Factors Associated with SF-12 Physical and Mental Health Quality of Life Scores in Adults with Stroke

Trajectories of post-stroke quality of life and long-term prognosis: Results from an eleven-year prospective study

PURPOSE

The relationship between quality of life (QoL) and long-term prognosis in stroke patients is still unclear. We explored physical and mental QoL trajectories during the first six months after stroke and determined the associations between trajectories and long-term prognosis in patients with first-ever ischemic stroke.

METHODS

Included were 733 participants from a prospective study. QoL was assessed with the 12-item Short Form Survey (SF-12) at baseline, 3 and 6 months. Patients' prognoses (stroke recurrence and death) were identified from 2010 to 2021. The latent class growth model (LCGM) was used to identify distinct trajectories of physical and mental QoL measured over the first 6 months. We employed the Cox model or Fine-Gray model for prognoses to examine the associations between QoL trajectories and prognosis.

RESULTS

Five trajectories of physical QoL and five trajectories of mental QoL were identified. For physical QoL of the Poor-Improved, and Moderate-Impaired trajectory versus Moderate-Improved trajectory, the hazard ratio (HR) for death was 2.39 (1.14 to 5.02), and 2.03(0.93 to 4.44); the HR for recurrence was 1.56 (0.83 to 2.94) and 2.33 (1.28 to 4.24). For mental QoL of the Moderate-Impaired trajectory versus the Moderate-Improved trajectory, the HR for death was 2.48 (1.21 to 5.07). The results were robust in the sensitivity analysis.

CONCLUSION

QoL during the first six months after ischemic stroke can be categorized into distinct groups. Change in QoL was associated with long-term survival. Secondary prevention of recurrent strokes might rely more on improving patients' physical QoL.

Factors Influencing Disabled Stroke Survivors' Quality of Life in Rural China: Based on the Structural Characteristics and Psychometric Properties of the SF-36 Assessment

Many stroke survivors' quality of life is impaired. Few studies of factors influencing their quality of life have been based on the factors tested by the short form 36 instrument. This study did so with 308 physically disabled stroke survivors in rural China. Principal components analysis was applied to refine the dimension structure of the short form 36 assessment, followed by backward multiple linear regression analysis to determine the independent factors influencing quality of life. The structure revealed differed from the generic structure in showing that the mental health and vitality dimensions are not unidimensional. Subjects who reported access to the outdoors as convenient demonstrated better quality of life in all dimensions. Those who exercised regularly achieved better social functioning and negative mental health scores. Other factors influencing a better quality of life in terms of physical functioning were younger age and not being married. Being older and better educated predicted better role-emotion scores. Being female correlated with better social functioning scores, while men scored better on bodily pain. Being less educated predicted higher negative mental health, while being less disabled predicted better physical and social functioning. The results suggest that the SF-36's dimension structure should be re-evaluated before using it to assess stroke survivors.

Measuring psychological flexibility and cognitive defusion in individuals with acquired brain injury

PURPOSE

Acceptance and Commitment Therapy (ACT) is used increasingly for individuals with psychological distress following acquired brain injury (ABI) in different countries. However, questionnaires measuring ACT-processes are often not validated for this patient group and need cross-cultural validation. This study investigated the psychometric properties of the Acceptance and Action Questionnaire for Acquired Brain Injury (AAQ-ABI; measuring psychological flexibility related to thoughts and feelings about ABI) and the Cognitive Fusion Questionnaire (CFQ-7; measuring cognitive defusion).

MATERIALS AND METHODS

Score distribution, reliability, and convergent validity of the AAQ-ABI and the CFQ-7 were examined in Dutch individuals with ABI.

RESULTS

Seventy-three patients with ABI were included. The AAQ-ABI showed good reliability (Cronbach's α = 0.87) and the CFQ-7 excellent reliability (Cronbach's α = 0.97). Both did not show a floor or ceiling effect, nor a skewed distribution. There were strong to moderate correlations between the questionnaires and measures of psychological flexibility, mood, quality of life, and value-driven behavior (AAQ-ABI: r = -0.70-0.81; CFQ-7 = -0.67-0.84). Inter-item total correlations indicate that the questions within each questionnaire measured the same construct (AAQ-ABI: r = 0.40-0.78; CFQ-7: r = 0.84-0.93).

CONCLUSIONS

The current study shows that the Dutch AAQ-ABI and CFQ-7 have acceptable to good psychometric properties when measuring psychological flexibility and cognitive defusion in patients with ABI.

Effect of repetitive transcranial magnetic stimulation on the kynurenine pathway in stroke patients

OBJECTIVE

Repetitive transcranial magnetic stimulation (rTMS) improves depressive symptoms and motor function in stroke patients. While metabolic derangement of the kynurenine pathway has been reported in stroke patients, the effect of rTMS on this pathway remains unknown. This study was performed to investigate the effect of rTMS on serum levels of kynurenine and tryptophan in stroke patients.

METHODS

Sixty-two stroke patients received rTMS in addition to intensive rehabilitation and 33 stroke patients received intensive rehabilitation alone for 14 days. The rTMS involved low-frequency stimulation (at 1 Hz) of the primary motor cortex on the unaffected side of the cerebrum. The depressive state of the patients was evaluated with the Beck Depression Inventory (BDI) before and after treatment. Motor function of the patients was evaluated with Fugl-Meyer Assessment (FMA). Serum levels of kynurenine and tryptophan levels were also measured before and after treatment.

RESULTS

The serum tryptophan level decreased in the group receiving rTMS to the right brain and increased in the group receiving rTMS to the left brain. The serum kynurenine/tryptophan ratio was elevated in the group receiving rTMS to the right brain. The BDI indicated improvement of depressive symptoms in the rehabilitation alone group and the group receiving rTMS to the right brain plus rehabilitation. The FMA improved in all groups.

CONCLUSIONS

The effect of low-frequency rTMS on the kynurenine pathway may differ depending on whether it is applied to the right or left cerebral hemisphere.

Age and Gender Differences in Trends and Impact of Depression on Quality of Life in the United States, 2008 to 2016

BACKGROUND

We aimed to examine age and gender differences in the relationship between depression and quality of life among United States adults.

METHODS

Medical Expenditure Panel Survey data for 2008 to 2016 on 227,663 adults were analyzed. The dependent variable, quality of life, included physical component summary scores and mental component summary scores from the Short Form Health Survey. The key independent variable, depression, was measured using the two-item Patient Health Questionnaire. General linear regression models examined the relationship between quality of life and depression. Models were adjusted for individual and environmental characteristics, symptom status, functional and biological status, and health perceptions and were stratified by gender and age.

RESULTS

In adjusted models, mental component summary scores were significantly lower among those with depression compared with those without depression (β = -0.39; 95% confidence interval [CI], 0.38 to -1.16) and lower among women compared with men (β = -0.10; 95% CI, 0.10 to -1.31). Models stratified by gender and age found women with depression ages 40 to 64 (β = -0.07; 95% CI, 0.07 to -0.20) and 65 or older (β = -0.08; 95% CI, 0.08 to -0.24) had significantly lower physical component summary scores compared with those without depression. Among men with depression, those ages 18 to 39 (β = -0.03; 95% CI, 0.03 to -0.10) and 40 to 64 (β = -0.09, 95% CI, 0.08 to -0.26) had lower physical component summary scores compared with those without depression. Women and men of all ages with depression had significantly lower mental component summary scores compared with those without depression.

CONCLUSIONS

Public health interventions and clinical approaches to address depression in women and men should target functional status in men and perceptions of health in women.

Association of leisure-time physical activity with perceived general health status among hypertensive people: an analysis of NHANES 2015-18

Although leisure-time physical activity (LTPA) improves general health, little is known about its impacts on the health of hypertensive people within the United States. We investigated the general health of hypertensive people and the relationship between LTPA and general health within this population. This cross-sectional study analyzed National Health and Nutrition Examination Survey 2015-18 data. None, some, and high LTPA were defined as '0', '>0 but <150', and '≥150' minutes of LTPA in each week, respectively. Hypertension was defined as the systolic/diastolic blood pressure ≥130/80 mmHg or taking BP-lowering drugs. General health status was dichotomized as whether participants reported 'very good to excellent' health status or not. After descriptive analysis, logistic regression was performed. Among 8504 participants (48.6% male and mean age: 48.2 years), about 47.9%, 41.4%, and 39.5% of people had hypertension, 'very good to excellent' health, and high LTPA, respectively. The odds of 'very good to excellent' health was lower among hypertensives than those without hypertension (adjusted odds ratio [AOR]: 0.7, 95% confidence interval [CI]: 0.6-0.8, p < 0.001). Among hypertensive individuals, about one-third reported 'very good to excellent' health (33.1%) and high LTPA (32.0%). Lastly, compared to people with no LTPA, those with some (AOR: 1.5, 95% CI: 1.0-2.0, p < 0.05) and high (AOR: 2.3, 95% CI: 1.7-3.0, p < 0.001) LTPA had greater odds of 'very good to excellent' health. We found positive relationships between LTPA and 'very good to excellent' health of hypertensive people. Therefore, improving general health could be an added advantage of LTPA for hypertensive people.

Disparities in Health Care for Black Patients in Physical Medicine and Rehabilitation in the United States: A Narrative Review

Racial health disparities continue to disproportionately affect Black persons in the United States. Black individuals also have increased risk of worse outcomes associated with social determinants of health including socioeconomic factors such as income, education, and employment. This narrative review included studies originally spanning a period of approximately one decade (December 2009-December 2019) from online databases and with subsequent updates though June 2020. The findings to date suggest pervasive inequities across common conditions and injuries in physical medicine and rehabilitation for this group compared to other racial/ethnic groups. We found health disparities across several domains for Black persons with stroke, traumatic brain injury, spinal cord injury, hip/knee osteoarthritis, and fractures, as well as cardiovascular and pulmonary disease. Although more research is needed, some contributing factors include low access to rehabilitation care, fewer referrals, lower utilization rates, perceived bias, and more self-reliance, even after adjusting for hospital characteristics, age, disease severity, and relevant socioeconomic variables. Some studies found that Black individuals were less likely to receive care that was concordant with clinical guidelines per the reported literature. Our review highlights many gaps in the literature on racial disparities that are particularly notable in cardiac, pulmonary, and critical care rehabilitation. Clinicians, researchers, and policy makers should therefore consider race and ethnicity as important factors as we strive to optimize rehabilitation care for an increasingly diverse U.S. population.

Factors Affecting Quality of Life among Post-Stroke Patients in the Sub-Himalayan Region

Background  Stroke is one of the most debilitating conditions contributing to significant disability and death globally. Identifying risk factors for quality of life (QoL) will enable to improve home-based rehabilitation in post-stroke phase.

Objective  This study was aimed to identify the risk factors of QoL in stroke patients in the sub-Himalayan region.

Materials and Methods  A cross-sectional hospital-based study assessed the QoL among stroke patients within a week after the onset of acute stroke and then re-evaluated at 3 months. World Health Organization QoL-BREF, Beck Depression Inventory, the Barthel Index, and Montreal Cognitive Assessment (MOCA) were used to seek data on QoL, depression, cognitive, and functional dependence status, respectively. Appropriate statistics were used to compute the results.

Results  In total, 129 stroke patients recruited, out of which 102 returned to a 3-month follow-up. QoL, MOCA, disability index, and depression score were compared using Wilcoxon Singed-rank test. In multivariate analysis, depression and disability together predicted 60% of the variance for physical QoL ( p < 0.0001). Similarly, poststroke depression and disability together predicted 61% of the variance for psychological QoL ( p < 0.0001) in stroke patients.

Conclusion  Findings indicated that depression and disability are leading risk factors of QoL in stroke patients. Early identification of poststroke depression and functional dependence status is, therefore, essential to devise screening procedure and to develop targeted intervention to improve rehabilitation outcomes.

The efficacy of Qigong exercises for post-stroke mental disorders and sleep disorders: Protocol for a systematic review and meta-analysis

BACKGROUND

Post-stroke mental disorders (PSMDs) and post-stroke sleep disorders (PSSDs) are quite common condition in stroke's patients. Qigong has been widely applied as a replaced and useful treatment for PSMDs and PSSDs. However, the exact effects and safety of Qigong have yet be systematically investigated. Our study focused on summary of efficacy and safety of Qigong for the treatment of advanced PSMDs and PSSDs through the systematic analysis and meta-analysis, in order to provide scientific reference for the clinical.

METHODS

The protocol followed Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols. Relevant randomized controlled trials were only considered. Search strategy will be performed in 4 English database including Cochrane Library, PubMed, Web of Science, Excerpt Medical Database, 4 Chinese Database including Chinese Biomedical Literature Database, China National Knowledge Infrastructure, China Scientific Journal Database, Wanfang Database, and WHO International Clinical Trials Registry Platform. Papers in English or Chinese published from their inception to 30 June 2020. Study selection and data extraction will be performed independently by 2 investigators. The clinical outcomes including overall Hamilton depression scale, Hamilton anxiety scale, the mental health part of the MOS item short from health survey, Generic Quality of Life Inventory-74, Center for Epidemiologic Studies Depression Scale, Pittsburgh sleep quality index. Based on the Cochrane Assessment tool and Physiotherapy Evidence Database scale, a modified assessment form should be used to evaluate the methodological quality. Review Manager 5.3 was used for data analysis and risk of bias.

RESULTS AND CONCLUSION

We provide some more practical and targeted results examine the effect of Qigong exercises for PSMDs and PSSDs in the relative meta-analysis. We find out defects or inadequacies of Qigong in previous studies. The findings of this research will provide more evidence-based guidance in clinical practice and more rigorous study.International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) registration number: INPLASY202070051.

Neighborhood Poverty and Physical Health at Midlife: The Role of Life-Course Exposure

Studies of the effect of neighborhood poverty on health are dominated by research designs that measure neighborhood poverty at a single point in time, ignoring the potential influence of exposure to neighborhood poverty over the life course. Applying latent class analysis to restricted residential history data from the National Longitudinal Survey of Youth, 1979 Cohort, we identify four trajectories of life-course exposure to high-poverty neighborhoods between adolescence and midlife and then examine how these groups differ in their physical health conditions (SF-12 score) and self-rated health at around age 40. Linear and logistic regression analyses show that life-course exposure to high-poverty neighborhoods is a stronger predictor of midlife physical health than are point-in-time measures of neighborhood poverty observed during either adolescence or midlife. Our findings suggest that a life-course approach can enhance our understanding of how neighborhood poverty affects physical health.

Brain Imaging Signs and Health-Related Quality of Life after Acute Ischemic Stroke: Analysis of ENCHANTED Alteplase Dose Arm

BACKGROUND AND PURPOSE

The influence of specific brain lesions on health-related quality of life (HRQoL) after acute ischemic stroke (AIS) is uncertain. We aimed to identify imaging predictors of poor HRQoL in alteplase-treated participants of the alteplase dose arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).

METHODS

ENCHANTED was an international trial of low- versus standard-dose intravenous alteplase in AIS patients, with functional outcome (modified Rankin scale [mRS]) and HRQoL on the 5-dimension European Quality of Life Scale (EQ-5D) assessed at 90 days post-randomization. Brain images were analyzed centrally by trained assessors. Multivariable logistic regression was undertaken in the study population randomly divided (2:1) into training (development) and validation (performance) groups, with age (per 10-year increase), ethnicity, baseline National Institutes of Health Stroke Scale (NIHSS) score, diabetes mellitus, premorbid function (mRS score 0 or 1), and proxy respondent, forced into all models. Data are presented with odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Eight prediction models were developed and validated in 2,526 AIS patients (median age 67.5 years; 38.4% female; 61.7% Asian) with complete brain imaging and 90-day EQ-5D utility score data. The best performance model included acute ischemic changes in the right (OR 1.69, 95% CI: 1.24-2.29) and deep (OR 1.50, 95% CI: 1.03-2.19) middle cerebral artery (MCA) regions. Several background features of brain frailty - atrophy, white matter change, and old infarcts - were significantly associated with adverse physical but not emotional HRQoL domains.

CONCLUSIONS

In thrombolysed AIS patients, right-sided and deep ischemia within the MCA territory predict poor overall HRQoL, whilst features of old cerebral ischemia are associated with reduced physical HRQoL.

Stroke symptoms impact on mental and physical health: A Lebanese population based study

BACKGROUND/OBJECTIVE

Stroke symptoms in the absence of diagnosed stroke are common worldwide and associated with stroke risk factors and great impact on the physical and mental health functioning. The aim of this study was to assess, at the national level, the association of stroke symptoms with mental and physical health.

METHODS

Quality of life was assessed using physical and mental component summary scores (PCS and MCS) of the Short Form 12v2 Health Survey in the Lebanese population. We assessed the differences in the mean PCS and MCS scores among asymptomatic individuals with no stroke/transient ischemic attack (TIA) history (n=1167), symptomatic individuals with no stroke/TIA history (n=125) and those with stroke/TIA history (n=46). Psychometric properties of the Lebanese version of the SF- 12v2 were evaluated using principal component analysis.

RESULTS

Symptomatic individuals had an average PCS scores of 2.31 (95%CI: 0.75-3.88) points lower and those with stroke/TIA history had 3.26 (95%CI: 1.01-5.51) points lower when compared with asymptomatic individuals with no stroke/TIA history. Similarly, MCS scores for symptomatic individuals were 2.58 (95%CI: 1.02-4.13) points lower and those with stroke/TIA history had 3.28 (95%CI: 1.06-5.50) points lower than asymptomatic individuals.

CONCLUSION

Physical and mental health functioning declined among symptomatic individuals and those with stroke/TIA history. Thus, frequent monitoring for the early detection of stroke symptoms may be recommended.

Quantifying heterogeneity of physical and mental health-related quality of life in chronic obstructive pulmonary disease patients in the United States

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a heterogenous condition. This study aims to quantify the heterogeneity of Health-related Quality of Life (HRQoL), and identify subgroups with the lowest HRQoL, in COPD patients in the United States (US). Methods Data from 2008-2015 Medical Expenditure Panel Survey were used to examine the heterogeneity of HRQoL between different COPD subgroups using mixed-effects modeling and G-computation. The Physical Composite Summary (PCS) and Mental Composite Summary (MCS) scores from the Short-Form-12 questionnaire were utilized. We also compared the heterogeneity of HRQoL in our COPD cohort against that in a matched non-COPD cohort. Results The final sample consisted of 1,866 (weighted = 19,952,143) COPD patients with a mean age of 63.2 years (Standard error (SE):0.38), mean MCS score of 46.84 (SE:0.35), and mean PCS score of 35.65 (SE:0.32). The adjusted MCS and PCS scores ranged from 36.19 to 53.06, and from 25.52 to 48.27, respectively, for COPD subgroups. COPD patients had statistically significantly lower MCS and PCS scores by 4.61, and 5.86 points, respectively, compared to the matched non-COPD cohort, and MCS scores showed a wider variability in the COPD cohort. Conclusion Our study quantifies substantial heterogeneity of HRQoL in COPD in the US and provides evidence for prioritizing COPD subgroups with the lowest HRQoL for targeted interventions.

Persistent depression is a predictor of quality of life in stroke survivors: results from a 5-year follow-up study of a Chinese cohort

BACKGROUND

Whether the time course of post-stroke depression (PSD) can be used to predict the quality of life (QoL) of patients with late-stage stroke remains unclear, this study investigated whether persistent depression at 1 year after stroke predicts QoL at 5 years following stroke.

METHODS

We analyzed the demographic and clinical data of patients with stroke in 56 hospitals across China that participated in the Prospective Cohort Study on the Incidence and Outcome of Patients with PSD in China Study. Follow-up assessments were performed at the following time points after stroke: in person, 2 weeks, 3 months, 6 months, and 1 year; by telephone, 5 years. National Institutes of Health Stroke Scale (NIHSS) score on admission, recurrence, disability, depression, QoL, and chronic complications were recorded. Depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders. QoL was measured using short form-12 (SF-12). Multivariable ordinal logistic regression analysis was used to identify factors that independently affected the physical component summary (PCS) and mental component summary (MCS) scores of the SF-12.

RESULTS

Of the 801 patients evaluated in this study, 80 had persistent depression. The multivariable regression analysis of data obtained at 5 years showed that persistent depression at 1 year (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.29-0.81) and disability at 5 years (OR: 0.34; 95% CI: 0.23-0.49) were associated with poor MCS scores at 5 years. Old age, a high NIHSS score on admission, disability at 5 years, and stroke recurrence within 5 years were associated with poor PCS scores at the 5-year follow-up.

CONCLUSIONS

Persistent depression at the 1-year follow-up could predict poor MCS scores at the 5-year follow-up. The development of interventional strategies targeting post-stroke patients with persistent depression is warranted.

Role of D-serine in the beneficial effects of repetitive transcranial magnetic stimulation in post-stroke patients

OBJECTIVE

Abnormalities in neurotransmission via N-methyl-D-aspartic acid receptor (NMDAR) play a role in the pathophysiology of neuropsychiatric disorders. The impact of repetitive transcranial magnetic stimulation (rTMS) on NMDAR-related amino acids remains unknown. We aim to investigate the effects of rTMS on NMDAR-related amino acids in serum of post-stroke patients.

METHODS

Ninety-five consecutive post-stroke patients with upper limb hemiparesis were recruited. In 27 patients, the Beck Depression Inventory (BDI) score was 10 or higher. Twelve depressed patients underwent rehabilitation in combination with rTMS and 15 non-depressed patients underwent rehabilitation only without rTMS for 14 days. 1 Hz rTMS was applied to the primary motor area in the non-lesional hemisphere. BDI was conducted before and after treatment. Serum glutamine, glutamate, glycine, L-serine, and D-serine levels were measured before and after treatment.

RESULTS

There were no differences between depressed patients and non-depressed patients in clinical characteristics, levels of the five amino acids in serum, and the ratio of amino acids. However, in 27 depressed patients there was a significant correlation between levels of glutamate in serum and BDI (ρ=0.428、p=0.026). BDI decreased significantly in depressed patients after treatment with or without rTMS. D-serine decreased in the rehabilitation with rTMS group, but increased in the rehabilitation without rTMS group. L-serine increased in the rehabilitation with rTMS group, but decreased in the rehabilitation without rTMS group.

CONCLUSIONS

The results suggest that rTMS can modulate NMDAR-related amino acids in blood, producing beneficial effects.

Association of income and health-related quality of life in atrial fibrillation

Objective

Health-related quality of life (HRQoL) is a patient-centred benchmark promoted by clinical guidelines in atrial fibrillation (AF). Income is associated with health outcomes, but how income effects HRQoL in AF has limited investigation.

Methods

We enrolled a convenience cohort with AF receiving care at a regional healthcare system and assessed demographics, medical history, AF treatment, income, education and health literacy. We defined income as a categorical variable (<$20 000; $20 000-$49 999; $50 000-$99 999; >$100 000). We used two complementary HRQoL measures: (1) the atrial fibrillation effect on quality of life (AFEQT), measuring composite and domain scores (daily activity, symptoms, treatment concerns, treatment satisfaction; range 0-100); (2) the 12-item Short Form Survey (SF-12), measuring general HRQoL with physical and mental health domains (range 0-100). We related income to HRQoL and adjusted for relevant covariates.

Results

In 295 individuals with AF (age 71±10, 40% women), we observed significant differences in HRQoL by income. Higher mean composite AFEQT scores were observed for higher income groups: participants with income <$20 000 had the lowest HRQoL (n=35, 68.2±21.4), and those with income >$100 000 had the highest HRQoL (n=64, 81.9±17.0; p=0.04). We also observed a significant difference by income in the AFEQT daily activity domain (p=0.02). Lower income was also associated with lower HRQoL in the mental health composite score of the SF-12 (59.7±21.5, income <$20 000 vs 79.3±16.3, income >$100 000; p<0.01).

Conclusion

We determined that income was associated with HRQoL in a cohort with prevalent AF. Given the marked differences, we consider income as essential for understanding patient-centred outcomes in AF.

The impact of the current economic crisis on mental health in Italy: evidence from two representative national surveys

Background

Economic crises pose major threats to health. Research on the association between the current economic crisis and health is accumulating. Scant evidence is available on the impact of economic downturns on mental health in Italy, one of the European countries most affected by the economic crisis.

Methods

We used data from the 2005 and 2013 'Health Conditions and Use of Health Services' surveys conducted by the Italian National Institute of Statistics to estimate Italian poor mental health prevalence in Italy and we applied Poisson regression analysis to explore how the risk (expressed as Prevalence Rate Ratios; PRR) of poor mental health has been impacted by the ongoing economic crisis, by gender and by different socio-economic strata.

Results

Poor mental health prevalence in Italy was 21.5% in 2005 and 25.1% in 2013. The risk of poor mental health increased between 2005 and 2013 by 17% in males (PRR: 1.17; 95%CI: 1.14-1.20) and by 4% in females (PRR: 1.04; 95%CI: 1.02-1.06), the increase being highest for young males (24%). Vulnerable subgroup is at higher risk of poor mental health but not differently affected by the impact of the economic crisis.

Conclusion

The economic crisis that hit Italy has posed threats to Italians' mental health and wellbeing, with a higher impact on young male populations. As further evidence from prospective studies is accumulating, our findings suggest strengthened primary and secondary prevention interventions should be planned and implemented by the Italian National Health Service so as to counter economic downturns' impact on population and individual-level health.

Effect of Tai Chi for post-stroke mental disorders and sleep disorders: A protocol for systematic review and meta-analysis

BACKGROUND

Post-stroke mental disorders (PSMDs) and post-stroke sleep disorders (PSSDs) are very common in stroke patients. Recently, Tai Chi (TC) as a form of Chinese traditional mind-body exercise has been gradually applied to stroke rehabilitation although its efficacy for PSMD and PSSD varies across different studies. The aim of this study is to explore the therapeutic effect of TC training for PSMD and PSSD.

METHODS

This review will only include randomized controlled trials (RCTs). Search strategy will be performed in 3 English databases, 4 Chinese databases, and the WHO International Clinical Trials Registry Platform. All English or Chinese RCTs, published from inception to February 28, 2019, will be sought. Two reviewers will screen, select studies, extract data, and assess quality independently. Primary outcomes are clinical scales, mainly including "Hamilton depression scale," "Hamilton anxiety scale," and "Pittsburgh sleep quality index." The methodological quality including the risk of bias of the included studies will be evaluated using a modified assessment form, which is based on Cochrane assessment tool and Physiotherapy Evidence Database scale. Review Manager Software (Revman5.3) will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis. We will use GRADE system to evaluate the quality of our evidence.

RESULTS

We will provide some more practical and targeted results investigating the effect of TC exercise for PSMD and PSSD in the current meta-analysis. Meanwhile, we will ascertain study progress of TC for PSMD and PSSD and find out defects or inadequacies of previous studies, so that future researchers could get beneficial guidance for more rigorous study.

CONCLUSION

The stronger evidence about TC's rehabilitative effect and safety for PSMD and PSSD will be provided for clinicians and policymakers.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018106608.

ETHICS AND DISSEMINATION

We do not apply for formal ethical approval from ethics committee because all of the study data in our review will be obtained in an anonymous way. Findings of this study are projected to be disseminated through peer-review publications.

Assessment of Reliability and Validity of SF-12v2 among a Diabetic Population

OBJECTIVES

To validate the Medical Outcomes Study Short Form version 2 (SF-12v2) in diabetic patients.

METHODS

Adults with self-reported diabetes from the Medical Expenditure Panel Survey (2011-2013) were identified. Reliability (internal consistency and test-retest) and validity (construct, concurrent, criterion, and predictive) of the SF-12v2 were assessed. The SF-12v2 consists of two normalized composite scores: the physical component summary score (PCS12) and the mental component summary score (MCS12). Confirmatory factor analysis was conducted to assess the instrument structure. Concurrent (convergent and discriminant) validity was assessed by a multitrait-multimethod matrix using the Patient Health Questionnaire, the Kessler Scale, and perceived health and mental health questions. The predictive validity was assessed by estimating future limitations. The concurrent validity was tested by comparing the MCS12, PCS12, and utility scores (six-dimensional health state short form) across comorbidity scores.

RESULTS

The final sample comprised 2214 diabetic patients with mean normalized (population mean 50; range 0-100) PCS12 and MCS12 scores of 40.81 (standard error 0.33) and 49.82 (standard error 0.26), respectively. The PCS12 and MCS12 scores showed good internal consistency (Cronbach α: PCS12 0.85; MCS12 0.83) and acceptable test-retest reliability (intraclass correlation coefficient: PCS12 0.72; MCS12 0.63) and produced acceptable goodness-of-fit indices (normed fit index 0.95; comparative fit index 0.95; root mean square error of approximation 0.11 [95% confidence interval 0.1017-0.1188]). The PCS12 and MCS12 were moderately correlated with perceived health and perceived mental health. The MCS12 was highly correlated with the Patient Health Questionnaire and the Kessler Scale. Both the PCS12 and the MCS12 could predict the future health limitations. The PCS12, MCS12, and utility scores demonstrated sensitivity to the presence of comorbidity scores.

CONCLUSIONS

The SF-12v2 is a valid generic instrument for measuring quality of life in diabetic patients.

Racial and ethnic disparities in stroke outcomes: a scoping review of post-stroke disability assessment tools

Purpose: To identify how post-stroke disability outcomes are assessed in studies that examine racial/ethnic disparities and to map the identified assessment content to the International Classification of Functioning, Disability, and Health (ICF) across the time course of stroke recovery. Methods: We conducted a scoping review of the literature. Articles published between January 2001 and July 2017 were identified through Scopus, PubMed, CINAHL, and PsycINFO according to predefined inclusion and exclusion criteria. Results: We identified 1791 articles through database and hand-searching strategies. Of the articles, 194 met inclusion criteria for full-text review, and 41 met inclusion criteria for study inclusion. The included studies used a variety of outcome measures encompassing domains within the ICF: body functions, activities, participation, and contextual factors across the time course of stroke recovery. We discovered disproportionate representation among racial/ethnic groups in the post-stroke disability disparities literature. Conclusions: A wide variety of assessments are used to examine disparities in post-stroke disability across the time course of stroke recovery. Several studies have identified disparities through a variety of assessments; however, substantial problems abound from the assessments used including inconsistent use of assessments, lacking evidence on the validity of assessments among racial/ethnic groups, and inadequate representation among all racial/ethnic populations comprising the US. Implications for Rehabilitation An enhanced understanding of racial/ethnic disparities in post-stroke disability outcomes is inherently important among rehabilitation practitioners who frequently engage with racial/ethnic minority populations across the time course of stroke recovery. Clinicians should carefully consider the psychometric properties of assessment tools to counter potential racial bias. Clinicians should be aware that many assessments used in stroke rehabilitation lack cultural sensitivity and could result in inaccurate assessment findings.

The earlier the better: health-related quality of life is inversely related to age of smoking cessation in older former Italian smokers

BACKGROUND

Quitting smoking has several health benefits, including an improvement in health-related quality of life. It is not well established if there is a relationship between the age when people stop smoking and health-related quality of life in older adults.

AIMS

The primary aim was to investigate the relationship between health-related quality of life and the age when people quit smoking in a national representative sample of community-dwelling older Italian adults. The secondary aim was to describe the characteristics of older former smokers according to their age when they stopped smoking.

METHODS

Data were drawn from the "Health and use of health care in Italy", a national cross-sectional survey (2004-2005). Seven thousand five hundred and sixty-two former smokers, aged 65 years and older, were evaluated by age of smoking cessation. Socio-demographic characteristics, physical activity, the 12-Item Short-Form Health Survey (SF-12) score and its physical (PCS-12) and mental (MCS-12) component summary scores, disability and comorbidities were analyzed.

RESULTS

Educational level, marital status and area of residence were associated with a different age of smoking cessation, as a higher level of disability and comorbidity. PCS-12 (β -0.144; p < 0.001) and MCS-12 (β -0.077; p < 0.001) component scores were lower in subjects who quit smoking later. The relationship was confirmed for the PCS-12 score even after adjustment for socio-demographic, disability and clinical variables (β -0.031; p < 0.001), while it disappeared for the MCS-12 score (β -0.010, p = 0.307), after adjustment for comorbidities.

CONCLUSION

Physical and mental health-related quality of life is influenced by the age of smoking cessation in older individuals, but this relationship is influenced by comorbidities, particularly depression. Some individual characteristics are related to the age of the person when he/she quit smoking.

Depression and Functional Status Among African American Stroke Survivors in Inpatient Rehabilitation

PURPOSE

To examine the prevalence of poststroke depression (PSD) among African American stroke survivors and the association of depression with functional status at inpatient rehabilitation facility (IRF) discharge.

METHODS

Secondary data analysis was conducted of a patient cohort who received care at 3 IRFs in the United States from 2009 to 2011. Functional status was measured by the Functional Independence Measure (FIM). Multiple linear regression models were used to examine associations of PSD and FIM motor and cognitive scores.

RESULTS

Of 458 African American stroke survivors, 48.5% were female, 84% had an ischemic stroke, and the mean age was 60.8 ± 13.6 years. Only 15.4% (n = 71) had documentation of PSD. Bivariate analyses to identify factors associated with depression identified a higher percentage of patients with depression than without who were retired due to disability (17.1% versus 11.6%) or employed (31.4% versus 19.6%) prestroke (P = .041). Dysphagia, cognitive deficits, and a lower admission motor FIM score were also significantly more common among those with depression. There was no significant relationship between depression and functional status after adjusting for patient characteristics.

CONCLUSIONS

In this study, 15% of the African Americans who received rehabilitation after a stroke had documentation of PSD but this was not associated with functional status at discharge.

Health-related quality of life and health condition of community-dwelling populations with cancer, stroke, and cardiovascular disease

[Purpose] The purpose of this study was to investigate health conditions and HRQoL (health-related quality of life) of community-dwelling populations with cancer, stroke, and CVD (cardiovascular disease) based on standardized data. [Subjects] The study subjects numbered 422 in total: 179 patients had cancer, 128 were stroke patients, and 115 were CVD patients. [Methods] This study used data collected during health interviews carried out as part of the sixth Korean National Health and Nutrition Examination Survey. Face-to-face health interviews were conducted by trained surveyors who visited households during 2013. The contents of the interviews included data on demographic factors, physical condition, psychological condition, and HRQoL. [Results] Stress perceptions related to health condition differed significantly across the populations of cancer, stroke, and CVD patients. The HRQoL items of mobility, self-care, usual activities, and anxiety/depression also differed significantly across these populations. [Conclusion] Healthcare teams will now be in a position to plan programs for improvement in these areas according to the features of each disease.

Factors that influence physical function and emotional well-being among Medicare-Medicaid enrollees

Dually enrolled Medicare-Medicaid older adults are a vulnerable population. We tested House's Conceptual Framework for Understanding Social Inequalities in Health and Aging in Medicare-Medicaid enrollees by examining the extent to which disparities indicators, which included race, age, gender, neighborhood poverty, education, income, exercise (e.g., walking), and physical activity (e.g., housework) influence physical function and emotional well-being. This secondary analysis included 337 Black (31%) and White (69%) older Medicare-Medicaid enrollees. Using path analysis, we determined that race, neighborhood poverty, education, and income did not influence physical function or emotional well-being. However, physical activity (e.g., housework) was associated with an increased self-report of physical function and emotional well-being of β = .23, p < .001; β = .17, p < .01, respectively. Future studies of factors that influence physical function and emotional well-being in this population should take into account health status indicators such as allostatic load, comorbidity, and perceived racism/discrimination.

Comorbidities of COPD have a major impact on clinical outcomes, particularly in African Americans

BACKGROUND

COPD patients have a great burden of comorbidity. However, it is not well established whether this is due to shared risk factors such as smoking, if they impact patients exercise capacity and quality of life, or whether there are racial disparities in their impact on COPD.

METHODS

We analyzed data from 10,192 current and ex-smokers with (cases) and without COPD (controls) from the COPDGene® cohort to establish risk for COPD comorbidities adjusted for pertinent covariates. In adjusted models, we examined comorbidities prevalence and impact in African-Americans (AA) and Non-Hispanic Whites (NHW).

RESULTS

Comorbidities are more common in COPD compared to those with normal spirometry (controls), and the risk persists after adjustments for covariates including pack-years smoked. After adjustment for confounders, eight conditions were independently associated with worse exercise capacity, quality of life and dyspnea. There were racial disparities in the impact of comorbidities on exercise capacity, dyspnea and quality of life, presence of osteoarthritis and gastroesophageal reflux disease having a greater negative impact on all three outcomes in AAs than NHWs (p<0.05 for all interaction terms).

CONCLUSIONS

Individuals with COPD have a higher risk for comorbidities than controls, an important finding shown for the first time comprehensively after accounting for confounders. Individual comorbidities are associated with worse exercise capacity, quality of life, and dyspnea, in African-Americans compared to non-Hispanic Whites.

Determinants of Quality of Life in Stroke Survivors After 6 Months, from a Comprehensive Stroke Unit

Background:

In the social model of stroke, health-related quality of life (HRQoL) is the result of interplay among stroke severity, social support, and health-promoting behaviors. Our objective was to identify determinants of HRQoL in stroke survivors.

Methods:

Ischemic stroke patients were evaluated at 6 months with the Short Form 12 Health Survey, including physical component survey (PCS) and mental health component survey (MCS) summary scores. Multivariate stepwise regression analyses determined independent predictors of scores. Models included age, gender, socioeconomic class, education, residential environment, social support, previous comorbidity (Charlson Index), previous stroke, side of stroke, National Institutes of Health Stroke Scale (NIHSS) score at admission, Barthel Index (BI) and modified Rankin Scale (mRS) scores at discharge, and length of stay.

Results:

A total of 131 patients participated (mean age 70.1, SD = 12.5; 62.6% males). In all, 33.6% had a BI score <90 and an mRS score >2 (poor outcome). The mean ( SD) PCS score was 39.46 (9.3) and mean ( SD) MCS score was 34.86 (10.1). Lower PCS score was associated with female sex (β = 0.204, p = .009), poor social support (β = −0.225, p = .003), and poor Charlson Index (β = −0.162, p = .032) and BI scores (β = 0.384, p < .0001). Lower MCS score was associated with female sex (β = 0.162, p = .062) and poor NIHSS (β = −0.265, p = .019) and BI scores (β = 0.203, p < .071).

Conclusion:

Stroke severity, disability, gender, social support, and previous stroke have significant impacts on the physical and mental domains of generic HRQoL.

The impact of overweight and obesity on health-related quality of life and blood pressure control in hypertensive patients

OBJECTIVE

Hypertension and obesity deteriorate patient health-related quality-of-life (HRQoL). This study assessed the impact of overweight and obesity on HRQoL and blood pressure (BP) control in hypertensive participants, according to sex.

METHODS

HRQoL was assessed using the 12-item Short Form Health Survey in 11,498 white patients treated for hypertension for at least 12 months. Nutritional status was diagnosed according to WHO criteria.

RESULTS

Overweight and obesity were associated with worse BP control, regardless of sex. In women, overweight and especially obesity were inversely associated with all analyzed HRQoL dimensions. Among men, obesity decreased all HRQoL dimensions, and overweight influenced only physical functioning, role physical, bodily pain, vitality, general health, and Physical Component Score (PCS) but not Mental Component Score (MCS). Overweight in men did not influence social functioning, or emotional and mental health. The BMI values associated with optimal PCS and MCS scores were higher for men than for women. Age-adjusted multivariate regression analysis revealed that PCS score was associated with obesity, higher education level, comorbidities, and antihypertensive therapy duration, whereas MCS score was associated with female sex. Polydrug BP control diminished PCS and MCS.

CONCLUSION

Overweight and obesity deteriorate BP control, regardless of age and polytherapy. BMI values associated with optimal HRQoL are higher for men than women treated for hypertension. Obesity more strongly diminishes the physical versus mental HRQoL component, regardless of sex. Overweight worsens HRQoL physical components in both sexes and mental component-only in women.

Quality of life in stroke survivor-caregiver dyads: a new conceptual framework and longitudinal study protocol

AIM

To describe a new conceptual framework and the research protocol of a study designed to examine the quality of life in stroke survivor-caregiver dyads.

BACKGROUND

Stroke has a significant impact on the patient-caregiver dyad. Few studies have been guided by a specific conceptual framework which considers the interactions among pre-existing situations prior to stroke, the new situation caused by the stroke and the moderating effects of environmental and caregiver-related variables.

DESIGN

Longitudinal study.

METHODS

A sample of stroke survivor-caregiver dyads will be enrolled at patient discharge from rehabilitation hospitals and will be surveyed every 3 months for 1-year. Hypotheses generated from the conceptual framework will test predictors, mediators and moderators of stroke survivor and caregiver quality of life from the pre-existing situation prior to the stroke, the new situation mediation poststroke and situation moderators. The study is supported by a grant from the Centre of Excellence for Nursing Scholarship, Rome, December 2013.

DISCUSSION

This study seeks to identify variables in the pre-existing situation prior to the stroke (e.g. living condition), the new situation mediation poststroke (e.g. type of stroke and caregiver burden) as well as situation moderators (e.g. social support) that influence stroke survivor-caregiver dyad's quality of life across the stroke trajectory. Also, the study will inform clinical practice and research by identifying variables that are potentially modifiable and therefore amenable to intervention. The proposed framework will also be helpful for future research focused on stroke survivor-caregiver dyads.

Assessment of problematic internet use by the Compulsive Internet Use Scale and the Internet Addiction Test: a sample of problematic and pathological gamblers

This study aims to analyze psychometric properties and validity of the Compulsive Internet Use Scale (CIUS) and the Internet Addiction Test (IAT) and, second, to determine a threshold for the CIUS which matches the IAT cut-off for detecting problematic Internet use. A total of 292 subjects with problematic or pathological gambling (237 men, 55 women) aged 14-63 years and with private Internet use for at least 1 h per working or weekend day were recruited via different recruitment channels. Results include that both scales were internally consistent (Cronbach's α=0.9) and had satisfactory convergent validity (r=0.75; 95% CI 0.70-0.80). The correlation with duration of private Internet use per week was significantly higher for the CIUS (r=0.54) compared to the IAT (r=0.40). Among all participants, 25.3% were classified as problematic Internet users based on the IAT with a cut-off≥40. The highest proportion of congruent classified cases results from a CIUS cut-off ≥18 (sensitivity 79.7%, specificity 79.4%). However, a higher cut-off (≥21) seems to be more appropriate for prevalence estimation of problematic Internet use.

Heterogeneity in healthy aging

For a surprisingly large segment of the older population, chronological age is not a relevant marker for understanding, measuring, or experiencing healthy aging. Using the 2003 Medical Expenditure Panel Survey and the 2004 Health and Retirement Study to examine the proportion of Americans exhibiting five markers of health and the variation in health-related quality of life across each of eight age groups, we find that a significant proportion of older Americans is healthy within every age group beginning at age 51, including among those aged 85+. For example, 48% of those aged 51-54 and 28% of those aged 85+ have excellent or very good self-reported health status; similarly, 89% of those aged 51-54 and 56% of those aged 85+ report no health-based limitations in work or housework. Also, health-related quality of life ranges widely within every age group, yet there is only a comparatively small variation in median quality of life across age groups, suggesting that older Americans today may be experiencing substantially different age-health trajectories than their predecessors. Patterns are similar for medical expenditures. Several policy implications are explored.