Associations of lifestyle factors, disease history and awareness with health-related quality of life in a Thai population

Active Ageing Awareness and Quality of Life among Pre-Elder Malaysian Public Employees

Increasing life expectancy has led to a global rise in late-life diseases. Quality of Life (QOL) is important for healthy life expectancy. The active ageing framework serves as a guide for policymakers to design policies that enhance the QOL of older people. This study aims to determine the association between awareness of active ageing and QOL. The Malay version of the 26-item WHOQOL-BREF questionnaire was utilised along with the 14-item Active Ageing Awareness Questionnaire (AAAQ). A total of 532 participants had a mean (SD) age of 50.2 (5.9), were largely ethnic Malay (96.2%), female (52.8%), and comprised largely of low-income households (65.4%). The median (IQR) AAAQ score was 71.4 (19.1). The hierarchical multiple regression analysis revealed significant positive association between AAAQ and the QOL domains of physical (β = 0.154, p < 0.001), psychological (β = 0.196, p < 0.001), social relationship (β = 0.175, p < 0.001), and environment (β = 0.145, p < 0.001) after adjusting for all covariates. Awareness of active ageing was found to have a positive effect on all domains of QOL among pre-elder employees, and thus, we recommend that policies to improve active ageing awareness should be implemented for healthy life expectancy in ageing populations.

Comparing different definitions of prediabetes with subsequent risk of diabetes: an individual participant data meta-analysis involving 76 513 individuals and 8208 cases of incident diabetes

Objective

There are currently five widely used definition of prediabetes. We compared the ability of these to predict 5-year conversion to diabetes and investigated whether there were other cut-points identifying risk of progression to diabetes that may be more useful.

Research design and methods

We conducted an individual participant meta-analysis using longitudinal data included in the Obesity, Diabetes and Cardiovascular Disease Collaboration. Cox regression models were used to obtain study-specific HRs for incident diabetes associated with each prediabetes definition. Harrell's C-statistics were used to estimate how well each prediabetes definition discriminated 5-year risk of diabetes. Spline and receiver operating characteristic curve (ROC) analyses were used to identify alternative cut-points.

Results

Sixteen studies, with 76 513 participants and 8208 incident diabetes cases, were available. Compared with normoglycemia, current prediabetes definitions were associated with four to eight times higher diabetes risk (HRs (95% CIs): 3.78 (3.11 to 4.60) to 8.36 (4.88 to 14.33)) and all definitions discriminated 5-year diabetes risk with good accuracy (C-statistics 0.79-0.81). Cut-points identified through spline analysis were fasting plasma glucose (FPG) 5.1 mmol/L and glycated hemoglobin (HbA1c) 5.0% (31 mmol/mol) and cut-points identified through ROC analysis were FPG 5.6 mmol/L, 2-hour postload glucose 7.0 mmol/L and HbA1c 5.6% (38 mmol/mol).

Conclusions

In terms of identifying individuals at greatest risk of developing diabetes within 5 years, using prediabetes definitions that have lower values produced non-significant gain. Therefore, deciding which definition to use will ultimately depend on the goal for identifying individuals at risk of diabetes.

Association Between Self-Care Behaviors and Quality of Life Among Elderly Minority Groups on the Border of Thailand

Introduction

Quality of life among the elderly is an important public health issue. However, few studies have examined the health and quality of life among ethnic minority groups. This research aimed to study the association between self-care behaviors and quality of life among the elderly from ethic minority groups living along the borders of Thailand.

Methods

Three provinces from the northern part of Thailand, including Tak, Nan, and Phayao, were selected for the area of study. The purposive method was employed to select districts within the province. Simple random sampling was used to select samples. A total number of 810 elderly citizens were recruited from ethnic minority groups as a research sample. The assessment questionnaire WHOQOL-OLD was used for interviewing the elderly.

Results

The mean age of the elderly in our sample was 68.3 years, representing ethnic groups of Lua (30.9%), Karens (24.6%), Tai Lue (23.3%), and Tai Hmong (21.2%). The level of self-care behaviors of these elderly was moderate (49.5%), low (45.9%), and high (4.6%). More than half of them exhibited the quality of life at a moderate level (69.1%) and low level (26.5%); only a few demonstrated a high level (4.4%). Linear regression analysis revealed that self-care behaviors were positively significantly related to the quality of life among ethnic groups (p-value<0.001). Other variables such as age, ethnic group, education, incurrent disease, and smoking were associated with quality of life among the elderly (p-value<0.05).

Conclusion

Health promotion to improve health and self-care behaviors among the elderly living along the borders of Thailand should be encouraged through the culture, tradition, and beliefs of particular ethnic groups. Proactive health services and health awareness should be promoted by health agencies and related organizations in order to improve the health, well-being, and quality of life among the elderly people from ethnic minority groups.

Correlates of physical activity and sedentary behaviour in the Thai population: a systematic review

BACKGROUND

Given the importance of knowing the potential impediments and enablers for physical activity (PA) and sedentary behaviour (SB) in a specific population, the aim of this study was to systematically review and summarise evidence on individual, social, environmental, and policy correlates of PA and SB in the Thai population.

METHODS

A systematic review of articles written in Thai and English was conducted. Studies that reported at least one correlate for PA and/or SB in a healthy Thai population were selected independently by two authors. Data on 21 variables were extracted. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 25,007 records were screened and 167 studies were included. The studies reported associations with PA for a total of 261 variables, mostly for adults and older adults. For most of the variables, evidence was available from a limited number of studies. Consistent evidence was found for individual-level and social correlates of PA in children/adolescents and adults and for individual-level correlates of PA in older adults. Self-efficacy and perceived barriers were consistently associated with PA in all age groups. Other consistently identified individual-level correlates in adults and older adults included self-rated general health, mental health, perceived benefits, and attitudes towards PA. Consistent evidence was also found for social correlates of PA in adults, including social support, interpersonal influences, parent/family influences, and information support. The influence of friendship/companionship was identified as a correlate of PA only in children/adolescents. A limited number of studies examined SB correlates, especially in older adults. The studies reported associations with SB for a total of 41 variables. Consistent evidence of association with SB was only found for obesity in adults. Some evidence suggests that male adults engage more in SB than females.

CONCLUSIONS

More Thai studies are needed on (i) PA correlates, particularly among children/adolescents, and that focus on environment- and policy-related factors and (ii) SB correlates, particularly among older adults. Researchers are also encouraged to conduct longitudinal studies to provide evidence on prospective and causal relationships, and subject to feasibility, use device-based measures of PA and SB.

Quality of life and associated factors in Brazilian women with chronic pelvic pain

Background

Chronic pelvic pain (CPP) is a common and debilitating clinical condition in women.

Objectives

The aim of this study was to compare the quality of life (QoL) of women with and without CPP and to investigate factors associated with the QoL of women with CPP.

Patients and methods

A cross-sectional study was conducted with 100 women with CPP and 100 women without CPP. QoL was evaluated using the abbreviated version of the World Health Organization QoL instrument (WHOQOL-BREF). Depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale, and sexual function was evaluated using the Female Sexual Function Index. Generalized linear models were used to analyze the data, permitting comparison of QoL scores and identification of the factors affecting QoL.

Results

Mean age (± SD) was 37.8±8.0 and 37.2±9.6 years for women with and without CPP, respectively (P=0.648). Following adjustment, women with CPP had significantly lower QoL scores in the physical health (P<0.001) and social relationships’ (P=0.025) domains. Anxiety, depression, sexual dysfunction, hypertension, diabetes mellitus, pain intensity, lower family income, and not having a partner were factors negatively associated with QoL, while being postmenopausal, being employed, and having a child were positively associated with QoL in women with CPP.

Conclusion

Women with CPP had poorer QoL than those without CPP. Factors affecting the QoL of women with CPP were identified, some for the first time in this population of women. Interventions targeting these factors may prove effective in minimizing the negative repercussion of CPP on QoL.

Physical activity and sedentary behaviour research in Thailand: a systematic scoping review

BACKGROUND

The number of deaths per year attributed to non-communicable diseases is increasing in low- and middle-income countries, including Thailand. To facilitate the development of evidence-based public health programs and policies in Thailand, research on physical activity (PA) and sedentary behaviour (SB) is needed. The aims of this scoping review were to: (i) map all available evidence on PA and SB in Thailand; (ii) identify research gaps; and (iii) suggest directions for future research.

METHODS

A systematic literature search was conducted through 10 bibliographic databases. Additional articles were identified through secondary searches of reference lists, websites of relevant Thai health organisations, Google, and Google Scholar. Studies written in Thai or English were screened independently by two authors and included if they presented quantitative or qualitative data relevant to public health research on PA and/or SB.

RESULTS

Out of 25,007 screened articles, a total of 564 studies were included in the review. Most studies included PA only (80%), 6.7% included SB only, and 13.3% included both PA and SB. The most common research focus was correlates (58.9%), followed by outcomes of PA/SB (22.2%), prevalence of PA/SB (12.4%), and instrument validation (3.2%). Most PA/SB research was cross-sectional (69.3%), while interventions (19.7%) and longitudinal studies (2.8%) were less represented. Most studies (94%) used self-reports of PA/SB, and few (2.5%) used device-based measures. Both sexes were examined in most studies (82.5%). Adults were the main target population group (51.1%), followed by older adults (26.9%), adolescents (15.7%), and children (6.3%). Clinical populations were investigated in the context of PA/SB in a relatively large number of studies (15.3%), most frequently those with cardiovascular disease, diabetes, and hypertension (22%, 21%, and 21% respectively).

CONCLUSIONS

The number of Thai papers on PA published per year has been increasing, indicating a growing interest in this research area. More studies using population-representative samples are needed, particularly among children and adolescents, and investigating SB as a health risk factor. To provide stronger evidence on determinants and outcomes of PA/SB, longitudinal studies using standardised measures of PA and SB are required.

Sociodemographic factors, level of physical activity and health-related quality of life in adults from the north-east of São Paulo, Brazil: a cross-sectional population study

OBJECTIVE

To verify the association among sociodemographic variables, physical activity level and health-related quality of life in adults aged 20 years and over.

METHODS

Population-based study, with household sample by clusters. The dependent variables were the PCS and MCS scores of the instrument 36-Item Short-Form Health Survey (SF-36), the independent variables were gathered in sociodemographic characteristics and the level of physical activity. Absolute and relative frequency distributions were used for categorical variables and bivariate analysis, using Student's t-test and ANOVA and multivariate using non-conditional logistic regression.

RESULTS

Of the 600 interviewees, the mean PCS score for men was 80.2 and for women 74.6, while for MCS, 83.8 (±16.9) and 76.5 (±23.3), for men and women, respectively. Women tend to report lower scores than men in all domains: men (OR=4.83) and women (OR=4.80) were older (OR=4.34) (OR=3.57) and sedentary women (OR=1.90) were associated with lower PCS scores, while older men (OR=3.96) and widowed and separated' (OR=3.03) had lower MSC scores.

CONCLUSION

HRQoL was associated with advancing age and schooling, in both sexes, sedentary women and widowed and separated men.

Health behavior and health-related quality of life in patients with a high risk of cardiovascular disease

Background

Health-related quality of life (HRQoL) is measuring a patient’s experience of his health status and represents an outcome of medical interventions. Existing data proves that a healthy lifestyle is positively associated with HRQoL in all age groups. Patients with a high risk for cardiovascular disease typically led an unhealthy lifestyle combined with risk diseases. We aimed to analyse these characteristics and their reflection in HRQoL.

Methods

A cross-sectional study in 36 family practices, stratified by location and size. Each practice invited 30 high-risk patients from the register. Data were obtained from medical records and patient questionnaire. The EQ-5D questionnaire and the VAS scale were used for measuring the patient’s HRQoL as an independent variable.

Results

871 patients (80.6% response rate) were included in the analysis. 60.0% had 3-4 uncontrolled risk factors for CVD. The average VAS scale was 63.2 (SD 19.4). The correlation of EQ-5D was found in the number of visits in the practice (r=-0.31, p<0.001), the socioeconomic status (r=-0.25, p=0.001), age (r=-0.27, p=0.001) and healthy diet (r=0.20, p=0.006). In a multivariate model, only physical activity among lifestyle characteristics was an independent predictor of HRQoL (p=0.001, t=3.3), along with the frequency of visits (p<0.001, t=-5.3) and age (p=0.025, t=-2.2).

Conclusion

This study has been performed on a specific group of patients, not being “really sick”, but having less optimal lifestyle in many cases. Encouragement to improve or keep healthy lifestyle, especially physical activity, is important, not only to lower the risk for CVD, but also to improve HRQoL.

Health Behavior and Health-related Quality of Life in Patients with a High Risk of Cardiovascular Disease

Background

Health-related quality of life (HRQoL) is measuring a patient’s experience of his health status and represents an outcome of medical interventions. Existing data proves that a healthy lifestyle is positively associated with HRQoL in all age groups. Patients with a high risk for cardiovascular disease typically led an unhealthy lifestyle combined with risk diseases. We aimed to analyse these characteristics and their reflection in HRQoL.

Methods

A cross-sectional study in 36 family practices, stratified by location and size. Each practice invited 30 high-risk patients from the register. Data were obtained from medical records and patient questionnaire. The EQ-5D questionnaire and the VAS scale were used for measuring the patient’s HRQoL as an independent variable.

Results

871 patients (80.6% response rate) were included in the analysis. 60.0% had 3-4 uncontrolled risk factors for CVD. The average VAS scale was 63.2 (SD 19.4). The correlation of EQ-5D was found in the number of visits in the practice (r=-0.31, p<0.001), the socioeconomic status (r=-0.25, p=0.001), age (r=-0.27, p=0.001) and healthy diet (r=0.20, p=0.006). In a multivariate model, only physical activity among lifestyle characteristics was an independent predictor of HRQoL (p=0.001, t=3.3), along with the frequency of visits (p<0.001, t=-5.3) and age (p=0.025, t=-2.2).

Conclusion

This study has been performed on a specific group of patients, not being “really sick”, but having less optimal lifestyle in many cases. Encouragement to improve or keep healthy lifestyle, especially physical activity, is important, not only to lower the risk for CVD, but also to improve HRQoL.

The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: a cross-sectional study

Background

Hypertension is a common and frequently occurring chronic disease of the cardiovascular system. Besides the pathological factors, the occurrence and exacerbation of hypertension are also associated with many factors of lifestyle and behaviors. Thus hypertensive patients’ Health-related quality of life (HRQL) is not only influenced by the disease itself but also by many subjective factors such as health literacy and self-management efficacy, especially in the deeper part of southwestern China and thus is less developed compared to the other places. The purpose of this study was to examine the association between the HRQL of hypertensive patients and health literacy and self-management efficacy as well as how they affect the HRQL, so as to provide a theoretical reference for improving the HRQL of patients with hypertension in less developed areas.

Methods

This was a cross-sectional study of baseline data from a clustered randomized controlled trial. The study design had passed a cross-national peer review and accepted grants by the China Medical Board. It was also registered in the Chinese Clinical Trial Registry (ChiCTR-OOR-14005563).

A standardized questionnaire adapted from a previous validated WHO questionnaire was used for the survey which included detailed questions about patient’s socio-demographic characteristics and self-reported information.

Patients’ HRQL was measured by the Mandarin version of the 36-item Short Form. We used the validated Mandarin version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale to assess patients’ self-management efficacy. The validated three-item Brief Health Literacy Screening (BHLS) was used to measure the patients’ health literacy.

A structural equation model was constructed, and p ≤ 0.05 was taken as significant.

Results

Demographic characteristics, health literacy and self-management efficacy have all significant effects on HRQL. Age, education level, self-management efficacy and health literacy were significantly related to the HRQL. The constructed model had a good fit for the data according to the model fit indices. Based on the model, health literacy (r = 0.604, p = 0.029) and Self-management efficacy (r = 0.714, p = 0.018) have a significant impact on HRQL. Demographic characteristics were inversely related to HRQL (r = −0.419, p = 0.007), but have a significant impact on health literacy (r = 0.675, p = 0.029) and self-management efficacy (r = 0.379, p = 0.029). At the same time, self-management efficacy was positively correlated to health literacy (r = 0.413, p < 0.01).

Conclusions

Age, education level, self-management efficacy and health literacy were all related to the HRQL of patient with hypertension, which means that patients who are more elderly and have lower education level, low self-management efficacy and poor health literacy get worse HRQL. This may imply the necessary to introduce routine assessment of health literacy and self-management efficacy into assessment procedures for hypertensive patients’ health management. Such assessment can help professionals to identify the population at greatest risk for poor health outcomes and low well-being in the future. In clinical practice, effective interventions such as direct guidance and education to raise the self-management efficacy and enhance health literacy might improve the HRQL of patients with hypertension.

Trial registration

Retrospectively registered Chinese Clinical Trial Registry (ChiCTR-OOR-14005563).

Name of registry: Effects of the integrated delivery system and payment system of community-based intervention on rural patients of chronic diseases in Qianjiang District, China

Date of registration: Retrospectively registered 23 November 2014.

Date of enrolment of the first participant to the trial: 5 July 2012

Imprisoned in the Cultural Stereotypes of Overactive Bladder: Cultural Meanings of Disease and Sick Role Adaptation in Hong Kong

BACKGROUND

Diseases often carry cultural meanings and metaphors, and these meanings can influence illness experiences and behavioral responses.

OBJECTIVES

This research investigated how old cultural stereotypes and new social understandings of overactive bladder (OAB) intertwined to influence sick role adaptation and behavioral responses among those with OAB.

METHODS

A qualitative approach using in-depth individual, semistructured interviews was adopted. Thirty patients having OAB were purposively sampled from a patient self-help group for people with OAB.

RESULTS

The cultural stereotypes about OAB-as an "old people" disease, as a hopeless disease without cure, as a sexually related disease, and as a disease of substance use-had significant impact on the social and illness experiences of participants, leading to difficulty in adapting to their sick role, indicated by behavioral responses of denial, concealment, resignation, and self-seclusion.

DISCUSSION

Cultural stereotypes of OAB significantly influenced sick role adaptation, which affected illness experiences of persons with OAB. These cultural stereotypes were associated with behavioral responses that led to difficulties in coping with OAB.

Effects of a psychological intervention on the quality of life of obese adolescents under a multidisciplinary treatment

OBJECTIVE

To investigate the effects of multidisciplinary treatment with and without psychological counseling on obese adolescents' self-reported quality of life.

METHODS

Seventy-six obese adolescents (15.87±1.53 y) were allocated into psychological counseling group (PCG; n=36) or control group (CG; n=40) for 12 weeks. All participants received the same supervised exercise training, nutritional and clinical counseling. Participants in PCG also received psychological counseling. QOL was measured before and after 12 weeks of intervention by Generic Questionnaire for the Evaluation of Quality of Life (SF-36).

RESULTS

The dropout rate was higher in GC (22.5%) when compared with PCG (0.0%) (p<0.001). After 12 weeks, participants from PCG presents lower body weight, relative fat mass and higher free fat mass (p<0.001 for all) compared to GC. QOL improved among adolescents from both groups (p<0.05), however, a better QOL was reported from those adolescents enrolled in PCG.

CONCLUSION

The inclusion of a psychological counseling component in multidisciplinary treatment for adolescent obesity appears to provide benefits observed for improved QOL as compared with treatment without psychological counseling.

Morbidades referidas e qualidade de vida: estudo de base populacional

RESUMO O objetivo deste trabalho foi verificar o nível de qualidade de vida relacionada à saúde (QVRS) em uma amostra de base populacional de adultos de 20 anos ou mais, residentes na cidade de Bauru, São Paulo, e sua associação com a quantidade de morbidades referidas. Foi realizado um inquérito populacional, por meio de uma amostragem complexa em dois estágios, totalizando 600 participantes da zona urbana de Bauru. Para a coleta de dados foram utilizados os seguintes instrumentos: 1. caracterização dos participantes (aspectos demográficos, socioeconômicos, nível de atividade física e hábito de fumar); 2. morbidade (referida por meio da pergunta: "No último ano, o (a) sr. (a) recebeu diagnóstico médico de alguma doença?"); 3. qualidade de vida (utilizando o questionário Medical Outcomes Study 36 - Item Short-Form Health Survey - SF-36). Foram realizadas análises descritiva e bivariada, por meio do teste t de Student e ANOVA. Observou-se que 70,5% apresentaram pelo menos uma doença, e as principais referidas foram a hipertensão, as artroses, a depressão e o diabetes. Quanto à associação entre os números de doenças, as pessoas mais idosas e as que referiram três ou mais doenças apresentaram piores escores de QVRS em todos os domínios físicos e nas limitações por aspectos sociais e emocionais. O maior número de morbidades associou-se aos menores escores de qualidade de vida relacionada à saúde.

The relationship between hypertension and health-related quality of life: adjusted by chronic pain, chronic diseases, and life habits in the general middle-aged population in Japan

OBJECTIVES

The aim of this study was to examine the relationship between hypertension and health-related quality of life (HRQoL) adjusted by chronic pain, other chronic diseases, and life habits in the general middle-aged population in Japan.

METHODS

This study is a population-based cross-sectional study. In this study, 1117 participants aged 40-65 years and living in Shika Town completed a self-administered questionnaire including Short Form-36 (SF-36). The scores of SF-36 among hypertensives were compared with those of normotensives. The independent association of hypertension with each SF-36 subscale was analyzed using a multiple linear regression model adjusted by age, BMI, chronic pain, chronic diseases, sleep, exercise, and occupational status. We analyzed two groups; Group 1 which contained 846 participants completed the questionnaire without coronary heart disease and cerebral vascular disease, Group 2 which contained 686 participants without coronary heart disease, cerebral vascular disease, or diseases accompanied by chronic pain (gastroduodenal ulcer, fracture, osteoarthritis, osteoporosis, rheumatoid arthritis, and disc herniation).

RESULTS

In Group 2, hypertensive women had a lower general health perception than normotensive women [unstandardized coefficients; B = -8.84, 95 % confidence interval (95 % CI) = -13.3 to -4.34, standardized coefficients; β = -0.200, p < 0.001], whereas hypertensive men had higher social functioning than normotensive men (B = 5.66, 95 % CI = 1.30-10.0, β = 0.149, p < 0.05) after adjusting by chronic pain and life habits.

CONCLUSIONS

These results may be due to the sex difference in the light of the perception for health.

Associations between Dietary Factors and Self-Reported Physical Health in Chinese Scientific Workers

BACKGROUND

Scientific workers play an important role in the development of science and technology. However, evidence is lacking with regard to the associations between their dietary factors and their health-related quality of life (HRQOL).

METHODS

A cross-sectional survey was conducted among 775 scientific workers from multiple universities and institutes in the Southwest region of China. A self-administered food-frequency questionnaire was used to collect the food consumption information, and the 36-item Short-Form Health Survey was used to assess physical HRQOL. Hierarchical multiple regression analysis was used to identify the factors associated with scientific workers' HRQOL.

RESULTS

Physical HRQOL was negatively associated with age and intake of fresh pork (fat) and animal viscera, whereas consumption of vegetables, fruits, refined cereals and dairy products were positively correlated with physical HRQOL. Participants with daily intake of vegetable oils or mixed oils showed higher physical HRQOL scores than those with intake of animal oils.

CONCLUSIONS

Dietary habits are closely associated with the physical HRQOL of scientific workers. The dietary patterns that had more vegetables and fruits, less fresh pork (fat) and animal viscera, and used vegetable oils during cooking corresponded to higher physical HRQOL scores. These findings are important for planning dietary strategies to improve physical health in scientific workers.

Health-related quality of life and related factors among elderly people in Jinzhou, China: a cross-sectional study

OBJECTIVES

With rapid reductions in fertility and mortality, China has to face the dramatic ageing of its population. Although an ageing population is associated with greater life expectancy, and reflects a huge improvement in people's living standards and health care services, it also means that more elderly people suffer from non-communicable diseases (NCDs). The prolonged course of illness and disability associated with chronic diseases may significantly reduce health-related quality of life (HRQoL) among elderly people. The aims of this study were to evaluate HRQoL of elderly people living in Jinzhou, and to identify the predictors of HRQoL.

STUDY DESIGN

Cross-sectional study with stratified sampling.

METHODS

A cross-sectional survey was conducted among 1015 elderly people (≥60 years) living in the three administrative regions (Linghe, Guta and Taihe) of Jinzhou. A demographic questionnaire and Short Form-36 were employed to collect demographic variables and evaluate HRQoL, respectively. Multiple stepwise linear regression analysis was performed to estimate factors related to HRQoL of the subjects.

RESULTS

Lowest HRQoL scores were obtained in the following dimensions: general health (65.44), role-emotional (69.74) and role-physical (70.20). Multiple stepwise regression showed that factors associated with HRQoL of elderly people were medical health checks, age, socio-economic status, NCDs, and various unhealthy lifestyle behaviours such as smoking, excessive drinking and insufficient exercise.

CONCLUSIONS

This study described overall HRQoL of elderly people in Jinzhou, and found that medical health checks, age, socio-economic status, NCDs, smoking, excessive drinking and insufficient exercise affected HRQoL. These findings will provide a basis for recommendations regarding health management of elderly people, and will also help local government to devise appropriate health intervention strategies for promoting the health status of elderly people in this region.

Perception of hypertension management by patients and doctors in Asia: potential to improve blood pressure control

BACKGROUND

Hypertension is one of the world's most common health conditions and is a leading risk factor for mortality. Although blood pressure can be modified, there is a large proportion of patients whose blood pressure remains uncontrolled. The aim of this study, termed Edvantage 360°, was to gain a deeper understanding of hypertension management in Asia from the perspective of patients and doctors, and to propose strategies to improve blood pressure control.

METHODS

Conducted in Hong Kong, Indonesia, Malaysia, the Philippines, South Korea, Taiwan, and Thailand, Edvantage 360° was a mixed-methods observational study that used both qualitative and quantitative elements: qualitative interviews and focus groups with patients (N = 110), quantitative interviews with patients (N = 709), and qualitative interviews with doctors (N = 85).

RESULTS

This study found that, although there is good understanding of the causes and consequences of hypertension among Asian patients, there is a lack of urgency to control blood pressure. Doctors and patients have different expectations of each other and a divergent view on what constitutes successful hypertension management. We also identified a fundamental gap between the beliefs of doctors and patients as to who should be most responsible for the patients' hypertension management. In addition, because patients find it difficult to comply with lifestyle modifications (often because of a decreased understanding of the changes required), adherence to medication regimens may be less of a limiting factor than doctors believe.

CONCLUSIONS

Doctors may provide better care by aligning with their patients on a common understanding of successful hypertension management. Doctors may also find it helpful to provide a more personalized explanation of any needed lifestyle modifications. The willingness of the doctor to adjust their patient interaction style to form a 'doctor-patient team' is important. In addition, we recommend that doctors should not attribute ineffectiveness of the treatment plan to patient non-adherence to medications, but rather adjust the medication regimen as needed.

Associations between disease awareness and health-related quality of life in a multi-ethnic Asian population

Background

Health related quality of life (HRQoL) is an important dimension of individuals' well-being, and especially in chronic diseases like diabetes and hypertension. The objective of this study was to evaluate the contributions of disease process, comorbidities, medication or awareness of the disease to HRQoL in diabetes mellitus, hypertension and dyslipidemia.

Methods

This was a cross-sectional study of 3514 respondents from the general community in Singapore, assessed for HRQoL, disease and comorbid conditions through self-report, clinical and laboratory investigations. HRQoL was assessed using SF-36 health survey version 2. For each condition, participants were categorized as having 1) no disease, 2) undiagnosed, 3) diagnosed, not taking medication, and 4) diagnosed, taking medication. Analysis used one-way ANOVA and multiple linear regression.

Results

Diagnosed disease was associated with lower physical health component summary (PCS) scores across all three conditions. After adjustment for comorbidities, this association remained significant only for those not on medication in diabetes (−2.7±1.2 points, p = 0.03) and dyslipidemia (−1.3±0.4 points, p = 0.003). Diagnosed hypertension (no medication −2.6±0.9 points, p = 0.002; medication −1.4±0.5 points, p = 0.004) and dyslipidemia (no medication −0.9±0.4 points, p = 0.03; medication −1.9±0.5 points, p<0.001) were associated with lower mental health component summary (MCS) scores. Undiagnosed disease was associated with higher MCS in diabetes (2.4±1.0 points, p = 0.01) and dyslipidemia (0.8±0.4 points, p = 0.045), and PCS in hypertension (1.2±0.4 points, p = 0.004).

Conclusions

Disease awareness was associated with lower HRQoL across the diseases studied, with PCS associations partially mediated by comorbidities. Equally importantly, undiagnosed disease was not associated with HRQoL deficits, which may partly explain why these individuals do not seek medical care.

Normative Data for the Singapore English and Chinese SF-36 Version 2 Health Survey

Introduction: The aim of this study is to report normative data for the Short-Form 36 version 2 (SF-36v2) for assessing health-related quality of life, in the Singapore general population. Materials and Methods: Data for English and Chinese-speaking participants of the Singapore Prospective Study Programme were analysed. The SF-36v2 scores were norm-based with the English-speaking Singapore general population as reference and reported by age (in decades), gender and ethnicity as well as for the 5 most prevalent chronic medical conditions. Scores were reported separately for the English and Chinese language versions. Results: A total of 6151 English-speaking (61.5% Chinese and 19.2% Malay) and 1194 Chinese-speaking participants provided complete data. Mean (SD) age of all participants was 49.6 (12.58) years with 52.4% being women. In both languages, women reported lower scores than men on all scales. Among the chronic medical conditions, stroke had the largest impact on all English SF-36v2 scales and on 3 Chinese SF-36v2 scales (role-physical, general health and social functioning). Conclusion: We have provided detailed normative data for the Singapore English and Chinese SF-36v2, which would be valuable in furthering HRQoL research in Singapore and possibly the region. Key words: Health-related quality of life, Health status, Mental well-being, Social well-being

Determinants of Health-Related Quality of Life (HRQoL) in the Multiethnic Singapore Population - A National Cohort Study

BACKGROUND

HRQoL is an important outcome to guide and promote healthcare. Clinical and socioeconomic factors may influence HRQoL according to ethnicity.

METHODOLOGY

A multiethnic cross-sectional national cohort (N = 7198) of the Singapore general population consisting of Chinese (N = 4873), Malay (N = 1167) and Indian (N = 1158) adults were evaluated using measures of HRQoL (SF-36 version 2), family functioning, health behaviours and clinical/laboratory assessments. Multiple regression analyses were performed to identify determinants of physical and mental HRQoL in the overall population and their potential differential effects by ethnicity. No a priori hypotheses were formulated so all interaction effects were explored.

PRINCIPAL FINDINGS

HRQoL levels differed between ethnic groups. Chinese respondents had higher physical HRQoL (PCS) than Indian and Malay participants (p<0.001) whereas mental HRQoL (MCS) was higher in Malay relative to Chinese participants (p<0.001). Regressions models explained 17.1% and 14.6% of variance in PCS and MCS respectively with comorbid burden, income and employment being associated with lower HRQoL. Age and family were associated only with MCS. The effects of gender, stroke and musculoskeletal conditions on PCS varied by ethnicity, suggesting non-uniform patterns of association for Chinese, Malay and Indian individuals.

CONCLUSIONS

Differences in HRQoL levels and determinants of HRQoL among ethnic groups underscore the need to better or differentially target population segments to promote well-being. More work is needed to explore HRQoL and wellness in relation to ethnicity.