Health-related quality of life and its predictors among outpatients with coronary heart disease in Singapore

AIMS AND BACKGROUND

Coronary heart disease (CHD) is a major cause of death and disability and negatively impacts on patients' health-related quality of life (HRQoL). This study aimed to explore HRQoL and identify its predictors among outpatients with CHD in Singapore.

METHODS

A correlational study was conducted with a convenience sample of 106 outpatients with CHD recruited from a public hospital. HRQoL outcomes were measured using the Short Form-12 Health Survey (SF-12), Medical Outcomes Study Social Support Survey (MOS-SSS) and Hospital Anxiety and Depression Scale (HADS).

RESULTS

Patients reported a generally high level of HRQoL as assessed by SF-12. Those aged over 65years reported significantly higher mental health and those who were married had higher levels of education or income reported significantly higher physical health. There were significant negative correlations between physical and mental health and anxiety and depression (p<.05). Perceived social support was negatively correlated with anxiety and depression and positively correlated with mental health. Education level and depression significantly predicted physical health, while age, anxiety and depression predicted mental health.

CONCLUSION

Anxiety, depression, age and education are significant predictors of HRQoL in this patient population and should be assessed routinely and, where appropriate, addressed through individually-tailored interventions.

Severely impaired health-related quality of life in chronic hyperventilation patients: exploratory data

Patients with hyperventilation syndrome (HVS) report severe symptom-related suffering and often complain from insufficient medical attention. However, quality of life data in this context are scarce. We aimed at assessing the health-related quality of life (HRQoL) of HVS patients. Twenty-one HVS patients with extensive cardiorespiratory workup including cardiopulmonary exercise testing (CPET) filled in the generic SF-36 questionnaire and the results were compared to French normal values. Correlations between SF36 dimensions and clinical and functional data were established. All SF-36 scores were markedly decreased in HVS patients compared to healthy subjects: Physical Functioning: 44 ± 24, Social Functioning: 57 ± 27, Role Physical: 21 ± 32, Role Emotional: 48 ± 42, Mental Health: 51 ± 27, Vitality: 34 ± 20, Body Pain: 41 ± 21, General Health: 42 ± 21. These figures were all significantly lower in the HVS patients respective to the normal reference population. They were also lower than corresponding values published in patients with asthma or chronic obstructive pulmonary disease (COPD). "Vitality" and "Physical Functioning" scores were correlated with Nijmegen score (r = -0.594, p = 0.047) and peak respiratory frequency during CPET (r = -0.644, p = 0.019). The SF-36 Social Functioning score was correlated with the ventilatory threshold (r = 0.629, p = 0.034), peak V'E/V'CO2 (ventilation/CO2 production) (r = 0.650, p = 0.016) and peak PaCO2 (r = -0.664, p = 0.027). In conclusion, this study shows that HRQoL can be severely impaired in patients with HVS, which is one more reason to take this condition seriously.

Hip and knee replacement patients prefer pen-and-paper questionnaires: Implications for future patient-reported outcome measure studies

Objectives

Electronic forms of data collection have gained interest in recent years. In orthopaedics, little is known about patient preference regarding pen-and-paper or electronic questionnaires. We aimed to determine whether patients undergoing total hip (THR) or total knee replacement (TKR) prefer pen-and-paper or electronic questionnaires and to identify variables that predict preference for electronic questionnaires.

Methods

We asked patients who participated in a multi-centre cohort study investigating improvement in health-related quality of life (HRQoL) after THR and TKR using pen-and-paper questionnaires, which mode of questionnaire they preferred. Patient age, gender, highest completed level of schooling, body mass index (BMI), comorbidities, indication for joint replacement and pre-operative HRQoL were compared between the groups preferring different modes of questionnaire. We then performed logistic regression analyses to investigate which variables independently predicted preference of electronic questionnaires.

Results

A total of 565 THR patients and 387 TKR patients completed the preference question. Of the THR patients, 81.8% (95% confidence interval (CI) 78.4 to 84.7) preferred pen-and-paper questionnaires to electronic questionnaires, as did 86.8% (95% CI 83.1 to 89.8) of TKR patients. Younger age, male gender, higher completed level of schooling and higher BMI independently predicted preference of electronic questionnaires in THR patients. Younger age and higher completed level of schooling independently predicted preference of electronic questionnaires in TKR patients.

Conclusions

The majority of THR and TKR patients prefer pen-and-paper questionnaires. Patients who preferred electronic questionnaires differed from patients who preferred pen-and-paper questionnaires. Restricting the mode of patient-reported outcome measures to electronic questionnaires might introduce selection bias.

Cite this article: Bone Joint Res 2013;2:238–44.

Alcohol drinking patterns and health-related quality of life reported in the Spanish adult population

OBJECTIVES

To examine the association between alcohol drinking patterns and health-related quality of life (HRQL).

METHODS

Population-based cross-sectional study was conducted in 2008-2010 among 12,715 adult individuals in Spain. HRQL was assessed with the SF-12 questionnaire and alcohol intake with a diet history. The threshold between average moderate drinking and average heavy drinking was ≥ 40 g/day of alcohol in men and ≥ 24 g/day in women. Binge drinking was defined as the intake of ≥ 80 g in men and ≥ 60 g in women at any drinking session during the preceding 30 days. Analyses were performed with linear regression and adjusted for the main confounders.

RESULTS

Compared to non-drinkers, all types of average drinkers reported better scores on the SF-12 physical component: β=1.42 (95% confidence interval 1.03 to 1.81) in moderate drinkers and β=1.86 (1.07 to 2.64) in heavy drinkers. In contrast, average alcohol consumption was not associated with the mental component of the SF-12. The number of binge drinking episodes and most types of beverage preference showed no association with physical or mental HRQL.

CONCLUSIONS

Alcohol drinkers, including those with heavy drinking, reported better physical HRQL than non-drinkers.

A physical fitness follow-up in children with cerebral palsy receiving 12-week individualized exercise training

Physical fitness in children with cerebral palsy (CP) is lower than in their peers. A 12-week individualized home-based exercise program completed by 11 children with CP 10 years earlier showed a favorable effect on physical fitness performance. We follow-up the physical fitness of those 11 children with CP, and compare their physical fitness and health-related quality of life (HRQoL) to children with CP without exercise training matched with age and motor levels. Eleven children with CP in the 2003 program as a follow-up group (FUG) and 12 volunteers recruited as a control group (CG) participated in this study. Physical fitness measures, including cardiopulmonary endurance, muscle strength, body mass index (BMI), flexibility, agility, balance, and the SF-36 Taiwan version, were assessed in both groups. After 10 years, the FUG showed better physical fitness in cardiopulmonary endurance and muscle strength (p<.05). Compared to the CG, the FUG demonstrated better muscle strength, agility, and balance (p<.05). However, the HRQoL did not show a significant difference between the FUG and the CG. Individualized home-based exercise training is beneficial for children with CP. Over 10 years, the FUG was more devoted to physical activity than was the CG. Physical exercise may not directly affect the HRQoL in this study.

Reliability and validity of a Spanish version of the Impact of Pediatric Epilepsy Scale in a Cuban population

The Impact of Pediatric Epilepsy Scale (IPES) is a brief, accurate, and acceptable measurement scale of the impact of pediatric epilepsy on the health-related quality of life (HRQOL) of both the child and the child's family as perceived by the child's parent(s). The aim of this study was to validate a Spanish language version of the IPES in Cuban children with epilepsy. The IPES was translated and adapted to Cuban culture and administered to 76 parents of children with epilepsy. The principal component analysis indicated that two factors accounted for 72% of the variance of the IPES (family relationships and health and social well-being). The IPES was also able to detect differences in HRQOL between subjects according to epilepsy severity. The internal consistency coefficient was 0.962, and the test-retest reliability was 0.979. The Cuban version of IPES can be used to measure a child's epilepsy-specific HRQOL in Cuba.

Health status, health-related quality of life, and quality of life following ankle fractures: a systematic review

INTRODUCTION

The number of disabling short- and long-term consequences after ankle fracture (AF) is high. Therefore, it is important to consider the health status (HS), health-related quality of life (HRQOL), and quality of life (QOL) of these patients. The aim of this study was to provide a systematic overview of studies on HS, HRQOL, and QOL in patients with AF. In addition, the conceptualisation of HS, HRQOL, and QOL in these studies was evaluated.

METHODS

A systematic literature search was conducted in Pubmed, Embase, The Cochrane Library, and PsycINFO (January 1976 to April 2012).

RESULTS

Twenty-three studies were included of which almost half had a cross-sectional design. The assessment of HRQOL or QOL was an explicit objective in 17.4% of the studies. The SF-36 and SMFA were the instruments most often used and measure respectively HS and a combination of HS and HRQOL. However, they had been labelled as functional status. Inconclusive results were reported regarding the predictive value of age, sex, education level, alcohol use, smoking, fracture type, and the role of syndesmotic reduction with regard to HS and HRQOL. Also, inconclusive results were found comparing HS and HRQOL scores of patients with AF with norm population scores and regarding the course of HS and HRQOL over time. The additional value of early mobilisation after AF was not confirmed.

CONCLUSIONS

There are few quality studies on HS and HRQOL following AF and results are inconclusive. Future studies should measure these important patient-reported outcomes, including QOL. The concepts HS and HRQOL are not applied in agreement with the content of the instruments and instruments are downgraded to assess functional status. The correct terminology should be used to warrant clear communication in the field.

Sensory phenomena: clinical correlates and impact on quality of life in adult patients with Tourette syndrome

Tourette syndrome (TS) is a neurodevelopmental condition characterised by multiple tics, with frequent behavioural co-morbidity. Sensory phenomena (SP) are unpleasant sensations which provide involuntary urges to tic in patients with TS. While SP have a central role in tic expression, little is known about their clinical correlates or association with health-related quality of life (HR-QOL) in TS. We conducted a cross-sectional study on 72 adult outpatients with TS, recruited at a specialist clinic. All participants completed a comprehensive battery of psychometric measures, including the Premonitory Urges for Tics Scale (PUTS) to assess SP and a disease-specific quality of life scale (GTS-QOL) to assess HR-QOL. SP were very common (97.2% of patients), with a median PUTS total score of 28/40. Bivariate analyses showed that PUTS scores were most significantly correlated with self-report measures of vocal tic severity and compulsivity. PUTS scores were also significantly correlated with GTS-QOL scores, most notably with the psychological subscale. SP are frequently reported by adults with TS, are associated with perceived tic severity and compulsivity, and can significantly affect psychological well-being. Standardised measurement of SP should be incorporated into routine assessment of patients with TS to optimise their clinical management.

The correlates of unemployment and its association with quality of life in cervical cancer survivors

Objective

Little is known regarding cervical cancer survivors' employment status, which represents social integration of cancer survivors as a pivotal domain of long-term quality of life. The goal of this study was to assess the correlates of unemployment and evaluate the impact on the comprehensive quality of life in cervical cancer survivors.

Methods

We enrolled 858 cervical cancer survivors from the gynecologic oncology departments of multi-centers in Korea. Factors associated with unemployment were identified using multivariate logistic regression analyses. We assessed different health-related quality of life domains with multivariate-adjusted least-square means between cervical cancer survivors who currently work and do not.

Results

After diagnosis and treatment, the percentage of unemployed survivors increased from 50.6% to 72.8%. Lower income (adjusted odds ratio [aOR], 1.97; 95% confidence interval [CI], 1.38 to 2.81), medical aid (aOR, 1.58; 95% CI, 1.05 to 2.38), two or more comorbidities (aOR, 1.80; 95% CI, 1.12 to 2.90), current alcohol drinkers (aOR, 2.33; 95% CI, 1.54 to 3.52), and employed at the time of diagnosis (aOR, 10.72; 95% CI, 7.10 to 16.16) were significantly associated with unemployment. Non-working groups showed significant differences with respect to physical functioning, role functioning, depression, and existential well-being.

Conclusion

The proportion of unemployed cervical cancer survivors seems to increase, with low-income status and the presence of medical aid negatively being associated with employment, in addition to other comorbidities and previous working status. Effort should be made to secure the financial status of cervical cancer survivors.

Impaired glucose metabolism and health related quality of life

AIMS

We aimed at investigating whether different categories of glucose tolerance have any effect on a person's HRQoL.

METHODS

Population-based cross-sectional study conducted as a community sample of apparently healthy middle-aged individuals living in Western Finland. The subjects of the study, 1383 individuals, aged 45-70 years, had at least one cardiovascular risk factor but no previous diagnoses of either diabetes or cardiovascular disease. They completed health related quality of life (HRQoL) questionnaire before the oral glucose tolerance test (OGTT) was performed to diagnose the gategories of glucose tolerance.

RESULTS

Persons with newly diagnosed type 2 diabetes (NDM) had lower scores for physical functioning, general health and emotional role than subjects with normal glucose tolerance.

CONCLUSION

The results of the HRQoL questionnaire demonstrated that NDM is negatively associated with HRQoL, but prediabetes - IFG or IGT - does not.

Self and parent perspectives on health-related quality of life of adolescents born very preterm

OBJECTIVES

To test whether health-related quality of life (HRQL) based on societal standards differs between very low birth weight/very preterm (VLBW/VP) and full-term (FT) adolescents using self and parent proxy reports. Also, to examine whether self and parent reported HRQL is explained by indicators of objective functioning in childhood.

STUDY DESIGN

This prospective cohort study followed 260 VLBW/VP adolescents, 12 VLBW/VP adolescents with disability, and 282 FT adolescents. Objective functioning was assessed at 8.5 years; HRQL was assessed at 13 years with the Health Utilities Index Mark 3 (HUI3).

RESULTS

Adolescents reported more functional impairment than their parents especially in the psychological aspects of health. The mean difference in HUI3 multi-attribute utility scores between FT and VLBW/VP adolescents was small (parents: 0.91 [95% CI, 0.90, 0.92] vs 0.88 [95% CI, 0.86, 0.90]; adolescents: 0.87 [95% CI, 0.85, 0.89] vs 0.84 [95% CI, 0.82, 0.86]), but high for VLBW/VP adolescents with disabilities (0.18, 95% CI, -0.04, 0.40). Objective function did not predict HRQL in FT adolescents but contributed to prediction of HRQL in VLBW/VP adolescents without disabilities. Different indicators of objective functioning were important for adolescent vs parent reports. More variation in HUI3 scores was explained by objective function in VLBW/VP parent reports compared with adolescent reports (25% vs 18%).

CONCLUSIONS

VLBW/VP adolescents reported poorer HRQL than their FT peers in early adolescence. Improvement in HRQL as VLBW/VP children grow up is, at least partly, explained by exclusion of the most disabled in self reports by VLBW/VP adolescents and the use of different reference points by adolescents compared with parents.

Non-motor symptoms in Chinese Parkinson's disease patients

This study was designed to survey the prevalence and distribution of non-motor symptoms (NMS) in Parkinson's disease (PD) patients in Shanghai, China, and to investigate the association between NMS and health-related quality of life (HRQoL). One hundred fifty-five PD patients were evaluated using the NMS Questionnaire 30 (NMSQuest), Unified Parkinson's Disease Rating Scale (UPDRS) and Parkinson's Disease Questionnaire-39 (PDQ-39). These data were compared with an international cross-sectional study, and the associations of motor and non-motor measures with HRQoL were estimated. Predictors of HRQoL were sought through multiple linear regression analyses. Each PD patient had eight different individual NMS on average. The problems of memory (65.82%), constipation (64.56%) and nocturia (61.39%) were the most frequent complaints. NMS prevalence in PD patients in Shanghai was consistent with that in the international study, although the composition proportions were different. There was a significant association of PDQ-39 score with NMSQuest score (rs=0.433, p=0.000), UPDRS III score (rs=0.473, p=0.000), Hoehn and Yahr (H-Y) stage (rs=0.567, p=0.000), disease duration (rs=0.220, p=0.005), and levodopa equivalent dosage (rs=0.263, p=0.001). H-Y stage (disease severity) and NMS score were the strongest predictors for PDQ-39 score. This study confirmed that NMS are common in PD, occurring across all disease stages and have a great impact on quality of life. NMS progression contributes significantly to HRQoL decline, and should be well recognized and treated.

To a broader concept of remission: rating the health-related quality of life in bipolar disorder

BACKGROUND

The relationship between remission and quality of life in bipolar disorder is incompletely understood. This study aimed to determine cut-points on the 36-item Short-Form Health Survey (SF-36) and the European Quality of Life Index (EQ-5D) that corresponded with an objective clinical measure of remission in bipolar disorder patients.

METHODS

Data from a 2-year prospective observational study of bipolar and schizoaffective patients were analysed. Concordant with previous research, the Clinical Global Impression-Bipolar Version (CGI-BP) was used as an index of remission, specifically the severity scores of 1 (normal, not at all ill) and 2 (borderline mentally ill). The mean SF-36 standardized mental component (SMC) and standardized physical component (SPC) total scores as well as the EQ-5D index score that corresponded with a CGI-BP severity score of 1 or 2 were determined.

RESULTS

The mean SF-36 score that corresponded with a CGI-BP severity score of 1 or 2, was below 50 for the SPC (49.3) and below 49 for the SMC (48.3). The mean EQ-5D score that corresponded with a CGI-BP severity score of 1 or 2 was below 0.88 (0.87).

LIMITATIONS

Although the initial sample is sufficiently large (n=240), 49 patients scored 1 and 2 on the CGI-S, of which 12 had schizoaffective disorder.

CONCLUSIONS

This study suggests that a cut-off score of ≥50 for the SPC and ≥49 for the SMC of the SF-36 and ≥0.88 for the EQ-5D index approximates a CGI-BP definition of remission.

Presence of anxiety and depression in patients with bronchiectasis unrelated to cystic fibrosis

INTRODUCTION

Patients with chronic bronchiectasis (BQ) may suffer from psychological disorders. The objective of this study was to assess the presence of anxiety and depression in patients from a specialised BQ Unit, using validated questionnaires.

PATIENTS AND METHODS

We included patients consecutively diagnosed with BQ (unrelated to cystic fibrosis) by high resolution computed tomography in the study. Patients were clinically stable in the previous three weeks and voluntarily completed the Beck Depression Inventory, State-Trait Anxiety Inventory and St. George's Respiratory Questionnaire, after signing the informed consent. They were classified according to their scores on the psychological screening questionnaires, and their results were compared with the clinical, radiological and functional parameters and Quality of Life.

RESULTS

Seventy patients were included, 48 women and 22 men, with a mean age of 64.19years. Thirty-four percent (34%) of patients showed symptoms of depression, and around 55% had scores above the 50th percentile in trait and state anxiety. The amount of sputum was associated with trait anxiety. Bacterial colonization was related to anxiety (trait and state), especially Pseudomonas aeruginosa colonization. Female patients showed a higher risk of depression. There was no relationship between the Quality of Life scores and the established classifications of anxiety and depression.

CONCLUSIONS

A high percentage of patients with BQ presented anxiety (trait and state) and depression. The daily sputum production and bacterial colonization (especially with P. aeruginosa) were the variables most related to anxiety; depression was more common in women. We believe that the presence of psychological disorders should be evaluated, especially in patients with this profile.

The impact of short stature on health-related quality of life in children with chronic kidney disease

OBJECTIVES

To compare the health-related quality of life (HRQoL) of children with chronic kidney disease (CKD) and short stature (SS) with that of children with CKD and normal height (NH), to evaluate the impact of catch-up growth and growth hormone (GH) use on HRQoL, and to describe the concordance of perceptions of HRQoL between children with SS and NH and their parents.

STUDY DESIGN

Four hundred eighty-three children and/or parents enrolled in the multicenter Chronic Kidney Disease in Children study who had completed the Pediatric Quality of Life Inventory (Version 4.0) on at least 2 Chronic Kidney Disease in Children study visits composed this substudy population. Participants were dichotomized into NH or SS groups. The demographic characteristics that varied at baseline (sex, glomerular filtration rate, and parent education) were controlled for in the main analysis evaluating the impact of catch-up growth and use of GH on HRQoL.

RESULTS

Multivariate modeling (controlling for confounding variables) revealed a significant association between both catch-up growth and GH use on parent-proxy reports of child physical functioning (P < .05) and social functioning (P < .05). Older children with CKD (15-17 years old) had significantly higher ratings than their parents on the Pediatric Quality of Life Inventory Physical, Emotional, Social, and School Functioning scales compared with younger children (8-14 years old).

CONCLUSION

The finding that height gains and GH use are associated with increases in physical and social functioning by parent report provides additional support for interventions to improve height in children with CKD. The importance of evaluating both the parent and child perceptions of HRQoL is supported by our results.

More than just body weight: the role of body image in psychological and physical functioning

The current study examined BMI and body image dissatisfaction as predictors of physical and mental health-related quality of life (HRQL) and psychosocial functioning in a sample of 414 undergraduate students (mean age=21.5, SD=4.9; mean BMI=23.6, SD=5.2). In men and women, higher BMI was correlated with body image dissatisfaction and physical HRQL, but not with any measures of psychosocial functioning, whereas higher body image dissatisfaction was associated with poorer physical HRQL and psychosocial functioning. Furthermore, body image dissatisfaction was observed to mediate the relationship between BMI and physical HRQL in men and women. Interestingly, in this model, higher BMI predicted increased self-esteem. These findings suggest that body image dissatisfaction may be an important target for health interventions.

Does coronary artery bypass grafting improve quality of life in elderly patients?

Traditional outcome measures such as long-term mortality may be of less value than symptomatic improvement in elderly patients undergoing coronary artery bypass grafting (CABG). In this systematic review, we analyse health-related quality of life (HRQOL) as a marker of outcome after CABG. We aimed to assess the role of HRQOL tools in making recommendations for elderly patients undergoing surgery, where symptomatic and quality-of-life improvement may often be the key indications for intervention. Twenty-three studies, encompassing 4793 patients were included. Overall, elderly patients underwent CABG at reasonably low risk. Our findings, therefore, support the conclusion that performing CABG in the elderly may be associated with significant improvements in HRQOL. In order to overcome previous methodological limitations, future work must clearly define and stringently follow-up this elderly population, to develop a more robust, sensitive and specialty-specific HRQOL tool.

Health-related quality of life among Norwegian children and adolescents with type 1 diabetes on intensive insulin treatment: a population-based study

AIM

To examine health-related quality of life (HRQOL) in children and adolescents with type 1 diabetes on intensive insulin treatment.

METHODS

All children and adolescents with type 1 diabetes above 8 years of age scheduled for follow-up at 21 paediatric departments in Norway, and one of their parents was invited to describe HRQOL by completing DISABKIDS questionnaires. HRQOL was related to sociodemographic factors (i.e. parental economy, education, marital status and to level of physical activity and disease characteristics, obtained from the Norwegian Childhood Diabetes Registry).

RESULTS

Nine hundred and thirty seven (48%) and one of their parents responded. Mean duration of diabetes was 4.9 years (SD 3.3), 51% were girls, 56% used insulin pumps, and 44% used multiple insulin injections, predominantly of long-acting and rapid insulin analogues. Mean HbA1c was 8.5% (SD 1.3). Lower HRQOL scores were significantly associated with higher HbA1c, being a girl and experience of diabetes ketoacidosis. Mothers scored lower than fathers on total score and most subscales. No significant differences in scores were found between users of an insulin pump and multi-injection treatment.

CONCLUSIONS

Health-related quality of life was related to metabolic control and gender, but not to mode of intensified insulin treatment.

Baseline physical health-related quality of life and subsequent depression outcomes in cardiac patients

Among 137 depressed cardiac patients, lower baseline physical health-related quality of life (HRQoL) was independently associated with greater depression persistence at 6 months among patients randomized to collaborative care, but not usual care. Low physical HRQoL may impact collaborative care effectiveness and indicate a need for alternate depression treatment.

Prevalence of minimal hepatic encephalopathy and quality of life evaluations in hospitalized cirrhotic patients in China

AIM: To investigate the prevalence of minimal hepatic encephalopathy (MHE) and to assess corresponding health-related quality of life (HRQoL) in hospitalized cirrhotic patients in China.

METHODS: This multi-center cross-sectional study included 16 teaching hospitals, which were members of “Hepatobiliary Cooperation Group, Society of Gastroenterology, Chinese Medical Association”, from different areas of China carried out between June and October in 2011. All the eligible hospitalized cirrhotic patients (n = 538) were required to complete triplicate number connection tests combined with one digit symbol test for diagnosing MHE. Patients’ clinical examination data were complemented by a modified questionnaire assessing HRQoL. Written informed consent was obtained from each patient.

RESULTS: Male was predominant (68.6%) in 519 patients who met the criteria of the study, with a mean age of 49.17 ± 11.02 years. The most common cause of liver cirrhosis was chronic hepatitis B (55.9%). The prevalence of MHE was 39.9% and varied by Child-Pugh-Classification score (CPC-A: 24.8%, CPC-B: 39.4% and CPC-C: 56.1%, P < 0.01). MHE (P < 0.01) and higher CPC scores (P < 0.01) were associated with a high HRQoL scores (reflecting poorer quality of life). The prevalence of MHE was proportionate to CPC (P = 0.01) and high quality of life scores (P = 0.01).

CONCLUSION: Hospitalized cirrhotic patients have a high prevalence of MHE that is proportionate to the degree of liver function and HRQoL impairment.

Association of Obstructive Sleep Apnea Severity with Exercise Capacity and Health-related Quality of Life

Background:

Current research is inconclusive as to whether obstructive sleep apnea severity directly limits exercise capacity and lowers health-related quality of life (HRQoL).

Aims:

The aim of this study was to evaluate the association of obstructive sleep apnea severity with determinants of exercise capacity and HRQoL.

Subjects and Methods:

Subjects were evaluated by home somnography and classified as no obstructive sleep apnea (n = 43) or as having mild (n = 27), moderate or severe obstructive sleep apnea (n = 21). Exercise capacity was assessed by a ramping cycle ergometer test, and HRQoL was assessed with the SF-36 questionnaire.

Results:

Greater obstructive sleep apnea severity was associated with older age, higher body weight, higher body mass index, lower peak aerobic capacity, a higher percentage of peak aerobic capacity at a submaximal exercise intensity of 55 watts, and lower physical component summary score from the SF-36. None of these variables were statistically different among obstructive sleep apnea severity groups after controlling for age and body weight. Obstructive sleep apnea severity was not associated with any cardiorespiratory fitness or HRQoL parameter.

Conclusions:

Obstructive sleep apnea severity has no independent association with exercise capacity or HRQoL.

Health-related quality of life in children and adolescents with cyclic vomiting syndrome: a comparison with published data on youth with irritable bowel syndrome and organic gastrointestinal disorders

OBJECTIVE

To evaluate health-related quality of life (HRQoL) in children with cyclic vomiting syndrome (CVS) and to compare child self-reports with those of their parents and with published reports of children with irritable bowel syndrome (IBS), children with organic gastrointestinal disorders, and a healthy control group.

STUDY DESIGN

Sixty-eight children aged 5-18 years with CVS confirmed in a gastroenterology clinic completed the Pediatric Quality of Life Inventory (PedsQL). Eighty-two parents completed the parent-proxy PedsQL for children aged 2-18 years. These results were compared with published data for children with IBS, organic gastrointestinal disorders, and a healthy control group using ANOVA. Intraclass correlation was used to evaluate concordance between child and parent reports of HRQoL.

RESULTS

HRQoL reported on the PedsQL by children with CVS was lower than that reported by children with IBS (P < .01) and healthy controls (P < .001), but did not differ from that reported by children with organic gastrointestinal disorders. Children with CVS also had lower HRQoL compared with healthy controls by parent-proxy report on the PedsQL (P < .001). Correlations between HRQoL reports by parents and children were moderate to good (intraclass correlation coefficients, 0.504-0.805; P < .01). Duration of CVS episodes, delay in CVS diagnosis, and number of school days missed due to CVS were associated with lower parent-rated HRQoL (P = .01).

CONCLUSION

Children with CVS reported lower HRQoL compared with those with IBS, and both parents and children reported lower HRQoL compared with healthy controls. Parent and child ratings of HRQoL converged. Improved recognition of CVS and school support might help mitigate the impact of CVS on HRQoL.

Influence of Social Support on Health-Related Quality of Life in New-Generation Migrant Workers in Eastern China

BACKGROUND

The World Health Organization Quality of Life-BREF (WHOQOL-BREF) has generally been used for patients, few studies in migrants who move from rural to urban within one country. Many studies asserted that social isolation presents a risk to individual health. Poor social networks are associated with worse QOL. This study examined health-related quality of life (HRQOL) and social support in new-generation migrant workers and compared it with urban workers.

METHODS

Nine hundred thirty new-generation migrant workers and 939 urban controls completed the WHOQOL-BREF questionnaire and Social Support Rating Scale (SSRS) by stratified sampling in 2011. Spearman's correlation was performed to clarify the relationship between social support and HRQOL in migrants. Multiple linear regression analyses were used to identify the variables that were associated with HRQOL.

RESULTS

The general health, psychological health, and environmental scores of QOL in new-generation migrant workers were lower than in urban workers. New-generation migrants had poorer social support compared with urban controls with regard to general support, objective support, and support utilization. A positive correlation was found between social support and HRQOL. Workers with a higher level of education achieved better psychological, environmental, and general scores than workers with a primary education. Physical, social, environmental, and general health was also closely connected with the age factor. Physical health scores were higher in males than in females.

CONCLUSION

These data suggest that new-generation migrant workers have significant impairment in HRQOL and receive less social support. HRQOL may be affected by social support, education, age, and gender.

The effect of substitution therapy on symptoms in patients with hypothyroidism following treatment for laryngeal and hypopharyngeal carcinomas

Hypothyroidism is a well-known complication following treatment of laryngeal or hypopharyngeal carcinomas, and may cause various psychological and physical problems that negatively affect quality of life. The aim of this study was to evaluate the effect of substitution therapy on symptoms in patients with hypothyroidism. A study-specific questionnaire on physical and psychological problems (before and after substitution therapy) was sent to 70 patients who had been treated between 1977 and 2008 with clinical or subclinical hypothyroidism. Ninety-four percent returned the questionnaire. Symptoms on energy levels were reported most often (67% always tired and 70% lack of energy). Moodiness and emotional and physical symptoms were reported more often in substituted (sub)clinical hypothyroidism. Substitution therapy resulted in an improvement of energy (P = 0.013), sense of general interest and enjoyment (P = 0.022) and a reduction of puffy face (P = 0.041). Most symptoms in patients with thyroid dysfunction do not improve after substitution therapy. Nevertheless, due to its impact on health-related quality of life and the low burden of substitution therapy, screening for hypothyroidism and subsequent substitution therapy remains important.

The effectiveness of an educational intervention on proper analgesic use for dysmenorrhea

OBJECTIVES

Primary dysmenorrhea is a common gynecologic disorder, but is often inappropriately managed due to ignorance and misunderstanding of its pharmacotherapy in many young women. The aim of this study was to assess the effectiveness of an educational intervention on proper analgesic use for dysmenorrhea among Korean female university students.

STUDY DESIGN

In March 2008, an educational intervention, a 10-min lecture using supplementary educational printed materials, was given to the intervention group (n=98). Two months later, changes and differences in knowledge, actual medication behavior, coping strategies, dysmenorrhea severity (VAS score), and Korean health-related quality of life (KQOLS) were assessed between the intervention and control (n=105) groups.

RESULTS

The prevalence of dysmenorrhea in the intervention and control groups was 75.1% and 77.1%, respectively. After the educational intervention, the medication rate of the intervention group was significantly increased (from 36.1% to 51.0%, P=0.007), and the knowledge of and actual behavior relating to the proper analgesic use were also significantly improved in this group. The VAS scores were significantly decreased among participants with dysmenorrhea in the intervention group (from 48.6 ± 22.0 to 37.8 ± 22.5, P<0.001). In addition, significant improvements in two domains of the KQOLS, physical function (from 89.3 ± 11.1 to 93.1 ± 8.8, P=0.007) and pain (from 80.4 ± 19.9 to 87.4 ± 14.3, P=0.001), were observed in the intervention group.

CONCLUSIONS

The findings of this prospective study suggest that a brief educational intervention can improve the severity of dysmenorrhea and the quality of life by enhancing medication knowledge and actual analgesic behavior in Korean female university students.

Depression, anxiety and their comorbidity in the Swedish general population: point prevalence and the effect on health-related quality of life

Background. Depression and anxiety disorders are major world-wide problems. There are no or few epidemiological studies investigating the prevalence of depression, generalized anxiety disorder and anxiety disorders in general in the Swedish population.

Methods. Data were obtained by means of a postal survey administered to 3001 randomly selected adults. After two reminders response rate was 44.3%. Measures of depression and general anxiety were the 9-item Patient Health Questionnaire Depression Scale (PHQ-9) and the 7-item Generalized Anxiety Disorder Scale (GAD-7). The PHQ-9 identified participants who had experienced clinically significant depression (PHQ-9 ≥ 10), and who had a diagnosis of major depression (defined by using a PHQ-9 scoring algorithm). Clinically significant anxiety was defined as having a GAD-7 score ≥ 8. To specifically measure generalized anxiety disorder, the Generalized Anxiety Disorder Questionnaire-IV (GAD-Q-IV) was used with an established cut-off. Health-related quality of life was measured using the EuroQol (EQ-5D). Experiences of treatments for psychiatric disorders were also assessed.

Results. Around 17.2% (95% CI: 15.1–19.4) of the participants were experiencing clinically significant depression (10.8%; 95% CI: 9.1–12.5) and clinically significant anxiety (14.7%; 95% CI: 12.7–16.6). Among participants with either clinically significant depression or anxiety, nearly 50% had comorbid disorders. The point prevalence of major depression was 5.2% (95% CI: 4.0–6.5), and 8.8% (95% CI: 7.3–10.4) had GAD. Among those with either of these disorders, 28.2% had comorbid depression and GAD. There were, generally, significant gender differences, with more women having a disorder compared to men. Among those with depression or anxiety, only between half and two thirds had any treatment experience. Comorbidity was associated with higher symptom severity and lower health-related quality of life.

Conclusions. Epidemiological data from the Swedish community collected in this study provide point prevalence rates of depression, anxiety disorders and their comorbidity. These conditions were shown in this study to be undertreated and associated with lower quality of life, that need further efforts regarding preventive and treatment interventions.

Relationship of health-related quality of life with fatigue and exercise capacity in patients with coronary artery disease

OBJECTIVE

The study objective was to evaluate the relationship of health-related quality of life (HRQoL) with fatigue and exercise capacity in coronary artery disease (CAD) patients.

METHODS

A total of 1072 consecutive CAD patients on admission to a cardiac rehabilitation program were evaluated for HRQoL (36-item Short Form Medical Outcome Questionnaire; SF-36), body mass index, clinical characteristics (New York Heart Association (NYHA) class, angina pectoris class, coronary interventions, treatment with beta blockers, hypertension and diabetes), symptoms of depression and anxiety (Hospital Anxiety and Depression Scale), fatigue (Multidimensional Fatigue Inventory-20; MFI-20), and exercise capacity (bicycle ergometer test).

RESULTS

In univariate regression analyses lower scores on all SF-36 domains were associated with greater scores on all MFI-20 subscales. Exercise capacity was associated with all SF-36 domains, except for social functioning and mental health domains. In multivariate regression analyses, after adjusting for age, gender, body mass index, NYHA class, angina pectoris class, hypertension, diabetes, coronary interventions, treatment with betablockers, and symptoms of depression and anxiety, greater limitation due to physical and due to emotional problems, poor social functioning, decreased energy/vitality, worse general health perception, reduced mental component summary and lower global SF-36 score were independently associated with higher MFI-20 general fatigue score. Reduced physical functioning, greater pain, and reduced physical component summary SF-36 scores were associated with greater MFI-20 physical fatigue score. Lower SF-36 mental health score was associated, with greater MFI-20 mental fatigue score.

CONCLUSION

In CAD patients undergoing rehabilitation, poor HRQoL is associated with greater fatigue and decreased exercise capacity independently from mental distress and CAD severity score.

Quality of life of patients with high-grade spondylolisthesis: minimum 2-year follow-up after surgical and nonsurgical treatments

BACKGROUND CONTEXT

Surgical intervention is generally indicated in a pediatric high-grade spondylolisthesis to prevent the progression of deformity or neurologic deterioration and improve the quality of life. However, the outcome of the treatment on the health-related quality of life (HRQOL) of patients with high-grade spondylolisthesis remains largely unknown.

PURPOSE

To describe the changes in the HRQOL of patients with pediatric high-grade spondylolisthesis after surgical and nonsurgical managements.

STUDY DESIGN

Observational case series with a minimal of 2-year follow-up.

PATIENT SAMPLE

Twenty-eight pediatric patients with high-grade spondylolisthesis from a single institution filled the inclusion criteria. Twenty-three patients were managed surgically and five were managed nonsurgically.

OUTCOME MEASURES

Self-report measures: Scoliosis Research Society questionnaires (SRS-22). Neurologic examination, radiographic evaluation of slip grade.

METHODS

The SRS-22 questionnaire was collected at the baseline (initial presentation for the nonsurgical group and preoperative visit for the surgical group) and at the last follow-up. Differences between baseline and last follow-up were evaluated in both groups. Correlation between the baseline score of SRS-22 score and improvement in the SRS-22 score was determined in surgical patients.

RESULTS

In surgical patients, total SRS-22 scores were 3.31 ± 0.50 at the baseline and 4.26 ± 0.50 at the last follow-up. In nonsurgical patients, total SRS-22 scores were 4.12 ± 0.16 at the baseline and 4.14 ± 0.38 at the last follow-up. Therefore, variation in the SRS-22 total score was +0.94 ± 0.77 (p<.001) for surgical patients and +0.02 ± 0.35 (p=.854) for nonsurgical patients. Improvement of the SRS-22 score was correlated with a low baseline value of SRS-22 (R²=0.61; p<.001). There was no neurologic or slip deterioration during the follow-up for patients treated nonsurgically.

CONCLUSIONS

The HRQOL improves after a surgical intervention for high-grade spondylolisthesis. Patients with lower baseline HRQOL scores are those who benefit the most from surgery. Close observation is a safe and feasible option in selected patients with a good baseline HRQOL and no neurologic impairment.

Cost-Effectiveness of Surgical Treatment for Adult Spinal Deformity: A Comparison of Dollars per Quality of Life Improvement Across Health Domains

DESIGN

Retrospective, single-center analysis of consecutive patients undergoing surgical treatment for adult spinal deformity (ASD).

OBJECTIVE

Assess the value of surgical treatment for ASD across different health domains.

SUMMARY OF BACKGROUND DATA

The cost of improvement in health-related quality of life (HRQOL) is an important consideration for resource allocation. There is also growing concern among policy makers regarding the incorporation of patient-specific preferences in the appropriate definition and assessment health care value.

METHODS

Single-center, retrospective study of consecutive ASD patients undergoing primary surgery with principal diagnosis code 737.0-737.9 from 2005 through May 2010. Patients less than 18 years of age were excluded. The HRQOL measures were based on the Short Form-36, the Oswestry Disability Index (ODI), and the Scoliosis Research Society (SRS)-22 questionnaire after at least 2 years after surgery. The SRS scores were translated to a 100-point scale. Costs were collected from hospital data on the total costs incurred for the episode of surgical care. Confidence intervals were calculated using nonparametric bootstrap methods.

RESULTS

Baseline and minimum 2-year HR follow-up data were available for 164 patients, with an average follow-up of 3.2 years and a range of 2 to 7.4 years. Patients were predominantly female (14; 88%) and ranged from 18 to 82 years of age at index surgery (average of 51 years of age). The cost-effectiveness (CE) ratios varied across different HRQOL outcomes, ranging from an average cost of $5,658 per 1-point improvement in SRS Self-image to an average cost of $25,918 per 1-point improvement in SF-36 Physical Component Score (PCS). Results revealed statistically significant differences (p < .05) in CE ratios across different HRQOL outcomes.

CONCLUSIONS

Statistically significant differences were found in CE ratios across HRQOL sub-domains. This has important implications in the assessment of patient-specific value of health care services, and illustrates that surgical treatment for ASD may be more cost-effective for some purposes (eg, pain reduction) and less cost-effective for others (eg, improved functional activity).

Health-related quality of life, assessed with a disease-specific questionnaire, in Swedish adults suffering from well-diagnosed food allergy to staple foods

Background

Our aim was to investigate the factors that affect health related quality of life (HRQL) in adult Swedish food allergic patients objectively diagnosed with allergy to at least one of the staple foods cow’s milk, hen’s egg or wheat. The number of foods involved, the type and severity of symptoms, as well as concomitant allergic disorders were assessed.

Methods

The disease-specific food allergy quality of life questionnaire (FAQLQ-AF), developed within EuroPrevall, was utilized. The questionnaire had four domains: Allergen Avoidance and Dietary Restrictions (AADR), Emotional Impact (EI), Risk of Accidental Exposure (RAE) and Food Allergy related Health (FAH). Comparisons were made with the outcome of the generic questionnaire EuroQol Health Questionnaire, 5 Dimensions (EQ-5D). The patients were recruited at an outpatient allergy clinic, based on a convincing history of food allergy supplemented by analysis of specific IgE to the foods in question. Seventy-nine patients participated (28 males, 51 females, mean-age 41 years).

Results

The domain with the most negative impact on HRQL was AADR, assessing the patients’ experience of dietary restrictions. The domain with the least negative impact on HRQL was FAH, relating to health concerns due to the food allergy. One third of the patients had four concomitant allergic disorders, which had a negative impact on HRQL. Furthermore, asthma in combination with food allergy had a strong impact. Anaphylaxis, and particularly prescription of an epinephrine auto-injector, was associated with low HRQL. These effects were not seen using EQ-5D. Analyses of the symptoms revealed that oral allergy syndrome and cardiovascular symptoms had the greatest impact on HRQL. In contrast, no significant effect on HRQL was seen by the number of food allergies.

Conclusions

The FAQLQ-AF is a valid instrument, and more accurate among patients with allergy to staple foods in comparison to the commonly used generic EQ-5D. It adds important information on HRQL in food allergic adults. We found that the restrictions imposed on the patients due to the diet had the largest negative impact on HRQL. Both severity of the food allergy and the presence of concomitant allergic disorders had a profound impact on HRQL.

Assessment of quality of life in a cohort of newly diagnosed patients on HAART regimen, in resource restricted tribal region of chhattisgarh, India: a prospective study

BACKGROUND

Highly active antiretroviral therapy regimens have resulted in the systemic/clinical healing for human immune deficiency virus-infected patients but the consequence of antiretroviral therapy on the whole quality of life has become a major concern. The current study correlates the relationship of quality of life with successful highly active antiretroviral therapy.

AIM

To determine the health-related quality of life in human immune deficiency virus-infected patients on highly active anti-retroviral therapy regimen in tribal region of Chhattisgarh.

DESIGN

An open label prospective study.

MATERIALS AND METHODS

Health-related quality of life was assessed using a standardized questionnaire, the Medical Outcomes Survey Short Form 36. Physical health summary scores and mental health summary scores were compared of pre-Highly Active Anti-Retroviral Therapy (at baseline) and post 12 months of therapy.

RESULTS

The increase in CD4 cell counts was extremely significant (P < 0.0001). The Physical Composite Summary (P value = 0.0003) improved significantly, whereas the Mental Composite Summary (with a baseline value of 40.7), post 12 months, was calculated as 42.8 (P value = 0.2371) and was statistically not significant.

CONCLUSION

Efficacy measurement is the key ingredient of highly active anti-retroviral therapy, which must also include assessment of health-related quality of life to maximize the holistic approach towards disease.

Contribution of attachment insecurity to health-related quality of life in depressed patients

AIM: To examine the individual contributions of insecure attachment styles and depression symptom severity to health-related quality of life (HRQoL) in patients diagnosed with adjustment disorder (AJD) with depressed mood.

METHODS: Participants were 67 patients diagnosed with International Classification of Diseases, Tenth edition AJD with depressed mood, who completed standardised self-report questionnaires measuring study variables. Mean scores and SDs were computed for the outcome and predictor measures. Pearson correlations among the measures were computed. The study hypotheses were tested using analysis of variance (ANOVA) and multiple regression analyses. All analyses were performed using the SPSS-17 software package (SPSS Inc., Chicago, IL, United States).

RESULTS: ANOVA showed a significant main effect of the insecure attachment styles on depression symptom severity and life satisfaction scores. The results suggest that depressive symptoms were more severe (F = 4.13, df = 2.67, P < 0.05) and life satisfaction was poorer (F = 5.69, df = 2.67, P < 0.01) in both anxious-ambivalently and avoidantly attached patients compared with their securely attached counterparts, whereas the two insecure groups did not significantly differ by these variables. The anxious/ambivalent attachment style and depression symptom severity significantly contributed to HRQoL, accounting for 21.4% and 29.7% of the total variance, respectively [R² = 0.79; Adjusted R² = 0.77; F (5, 67) = 33.68, P < 0.0001], even after controlling for gender, marital and employment status confounders.

CONCLUSION: The results show that the anxious/ambivalent attachment style together with depression symptom severity substantially and independently predict the HRQoL outcome in AJD with depressed mood.

OnabotulinumtoxinA for treatment of chronic migraine: PREEMPT 24-week pooled subgroup analysis of patients who had acute headache medication overuse at baseline

Acute headache medication overuse (MO) is common in patients with chronic migraine (CM). We evaluated safety and efficacy of onabotulinumtoxinA as preventive treatment of headache in CM patients with baseline MO (CM+MO) in a planned secondary analysis from two similarly designed, randomized, placebo-controlled, parallel, Phase III trials. Patients were randomized to treatment groups (155-195 U of onabotulinumtoxinA or placebo) using MO (patient-reported and diary-captured frequency of intake) as a stratifying variable. Of 1384 patients, 65.3% (n=904) met MO criteria (onabotulinumtoxinA: n=445, placebo: n=459). For the CM+MO subgroup at Week 24, statistically significant between-treatment group mean changes from baseline favoring onabotulinumtoxinA versus placebo were observed for headache days (primary endpoint: -8.2 vs. -6.2; p<0.001) and other secondary endpoints: frequencies of migraine days (p<0.001), moderate/severe headache days (p<0.001), cumulative headache hours on headache days (p<0.001), headache episodes (p=0.028), and migraine episodes (p=0.018) and the percentage of patients with severe Headache Impact Test-6 category (p<0.001). At Week 24, change from baseline in frequency of acute headache medication intakes (secondary endpoint) was not statistically significant (p=0.210) between groups, except for triptan intakes (p<0.001), where the onabotulinumtoxinA-treated group was favored. OnabotulinumtoxinA was effective and well tolerated as headache prophylaxis in CM+MO patients.

Iron deficiency is a key determinant of health-related quality of life in patients with chronic heart failure regardless of anaemia status

Aims

To evaluate the effect of iron deficiency (ID) and/or anaemia on health-related quality of life (HRQoL) in patients with chronic heart failure (CHF).

Methods and results

We undertook a post-hoc analysis of a cohort of CHF patients in a single-centre study evaluating cognitive function. At recruitment, patients provided baseline information and completed the Minnesota Living with Heart Failure questionnaire (MLHFQ) for HRQoL (higher scores reflect worse HRQoL). At the same time, blood samples were taken for serological evaluation. ID was defined as serum ferritin levels <100 ng/mL or serum ferritin <800 ng/mL with transferrin saturation <20%. Anaemia was defined as haemoglobin ≤12 g/dL. A total of 552 CHF patients were eligible for inclusion, with an average age of 72 years and 40% in NYHA class III or IV. The MLHFQ overall summary scores were 41.0 ± 24.7 among those with ID, vs. 34.4 ± 26.4 for non-ID patients (P = 0.003), indicating worse HRQoL. When adjusted for other factors associated with HRQoL, ID was significantly associated with worse MLHFQ overall summary (P = 0.008) and physical dimension scores (P = 0.002), whereas anaemia was not (both P > 0.05). Increased levels of soluble transferrin receptor were also associated with impaired HRQoL (P ≤ 0.001). Adjusting for haemoglobin and C-reactive protein, ID was more pronounced in patients with anaemia compared with those without (P < 0.001).

Conclusion

In patients with CHF, ID but not anaemia was associated with reduced HRQoL, mostly due to physical factors.

The relationships between asthma control, daytime sleepiness, and quality of life among children with asthma: a path analysis

OBJECTIVES

We aimed to examine the relationships between asthma control, daytime sleepiness, and asthma-specific health-related quality of life (HRQOL) among children with asthma. Path analyses were conducted to test if daytime sleepiness can mediate the effect of asthma control status on asthma-specific HRQOL.

METHODS

160 dyads (pairs) of asthmatic children and their parents were collected for analyses. The Asthma Control and Communication Instrument (ACCI) was used to categorize adequate and poor asthma control status. The Cleveland Adolescent Sleepiness Questionnaire (CASQ) was used to measure children's daytime sleepiness, including sleep in school, awake in school, sleep in evening, and sleep during transport. The Patient-Reported Outcomes Measurement Information System (PROMIS) Asthma Impact Scale was used to measure asthma-specific HRQOL.

RESULTS

Poorly controlled asthma was associated with daytime sleepiness and impaired asthma-specific HRQOL. Asthma control status was directly associated with asthma-specific HRQOL (P<.05), whereas sleep in school and sleep in evening domains of daytime sleepiness significantly mediated the relationship between poor asthma control and impaired HRQOL (P<.01).

CONCLUSIONS

Asthma control status was associated with pediatric asthma-specific HRQOL, and the association was significantly mediated by daytime sleepiness. Healthcare providers need to address pediatric sleep needs related to poor asthma control to reduce the negative impact on HRQOL.

Assessing the impact of dabigatran and warfarin on health-related quality of life: results from an RE-LY sub-study

BACKGROUND

Anticoagulation is recommended in patients with atrial fibrillation (AF) to prevent strokes. Vitamin K antagonists, such as warfarin, are associated with numerous practical limitations--frequent anticoagulation monitoring, lifestyle and dietary restrictions--that complicate patient management and may impact health-related quality of life (HRQoL). This study derived HRQoL estimates for AF patients receiving warfarin or dabigatran etexilate (dabigatran), a new oral anticoagulant not requiring anticoagulation monitoring, during one year of stable treatment, i.e. in the absence of outcome events, such as strokes or major bleedings.

METHODS

Changes in HRQoL over time and between treatments were assessed using the EQ-5D (utility and Visual Analogue Scale (VAS) scores) at baseline, 3 and 12 months in a sub-group of 1435 patients participating in the RE-LY trial. RE-LY was a phase III study that compared the safety and efficacy of warfarin, dabigatran 150 mg bid and dabigatran 110 mg bid for stroke prevention in patients with AF.

RESULTS

Utilities ranged from 0.805 (dabigatran 150 mg bid) to 0.811 (dabigatran 110 mg bid) at baseline, and did not change over the one year observation period. No differences between the dabigatran groups and warfarin were statistically significant except for the dabigatran 150 mg bid group at 3 months. Similarly, none of the within-group or between-group differences in VAS scores were statistically significant.

CONCLUSIONS

Over the course of one year, all anticoagulated patients without outcome events (e.g. strokes or major bleedings) had stable HRQoL. Scores between dabigatran and warfarin were comparable, which was unexpected given the known complexities of warfarin treatment.

Cross-cultural adaptation and validation of the Portuguese version of the Living with Asthma Questionnaire

OBJECTIVE

To translate and culturally adapt the Living with Asthma Questionnaire (LWAQ) to the Portuguese language and to test its reliability and validity.

METHODS

The Portuguese version of this disease-specific health-related quality of life measure was obtained with forward/backward translations, consensus panels and a pre-test. The Portuguese LWAQ and Medical Outcomes Study - 36 item Short Form (SF-36) questionnaires, and a form for the characteristics of the patients were administered to 61 subjects with asthma.

RESULTS

Reliability of LWAQ scores was good with Cronbach's alpha coefficients ranging from 0.70 to 0.97 [with the exception of "preoccupation" (0.62) construct, and "sleep" (0.67) and "effects on others" (0.47) domains] and intraclass correlation coefficients between 0.86 and 0.99. Construct validity was supported by the confirmation of predefined hypotheses involving expected significant correlations between LWAQ total, constructs and domains, and SF-36 dimensions with similar content.

CONCLUSION

The Portuguese LWAQ exhibited suitable psychometric properties, in terms of internal consistency, reproducibility and construct validity.

Ensuring comprehensive assessment of urinary problems in prostate cancer through patient-physician concordance

OBJECTIVES

To examine the concordance between clinicians and men diagnosed with prostate cancer on a clinician-derived pathophysiological classification of the following self-reported urinary complications: storage (irritative), voiding (obstructive), and leakage/incontinence.

MATERIALS AND METHODS

Fourteen urology experts classified 37 urinary function questionnaire items into 3 primary conceptual dimensions (e.g., storage [irritative], voiding [obstructive] and urinary leakage/incontinence) that would best reflect each item's content. In addition, 218 patient participants provided responses to the 37 items. Using classifications by experts to develop the conceptual framework, the structure was tested using confirmatory factor analyses with patient data.

RESULTS

Expert consensus was achieved in the classification of 31 out of 37 items. Using the 3-factor conceptual framework and patient data, the fit indices for the overall correlated factor model suggested an acceptable overall model fit. The analyses of the separate domains showed acceptable fit for the storage/irritative domain and the leaking/incontinence domain. The dimensionality of the voiding/obstructive domain was too difficult to estimate.

CONCLUSIONS

Our analysis found items that conceptually and psychometrically support 2 constructs (leaking/incontinence and storage/irritative). The consistency of this support between the groups suggests a clinical relevance that is useful in treating patients. We have conceptual support for a third hypothesis (voiding/obstructive), although there were too few items to assess this psychometrically. Relative motivating factors of bother and urinary complaints were not addressed and remain an unmet need in this field.

Patient-reported outcome measures for chronic wounds with particular reference to pressure ulcer research: a systematic review

OBJECTIVES

Pressure ulcers are a major health problem, affect patient psychological, physical and social functioning, and cause significant treatment burden. For comprehensive assessment of the benefits of an intervention, patient-reported evidence of the impact of an intervention on important patient outcomes should be made. We systematically reviewed the quality of life literature on chronic wounds to determine the suitability of generic and chronic wound-specific outcome measures for use in evaluating patient outcomes in pressure ulcer research.

DESIGN

A systematic review of the literature.

DATA SOURCES

Searches of eight electronic databases from inception until May 2012 were undertaken.

REVIEW METHODS

Quality of life domains, item content and content relevance were determined for identified outcome measures. The content validity of identified measures was assessed against an empirically derived pressure ulcer-specific conceptual framework.

RESULTS

Three generic and 14 chronic wound measures were identified but no pressure ulcer-specific measures. None of the existing measures cover all quality of life domains important in pressure ulcers. One condition-specific measure, the Venous Leg Ulcer Measure, matched most closely conceptually, but failed to represent three important domains and contained items not specific to pressure ulcers.

CONCLUSIONS

Currently, outcomes important in pressure ulcers are inadequately covered by generic and chronic wound-specific instruments despite similar conceptual models. Highlighted is the need for clear conceptualisation of content as well as determining appropriateness when selecting outcome measures in the future.

Association Between Fulfilment of Expectations and Health-related Quality of Life after Gastric Bypass

The objective was to examine the relationship between fulfilment of expectations and health-related quality of life 4 and 12 months after gastric bypass. A follow-up study based on patients undergoing gastric bypass at Aalborg Hospital - Aarhus University Hospital during February 2008 to December 2009. Health-related quality of life was assessed by Short Form 36 and summarized into the physical component summary and the mental component summary. Information on expectations was questionnaire based. Associations were analysed by linear regression. Included were 87 gastric bypass patients. Compared with patients with fulfilled expectations having expectations partly fulfilled -7.3 (-11.3; -3.3) or not having expectations fulfilled -11.2 (-18.8 ; -3.5) was associated with low a mental component summary 4 months after surgery. At 12 months follow-up patients who reported not to have expectations fulfilled had a low mental component summary score -16.3 (-26.5; -6.2) when compared to their counterparts with fulfilment of expectations. Not having expectations to changes in general well-being fulfilled is associated with low mental component summary. This is seen at follow-up points 4 and 12 months after gastric bypass.

Health and health-related quality of life among treatment-seeking overweight and obese adults: associations with internalized weight bias

BACKGROUND

Weight bias is widespread and has numerous harmful consequences. The internalization of weight bias has been associated with significant psychological impairment. Other forms of discrimination, such as racial and anti-gay bias, have been shown to be associated with physical health impairment. However, research has not yet examined whether internalized weight bias is associated with physical as well as psychological impairment in health-related quality of life.

METHODS

Participants included 120 treatment-seeking overweight and obese adults (mean body mass index = 35.09; mean age = 48.31; 68% female; 59% mixed or Asian ethnicity). Participants were administered measures of internalized weight bias and physical and mental health-related quality of life, and they were assessed for the presence of chronic medical conditions, use of prescription and non-prescription medications, and current exercise.

RESULTS

Internalized weight bias was significantly correlated with health impairment in both physical (r = -.25) and mental (r = -.48) domains. In multivariate analyses controlling for body mass index, age, and other physical health indicators, internalized weight bias significantly and independently predicted impairment in both physical (β = -.31) and mental (β = -.47) health.

CONCLUSIONS

Internalized weight bias was associated with greater impairment in both the physical and mental domains of health-related quality of life. Internalized weight bias also contributed significantly to the variance in physical and mental health impairment over and above the contributions of BMI, age, and medical comorbidity. Consistent with the association between prejudice and physical health in other minority groups, these findings suggest a link between the effects of internalized weight-based discrimination and physical health. Research is needed on strategies to prevent weight bias and its internalization on both a societal and individual level.

Validity and reliability of the SF-36 in Chilean older adults: the ALEXANDROS study

To validate short-form-36 health survey (SF-36) with specific scoring algorithm obtained in a large sample of Chilean older people and to associate quality of life in this sample with social and health related factors. A cross-sectional study on 2,143 community-living subjects aged 60-92 years (33 % men and 67 % women) conducted in Santiago, Chile. Scores in 8 scales of SF-36-physical function (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE) and mental health (MH)-, were calculated. Factor analysis was used to extract two principal factors and logistic regression model was applied to estimate its association with socio-demographic and health variables. The internal consistency of scales was high (Cronbach's alpha 0.86-0.87). Factor analysis retained two factors: mental (MCS) and physical (PCS) components accounting for 65.3 % of total variance (55.3 and 10.0 % respectively). High correlations (0.61-0.94) between MCS and MH, V, RE and SF were obtained. PCS correlated highest (0.72-0.86) with RP, PF and BP. Self-perceived symptoms of depression (GDS-15 ≥5) was the main variable explaining low scores in both MCS and PCS (adjusted OR = 26.9; 95 % CI: 15.3-47.2; OR = 3.4; 95 % CI: 2.1-5.5, respectively). We have demonstrated the reliability and validity of SF-36 questionnaire to evaluate health related quality of life, reporting Chilean-Specific factor score coefficients for MCS and PCS based in national Chilean means and standard deviations for older people. After adjusting by age and gender, the main predictors of low health related QoL in Chilean older people were self-perceived symptoms of depression, the presence of two or more chronic diseases and illiteracy. Important gender inequalities were observed in all of these results, being consistently less favorable in women than in men.

[Risk factors for the deterioration of quality of life in critical trauma patients. Assessment at 6 and 12 months after discharge from the intensive care unit]

OBJECTIVE

To evaluate factors influencing the deterioration of health-related quality of life (HRQoL) in trauma patients admitted to an ICU.

DESIGN

A prospective observational study was carried out.

SETTING

The combined medical/surgical ICU in a university secondary hospital with 24-hour neurosurgery service.

PATIENTS

Trauma patients admitted to the ICU during a two-year period. HRQoL assessment prior to admission to the ICU, and at 6 and 12 months after discharge.

MAIN VARIABLES

Demographic variables, type and severity of injury (AIS), severity (APACHE II, ISS, TRISS), length of stay, procedures, mortality and HRQoL according to the SF-36 and EQ-5D.

RESULTS

We completed the monitoring of 110 patients that showed significant impairment of their HRQoL in all the dimensions assessed. According to the SF-36, physical role was more deteriorated at 12 months, but the mental component decreased more than the physical component after 6 months. The VAS scale of the EQ-5D decreased to 55 at 6 months (19) and increased to 66 at 12 months (17). In the multiple logistic regression analysis, the variables associated with poorer HRQoL were age > 45 years, TRISS > 10, previous porer quality of life, and serious injuries in the extremities.

CONCLUSIONS

Patients showed marked deterioration of their HRQoL at 6 months, followed by overall improvement at 12 months, though without reaching their previous state. The factors that determine poorer quality of life include age, severity, previous HRQoL, and severe injuries in the extremities.

Short-, Intermediate-, and Long-term Quality of Life Outcomes Following Radical Prostatectomy for Clinically Localized Prostate Cancer

Many clinically localized prostate cancers that are diagnosed today are low risk, and prevention of disease-specific mortality may only be realized decades after treatment. Radical prostatectomy (RP) may adversely impact health-related quality of life (HRQOL) by causing both transient or permanent urinary incontinence and erectile dysfunction. In contrast, RP may also improve HRQOL via relief of lower urinary tract symptoms in men suffering from these symptoms prior to surgery. Because the average man treated for prostate cancer has a life expectancy of approximately 14 years, it is imperative to consider the long-term impact of RP on both survival and HRQOL in treatment decision making. This comprehensive literature review examines short-, intermediate-, and long-term HRQOL following RP. In addition, the long-term results of RP are compared with other treatment modalities for treating clinically localized prostate cancer.

Health-related Quality of Life and Existential Concerns Among Patients with End-stage Renal Disease

Background:

Health-Related Quality Of Life (HRQOL) among patients with End-Stage Renal Disease (ESRD) is significantly impacted by virtue of varied disease or treatment-related factors, and its evaluation along with existential concerns is required for providing comprehensive care to the patient.

Aim:

The aim of this study was to describe the various dimensions of HRQOL and existential concerns and to examine the relationship between the two among patients with ESRD.

Materials and Methods:

A cross-sectional descriptive study was conducted among 54 patients with ESRD undergoing maintenance hemodialysis in a teaching hospital. A semi-structured questionnaire was used to assess socio-demographic characteristics and existential concerns of the respondents. The HRQOL was evaluated using a standardized scale of Kidney Disease Quality of Life-Short Form (KDQOL-SF™) questionnaire. Data were presented as frequencies, mean ± Standard Deviation (SD) for baseline characteristics and scores. Pearson correlation was used to study the association between various domains of quality of life and existential concerns.

Results:

Among HRQOL, the worst results obtained were in the domain of burden of kidney disease (33.45 ± 13.53), work status (49.07 ± 24.75), quality of social interaction (62.22 ±11.80), general health (43.06 ± 13.01), and physical functioning (47.50 ± 18.88). Disrupted personal integrity (12.80 ± 2.81) and loss of continuity (5.37 ± 1.17) were most bothersome existential concerns. A co-relational model behaves distinctly eliciting weak to strong association among various domains of HRQOL and existential concerns.

Conclusion:

Patients with ESRD reported impaired HRQOL in most of the domains. Existential concerns are distinguished as important dimensions of HRQOL. Association between HRQOL and existential concerns showed that these dimensions are distinct, and there is a need for assessing and attending these entities through a multidisciplinary approach to alleviate the suffering and achieving a sense of overall wellbeing among patients.

Health-related quality of life and chronic obstructive pulmonary disease in North Carolina

Background:

Comparisons of health-related quality of life (HRQOL) between persons with chronic obstructive pulmonary disease (COPD) and adults in the general population are not well described.

Aims:

To examine associations between COPD and four measures of HRQOL in a population-based sample.

Patients & Methods:

These relationships were examined using data from 13,887 adults aged >18 years who participated in the 2007 Behavioral Risk Factor Surveillance System (BRFSS) conducted in North Carolina (NC). Logistic regression was used to obtain adjusted relative odds (aOR).

Results:

The age-adjusted prevalence of COPD among NC adults was 5.4% (standard error 0.27). Nearly half of adults with COPD reported fair/poor health compared with 15% of those without the condition (age-aOR, 5.5; 95% confidence interval [ CI] , 4.4 to 6.8). On average, adults with COPD reported twice as many unhealthy days (physical/mental) as those without the condition. The age-adjusted prevalence of >14 unhealthy days during the prior 30 days was 45% for adults with COPD and 17% for those without. The aOR of >14 unhealthy days was 1.7 (95% CI, 1.4 to 2.2) times greater among adults with COPD compared with those without.

Conclusions:

These results suggest COPD is independently associated with lower levels of HRQOL and reinforce the importance of preventing COPD and its complications through health education messages stressing efforts to reduce total personal exposure to tobacco smoke, occupational dusts and chemicals, and other indoor and outdoor air pollutants linked to COPD and early disease recognition. Our findings represent one of the few statewide efforts in the US and provide guidance for disease management and policy decision making.

Multidisciplinary pain treatment - Which patients do benefit?

Background The prevalence of chronic non-malignant pain in developed countries is high, ranging from 14% to 50%. Patients with chronic pain are active users of health-care services and they report impaired health-related quality of life (HRQoL) when compared with the general population. Psychological distress has been identified as one of the risk factors for pain chronicity. Depression, anxiety and negative beliefs are associated with pain interference and perceived disability. Multidisciplinary pain management (MPM) aims to rehabilitating chronic pain patients by addressing both physical, psychological, social and occupational factors related to the pain problem. MPM programmes have been shown to be effective in reducing pain and improving function in patients with diverse chronic pain states. However, MPM programmes are often heterogeneous and predicting MPM treatment results in different patients groups may be difficult. Methods The present study examined changes in HRQoL after MPM in 439 patients treated at a multidisciplinary pain clinic using the 15D HRQoL questionnaire. The characteristics of the 100 patients with the greatest improvement and the 100 patients with the largest decrease in HRQoL were examined more closely (demographics, characteristics of pain, pain interference, psychiatric comorbidity, employment status, details of MPM) after answering a follow-up 15D questionnaire at three years after their MPM had ended. Result During MPM, HRQoL was significantly improved in 45.6% of the 439 patients, decreased in 30.7% of the patients and did not change in 23.7% of the patients. Patient-related factors that predicted a better HRQoL among the 100 patients with good MPM outcome compared with the 100 patients with poor MPM outcome were higher education and better employment status. Age, gender, marital status, duration of pain, number of pain sites, pain intensity or pain interference at baseline did not differ between the patient groups. Patient expectations regarding MPM were similar. A tendency towards more psychiatric comorbidity in the non-responder group was seen. The duration of MPM in the two patient groups was similar, as well as the number of medications started, the variety of specialists seen and psychiatric counselling with supportive therapy included. More non-responder than responder patients had died during the three-year follow-up period, some of the deaths were related to substance abuse. Conclusions and Implications HRQoL in chronic pain patients was significantly improved during MPM compared with the baseline. Pain duration of several years, multiple pain sites and neuropathic pain were not discerning factors between the responders and non-responders of the present study, implying that a positive change in HRQoL may be achieved by MPM even in these pain patients. In agreement with previous studies, factors predicting poor treatment outcome in the non-responder group of chronic pain patients were not treatment related. To further improve MPM outcome even in pain patients with risk factors for less benefit of treatment such as low education and poor general health, more individualized MPM approaches with emphasis on analysis and treatment of psychological symptoms and patient beliefs is essential.

Health-related quality of life of 256 recipients after liver transplantation

AIM: To investigate health-related quality of life (HRQoL) and psychological outcomes in 256 adults who had undergone liver transplantation (LT).

METHODS: A stratified random sampling method was used in this follow-up multicenter study to select a representative sample of recipients undergoing either living donor liver transplantation (LDLT) or deceased donor liver transplantation (DDLT). HRQoL was measured by using the Chinese version of Medical Outcome Study Short Form-36 (SF-36), and psychological outcomes by using the beck anxiety inventory (BAI) and the self-rating depression scale (SDS). Clinical and demographic data were collected from the records of the Chinese Liver Transplant Registry and via questionnaires.

RESULTS: A total of 256 patients were sampled, including 66 (25.8%) receiving LDLT and 190 (74.2%) undergoing DDLT; 15 (5.9%) recipients had anxiety and four (1.6%) developed severe depression after the operation. Compared with LDLT recipients, DDLT patients had higher scores in general health (60.33 ± 16.97 vs 66.86 ± 18.42, P = 0.012), role-physical (63.64 ± 42.55 vs 74.47 ± 36.46, P = 0.048), role-emotional (61.11 ± 44.37 vs 78.95 ± 34.31, P = 0.001), social functioning (78.60 ± 22.76 vs 88.16 ± 21.85, P = 0.003), vitality (70.30 ± 15.76 vs 75.95 ± 16.40, P = 0.016), mental health (65.88 ± 12.94 vs 71.85 ± 15.45, P = 0.005), physical component summary scale (PCS, 60.07 ± 7.36 vs 62.58 ± 6.88, P = 0.013) and mental component summary scale (MCS, 52.65 ± 7.66 vs 55.95 ± 10.14, P = 0.016). Recipients > 45 years old at the time of transplant scored higher in vitality (77.33 ± 15.64 vs 72.52 ± 16.66, P = 0.020), mental health (73.64 ± 15.06 vs 68.00 ± 14.65, P = 0.003) and MCS (56.61 ± 10.00 vs 54.05 ± 9.30, P = 0.037) than those aged ≤ 45 years. MCS was poorer in recipients with than in those without complications (52.92 ± 12.21 vs 56.06 ± 8.16, P = 0.017). Regarding MCS (55.10 ± 9.66 vs 50.0 ± 10.0, P < 0.05) and PCS (61.93 ± 7.08 vs 50.0 ± 10.0, P < 0.05), recipients scored better than the Sichuan general and had improved overall QoL compared to patients with chronic diseases. MCS and PCS significantly correlated with scores of the BAI (P < 0.001) and the SDS (P < 0.001).

CONCLUSION: Age > 45 years at time of transplant, DDLT, full-time working, no complications, anxiety and depression were possible factors influencing postoperative HRQoL in liver recipients.

Which clinical variable influences health-related quality of life the most after spontaneous subarachnoid hemorrhage? Hunt and Hess scale, Fisher score, World Federation of Neurosurgeons score, Brussels coma score, and Glasgow coma score compared

OBJECTIVE

To determine the strength of the correlation between the Hunt and Hess scale, Fisher score, Brussels coma score, World Federation of Neurosurgeons score, and Glasgow coma score and health-related quality of life.

METHODS

Evaluable questionnaires from 236 patients (5.6 years [± standard deviation, 2.854 years] on average after hemorrhage) were included in the analysis. Quality of life was documented using the MOS-36 item short form health survey. Because of the ordinal nature of the variables, Kendall tau was used for calculation. Significance was established as P ≤ 0.05.

RESULTS

Weak and very weak correlations were found in general (r ≤ 0.28). The strongest correlations were found between the Glasgow coma score and quality of life (r = 0.236, P = 0.0001). In particular, the "best verbal response" achieved the strongest correlations in the comparison, at r = 0.28/P = 0.0001. The Fisher score showed very weak correlations (r = -0.148/P = 0.012). The Brussels coma score (r = -0.216/P = 0.0001), Hunt and Hess scale (r = -0.197/P = 0.0001), and the World Federation of Neurosurgeons score (r = -0.185/P = 0.0001) revealed stronger correlations, especially in terms of the physical aspects of quality of life.

CONCLUSIONS

The Glasgow coma scale revealed the strongest, and the Fisher score showed the weakest correlations. Thus the Fisher score, as an indicator of the severity of a hemorrhage, has little significance in terms of health-related quality of life.