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Šetinc M, Zajc Petranović M, Slivšek G, Mijač S, Celinščak Ž, Stojanović Marković A, Bišof V, Peričić Salihović M, Škarić-Jurić T. Genes Involved in DNA Damage Cell Pathways and Health of the Oldest-Old (85+). Genes (Basel) 2023; 14:1806. [PMID: 37761946 PMCID: PMC10530973 DOI: 10.3390/genes14091806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Some sources report a connection of cellular senescence with chronic pathological conditions; however, the association between particular cellular processes and general health is rarely examined. This study aims to test the relationship of general health with DNA damage pathways that play a crucial role in senescence. The association of ten selected SNPs with subjective and objective general health and functional ability indicators has been tested in 314 oldest-old people from Croatia. Multivariate logistic regression was employed to simultaneously test the impact of variables potentially influencing targeted health and functional ability variables. The best model, explaining 37.1% of the variance, has six independent significant predictors of functional ability scores: rs16847897 in TERC, rs533984 in MRE11A, and rs4977756 in CDKN2B, chronic disease count, Mini-Mental State Examination scores, and age at surveying. In conclusion, the examined ten loci involved in DNA damage repair pathways showed a more significant association with self-rated health and functional ability than with the number of disease or prescribed medicaments. The more frequent, longevity-related homozygote (GG) in rs16847897 was associated with all three aspects of self-assessments-health, mobility, and independence-indicating that this TERC locus might have a true impact on the overall vitality of the oldest-old persons.
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Affiliation(s)
- Maja Šetinc
- Institute for Anthropological Research, 10000 Zagreb, Croatia; (M.Š.); (Ž.C.); (A.S.M.); (M.P.S.); (T.Š.-J.)
| | - Matea Zajc Petranović
- Institute for Anthropological Research, 10000 Zagreb, Croatia; (M.Š.); (Ž.C.); (A.S.M.); (M.P.S.); (T.Š.-J.)
| | - Goran Slivšek
- Faculty of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (G.S.); (S.M.); (V.B.)
| | - Sandra Mijač
- Faculty of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (G.S.); (S.M.); (V.B.)
- Department of Science and Research, Children’s Hospital Srebrnjak, 10000 Zagreb, Croatia
| | - Željka Celinščak
- Institute for Anthropological Research, 10000 Zagreb, Croatia; (M.Š.); (Ž.C.); (A.S.M.); (M.P.S.); (T.Š.-J.)
| | - Anita Stojanović Marković
- Institute for Anthropological Research, 10000 Zagreb, Croatia; (M.Š.); (Ž.C.); (A.S.M.); (M.P.S.); (T.Š.-J.)
| | - Vesna Bišof
- Faculty of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (G.S.); (S.M.); (V.B.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Marijana Peričić Salihović
- Institute for Anthropological Research, 10000 Zagreb, Croatia; (M.Š.); (Ž.C.); (A.S.M.); (M.P.S.); (T.Š.-J.)
| | - Tatjana Škarić-Jurić
- Institute for Anthropological Research, 10000 Zagreb, Croatia; (M.Š.); (Ž.C.); (A.S.M.); (M.P.S.); (T.Š.-J.)
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Harada M, Suzuki Y, Matsuzawa R, Watanabe T, Yamamoto S, Imamura K, Yoshikoshi S, Aoyama N, Osada S, Yoshida A, Matsunaga A. Physical function and physical activity in hemodialysis patients with peripheral artery disease. Hemodial Int 2023; 27:74-83. [PMID: 35791740 DOI: 10.1111/hdi.13036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/08/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Peripheral artery disease (PAD) is commonly observed in patients undergoing hemodialysis. PAD impairs the vasculature and leads to pathophysiologic changes in the skeletal muscles, causing physical function impairment and physical inactivity in general. However, it is unclear whether PAD adversely affects physical function and physical activity in patients on hemodialysis. METHODS We performed a cross-sectional study with a retrospective review of the data to determine whether PAD is associated with impaired physical function and physical activity in patients undergoing hemodialysis. The study population comprised 310 patients and 88 healthy subjects. PAD was diagnosed based on an ankle-brachial index of <1.00 in patients on hemodialysis. Measurements of physical function included maximum walking speed, muscle strength in the lower extremities, and balance while standing. FINDINGS Of the 310 patients, 84 (27.1%) had PAD. When patients undergoing hemodialysis were divided into those without PAD and those with PAD, both groups had poorer physical function and physical activity than the healthy control subjects. After adjustments for potential confounders, it was found that patients on hemodialysis with PAD had slower walking speed, poorer standing balance, and less physical activity than those without PAD. However, there was no significant difference in lower extremity muscle strength between the two groups. DISCUSSION PAD diagnosed based on an ankle-brachial index of <1.00 was independently associated with impaired physical function and reduced physical activity in patients undergoing hemodialysis.
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Affiliation(s)
- Manae Harada
- Department of Rehabilitation, Sagami Circulatory Organ Clinic, Sagamihara, Japan
| | - Yuta Suzuki
- Department of Rehabilitation, Sagami Circulatory Organ Clinic, Sagamihara, Japan.,Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan
| | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe, Japan
| | - Takaaki Watanabe
- Department of Rehabilitation, Kitasato University Medical Center, Kitamoto, Japan
| | - Shohei Yamamoto
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Shinjuku, Japan
| | - Keigo Imamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Shun Yoshikoshi
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Naoyoshi Aoyama
- Department of General Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shiwori Osada
- Department of Nephrology, Tokyo Ayase Kidney Center, Katsushika, Japan
| | - Atsushi Yoshida
- Department of Hemodialysis Center, Sagami Circulatory Organ Clinic, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
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Schick-Makaroff K, Levay A, Thompson S, Flynn R, Sawatzky R, Thummapol O, Klarenbach S, Karimi-Dehkordi M, Greenhalgh J. An Evidence-Based Theory About PRO Use in Kidney Care: A Realist Synthesis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 15:21-38. [PMID: 34109571 DOI: 10.1007/s40271-021-00530-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is international interest on the use of patient-reported outcomes (PROs) in nephrology. OBJECTIVES Our objectives were to develop a kidney-specific program theory about use of PROs in nephrology that may enhance person-centered care, both at individual and aggregated levels of care, and to test and refine this theory through a systematic review of the empirical literature. Together, these objectives articulate what works or does not work, for whom, and why. METHODS Realist synthesis methodology guided the electronic database and gray literature searches (in January 2017 and October 2018), screening, and extraction conducted independently by three reviewers. Sources included all nephrology patients and/or practitioners. Through a process of extraction and synthesis, each included source was examined to assess how contexts may trigger mechanisms to influence specific outcomes. RESULTS After screening 19,961 references, 84 theoretical and 34 empirical sources were used. PROs are proposed to be useful for providing nephrology care through three types of use. The first type is use of individual-level PRO data at point of care, receiving the majority of theoretical and empirical explorations. Clinician use to support person-centered care, and patient use to support patient engagement, are purported to improve satisfaction, health, and quality of life. Contextual factors specific to the kidney care setting that may influence the use of PRO data include the complexity of kidney disease symptom burden, symptoms that may be stigmatized, comorbidities, and time or administrative constraints in dialysis settings. Electronic collection of PROs may facilitate PRO use given these contexts. The second type is use of aggregated PRO data at point of care, including public reporting of PROs to inform decisions at point of care and improve quality of care, and use of PROs for treatment decisions. The third type is use of aggregated PRO data by organizations, including publicly available PRO data to compare centers. In single-payer systems, regular collection of PROs by dialysis centers can be achieved through economic incentives. Both the second and third types of PRO use include pressures that may trigger quality improvement processes. CONCLUSION The current state of the evidence is primarily theoretical. There is pressing need for empirical research to improve the evidence-base of PRO use at individual and aggregated levels of nephrology care.
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Affiliation(s)
- Kara Schick-Makaroff
- Faculty of Nursing, University of Alberta, Third Floor, Edmonton Clinica Health Academy, Edmonton, AB, Canada.
| | - Adrienne Levay
- Faculty of Nursing, University of Alberta, Third Floor, Edmonton Clinica Health Academy, Edmonton, AB, Canada
| | - Stephanie Thompson
- Division of Nephrology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rachel Flynn
- Faculty of Nursing, University of Alberta, Third Floor, Edmonton Clinica Health Academy, Edmonton, AB, Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, BC, Canada.,Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Onouma Thummapol
- Faculty of Nursing Science, Assumption University of Thailand, Bangkok, Thailand
| | - Scott Klarenbach
- Division of Nephrology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mehri Karimi-Dehkordi
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
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Corwin TR, Ozieh MN, Garacci E, Palatnik A, Egede LE. The relationship between financial hardship and incident diabetic kidney disease in older US adults - a longitudinal study. BMC Nephrol 2021; 22:167. [PMID: 33952186 PMCID: PMC8101204 DOI: 10.1186/s12882-021-02373-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/19/2021] [Indexed: 01/09/2023] Open
Abstract
Background Financial hardship is associated with poor health, however the association of financial hardship and incident diabetic kidney disease (DKD) is unknown. This study aimed to examine the longitudinal relationship between financial hardship and incident DKD among older adults with diabetes. Methods Analyses were conducted in 2735 adults age 50 or older with diabetes and no DKD using four waves of data (2006–2012) from the Health and Retirement Study, a national longitudinal cohort. The primary outcome was incident DKD. Financial hardship was based on three measures: 1) difficulty paying bills; 2) food insecurity; and 3) cost-related medication non-adherence using validated surveys. A dichotomous financial hardship variable (0 vs 1 or more) was constructed based on all three measures. Cox regression models were used to estimate the association between financial hardship, change in financial hardship experience and incident DKD adjusting for demographics, socioeconomic status, and comorbidities. Results During the median follow-up period of 4.1 years, incident DKD rate was higher in individuals with versus without financial hardship (41.2 versus 27/1000 person years). After adjustment, individuals with financial hardship (HR 1.32, 95% CI 1.04–1.68) had significantly increased likelihood of developing DKD compared to individuals without financial hardship. Persistent financial hardship (adjusted HR 1.52 95% CI 1.06–2.18) and negative financial hardship (adjusted HR 1.54 95% CI 1.02–2.33) were associated with incident DKD compared with no financial hardship experience. However, positive financial hardship was not statistically significant in unadjusted and adjusted (adjusted HR 0.89 95% CI 0.55–1.46) models. Cost-related medication non-adherence (adjusted HR 1.43 95% CI 1.07–1.93) was associated with incident DKD independent of other financial hardship measures. Conclusions Financial hardship experience is associated with a higher likelihood of incident DKD in older adults with diabetes. Future studies investigating factors that explain the relationship between financial hardship and incident DKD are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02373-3.
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Affiliation(s)
- Timothy R Corwin
- Medical College of Wisconsin School of Medicine, Milwaukee, WI, USA.,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Mukoso N Ozieh
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA. .,Department of Medicine, Division of Nephrology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA. .,Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA.
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.,Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Anna Palatnik
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.,Department of Obstetrics and Gynecology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Leonard E Egede
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.,Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
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5
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Golestaneh L. Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift. Semin Dial 2018; 31:278-288. [DOI: 10.1111/sdi.12675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Ladan Golestaneh
- Nephrology Division; Department of Medicine; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
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6
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SF36 Quality of Life and Mortality across Different Levels of Serum Albumin in Patients with Hemodialysis. Nephrourol Mon 2017. [DOI: 10.5812/numonthly.45319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Steiber AL, Davis AT, Spry L, Strong J, Buss ML, Ratkiewicz MM, Weatherspoon LJ. Carnitine Treatment Improved Quality-of-Life Measure in a Sample of Midwestern Hemodialysis Patients. JPEN J Parenter Enteral Nutr 2017; 30:10-5. [PMID: 16387893 DOI: 10.1177/014860710603000110] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previously, we demonstrated that selected groups of hemodialysis patients might be more likely to have abnormalities of carnitine metabolism. The purpose of the present study was to examine the effects of carnitine therapy in these selected groups of hemodialysis patients on quality-of-life measures and erythropoietin dose. METHODS This was a double-blind, randomized, controlled trial, in which 50 hemodialysis patients were treated with either 2 g i.v. carnitine or placebo. The treatment period was for 24 weeks. RESULTS Thirty-four patients (15 in the treatment group) completed the study. The mean age was 69 +/- 15 years, 35% were women, and 44% had diabetes. Mean initial plasma total, free, short-chain acyl and long-chain acyl carnitine concentrations (micromol/L; mean +/- SEM) were 35.9 +/- 1.8, 18.2 +/- 1.1, 11.6 +/- 0.6, and 6.0 +/- 0.3, whereas the plasma acyl-to-free-carnitine ratio was 1.02 +/- 0.05. With respect to the Medical Outcomes Short Form-36 (SF-36), improvements from baseline were noted in the treatment group (n = 13) for role-physical (33.9 +/- 1.9 to 43.2 +/- 3.0, p < .05) and the SF-36 physical component summary score (36.1 +/- 2.7 to 39.7 +/- 2.3, p = .09) relative to changes in the control group (n = 14). The erythropoietin dose over the 24-week period was reduced from baseline in the treatment group relative to the placebo group (-1.62 +/- 0.91 vs 1.33 +/- 0.79 units erythropoietin/dry weight/hemoglobin concentration, respectively, p < .05). CONCLUSIONS After 24 weeks of i.v. carnitine therapy, SF-36 scores were improved and erythropoietin doses were reduced in hemodialysis patients, relative to the control group.
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Affiliation(s)
- Alison L Steiber
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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8
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Bagheri Z, Jafari P, Faghih M, Allahyari E, Dehesh T. Testing measurement equivalence of the SF-36 questionnaire across patients on hemodialysis and healthy people. Int Urol Nephrol 2015; 47:2013-21. [PMID: 26329745 DOI: 10.1007/s11255-015-1092-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Differential item functioning (DIF) occurs when members from different groups respond differently to particular items in a health-related quality of life (HRQoL) questionnaire after controlling for underlying HRQoL construct. This study aimed to assess DIF in the SF-36 questionnaire and its effect on comparing HRQoL scores across patients on HD and healthy people. METHODS One hundred fifty patients on maintenance hemodialysis (HD) and 642 healthy individuals filled out the Persian version of the SF-36 questionnaire. Multiple-group multiple-indicator multiple-causes (MG-MIMIC) model was used to assess DIF across patients on HD and healthy population. RESULTS Sixteen out of 36 (44.4 %) items were flagged with DIF. Six out of 16 items (37.5 %) were flagged with uniform DIF, nine items (56.2 %) with non-uniform DIF, and one item (6.2 %) with both uniform DIF and non-uniform DIF. DIF items were associated with all subscales with the exception of the limitation due to physical problems and bodily pain subscales. The significant lower HRQoL scores of patients on HD in comparison with healthy people in the physical functioning and vitality subscales did not change after removing the items with uniform DIF. CONCLUSIONS Our findings revealed that patients on HD and healthy people perceived the meaning of the items in SF-36 questionnaire differently. Although the impact of DIF is minimal, the cross-group comparison across patients on HD and healthy people should be performed with caution.
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Affiliation(s)
- Zahra Bagheri
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Jafari
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Marjan Faghih
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elahe Allahyari
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tania Dehesh
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
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9
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Kashii M, Yamazaki R, Yamashita T, Okuda S, Fujimori T, Nagamoto Y, Tamura Y, Oda T, Ohwada T, Iwasaki M, Yoshikawa H. Factors affecting postoperative activities of daily living in patients with osteoporotic vertebral collapse with neurological deficits. J Bone Miner Metab 2015; 33:422-31. [PMID: 24997524 DOI: 10.1007/s00774-014-0604-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 05/18/2014] [Indexed: 01/22/2023]
Abstract
Surgical treatment of osteoporotic vertebral collapse (OVC) with neurological deficits presents significant clinical challenges because some patients have fragile bones and often have medical comorbidities, which affect the severity of osteoporosis. We hypothesized that clinical results of surgery in these patients depend on the extent of medical comorbidities that induce secondary osteoporosis. The aim of this study is to examine the effects of medical history and comorbidities on surgical outcomes for these patients, along with the factors that predict postoperative function in activities of daily living (ADL). We retrospectively reviewed data for 88 patients with OVC and neurological deficits who underwent surgery. We assessed clinical results regarding neurological deficits and function in ADL. The presence or absence of comorbidities responsible for secondary osteoporosis and treatments or medical events that affect bone metabolism were examined. We performed statistical analysis to examine prognostic factors for postoperative function in ADL. Of 88 patients, the distributions of comorbidities, treatment, and events in medical history were as follows: hypertension, 57 patients (64.8%); chronic kidney disease (CKD) stage 3 or 4, 32 (36.4%); diabetes mellitus, 16 (18.2%); liver dysfunction, 11 (12.5%); cardiovascular disease, 10 (11.4%); rheumatoid arthritis, 9 (10.2%); and glucocorticoid intake, 8 (9.1%). Twenty-five patients (28.4%) represented poor postoperative ADL (chair-bound or bed-bound), and 11 of 25 patients with poor postoperative ADL represented full neurological recovery. Multivariate analysis revealed decreased estimated glomerular filtration rate (odds ratio 0.96; 95% confidence interval 0.93-0.99; p = 0.005) and a high serum alkaline phosphatase (ALP) level (odds ratio 1.01; 95% CI 1.00-1.02; p = 0.01) were strong predictive factors for poor postoperative function in ADL. The majority of patients with poor postoperative function in ADL had advanced CKD with a disorder of bone metabolism as well as bone fragility.
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Affiliation(s)
- Masafumi Kashii
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan,
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Sanz-Barbero B, Prieto ME, Cambas N. Factors associated with a positive attitude towards receiving cancer information: a population-based study in Spain. Health Expect 2015; 19:288-98. [PMID: 25639789 DOI: 10.1111/hex.12349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND It is necessary to raise a positive attitude towards cancer information to improve disease prevention and control. OBJECTIVE To identify social factors, health characteristics and cancer-related perceptions and knowledge associated with a positive attitude towards cancer information. DESIGN We ran multivariate logistic regression models to analyse population-based data from OncoBarómetro-2010, a Spanish representative survey on perceptions and knowledge, related to cancer, conducted among 7938 people aged 18 years or more. MEASUREMENT Attitudes towards cancer information. A positive attitude includes feeling motivated to keep informed, to have screening tests or to change lifestyle. A negative attitude includes feeling indifference, concern, frustration or fear. RESULTS 38.3% of the studied population reported having received information related to cancer (within the last 6 months). Among those, 31.5% expressed a negative attitude towards cancer information. People more likely to have a positive attitude towards cancer information (reference category: negative attitude) were people aged 35-74 (ref: aged 18-34) (P < 0.001) and cancer survivors (ref: those who had not had cancer) (OR: 3.05; 95% CI: 1.73-5.38). The likelihood of a positive attitude increased with the level of education (P < 0.001). The variables negatively associated with a positive attitude towards cancer information were poor self-rated health status (ref: fair) (OR: 0.63; 95% CI: 0.42-0.95) and high self-perceived risk of developing cancer (ref: low) (OR: 0.75; 95% CI: 0.60-0.92). CONCLUSIONS These findings have potential to inform programmes designed to promote cancer prevention behaviours. Policies should target population groups with low socio-economic groups, those with poor self-rated health and individuals with high self-perceived risk of cancer. Further, in order to increase knowledge of cancer symptoms, we need to focus on individuals with unhealthy lifestyles.
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Affiliation(s)
- Belén Sanz-Barbero
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Eugenia Prieto
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain.,AECC Cancer Observatory, Scientific Foundation Spanish Association Against Cancer, Madrid, Spain
| | - Naiara Cambas
- AECC Cancer Observatory, Scientific Foundation Spanish Association Against Cancer, Madrid, Spain
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11
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Tuot DS, Plantinga LC. What patients don't know may hurt them: knowledge and the perception of knowledge among patients with CKD. Kidney Int 2012; 80:1256-7. [PMID: 22126982 DOI: 10.1038/ki.2011.269] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is generally accepted that informed patients have better health outcomes. Wright Nunes et al. report low levels of perceived chronic kidney disease (CKD) knowledge among patients treated in a nephrology clinic and describe a low-to-moderate association between perceived and objective CKD knowledge. Association of these two types of knowledge with health behaviors and clinical outcomes should be further explored to inform the development and evaluation of CKD educational interventions as well as communication between nephrologists and patients.
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12
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Plantinga LC, Johansen K, Crews DC, Shahinian VB, Robinson BM, Saran R, Burrows NR, Williams DE, Powe NR. Association of CKD with disability in the United States. Am J Kidney Dis 2010; 57:212-27. [PMID: 21036441 DOI: 10.1053/j.ajkd.2010.08.016] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 08/09/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Little is known about disability in early-stage chronic kidney disease (CKD). STUDY DESIGN Cross-sectional national survey (National Health and Nutrition Examination Survey 1999-2006). SETTING & PARTICIPANTS Community-based survey of 16,011 noninstitutionalized US civilian adults (aged ≥20 years). PREDICTOR CKD, categorized as no CKD, stages 1 and 2 (albuminuria and estimated glomerular filtration rate [eGFR] ≥60 mL/min/1.73 m²), and stages 3 and 4 (eGFR, 15-59 mL/min/1.73 m²). OUTCOME Self-reported disability, defined by limitations in working, walking, and cognition and difficulties in activities of daily living (ADL), instrumental ADL, leisure and social activities, lower-extremity mobility, and general physical activity. MEASUREMENTS Albuminuria and eGFR assessed from urine and blood samples; disability, demographics, access to care, and comorbid conditions assessed using a standardized questionnaire. RESULTS Age-adjusted prevalence of reported limitations generally was significantly greater with CKD: for example, difficulty with ADL was reported by 17.6%, 24.7%, and 23.9% of older (≥65 years) and 6.8%, 11.9%, and 11.0% of younger (20-64 years) adults with no CKD, stages 1 and 2, and stages 3 and 4, respectively. CKD also was associated with greater reported limitations and difficulty in other activities after age adjustment, including instrumental ADL, leisure and social activities, lower-extremity mobility, and general physical activity. Other demographics, socioeconomic status, and access to care generally only slightly attenuated the observed associations, particularly in older individuals; adjustment for cardiovascular disease, arthritis, and cancer attenuated most associations such that statistical significance no longer was achieved. LIMITATIONS Inability to establish causality and possible unmeasured confounding. CONCLUSION CKD is associated with a higher prevalence of disability in the United States. Age and other comorbid conditions account for most, but not all, of this association.
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Affiliation(s)
- Laura C Plantinga
- Department of Medicine, San Francisco General Hospital, University of California, 94110, USA.
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13
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Argyropoulos C, Chang CCH, Plantinga L, Fink N, Powe N, Unruh M. Considerations in the statistical analysis of hemodialysis patient survival. J Am Soc Nephrol 2009; 20:2034-43. [PMID: 19643932 PMCID: PMC2736780 DOI: 10.1681/asn.2008050551] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 05/05/2009] [Indexed: 11/03/2022] Open
Abstract
The association of hemodialysis dosage with patient survival is controversial. Here, we tested the hypothesis that methods for survival analysis may influence conclusions regarding dialysis dosage and mortality. We analyzed all-cause mortality by proportional hazards and accelerated failure time regression models in a cohort of incident hemodialysis patients who were followed for 9 yr. Both models identified age, race, heart failure, physical functioning, and comorbidity scores as important predictors of patient survival. Using proportional hazards, there was no statistically significant association between mortality and Kt/V (hazard ratio 0.72; 95% confidence interval 0.45 to 1.14). In contrast, using accelerated failure time models, each 0.1-U increment of Kt/V improved adjusted median patient survival by 3.50% (95% confidence interval 0.20 to 7.08%). Proportional hazard models also yielded less accurate estimates for median survival. These findings are consistent with an additive damage model for the survival of patients who are on hemodialysis. In this conceptual model, the assumptions of the proportional hazard model are violated, leading to underestimation of the importance of dialysis dosage. These results suggest that future studies of dialysis adequacy should consider this additive damage model when selecting methods for survival analysis. Accelerated failure time models may be useful adjuncts to the Cox model when studying outcomes of dialysis patients.
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Affiliation(s)
- Christos Argyropoulos
- Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA.
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14
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Kontos PC, Miller KL, Brooks D, Jassal SV, Spanjevic L, Devins GM, De Souza MJ, Heck C, Laprade J, Naglie G. Factors influencing exercise participation by older adults requiring chronic hemodialysis: a qualitative study. Int Urol Nephrol 2007; 39:1303-11. [PMID: 17902035 DOI: 10.1007/s11255-007-9265-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 07/18/2007] [Indexed: 12/01/2022]
Abstract
Despite the recognized health and psychosocial benefits of exercise for older adults with end-stage renal disease (ESRD), exercise participation remains poor. Previous research has attributed low levels of exercise to patient-related factors such as lack of motivation and fear of adverse consequences. This qualitative study involving focus group discussions with hemodialysis patients, nephrology nurses, and family care providers explored specific motivators and barriers to exercise participation in older adults requiring hemodialysis. Nurse participants were chosen for the health care provider focus groups because their prolonged and sustained contact with hemodialysis patients during the dialysis treatment sessions positions them well to encourage and promote exercise. Motivators to exercise included patient aspirations to exercise and their experiences of improvements from exercising, as well as the formal incorporation of exercise into the overall dialysis treatment plan. Barriers to exercise included nurses' lack of encouragement to exercise, transportation issues, and the use of exercise equipment that precludes participation by patients who recline during dialysis and inhibits exercise encouragement by nurses due to concerns of equipment-related injury. These findings support the need for a broader recognition of the systemic factors that may impede exercise participation by older adults requiring hemodialysis. A shift is required in the culture of ESRD treatment programs towards a wellness perspective that includes expectations of exercise encouragement by the health care team and participation by patients.
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Affiliation(s)
- Pia C Kontos
- Toronto Rehabilitation Institute, 11035-550 University Ave, Toronto, ON, Canada, M5G 2A2.
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15
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Painter P, Johansen KL. Improving Physical Functioning: Time to Be a Part of Routine Care. Am J Kidney Dis 2006; 48:167-70. [PMID: 16797401 DOI: 10.1053/j.ajkd.2006.05.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Accepted: 05/11/2006] [Indexed: 12/31/2022]
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16
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Majchrzak KM, Pupim LB, Chen K, Martin CJ, Gaffney S, Greene JH, Ikizler TA. Physical activity patterns in chronic hemodialysis patients: comparison of dialysis and nondialysis days. J Ren Nutr 2006; 15:217-24. [PMID: 15827895 DOI: 10.1053/j.jrn.2004.08.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To determine physical activity patterns in chronic hemodialysis patients with a specific emphasis on the difference between dialysis and nondialysis days. Design A cross-sectional single-center study. SETTING Vanderbilt University Outpatient Dialysis Unit. PATIENTS Twenty current chronic hemodialysis patients: 10 male, 10 female; 15 black, 5 white; mean age, 50.1 +/- 9.9 years; height, 164.5 +/- 10.9 cm; weight, 82.5 +/- 15.4 kg; length on dialysis, 57.3 +/- 45.3 months. METHODS Minute-by-minute physical activity was assessed over a 7-day period using a triaxial accelerometer, which consists of raw numbers or counts calculated by the 3 axes of the accelerometer (PA counts). PA counts were extrapolated on a daily and hourly basis. Physical functioning tests included: sit-to-stand, 6-minute walk, and 1-repetition maximal leg press exercise. Laboratory values for serum concentrations of albumin, prealbumin, C-reactive protein, and cholesterol were also collected. MAIN OUTCOME MEASURE PA counts. RESULTS Total PA counts were significantly lower on dialysis days when compared with nondialysis days (128,279 +/- 74,009 versus 168,744 +/- 95,168, respectively, P = .025). The average PA counts during the 4-hour dialysis time period were significantly lower on dialysis days when compared with nondialysis days (3,086 +/- 3,749 versus 11,070 +/- 7,695, respectively, P = .001). At postdialysis hours 1 and 2, PA counts on dialysis days were significantly higher than on nondialysis days (11,410 +/- 5,340 versus 9,082 +/- 6,646, P = .008, and 14,048 +/- 9,728 versus 8,662 +/- 6,433, P = .016, respectively). By postdialysis hour 4, PA counts on dialysis days had significantly decreased when compared with nondialysis days (6,068 +/- 6,268 versus 10,512 +/- 7,420 PA counts, P = .01, respectively). From postdialysis hours 5 to 20, there was no significant difference in PA counts between dialysis and nondialysis days. CONCLUSION This study shows that physical activity is lower on dialysis days when compared with nondialysis days, and this decrease is caused by the lack of activity during the 4-hour hemodialysis procedure. New behavior modification strategies involving physical activity, both during hemodialysis and on nondialysis days, must be examined in this patient population.
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Affiliation(s)
- Karen M Majchrzak
- Department of Medicine, Division of Nephrology, Vanderbilt University School of Medicine, Nashville, TN, USA
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17
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Assal HS, . HME, . NAELG. Health Related Quality of Life among Egyptian Patients on Hemodialysis. JOURNAL OF MEDICAL SCIENCES 2006. [DOI: 10.3923/jms.2006.314.320] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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18
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Abstract
This study focused on the relationship between patients' locus of control and their ability to improve selected clinical outcomes related to kidney dialysis. The main hypothesis of this study stated that patients who viewed themselves as having control over their situation would be more successful at improving targeted clinical outcomes than those who believed someone other than themselves had control over their situation. The study found that interventions aimed at increasing awareness of who has control and reducing the aspect of chance had a more significant positive impact on outcomes than did pure cognitive or educational interventions geared mainly toward emotional issues or educational deficits. Interventions that work with the dominant locus of control to increase awareness of where control lies appeared to be more effective in assisting the patients to improve their targeted clinical outcomes rather than are interventions to change the locus of control between internal and powerful others (external).
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Affiliation(s)
- Elaine Dec
- Renal Care Group, Ft. Wayne, IN 46825, USA.
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19
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Thomas-Hawkins C. Assessing role activities of individuals receiving long-term hemodialysis: psychometric testing of the revised Inventory of Functional Status-Dialysis (IFS-DialysisR). Int J Nurs Stud 2005; 42:687-94. [PMID: 15982466 DOI: 10.1016/j.ijnurstu.2004.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Revised: 10/11/2004] [Accepted: 10/19/2004] [Indexed: 11/20/2022]
Abstract
The purpose of the study was to examine the reliability and validity of the revised IFS-Dialysis, a theory-based self-report measure of the extent to which individuals receiving long-term hemodialysis are actually performing role activities. The IFS-Dialysis was administered to 186 individuals receiving hemodialysis. Chronbach's alpha was used to assess internal consistency reliability, and structural equation modeling was used to assess the construct validity of the revised measure. Alpha reliability for the total instrument was 0.88, and subscale alpha coefficients ranged from 0.75 to 0.85. Construct validity of the IFS-Dialysis was supported by the significant relationship of each item to its respective subscale latent variable, and model testing indicated a good fit of the measurement model to the data. The IFS-Dialysis can be used to obtain clinical assessments of the extent to which individuals receiving long-term hemodialysis treatments are engaging in role activities. Interventions can then be implemented to facilitate an optimal level of activity performance for each individual.
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20
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Steiber AL, Weatherspoon LJ, Spry L, Davis AT. Serum carnitine concentrations correlated to clinical outcome parameters in chronic hemodialysis patients. Clin Nutr 2004; 23:27-34. [PMID: 14757390 DOI: 10.1016/s0261-5614(03)00085-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Carnitine metabolism and the therapeutic use of carnitine has been a major area of interest in dialysis patients. The purpose of this study was to determine whether any correlations exist between carnitine status and selected clinical parameters in hemodialysis (HD) patients. This study was an observational study of data from patients receiving HD at a Midwest dialysis center. The subjects (n=49) were 60+/-16 (mean+/-SD) years of age and 48% male. Fifteen percent of the subjects had type 1 diabetes mellitus (DM), 29% had type 2 DM, and 25% had left ventricular hypertrophy (LVH). The serum-free and total carnitine, and acylcarnitine concentrations were: 40.3+11.8 microm/l, 22.8+/-7.3, and 17.5+/-5.9 microm/l, respectively. The serum acylcarnitine to free carnitine ratio (A/F) was 0.80+/-0.27. Blood urea nitrogen (BUN), parathyroid hormone and ejection fraction were positively correlated and age and left atrial dilation (cm) were negatively correlated with serum total carnitine (P<0.05). BUN and hematocrit were positively correlated (P<0.05) and age was negatively correlated with free carnitine. Subjects who used mannitol or were male had significantly higher concentrations of both free and total carnitine, respectively (P<0.05). Subjects using aspirin had lower concentrations of serum total carnitine (P<0.10). These results suggest certain subgroups of patients may need to be targeted for further studies with carnitine replacement therapy, i.e. long-term patients, older patients, patients with left verticular hypertrophy and left atrial enlargement, females and patients on aspirin therapy.
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Affiliation(s)
- A L Steiber
- Michigan State University, 334 GM Trout Building, Food Science and Human Nutrition Department, East Lansing, MI 48824, USA.
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21
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Lowrie EG, Curtin RB, LePain N, Schatell D. Medical outcomes study short form-36: a consistent and powerful predictor of morbidity and mortality in dialysis patients. Am J Kidney Dis 2003; 41:1286-92. [PMID: 12776282 DOI: 10.1016/s0272-6386(03)00361-5] [Citation(s) in RCA: 231] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND One of the guidelines released by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) recommends that patients with glomerular filtration rate (GFR) less than 60 mL/min/1.73 m2 undergo regular assessment of functioning and well-being (FWB) to establish baselines, monitor changes in FWB over time, and assess the effect of interventions on FWB. Although this recommendation stresses the importance of assessing and monitoring physical and mental health functioning, the Medical Outcomes Study Short Form-36 (MOS SF-36) might also be useful for predicting crucial longer-term patient outcomes. This cross-sectional study tested the hypothesis that the Physical Component Summary (PCS) and Mental Component Summary (MCS) scales of the MOS SF-36 predict morbidity (measured as hospitalization) and mortality rates among dialysis patients. METHODS Data were collected from 13,952 prevalent dialysis patients served by Fresenius Medical Care North America including age, gender, race, diabetes, serum albumin, creatinine, bicarbonate, potassium, phosphorus, hemoglobin, iron, ferritin, white blood cell count, urea reduction ratio, serum glutamic oxaloacetic-transaminase, and systolic blood pressure. FWB was measured via the MOS SF-36 Summary scale scores, PCS, and MCS. Also collected was information about hospitalizations and patient mortality. RESULTS PCS and MCS were consistent predictors of hospitalizations and mortality rates even after adjustment for clinically relevant factors. CONCLUSION Because PCS and MCS are associated with hospitalization and mortality, administering this self-report measure may serve as a valuable supplement to clinical measures traditionally relied on to predict patient outcomes. Moreover, such information may be unavailable through any other single mechanism.
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22
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Miller B, Ahmad S. A review of the impact of L-carnitine therapy on patient functionality in maintenance hemodialysis. Am J Kidney Dis 2003; 41:S44-8. [PMID: 12751053 DOI: 10.1016/s0272-6386(03)00116-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Goals of maintenance hemodialysis therapy include not only the preservation of an individual patient's life in the presence of kidney failure, but also restoration of optimal quality of life. Although many conceptual and method problems are associated with the definition and assessment of quality of life in the chronically ill, there is broad agreement that patient quality of life is related to physical function and well-being. Evidence exists that despite advances in dialysis therapy, a high percentage of patients on maintenance dialysis therapy report chronic psychological symptoms, impaired activities of daily living and social function, and incomplete occupational rehabilitation that impair their functionality. This article reviews the impact of L-carnitine therapy on several dimensions of functionality in maintenance hemodialysis patients.
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Affiliation(s)
- Brent Miller
- Barnes Jewish Dialysis Center, St Louis, MO 63108, USA.
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23
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Johansen KL, Shubert T, Doyle J, Soher B, Sakkas GK, Kent-Braun JA. Muscle atrophy in patients receiving hemodialysis: effects on muscle strength, muscle quality, and physical function. Kidney Int 2003; 63:291-7. [PMID: 12472795 DOI: 10.1046/j.1523-1755.2003.00704.x] [Citation(s) in RCA: 264] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Dialysis patients are less active and have reduced functional capacity compared to individuals with normal renal function. Muscle atrophy and weakness may contribute to these problems. This investigation was undertaken to quantify the extent of atrophy in the lower extremity muscles, to determine whether defects in muscle specific strength (force per unit mass) or central nervous system (CNS) activation are present, and to assess the relationship between muscle size and physical performance in a group of patients on hemodialysis. METHODS Thirty-eight dialysis subjects (aged 55 +/- 15 years) and nineteen healthy sedentary controls (aged 55 +/- 13 years) were enrolled. Magnetic resonance imaging of the lower leg was used to determine the total cross-sectional area (CSA) and the area of contractile and non-contractile tissue of the ankle dorsiflexor muscles. Isometric dorsiflexor strength was measured during a maximal voluntary contraction with and without superimposed tetanic stimulation (N = 22 for dialysis subjects, N = 12 for controls). Physical activity was measured by accelerometry, and gait speed was recorded as a measure of physical performance. RESULTS Dialysis subjects were weaker, less active, and walked more slowly than controls. Total muscle compartment CSA was not significantly different between dialysis subjects and controls, but the contractile CSA was smaller in the dialysis patients even after adjustment for age, gender, and physical activity. Central activation and specific strength were normal. Gait speed was correlated with contractile CSA. CONCLUSIONS Significant atrophy and increased non-contractile tissue are present in the muscle of patients on hemodialysis. The relationship between contractile area and strength is intact in this population. Muscle atrophy is associated with poor physical performance. Thus, interventions to increase physical activity or otherwise address atrophy may improve performance and quality of life.
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Affiliation(s)
- Kirsten L Johansen
- Department of Medicine, San Francisco VA Medical Center, University of California, San Francisco 94121, USA.
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24
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Curtin RB, Klag MJ, Bultman DC, Schatell D. Renal rehabilitation and improved patient outcomes in Texas dialysis facilities. Am J Kidney Dis 2002; 40:331-8. [PMID: 12148106 DOI: 10.1053/ajkd.2002.34517] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Because a cure is not a reasonable goal for patients with end-stage renal disease (ESRD), optimal physical and mental health functioning are primary objectives of care and major determinants of health-related quality of life, morbidity, and mortality. This cross-sectional study used facility-level survey data to test the hypothesis that dialysis unit rehabilitation activities are associated with higher patient functional status. METHODS Data were collected from 169 dialysis facilities in the ESRD Network of Texas (Network 14), including facility characteristics, facility-level patient demographic and clinical characteristics, and facility rehabilitation activities measured by the Life Options Unit Self-Assessment Tool (USAT). Facility-level data on patient functioning and well-being measured by the Medical Outcomes Study 36-Item Short-Form Health Survey were obtained from all 86 of the respondent facilities that collected it. RESULTS Most participating facilities reported performing rehabilitation activities in all five categories (encouragement, education, exercise, employment, and evaluation). The median number reported was 32 of a possible 100 activities. Exercise interventions were the least often implemented activities. Linear multiple regression showed that facility rehabilitation activity scores measured by the USAT were associated with higher facility mean Mental Component Scale (MCS) scores, controlling for facility characteristics (size, profit status), facility-level patient demographic characteristics (diabetes, race, sex, age), and facility-level patient laboratory variables: urea reduction ratio and hemoglobin and serum albumin levels. CONCLUSION Because MCS scores have been shown in other studies to be inversely related to morbidity and mortality, this finding suggests that the introduction of rehabilitation interventions into the dialysis care regimen may prove beneficial.
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Affiliation(s)
- Roberta Braun Curtin
- Medical Education Institute, Inc, Life Options Rehabilitation Program, Madison, WI 53719, USA.
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25
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Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. J Am Soc Nephrol 2001; 12:2797-2806. [PMID: 11729250 DOI: 10.1681/asn.v12122797] [Citation(s) in RCA: 314] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Patients on maintenance hemodialysis (MHD) often show substantial reductions in quality of life (QoL). The SF36 (Short Form with 36 questions), a well-documented, self-administered QoL scoring system that includes eight independent scales and two main dimensions, has been widely used and validated. In 65 adult outpatients on MHD, the SF36 and its scales and dimensions, scored as a number between 0 and 100, and the nutritional and inflammatory state measured by subjective global assessment, near-infrared (NIR) body fat, body mass index (BMI), and pertinent laboratory values, including hemoglobin, albumin, and C-reactive protein were assessed. Twelve-month prospective hospitalization rates and mortality were used as the clinical outcomes. Multivariate (case-mix) adjusted correlation coefficients were statistically significant between SF36 scores and serum albumin and hemoglobin concentrations. There were significant inverse correlations between SF36 scores and the BMI and NIR body fat percentage. Hypoalbuminemic, anemic, and obese patients on MHD had a worse QoL. Prospective hospitalizations correlated significantly with the SF36 total score and its two main dimensions (r between -0.28 and -0.40). The Cox proportional regression relative risk of death for each 10 unit decrease in SF36 was 2.07 (95% CI, 1.08 to 3.98; P = 0.02). Of the eight components and two dimensions of the SF36, the Mental Health dimension and the SF36 total score had the strongest predictive value for mortality. Thus, in patients on MHD the SF36 appears to have significant associations with measures of nutritional status, anemia, and clinical outcomes, including prospective hospitalization and mortality. Even though obesity, unlike undernutrition, is not generally an indicator of poor outcome in MHD, the SF36 may detect obese patients on MHD at higher risk for morbidity and mortality.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- * University of California, San Francisco and Division of Nephrology San Francisco General Hospital, San Francisco, California; University of California, Los Angeles, Division of Nephrology Harbor-UCLA Medical Center, Torrance, California; University of California, Berkeley, School of Public Health, Berkeley, California
| | - Joel D Kopple
- * University of California, San Francisco and Division of Nephrology San Francisco General Hospital, San Francisco, California; University of California, Los Angeles, Division of Nephrology Harbor-UCLA Medical Center, Torrance, California; University of California, Berkeley, School of Public Health, Berkeley, California
| | - Gladys Block
- * University of California, San Francisco and Division of Nephrology San Francisco General Hospital, San Francisco, California; University of California, Los Angeles, Division of Nephrology Harbor-UCLA Medical Center, Torrance, California; University of California, Berkeley, School of Public Health, Berkeley, California
| | - Michael H Humphreys
- * University of California, San Francisco and Division of Nephrology San Francisco General Hospital, San Francisco, California; University of California, Los Angeles, Division of Nephrology Harbor-UCLA Medical Center, Torrance, California; University of California, Berkeley, School of Public Health, Berkeley, California
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26
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Hricik DE, Halbert RJ, Barr ML, Helderman JH, Matas AJ, Pirsch JD, Schenkel FA, Siegal B, Ferguson RM. Life satisfaction in renal transplant recipients: preliminary results from the transplant learning center. Am J Kidney Dis 2001; 38:580-7. [PMID: 11532692 DOI: 10.1053/ajkd.2001.26884] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Transplant Learning Center (TLC) was designed to improve quality of life (QOL) and preserve graft function in solid-organ transplant recipients. To meet the specific goals of the program, the Life Satisfaction Index and Transplant Care Index were designed to serve as composite measures for measuring transplant-specific QOL and the ability to care for a transplant, respectively. In this study, we analyzed self-reported health information to examine relationships between comorbidities and individual posttransplantation side effects, life satisfaction, and transplant care, defined by renal transplant recipients. Patients entered the TLC through self-referral or referral by a health professional. Included in the analysis were 3,676 TLC enrollees with a mean time since transplantation of 4.8 years. Comorbidities and adverse effects were common, with high blood pressure reported by 89% of respondents and unusual hair growth reported by 70%. Sexual dysfunction and headache had a greater impact on QOL than more common adverse effects, such as changes in body and facial shape, hirsutism, and tremor. Regression modeling was used to identify the most significant associations between QOL indices and structural (nonmedical), medical, and psychosocial factors. Greater life satisfaction was most strongly associated with being in control of one's health and living a normally active life with satisfying emotional relationships. Management of such clinical problems as adverse effects of medication and nonadherence should be informed by the patient's perspective. Clinicians should actively solicit information about physical activity, appearance concerns, side effects of medications, nonadherence, and sexual and relationship issues when evaluating renal transplant recipients.
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Affiliation(s)
- D E Hricik
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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Painter P, Krasnoff J, Paul SM, Ascher NL. Physical activity and health-related quality of life in liver transplant recipients. Liver Transpl 2001; 7:213-9. [PMID: 11244162 DOI: 10.1053/jlts.2001.22184] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The US Surgeon General's Report on Physical Activity and Health recommends that people of all ages engage in regular physical activity, and that significant health benefits can be obtained through a moderate amount of physical activity. Physical activity appears to improve health-related quality of life (HRQOL) by enhancing physical functioning in persons compromised by poor health. The Medical Outcomes Study Short Form-36 (SF-36) Health Status Questionnaire was sent to all patients who were 5 years or more post-liver transplantation at the University of California at San Francisco. Additional questions related to coexisting medical conditions and participation in regular physical activity were included. SF-36 scale scores were compared between active and inactive patients. Regression analysis was also performed to determine the contributions of coexisting medical conditions and physical activity to the physical scales of the SF-36 questionnaire. Patients who participated in regular physical activity had significantly higher scores on all physical scales and the physical component scale (PCS). The regression model, which included age, sex, time posttransplantation, retransplantation, recurrence of hepatitis C, number of comorbid conditions, and physical activity participation showed that both the number of comorbid conditions and participation in physical activity were significant independent contributors to the physical functioning scale and PCS. This study indicates that physical activity is related to HRQOL after liver transplantation independent of other coexisting medical conditions.
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Affiliation(s)
- P Painter
- Department of Physiological Nursing, Box 0610, University of California at San Francisco, San Francisco, CA 94143, USA.
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Oberley ET, Sadler JH, Alt PS. Renal rehabilitation: obstacles, progress, and prospects for the future. Am J Kidney Dis 2000; 35:S141-7. [PMID: 10766012 DOI: 10.1016/s0272-6386(00)70241-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The definition of rehabilitation for end-stage renal disease (ESRD) patients has changed significantly over the past 40 years. Initially, the concept focused on return to employment. In the early days, most members of the small, select group of patients chosen for dialysis met this criterion and were considered successfully rehabilitated. However, this "success" could not be replicated in the broader ESRD population when Medicare coverage was expanded to include older and more debilitated patients. This raised serious questions about the feasibility of renal rehabilitation efforts. Government policy makers and the nephrology community responded by (1) gathering data to enable the measurement and improvement of health-related quality of care, and (2) redefining rehabilitation and its goals. Today, renal rehabilitation is defined broadly, in terms of optimal functioning for individual patients and restoration to productive activities-not simply employment. To foster renal rehabilitation and guide program development, the Life Options Rehabilitation Advisory Council (LORAC) identified five core principles, called the "5 E's"-Encouragement, Education, Exercise, Employment, and Evaluation. Considerable progress has been made in measuring outcomes of care and in establishing a connection between rehabilitation interventions and improved outcomes. Increasingly, research is focused on the relationship between patient self-reports and health status outcomes. In the years ahead, clinicians and researchers will see growing evidence of relationships between specific rehabilitation interventions, improved outcomes (including health-related quality of life), and cost-effective delivery of care.
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Affiliation(s)
- E T Oberley
- Life Options Rehabilitation Program, Medical Media Associates, Madison, WI 53711-1074, USA.
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Painter P, Carlson L, Carey S, Paul SM, Myll J. Physical functioning and health-related quality-of-life changes with exercise training in hemodialysis patients. Am J Kidney Dis 2000; 35:482-92. [PMID: 10692275 DOI: 10.1016/s0272-6386(00)70202-2] [Citation(s) in RCA: 236] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The Renal Exercise Demonstration Project was designed to test the effects of two different approaches to exercise programming on the levels of physical activity, physical functioning, and self-reported health status in hemodialysis patients. Two hundred eighty-six patients were recruited for participation. Intervention patients were given individually prescribed exercise for 8 weeks of independent home exercise, followed by 8 weeks of incenter cycling during dialysis. Physical performance testing was performed at baseline and after each intervention using gait speed, sit-to-stand test, and 6-minute walk. The Medical Outcomes Study Short Form 36-item (SF-36) questionnaire was used to assess self-reported health status. The intervention group showed increased participation in physical activity. There were significant differences between the intervention and nonintervention groups in change over time in normal and fast gait speed, sit-to-stand test scores, and the physical scales on the SF-36, including the physical component scale. The intervention group improved in these test results, whereas the nonintervention group either did not change or declined over the duration of the study. It is clear that improvements in physical functioning result from exercise counseling and encouragement in hemodialysis patients. Because self-reported physical functioning is highly predictive of outcomes in hemodialysis patients, more attention to patients' levels of physical activity is warranted.
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Affiliation(s)
- P Painter
- University of California at San Francisco, Department of Physiological Nursing, San Francisco, CA 94143-0116, USA.
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