed the Functional Assessment of Cancer Therapy-General (FACT-G) quality of life questionnaire at least 6 months after treatment for a gynecologic malignancy. Responses were compared to unmatched healthy women who were seen for standard gynecologic screening examinations. Statistical calculation was done using chi-squared tests, Wilcoxon rank-sum, and Kruskal-Wallis one-way analysis and Spearman rank correlations. Factors associated with FACT-G scores were evaluated using univariate and multivariate analyses.

Results

Eight hundred and seventy patients were recruited. The median time since therapy was 61 months (range, 6 to 173 months). The overall FACT-G scores were higher in the patient group than in the healthy group (p<0.05). The scores of each subscale measuring physical, functional, social/family and emotional well-being were also higher in the patient group (p<0.05). Multivariate analysis revealed correlation between Eastern Cooperative Oncology Group performance status, educational level, care giver, presence of economic problems and FACT-G scores.

Conclusion

The quality of life scores were higher in gynecologic cancer patients after treatment. And the factors that associated with the higher score in the patient group are having husband as a caregiver, no financial problem, Eastern Cooperative Oncology Group score 0 or 1 and having high school or higher education.

A timely referral to palliative care team improves quality of life

In the trajectory of disease progress and treatment plan, patients and the family members are confronted with challenging situations like unsurmountable physical distress, inadequate coping patterns, unanswered spiritual issues in the background of serious threat to very existence of life leads to a debilitating Quality of life.The Palliative Care team approach addresses all the issues and also sees the patient to go through the protocols of Palliative care management as well as Oncological treatment plan. Further, this fecilitates a smooth transition from the hospital to home and hospice care. Various studies conducted globally revealed that patients received palliative care intervention along with oncological treatments had higher scores of Quality of life compared to patients received onlyoncology care alone.This article discusses the various factors contributing to late referrals to palliative care team and also care giver’s views pertaining to need for early referral. Timely referral to palliative care minimises the patient’s and care giver’s distress, ensures modest Quality of life and appropriate measures at the end of life care.

Comparison of presentation and impact on quality of life of gastroesophageal reflux disease between young and old adults in a Chinese population

AIM

To compare the presentation and impact on quality of life of gastroesophageal reflux disease (GERD) in old and young age groups.

METHODS

Data from adult patients with GERD diagnosed by endoscopic and symptomic characteristics were collected between January and November 2009. Exclusion criteria included combined peptic ulcers, malignancy, prior surgery, antacid medication for more than 2 mo, and pregnancy. Enrolled patients were assigned to the elderly group if they were 65 years or older, or the younger group if they were under 65 years. They had completed the GERD impact scale, the Chinese GERD questionnaire, and the SF-36 questionnaire. Data from other cases without endoscopic findings or symptoms were collected and these subjects comprised the control group in our study.

RESULTS

There were 111 patients with GERD and 44 normal cases: 78 (70.3%) and 33 patients (29.7%) were in the younger and elderly groups, respectively. There were more female patients (60.3%) in the younger group, and more males (72.7%) in the elderly group. The younger cases had more severe and frequent typical symptoms than the elderly patients. Significantly more impairment of daily activities was noted in the younger patients compared with the elderly group, except for physical functioning.

CONCLUSION

Elderly patients with GERD were predominantly male with rare presentation of typical symptoms, and had less impaired quality of life compared with younger patients in a Chinese population.

Effectiveness of Tele-guided Interceptive Prosthodontic treatment in rural India: A comparative pilot study

Loss of teeth and resultant resorption of the residual ridges is a major oral health problem in India. The resorption leads to irreversible loss of bone volume of the jaws and seriously undermines retention and stability of future dentures. Loss of masticatory efficiency causes nutritional deficiencies and affects quality of life. However, construction of over-dentures (dentures anchored to modified teeth or roots), a sophisticated procedure requiring skills of several dental specialists, can arrest the resorption and provide retentive dentures. Dental specialists in India are, however, concentrated in urban areas leaving the rural populace under-serviced. The aim of our study was to find out whether newly graduated dentists, under remote guidance from specialists, can fabricate over-dentures that are functional and improve the oral health related quality of life.

Two groups of subjects were treated with over-dentures. Group 1 consisted of subjects attending a rural dental health clinic (site1) and group 2 at a university teaching hospital (site 2). Two dental graduates at each site carried out treatments. Operators at site 1 were guided remotely over a telemedicine link, cell phones, and emails while those at site 2 were guided directly. Functional assessment of dentures was carried out at the end of the treatment period to determine the technical quality of dentures. Subjective evaluation was carried out by subjects completing the Oral Health Impact Profile (OHIP-EDENT) questionnaire for edentulous subjects before and after treatment.

No statistically significant difference was seen between the functional assessment scores of dentures from the two sites (p=0.08) at 95% confidence interval. Both groups also experienced significant improvement in all domains of OHIP - EDENT.

Remotely supervised newly graduated general dentists can provide over-dentures of sufficient quality to rural population. This strategy has the potential to improve access to care and elevate the level of dentistry available to rural population when referral to specialists in not feasible. The results of the study provide pointers for dental public health policy makers and administrators in developing nations on how to leverage Information and Communication Technology infrastructure to enhance access to care in rural areas.

Assessment of quality of life in menopausal periods: a population study in kashan, iran

BACKGROUND

Menopause is a physiological process in women's life. The aim of this study was to assess QOL and related factors among menopausal women in Kashan city in Iran.

METHODS

Seven hundred women aged 40-60 years were assessed using cluster sampling. Women with mental and physical problems or systemic diseases were excluded. Data were collected by standard questionnaire of quality of life in the menopause.

RESULTS

The mean menopausal age was 47.6±4.1 years. 55.6% of women had been postmenopausal for less than 5 years. The overall mean scores obtained for each domain was 2.82±1.64 for vasomotor, 2.71±1.2 for psychosocial, 2.46±0.99 for physical and 2.89±1.73 for sexual domains.

CONCLUSION

Age, working status, physical activity, educational level, duration of menopause, income satisfaction, marriage satisfaction and the number of children in those living with family had influence on quality of life in menopausal women.

Determinants of health related quality of life on people living in bandar abbas, iran

BACKGROUND

The relationship between socio demographic status and Health Related Quality of Life (HRQOL) has not been well documented in most population of Asian countries including Iran. This study aimed to investigate the determinants of HRQOL in general population living in Bandar Abbas.

METHODS

This cross sectional study was conducted among general population living in Bandar Abass, Iran from Jun to Jul, 2007. Using a multistage sampling method, a random sample of individuals aged 15 years and over were interviewed through SF-36 questionnaire .Multiple logistic regression analysis were used to predict determinant factors on health related quality of life.

RESULTS

Overall, 1675 Iranian adults were interviewed. The majority of the participants were female (50.4%), married (70.9%) and employed (36.8%). The range of education years of most participants (56.7%) were from 6 to 12 years. Female participated in this study had significantly poorer HRQOL than male in all aspects of SF-36 except for Role Emotional (P< 0.001). Furthermore there were significant differences between different age groups in all individually scales and two summaries (P< 0.001). After adjusting for the impacts of other socio demographic factors, variable such as older age, female gender and lower educational level could independently decrease both mental and physical aspect of HRQOL (P< 0.01).

CONCLUSION

Female, older and less educated people are at higher risk of poorer health quality of life in both mental and physical aspects and should be considered as high risk groups in priority health programs.

Quality-of-Life Evaluation of Patients Undergoing Lumbar Discectomy Using Short Form 36

Background:

Back pain is one of the most common health problems for which physicians are consulted, and it can considerably decrease the quality of life of patients during a great part of their lives.

Objectives:

Our study was designed for assessing the improvement in the quality of life of patients undergoing lumbar discectomy for chronic low back pain.

Patients and Methods:

We included 148 patients with chronic low back pain in the analytic observational study. Using the 36-Item Short-Form Health Survey (SF-36), we evaluated the quality of life before and 6 and 12 months after lumbar discectomy.

Results:

Physical and mental health scores of patients significantly improved after 6 and 12 months of lumbar discectomy. The mean improvement in physical health scores was significantly higher in female patients than in male patients. However, the improvement in mental health scores was not significantly difference between the 2 sexes and the educational and body mass index (BMI) groups.

Conclusions:

Lumbar discectomy improves both the physical and mental health subscale of the quality of life in patients with chronic disc herniation.

Associated factors of quality of life in first-episode schizophrenia patients

OBJECTIVE

Improving quality of life is an important goal in the treatment of schizophrenia. In previous research, quality of life has been reported to be compromised in patients with schizophrenia. The aim of this study was to investigate whether quality of life may be impaired in first-episode schizophrenia patients and to identify the associated factors of quality of life in first-episode schizophrenia.

METHODS

Forty-eight patients with first-episode schizophrenia and 20 normal controls were recruited. Quality of life was measured by using the Quality of Life scale (QLS). General and social self-efficacy, perceived social support were measured by using the self-report scales. The clinical assessments and comprehensive neurocognitive battery were also administered.

RESULTS

First-episode group showed significantly decreased QLS total and QLS subscale scores compared to normal controls group. The key associated factors of quality of life in patients with first-episode schizophrenia were the negative symptoms and social self-efficacy.

CONCLUSION

This finding implies that compromised quality of life may be already emerged in schizophrenia in their first-episode and the psychosocial interventions should be targeting the negative symptoms and the psychosocial protective factors including self-efficacy in addition to simply ameliorating the positive symptoms to foster social reintegration and recovery of first-episode patients.

What QLQ-C15-PAL Symptoms Matter Most for Overall Quality of Life in Patients With Advanced Cancer?

Background

Few studies have evaluated the QLQ-C15-PAL health-related quality of life (QOL) questionnaire, an abbreviated version of the QLQ-C30 questionnaire that was designed specifically for patients with advanced cancer. The present study assessed whether certain symptoms or functional domains from the QLQ-C15-PAL predicted overall QOL when rated prior to palliative radiation treatment (RT).

Patients and Methods

Patients attending an outpatient palliative radiotherapy clinic completed QLQ-C15-PAL questionnaires prior to palliative RT for bone, brain or lung disease. Pearson correlations were computed between the QLQ-C15-PAL functional/symptom scores and overall QOL scores. Multiple linear regressions were used to evaluate the relative importance of functional/symptom scales in association with overall QOL.

Results

Data from 369 patients were analyzed. The QLQ-C15-PAL domains of physical and emotional functioning, pain, and appetite loss were significant predictors of overall QOL in these patients with advanced cancer. Appetite loss was the only significant independent predictor of overall QOL in the subgroup of patients with advanced lung cancer (n = 29). Both appetite loss and emotional functioning were independently predictive of overall QOL in patients with bone metastases (n = 190). In patients with brain metastases (n = 150), independent predictors of overall QOL included physical and emotional functioning as well as fatigue.

Conclusion

The QLQ-C15-PAL domains of physical and emotional functioning, pain and appetite loss were significant predictors of overall QOL in this cohort of patients with advanced cancer. Different functional and symptom scales predicted overall QOL in patients with bone metastases, brain metastases or advanced lung cancer.

Incorporating person centred care principles into an ongoing comprehensive cancer management program: an experiential account

Recent research indicates a definite positive impact on treatment outcomes when an integrative approach that focuses on symptom control and quality of life is provided along with the standard therapeutic regimens. However implementation or practice of this approach is not seen widely due to the culture of medical training and practice. This article presents the initial development of a program for incorporating integrative care principles into an ongoing comprehensive cancer care program at a tertiary centre. The key purpose of the program being to develop, facilitate, and establish comprehensive and holistic processes including palliative care principles, that would positively enhance the quantity and quality of life of the person with disease, as well as create an environment that reflects and sustains this approach. The vision, objectives, goals, strategies, activities and results within the 7 months of implementation are documented. The new learnings gained during the process have also been noted in the hope that the model described may be used to conceptualize similar care giving facilities in other centres.

Comparison of Attitudes Regarding Quality of Life between Insulin-Treated Subjects with Diabetes Mellitus and Healthy Populations

BACKGROUND

Diabetes mellitus is a chronic disease and one of the main causes of mortality in developing countries. The main objective of treating all chronic diseases, of course, is to improve well-being and attain a satisfactory quality of life (QOL). The major goal of this study is comparison of attitude toward QOL in insulin-dependent subjects with diabetes mellitus and healthy subjects.

METHODS

In this study, insulin-dependent subjects with diabetes mellitus and healthy subjects were gathered via convenience sampling. The subjects were asked to complete the Hanestad & Albrektsen Attitude to Quality of Life Questionnaire. The questionnaire evaluates five quality of life dimensions-physical, social, mental-emotional, behavioral-activity, and economic-using a scoring system similar to the Likert scale. The Wilcoxon test was used to compare scores between the two groups.

RESULTS

The mean total score on attitude toward QOL in the healthy control group was 53.8, and it in the insulin-dependent subjects with diabetes mellitus group was 35.9. The mean total score of attitude toward QOL in the physical dimension, mental-emotional and feelings of well-being dimension, and behavioral-activity dimension were significantly higher in the healthy population than they were in diabetes mellitus groups. Such a difference was not seen in the social and economic dimensions.

CONCLUSION

Since the attitudes of insulin-dependent subjects with diabetes mellitus toward QOL are used as an index of individual and societal health levels, it appears that this group may benefit from education and professional counseling to improve their QOLs.

Assessing health-related resources in senior living residences

This study evaluated a new tool, "The Audit of Physical Activity Resources for Seniors" (APARS), which assesses the physical activity environment in Senior Living Residences (SLRs). Audits were conducted in 29 SLRs and inter-rater reliability was assessed. Pearson correlations were examined between APARS items and objectively measured physical activity and sedentary time, and self-rated health, collected from residents at a subset of 12 SLRs (N=147). Eighty-nine of the 90 items (98.9%) demonstrated Kappa or ICC values above .70 and/or percent agreement above 80%. The 90 items were summarized into nine scales. Two scales (outside supportive physical activity features/functionality and outside exercise facilities) were related to greater physical activity and less sedentary time. Four scales (inside social facilities, onsite services, exercise programs, and social activities) were related to greater sedentary time and better self-rated health. APARS items demonstrated adequate inter-rater reliability and some evidence for construct validity to assess health-related environments in retirement facilities. Social activities in SLRs could benefit residents by incorporating more physical activity. Use of APARS could inform more health-promoting designs of senior living facilities.

An epidemiological study of urinary incontinence and its impact on quality of life among women aged 35 years and above in a rural area

BACKGROUND

There have been few community-based epidemiological studies on urinary incontinence (UI) evaluating the risk factors and impact on quality of life (QOL) in India.

OBJECTIVES

This study was designed (1) to estimate age-specific prevalence and risk factors of UI among women aged 35 years and above in a rural area and (2) to analyze the impact of UI on the QOL of incontinent women.

DESIGN AND SETTING

A cross-sectional descriptive study was conducted.

MATERIALS AND METHODS

A semi-structured questionnaire assessing socio-demographic factors, severity and type of incontinence, and obstetrical and other risk factors along with impact on QOL was administered in two clusters (villages) in Karimnagar district through multistage cluster sampling.

RESULTS

In a sample of 552 women, 53 (10%) reported episodes of UI. The prevalence of UI showed significant association with increasing age (P < 0.01). Fifty-seven percent of the women had symptoms of stress incontinence, 23% of urge, and 20% mixed symptoms. Obstetrical factors associated with UI included high parity (P < 0.003), young age at first childbirth (P < 0.01), forceps delivery (P < 0.001), and prolonged labor (P < 0.001). Chronic constipation, chronic cough, and history of urinary tract infection were predictors of UI in regression analysis (Nagelkerke R (2)= 0.7). Women with stress incontinence had the severest perceived impact on QOL on a five-point scale questionnaire, mean 24.87 (95% CI 21.26-28.47).

CONCLUSION

One in 10 women reported episodes of UI with impaired QOL. The outcome is predicted both by obstetric and other risk factors.

Pediatric facial burns: Is facial transplantation the new reconstructive psychosurgery?

INTRODUCTION

Current pediatric burn care has resulted in survival being the expectation for most children. Composite tissue allotransplantation in the form of face or hand transplantation may present opportunities for reconstructive surgery of patients with burns. The present paper addresses the question "Could facial transplantation be of therapeutic benefit in the treatment of pediatric burns associated with facial disfigurement?"

METHODS

Therapeutic benefit of facial transplantation was defined in terms of psychiatric adjustment and quality of life (QOL). To ascertain therapeutic benefit, studies of pediatric burn injury and associated psychiatric adjustment and QOL in children, adolescents and adults with pediatric burns, were reviewed.

RESULTS

Pediatric burn injury is associated with anxiety disorders, including post-traumatic stress disorder and depressive disorders. Many patients with pediatric burns do not routinely access psychiatric care for these disorders, including those for psychiatric assessment of suicidal risk. A range of QOL outcomes were reported; four were predominantly satisfactory and one was predominantly unsatisfactory.

DISCUSSION

Facial transplantation may reduce the risk of depressive and anxiety disorders other than post-traumatic stress disorder. Facial transplantation promises to be the new reconstructive psychosurgery, because it may be a surgical intervention with the potential to reduce the psychiatric suffering associated with pediatric burns. Furthermore, patients with pediatric burns may experience the stigma of disfigurement and psychiatric conditions. The potential for improved appearance with facial transplantation may reduce this 'dual stigmata'. Studies combining surgical and psychiatric research are warranted.

Physical activity participation in youth with surgically corrected congenital heart disease: Devising guidelines so Johnny can participate

While most youth with congenital heart disease have simple structural lesions and near-normal activity tolerance and functioning, youth with complex structural defects may be affected by significant morbidity. Efforts are being made to consider the impact of exercise and physical activity on quality of life. The benefits of physical activity are well documented; however, the levels of participation and self-efficacy for activity remain low, thus increasing the risk of obesity and cardiovascular morbidity. Rehabilitation is a novel and emerging area, and decisions regarding advocacy versus restriction of physical activity may pose a challenge for both cardiologists and nonspecialists. The present article outlines the rationale for physical activity recommendations in youth with surgically corrected congenital heart disease and the psychosocial determinants of participation. Clinical recommendations and future directions are proposed.

Quality of life in patients with skull base tumors: current status and future challenges

In selection of the right treatment for a specific patient, the surgeon should consider not only the best approach to remove a tumor but also the impact of treatment on the quality of life (QOL) of the patient. Procedures involving extirpation of skull base tumors may be associated with high morbidity. It is therefore important to study patients with skull base neoplasms, because survival differences between various treatment modalities may be small, yet larger differences are expected regarding morbidity. The overall QOL in the majority of patients after skull base tumor resection can be classified as "good," with significant improvement taking place within 12 months following surgery. Patients with carcinomas, acoustic schwannoma, or Cushing's disease suffer from more significant deterioration in their QOL after any intervention. Data retrieved from disease-specific questionnaires revealed that the financial and emotional domains have the worse impact on patients QOL. Old age, malignancy, comorbidity, radiotherapy, and extensive surgery were found to be also negative prognostic factors for QOL. Pain control regimens, antidepressants, and other psychological modalities, including group support, can improve QOL measures in these patients. It is critical that surgeons understand that they cannot assess their patients' perspectives on QOL correctly without asking them. For adequate assessment, validated disease-specific instruments addressing multiple domains of QOL should be utilized.

Extended-release medications for children and adolescents with attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) affects one in 20 Canadian children, and is associated with unfavourable academic and employment records, high rates of injury and substance abuse, poor interpersonal relationships, poor mental health outcomes and poor quality of life. Medications have been shown to be efficacious in treating ADHD symptoms in controlled trials, and are associated with better social and health outcomes in observational studies. Extended-release (XR) medications for ADHD are preferred over short-acting immediate-release medications by many families and their treating physicians. The XR preparations are often unaffordable for affected families who are disproportionally among the lower socioeconomic strata.The objective of the present statement was to critically appraise the evidence for the relative effectiveness of XR versus immediate-release medications, and to make recommendations for their appropriate use in the treatment of ADHD.When medication is indicated, XR preparations should be considered as first-line therapy for ADHD because they are more effective and less likely to be diverted. Future research and cost-benefit analyses should consider both efficacy and effectiveness, and the diversion and misuse potentials of these medications. Industry, insurance companies and government must work together to make these medications accessible to all children and youth with ADHD.

Living with complex congenital heart disease

A child with complex congenital heart disease in 2008 is very likely to survive a series of surgical and medical interventions, and confront an array of medical and psychosocial stressors that are presently poorly understood. As approaches to medical problems change, careful assessment of those results is essential, and the initial work of the multicentre Pediatric Heart Network is a huge step in the right direction, setting the stage for proper controlled trials of therapies. Major complications, notably ventricular failure, rhythm problems and thromboembolism, will affect nearly one-quarter of survivors, necessitating further interventions. Appropriate educational and psychosocial support for these children and their families is the next challenge for all of us in the field of paediatrics. How ironic would it be to have invested so much in early survival, only to allow the child to fail in life itself.

Physical therapy in palliative care: from symptom control to quality of life: a critical review

Physiotherapy is concerned with identifying and maximizing movement potential, within the spheres of promotion, prevention, treatment and rehabilitation. Physical therapists practice in a broad range of inpatient, outpatient, and community-based settings such as hospice and palliative care centers where as part of a multidisciplinary team of care, they address the physical and functional dimensions of the patients’ suffering. Physiotherapy treatment methods like therapeutic exercise, electrical modalities, thermal modalities, actinotherapy, mechanical modalities, manual physical therapy and assistive devices are useful for a range of life-threatening and life-limiting conditions like cancer and cancer-associated conditions; HIV; neurodegenerative disorders like amyotrophic lateral sclerosis, multiple sclerosis; respiratory disorders like idiopathic pulmonary fibrosis; and altered mental states. The professional armamentarium is still expanding with inclusion of other miscellaneous techniques which were also proven to be effective in improving quality of life in these patients. Considering the scope of physiotherapy in India, and in palliative care, professionals in a multidisciplinary palliative care team need to understand and mutually involve toward policy changes to successfully implement physical therapeutic palliative care delivery.

Functional outcome in the neurosurgical patient and its impact on quality of life

Outcomes research has become an integral part of most clinical studies today. Extent of resection, increased median survival, and "time to progression" are no longer the only important end points in need of assessment. Identifying the long-term adverse effects of treatment has become increasingly important as patients try to resume previous activities and an independent lifestyle. The measurement of functional states and health-related quality of life issues are at the forefront of medicine and have become necessary measures of functional outcome following the treatment of a variety of medical and surgical disorders. In this article, we review the most recent studies on the functional outcome of patients undergoing neurological surgeries and its impact on quality of life.

Epidemiology of uninvestigated and functional dyspepsia in Asia: facts and fiction

Dyspepsia is a syndrome consisting of epigastric pain, burning, fullness, discomfort, early satiety, nausea, vomiting and belching. Functional dyspepsia (FD) is diagnosed if upper gastrointestinal endoscopy does not show structural abnormality explaining these symptoms. 8%-30% and 8%-23% of Asian people suffer from of uninvestigated dyspepsia and FD, respectively. Most patients with uninvestigated dyspepsia are found to have FD. Patients with FD are usually young and there is no predilection to any gender. Overlap of FD with other functional bowel diseases such as irritable bowel syndrome and gastroesophageal reflux disease is common in Asia. Cultural difference in reporting of symptoms of dyspepsia is well-known. Moreover, dietary factors, socio-cultural and psychological issues, gastrointestinal infection including that caused by Helicobacter pylori, frequency of organic diseases such as peptic ulcer and gastric cancer responsible for dyspeptic symptoms in the study population may also influence epidemiology of dyspepsia. There is considerable heterogeneity in the above issues among different Asian countries. More studies on epidemiology of FD are needed in Asia.

Health related quality of life in functional gastrointestinal disorders in Asia

The importance of health-related quality of life (HRQOL) continues to grow, as clinicians and clinical researchers have recognized the impact of the functional gastrointestinal disorders. Limited information is available on the performance of HRQOL questionnaires in Asia. Furthermore, the effect across different cultural settings of functional gastrointestinal disorders on HRQOL has been little studied in Eastern countries. We summarized recent studies on HRQOL in Korean patients with functional gastrointestinal disorders as well as other Asian literatures. Functional gastrointestinal disorders-related symptoms had a great effect on the HRQOL of Korean patients. These results and their considerable prevalence in Korea indicate that functional gastrointestinal disorders have a substantial social impact in this country.

Impact of nocturia on health-related quality of life and medical outcomes study sleep score in men

Purpose

To evaluate the impact of nocturia on health-related quality of life and sleep in men.

Methods

From January 2008 to December 2008, 284 patients with lower urinary tract symptoms were selected for this study. The participants completed a series of questionnaires on health-related quality of life (the overactive bladder questionnaire, or OAB-q), the Medical Outcomes Study (MOS) sleep scale, and the frequency volume chart.

Results

The patient population had a mean age of 60.0±13.4 years (range, 40 to 79 years). The mean duration of symptoms was 28.8±34.6 months. The mean number of voiding episodes per night was measured as follows: 88 patients (31.0%) reported no nocturia, 60 patients (21.1%) reported 2>voids/night ≥1, 56 patients (19.7%) reported 3>voids/night ≥2, and 80 patients (28.2%) reported ≥3 voids/night. The mean number of nocturia episodes increased with age (P=0.001), and the number of nocturia episodes was significantly associated with the OAB-q symptom score (P=0.001) and symptom bother (P=0.001). Among the categories of the MOS sleep scale, sleep index I (P=0.020), sleep disturbance (P=0.010), adequacy of sleep (P=0.005), and somnolence (P=0.041) were significantly associated with an increased number of nocturia episodes.

Conclusions

The number of nocturia episodes increased with age in men. Nocturia appeared to be associated with further negative effects on sleep quality, health-related quality of life, and symptom bother.

Quality of Life Differences between Younger and Older Breast Cancer Patients

PURPOSE

This study was designed to investigate quality of life (QOL) differences between younger (<50 years) and older (≥50 years) breast cancer survivors and to determine the unique effect of age on QOL after adjusting age-correlated variables.

METHODS

One thousand two hundred fifty patients were enrolled. Clinicopatholgical and social parameters were reviewed and Functional Assessment of Cancer Therapy-Breast cancer instrument (FACT-B) and the Ladder of Life scale were used to measure the QOL. Among 1,250 eligible patients, 1,094 patients completed the questionnaire and were used for analysis. Chi-square test, t-test and a series of multiple regression analyses were conducted to verify age-related differences in QOL between two groups and to evaluate the unique contribution of age variable on QOL of breast cancer patients.

RESULTS

Significant socio-demographic and clinical differences existed based on age categories, including education, job, time since surgery, chemotherapy and daily activity. Also, there were significant age-related differences in FACT-B total, physical well-being, social/family well-being, functional well-being and breast cancer subscale and in subjective QOL. Older patients ≥50 years showed significantly lower QOL than younger patients <50 years. However, after controlling for age-correlated variables including job, education, time since surgery, chemotherapy, and daily activity, there was no unique age difference in QOL among breast cancer survivors.

CONCLUSION

Our study results suggest that older women with breast carcinoma suffered significantly lower QOL, even though the unique age effect was not found. Therefore, various interventions for enhancing QOL for women with breast carcinoma should be provided to older age group.

Effects of Fatigue and Postpartum Depression on Maternal Perceived Quality of Life (MAPP-QOL) in Early Postpartum Mothers

PURPOSE

This study was done to identify effects of fatigue and postpartum depression on quality of life in early postpartum mothers.

METHODS

The data were collected from 130 mothers at four general hospitals in J and M metropolitan cities. Instruments used to collect the data for the study were the Fatigue Scale developed by Pugh (1993); Postpartum Depression Scale developed by Cox, Holden & Sagovsky (1987), and the Quality of Life Scale developed by Hill, Aldag, Hekel, Riner, G., & Bloomfield (2006).

RESULTS

Results showed that the mean for fatigue was 56.74, the mean for postpartum depression was 8.00+/-4.37 and mean for quality of life was 19.78. The quality of life variable showed statistically significant differences for the variable: age (F=3.20, p=.026). The relationship between fatigue and quality of life showed a significant negative correlation (r=-.44, p<.001). The relationship between postpartum depression and quality of life also showed a negative correlation (r=-.42, p<.001). The relationship between postpartum depression and fatigue showed a positive correlation (r=.59, p<.001). These factors explained 23% of the variance in quality of life.

CONCLUSION

The results indicate that it is necessary to develop nursing intervention programs to improve quality of life in for early postpartum mothers.

Validation of Pediatric Functional Assessment of Cancer Therapy Questionnaire (Version 2.0) in Brain Tumor Survivor Aged 13 Years and Older (Parent Form)(PedsFACT-BrS Parent of Adolescent)

OBJECTIVE

The aim of this study was to evaluate the reliability and validity of the Pediatric Functional Assessment of Cancer Therapy Questionnaire Brain Tumor Survivor (version 2.0) Aged 13 years and older (Parent Form) (pedsFACT-BrS parent of adolescent).

METHODS

The pedsFACT-BrS parent of adolescent was translated and cross-culturally adapted into Korean, following standard Functional Assessment of Chronic Illness Therapy (FACIT) methodology. The psychometric properties of the pedsFACT-BrS parent of adolescent were evaluated in 170 brain tumor patient's mothers (mean age=43.38 years). Pretesting was performed in 30 mothers, and the results indicated good symptom coverage and overall comprehensibility. The participants also completed the Child Health Questionnaire Parent Form 50 (CHQ-PF-50), Neuroticism in Eysenck Personality Questionnaire, and Karnofsky score.

RESULTS

In validating the pedsFACT-BrS parent of adolescent, we found high internal consistency, with Cronbach's α coefficients ranging from 0.76 to 0.94. The assessment of test-retest reliability using intraclass correlation coefficient revealed satisfactory values with ICCs ranging from 0.84 to 0.93. The pedsFACT-BrS for parent of adolescent also demonstrated good convergent and divergent validities when correlated with the Child Health Questionnaire Parent Form 50 (CHQ-PF-50) and the Neuroticism in Eysenck Personality Questionnaire. The pedsFACT-BrS parent of adolescent showed good clinical validity, and effectively differentiated between clinically distinct patient groups according to the type of treatment, tumor location, shunt, and Karnofsky score of parent proxy report.

CONCLUSION

We confirmed that this reliable and valid instrument can be used to properly evaluate the quality of life of Korean adolescent brain tumor patients by their parents' proxy report.

Effect of Palliative Drug Therapy on Quality of life in Advanced Head and Neck Cancer Patients

Advanced cancer patients are managed by palliative care and its main aim is to provide best possible quality of life to the patients by symptom management. Pain is the most agonizing symptom experienced by advanced head and neck cancer patients. Control of pain hence requires more attention by the caregiver in order to improve their quality of life. Recently quality of life issues have emerged as a main focus of cancer treatment as compared to conventional increase in survival rate. This study mainly focuses on the effect of palliative drug therapy on quality of life.

Impact of chronic urticaria on the quality of life in Australian and Sri Lankan populations

BACKGROUND

Chronic idiopathic urticaria (CIU) has a significant impact on patients' quality of life.

OBJECTIVE

The purpose of this study is to assess that impact and to compare differences by culture, gender, age or duration of treatment.

METHODS

We used the modified chronic urticaria quality of life questionnaire, consisting of 15 questions. Over the course of 6 months, patients attending Immunology clinics at Campbelltown Hospital and private rooms in Australia and at the faculty of Medicine, University of Kelaniya in Sri Lanka were asked to fill out the questionnaires. We have obtained the data from 125 patients (43 Australian vs. 82 Sri Lankan). There were significantly more female patients (P < 0.01). The data was analysed using SAS.

RESULTS

Overall, patients were affected mostly by itch and wheals and least affected by the side effects of treatments. Sri Lankan populations were more affected by wheals and by interference on activities, mood and food choices but were less affected by tiredness due to sleep disturbances (P < 0.01). Females were more affected by sleep disturbance (P < 0.05) while those older than 40 years of age were more impacted by tiredness and by the side effects from medications (P < 0.05), though the complaints themselves were mild. Those who suffered from CIU for more than 1 year were more affected by wheal, tiredness and irritability (P ≤ 0.05).

CONCLUSION

The questionnaire highlighted some differences between patients attending Australian versus Sri Lankan outpatients. Significant differences were found in one third of parameters which include mood, sleep, daily activities and food choices.

Quality of Life in Patients Treated with Palliative Radiotherapy for Advanced Lung Cancer and Lung Metastases

Background

The purpose of this study was to investigate quality of life (QOL) in patients receiving palliative radiotherapy (RT) for advanced lung cancer/lung metastases using the EORTC QLQ-LC13 and the EORTC QLQ-C15-PAL questionnaires.

Methods

Patients who received palliative RT for lung metastases or advanced lung cancer between November 2007 and October 2010 completed the EORTC QLQ-LC13 and the QLQ-C15-PAL at baseline prior to RT, 1, 2, 4, 8 and 12 weeks post-treatment. The Wilcoxon Signed Rank test was used to compare QOL scores between baseline and each follow-up period.

Results

Thirty-one patients with advanced lung disease were included in this study; 61% of participants were male and 39% were female. The median age was 69 years (range 38 - 85), and median KPS and PPS scores at baseline were both 70 (range 30 - 90). All patients received radiotherapy to the lung. None of the QLQ-LC13 scores significantly improved or deteriorated at any follow-up. Of the QLQ-C15-PAL scales, fatigue, pain, insomnia and physical functioning significantly improved at their respective follow-ups.

Conclusions

This was the first study to use the EORTC QLQ-LC13 in conjunction with the EORTC QLQ-C15-PAL questionnaires. Future studies should continue to incorporate quality of life assessment tools specific to disease characteristics in advanced cancer patients.

Radical cystectomy and orthotopic bladder substitution using ileum

Over the past decade, continent urinary diversion, especially orthotopic bladder substitutions, has become increasingly popular following radical cystectomy for bladder cancer. The ultimate goal of orthotopic bladder substitution is to offer patients the best quality of life, similar to that of patients with native bladders. To achieve that purpose, surgeons should be familiar with the characteristics of good candidates for neobladders, the possible intraoperative and postoperative problems related to the surgery, and the solutions to these problems. Postoperative surveillance and instructions given to the patients also contribute to successful, functional results. Here, we reviewed the indications, pitfalls, and solutions for orthotopic bladder substitutions and the patients' quality of life after surgery. When performed properly, orthotopic continent diversion offers good quality of life with few long-term complications. Therefore, we believe it is the best option for the majority of patients requiring cystectomy.

Functional Interference due to Pain Following Palliative Radiotherapy for Bone Metastases Among Patients in Their Last Three Months of Life

Background

To compare the self-reported ratings of functional interference caused by pain between patients who did and did not respond to palliative radiotherapy for bone metastases during their last three months of life.

Methods

A prospectively gathered Brief Pain Inventory (BPI) database compiled from patients receiving palliative radiotherapy for painful bone metastases was reviewed. Demographic and clinical data, pain response rates and self-reported ratings of functional interference caused by pain were analyzed for those patients who died within three months of beginning radiotherapy.

Results

From 400 patients in the database, 83 died within 3 months of beginning radiotherapy. There were 54 male and 29 female patients. Their median age was 69 years and their median KPS was 70. The three most common primary cancers were lung (40%), gastrointestinal (16%) and breast (14%). For patients with available follow-up information the 1-month overall pain response rate was 78% and the 2-month rate was 83%, which include both complete and partial responses as defined by the International Bone Metastases Consensus. At 1 month, patients responding to treatment reported significantly less interference by pain on their general activity, walking ability, normal work, sleeping, and enjoyment of life than did patients not responding to treatment.

Conclusions

Patients that responded to treatment reported less functional interference due to pain than did patients who did not respond. Despite being very near the end of life, patients responding to palliative radiotherapy for painful bone metastases may benefit from more than pain relief alone.

A nurse-led telephone session and quality of life after radiotherapy among women with breast cancer: a randomized trial

The purpose of this study was to investigate whether a nurse-led telephone session with patients suffering from breast cancer approximately ten days after final radiotherapy treatment affected their quality of life two to four weeks after radiotherapy. The study was conducted at the Radiotherapy ward at Vejle Hospital, Denmark between January and May 2010. The study population consisted of 100 patients, who were randomized with a 1:1 ratio to have either ordinary supportive conversations (control group), or ordinary supportive conversations and a supplementary nurse-led telephone session (intervention group). The quality of life was assessed using the questionnaires EORTC QLQ-C30 and EORTC QLQ-BR23. For statistical comparison of quality of life and for adjustment for covariates, multiple linear regression analysis was conducted. The mean [95 % CI] quality of life was 72.0 [66.4-77.6] in the control group and 69.9 [64.3-75.2] in the intervention group. Adjustment for covariates did not change the estimates. No statistically significant differences were found in the groups in either of the analyses. The nurse-led telephone session had no positive effect on the quality of life of patients with breast cancer two to four weeks after their final radiotherapy.

Anxiety, depression and quality of life in patients with irritable bowel syndrome

BACKGROUND/AIMS

There have been few Asian studies regarding anxiety and depression associated with irritable bowel syndrome (IBS). The aim of this study was to evaluate the frequency and importance of anxiety and depression in Korean patients with IBS.

METHODS

A total of 124 IBS patients and 91 healthy subjects were enrolled consecutively. All participants were asked to complete self-administered questionnaires: one addressing symptom severity, the Short Form 36, and the Hospital Anxiety and Depression Scale (HADS). The patients were also asked to complete the IBS-specifi c quality of life (IBS-QOL) questionnaire.

RESULTS

Anxiety and depression were observed in 38.6% and 38.6% of IBS patients, respectively, and in 24.2% and 16.5% of healthy subjects, respectively (p<0.05 for both). The mean HADS scores for anxiety and depression in IBS patients were 6.8±4.5 and 7.1±4.4, respectively. Both anxiety and depression were associated with self-reported symptom severity (p<0.012 and p<0.001, respectively). As determined by multivariate analysis, symptom severity was the most important factor in the prediction of anxiety and depression. Self-reported symptom severity and depression were clearly and independently associated with the overall IBS-QOL score.

CONCLUSIONS

Anxiety and depression were frequently observed in Korean IBS patients and were related to the severity of their symptoms and the impairment of the patient's QOL. Our data suggest that assessing anxiety and depression is important when evaluating IBS patients.