Health-related quality of life in asthma studies. Can we combine data from different countries?

Health-Related Quality of Life and Mental Health in Drug Hypersensitivity Reactions and Drug-Induced Anaphylaxis: A Systematic Review and Meta-Analysis

BACKGROUND

Drug hypersensitivity reactions (DHRs) are adverse drug reactions (ADRs) that are particularly impactful on health-related quality of life (HRQoL) and mental health. Although the role of HRQoL as an important patient-reported outcome has been recognized in past years, HRQoL and mental health in patients with ADRs are still poorly investigated.

OBJECTIVE

To evaluate the prevalence, severity, and risk factors of HRQoL and mental health in DHRs, with a particular focus on drug-induced anaphylaxis.

METHODS

We searched the MEDLINE, Scopus, and American Psychological Association PsycArticles databases to identify all studies up to December 31, 2022 that included subjects with at least one episode of DHR and assessments of mental health and/or quality of life. Results were reported as qualitative and quantitative analyses, with meta-analyses after assessment for risk of bias and heterogeneity.

RESULTS

A total of 45 observational studies were included. Overall, a high prevalence of depression (up to 51.4%; odd ratio = 2.94; 95% CI, 1.42-6.10) and anxiety (up to 48%; odd ratio = 3.92; 95% CI, 1.91-8.05) were reported compared with healthy subjects. The HRQoL was significantly affected, especially in the case of drug-induced anaphylaxis (mean score, +5.88; 95% CI, 0.77-10.98).

CONCLUSIONS

Despite the scarce and heterogeneous studies on this topic, the review shows that HRQoL and mental health are markedly affected after ADRs. A better assessment of HRQoL and characterization of patients' mental status may improve the efficacy of therapeutic strategies, which should include psychological support.

The spatial differentiation of quality of rural life based on natural controlling factors: A case study of Gansu Province, China

The laws of regional differentiation of county development and influencing factors on the quality of rural life (QRL), affect not only the vital interests of rural residents but also the scientific implementation of rural revitalization strategy. In this paper, taking 87 counties (cities, districts) of Gansu Province as the region of study, we constructed five-dimensional model of QRL index. Then, Pearson correlation, spatial coupling, geographical detector and tradeoff analysis methods were used to analyze the QRL's spatial differentiation and quantitively identify its natural controlling factors. Further, we discussed the mechanism of spatial differentiation of QRL in Gansu Province and provided recommendations for improving QRL. The results show that: (1) QRL in Gansu Province is characterized by spatial heterogeneity and agglomeration, and decreases from west to east. There are five hot spots and four cold spots of QRL. (2) Altitude, slope, precipitation, and distance to the provincial capital (DTTPC) are the natural controlling factors of spatial differentiation of QRL in Gansu Province. Their influences are quantified to be 0.19, 0.37, 0.37 and 0.20, respectively. (3) The tradeoff between QRL and precipitation is the strongest, with root mean square deviation (RMSD) of 0.293. The tradeoff between QRL and altitude/slope/DTTCC are of medium level and decrease successively, with values of 0.238, 0.255 and 0.2 respectively. (4) According to the different influences of natural controlling factors on QRL, Gansu Province was classified into three regional types: natural environment restricted type, resource abundance restricted type and economic location restricted type. Thus, we can improve the QRL on the basis of identifying driving mechanisms in different regions, make policies according to local conditions, and further promote the rural development.

Health Service Utilization and Poor Health Reporting in Asthma Patients

The management and treatment of adult asthma has been associated with utilization of health services.

OBJECTIVES

First, to investigate the likelihood of health service utilization, including primary care, emergency department, and hospital stays, among persons diagnosed with an asthma condition relative to those that do not have an asthma condition. Second, to examine the likelihood of poor physical health among asthma respondents relative to those that do not have an asthma condition. Third, to demonstrate that these relationships vary with frequency of utilization. Fourth, to discuss the magnitude of differences in frequent utilization between asthma and non-asthma respondents.

DATA SOURCE

Data is derived from a random, stratified sampling of Hampton Roads adults, 18 years and older (n = 1678).

STUDY DESIGN

Study participants are interviewed to identify asthma diagnosis, access to primary care, frequency of emergency department utilization, hospital admissions, and days of poor physical health. Odds-ratios establish relationships with the covariates on the outcome variable.

FINDINGS

Those with asthma are found more likely (OR 1.50, 95% CI 1.05-2.15) to report poor physical health relative to non-asthma study participants. Further, asthma respondents are found more likely (OR 4.23, 95% CI 1.56-11.69) to frequently utilize primary care that may be associated with the management of the condition and are also more likely to utilize treatment services, such as the emergency department (OR 1.87, 95% CI 1.32-2.65) and hospitalization (OR 2.21, 95% CI 1.39-3.50), associated with acute and episodic care. Further, it is a novel finding that these likelihoods increase with frequency of utilization for emergency department visits and hospital stays.

CONCLUSION

Continuity in care and better management of the diseases may result in less demand for emergency department services and hospitalization. Health care systems need to recognize that asthma patients are increasingly more likely to be characterized as frequent utilizers of both primary and emergency department care as the threshold for what constitutes frequent utilization increases. Investments in prevention and better management of the chronic condition may result in less demand for acute care services, especially among high frequency utilizers.

Assessing the validity of the RAND negative impact of asthma on quality of life short forms

BACKGROUND

In response to recommendations from the 2010 National Institutes of Health Asthma Outcomes Workshop, we developed a system for measuring the negative impact of asthma on quality of life (QoL), which was referred to as the RAND Negative Impact of Asthma on Quality of Life (RAND-IAQL) item bank. The bank contains 65 items that focus on the patient's perception of the impact or bother of asthma on his or her life.

OBJECTIVE

Evidence for the validity of 2 short forms, the RAND-IAQL 4-item and 12-item Short Forms, from the bank is presented.

METHODS

Using a sample of 2032 adults with asthma, we validated our short forms against the Asthma Quality of Life Questionnaire-Marks (AQLQ-M), the Asthma Control Test, and generic measures of QoL developed by the Patient-reported Outcomes Measurement Information System (PROMIS). Discriminant validity was examined by comparing scores of respondents who differed according to multiple health indicators.

RESULTS

Our sample ranged in age from 18 to 99 years (mean, 43 years), with 14% Hispanic, 11% Asian, 19% African American, and 56% non-Hispanic white race/ethnicity. Men had a significantly worse impact of asthma on QoL than women. The impact of asthma on QoL was greatest in African American and Hispanic subjects compared with that seen in non-Hispanic white subjects. Our measures correlated highly with the AQLQ-M and more strongly with the PROMIS global physical than mental scales. They differentiated between adults with asthma according to their perceived severity, level of control, presence or absence of exacerbations, and physical comorbidity.

CONCLUSION

The RAND-IAQL item bank, measuring the impact of asthma on QoL, will complement other patient-reported outcomes, such as measures of asthma symptoms, functioning, and control.

Health-related quality of life among adults with work-related asthma in the United States

PURPOSE

The objective of this study was to examine health-related quality of life among adults with work-related asthma.

METHODS

We analyzed 2006-2009 Behavioral Risk Factor Surveillance System Asthma Call-back Survey data for ever-employed adults with current asthma from 38 states and District of Columbia. Individuals with work-related asthma had been told by a doctor or other health professional that their asthma was related to any job they ever had. Health-related quality of life indicators included poor self-rated health, impaired physical health, impaired mental health, and activity limitation. We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education, income, employment, and health insurance.

RESULTS

Of ever-employed adults with current asthma, an estimated 9.0% had work-related asthma, 26.9 % had poor self-rated health, 20.6% had impaired physical health, 18.2% had impaired mental health, and 10.2% had activity limitation. Individuals with work-related asthma were significantly more likely than those with non-work-related asthma to have poor self-rated health [PR, 1.45; 95% confidence interval (CI), 1.31-1.60], impaired physical health (PR, 1.60; 95% CI, 1.42-1.80), impaired mental health (PR, 1.55; 95% CI, 1.34-1.80), and activity limitation (PR, 2.16; 95% CI, 1.81-2.56).

CONCLUSIONS

Future research should examine opportunities to improve health-related quality of life among individuals with work-related asthma.

The living with chronic obstructive pulmonary disease scale was successfully adapted for use in Southern European (Italian and Spanish) and Eastern European (Russian) cultures

OBJECTIVE

The living with chronic obstructive pulmonary disease (LCOPD) scale was developed in the United Kingdom and the United States to assess the quality of life (QoL) of people with chronic obstructive pulmonary disease. The scale was shown to be well accepted by patients, to be unidimensional, and to have very good psychometric properties. This article reports on the adaptation of the measure for use in representative Southern European (Italian and Spanish) and Eastern European (Russian) languages.

STUDY DESIGN AND SETTING

The same methodology was used in each country: translation panels were held to produce new language versions. These were then tested with patients to ensure face and content validity. Finally, test-retest postal surveys were conducted to establish internal consistency, reproducibility, and construct validity.

RESULTS

Few problems were found in translating the LCOPD, and patient interviews indicated that the measure was considered relevant and easy to complete. The validation surveys showed that the new versions of the LCOPD were consistent, reproducible, and had good construct validity. The psychometric properties of the new versions were similar to those found for the original U.K. and U.S. versions.

CONCLUSION

The study was successful in adapting the LCOPD for use in Southern and Eastern European languages.

Multinational trials-recommendations on the translations required, approaches to using the same language in different countries, and the approaches to support pooling the data: the ISPOR Patient-Reported Outcomes Translation and Linguistic Validation Good Research Practices Task Force report

OBJECTIVES

With the internationalization of clinical trial programs, there is an increased need to translate and culturally adapt patient-reported outcome (PRO) measures. Although guidelines for good practices in translation and linguistic validation are available, the ISPOR Patient-Reported Outcomes Translation and Linguistic Validation Task Force identified a number of areas where they felt that further discussion around methods and best practices would be beneficial. The areas identified by the team were as follows: 1) the selection of the languages required for multinational trials; 2) the approaches suggested when the same language is required across two or more countries; and 3) the assessment of measurement equivalence to support the aggregation of data from different countries.

METHODS

The task force addressed these three areas, reviewed the available literature, and had multiple discussions to develop this report.

RESULTS

Decision aid tools have also been developed and presented for the selection of languages and the approaches suggested for the use of the same language in different countries.

CONCLUSION

It is hoped that this report and the decision tools proposed will assist those involved with multinational trials to 1) decide on the translations required for each country; 2) choose the approach to use when the same language is spoken in more than one country; and 3) choose methods to gather evidence to support the pooling of data collected using different language versions of the same tool.

The potential of a 2Tone Trainer to help patients use their metered-dose inhalers

BACKGROUND

Many patients have problems using the correct inhalation technique when they use their metered-dose inhalers (MDIs). We have investigated whether a training aid (2Tone Trainer [2T]; Canday Medical Ltd; Newmarket, UK) helps to maintain the correct inhaler technique after patients leave the clinic

METHODS

Ethics committee approval was obtained, and patients gave consent. Asthmatic patients who had been prescribed an MDI had their inhalation technique assessed. Their peak inhalation flow (PIF) when using their MDI, FEV(1), and the Juniper asthma quality of life questionnaire (AQLQ) score were measured. Those patients using the recommended MDI technique were the good-technique (GT) group. The remainder were randomized to receive verbal training (VT) or VT plus the 2T to improve their MDI technique. All patients returned 6 weeks later.

RESULTS

There were 36, 35, and 36 asthmatic patients, respectively, who completed the GT, VT, and 2T procedures. FEV1 did not change within all groups between visit 1 and 2. PIF and AQLQ score did not change in the GT group. In the VT and 2T groups, the AQLQ score increased by mean differences of 0.33 (95% confidence interval [CI], 0.14 to 0.53; p < 0.001) and 0.74 (95% CI, 0.62 to 0.86; p < 0.001). At visit 1, all patients in the VT and 2T groups inhaled > 90 L/min decreasing to 12 patients and 1 patient, respectively, at visit 2 (p < 0.001 both groups). The overall changes in the 2T group for PIF and AQLQ score, between visits 1 and 2, were significantly (p < 0.001) greater than the corresponding changes in the VT group.

CONCLUSION

The 2T helps patients to maintain the recommended MDI technique posttraining with improvements in AQLQ score.

The health related quality of life of the employees in the Greek hospitals: assessing how healthy are the health workers

Background

The main aim of the study was to assess the health status and health related quality of life of the personnel of the Hellenic Network of Health Promotion Hospitals. The instrument used was SF-36. An additional aim was to contribute to the validation of the SF-36.

Methods

The study instrument was administered to 347 randomly selected employees from seven hospitals within major Athens area. Completed questionnaire were obtained by 292 employees. The statistical significance of the observed differences was tested with parametric (t-test and ANOVA) and non-parametric tests (Mann-Whitney and Kruskall-Wallis). Also, since the Greek national norms have not been published yet, the mean scores on all eight SF-36 dimensions of this study were compared with the U.S and several European national norms just to assess the extent to what there are significant differences between a Greek healthy population and the general populations of several other countries.

Results

Medical doctors and technical personnel (mostly engineers) reported better health status than nurses and administrative and auxiliary personnel; women reported poorer health status than men on all eight SF-36 dimensions; younger employees reported poorer health status than their older counterpartners. Moreover the mean scores on all SF-36 dimensions reported by the participants on this study were considerably lower than the U.S and many European national norms. Also the study results constitute an indication of the SF-36 construct validity.

Conclusion

The findings of this study show that there are major and intense health inequalities among the employees in Greek hospitals.