Health-related quality of life in type 2 diabetic patients

Assessment of Health-Related Quality of Life Among Patients with Chronic Diseases and Its Relationship with Multimorbidity: A Cross-Sectional Study from Saudi Arabia

Objective

Chronic diseases hold the potential to worsen the overall health of patients by limiting their functional status, productivity, and capacity to live well, affecting their overall health-related quality of life (HRQoL). The purpose of the study was to assess the HRQoL of individuals with chronic diseases residing in the Al-Jouf region of Saudi Arabia. Furthermore, the current study also sought to ascertain the impact of multimorbidity and the duration of illness on HRQoL.

Material and Methods

A cross-sectional study was conducted among the residents of Al-Jouf region for a period of 6 months. A self-administered EuroQoL (EQ-5D-5L) study tool was used. Appropriate statistical analysis was conducted to ascertain the relationship between various variables and HRQoL.

Results

A total of 500 out of 562 participants completed the study, with a response rate of 88.97%. Participants had a mean age of 46.15 ± 16.79 years, and the majority were female (n = 299; 59.80%). A mean HRQoL score of 0.82 ± 0.20 was reported, poorest in patients with kidney failure (0.65 ± 0.26) and highest in hepatitis. However, nearly half of the participants had diabetes mellitus type II (n = 205, 39.20%). Patients aged <30 years (OR: 0.109; p = 0.002), male participants (OR: 0.053; p < 0.001), no disability (OR: 0.143; p = 0.002), and <2 comorbid diseases (0.84 ± 0.18; p < 0.001) reported better QoL. Additionally, comorbid conditions such as DM, prolong the duration of the overall illness (14.19 ± 7.67 years). Overall, imperfect health (n = 390, 78%) was reported by the study participants.

Conclusion

The present study provided preliminary data about the current HRQoL status of individuals with imperfect health and lower HRQoL. In the future, large-scale longitudinal studies are required to investigate the most prevalent chronic diseases, their associations, and change in HRQoL, as there is a dearth of information in the Saudi population.

Effect of Adding Early Bedside Cycling to Inpatient Cardiac Rehabilitation on Physical Function and Length of Stay After Heart Valve Surgery: A Randomized Controlled Trial

OBJECTIVE

To assess whether adding bedside cycling to inpatient cardiac rehabilitation (CR) early after heart valve surgery could lead to better physical function and shorter length of hospital stays.

DESIGN

This is a single-centered, randomized, controlled, parallel-group intervention study.

SETTINGS

This study was conducted at the National Heart Institute from December 2022 to June 2023.

PARTICIPANTS

Thirty-one patients following heart valve surgery completed this study after being randomized into 2 groups: an intervention group (n1=16) and an active control group (n2=15). Eligibility criteria were heart valve surgery with median sternotomy, clinical stability, and age from 20 to 40 years.

INTERVENTIONS

The intervention group received early bedside cycling for the lower limbs, using a mini bike, in addition to an inpatient CR program, and the control group received the inpatient CR program alone.

MAIN OUTCOME MEASURE

The primary outcome was the physical functional capacity assessed by the 6-minute walk distance (6MWD). The secondary outcomes were the Barthel Index (BI), the forced vital capacity (FVC), the length of intensive care unit (ICU) stay, the total length of hospital stay, and the physical component summary (PCS) of the 12-item Short Form (SF-12) Health Survey.

RESULTS

Compared with the control group, the intervention group showed significantly greater 6MWD (P<.001), BI score (P<.001), and FVC (P=.006) at hospital discharge, and shorter ICU stay (P=.002) and total hospital stay (P=.015). At 1-month follow-up, the intervention group showed a non-significantly higher PCS mean score than the control group (P=.057).

CONCLUSION

Adding early bedside cycling to a usual inpatient CR program after heart valve surgery could induce significantly greater short-term physical functional capacity as assessed by the 6MWD, better activities of daily living as evaluated by the BI, higher pulmonary function as measured by the FVC, and shorter lengths of ICU and total hospital stays than the usual inpatient CR program alone.

Burden, Depression and Quality of Life in Carers of Newly Diagnosed Advanced Cancer Patients in Egypt

CONTEXT

The goal of palliative care (PC) is to improve the quality of life (QoL) of patients with life-limiting illnesses as well as their families. Ideally, PC is integrated early in the course of life-limiting illnesses. Less attention has been paid to the need for early PC for family caregivers (FCs) in lower-income settings.

OBJECTIVES

This observational cross-sectional study was conducted to explore the burden experienced by FCs of newly diagnosed incurable cancer patients in Egypt and characterize its relation to depression and QoL.

METHODS

Ninety-five adult FCs of adult patients with newly diagnosed incurable cancer completed the 22-item Zarit Burden Interview (ZBI-22), Patient Health Questionnaire (PHQ-9), and Short Form 12 (SF-12) to assess caregiving burden, depression, and QoL among FCs, respectively.

RESULTS

The median (IQR) ZBI-22 score was 17(11-24) and 34% of FCs had significant burden (ZBI-22 score > 20). Assistance with late loss activities of daily living and availability for longer caregiving duration were associated significantly with higher caregiving burdens (P = 0.004 and 0.047, respectively). FCs with significant burden had significantly higher PHQ-9 scores (P = 0.0003). There was a significant negative correlation between ZBI-22 scores and the bodily pain, general health, mental health, physical function, role emotional, and social function subscales/items of SF-12.

CONCLUSIONS

A substantial proportion of Egyptian FCs of incurable cancer patients experience significant burden early in the course of the disease. This burden is associated with depressive symptoms and worse QoL dimensions, physical, psychological, and social. In a lower-income setting, early PC interventions for FCs of incurable cancer patients are needed.

The association between quality of life and diabetes: the Bushehr Elderly Health Program

BACKGROUND AND OBJECTIVE

Considering the importance of diabetes and its increased prevalence with aging, this study aimed to evaluate the association between diabetes status and quality of life (QOL) and the determining factors in individuals over 60.

METHODS

Two thousand three hundred seventy-five individuals including 819 (34.5%) with diabetes, aged 69.4 ± 6.4, from Bushehr Elderly Health Program (BEHP) were enrolled. We categorized the participants as non-diabetic, controlled diabetic, and poorly controlled diabetic. The QOL was assessed using the SF-12 questionnaire. The physical (PCS) and mental (MCS) component summaries of QOL were estimated. We compared the SF-12 domains and components between the categories using ANOVA. Further, the association of diabetes status with PCS and MCS was assessed after adjustment for possible confounders including age, sex, depression, cognitive impairment, physical activity, and other relevant factors using linear regression analysis.

RESULTS

Individuals with diabetes had lower PCS (40.9 ± 8.8 vs. 42.7 ± 8.6, p-value < 0.001), and MCS scores (45.0 ± 10.2 vs. 46.4 ± 9.4, p-value < 0.001) compared to participants without diabetes. No significant differences were observed in PCS or MCS scores between controlled or poorly controlled individuals with diabetes. Diabetes status was associated with PCS and MCS scores in univariable analysis. Regarding physical component of QOL, after adjusting for other confounders, poorly controlled diabetes was significantly associated with PCS [beta: -1.27 (-2.02, -0.52)]; some other determinants include depression [-7.66 (-8.51, -6.80)], male sex [3.90 (3.24,4.57)], and good physical activity [1.87 (1.17,2.57)]. As for the mental component, controlled diabetes was significantly associated with MCS [-1.17 (-2.13, -0.22)]; other contributing factors include depression [-14.35 (-15.34, -13.37)], male sex [1.97 (1.20,2.73)], good physical activity [-1.55 (-2.35, -0.75)], and smoking [-1.42 (-2.24, -0.59)]. BMI had an inverse association with PCS [-0.19 (-0.26, -0.13)] and a direct association with MCS [0.14 (0.07,0.21)].

CONCLUSION

Individuals with diabetes exhibited reduced QOL scores. Upon adjusting for other variables, it was found that uncontrolled diabetes correlated with decreased PCS scores, whereas controlled diabetes was linked to lower MCS scores. Factors such as depression and being female were identified as contributors to diminished QOL in both physical and mental aspects. These results have the potential to guide healthcare decision-making, facilitating the creation of tailored interventions aimed at improving the QOL for individuals with diabetes, with a specific focus on women and depression.

The health and quality of life of dental workers in jordan during COVID-19: A cross-sectional study

BACKGROUND

Dental team members are susceptible to high mental and physical stress levels, which could have increased during the Coronavirus disease 2019 (COVID-19).

OBJECTIVE

This study aimed to evaluate Jordanian dental workers' health-related quality of life (HRQoL) and determine its predictors during the COVID-19 Pandemic.

METHODS

This was a cross-sectional survey study conducted on dental team members, namely; Dentists, dental Assistants, and Dental Technicians. The survey questionnaire was composed of questions related to stress during COVID-19, a short-form survey of 12 items (SF-12), a Depression, Anxiety, and Stress scale (DASS-21), and a Nordic musculoskeletal disorder questionnaire (NMQ). Descriptive analyses were used to describe the main outcome measures, and multiple variable regression analysis was conducted to identify the quality of life predictors.

RESULTS

Participants' HRQoL measured by SF-12 showed a mean±SD score of 67.1±17.19 for the physical component and 54.51±20.27 for the mental component. The Nordic scale showed symptoms of lower back pain as 63.9% over 12 months, 32% over 12 months' functional limitation symptoms, and 45% in 7 days The regression model was found strong for our study with 53.8% variations (r2 = 0.538, F = 43.739, P <  0.001) in health-related quality of life.

CONCLUSIONS

Our study concluded that the level of HRQoL among Jordanian dental specialists during COVID-19 was observed to impact levels of physical and mental well-being which negatively influence the quality of life. Predictive factors like depression, stress, anxiety, musculoskeletal health, and individual everyday quality of life significantly affect the HRQoL of dental specialists.

Quality of life for people with psychiatric disabilities employed in extended employment programs in two Arab towns in Israel: an exploratory study

Introduction

This study aims to examine the quality of life (QOL) for people with psychiatric disabilities who are engaged in extended employment programs (homogeneous versus heterogeneous) in the Arab-populated Triangle Area of Israel. The homogeneous program participants are exclusively Arab while the heterogeneous program includes both Arabs and Jews.

Methods

Quantitative research study of 104 adults with psychiatric disabilities engaged in two communal extended employment programs. Participants completed demographic (age (years), gender, marital status (married, widowed/separated, married, single), religion (Muslim, Jewish, Christian), dichotomous nationality variable (Jewish/Arab), and years of education) and employment questionnaires (length of time in the employment program, number of working days/h and salary satisfaction); SF 12 Scale; and The Personal Wellbeing Index questionnaire. Two-sample T-Test, exploratory factor analysis and multiple linear regressions were conducted for tracking the differences between participants in homogeneous and heterogeneous programs.

Results

A significant difference was found between the programs in two QOL components, insofar as satisfaction with the standard of living, together with health satisfaction were rated higher for participants in the heterogeneous program than for their homogeneous program counterparts. Furthermore, the results indicate that physical health and gender were the most important variables in explaining QOL in both programs, while the employment variables were not significant.

Discussion

Since the research findings show that the employment-related-items aren't significant in predicting the employees' QOL, the definition and suitability of extended employment environments as a mental health service must be reexamined. Cultural elements may also have an impact on QOL when the programs are located in a traditional town, with gender playing a key role. The family's role is pivotal in traditional societies, influencing an individual's ability to participate in employment programs and the support they receive. In patriarchal societies, there can be added pressure on men with psychiatric disabilities to conform to societal expectations. Given the general lack of health awareness in Arab communities, there is a need to develop additional projects or incorporate physical health improvement as a rehabilitation goal when working with individuals with psychiatric disabilities, regardless of the type of community rehabilitation program.

Effects of aerobic, resistance, and combined training on thyroid function and quality of life in hypothyroidism. A randomized controlled trial

PURPOSE

This study aimed to compare the effects of aerobic, resistance, and combined exercises on thyroid function, lipid profile, exercise capacity, and quality of life (QoL) in hypothyroid women.

METHODS

Sixty women aged 35 to 45 with clinical hypothyroidism were randomized to four equal groups: aerobic training (AT), resistance training (RT), combined AT/RT, and control groups. All exercises were performed at low to moderate intensity, three days per week, and for 12 weeks. Patients in all groups were on levothyroxine therapy. Outcome measures were free thyroxin (T4), thyroid stimulating hormone (TSH), lipid profile, estimated maximal oxygen consumption (VO2 max) and QoL assessed by the 12-item Short Form (SF-12) Health Survey.

RESULTS

All exercise groups showed significant improvements in all outcome measures compared to the baseline and the controls (p < 0.05). The combined AT/RT group showed more significant improvements in TSH and the mental component summary score of the SF-12 compared to the AT and RT groups (p < 0.05). The AT group showed the most significant improvement in estimated VO2 max, followed by the combined AT/RT and then the RT group. Non-significant differences were found between exercise groups in T4, blood lipids, and the physical component summary score of the SF-12 (p > 0.05).

CONCLUSION

In women with hypothyroidism on levothyroxine treatment, all AT, RT, and combined AT/RT could equally improve T4 levels, lipid profile, and physical health-related QoL. However, the combined AT/RT could induce the greatest improvements in TSH and mental health-related QoL, while the AT could have the greatest impact on exercise capacity in these patients.

TRIAL REGISTRATION

Pan African Clinical Trial Registry (PACTR), retrospective, PACTR202305810673587.

Predictors of Dizziness and Hearing Disorders in People with Long COVID

Background and Objectives: Individuals report persistent symptoms after becoming infected by SARS-CoV-2 (COVID-19) that last for >4 weeks (long-COVID syndrome). Dizziness and hearing loss have been reported among long-COVID symptoms. However, little is known about the potential predictors of dizziness and hearing loss in individuals with long COVID. This study aimed to explore the presence and correlates of dizziness and hearing loss in a sample of people with long-COVID syndrome. Materials and Methods: Individuals aged 18 years and older who were infected with COVID-19 at least 8 weeks prior to the start of the study were included if they were not diagnosed with dizziness or hearing loss before getting COVID-19. Demographics and COVID-19-related information were collected. Participants completed the Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence (ABC) scale, Falls Efficacy Scale International (FES-I), Modified Fatigue Impact Scale (MFIS), and Medical Outcomes Study Short Form 12 (SF-12). Finally, hearing was assessed using pure-tone audiometry (PTA) in a subsample. Results: Two hundred and nine individuals (66% female) with a mean (SD) age of 27 (9) participated in the study. Perceived dizziness and hearing loss were reported in 26 and 15.3% of the sample, respectively. Logistic regression was conducted to identify potential predictors of dizziness and hearing loss separately. After controlling for age and severity of dizziness, female sex and high fatigue severity were associated with an increased likelihood of reporting dizziness (R2 = 31%). The severity of dizziness and neurological symptoms during the acute stage of COVID-19 were associated with an increased likelihood of reporting hearing loss (R2 = 10.4%) after controlling for age. Conclusions: Dizziness and hearing loss present in long COVID and can be disabling. Females with high levels of fatigue should be questioned about persistent dizziness. Hearing loss should be considered in individuals with neurological symptoms and severe dizziness as a consequence of long COVID.

The Effect of Visual Impairment and Its Severity on Vision-Related and Health-Related Quality of Life in Jordan: A Comparative Cross-Sectional Study

Purpose

To assess the effect of visual impairment (VI), its severity, and ocular diseases on vision-related and health-related quality of life (QoL) in Jordan.

Patients and Methods

A comparative, cross-sectional, hospital-based study was conducted among a group of 278 patients with VI aged ≥ 18 years, and age and sex-matched control group of 278 individuals with no VI. An interviewer administered the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12) to all participants.

Results

All the mean VFQ-25 subscales scores, physical component scale (PCS) and the mental component scale (MCS) of the SF-12 were significantly lower in patients with VI compared to controls with no VI. The VFQ-25 subscales (except general health and ocular pain), PCS, and MCS scores significantly decreased with more severity of VI. In the adjusted multivariate analysis, lower level of education (p=0.013), male sex (p=0.016), and the presence of cerebrovascular disease (p=0.019) were significantly associated with lower VFQ-25 composite scores in visually impaired patients compared to controls. Ocular disease duration of >5 years and progressive VI were significantly associated with lower VFQ-25 composite scores (p= 0.026 and p<0.001) respectively, in patients with VI. Glaucoma had a significantly larger reduction in mean scores of all the VFQ-25 subscales, and the PCS of the SF-12 compared to all other ocular diseases.

Conclusion

Both VI and increasing severity of impairment were associated with reduced vision-related and health-related quality of life in adult Jordanians. Glaucoma patients and less educated people were particularly affected. Routine assessment of QoL in visually impaired patients and improving referral protocols to vision rehabilitation services is recommended to improve the QoL in those patients.

Effects of low-versus high-volume high-intensity interval training on glycemic control and quality of life in obese women with type 2 diabetes. A randomized controlled trial

Background/objective

Comparison between different training volumes of high-intensity interval training (HIIT) is understudied in type 2 diabetes. This study aimed to compare the effects of low- and high-volume HIIT on glycemic control, blood lipids, blood pressure, anthropometric adiposity measures, cardiorespiratory fitness, and health-related quality of life (HRQoL) in women with type 2 diabetes.

Methods

Seventy-two obese women with type 2 diabetes aged 36-55 were randomly assigned to a low-volume HIIT group (i.e., 2 × 4-min high-intensity treadmill exercise at 85%-90% of peak heart rate, with a 3-min active recovery interval in between), a high-volume HIIT group (i.e., 4 × 4-min high-intensity treadmill exercise at 85%-90% of peak heart rate, with three 3-min active recovery intervals in between), and a non-exercising control group. Patients in HIIT groups exercised three days a week for 12 weeks. All patients received oral hypoglycemic medications with no calorie restrictions. The outcome measures were glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), 2-hour postprandial blood glucose (2-hr PPBG), total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), waist circumference (WC), waist-to-hip ratio, time to maximal exhaustion determined from a maximal treadmill exercise test (i.e., a measure of cardiorespiratory fitness), and HRQoL assessed by the 12-item Short Form (SF-12) Health Survey.

Results

The low- and high-volume HIIT groups showed significant improvements in all outcome measures compared to the baseline and the non-exercising group (P < 0.05), except for DBP in the low-volume HIIT group (p > 0.05). Also, both low- and high-volume HIIT groups showed similar improvements in TC, HDL, SBP, DBP, BMI, WC, waist-to-hip ratio, and the SF-12 scores, with no significant between-groups difference (p > 0.05). The high-volume HIIT group, however, showed more significant improvements in HbA1c, FBG, 2-hr PPBG, TG, LDL, and treadmill time to maximal exhaustion than the low-volume HIIT group (p < 0.05). The non-exercising group showed non-significant changes in all outcome measures (p > 0.05).

Conclusion

Low-volume HIIT could be equally effective as high-volume HIIT for improving TC, HDL, blood pressure, anthropometric adiposity measures, and HRQoL in obese women with type 2 diabetes. Nevertheless, high-volume HIIT could have a greater impact on glycemic control, TG, LDL, and cardiorespiratory fitness in these patients.

Trial registration

ClinicalTrials.gov, NCT05110404.

Physical activity and health-related quality of life among adults living in Jeddah city Saudi Arabia

Background

Physical activity can improve health-related quality of life (HRQoL) in adults. However, the effect of physical activity on quality of life is unclear among the Saudi adult population. The study aimed to determine the association between physical activity and HRQoL in apparently healthy adults in Jeddah, Saudi Arabia.

Methods

This cross-sectional study was conducted among visitors of shopping malls, walking tracks/fitness centres/gyms and governmental hospitals in Jeddah from March to September 2022. Physical activity was measured with the electronic template of the general practice physical activity questionnaire (GPPAQ), while the HRQoL was measured using the 36-Item Short Form Survey (SF-36) questionnaire. A multiple linear regression model investigated the relationship between physical activity and HRQoL.

Results

A total of 693 individuals participated in this study, with a mean age of 36 (±11). Individuals who fall in the active category of the physical activity level were mostly younger men (37% vs 21%), were non-smokers (30% vs 10%) and had no comorbid condition (29% vs 15%). After adjusting for covariates, men (adjusted β 4.43, 95% CI [1.44-7.41]) with higher physical activity levels (active-adjusted β 10.11, 95% CI [5.44-14.77]) had better scores on the physical component summary (PCS). Similarly, mental component summary (MCS) scores for men (adjusted β 6.51, 95% CI [3.40-9.63]) and physical activity levels (active-adjusted β 9.77, 95% CI [4.90-14.64]) were high.

Conclusion

The article reinforces how physical activity contributes towards each dimension of HRQoL. Physical inactivity is a growing public health challenge in Saudi Arabia, affecting all age groups. Investing in innovative strategies and establishing targeted health education programs for academic institutions and communities are required to enhance healthy habits. Additionally, constructing more local sports facilities and concession packages, especially for the females at the gyms, can motivate individuals and promote physical activity.

Arabic translation, cultural adaptation, and validation of the Bristol Impact of Hypermobility questionnaire

BACKGROUND

The Bristol Impact of Hypermobility questionnaire (BIoH) is the first condition-specific patient reported outcome measure for people with hypermobility-related conditions. The BIoH original version is in English, which limits its use for patients who speak other languages. The study aimed to translate and culturally adapt the BIoH into Arabic and determine its concurrent validity, reliability, internal consistency and smallest detectable change.

METHODS

Forward-backward translation and cross-sectional designs were used. The Ethics Committee of Kuwait Ministry of Health approved the study. Spearman correlation coefficient, intraclass correlation coefficient (ICC), and Cronbach's α were used for statistical analysis. Patients with hypermobility spectrum disorders (HSD) were included, diagnosed using the 2017 classification framework.

RESULTS

55 HSD patients were included, aged 26.0 (18.0) years old; median (IQR), and 85.5% were women. The BIoH showed very good concurrent validity when correlated with the SF-12 total and physical component scores; r = -0.743 and - 0.740, respectively (p < 0.05). Good correlation was identified between the BIoH and the SF-12 mental component score; r = -0.496 (p < 0.05). The BIoH demonstrated excellent test-retest reliability; ICC = 0.934 (0.749-0.983 95% CI) (p < 0.05), and high internal consistency (Cronbach's α = 0.933). The smallest detectable change was 30.90 points, representing 19.8% of the mean baseline score.

CONCLUSIONS

The study successfully translated the BIoH into Arabic and demonstrated high psychometric properties. The translated score can help Arabic patients with HSD in their clinical evaluation process. Future research needs to determine the responsiveness of the Arabic version and translate the BIoH to other languages.

Pharmacoeconomic evaluation of insulin aspart and glargine in type 1 and 2 diabetes mellitus in Iran

Purpose

The higher costs of insulin analogs including short-acting insulin aspart (IAsp) and long-acting insulin glargine (IGla) have restricted their widespread uptake despite having improved pharmacokinetic and pharmacodynamic properties and patient convenience. This study aims to evaluate the cost-effectiveness of IAsp versus Regular Insulin (RI) and IGla versus NPH Insulin in type 1 and 2 diabetes from the perspective of the Iranian healthcare system.

Methods

Clinical data including HbA1c levels, hypoglycemia, weight gain, and health-related quality of life were derived from the included systematic review and meta-analysis studies. Different methods of pharmacoeconomic evaluation were used for an annual time horizon. Utility decrements for diabetes-related complications were extracted from the literature. Direct medical costs were calculated in 2022 prices. A one-way sensitivity analysis was also performed.

Results

In type 1 diabetes, IAsp was associated with more costs and effects in terms of reducing HbA1c compared with RI. An incremental cost of $83 was estimated to obtain an additional 1% reduction in HbA1c per patient per year. Similarly, an incremental cost of $16 was estimated for IGla compared with NPH. In type 2 diabetes, IAsp and RI were associated with equal efficacy and safety. For IGla versus NPH, the incremental cost-effectiveness ratio was calculated at $1975 per quality-adjusted life-year. The robustness of the result was confirmed through sensitivity analysis.

Conclusion

Insulin analogs, IAsp and IGla, are cost-effective for type 1 diabetes versus human insulins, RI and NPH. For type 2 diabetes, IAsp is not cost-effective when compared with RI. For IGla versus NPH, however, the incremental cost-effectiveness ratio seems to be within the accepted thresholds.

Effects of backward walking exercise using lower body positive pressure treadmill on knee symptoms and physical function in individuals with knee osteoarthritis: a protocol for RCT

OBJECTIVES

The primary aim is to compare the effects of backward walking exercise to forward walking exercise on knee pain, knee functions, and thigh muscle strength in individuals with mild to moderate knee osteoarthritis using lower body positive pressure, in addition to mobility functions, balance, and self-reported health status.

METHODS

The study is a single blind randomized clinical trial with two independent groups. This study will enroll 26 participants with mild to moderate knee osteoarthritis. The participants will be randomized into either experimental group (backward walking exercise) or control group (forward walking exercise). Both groups will use lower body positive pressure treadmill for walking exercise. Both groups will perform regular conventional exercise and worm-up exercise before walking exercise. The treatment will be three times a week for six weeks. Walking session will be up to 30 min each session. Data collection will be collected during pre- and post- intervention including primary outcomes including numeric pain rating scale (NPRS), knee injury and osteoarthritis outcome score (KOOS), and thigh muscle strength test. The secondary outcomes include five times sit to stand test (FTSTS), 3-meter backward walk test (3MBWT), timed up and go test (TUG), four square step test (FSST), functional reach test (FRT), 10-meter walk test (10-MWT), six minute walk test (6MWT), medical outcomes study short form 12 (SF-12), patient health questionnaire -9 (PHQ-9), and rapid assessment of physical activity (RAPA). An independent t-test will be used to evaluate the effect of treatment on the outcome measures.

RESULTS

Not applicable.

CONCLUSION

Using lower body positive pressure may have promising results against knee osteoarthritis. Moreover, walking backward exercise using lower body positive pressure might add more benefits to individuals with knee osteoarthritis and help clinicians in decision making.

TRIAL REGISTRATION

This study was registered in ClinicalTrails.gov (ID: NCT05585099).

The Impact of Allergic Rhinitis on Asthma and Its Effect on the Quality of Life of Asthmatic Patients

Background Allergic rhinitis (AR) and asthma are one of the most common diseases in the Kingdom of Saudi Arabia. Asthma and AR patients report significant reductions in their daily activities due to this condition. Therefore, measuring health-related quality of life (HRQOL) in adult asthmatic and AR patients and evaluating the use of allergic rhinitis treatment modalities to improve asthma control may help prevent future respiratory complications, improve patient quality of life, and reduce morbidity. Methods This cross-sectional observational study was conducted through an online self-administrated questionnaire distributed electronically on social media through "Survey Monkey" (http://www.surveymonkey.com) from April 2 to September 18, 2021. The study targeted adult patients with asthma and/or allergic rhinitis residing in the Riyadh region of Saudi Arabia. The study compared and evaluated HRQOL between three groups: asthmatic patients with concomitant AR, patients with asthma only, and patients with AR only. Results A total of 811 questionnaires were analyzed. Of those, 23.1% were diagnosed with asthma and 64% were diagnosed with allergic rhinitis; from those who were diagnosed with AR, 27.2% were asthmatics. A statistically significant association was observed between receiving AR medications and asthma control in respondents with intermittent AR (P < 0.001). However, no association was observed between asthma control and receiving medications for AR in respondents with persistent AR (P = 0.589). The average scores for all eight-item short-form (SF-8) QOL dimensions were lower in patients with combined asthma and AR than in patients with AR only and asthma only (P < 0.001). Conclusions This study suggested that AR was associated with more severe asthma and quality of life impairment.

Patient-centred care, diabetes self-management and glycaemic control among Omani patients with type-2 diabetes

AIM

This study examined the relationships between patient-centred care, diabetes self-management and selected health outcomes for Omani patients with type-2 diabetes.

METHODS

Cross-sectional surveys were administered for 237 patients with type-2 diabetes. Hierarchical regression analyses examined the relationships between the selected study variables.

RESULTS

The sample was middle-aged (M = 48, SD = 11.0 years) with nearly a decade (M = 9.68, SD = 6.11) since being diagnosed with type-2 diabetes, with higher than ideal glycaemic control measures (M = 8.8%, SD = 2.4%). In bivariate analyses, patient-centred care was positively associated with diabetes self-management but not with glycaemic control or quality of life. However, after controlling demographic and clinical characteristics, patient-centred care was positively associated with both physical and mental aspects of health-related quality of life. In the final regression model, controlling for demographic and clinical characteristics and patient-centred care, diabetes self-management significantly predicted both glycaemic control and both physical and mental aspects of health-related quality of life.

CONCLUSIONS

The findings support that providing individualized care may contribute to the self-management of chronic conditions. For achieving optimal outcomes, it may be necessary for providers to effectively assess patients' unique challenges and motivations. Increasing diabetes self-management may improve quality of life and reduce diabetes complications.

One-year recurrence of stroke and death in Lebanese survivors of first-ever stroke: Time-to-Event analysis

BACKGROUND

To date, despite the application of secondary prevention worldwide, first-ever stroke survivors remain at imminent risk of stroke recurrence and death in the short and long term. The present study aimed to assess the cumulative risk rates and identify baseline differences and stroke characteristics of Lebanese survivors.

METHODS

A prospective longitudinal study was conducted among survivors ≥18 years old who were followed-up for 15 months through a face-to-face interview. Kaplan-Meier method was used to calculate the cumulative rates of stroke mortality and recurrence. Cox-regression univariate and multivariable analyses were performed to identify the predictors of both outcomes.

RESULTS

Among 150 subjects (mean age 74 ± 12 years; 58.7% men vs. 44.3% women; 95.3% with ischemic stroke vs. 4.3% with intracerebral hemorrhage), high cumulative risk rates of stroke recurrence (25%) and death (21%) were highlighted, especially in the acute phase. Survival rates were lesser in patients with stroke recurrence compared to those without recurrence (Log rank test p < 0.001). Older age was the main predictor for both outcomes (p < 0.02). Large artery atherosclerosis was predominant in patients with stroke recurrence and death compared to small vessel occlusion (p < 0.02). Higher mental component summary scores of quality of life were inversely associated with stroke recurrence (p < 0.01). Lebanese survivors exhibited the highest percentages of depression and anxiety; elevated Hospital Anxiety and Depression Scale (HADS) scores were seen in those with stroke recurrence and those who died (≥80% with mean HADS scores ≥8). Lower Mini-Mental State Examination scores at the acute phase increased the risk of both outcomes by 10% (p < 0.03). Three out of 13 mortalities (23.1%) were presented with early epileptic seizures (p = 0.012). High educational level was the protective factor against stroke recurrence (p = 0.019). Administration of intravenous thrombolysis decreased the risk of both outcomes by 10% (p > 0.05).

CONCLUSION

Higher rates of stroke recurrence and death were observed in the first year following a stroke in Lebanon. Various factors were identified as significant determinants. Thus, health care providers and officials in Lebanon can use these findings to implement effective preventive strategies to best address the management of these factors to reduce the stroke burden and improve the short and long-term prognosis of stroke survivors.

Postpartum depression and health-related quality of life: a Saudi Arabian perspective

Background and Objectives

The mental and physical functioning of an individual is partly determined by their health-related quality of life (HRQOL), which is a multifaceted component. Women who have recently given birth must have a good quality of life to provide proper care and development for their infant. The purpose of this study was to assess the relationship between postpartum depression (PPD) and HRQOL in Saudi Arabian women and to identify potential risk factors that could influence them.

Methods

This study comprised 253 mothers aged 1-24 weeks postpartum from several health centers in Saudi Arabia, recruited by random purposive sampling. The study's questionnaire featured three sections: the first section had demographic information; the second and third sections contained the Edinburgh Postnatal Depression Scale (EPDS) scale and the HRQOL scale (SF-12), respectively. Data were analyzed using descriptive statistics, chi square analyses, independent samples t-tests and binary logistic regression analysis using IBM SPSS 25.

Results

Results of current study indicate that 59.68% of the patients exhibited probable post-partum depression symptoms. Participants who were depressed had significantly lower mental component (MCS) and physical component scores than participants who were in good health. When compared to non-smokers, smokers have a 21-fold higher risk of developing depression. Similar to this, mothers who worked had a 3.98 times higher risk of depression, and patients with a history of depression had a 3.6 times higher chance of getting PPD. The probability of developing PPD was also significantly higher in those who lived outside the Riyadh region, had given birth more than twice before this time, and had experienced undesired pregnancies.

Conclusion

Our study demonstrated an inverse correlation between postpartum depression and health-related quality of life scores. Treatment for depression, particularly among mothers, is crucial for improving their quality of life and, as a result, creating a favorable environment for the development of newborn babies.

Health-related quality of life and associated factors among type 2 diabetic adult patients in Debre Markos Referral Hospital, Northwest Ethiopia

Health-related quality of life (HRQOL) is a multifaceted concept that is strongly impacted by Type II diabetes in developing countries. The majority of studies indicate diabetes mellitus prevalence without looking at people's quality of life.

This study was conducted using an Institution-based cross-sectional design in Debre Markos Referral Hospital from March 03 to March 31, 2020. We evaluated HRQOL using the WHO quality of life BREF and data were obtained through face-to-face interviews. We used a systematic random sampling technique to select study participants. Data were entered into Epi data version 3.1 and exported to STATA version 14.0. Candidates for multivariable analysis were variables with a P-value less than 0.25 in the bivariable analysis and P-value less than 0.05 were considered to declare a statistically significant association. The final model was tested for its goodness of fit using Hosmer and Lemeshow's statistics.

The analysis included a total of 368 adult individuals with type II diabetes and 206 (56%) had a good HRQOL. Being male (AOR = 4.28, 95%CI:2.36, 7.78), having duration of disease of more than 59 months (AOR = 2.93, 95%CI:1.61, 5.34), doing a physical exercise (AOR = 2.33,95%CI:1.34, 4.05) and got counseling (AOR = 3.33; 95%CI:1.82, 5.94) were directly associated with good HRQOL whereas the presence of diabetic complications (AOR = 0.46, 95%CI:0.26, 0.80), comorbidity (AOR = 0.45; 95%CI:0.25, 0.84) and drinking alcohol (AOR = 0.27, 95%CI:0.16, 0.48) had an inverse relationship with good HRQOL.

More than half of type 2 diabetic adult patients had a good HRQOL. Being male, drinking alcohol, getting counseling, doing physical exercise, absence of diabetic complications, and comorbidity and long duration of disease were predictors of good HRQOL. Therefore, avoiding drinking alcohol and promoting physical exercise and counseling should be encouraged.

Predictors of neck disability among undergraduate students: A cross-sectional study

BACKGROUND: Many cross-sectional studies have examined the predictors of neck pain among adolescents and working-age populations, but there are limited studies included undergraduate students. OBJECTIVE: To investigate the predictors of neck disability among undergraduate students. METHODS: A cross-sectional study using a self-administered online survey. Students completed the survey that included socio-demographic factors, academic-related factors, health and lifestyle factors, and standardized questionnaires including Neck Disability Index (NDI), 12-Item Short-Form Health Survey (SF-12), Depression Anxiety Stress Scales (DASS-21), and Pittsburgh Sleep Quality Index (PSQI). Students who reported an NDI score higher than 15 were considered as having a neck disability. A multivariable logistic regression model was used to identify the significant predictors of neck disability. RESULTS: Of all students (n = 1292), 20.8% reported neck disability. Among all possible predictors, students’ major satisfaction (OR 1.46 [95% CI 1.06–2.01]; p = 0.019), DASS-21 anxiety score (OR 1.06 [95% CI 1.03–1.09]; p < 0.001), SF-12 total score (OR 0.89 [95% CI 0.86–92]; p < 0.001), and PSQI score (OR 1.21 [95% CI 1.15–1.28]; p < 0.001) were the only significant predictors of neck disability. CONCLUSIONS: Increased levels of academic stressors and anxiety, and decreased levels of quality of life and sleep quality are associated with increased neck disability among undergraduate students.

The Effect of Social Isolation Types on Quality of Life during the Coronavirus Disease 2019 Pandemic in Saudi Arabia: A Cross-Sectional Study

COVID-19 has caused a global pandemic that has spread rapidly to six continents, with over 2.5 million deaths from December 2019 to March 2021. The number of confirmed COVID-19 cases is still growing worldwide, and quarantines have been recommended to prevent the disease's spread. However, quarantines affect people's quality of life (QOL). The aim of this study is to assess the effect of social isolation-quarantine-on QOL during the first wave of the COVID-19 pandemic in Saudi Arabia. A cross-sectional, descriptive design was used in the present study. We obtained data from an online survey conducted in Saudi Arabia. We included a convenience sample of 775 participants in the study. Most of the participants were female (67%), with a mean age of 46 years ranging from 18 to 75 years. Many participants were government employees (n = 308, 39.7%) and had a bachelor's degree or greater (n = 513, 66.2%). Most of the participants (n = 629, 81%) were free from any chronic disease. Nearly 88% of participants were partially isolated socially owing to COVID-19. Concerning QOL, the means of both the Physical Health Composite Scale and the Mental Health Composite Scale SF-12 scores were 44.7 and 34.6, respectively. Furthermore, the results demonstrate that partially socially isolated participants appeared to have significantly better physical health statuses (M = 44.96, SD = 5.90) than completely socially isolated participants (M = 42.87 ± 7.26). There was no significant social isolation effect on mental health status (t (773) = 2.5, p = 0.115). Social isolation during the COVID-19 pandemic considerably influenced various aspects of QOL including physical and mental health. Community-based interventions such as online counseling services and wellness programs are required to reduce the pandemic's negative impact and enhance overall health status and QOL.

Cognitive illness representations among Israeli Arabs diagnosed with depression and their relationship with health-related quality of life

BACKGROUND

The number of studies that have assessed cognitive illness representations among people diagnosed with depression, and their relationship to health outcomes, has clearly grown. Nevertheless, the relationship between cognitive illness representations and health-related quality of life (HRQoL) has received very little research attention.

AIMS

This study examined cognitive illness representations, based on the self-regulation model (SRM), and the contribution of each dimension of these cognitive illness representations to health-related quality of life (HRQoL) among Israeli Arabs diagnosed with depression.

METHODS

A convenience sample of 160 Israeli Arabs with depression completed measures of cognitive illness representations (identity, timeline, consequences, personal control, treatment control, and coherence), HRQoL, and sociodemographic and health characteristics.

RESULTS

Participants reported high levels of negative perceptions in the identity, timeline, and consequences dimensions, and moderate levels in the dimensions of personal control, treatment control, and coherence. Also, participants reported low levels of HRQoL. Identity, consequences, and coherence were found to be the main determinants of HRQoL.

CONCLUSION

This study underlines the crucial role of the identity, consequences, and coherence dimensions in the HRQoL of individuals diagnosed with depression. The findings indicate that clinical interventions targeting cognitive illness representations of individuals with depression, and in particular identity, consequences, and coherence, might be helpful in improving the HRQoL of this population.

The concept of HRQoL for patients on hemodialysis in Saudi Arabia: an exploratory study

BACKGROUND

The concept of health-related quality of life (HRQoL), a patient-reported outcome measure, is poorly defined within the Saudi literature. There is a lack of culturally adapted measures to assess the HRQoL of patients on hemodialysis in Saudi Arabia. Hence, this study aims to explore and define the concept of HRQoL, identify its key domains and develop a conceptual model as perceived by patients with renal failure who are undergoing hemodialysis in Saudi Arabia.

METHODS

Qualitative research methods was used; data were collected in one dialysis center in the Eastern Region of Saudi Arabia. Twenty-two semi structured qualitative interviews were conducted using a topic guide. The data were analyzed using thematic analysis methods as the transcripts were coded, the categories identified, and the themes generated.

RESULTS

Seven definitions of the HRQoL concept emerged from data analysis in terms of health status and psychological wellbeing including the satisfaction with life, socialization and the ability to play the expected social role and having social relationships that are supportive, religiosity and the belief in God and being able to perform religious worships and finally needs satisfaction was used to define HRQoL which included financial needs and the quality of healthcare services. All these themes were utilized to develop one common definition that emphasized the personal satisfaction with health, social, psychological and financial needs in addition to religious performance and the quality of healthcare services provided. The conceptual model was developed using five key domains of HRQoL: physiological, social, psychological, religious and vocational domains that were defined by certain indicators and the relationships between the domains were clarified in the model.

CONCLUSION

The findings of this study could guide the selection of the appropriate HRQoL instrument to assess the HRQoL of patients on hemodialysis in Saudi Arabia, which would ensure the validity of the findings that could be used in healthcare decisions and planning of care.

Quality of Life and Related Paraclinical Factors in Iranian Patients with Transfusion-Dependent Thalassemia

Background

Thalassemia is one of the most common genetic hematologic disorders in the world. Despite outstanding achievements in prenatal diagnosis and a decrease in the number of patients, thalassemia is still a significant issue in most parts of the world, especially in the Mediterranean countries. Understanding the factors associated with this condition is crucial to help clinicians and policymakers provides social and medical support for patients to facilitate their lives. This study aims to appraise the quality of life (QoL) and its related paraclinical factors in Iranian transfusion-dependent thalassemia patients.

Methods and Materials

This study is a cross-sectional study performed in the thalassemia clinic of Imam-Ali Hospital, Karaj, Iran. The demographic, clinical, and laboratory data of 100 patients with transfusion-dependent thalassemia were recorded. The patients' QoL was measured by the World Health Organization Quality of Life Instruments Brief (WHOQOL-BREF) version questionnaire. The results were analyzed using SPSS software.

Results

This study demonstrated that all four features of life are influenced in transfusion-dependent thalassemia patients. Also, higher educational status and lower serum ferritin levels were associated with better scores in assessing the QoL. On the other hand, an elevated level of AST (aspartate transaminase), ALT (alanine transaminase), and FBS (fasting blood sugar) are associated with lower scores.

Conclusion

All features of QoL are correlated to the patients' laboratory findings. Our data suggest that managing patients' laboratory indices is attributed to their higher QoL. We also suggest regular screening of patients' QoL to manage disease complications more efficiently.

Examining the influence of health on employment and work ability of Saudi haemodialysis patients: A mixed-methods study

AIMS

To explore the employment, work productivity, activity impairment, and sustainability of work of Saudi patients with chronic kidney disease (CKD) on haemodialysis (HD).

BACKGROUND

Failure to address CKD-related challenges may cause HD patients to lose their job, create a lack of compassion from co-workers and receive discrimination hindering progress in their profession.

DESIGN

This is a cross-sectional explanatory sequential mixed-methods study.

METHODS

A convenience sample of 130 CKD patients was surveyed in the quantitative phase using the 'Short-Form Health Survey' and 'Work Productivity and Activity Impairment Questionnaire.' For the qualitative phase, face-to-face, semi-structured interviews took place with 16 CKD patients. Data were collected in 2017.

RESULTS

The respondents reported poor physical and mental health. Both employed and unemployed respondents reported moderate levels of work productivity. Better physical health was related to an increased likelihood of being employed. Physical health was negatively correlated with presenteeism, whereas mental health was negatively associated with activity impairment. Five key themes emerged from the qualitative data: work retention, sustaining employment, suitability of work, losing the work and unemployment.

CONCLUSIONS

Physical condition, personal distinctiveness, cultural and traditional aspects, and employment policies and approaches affect the employment status of CKD patients on HD.

Validation of the Arabic version of the "12-item short-form health survey" (SF-12) in a sample of Lebanese adults

Background

In clinical practice, quality of life measures can be used alongside some types of assessment to give valuable information that can identify areas that influence an individual and help the clinician make the best healthcare choices. This study aimed to investigate the psychometric properties of the Arabic version of the 12-item short-form health survey (SF-12) in a sample of Lebanese adults.

Methods

This cross-sectional study performed between July and November 2019 recruited 269 participants. Cronbach’s alpha was used to assess the reliability of the SF-12 questionnaire, and a factor analysis using the principal component analysis was performed to confirm its construct validity.

Results

The mean score for the “physical component summary (PCS-12)” was 50.27 ± 8.94 (95 % CI: 49.18–51.36) and for the “Mental component summary (MCS-12)” was 44.95 ± 12.17 (95 % CI: 43.47–46.43). A satisfactory Cronbach’s alpha was found for the two components: MCS (α = 0.707) and PCS (α = 0.743). The principal component analysis converged over a two-factor solution (physical and mental), explaining a total variance of 55.75 %. Correlations between the SF-12 scales and single items were significant, showing a good construct validity. The “physical functioning”, “role physical”, “bodily pain”, and “general health” subscales were highly associated with “PCS-12”, while the “vitality”, “social functioning”, “role emotional”, and “mental health” subscales were more associated with MCS-12.

Conclusions

The Arabic version of the SF-12 is a reliable, easy-to-use, and valid tool to measure health-related quality of life in the general population. Future studies using a larger sample size and focusing on questionnaire psychometric properties are necessary to confirm our findings.

Lower body extremity function is associated with health-related quality of life: a cross-sectional analysis of overweight and obese older adults with and without type 2 diabetes mellitus

PURPOSE

We aimed to explore the relationship between characteristics of the sarcopenic phenotype and health-related quality of life (HRQoL) in community-dwelling overweight and obese older adults with and without type 2 diabetes mellitus (T2DM).

METHODS

Appendicular lean mass (ALM), corrected for height (ALM/m²) was assessed by dual-energy X-ray absorptiometry. Muscle strength was assessed using handgrip strength (HGS), and lower extremity physical function was assessed using the Short Performance Physical Battery (SPPB) and gait speed. HRQoL was determined using the short-form 36 (SF-36) survey. Multiple regression analysis was used to examine the association between characteristics of the sarcopenic phenotype and domains of HRQoL.

RESULTS

A total of n = 152 community-dwelling older adults were included (T2DM cohort: n = 87, 71.2 ± 8.2 years, BMI: 29.5 ± 5.9 kg/m²; Obese cohort: n = 65, 68.7 ± 5.6 years, BMI: 33.7 ± 4.9 kg/m²). After adjusting for potential confounders, gait speed and SPPB were positively associated with the physical function subscale of HRQoL (Gait speed: ß = 0.658; P < 0.001; SPPB: ß = 0.478; P < 0.001). This relationship was also maintained for gait speed when assessed independently by cohort (T2DM cohort: ß = 0.637; P < 0.001; Obese cohort: ß = 0.507; P = 0.003).

CONCLUSIONS

Our results further contribute to the literature suggesting that lower body extremity function is associated with the physical function subscale of HRQoL. However, larger longitudinal data are required to assess whether lower body extremity function is independently associated with HRQoL, which includes the potential impact of nutrition and physical activity status.

The Association of COVID-19 Pandemic Stress With Health-Related Quality of Life in the Kingdom of Saudi Arabia: A Cross-Sectional Analytical Study

Background: There is a global disaster since WHO declared Covid-19 as a pandemic. With the increase in cases & mortality rate, various health issues viz., stress, mental disorders and altered health-related quality of life have been noted as a result of pandemic and lockdowns. This study aimed to assess the association of COVID-19 pandemic stress with health-related quality of life in the Kingdom of Saudi Arabia. Methodology: It was a cross-sectional analytical study. Subjects included 878 citizens and residents of Saudi Arabia aged 18 years and above. Convenience, non-probability sampling technique was used. A web-based, self-administered, electronic questionnaire in Arabic language having three sections; Sociodemographic & clinical profile, Standard PSS-10, and Standard SF-12 was used as the study tool and distributed through various social media means. The study period was of 2 months. Data were analyzed using SPS version 25. Descriptive statistics, Pearson's correlation coefficient, independent sample t-test and the one-way analysis of variance (ANOVA) were employed for suitable statistical analysis. Results: Almost two-thirds of the subjects were between the age of 18 to < 40 and majority (74.1%) being females. Majority (83.0%) reported as having no chronic diseases, and 69.5% had no contact history with COVID-19 cases. The mean of MCS & PCS was (32.34 ± 25.30) & (41.65 ± 11.82), respectively. Majority (67.6%) had a moderate level of COVID-19 stress. A significant negative relationship between total stress scores and HRQOL domains was observed. Conclusion: Majority subjects had a moderate level of stress related to COVID-19 lockdown. Stress during COVID-19 has a significant negative association with both physical and mental HRQOL in which MCS was significantly lower than PCS. It is recommended to evaluate the effectiveness of stress management program and follow a holistic approach.

A case-control study of pattern and determinants of quality of life of patients with diabetes in a developing country

Background

Globally, diabetes is a leading cause of impairment of quality of life. In the sub-Saharan African region, there is a need for studies that provide more valid assessment of effect of diabetes on quality of life (QoL). This study aimed at assessing quality of life among patients with diabetes attending a tertiary health service in Nigeria.

Methods

The study design was a case-control. Diabetic cases were randomly recruited from the University of Calabar Teaching Hospital, while non-diabetic controls were civil servants and retirees. The validated and pretested WHOQoL-BREF instrument was used to assess quality of life, with higher scores indicating higher quality of life.

Results

Three hundred and thirty subjects were studied, with mean ages of males and females of 55.2 ± 4.8 and 51.8 ± 6.3 years, respectively. The mean total QoL score was 75.77 ± 11.2, with no significant difference between males and females. Among male and female cases, the mean score of the physical health domain was significantly lower for cases compared with controls (p = 0.05). Male cases compared with controls had higher scores for the environment domain (p < 0.05). Older age and higher systemic blood pressure were associated with lower QoL scores for both sexes (p < 0.05). Unmarried status, obesity, and poor glycemic control (HbA1c > 7%) were associated with lower QoL scores (p < 0.05). Fasting blood sugar (FBS) level and lipid profile were not significantly correlated with QoL score in both sexes (p > 0.05).

Conclusion

Diabetes contributes to low quality of life among males and females, with significant differences in the affected domains. Diabetes care providers should identify affected domains during clinic consultation, in order to improve provision of more effective care.

Prevalence of painful diabetic peripheral neuropathy and its impact on quality of life among diabetic patients in Western region, Saudi Arabia

Background

Diabetic neuropathy is the most common long-term complications of diabetes, frequently presenting as painful diabetic peripheral neuropathy (PDPN), which can significantly impair patients' quality of life (QOL). This study set to estimate the prevalence of PNPD and health-related quality of life (HRQoL) in the setting of primary health care in Saudi Arabia.

Methods

This study was conducted in primary health-care centers affiliated with the National Guard Health Affairs in Western Saudi Arabia. Arabic version of the Douleur Neuropathique 4 questionnaire was administered on diabetic patients to screen for neuropathic pain and short-form 12 questionnaire to assess HRQoL.

Results

The study screened (n = 349) Type 2 diabetic patients. The prevalence of PDPN was 33.2%. PDRN was more likely to affect females (adjusted odds ratio ["AOR"] =1.96, P = 0.024), and those living with diabetes for over 15 years (AOR = 2.26, P = 0.039), and those on insulin treatment (AOR: 2.33, P = 0.010) alone or in combination (AOR = 1.78, P = 0.034). Both physical and mental components (MCs) of QOL scores were significantly higher in diabetic patients without PDPN compared to those with it; 49.57 ± 9.31 versus 40.77 ± 8.14 for physical component QOL and 51.72 ± 9.36 versus 44.35 ± 8.12 for MC QOL, P < 0.001.

Discussion and Conclusion

Painful peripheral neuropathy is relatively common among type 2 diabetic patients in Western Saudi Arabia and impacts both physical and MCs of the QOL of affected patients.

Depressive disorders in the Arabian Gulf Cooperation Council countries: a literature review

OBJECTIVE

To determine the contributions from the six Arabian Gulf Cooperation Council (GCC) countries to the national scientific literature on depressive disorders.

METHODS

This literature review identified all of the published studies on all major depressive disorders as cited on the PubMed® and APA PsycInfo® databases from inception to 31 December 2016 from the six GGC countries. Data were extracted using a standardized form. The study compared the volume of research production between the countries by calculating an index that allowed for the country population size.

RESULTS

A total of 28 studies met the inclusion criteria. Saudi Arabia headed the list of publications (10 articles) followed by the United Arab Emirates (n = 6), Kuwait (n = 5), Qatar (n = 3); and Bahrain and Oman produced two articles each. Only six out of the 28 (21.4%) studies included a random sample or adopted good sampling strategies. The majority of studies (24 of 28; 85.7%) were cross-sectional in design. Only one study clearly stated the use of the DSM-4 criteria for diagnosis.

CONCLUSION

The scientific literature published by the GCC countries on depressive disorders is scant and lacking scientific depth. These findings should be considered as a wake-up call for public health researchers, mental health workers and policymakers.

The impact of diabetes mellitus on health-related quality of life in Saudi Arabia

Objective

To evaluate the effect of different demographic, clinical and social factors on diabetic patients' quality of life (QOL).

Research design and methods

A cross sectional study conducted on patients with type 2 diabetes who attended King Abdulaziz University Hospital outpatient clinics between February and March 2017. The patients were asked about sociodemographic data including age, sex, educational level, exercise history and marital status in addition to clinical data such as duration of diabetes, presence of comorbidities as well as medication history. The patients' QOL were assessed using EQ-5D-5L Arabic version.

Results

131 participants were included in the study with a median age 55 years old. Forty five percent of participants were male. Regarding EQ-5D scores, there were significant correlation with gender, exercise, hypertension, heart disease, marital status, educational level and duration of diabetes while there was a significant difference in EQ-VAS scores with respect to heart disease, level of education and duration of diabetes.

Conclusion

More attention needs to be given to the assessment of the QOL of diabetic patients and assessing the effect of different treatment modalities on improvement of patients’ QOL.

Health-related quality of life among Israeli Arabs diagnosed with depression: the role of illness representations, self-stigma, self-esteem, and age

BACKGROUND

Studies that examined health-related quality of life (HRQoL) and related factors among people diagnosed with depression, have only focused on sociodemographic and clinical factors. This study examined the contribution of illness representations (IRs), self-stigma, self-esteem, and age group (younger adults aged 18 to 64 and older adults aged 65+) to HRQoL among Israeli Arabs diagnosed with depression.

METHODS

A convenience sample of 160 Israeli Arabs with depression completed measures of cognitive and emotional IRs, self-stigma, self-esteem, HRQoL, and sociodemographic and health characteristics.

RESULTS

Participants reported low levels of HRQoL, with the older adults reporting significantly lower levels of HRQoL in comparison to those reported by the younger adults. Low levels of HRQoL were significantly associated with negative cognitive and emotional IRs, high levels of self-stigma, and low levels of self-esteem. Cognitive IRs, self-stigma, self-esteem, and age group were found to be the main determinants of HRQoL.

LIMITATIONS

Limitations of the study include use of a cross-sectional design among culturally homogeneous sample. This limits the generalizability of our results and conclusions, and prevented us from determining causal relationships.

CONCLUSIONS

This study emphasizes the role of cognitive IRs, self-stigma, and self-esteem, as well as age, in the HRQoL of individuals diagnosed with depression. Intervention programs should be mindful of these determinants in order to improve the HRQoL of individuals diagnosed with depression.

Predictors of health-related quality of life among patients with diabetes on follow-up at Nekemte specialised Hospital, Western Ethiopia: a cross-sectional study

OBJECTIVE

To assess health-related quality of life (HRQoL) and its predictors among patients with diabetes on follow-up at Nekemte Specialised Hospital in Western Ethiopia.

DESIGN, SETTING AND PARTICIPANTS

This facility-based cross sectional study was conducted among 224 patients with diabetes mellitus (types I and II) on follow-up at one of the public hospitals in western Ethiopia. Respondents were selected by systematic random sampling and interviewed with the aid of a questionnaire.

MAIN OUTCOME MEASURED

HRQoL was measured by using the Medical outcomes study 36-item Short Form (SF-36) Health Survey from 15 April to 5 June 2019. A structured questionnaire was used for data collection from participants selected by systematic random sampling. Multiple linear regression was used for the final model.

RESULT

A total of 215 patients with diabetes consented and completed the study, giving a response rate of 96%. The mean score of the overall HRQoL of the study participants was 50.3±18.1. The highest mean score was obtained in the physical functioning domain and the lowest mean score in the general health domain. Age, education status, history of smoking, feeling of stigmatisation and body mass index were inversely associated with the overall HRQoL. Gender (male), marital status (currently married), absence of comorbidity and absence of chronic complications related to diabetes mellitus were positively associated with overall HRQoL.

CONCLUSION

The overall HRQoL of patients with diabetes on follow-up at the study area was found to be moderate. General health, mental health, bodily pain and vitality were the most affected domains. Both the mental and physical components need to be considered when caring for the patients with diabetes on follow-up beyond provision of treatment.

Sleep hygiene, sleep-related problems, and their relations with quality of life in a primary-care population in southwest Saudi Arabia

BACKGROUND

Little is recognized about factors affecting poor sleep hygiene and relations of sleep problems with the quality of life among adults.

AIMS

To evaluate sleep hygiene, explore its associated factors, assess the prevalence of excessive daytime sleepiness (EDS) and insomnia, and their relations with sleep hygiene. Besides, correlate sleep problems with life quality.

METHODS

A representative sample of primary healthcare population was surveyed using questionnaires comprising sociodemographic characters, personal lifestyles, validated Arabic versions of Epworth sleepiness scales, Athens insomnia scale, short-form health survey questionnaire (SF-12), and developed Arabic sleep hygiene index (SHI).

RESULTS

A total of 401 adults participated in the study. The average SHI score was 17.25 ± 7.33. Poorer sleep hygiene was significantly detected in younger age, unmarried, unemployed, smokers, and energy drinks consumers (P < 0.05). Positive significant correlations were correlated with cellphone and video-gaming duration. About 56.61% and 39.90% of participants suffered insomnia symptoms and EDS, respectively. Significant poorer SHI was detected among insomnia and EDS sufferers. Negative significant correlations were observed between scores of both components of SF-12 and EDS, insomnia, and SHI.

CONCLUSION

Significant negative associations were detected between SHI, EDS, insomnia, and both components of life quality. The role of sleep hygiene education programs in the promotion of sleep and quality of life need to be considered.

Heath related quality of life and associated factors among adults with and without diabetes in Adama city East Shewa, Ethiopia 2019; using generalized structural equation modeling

BACKGROUND

Diabetes mellitus (DM) is a chronic disease, leading to many complications and substantial decrease in patients' Health Related Quality of Life (HRQoL). HRQoL among diabetic patients could affect by concurrent various factors. Therefore, analysis of these concomitant factors using generalized structural equation model (GSEM) that takes account the complex network of relationship could be a more utilitarian approach to better understand factor affecting HRQoL. The present study aimed to assesses the level of HRQoL and its associated factors among adults with and without diabetes.

METHODS

A comparative cross-sectional study was conducted from March 13 to April 4, 2019 in Adama Hospital and Medical College and Adama city Kebele 2, 4 and 5, East Shewa Ethiopia. Data related to socio-demographics, behavioral, clinical factors and HRQoL were collected from 359 adults with diabetes & 415 adults without diabetes through face to face interviews. Data was entered to Epi-data 3.1 then it was exported to STATA 14 for further analysis. GSEM was employed to verify relationships and association among exogenous, mediating and endogenous variable concurrently.

RESULTS

Diabetic groups had a significant lower mean score in all domains of HRQoL than non- diabetic group (p-value< 0.0001). Depression had a direct negative effect on all domains of HRQoL in both groups. Fasting blood sugar also had a direct negative effect on all domains of HRQoL except social relation. Diabetes mellitus complication had a direct negative effect on both physical and psychological health. Low Medication adherence and poor diabetic self-care activity had a negative direct, indirect and total effect on physical and environmental health through fasting blood sugar.

CONCLUSION

Diabetic patients had lower HRQoL in all the domains of quality of life. Socio-demographic factor (Age, residence and marital status), clinical factor (Depression & Diabetes mellitus complication) and behavioral factor (diabetic self-care activity and medication adherence) mediated by fasting blood sugar were factor associated HRQoL among the diabetic group. Thus, we recommend that integration of screening for depression and give counseling on medication adherences and diabetic self-care activity along with the already existing DM treatment.

Changes in the Quality of Life in Patients with Type 2 Diabetes Mellitus According to Physician and Patient Behaviors

BACKGROUND

Diabetes mellitus (DM) is the most common chronic metabolic disorder with an increasing prevalence worldwide. According to a previous study, physicians' treatment patterns or patients' behaviors change when they become aware of the risk for cardiovascular (CV) disease in patients with DM. However, there exist controversial reports from previous studies in the impact of physicians' behaviors on the patients' quality of life (QoL) improvements. So we investigate the changes in QoL according to physicians and patients' behavioral changes after the awareness of CV risks in patients with type 2 DM.

METHODS

Data were obtained from a prospective, observational study where 799 patients aged ≥40 years with type 2 DM were recruited at 24 tertiary hospitals in Korea. Changes in physicians' behaviors were defined as changes in the dose/type of antihypertensive, lipid-lowering, and anti-platelet therapies within 6-month after the awareness of CV risks in patients. Changes in patients' behaviors were based on lifestyle modifications. Audit of Diabetes Dependent Quality of Life comprising 19-life-domains was used.

RESULTS

The weighted impact score change for local or long-distance journey (P=0.0049), holidays (P=0.0364), and physical health (P=0.0451) domains significantly differed between the two groups; patients whose physician's behaviors changed showed greater improvement than those whose physician's behaviors did not change.

CONCLUSION

This study demonstrates that changes in physicians' behaviors, as a result of perceiving CV risks, improve QoL in some domains of life in DM patients. Physicians should recognize the importance of understanding CV risks and implement appropriate management.

Health-related quality of life among patients with type 2 diabetes mellitus in Eastern Province, Saudi Arabia: A cross-sectional study

Diabetes mellitus has reached epidemic levels, and it threatens the economy and health globally and Saudi Arabia in particular. The study assessed health-related quality of life using EuroQol instrument and its predictors among patients with Type 2 diabetes mellitus in Eastern Province, Saudi Arabia. A cross-sectional study was conducted among 378 patients with Type 2 diabetes mellitus from two major health centers in Eastern Province. The study showed moderate health-related quality of life, as reported by the median index score of 0.808 with more than a quarter of patients with severe-extreme health state in some or all domains. Multiple-regression models showed that male gender, high monthly income, having no diabetes-related complications and having random blood glucose level less than 200 mg/dl were prone to have a higher index score compared to the corresponding contrary groups. The study will help in guiding the development of effective intervention programs to improve diabetes-related health-related quality of life among the Saudi population.

Effects of Diabetic Complications on Health-Related Quality of Life Impairment in Vietnamese Patients with Type 2 Diabetes

Complications of type 2 diabetes mellitus (T2DM) adversely influence patients' health-related quality of life (HRQOL). This study is aimed at examining HRQOL of T2DM patients, as well as the effects of diabetic complications and comorbidities on HRQOL in this population. This was a hospital-based cross-sectional study on 214 T2DM patients in Hanoi, Vietnam. Short-form 12 version 2 (SF-12v2) and EuroQOL-5 Dimensions-5 Levels (EQ-5D-5L) were employed to measure the HRQOL. The median physical component summary score (PCS), mental component summary score (MCS), and EQ-5D index were 45.6, 56.3, and 0.94, respectively. Having at least one diabetic complication was associated with the reduction of SF-12 scores in social functioning (Diff. = -5.69, 95%CI = -9.24; -2.13), role emotional (Diff. = -1.81, 95%CI = -3.12; -0.51), and MCS (Diff. = -2.55, 95%CI = -5.01; -0.1). Significant decrement of physical functioning, role physical, social functioning, role emotional, and MCS was found in patients having diabetic heart diseases compared to those without diabetic complications. The study revealed that HRQOL of Vietnamese patients with diabetic complications was moderately low, especially in social and mental health perspectives. Strategies to prevent the onset of diabetic complications should be developed as a priority in diabetes management.

Clinical and psychological characteristics of liraglutide treatment among patients with type 2 diabetes

Aim:

This study aimed to evaluate the glycemic control, quality of life (QOL), and sleep quality in type 2 diabetes mellitus (T2DM) patients who are treated with liraglutide and to investigate whether the QOL and sleep quality were correlated with the glycemic control of this population.

Methods:

A cross-sectional study was carried out on T2DM patients who were treated with liraglutide. Data on body weight and glycemic control were recorded while the QOL and sleep quality were assessed using the Short-Form Health Survey (SF-36), the 5-item World Health Organization Well-Being Index (WHO-5), and the Pittsburgh Sleep Quality Index (PSQI) questionnaires.

Results:

Eighty-four T2DM patients who initiated liraglutide with a mean age of 46.7 years were included in the study. The mean hemoglobin A1c (HbA1c) was 7.76% (standard deviation [SD] =0.62), and about 88.1% of patients had HbA1c > 7%. The PSQI score showed not too bad sleep quality (mean 4.3 ± 1.9). The mean WHO-5 score of the study population showed a “moderate” QOL (12.4 ± 3). Patients had lowest SF-36 score (mean = 52.3) in the subscale of “energy and fatigue.” There was a significant positive correlation between HbA1C and the “energy and fatigue” (r = 0.232, P = 0.034) but not with the other subscales.

Conclusion:

Patients with T2DM taking liraglutide have moderate sleep difficulty and QOL score. Nonetheless, none of these outcomes was significantly correlated with glycemic control. Further well-designed studies with long-term follow-up and larger population sizes are needed to confirm our findings.

Diabetes in women and health-related quality of life in the whole family: a structural equation modeling

Background

Although several studies indicate the effects of diabetes type 2 on health-related quality of life (HRQoL) in female subjects, the related impact of the disease on HRQoL in their family members has rarely been the focus of the empirical research. In this study we aim to investigate associations between diabetes in women and the HRQoL in these women and their family members, using the structural equation modeling (SEM).

Methods

This family-based study was conducted on 794 women (11.1% with diabetes) as well as their spouses and children who participated in the Tehran Lipid and Glucose Study (TLGS) from 2014 to 2016. Data on HRQoL were collected using the Iranian version of the Short-Form 12-Item Health Survey version 2 (SF-12v2) and the Pediatric Quality of Life Inventory version™ 4.0 (PedsQL). SEM was conducted to evaluate the network of associations among studied variables. Data were analyzed using IBM SPSS Statistics & AMOS version 23 software.

Results

Mean age of women was 41.37 ± 5.32 years. Diabetes in women significantly affected their mental HRQoL (β = − 0.11, P < 0.01) but showed no significant direct associations with physical and mental HRQoL in their spouses or their children. However, poor mental HRQoL in women with diabetes was associated with decrease in both physical (β = − 0.02, P = 0.013) and mental (β = − 0.03, P < 0.01) HRQoL in their spouses and total HRQoL score in children (β = − 0.02, P < 0.01).

Conclusions

Among women with diabetes type 2, beyond its effect on their mental HRQoL per se, demonstrated a negative association with the self-assessment of health status in their spouses and children. Such familial consequences are mainly attributed to the negative effect of the disease on the mental rather than the physical HRQoL in women with diabetes.

Respiratory health and quality of life in young exclusive, habitual smokers - a comparison of waterpipe smokers, cigarette smokers and non-smokers

Purpose

Waterpipe (WP) use has become a global trend in young populations. However, there are few well-controlled studies focusing specifically on the chronic effects of exclusive WP use on young adults’ respiratory health. We sought to compare in young adults the burden of respiratory symptoms in regular WP smokers (WPS) relative to regular cigarette smokers (CS, positive controls) and non-smokers (negative controls); and to evaluate differences in health-related quality of life between the three groups.

Method

We implemented a cross-sectional survey in college campuses across four countries (Egypt, Jordan, Morocco and Oman). Purposive sampling was employed to identify habitual (regular) healthy WPS (smoked 3 or more WP per week for 3 or more years); CS (smoked 5 or more cigarettes daily for 3 or more years); and non-smokers. Respiratory symptoms were assessed using the European Community Respiratory Health Survey and the American Thoracic Society and the Division of Lung Diseases Questionnaire. Health-related quality of life was measured using the Short-Form 12. Demographic, environmental and lifestyle factors also were measured.

Result

The analytic sample included 135 WPS, 303 CS, and 300 non-smokers. Either tobacco group had significantly greater proportions of males than the non-smoker group. A significantly lower proportion of non-smokers (than either tobacco group) was overweight or obese. Average numbers of reported respiratory symptoms were 5.1, 5.8, and 2.9 in WPS, CS, and non-smokers, respectively. In multivariable regressions controlling for environmental exposures, body mass index, and physical activity, WPS and CS exhibited significantly higher rates of respiratory symptoms than non-smokers (1.6 times greater and 1.9 times greater rate of respiratory symptoms than non-smokers, respectively). Non-smokers reported significantly higher scores for general health relative to either WPS or CS.

Conclusion

Relative to their young non-smoking counterparts, young habitual WPS exhibit a significant burden of respiratory symptoms that is comparable to that observed with CS. Young WPS (and CS), despite their age, may be well on their way to developing respiratory disease.

Impact of type 2 diabetes treated with non-insulin medication and number of diabetes-coexisting diseases on EQ-5D-5 L index scores in the Finnish population

BACKGROUND

Type 2 diabetes (T2D) causes significant health and economic burden. In addition to comorbidities there are also coexisting diseases linked to obesity, lifestyle and T2D. The aim of this study was to examine the effect of T2D and T2D-coexisting diseases on health-related quality of life (HRQoL) in the Finnish population and whether it is T2D or the coexisting diseases that have the largest impact on HRQoL.

METHODS

The study was based on a national cross-sectional population survey (n = 5305). Respondents' HRQoL was measured using the EQ-5D-5 L instrument. Our study included diabetic respondents treated with non-insulin medications (NI-T2D) with or without insulin and non-diabetic respondents, whereas diabetic respondents not taking any anti-diabetic medications or treated with insulin alone were excluded. A crosswalk algorithm was used to convert EQ-5D-5 L index scores into EQ-5D-3 L index scores as a sensitivity analysis. A two-part model was used to examine the association between T2D and coexisting diseases and HRQoL.

RESULTS

The unadjusted mean (SD) EQ-5D-5 L index scores for non-diabetics (n = 4856) was 0.90 (0.13) and 0.85 (0.16) for respondents with NI-T2D (n = 449). With adjustment for demographic factors, the difference in EQ-5D-5 L index scores was 0.036 (95% CI 0.023-0.050). After adjusting for the number of coexisting diseases, the EQ-5D-5 L index scores among respondents with NI-T2D and three or more coexisting diseases were lower when compared to all non-diabetics but not when compared to non-diabetics with similar number of coexisting diseases. The number of T2D-coexisting diseases had a larger effect on EQ-5D-5 L index scores in younger age groups (20 and 40 years old).

CONCLUSIONS

Lower EQ-5D-5 L index score is associated with NI-T2D when compared to non-diabetic respondents. When compared to non-diabetics, the disutility associated with NI-T2D increases as more coexisting diseases appear. The disutility effect of coexisting diseases was equally large in non-diabetics and respondents with NI-T2D. Thus, public health interventions targeting the prevention of both T2D and its coexisting diseases have potential to have significant benefits also in terms of HRQoL.

National rates of emergency department visits associated with diabetes in Saudi Arabia, 2011-2015

BACKGROUND

Despite the fact that diabetes is an important component of the burden of disease on the individual and on the national healthcare systems in Saudi Arabia, knowledge of the volume of emergency department (ED) visits for diabetes is unclear.

OBJECTIVE

Examine changes in ED visit rates associated with diabetes.

DESIGN

Retrospective.

SETTINGS

Governmental hospitals.

METHODS

Publicly available records of health statistics published by the Saudi Ministry of Health from 2011 through 2015 were used to extract data on ED visits related to diabetes. ED visits associated with diabetes were compared over time and by gender. We calculated diabetes-specific rates per 10000 persons for each sex category by dividing the total number of diabetes-associated ED visits in that category by the sex-specific population. We calculated the rate difference (RD) with 95% CI between 2011 and 2015.

MAIN OUTCOME MEASURES

Diabetes-specific rates per 10000 persons for each sex category.

RESULTS

Total annual visits to the ED for management of diabetes increased from 617683 cases in 2011 to 748605 in 2015. The annual number of ED visits associated with diabetes increased by 21% over the study period (20% for males and 23% for females). Compared to males, females had a larger increase in visit rates from 240.5 to 249.8 visits per 10000 women over the study years (RD, 9.6 per 10000 persons, 95% CI -16.4 to 26.6 versus 5.7 per 10 000 persons, 95% CI-13.6 to 18.3 ; P=.01).

CONCLUSION

Although diabetes-associated ED visit rates dramatically increased in 2012, they remained relatively stable after 2012 to the end of the study period. More effective preventive diabetes programs that prevent the use of ED visits and other expensive healthcare resources among people with diabetes are needed.

LIMITATIONS

We had no information on the specific indications for the reported ED visits. These estimates may represent a lower bound on ED visits associated with diabetes since the private sector was not included.

CONFLICT OF INTEREST

None.

Impaired quality of life and diabetic foot disease in Saudi patients with type 2 diabetes: A cross-sectional analysis

Objectives:

This study aimed to assess the overall health-related quality of life in type 2 diabetes mellitus patients with diabetic foot disease compared to diabetic patients without diabetic foot and to identify the clinical utility of this assessment.

Methods:

A total of 250 consecutive patients with type 2 diabetes mellitus (100/150 with/without diabetic foot, respectively) were interviewed. The questionnaires of the 36-item short-form survey and region-specific foot and ankle ability measure were applied. Wagner–Meggitt wound classification was used for foot-ulcer evaluation. Follow-up of patients for 3–6 weeks was done to identify the potential clinical short outcomes of diabetic foot ulcers.

Results:

Type 2 diabetes mellitus patients with diabetic foot exhibited poor mental and physical health consequences. Females had more prevalence of forefoot lesions, larger ulcer size, advanced Wagner grade, and higher frequency of unhealed ulcers. Receiver operating characteristic curve analysis demonstrated high value of foot and ankle ability measure and 36-item short-form questionnaires to discriminate type 2 diabetes mellitus patients with and without diabetic foot at cutoff values of 66 and 49.6, respectively. Foot and ankle ability measure questionnaire also showed high performance for differentiating the clinical outcome of foot ulcer. Total foot and ankle ability measure subscale score above the cutoff value of 65.5 could discriminate patients with complete healing and unhealed ulcer lesions at a high sensitivity and specificity.

Conclusion:

The current findings confirm the impact of diabetic foot disease on type 2 diabetes mellitus overall health-related quality of life reflected in 36-item short-form questionnaire and foot and ankle ability measure questionnaire which showed high discriminative values for type 2 diabetes mellitus patient sub-grouping. Their application in routine clinical health assessment with continuous medical education programs is highly recommended to achieve a better health-related quality of life.

General health status in Iranian diabetic patients assessed by short-form-36 questionnaire: a systematic review and meta-analysis

BACKGROUND

Diabetes mellitus is one of the most prevalent diseases worldwide. Diabetes is a chronic disease associated with micro- and macro-vascular complications and deterioration in general health status. Therefore, the aim of this study was to estimate general health status among Iranian diabetic patients through a systematic review and meta-analysis of study utilizing the Short-Form-36 questionnaire.

METHODS

Searching the EMBASE, PubMed, ISI/Web of Sciences (WOS), MEDLINE via Ovid, PsycoINFO, as well as Iranian databases (MagIran, Iranmedex, and SID) from January 2000 to December 2017. The methodological quality of the studies was evaluated using the "A Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions" (ACROBAT-NRSI). Random-effect model was used and the means were reported with their 95% confidence interval (CI). To evaluate the heterogeneity between studies, I² test was used. Egger's regression test was used to assess the publication bias.

RESULTS

Fourteen studies were retained in the final analysis. The mean general health status using SF-36 in diabetic patients of Iran was 51.9 (95% CI: 48.64 to 53.54). The mean physical component summary was 52.92 [95% CI: 49.46-56.38], while the mean mental component summary was 51.02 [95% CI: 46.87-55.16].

CONCLUSION

The findings of this study showed that general health status in Iranian diabetic patients is low. Health policymakers should work to improve the health status in these patients and take appropriate interventions.

Health Related Quality of Life of Patients with Diabetes in Romania

Background and aims: This paper aims at understanding patient’s perspective in coping with diabetes in Romania. The study analyzes whether there are significant differences between health related quality of life (HRQL) of patients with diabetes, based on socio-demographic and disease-related characteristics.

Material and methods: The study included 128 patients aged ≥ 18 years, diagnosed with type 1 and 2 diabetes and was conducted in the period of November 2015 – July 2016. The project included two main research instruments – one questionnaire applied face-to-face to each patient and one questionnaire completed by the physicians including health data for each patient who agreed to participate in the study. The set of tested characteristics includes: (i) gender; (ii) place of residence; (iii) education level; (iv) marital status; (v) employment status; (vi) level of personal income; (vii) age; (viii) type of diabetes; (ix) duration of diabetes; (x) household composition (another person with diabetes); (xi) network support and (xii) patient’s access to information and communication technology (ICT).

Results: The mean age was 54.23±12.76 years, with three quarters of respondents above the age of 40 years and 68% married. More than half of participants have access to internet, either at home or at work.

Conclusions: The results indicate that gender, household’s composition, place of residence, access to ICT, employment status, type of diabetes, personal income level, the presence of a support network, age and diabetes duration differentiate between reported HRQL indicators. The study adds knowledge for understanding chronic disease patients’ self-assessment of HRQL in Romania.

Health-Related Quality of Life in Adults with Osteogenesis Imperfecta

Osteogenesis imperfecta (OI) is a systemic connective tissue disorder most often caused by mutations in collagen type 1 related genes. Patients with OI suffer from multiple fractures and various degrees of growth deficiency and bone deformity. It is unknown whether the systemic effect of defect collagen type 1 influences the quality of life in patients with OI. We therefore aimed to investigate health-related quality of life (HRQoL) in a well-characterized cohort of adult patients with OI. We included 85 adult patients with mild to severe OI (types I, III, and IV) and obtained information about skeletal- and non-skeletal phenotypes and patient demographics. We investigated physical and mental HRQoL using a validated questionnaire, SF-36, and compared the data to values obtained in a population without OI. Patients with mild, moderate, and severe OI all had lower mean scores on domains describing physical HRQoL and a lower mean physical component score compared to the general population, p < 0.001. Patients with severe OI had lower mean scores on physical HRQoL, p < 0.05. The scores on domains reflecting mental HRQoL were more inhomogenously affected, but did not differ significantly from the general population. OI has an impact on physical and some aspects of mental HRQoL. The scores on physical health were correlated to severity of the OI disease. The mental component score in the OI patients was unaffected and comparable with the general population.

The impact of drug related problems on health-related quality of life among hypertensive patients in Jordan

BACKGROUND

Hypertension is a major cause of cardiovascular diseases with a high prevalence in Jordan. No previous studies have been carried out to determine the effect of the presence of drug-related problems (DRPs) on the health-related quality of life (HRQOL) among hypertensive patients.

OBJECTIVES

The purpose of this study was to identify the influence of different types of DRPs on the HRQOL of hypertensive patients.

METHODS

A total of 200 hypertensive patients were recruited in this cross-sectional correlation study that was conducted across the cardiac outpatient clinic at Jordan University Hospital. Ethical approval was obtained and patients were recruited using convenience sampling technique. During the study period, patients' data was used to evaluate their quality of life using RAND-12 scale and to identify DRPs utilizing a systematic evidence based approach.

RESULTS

200 hypertensive patients (mean age 59.7 years (SD=10.2)) were recruited in this study. Patients showed a poor quality of life on both the physical and mental domains of the RAND-12 scale. The average number of DRPs was 5.1 (SD=2.3). Multiple linear regression analysis showed that among DRPs categories, non-adherence to medications, non-adherence to non-pharmacological therapies and inadequate knowledge about medications were among the main predictors of the poor physical domain of the RAND-12 (Beta= -0.149, -0.226 and -0.230 respectively, p-value < 0.05 for all). On the other hand, only non-adherence to medication and non-adherence to non-pharmacological therapies were significantly associated with poor mental domain of the RAND-12 (Beta= -0.208 and -0.191 respectively, p-value < 0.05 for both).

CONCLUSION

Prevalence of DRPs among hypertensive patients is a concern that needs attention. These DRPs were associated with poor HRQOL on both the physical and mental domain of the RAND-12 scale. The pharmaceutical care service delivered by pharmacists is needed to identify, prevent and resolve DRPs, which may improve patients HRQOL.