Gender differences in quality of life among cardiac patients

Sense of vitality is associated with cardiovascular events in type 2 diabetes independently of traditional risk factors and arterial stiffness

AIMS

The aim of this study was to determine if single items in the quality of life questionnaire short form 36 (SF36) were associated with cardiovascular events in patients with type 2 diabetes mellitus (T2DM).

METHODS

In 756 T2DM patients (260 women) from the CARDIPP study, nine questions from the domains vitality and well-being in SF36 were analysed. Patients, 55-66 years, were recruited in 2005-2008 and followed up until 31 December 2018 for the incidence of major adverse cardiovascular events (MACE), that is, myocardial infarction, stroke or cardiovascular death.

RESULTS

Median follow-up time: 11.6 years, during which 119 (16%) MACE occurred. The SF36 items: 'seldom full of pep' (HR 1.2, 95% CI: 1.1-1.4, p = 0.006), 'seldom a lot of energy' (HR 1.3, 95%CI: 1.1-1.5, p < 0.001), 'worn out' (HR 1.2, 95%CI: 1.0-1.4, p = 0.020) and 'seldom happy' (HR 1.2, 95%CI: 1.0-1.4, p = 0.012) were independent risk factors for MACE in separate models, as well as male sex, diabetes duration, HbA1c , sagittal abdominal diameter and aortic pulse wave velocity. The variables 'seldom full of pep' and 'seldom a lot of energy' remained associated with MACE when conducting separate analyses for sexes. Only 'seldom a lot of energy' remained associated with MACE when all items from SF-36 were comprised in the same model.

CONCLUSIONS

One single question regarding energy levels from SF36 may be used as an independent risk factor for cardiovascular events in T2DM patients in primary care, for both men and women. This item may be included in future risk assessment for use in clinical practice for cardiovascular risk stratification of T2DM patients.

TRIAL REGISTRATION

The study was registered in clinicaltrial.gov (NCT01049737) in 14 January 2010.

Sex differences in quality of life of patients following percutaneous coronary intervention in Vietnam

PURPOSE

Data regarding the health-related quality of life (HRQoL) in men and women after percutaneous coronary intervention (PCI) in low-and-middle incomes countries remains scarce. To investigate sex difference in the HRQoL at 30 days and 12 months post PCI in Vietnam.

METHODS

We used data from a single percutaneous coronary registry established in the Vietnam National Heart Institute. The HRQoL was measured using the EQ-5D-3L instrument via telephone interviews, and information about demographics, clinical presentation and procedures was obtained through face-to-face interviews and medical records. The HRQoL between men and women were compared using independent samples t tests, the Mann-Whitney U test or univariate/multivariate logistic regression.

RESULTS

There were 866 patients included in this cohort, with the proportion of women being nearly half of men (32.1 vs 67.9%). Women were 3.5 years older, had lower income and educational levels but greater prevalence of cardiovascular risk factors. At 30 days, women significantly had more problems in mobility, personal care and pain/discomfort compared to men. At 12 months, women had more problem than men in usual activity. The geometric means of HRQoL was lower in women at 30 days, but not in 12 months. From 30 days to 12 months after discharge, women showed better recovery in mobility compared to men, but not in other dimensions.

CONCLUSIONS

In this first insight of sex differences in HRQoL following PCI in Vietnam, women appeared to have worse quality of life, especially at 30 days after discharge but they showed better recovery in mobility at 12 months compared to men.

Gender differences in patient-reported outcomes in patients with acute myocardial infarction

AIMS

Women report worse health-related patient-reported outcomes (PROs) compared with men following acute myocardial infarction (AMI). However, this association is not well established when accounting for demographic and clinical patient characteristics at discharge. This knowledge is essential for clinicians when planning individualised care for patients following AMI. The aim of this study is to examine whether gender is associated with health-related PROs at discharge from a Danish heart centre, combining PROs with data from the national health and administrative registries.

METHODS AND RESULTS

A cross-sectional study of 2131 patients with AMI discharged from a Danish heart centre responding to the following health-related PRO questionnaires: the Health-survey Short-Form-12 (SF-12), generating a physical component summary (PCS) and a mental component summary (MCS) score; the HeartQoL, providing a global, emotional, and physical score; the EuroQol five-dimensional questionnaire (EQ-5D-5L) and the EQ visual analogue scale (EQ VAS); the Hospital Anxiety and Depression Scale (HADS), generating an anxiety and depression score (HADS-A and HADS-D); the Edmonton Symptom Assessment Scale (ESAS); the Brief Illness Perception Questionnaire (B-IPQ). Patient-reported outcomes were linked to registry-based information adjusting for potential demographic and clinical confounding factors. In adjusted regression models, women reported worse health-related PROs compared with men in SF-12 PCS and SF-12 MCS, HeartQoL global, the HeartQoL emotional and HeartQoL physical score, EQ-5D-5L and EQ VAS, the HADS-A, ESAS, and in six out of eight B-IPQ items.

CONCLUSIONS

Women reported worse health-related PROs compared with men. Health-related PROs have the potential to be further investigated to facilitate a more individualised healthcare follow-up after AMI.

Sex differences in health-related quality of life trajectories following myocardial infarction: national longitudinal cohort study

OBJECTIVES

To investigate sex-based differences in baseline values and longitudinal trajectories of health-related quality of life (HRQoL) in a large cohort of myocardial infarction (MI) survivors after adjusting for other important factors.

DESIGN

Longitudinal cohort study.

SETTING

Population-based longitudinal study the Evaluation of the Methods and Management of Acute Coronary Events study linked with national cardiovascular registry. Data were collected from 77 hospitals in England between 1 November 2011 and 24 June 2015.

PARTICIPANTS

9551 patients with MI. Patients were eligible for the study if they were ≥18 years of age.

PRIMARY AND SECONDARY OUTCOME MEASURES

HRQoL was measured by EuroQol five-dimension, visual analogue scale (EQ-5D, EQ VAS) survey at baseline, 1, 6 and 12 months after discharge. Multi-level linear and logistic regression models coupled with inverse probability weighted propensity scoring were used to evaluate sex differences in HRQoL following MI.

RESULTS

Of the 9551 patients with MI and complete data on sex, 25.1% (2,397) were women. At baseline, women reported lower HRQoL (EQ VAS (mean (SD) 59.8 (20.4) vs 64.5 (20.9)) (median (IQR) 60.00 (50.00-75.00) vs 70.00 (50.00-80.00))) (EQ-5D (mean (SD) 0.66 (0.31) vs 0.74 (0.28)) (median (IQR) 0.73 (0.52-0.85) vs 0.81 (0.62-1.00))) and were more likely to report problems in each HRQoL domain compared with men. In the covariate balanced and adjusted multi-level model sex differences in HRQoL persisted during follow-up, with lower EQ VAS and EQ-5D scores in women compared with men (adjusted EQ VAS model sex coefficient: -4.41, 95% CI -5.16 to -3.66 and adjusted EQ-5D model sex coefficient: -0.07, 95% CI -0.08 to -0.06).

CONCLUSIONS

Women have lower HRQoL compared with men at baseline and during 12 months follow-up after MI. Tailored interventions for women following an MI could improve their quality of life.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (NCT04598048, NCT01808027, NCT01819103.

Sex-related differences in self-reported treatment burden in patients with atrial fibrillation

Background

Treatment burden (TB) is defined as the patient’s workload of healthcare and its impact on patient functioning and wellbeing. High TB can lead to non-adherence, a higher risk of adverse outcomes and lower quality of life (QoL). We have previously reported a higher TB in patients with atrial fibrillation (AF) vs. those with other chronic conditions. In this analysis, we explored sex-related differences in self-reported TB in AF patients.

Materials and methods

A single-center, prospective study included consecutive patients with AF under drug treatment for at least 6 months before enrollment from April to June 2019. Patients were asked to voluntarily and anonymously answer the Treatment Burden Questionnaire (TBQ). All patients signed the written consent for participation.

Results

Of 331 patients (mean age 65.4 ± 10.3 years, mean total AF history 6.41 ± 6.62 years), 127 (38.4%) were females. The mean TB was significantly higher in females compared to males (53.7 vs. 42.6 out of 170 points, p &lt; 0.001), and females more frequently reported TB ≥ 59 points than males (37.8% vs. 20.6%, p = 0.001). In females, on multivariable analysis of the highest TB quartile (TB ≥ 59), non-vitamin K Antagonist Oral Anticoagulant (NOAC) use [Odds Ratio (OR) 0.319; 95% Confidence Interval (CI) 0.12–0.83, P = 0.019], while in males, catheter ablation and/or ECV of AF (OR 0.383; 95% CI 0.18–0.81, P = 0.012) were negatively associated with the highest TB quartile.

Conclusion

Our study was the first to explore the sex-specific determinants of TB in AF patients. Females had significantly higher TB compared with males. Approximately 2 in 5 females and 1 in 5 males reported TB ≥ 59 points, previously shown to be an unacceptable burden of treatment for patients. Using a NOAC rather than vitamin K antagonist (VKA) in females and a rhythm control strategy in males could decrease TB to acceptable values.

Gender Differences in Visual Functioning Questionnaire Scores among Patients with Age-Related Macular Degeneration

PURPOSE

To examine gender differences in visual functioning using the National Eye Institute Visual Functioning Questionnaire-25 (VFQ-25) in a Colorado cohort of patients with age-related macular degeneration (AMD).

METHODS

A retrospective cohort study was conducted using a registry of AMD patients who attended the Sue Anschutz-Rodgers Eye Center (2014 to 2019). Demographic, clinical, and image data were collected, and AMD was categorized as Early/Intermediate AMD, or unilateral/bilateral neovascular (NV) AMD, geographic atrophy (GA), or Both Advanced using the Beckman Classification. Each patient completed the VFQ-25, which evaluates visual functioning, generating a composite score and subscale scores for vision-specific activities. Univariate and multivariable general linear models were used to estimate the associations between gender and VFQ-25 scores with parameter estimates (PE) and standard errors (SE).

RESULTS

Among 739 patients with AMD, 294 (39.8%), 115 (15.6%), 168 (22.7%), and 162 (21.9%) were diagnosed with Early/Intermediate AMD, GA, NV AMD, and Both Advanced, respectively. Adjusted for AMD classification, age and habitual visual acuity in the better-seeing and worse-seeing eyes, female gender was not significantly associated with lower composite VFQ-25 scores (PE (SE): -1.2 (0.9), p = .193), and was significantly associated with reportedly worse ocular pain and driving subscale scores (PE (SE): -4.6 (1.0), p < .0001 and -9.1 (2.1), p < .0001, respectively).

CONCLUSION

Gender plays a role in reported driving activities and ocular pain among patients with AMD. This may need to be accounted for in future research related to the use of VFQ-25 for AMD.

Health-related quality of life in men and women who experienced cardiovascular diseases: Tehran Lipid and Glucose Study

Background

Cardiovascular diseases (CVDs) are among the most common causes of death worldwide, including in Iran. Considering the adverse effects of CVDs on physical and psychosocial health; this study aims to investigate the association between experience of CVDs and health-related quality of life (HRQoL) in adult participants of the Tehran Lipid and Glucose Study (TLGS).

Methods

The participants of this cross-sectional study were 7009 adults (≥ 20 years) who participated in the TLGS during 2014–2017. Demographic information and HRQoL data was collected through validated questionnaires by trained interviewers. HRQoL was assessed by the Iranian version of the SF-12 questionnaire. Data was analyzed using the SPSS software.

Results

The mean age of participants was 46.8 ± 14.6 years and 46.1% of them were men. A total of 9.0% of men and 4.4% of women had CVDs. In men, the mean physical HRQoL summary score was significantly lower in those with CVDs compared to those without CVDs (46.6 ± 0.8 vs. 48.5 ± 0.7, p > 0.001). In women, the mean mental HRQoL summary scores was significantly lower in those with CVDs compared to those without CVDs (42.8 ± 1.0 vs. 45.2 ± 0.5, p = 0.009). In adjusted models, men with CVDs were more likely to report poor physical HRQoL compared to men without CVDs (OR(95%CI): 1.93(1.32–2.84), p = 0.001); whereas for women, the chance of reporting poor mental HRQoL was 68% higher in those with CVDs than those without CVDs (OR(95%CI): 1.68(1.11–2.54), p = 0.015).

Conclusion

The findings of the current study indicate poorer HRQoL in those who experienced CVDs compared to their healthy counterparts with a sex specific pattern. While for men, CVDs were associated with more significant impairment in the physical dimension of HRQoL, women experienced a similar impairment in the mental dimension of HRQoL.

How to predict the outcome of septorhinoplasty? A normative study of ROE and FROI-17 scores

Objective

Normative values of patient-reported outcome instruments are needed to identify good candidates for rhinoplasty. Rhinoplasty Outcome Evaluation (ROE) and Functional Rhinoplasty Outcome Inventory-17 (FROI-17) are disease-specific questionnaires that evaluate quality of life in patients undergoing rhinoplasty.

Methods

The reference cohort contained 1,000 participants, selected from a non-probability panel. Normative ROE and FROI-17 scores from this reference cohort were compared with ROE and FROI-17 scores from a patient cohort before (n = 104) and 6 (n = 55) and 12 months (n = 32) after septorhinoplasty.

Results

Mean FROI-17 scores (± SD) were: overall score, 20.8 ± 17; nasal symptoms, 16.8 ± 7; general symptoms, 24.8 ± 22; and self-confidence, 16.4 ± 21. The ROE total score was 73.1 ± 16. Normative values differed significantly from the preoperative ROE and FROI-17 scores of septorhinoplasty patients (p < 0.01). Except for the FROI-17 general score at 12 months postoperatively (p = 0.004), there were no significant differences between normative ROE/FROI-17 and septorhinoplasty scores postoperatively, indicating that they returned to normalcy.

Conclusions

Normative scores for ROE and FROI-17 provide a reference point from which to identify patients who are most likely to benefit from rhinoplasty.

Cardiac Rehabilitation Following Percutaneous Coronary Intervention Is Associated With Superior Psychological Health and Quality of Life in Males but Not in Females

PURPOSE

Cardiac rehabilitation (CR) improves psychological health and health-related quality of life (HR-QoL). Yet, available evidence suggests that their degree of improvements following CR may depend on patient sex and the mode of revascularization. We examined the interplay between sex and mode of revascularization on the psychological health and HR-QoL of patients completing CR.

METHODS

We analyzed the longitudinal records of patients who completed a 3-mo outpatient CR program following coronary revascularization. Levels of anxiety and depression were measured by the Hospital Anxiety and Depression Scale and HR-QoL was measured by the Medical Outcomes Study Short Form-36 before and after CR. A two-by-two analysis of covariance (females vs males by coronary artery bypass graft surgery [CABG] vs percutaneous coronary intervention [PCI]) was used to examine the sex-by-revascularization procedure interaction effect on changes in psychological health and HR-QoL.

RESULTS

Of the 278 participants (age: 65 ± 9 yr) included in the analysis, 191 (69%) underwent PCI and 55 (20%) were females. Following CR, there was a significant sex-by-revascularization procedure interaction effect on anxiety (P = .033) and mental HR-QoL (mental component summary [MCS]; P = .040). Following CABG, females and males showed similar improvements in anxiety (-1.3 ± 3.4 vs -1.1 ± 3.6 points, P = .460) and MCS scores (5.4 ± 8.9 vs 4.5 ± 8.7 points, P = .887); following PCI, females experienced worse anxiety levels and mental component summary scores while males showed improvements (anxiety: +1.0 ± 3.8 vs -1.3 ± 3.8 points, P = .002; MCS: -1.6 ± 9.3 vs + 4.4 ± 8.9 points, P = .008, respectively). There was no interaction effect on depression.

CONCLUSIONS

Continued efforts are required to improve anxiety and mental HR-QoL in females treated with PCI participating in CR.

EmPHasis-10 as a measure of health-related quality of life in pulmonary arterial hypertension: data from PHAR

INTRODUCTION

While the performance of the emPHasis-10 (e10) score has been evaluated against limited patient characteristics within the United Kingdom, there is an unmet need for exploring the performance of the e10 score among pulmonary arterial hypertension (PAH) patients in the United States.

METHODS

Using the Pulmonary Hypertension Association Registry, we evaluated relationships between the e10 score and demographic, functional, haemodynamic and additional clinical characteristics at baseline and over time. Furthermore, we derived a minimally important difference (MID) estimate for the e10 score.

RESULTS

We analysed data from 565 PAH (75% female) adults aged mean±sd 55.6±16.0 years. At baseline, the e10 score had notable correlation with factors expected to impact quality of life in the general population, including age, education level, income, smoking status and body mass index. Clinically important parameters including 6-min walk distance and B-type natriuretic peptide (BNP)/N-terminal proBNP were also significantly associated with e10 score at baseline and over time. We generated a MID estimate for the e10 score of -6.0 points (range -5.0--7.6 points).

CONCLUSIONS

The e10 score was associated with demographic and clinical patient characteristics, suggesting that health-related quality of life in PAH is influenced by both social factors and indicators of disease severity. Future studies are needed to demonstrate the impact of the e10 score on clinical decision-making and its potential utility for assessing clinically important interventions.

Impact of diabetes and periodontal status on life quality

Objectives

To investigate impact of periodontal status on quality of life (QoL) in type-1 (T1D) and type-2 (T2D) diabetes patients pre- and post-periodontal treatment using the Well-being Questionnaire 12 (W-BQ12) and Audit of Diabetes-Dependent Quality of Life-19 (ADDQoL-19).

Methods

W-BQ12 and ADDQoL-19 were self-completed by 56 T1D and 77 T2D patients at baseline and by those with periodontitis 3 and 6-months after therapy.

Results

At baseline, T1D patients had significantly higher general W-BQ12 [Median (IQR); 24.00 (20.25–27.75)] and positive well-being scores [8.00 (6.00–9.00)] (indicating better QoL) compared to T2D patients [22.00 (15.50–26.00) and 6.00 (3.50–9.00)], respectively (p < 0.05). Within both groups, general W-BQ12 scores did not differ significantly between patients with periodontal health, gingivitis, or periodontitis (p > 0.05). Significantly higher general W-BQ12 scores were observed in T1D patients at month 3 [28.00 (22.00–29.50)] compared to baseline [22.00 (17.00–24.50)] (p < 0.01), suggesting an initial improvement in QoL post-treatment. ADDQoL-19 identified that diabetes had greatest impact on the domain ‘freedom to eat’, with participants placing most importance on ‘family life’. No significant changes in ADDQoL-19 scores were seen post-treatment (p > 0.05).

Conclusions

Diabetes had impacts upon aspects of life quality in both T1D and T2D patients, though any additional impact based on periodontal status was not observed when using W-BQ12 and ADDQoL-19.

How I See and Feel About Myself: Domain-Specific Self-Concept and Self-Esteem in Autistic Adults

Few studies have examined the self-perceptions of autistic adults. This study aimed firstly to investigate domain-specific self-concepts and global self-esteem in autistic adults. The second aim was to examine associations between autism self-appraisals, perceived social support and global self-concept and self-esteem. The third was to determine which domains of self-concept were most closely associated with self-esteem. Participants included 71 autistic adults aged 18-70 years and 65 age, sex and education matched typically developing individuals. Participants completed an online survey of autism characteristics, global self-esteem and domain-specific self-concepts (i.e. likeability, task accomplishment, power, giftedness, invulnerability, and morality), self-appraisals about autism, and perceived social support. Autistic participants reported significantly lower power and global self-esteem than typically developing individuals after controlling for autism characteristics. More positive self-appraisals about autism (i.e. greater perceived benefits and lower helplessness) were significantly related to better global self-concept and self-esteem. Global self-esteem was significantly and positively associated with perceptions of giftedness, emotional resilience and power. These findings suggest that autistic adults may perceive themselves as having a low sense of power in their relationships and have negative global perceptions of their self-worth. However, those able to find positive meaning or benefits associated with autism are likely to have more positive global self-perceptions. This study provides new insights into how autistic adults perceive themselves which may guide the focus of psychosocial interventions that seek to recognize and promote unique talents and emotional resilience.

Gender difference in relation to depression and quality of life among patients with a primary brain tumor

Objective. –

We studied the relationship between depressive symptoms and quality of life (QOL) as well as functional status in primary brain tumor patients at recurrent measurements. Differences in QOL between depressive and non-depressive samples by gender were controlled for tumor characteristics and patients' psychosocial factors.

Materials and methods. –

The data consisted of 77 patients with a primary brain tumor, 30 males and 47 females. Depression of the patients was assessed by Beck Depression Inventory (BDI) and Crown-Crisp Experiential Index (CCEI), functional status by Karnofsky Performance scale (KPS) and QOL by Sintonen's 15D before tumor operation as well as at 3 months and at 1 year from surgical operation of the tumor.

Results.

The level of QOL in females was lower compared to that of males. Depression was the main predictor for worse QOL in the patients at all measurements. Depressive patients with a benign brain tumor had significantly worse QOL versus non-depressive ones.

Discussion and conclusion. –

Decreased QOL was strongly related to depression, especially among patients with a benign brain tumor. Further studies are needed to find whether sufficient depression therapy improves the QOL of patients.

Gender Differences in Postoperative Outcomes After Cardiac Surgery

Women presenting for cardiac surgery tend to be older and have hypertension, diabetes, and overweight or underweight body mass index than men. Despite improvements in surgical techniques and medications, women have increased risk for morbidity and mortality after multiple types of cardiac surgery. Women presenting for transcatheter aortic valve replacement are older and frailer than men, and have increased risk of intraoperative complications, but lower mortality at mid- and long-term ranges compared with men. Adherence to recovery and rehabilitation from cardiac surgery is challenging for women. Solutions should focus on increased family support, and use of group exercise and activities.

Does sex predict quality of life after acute coronary syndromes: an Australian, state-wide, multicentre prospective cohort study

OBJECTIVE

Women have reported higher mortality and major adverse cardiovascular events (MACE) following acute coronary syndromes (ACSs) compared with men. With this in mind, we aimed to identify predictors of poor quality of life (QoL) post-ACS as our primary outcome. We examined predictors of MACE, major cerebrovascular events and major bleeding as our secondary outcome.

DESIGN

Prospective cohort study.

SETTING

30 metropolitan centres across the Victorian Cardiac Outcomes Registry network.

PARTICIPANTS

16 517 patients treated with percutaneous coronary intervention (PCI) for ACS (22.9% females). Selection/inclusion criteria: consecutive patients with successful or attempted PCI for ACS from 2013 to 2016, alive at 30 days post-PCI.

EXCLUSION CRITERIA

patients not fulfilling ACS criteria. At 30 days, 2497 (64.7% females) completed the QoL EQ-5D-3L instrument.

PRIMARY AND SECONDARY OUTCOME MEASURES

QoL, assessed using the EuroQo-5Dimensions (EQ-5D-3L) instrument by telephone at 30 days. Independent predictors of QoL were identified by univariate and multivariate logistic regression analyses.

RESULTS

Women were significantly older with more diabetes, cerebrovascular disease and renal failure. Regarding the primary outcome, female sex was independently associated with moderate/severe impairment in all EQ-5D-3L domains including mobility (OR 2.38, 95% CI 2.06 to 2.75, p<0.001), personal care (OR 2.14, 95% CI 1.73 to 2.66, p<0.001), activities of daily living (OR 1.84, 95% CI 1.63 to 2.08, p<0.001), pain/discomfort (OR 1.44, 95% CI 1.24 to 1.67, p<0.001) and anxiety/depression (OR 1.49, 95% CI 1.30 to 1.70, p<0.001). Women had significantly lower self-rated Visual Analogue Scale scores (80.0 for both groups, IQR 60-85 vs 70-90, p<0.001). There was no significant difference between the sexes in secondary outcomes.

CONCLUSIONS

Female sex was a predictor of poorer QoL following PCI for ACS including significantly higher pain, anxiety and depression. This was independent of age, comorbidities and ACS presentation. There is a clinical need for a tailored approach in female ACS management, for example, emphasis on management of depressive and anxiety symptoms.

Estimating the burden of illness related to genital warts in the Philippines: a nationally representative cross-sectional study

Background

This study estimated genital warts prevalence, genital-warts-related healthcare resource use and costs, and self-reported human-papillomavirus-related psychosocial impact among male and female patients aged 18-60 years in the Philippines.

Methods

Prevalence was estimated using daily logs numbering genital warts patients treated by participating physicians in 4 Philippine regions over a 5-week period (09JUL2011-24SEP2012). Physicians also completed a survey assessing patient referral patterns, healthcare resource use, treatment, and follow-up care. Psychosocial impact was estimated using the human papillomavirus impact profile and the EQ-5D questionnaires. HIP and EQ-5D scores were compared according to the presence of GW (males) and HPV disease (females). CECA scores were also compared by gender and age groups.

Results

Overall genital warts prevalence was estimated at 4.78% (95% confidence interval [CI]: 4.58-4.98%) for men and women aged 18-60 years. Genital warts prevalence was 3.39% (95% CI: 3.13-3.65%) and 8.0% (95% CI: 7.69-8.31%) among women and men, respectively. Prevalence estimates were highest in infectious disease specialist practices 18.67% (95% CI: 18.66-18.69%). Two thirds of the 233 (69.14%) male and 166 (67.20%) female patients were newly-diagnosed genital warts cases. Median costs for genital warts diagnosis and treatment reached 7121 and 7000 Philippine pesos among men and women, respectively. In the Cuestionario Específico para Condiloma Acuminado questionnaire, no statistically significant differences between patients were observed. In the EQ-5D questionnaire, male genital warts patients reported lower mean visual analogue scale scores than those without genital warts (78.20 vs 86.34, p < 0.0001). Mean visual analogue scale score values and utility values were lower for women with human-papillomavirus-related diseases than those without (77.98 vs 78.93, and 0.84 vs 0.88, respectively).

Conclusions

Genital warts is prevalent in the Philippines; more than 60% of cases were newly diagnosed, contributing to high genital-warts-related healthcare resource costs. Diagnosis of genital warts and human papillomavirus negatively impacted psychosocial indices such as patient well-being and health-related quality of life.

Gender differences? Factors related to quality of life among patients with Heart failure

Heart failure (HF) is a chronic, progressive disease that substantially decreases patients' quality of life. Few studies have compared quality of life and its related factors across genders in patients with HF. To explore gender differences in quality of life and related factors among adult patients with HF. A comparative study was conducted with 245 HF patients recruited from a medical center and a regional teaching hospital in Taiwan from February 2009 to February 2011. Descriptive and inferential statistics were used, including stepwise multiple regressions. The mean quality of life scores of males were significantly higher than those of females (87.78 ± 13.99 vs. 84.49 ± 11.85). The factors significantly related to quality of life for the male HF patients, in descending order of strength of association were depressive symptoms, physical symptoms, and monthly family income-less than USD 1,000; for the females, the significantly related factors were physical symptoms, depressive symptoms, and monthly family income-less than USD 1,000. The amount variance for which quality of life accounted for male and female HF patients was similar (60% vs. 64%). The results could be used for health professionals to provide more appropriate assessments and care according to gender in the future.

The Relationship Between Culture, Quality of Life, and Stigma in Hispanic New Mexicans With Dysphagia: A Preliminary Investigation Using Quantitative and Qualitative Analysis

Purpose The purpose of this investigation was to (a) identify the relationship between level of acculturation, and quality of life (QOL) and stigma and (b) explore the QOL experiences for Hispanic New Mexicans with dysphagia. Method This study includes 7 New Mexicans who self-identified as Hispanic. This prospective investigation was completed in 2 phases. In the quantitative phase, all participants completed the (a) the SWAL-QOL ( McHorney et al., 2000 ), (b) the Neuro-QoL Stigma subtest ( Gershon et al., 2012 ), and (c) the Acculturation Rating Scale for Mexican Americans-II (ARSMA-II; Cuellar, Arnold, & Maldonado, 1995 ). In the qualitative phase, 3 participants were selected from the quantitative phase to complete the qualitative phase. These participants were selected to allow for distribution across levels of acculturation, and each of them participated in interviews designed to explore QOL experiences. Interviews were analyzed to identify themes. The occurrence of themes is discussed as a function of level of acculturation. Results There is no clear relationship between acculturation and QOL. A strong nonsignificant correlation was observed between acculturation and stigma. QOL experiences, as identified from the interviews, were classified into 2 broad categories: emotional experiences (stigma, distrust, fear, frustration, religion, and impact) and swallow safety (symptoms, treatment, triggers, and compensatory strategies). Conclusions Level of acculturation did not relate to measures of mental health or fatigue. Yet, both quantitative and qualitative analyses support a relationship between level of acculturation, and symptom reporting and religion, as well as patient perception of stigma.

Gender differences in incidence and in-hospital outcomes of surgical aortic valve replacement in Spain, 2001–15

Background

we aim to examine trends in the incidence of surgical aortic valve replacement (SAVR) among women and men in Spain from 2001 to 2015; compare in-hospital outcomes for mechanical and bioprosthetic SAVR by gender and; to identify factors associated with in-hospital mortality (IHM) after SAVR.

Methods

We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001–15. We included patients that had SAVR as procedure in their discharge report. Propensity score matching (PSM) was performed to assess the impact of gender on the outcomes of mechanical and bioprosthetic SAVR.

Results

We identified 86 578 patients who underwent SAVR (40% women). Incidence of SVAR was higher in men (incidence rate ratio 1.57; 95%CI 1.55–1.59). In 2001, 73.36% of the men and 71.57% of women received a mechanical prosthesis; these proportions decreased to 43.04% in men and 35.89% in women in 2015, whereas bioprosthetic SAVR increased to 56.96% and 64.11%. After PSM we found that IHM was higher in women than in matched men for mechanical (8.94% vs. 6.79%; P < 0.001) and bioprosthetic (6.51 vs. 5.42%; P = 0.001) SAVR. The mean length of hospital stay was longer (19.54 vs. 18.74 days; P < 0.001) among females than males undergoing mechanical SAVR. Higher IHM after SAVR was associated with older age, comorbidities (except diabetes and atrial fibrillation), concomitant coronary artery bypass graft and emergency room admission.

Conclusions

This nation-wide analysis over 15 years of gender-specific outcomes after SAVR showed that, after PSM women have significantly higher IHM after mechanical and bioprosthetic SAVR than men.

Education level and health-related quality of life after oesophageal cancer surgery: a nationwide cohort study

OBJECTIVE

The purpose of the study was to investigate whether low education level was associated with patients' health-related quality of life (HRQOL) after oesophageal cancer resection.

SETTING

A nationwide cohort study in Sweden.

PARTICIPANTS

In total, 378 patients who underwent oesophageal cancer surgery in 2001-2005 were followed up 6 months and 3 years after surgery.

OUTCOME MEASURES

HRQOL was assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30) and the oesophageal cancer-specific module. The association between level of education and HRQOL was calculated with linear regression models, providing mean score differences (MD) and 95% CIs. Data were analysed separately for women and men.

RESULTS

Education level was not associated with HRQOL recovery after oesophageal cancer surgery. However, when data were stratified by sex, lower education was associated with worse emotional function (MD -13; 95% CI -22 to -3), more symptoms of insomnia (MD 20; 95% CI 8 to 32) and reflux (MD: 15; 95% CI 3 to 26) for women, but not for men. Among women, low education was in general associated with worse functioning and more symptoms.

CONCLUSIONS

Low education was not associated with worse HRQOL after oesophageal cancer surgery. However, when data were stratified for sex, low education level was associated with worse functioning and more symptoms in certain HRQOL domains for women, particularly in a short-term perspective. For men, no such association was found.

Quality of life in adults with lymphedema cholestasis syndrome 1

BACKGROUND

LCS1 (Lymphedema Cholestasis Syndrome 1/Aagenaes syndrome) is a rare, hereditary disorder, where the highest known prevalence is in Norway. The disorder is characterized by lymphedema and periodic cholestasis from birth or the neonatal period. This study aimed to examine internal reliability of the SF-36, in addition to the group's overall- and health related quality of life (OQoL and HRQoL) and psychosocial well-being.

METHODS

Twenty adults (aged 18-65) in Norway have been diagnosed with LSC1. Eighteen of these patients were included in the study and completed four questionnaires on overall and health related quality of life and psychosocial well-being: Cantril's Ladder (CL), The Kaasa Test, the SF-36, and a lymphedema anamnesis questionnaire. Demographic data were registered, and 15 of the patients underwent a physical examination of the lymphedema. SF-36 scores were compared with those of 360 age and gender matched controls drawn from an earlier survey of the Norwegian general population. The Mann-Whitney U test and Chi-square (χ²) test were used to test internal differences in the patient group.

RESULTS

Health-related quality of life (HRQOL) was significantly reduced in patients with LSC1 compared to controls, in three out of eight areas, role physical, general health and mental health. Females scored significantly better than males in the patient group in two areas of SF-36, in CL, and in one of three scales of The Kaasa Test. Severe lymphedema was found to be significantly correlated to bodily pain and reduced mental health. The level of education was positively correlated to mental health.

CONCLUSION

Overall quality of life (OQoL), health related quality of life (HRQoL) and psycho-social well-being were good in the patient group, but some dimensions of HRQoL were reduced. More severe extent of lymphedema was associated with poorer HRQoL.

Analysis of factors affecting baseline SF-36 Mental Component Summary in Adult Spinal Deformity and its impact on surgical outcomes

OBJECTIVES

To identify the factors that affect SF-36 mental component summary (MCS) in patients with adult spinal deformity (ASD) at the time of presentation, and to analyse the effect of SF-36 MCS on clinical outcomes in surgically treated patients.

METHODS

Prospectively collected data from a multicentric ASD database was analysed for baseline parameters. Then, the same database for surgically treated patients with a minimum of 1-year follow-up was analysed to see the effect of baseline SF-36 MCS on treatment results. A clinically useful SF-36 MCS was determined by ROC Curve analysis.

RESULTS

A total of 229 patients with the baseline parameters were analysed. A strong correlation between SF-36 MCS and SRS-22, ODI, gender, and diagnosis were found (p < 0.05). For the second part of the study, a total of 186 surgically treated patients were analysed. Only for SF-36 PCS, the un-improved cohort based on minimum clinically important differences had significantly lower mean baseline SF-36 MCS (p < 0.001). SF-36 MCS was found to have an odds ratio of 0.914 in improving SF-36 PCS score (unit by unit) (p < 0.001). A cut-off point of 43.97 for SF-36 MCS was found to be predictive of SF-36 PCS (AUC = 0.631; p < 0.001).

CONCLUSIONS

The factors effective on the baseline SF-36 MCS in an ASD population are other HRQOL parameters such as SRS-22 and ODI as well as the baseline thoracic kyphosis and gender. This study has also demonstrated that baseline SF-36 MCS does not necessarily have any effect on the treatment results by surgery as assessed by SRS-22 or ODI.

LEVEL OF EVIDENCE

Level III, prognostic study.

Quality of life of patients with first-time AMI: a descriptive study

Background

Outcomes following acute myocardial infarction (AMI) may result in death, increased morbidity, and change in quality of life (QOL). This study explores health-related QOL of first-time patients following AMI.

Methods

This cross-sectional study used a sample of patients with first-time AMI experienced between April 2011 and March 2015 at a tertiary health institution. Recruited patients belonged to different post-AMI periods: 2–10 weeks, 5–22 months, and > 22 months to 4 years post AMI. Inclusion criteria were not confused and communicating freely. Exclusion criteria were non-contactable, refusing to participate, and deceased. One-on-one interviews were conducted using the validated and pre-tested Quality of Life after Myocardial Infarction (QLMI) questionnaire. QOL of patients after AMI was evaluated at each period. Descriptive, Mann–Whitney U, Kruskal–Wallis, and regression analyses were conducted using SPSS version 24.

Results

A total of 534 participant interviews (overall response rate 65.4%) were conducted. Interviewees were predominantly male (67%), aged 51–65 years (45%), Indo-Trinidadian (81.2%), NSTEMI (64.4%), and hypertensive (72.4%). Overall QOL improved over time and in all domains: Emotional, Physical, and Social. Lower QOL was found among women, patients with NSTEMI, and diabetics in all domains; in patients with hypertension and renal disease in the Physical and Social domains only; and in patients with ischaemic heart disease (IHD) in the Physical domain only. Self-reported stress and lack of exercise were associated with lower QOL while drinking alcohol and eating out were related to better QOL. Hypercholesterolemia, smoking, and ethnicity showed no association with QOL. Declining QOL in the Physical domain with age was also found. The leading components of QOL were self-confidence and social exclusion (early post AMI), lack of self-confidence (intermediate post AMI), and tearfulness (late post AMI).

Conclusions

QOL in AMI survivors improves over time. Female gender, NSTEMI, diabetes, hypertension, renal disease, stress, and lack of exercise were associated with lower QOL while hypercholesterolemia, smoking, and ethnicity showed no association with QOL. Cardiac rehabilitation and psychological support may enhance earlier increased QOL among survivors, particularly among vulnerable groups.

Health related quality of life among myocardial infarction survivors in the United States: a propensity score matched analysis

Background

Little is known regarding the health-related quality of life among myocardial infarction (MI) survivors in the United States. The purpose of this population-based study was to identify differences in health-related quality of life domains between MI survivors and propensity score matched controls.

Methods

This retrospective, cross-sectional matched case-control study examined differences in health-related quality of life (HRQoL) among MI survivors of myocardial infarction compared to propensity score matched controls using data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. Propensity scores were generated via logistic regression for MI survivors and controls based on gender, race/ethnicity, age, body mass index (BMI), smoking status, and comorbidities. Chi-square tests were used to compare differences between MI survivors to controls for demographic variables. A multivariate analysis of HRQoL domains estimated odds ratios. Life satisfaction, sleep quality, and activity limitations were estimated using binary logistic regression. Social support, perceived general health, perceived physical health, and perceived mental health were estimated using multinomial logistic regression. Significance was set at p < 0.05.

Results

The final sample consisted of 16,729 MI survivors matched to 50,187 controls (n = 66,916). Survivors were approximately 2.7 times more likely to report fair/poor general health compared to control (AOR = 2.72, 95% CI: 2.43–3.05) and 1.5 times more likely to report limitations to daily activities (AOR = 1.46, 95% CI: 1.34–1.59). Survivors were more likely to report poor physical health >15 days in the month (AOR = 1.63, 95% CI: 1.46–1.83) and poor mental health >15 days in the month (AOR = 1.25, 95% CI: 1.07–1.46) compared to matched controls. There was no difference in survivors compared to controls in level of emotional support (rarely/never: AOR = 0.75, 95% CI: 0.48–1.18; sometimes: AOR = 0.73, 95% CI: 0.41–1.28), hours of recommended sleep (AOR = 1.14, 95% CI: 0.94–1.38), or life satisfaction (AOR = 1.62, 95% CI: 0.99–2.63).

Conclusion

MI survivors experienced lower HRQoL on domains of general health, physical health, daily activity, and mental health compared to the general population.

Sex differences in long-term mortality among acute myocardial infarction patients: Results from the ISAR-RISK and ART studies

BACKGROUND

Mortality rates in females who survived acute myocardial infarction (AMI) exceed those in males. Differences between sexes in age, cardiovascular risk factors and revascularization therapy have been proposed as possible reasons.

OBJECTIVE

To select sets of female and male patients comparable in respect of relevant risk factors in order to compare the sex-specific risk in a systematic manner.

METHODS

Data of the ISAR-RISK and ART studies were investigated. Patients were enrolled between 1996 and 2005 and suffered from AMI within 4 weeks prior to enrolment. Patients of each sex were selected with 1:1 equivalent age, previous AMI history, sinus-rhythm presence, hypertension, diabetes mellitus, smoking status, left ventricular ejection fraction (LVEF), and revascularization therapy. Survival times were compared between sex groups in the whole study cohort and in the matched cohort.

RESULTS

Of 3840 consecutive AMI survivors, 994 (25.9%) were females and 2846 (74.1%) were males. Females were older and suffered more frequently from hypertension and diabetes mellitus. In the whole cohort, females showed an increased mortality with a hazard ratio (HR) of 1.54 compared to males (p<0.0001). The matched cohort comprised 802 patients of each sex and revealed a trend towards poorer survival in females (HR for female sex 1.14; p = 0.359). However, significant mortality differences with a higher risk in matched females was observed during the first year after AMI (HR = 1.61; p = 0.045) but not during the subsequent years.

CONCLUSION

Matched sub-groups of post-AMI patients showed a comparable long-term mortality. However, a female excess mortality remained during first year after AMI and cannot be explained by differences in age, cardiovascular risk factors, and modes of acute treatment. Other causal factors, including clinical as well as psychological and social aspects, need to be considered. Female post-AMI patients should be followed more actively particularly during the first year after AMI.

Choosing the right rehabilitation setting after herniated disc surgery: Motives, motivations and expectations from the patients' perspective

Objectives

This study aims to investigate (1) motives, motivations and expectations regarding the choice for a specific rehabilitation setting after herniated disc surgery and (2) how rehabilitation-related motivations and expectations are associated with rehabilitation outcome (ability to work, health-related quality of life and satisfaction with rehabilitation) three months after disc surgery.

Methods

The longitudinal cohort study refers to 452 disc surgery patients participating in a subsequent rehabilitation. Baseline interviews took part during acute hospital stay (pre-rehabilitation), follow-up interviews three months later (post-rehabilitation). Binary logistic regression and multiple linear regression analyses were applied.

Results

(1) Motives, motivations and expectations: Inpatient rehabilitation (IPR) patients stated “less effort/stress” (40.9%), more “relaxation and recreation” (39.1%) and greater “intensity of care and treatment” (37.0%) regarding their setting preference, whereas outpatient rehabilitation (OPR) patients indicated “family reasons” (45.3%), the wish for “staying in familiar environment” (35.9%) as well as “job-related reasons” (11.7%) as most relevant. IPR patients showed significantly higher motivation/expectation scores regarding regeneration (p < .001), health (p < .05), coping (p < .001), retirement/job (p < .01), psychological burden (p < .05) and physical burden (p < .001) compared to OPR patients. (2) Associations with rehabilitation outcome: Besides other factors (e.g. age, gender and educational level) rehabilitation-related motivations/expectations were significantly associated with rehabilitation outcome measures. For example, patients with less motivations/expectations to achieve improvements regarding “physical burden” showed a better health-related quality of life (p < .01) three months after disc surgery. Less motivations/expectations to achieve improvements regarding “psychological burden” was linked to a better mental health status (p < .001) and a greater satisfaction with rehabilitation (OR = .806; p < .05).

Conclusion

Rehabilitation-related motivations and expectations differed substantially between IPR and OPR patients before rehabilitation and were significantly associated with rehabilitation outcome. Taking motivational and expectation-related aspects into account may help to improve allocation procedures for different rehabilitation settings and may improve rehabilitation success.

Construct Validity of the EUROHIS-QOL for Rehabilitation Assessment

The use of the EUROHIS as a brief measure of quality of life (QOL) in applied settings is increasingly commonplace, including in rehabilitation assessment contexts. However, there are concerns about the validity of data produced by the measure, chief amongst which is the latent structure underlying scores. This article reports on research conducted to investigate the dimensionality of scores derived from the EUROHIS. In addition, the factorial invariance of the retained model across gender as well as latent mean differences in QOL over age, employment status, and psychiatric severity were examined. Based on 251 responses to the EUROHIS by compensable accident victims, support was found for a complex one-factor model, which was found to be partially replicable across gender. Some evidence for differential item functioning across gender, age, and employment status was found. Finally, a U-shaped effect of age on QOL, characterized by a mid-life nadir, as well as effects of psychiatric severity on QOL, and a marginally significant effect of employment status were evident. Collectively, though the results of the present study yield validation data for the EUROHIS, they also raise concerns about the measure. We offer some tentative guidelines for working with the measure for both researchers and practitioners.

Socioeconomic inequalities in health-related quality of life between men and women, 5 years after a coronary angiography

Background

The aim of this study is to measure gender differences in health-related quality of life (HRQOL) among men and women patients with cardiovascular diseases (CVD), and to assess the impact of socioeconomic factors on HRQOL between men and women, 5 years after a coronary angiography.

Methods

The study included 1,289 out of 4,391 patients who had undergone an angiography in the National Institute for Cardiac Surgery and Interventional Cardiology, Luxembourg in 2008/2009. Four indicators of the WHOQOL-BREF questionnaire (Self-rated health, Quality of life, Physical health, and Psychological health) were used in this study as interest variables. To assess the socioeconomic inequalities in HRQOL between men and women, general linear models were constructed for every indicator, with educational level and living conditions as predictors, and demographic variables, cardiovascular risk factors, and cardiovascular events as covariates.

Results

Women were older than men (71.5 versus 68.1, p <0.0001) and less likely to be married. HRQOL was significantly different between men and women despite the fact they had the same socioeconomic status. The average score for overall health was 3.7/5 for men versus 3.5/5 for women; similarly, the life quality score was 3.8/5 for men versus 3.6/5 for women. Education level and living conditions were associated with lower HRQOL scores in men and women.

Conclusion

The findings showed that women have lower HRQOL than men regarding self-rated health, quality of life, and the WHOQOL-BREF physical and psychological domains 5 years after a coronary angiography. Socioeconomic inequalities affect HRQOL, and their influence was similar in both men and women. Socioeconomic inequalities in HRQOL in women and men with CVD are strong 5 years after a coronary angiography. Taking into account differences in gender and socioeconomic status in intervention strategies to substantially reduce the differences observed between women and men could help improve the effectiveness of secondary prevention.

Health status and health service utilization in remote and mountainous areas in Vietnam

BACKGROUND

Self-rated health status and healthcare services utilization are important indicators to evaluate the performance of health system. In disadvantaged areas, however, little is known about the access and outcomes of health care services. This study aimed to assess health-related quality of life (HRQOL), health status and healthcare access and utilization of residents in mountainous and remote areas in Vietnam.

METHODS

A cross-sectional study was conducted in a convenient sample of residents in two provinces of Vietnam. Information about socio-economic, health status, HRQOL, healthcare seeking and services utilization were interviewed. EuroQol - 5 Dimensions - 5 Levels (EQ-5D-5 L) was used to measure HRQOL.

RESULTS

Of 200 respondents, mean age was 44.9 (SD = 13.9), 38.0 % were male. One third reported having any problem in Mobility, Usual activities, Pain or Discomfort, Anxiety or Depression. Women tended to suffer more problems in Pain/Discomfort and Anxiety/Depression and lower overall HRQOL than men. Over 90 % of respondents reported at least one health problem. Flu, cold and headache were the most commonly reported symptoms (41.5 %). Most of people preferred community health center when they had illness (96.0 %). Only 18.5 % people used traditional healers with the average of 5.8 times per year. Ethnicity, households' expenditure, illness and morbidity status, difficulty in accessing health care services were related to HRQOL.; Meanwhile, socioeconomic status, health problems, quality of services, and distances were associated with access to healthcare and traditional medicine services.

CONCLUSIONS

Residents in difficult-to-reach areas had high prevalence of health problems and experienced social and structural barriers of healthcare services access. It is necessary to improve the availability and quality of healthcare and traditional medicine services to improve the health status of disadvantaged people.

Levels of depressive symptoms may modify the relationship between the WHOQOL-BREF and its determining factors in community-dwelling older adults

BACKGROUND

Depression is closely associated with quality of life (QOL) in older adults. Being elderly and exhibiting mild depressive symptoms may not lead to a depression diagnosis, but these attributes are clinically important. However, the extent to which these factors influence QOL and its determinants in older adults remains unclear.

METHODS

Questionnaires were administered to people aged 65 years or older at community senior centers in Taiwan to collect socio-demographic information and to assess results from the brief version of the World Health Organization's Quality of Life instrument (WHOQOL-BREF), Modified Barthel Index (MBI), 15-item Geriatric Depression Scale (GDS), and Mini-Mental State Examination (MMSE). Levels of depressive symptoms were classified as no depressive symptoms (NDS), lower level of depressive symptoms (LLDS), and higher level of depressive symptoms (HLDS), corresponding to GDS = 0, 1≦GDS≦5, and GDS>5, respectively. Multiple linear regression analyses were conducted to assess associations between the WHOQOL-BREF and its covariates for different levels of depressive symptoms.

RESULTS

A total of 454 older adults participated. The GDS and MBI scores significantly affected the WHOQOL-BREF physical and psychological domain scores in the LLDS group. Gender influenced the WHOQOL-BREF scores in the NDS group, and increased age demonstrated protective effects on the three domains in the HLDS group. Moreover, the association between the WHOQOL-BREF and its covariates varied for different levels of depressive symptoms.

CONCLUSIONS

Treatment for depressive symptoms is of high priority, and early recognition of and appropriate intervention for mild depressive symptoms may improve community-dwelling older adults' QOLs.

Multivariate Meta-Analysis of Preference-Based Quality of Life Values in Coronary Heart Disease

BACKGROUND

There are numerous health-related quality of life (HRQol) measurements used in coronary heart disease (CHD) in the literature. However, only values assessed with preference-based instruments can be directly applied in a cost-utility analysis (CUA).

OBJECTIVE

To summarize and synthesize instrument-specific preference-based values in CHD and the underlying disease-subgroups, stable angina and post-acute coronary syndrome (post-ACS), for developed countries, while accounting for study-level characteristics, and within- and between-study correlation.

METHODS

A systematic review was conducted to identify studies reporting preference-based values in CHD. A multivariate meta-analysis was applied to synthesize the HRQoL values. Meta-regression analyses examined the effect of study level covariates age, publication year, prevalence of diabetes and gender.

RESULTS

A total of 40 studies providing preference-based values were detected. Synthesized estimates of HRQoL in post-ACS ranged from 0.64 (Quality of Well-Being) to 0.92 (EuroQol European"tariff"), while in stable angina they ranged from 0.64 (Short form 6D) to 0.89 (Standard Gamble). Similar findings were observed in estimates applying to general CHD. No significant improvement in model fit was found after adjusting for study-level covariates. Large between-study heterogeneity was observed in all the models investigated.

CONCLUSIONS

The main finding of our study is the presence of large heterogeneity both within and between instrument-specific HRQoL values. Current economic models in CHD ignore this between-study heterogeneity. Multivariate meta-analysis can quantify this heterogeneity and offers the means for uncertainty around HRQoL values to be translated to uncertainty in CUAs.

The use of HeartQoL in patients with coronary heart disease: Association with risk factors and European reference values. The EUROASPIRE IV study of the European Society of Cardiology

BACKGROUND

HeartQoL is a recently developed core health-related quality of life instrument for patients with coronary heart disease. The current study aims to investigate its association with patients' coronary risk profile and to provide reference values for patients with coronary heart disease across Europe.

DESIGN

Analyses are based on the EUROASPIRE IV (EUROpean Action on Secondary and Primary prevention through Intervention to Reduce Events) cross-sectional survey.

METHODS

Patients with a diagnosis of coronary heart disease were examined and interviewed six months to three years after their coronary event. The HeartQoL questionnaire was completed by 7261 coronary heart disease patients. Reference values were calculated and the association with the coronary risk profile was assessed.

RESULTS

Significantly worse outcomes were observed in higher-risk patient groups. Both metabolic and behavioural risk factors were associated with worse HeartQoL outcomes. Further, the HeartQoL scores decreased as the number of risk factors increased. The mean global reference values in males were 2.27 ± 0.65 (<60 years), 2.30 ± 0.61 (between 60 and 69 years) and 2.19 ± 0.64 (≥70 years). Likewise, in females, the respective global HeartQoL reference values were 2.02 ± 0.67, 2.01 ± 0.66 and 1.83 ± 0.70. The ceiling effect in males was 11.4%, 10.4% and 7.4% for the three age classes respectively, whereas in females the ceiling effect was 5.2%, 3.5% and 1.9%, respectively.

CONCLUSION

HeartQoL scores were associated with patients' coronary risk profile. The reference values may help other researchers to interpret HeartQoL scores. Further research should focus on the minimal important difference needed to evaluate the effect of therapies and lifestyle changes.

Gender Differences in the Impact of Obesity on Health-Related Quality of Life

This study investigated the association between health-related quality of life (HRQoL) and obesity stratified by sex in 34 935 Korean adults. We used data from the Korea National Health and Nutrition Examination Survey, a cross-sectional, nationwide, population-based survey, from 2007 to 2012. Individuals with higher than average health value scores using the EQ-5D-3L to measure HRQoL were classified as being in good health. Multiple logistic regressions were used to determine the association between obesity and good health. Of the 34 935 adults, 28.0% (9767) were classified as obese, 3.8% (1326) as severely obese, and 23.6% (8249) as overweight. Through multiple logistic regressions after adjustments, women who were severely obese had 31% significantly lower HRQoL than women with normal weight (95% confidence interval = 1.12-1.53). However, the same trend was not found in men. Additional interventional studies would be needed to better understand the causality of the association between obesity and HRQoL in women.

Influence of age and gender in the normal values of Sino Nasal Outcome Test-22

OBJECTIVES

Sino Nasal Outcome Test (SNOT)-22 is a disease-specific outcomes measure questionnaire that combines rhinologic issues with general health issues. These issues may have variable weight on quality of life perception, and the influence of several factors such as gender, ethnicity, age, socio-cultural status and co-morbidities is unknown. The aim of this study was to evaluate the influence of gender and age on normal values of SNOT-22.

DESIGN

Cross-sectional study based on application of SNOT-22 questionnaires to healthy volunteers. Participants were divided according to gender, and each gender was subdivided into age groups: 18-30 years, 31-40 years, 41-50 years, 51-60 years and over 60 years.

SETTING

Rhinology Section, Sao Paulo Federal University.

PARTICIPANTS

A total of 539 healthy volunteers (253 men and 286 women) were selected, so that each age group of each gender consisted of at least 50 individuals.

MAIN OUTCOMES MEASURES

We applied SNOT-22 questionnaire to volunteers with no nasal or sinus disease. Median of score distribution was used as normal reference.

RESULTS

Men presented lower scores than women (7 versus 9, P = 0.005). Subjects over 60 years presented significantly lower scores than other age groups (18-30 years = 10; 31-40 years = 8; 41-50 years = 9; 51-60 years = 9; over 60 years = 7). Men presented lower scores than women especially in 41-50 year and 51-60 year groups.

CONCLUSION

Men and elderly presented the lowest Brazilian version SNOT-22 scores. The range of 0-8 points seemed to be more suitable as a normal value for this instrument, but this cut-off score could be tailored to age and gender specificities.

The influence of hospitalization or intensive care unit admission on declines in health-related quality of life

RATIONALE

Survivors of critical illness report impaired health-related quality of life (HRQoL) after hospital discharge, but the degree to which these impairments are attributable to critical illness is unknown.

OBJECTIVES

We sought to examine changes in HRQoL associated with an intensive care unit (ICU) stay and the differential association of type of hospitalization (critical illness versus noncritical illness) on changes in HRQoL.

METHODS

We identified 11,243 participants in the Ambulatory Care Quality Improvement Project (a multicenter randomized trial of Veterans conducted March 1997 to August 2000) completing at least two Medical Outcomes Study Short-Form 36 questionnaires over 2 years, and categorized patients by hospitalization status during the interval between measures. We used multiple linear regression with generalized estimating equations for analysis.

MEASUREMENTS AND MAIN RESULTS

Our primary outcome was change in the Physical Component Summary score. Participants requiring hospitalization or ICU admission had significantly worse baseline HRQoL than those not hospitalized (P < 0.001). Compared with patients who were not hospitalized, follow-up Physical Component Summary scores were lower among non-ICU hospitalized patients and ICU patients (adjusted β-coefficient = -1.40 [95% confidence interval, -1.81, -0.99] and adjusted β-coefficient = -1.53 [95% confidence interval, -2.11, -0.95], respectively), with no difference between the two groups (P value = 0.80). Similar results were seen for the Mental Component Summary score and each of the Medical Outcomes Study Short-Form 36 subdomains.

CONCLUSIONS

Prehospital HRQoL is a significant determinant of HRQoL after hospitalization or ICU admission. Hospitalization is associated with increased risk of impairment in HRQoL after discharge, yet the overall magnitude of this reduction is small and similar between non-ICU hospitalized and critically ill patients.

Personal Strengths and Health Related Quality of Life in Dementia Caregivers from Latin America

The research literature has begun to demonstrate associations between personal strengths and enhanced psychosocial functioning of dementia caregivers, but these relationships have not been examined in the context of dementia caregivers in Latin America. The present study examined whether personal strengths, including resilience, optimism, and sense of coherence, were associated with mental and physical health related quality of life (HRQOL) in 130 dementia caregivers in Mexico and Argentina. Structural equation modeling found that the personal strengths collectively accounted for 58.4% of the variance in caregiver mental HRQOL, and resilience, sense of coherence, and optimism each had unique effects. In comparison, the personal strengths together accounted for 8.9% of the variance in caregiver physical HRQOL, and only sense of coherence yielded a unique effect. These results underscore the need to construct and disseminate empirically supported interventions based in part on important personal strengths, particularly sense of coherence, for this underrepresented group.

Gender differences in the trajectory of recovery in health status among young patients with acute myocardial infarction: results from the variation in recovery: role of gender on outcomes of young AMI patients (VIRGO) study

BACKGROUND

Despite the excess risk of mortality in young women (≤55 years of age) after acute myocardial infarction (AMI), little is known about young women's health status (symptoms, functioning, quality of life) during the first year of recovery after an AMI. We examined gender differences in health status over time from baseline to 12 months after AMI.

METHODS AND RESULTS

A total of 3501 AMI patients (67% women) 18 to 55 years of age were enrolled from 103 US and 24 Spanish hospitals. Data were obtained by medical record abstraction and patient interviews at baseline hospitalization and 1 and 12 months after AMI. Health status was measured by generic (Short Form-12) and disease-specific (Seattle Angina Questionnaire) measures. We compared health status scores at all 3 time points and used longitudinal linear mixed-effects analyses to examine the independent effect of gender, adjusting for time and selected covariates. Women had significantly lower health status scores than men at each assessment (all P values <0.0001). After adjustment for time and all covariates, women had Short Form-12 physical/mental summary scores that were -0.96 (95% confidence interval [CI], -1.59 to -0.32) and -2.36 points (95% CI, -2.99 to -1.73) lower than those of men, as well as worse Seattle Angina Questionnaire physical limitations (-2.44 points lower; 95% CI, -3.53 to -1.34), more angina (-1.03 points lower; 95% CI, -1.98 to -0.07), and poorer quality of life (-3.51 points lower; 95% CI, -4.80 to -2.22).

CONCLUSION

Although both genders recover similarly after AMI, women have poorer scores than men on all health status measures, a difference that persisted throughout the entire year after discharge.

Autoimmune blistering diseases in females: a review

The autoimmune blistering diseases (AIBDs) are a group of heterogeneous skin diseases with autoantibodies directed against structural proteins in the skin. A new interest in the female bias towards autoimmune diseases in general has led to our attention to focus on how and why this female bias manifests in AIBD. The authors aim to review and explore the various aspects of AIBD affecting females more than males, including the higher prevalence, worse quality of life, and complex management issues such as pregnancy and lactation.

What is already known on this topic?

•

Echoing autoimmune diseases in general, most autoimmune blistering diseases (AIBDs) have a female predominance, but the exact level of predominance is unknown.

•

Pregnancy raises several complicated management issues for females with an AIBD.

What does this article add to our knowledge?

•

Review of sex-specific epidemiology and etiology of each AIBD.

•

Exploration and explanation of the key factors underlying the detrimental impacts of AIBD on women’s quality of life (QOL).

•

Discussion of management issues in pregnancy and lactation for females with an AIBD.

How does this information impact clinical practice and/or change patient care?

•

An awareness and understanding of the female predominance in AIBDs will ensure more appropriate diagnosis, evaluation, and future research.

•

Emphasizing holistic care targeting the debilitating effects of AIBDs on women’s QOL.

•

Informing the reader of optimal, yet safe interventions for pregnant women with an AIBD.

Gender differences in pre-event health status of young patients with acute myocardial infarction: A VIRGO study analysis

AIMS

We assessed gender differences in pre-event health status (symptoms, functioning, quality of life) in young patients with acute myocardial infarction and whether or not this association persists following sequential adjustment for important covariates. We also evaluated the interaction between gender and prior coronary artery disease, given that aggressive symptom control is a cornerstone of care in those with known coronary disease.

METHODS AND RESULTS

A total of 3501 acute myocardial infarction patients (2349 women) aged 18-55 years were enrolled from 103 US/24 Spanish hospitals (2008-2012). Clinical/health status information was obtained by medical record abstraction and patient interviews. Pre-event health status was measured by generic (Short Form-12, EuroQoL) and disease-specific (Seattle Angina Questionnaire) measures. T-test/chi-square and multivariable linear/logistic regression analysis was utilized, sequentially adjusting for covariates. Women had more co-morbidities and significantly lower generic mean health scores than men (Short Form-12 physical health = 43 ± 12 vs. 46 ± 11 and mental health = 44 ± 13 vs. 48 ± 11); EuroQoL utility index = 0.7 ± 0.2 vs. 0.8 ± 0.2 and visual analog scale = 63 ± 22 vs. 67 ± 20, P < 0.0001 for all. Their disease-specific health status was also worse, with more angina (Seattle Angina Questionnaire angina frequency = 83 ± 22 vs. 87 ± 18), worse physical function (physical limitation = 78 ± 27 vs. 87 ± 21) and poorer quality of life (55 ± 25 vs. 60 ± 22, P<0.0001 for all). In multivariable analysis, the association between female gender and worse generic physical/mental health persisted, as well as worse disease-specific physical limitation and quality of life. The interaction between gender and prior coronary artery disease was not significant in any of the health status outcomes.

CONCLUSION

Young women have worse pre-event health status as compared with men, regardless of their coronary artery disease history. While future studies of gender differences should adjust for baseline health status, an opportunity may exist to better address the pre-event health status of women at risk for acute myocardial infarction.

Effect of low perceived social support on health outcomes in young patients with acute myocardial infarction: results from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study

Background

Social support is an important predictor of health outcomes after acute myocardial infarction (AMI), but social support varies by sex and age. Differences in social support could account for sex differences in outcomes of young patients with AMI.

Methods and Results

Data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, an observational study of AMI patients aged ≤55 years in the United States and Spain, were used for this study. Patients were categorized as having low versus moderate/high perceived social support using the ENRICHD Social Support Inventory. Outcomes included health status (Short Form‐12 physical and mental component scores), depressive symptoms (Patient Health Questionnaire), and angina‐related quality of life (Seattle Angina Questionnaire) evaluated at baseline and 12 months. Among 3432 patients, 21.2% were classified as having low social support. Men and women had comparable levels of social support at baseline. On average, patients with low social support reported lower functional status and quality of life and more depressive symptoms at baseline and 12 months post‐AMI. After multivariable adjustment, including baseline health status, low social support was associated with lower mental functioning, lower quality of life, and more depressive symptoms at 12 months (all P<0.001). The relationship between low social support and worse physical functioning was nonsignificant after adjustment (P=0.6). No interactions were observed between social support, sex, or country.

Conclusion

Lower social support is associated with worse health status and more depressive symptoms 12 months after AMI in both young men and women. Sex did not modify the effect of social support.

Health-related quality of life in premature acute coronary syndrome: does patient sex or gender really matter?

Background

Limited data exist as to the relative contribution of sex and gender on health‐related quality of life (HRQL) among patients with acute coronary syndrome (ACS). This study aims to evaluate the effect of sex and gender‐related variables on long‐term HRQL among young adults with ACS.

Methods and Results

GENESIS‐PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond‐Premature Acute Coronary SYndrome) is a multicenter, prospective cohort study (January 2009 to August 2013) of adults aged 18 to 55 years, hospitalized with ACS. HRQL was measured at baseline, 1, 6, and 12 months using the Short Form‐12 and Seattle Angina Questionnaire (SAQ) among 1213 patients. Median age was 49 years. Women reported worse HRQL than men over time post‐ACS, both in terms of physical and mental functioning. Gender‐related factors were more likely to be predictors of HRQL than sex. Femininity score, social support, and housework responsibility were the most common gender‐related predictors of HRQL at 12 months. We observed an interaction between female sex and social support (β=0.44 [95% confidence interval, 0.01, 0.88]; P=0.047) for the physical limitation subscale of the SAQ.

Conclusions

Young women with ACS report significantly poorer HRQL than young men. Gender appears to be more important than sex in predicting long‐term HRQL post‐ACS. Specific gender‐related factors, such as social support, may be amenable to interventions and could improve the HRQL of patients with premature ACS.

Self-reported health status in coronary heart disease patients: a comparison with the general population

BACKGROUND

The aim of our study was to compare Euroqol-5D (EQ-5D) outcomes in coronary heart disease (CHD) patients with those from the general population. We aimed to identify those dimensions which were mostly impaired.

METHODS

EQ-5D results (both the dimensions and the EQ-5D visual analogue scale (EQ-VAS)) from a European sample (11 countries) of coronary patients were compared with published age- and gender-specific normative data.

RESULTS

EQ-5D outcomes differed across countries and gender. Overall, the age-adjusted EQ-VAS scores were significantly lower in coronary patients compared with the general population, both in males (mean difference (MD)= -5.24(-7.59 to -2.88)) and in females (MD= -8.32 (-11.69 to -4.95)). Coronary patients had a significantly higher risk to report moderate or severe problems related to anxiety/depression (odds ratio (OR) male=1.84 (1.14-2.95); OR female=3.20 (2.32-4.40)). Furthermore, female coronary patients reported more problems on the mobility (OR=2.00 (1.38-2.90)), usual activity (OR= 2.54 (1.81-3.57)) and pain/discomfort dimension (OR=1.73 (1.23-2.43)) whereas in males, a borderline significant OR was found on the mobility (OR=1.43 (0.97-2.11)) and usual activity dimension (OR=1.44 (0.94-2.20)). The difference between the general population and the CHD patients attenuated as age increased.

CONCLUSIONS

CHD has a negative influence on patient's self-reported health status, both the EQ-VAS as well as the EQ-5D dimensions (with the exception of self-care in both genders and pain/discomfort in males) were impaired. The relative impairment was the greatest in female patients and the differences in the proportion of reported problems diminished with increasing age. The EQ-5D instrument is appropriate in capturing problems related to anxiety/depression, pain/discomfort, mobility and usual activities. Within clinical practice, particular attention should be given to females and younger CHD patients.

Health-related quality of life and sense of coherence among people with obesity: Important factors for health management

OBJECTIVES

The purpose of this study was to evaluate whether health-related quality of life and levels of sense of coherence among people with obesity are correlated with body mass index, age, and gender.

METHODS

A cross-sectional, descriptive research design was used. Subjects (n = 157) were selected from a sample of participants in an ongoing survey and had a body mass index >30 kg/m(2). Data were collected using the Short Form-36 Health Survey and the Sense of Coherence Scale.

RESULTS

The mean body mass index of women was higher than that of men. Compared to men, a greater proportion of women had a low sense of coherence. There was a significant relationship between low physical health and high body mass index. Female gender and older age correlated with a low sense of coherence and showed a significant association with high body mass index.

CONCLUSION

To increase the health-related quality of life, people with obesity need support to help manage their life situation based on their individual needs and personal resources.

Does health status affect perceptions of factors influencing dignity at the end of life?

CONTEXT

More people are surviving into old age, and chronic diseases tend to become more common with age. Ill health and disability can lead to concerns about loss of personal dignity.

OBJECTIVES

To investigate whether health status affects the perceptions of factors influencing personal dignity at the end of life, and the relationship between those perceptions and sociodemographic characteristics.

METHODS

A subsample (n=2282) of a large advance directives cohort study was used. Three different health status groups (good, moderate, and poor) were defined based on the Euroqol-5D and a question on whether they had an illness. For each health status group, we calculated the percentage of respondents who indicated the extent to which the items of the Patient Dignity Inventory would influence their dignity as (very) large. Logistic regression analyses were used to investigate the associations between the perceptions of factors influencing personal dignity and sociodemographics.

RESULTS

The percentage of respondents who indicated the factors as having a (very) large influence on dignity at the end of life were not significantly different for the three health status groups, except for three physical items on symptoms, roles, and routines. Those items were significantly more influential on dignity for people with a poor health status. Gender, old age, having a partner, and having a belief or religion that is important to one's life were associated with an understanding of factors influential to dignity.

CONCLUSION

Health status seems only to affect the perceptions of physical factors maintaining dignity at the end of life. This might suggest that the understanding of dignity will not substantially change as health status changes and may support starting advance care planning early.