Innovative methods for health monitoring in Europe: results of a cross-sectional study

Background

Innovative solutions are used to monitor the spread of COVID-19, to research and develop vaccines, and to ensure online privacy and security. The aim of the study is to investigate which innovative methods, including algorithms and digital tools (e.g., social media, artificial intelligence, contact tracing applications) are used to monitor health issues related to COVID-19 in Europe, and who is using them.

Methods

A questionnaire was developed and administered online to European countries’ representatives and stakeholders of the project Population Health Information Research Infrastructure (PHIRI). The survey investigated the use of innovative solutions and digital tools in Europe to monitor COVID-19 and vaccination programs, to research and develop diagnostics and teleconsultations, and to fight online disinformation. Legislative and ethical aspects were also considered. A descriptive data analysis was performed.

Results

19 responses were collected from 14 countries. Digital tools are used to monitor COVID-19 (13/14 countries), vaccination programs (12/14), for telemedicine (7/14), and to fight disinformation (10/14). Specific algorithms to detect the patterns of the pandemic spread are available in five countries. The main target groups of the tools are the general population, healthcare providers, patients and epidemiologists. The uptake rate of the tools ranged 5-100% across countries. Measures to evaluate the impact of digital tools (e.g., user surveys, reviews, evaluation teams) have been adopted in seven countries. Information on legislative and ethical aspects related to the use of digital solutions are available in 10 countries.

Conclusions

The development and use of innovative methods for population health monitoring and research purposes have been the key to mitigate the COVID-19 pandemic. Improving the uptake rate, impact assessment of digital tools and fight against disinformation could enhance countries’ preparedness for future pandemics.

Key messages

• Given that digital solutions are deployed in population health monitoring, research, and for online privacy and security, they have a key role in mitigating the COVID-19 pandemic.

• Enhancement of the uptake rate and assessment of digital tools, and fight against disinformation could strengthen countries’ preparedness for future pandemics.

Changes in perceived health status in older men and women during the COVID-19 pandemic

Background

The COVID-19 pandemic has severely impacted older people. The disease and the measures to combat it have had a differential impact according to gender, with higher mortality rates in men and worse psychological and social consequences in women. The objective of this work is to analyze the changes in perceived health of older people in Europe during the first months of the pandemic and to assess the combined role of age and gender.

Methods

Wave 8 data of SHARE-corona (Survey of Health, Aging and Retirement in Europe) (n = 51,695, aged≥50) collected between Jun-Aug 2020 were used. Perceived health status was explored with a question on whether there has been a change compared with the health status before the COVID-19 outbreak (response options: worse, the same and better). Two-way ANOVA with interaction and Student's t-test with Bonferroni correction were used to compare the effects of gender and age group (50-59 years, 60-69 years, 70-79 years, and ≥80) in changes in perceived health.

Results

Differences in perceived health were observed by age, as well as by gender in participants aged ≥70 years (F = 91.94; p < 0.001). These differences were significant both by gender (F = 19.39; p < 0.001) and age (F = 191.79; p < 0.001). No interaction was detected between both factors (p = 0.170), which allowed their effect to be studied individually. Among the people who reported a worsening in their perceived health, women aged 70 to 79 years predominated (11.1%), followed by men aged 80 and over (15.3%) and women of the same age group (16.4%).

Conclusions

The results suggest an association between the change in perceived health during the pandemic and age. Women have a slightly worse health status than men in all age groups. Therefore, gender can be considered as an influential factor in perceived health in old age, which in turn can have a potential impact in the quality of life of older people.

Funding

Projects Ref. H2019/HUM-5698 and Ref. 202010E158.

Key messages

Review of direct impact health indicators of COVID-19 in the scientific literature published between January 2020 and June 2021

Background

The Joint Action Population Health Information Research Infrastructure (PHIRI) seeks to create infrastructures to generate quality data on the COVID-19 pandemic between European countries. The aim of this study is to present a synthesis of health indicators used to evaluate the direct impact of COVID-19

Methods

Scoping review using a common search strategy in Pubmed, Embase and WHO Covid-19 databases. Health indicators of direct impact of COVID-19 were obtained from observational studies in the general population, hospitals and long-term care facilities from papers published worldwide in English between 01/01/2020 and 06/31/2021. Titles and abstracts were screened first by 15 reviewers using the Rayyan tool. Any discrepancies were solved by agreement between reviewers. Then, articles containing indicators of direct impact were selected in a full-text reading phase. Of them, a random sample of 35 was drawn and their indicators were described.

Results

After eliminating 262 duplicates 3891 records were reviewed. Screening discarded 3171 abstracts. Of 720 articles sought for retrieval, 445 met inclusion criteria for indicators extraction. In a sample of 35 papers (8.1%), 116 direct impact indicators of COVID-19 were identified. 28 morbidity indicators were found, classified as indicators of prevalence (n = 15), incidence (6), transmissibility (4) and underreported infection (4); 32 of mortality (mortality rate, 9; case fatality rate, 17; time to death, 2); and 54 for severity (complications, 27; mechanical ventilation, 12; hospitalization, 8; requiring ICU admission, 1; time from hospitalization to ICU admission, 1). Two composite indicators of severity and mortality were also identified.

Conclusions

According to the scientific literature, a wide variety of health indicators has been used to measure the direct impact of COVID-19. The systematization of indicators used in the current COVID-19 pandemic could help for future health crises management.

Research methodologies to assess the impact of COVID-19

Background

PHIRI WP5 aims at identifying the research approaches, data uses, pathways, indicators, and new methodologies to assess the impact of COVID-19 on Population Health.

Methods

Based on a collaborative work of researchers from 20 European institutions, several literature reviews were planned using automatized strategies to map the research methods analysing the impact of COVID-19 and data pathways: i) a scoping literature search to identify indicators of direct and indirect impact; ii) systematic literature reviews on determinants of severity for short and longterm health outcomes; and iii) a systematic literature review and meta-analysis to determine the effectiveness and impact of tracking COVID-19 patients using digitals tools.

Results

In November 2020, more than 73,000 papers about COVID-19 were published. About 16,000 (22%) reported data aspects, and approximately half reported both data aspects and methodologies. The most used indicators of direct impact are incidence and prevalence, mortality, severity and sequelae. To explore the etiological and prognostic effects of frailty, multimorbidity and socioeconomic status, the main identified outcomes were: infection, hospitalization, ICU admission, mortality by COVID-19 (etiological); as well as ICU admission, hospitalization, survival, functional decline, quality of life, disability, mental health difficulties and work absence (prognostic). The search generated 10,139 records. The initial literature search about mobile applications and electronic devices for tracking of COVID-19 patients yielded 2500 records.

Conclusions

The use of machine learning tools to synthesize the research about methods and data pathways on COVID-19 impact is feasible, as the amount of published evidence is very large. The vast amount of available literature on COVID-19 requires specific methods of literature search and synthesis, and an integrated effort of an extensive network of researchers.

HAE-AS: A Specific Disease Activity Scale for Hereditary Angioedema With C1-Inhibitor Deficiency

BACKGROUND AND OBJECTIVE

The activity of hereditary angioedema due to C1-inhibitor deficiency (C1-INH-HAE) varies between patients and within individual patients. Objective: This study aims to develop a disease activity scale for C1-INH-HAE (HAE-AS) with sound measurement properties.

METHODS

Eleven countries participated in a prospective multicenter cohort study. A clinical questionnaire was self-completed by 290 adult patients with C1-INH-HAE. Patients also completed 2 quality of life scales, the SF-36v2 and the HAE-QoL. Rasch analysis and classic psychometric methods were used to preselect a series of clinical items: number of attacks by location and number of treated attacks, emergency room visits, psychological/psychiatric treatment, missed school/workdays in the previous 6 months; general health; and impairment in everyday work/activities due to pain.

RESULTS

The mean (SD) age was 41.5 (14.7; range, 18-84) years, and 69% were females. The final 12-item Rasch model showed that the HAE-AS had satisfactory reliability (person separation index, 0.748), local item independence, unidimensionality, and no item bias by age or sex. The HAE-AS provided scores in a linear measure, with a mean of 10.66 (3.92; range, 0-30). Further analysis with classic psychometric methods indicated that the HAE-AS linear measure presented moderate-to-high convergent validity with quality of life scales (SF-36v2: physical component, r=-0.33; mental component, 0.555; HAE-QoL, -0.61), and good discriminative validity by age, sex, and disease severity (P<.05).

CONCLUSIONS

The HAE-AS is a short, valid, reliable, and psychometrically sound measure of the activity of C1-INH-HAE that could prove useful for research studies.

Examining the impact of mental disease on type 2 diabetes outcomes: results from the EpiChron Cohort

Background

Type 2 diabetes mellitus (T2D) is often accompanied by other chronic diseases, including mental diseases (MD). This work aimed at studying MD prevalence in T2D patients and analyse its impact on T2D health outcomes.

Methods

Retrospective, observational study of individuals of the EpiChron Cohort aged 18 and over with prevalent T2D at baseline (2011) in Aragón, Spain (n = 63,365). Participants were categorized by the existence or absence of MD, defined as the presence of depression, anxiety, schizophrenia or substance abuse. MD prevalence was calculated, and a logistic regression model was performed to analyse the likelihood of the four studied health outcomes (4-year all-cause mortality, all-cause hospitalization, T2D-hospitalization, and emergency room visits) based on the presence of each type of MD, after adjusting by age, sex and number of comorbidities.

Results

Mental diseases were observed in 19% of T2D patients, with depression being the most frequent condition, especially in women (20.7% vs. 7.57%). Mortality risk was significantly higher in patients with MD (odds ratio -OR- 1.24; 95% confidence interval -CI- 1.16-1.31), especially in those with substance abuse (OR 2.18; 95% CI 1.84-2.57) and schizophrenia (OR 1.82; 95% CI 1.50-2.21). The presence of MD also increased the risk of T2D-hospitalization (OR 1.51; 95% CI 1.18-1.93), emergency room visits (OR 1.26; 95% CI 1.21-1.32) and all-cause hospitalization (OR 1.16; 95% CI 1.10-1.23).

Conclusions

The high prevalence of MD among T2D patients, and its association with health outcomes, underscores the importance of providing integrated, person-centred care and early detection of comorbid mental diseases in T2D patients to improve disease management and health outcomes.

Key messages

Comprehensive care of T2D should include specific strategies for prevention, early detection, and management of comorbidities, especially mental disorders, in order to reduce their impact on health. Substance abuse was the mental disease with the highest risk of T2D-hospitalization, emergency room visits and all-cause hospitalization.

Overcoming multimorbidity: Chrodis Integrated Multimorbidity Care Model pilot implementation

Background

Multimorbidity (MM) has become one of the greatest challenges for patients and healthcare providers, calling for the development of care models that offer holistic, patient-centered care plans. Our objective was to assess the applicability and effectiveness of the Chrodis Integrated Multimorbidity Care Model (IMCM) to improve care for patients with MM in the Public Health System of Aragón, a region in northeastern Spain where MM affects 80% of people over 65 years of age.

Methods

We developed and implemented a set of actions (”change package”) to target three main improvement areas (i.e., care fragmentation, training of professionals and community care) covering all five dimensions of the model. We used key process and outcome indicators to evaluate each action, including healthcare service use (hospitalizations, emergency room visits), delivery of care (care plans, case managers), improvement in MM management skills of professionals (online training course), and patient self-perceived quality of care (ad-hoc questionnaire).

Results

291 patients of over 65 years of age with MM were recruited. At the end of the implementation every patient had a designated case manager and an individualized care plan, and 96.7% had their social situation assessed. During the 1-year pilot intervention, patients averaged 0.69 hospitalizations and 1.24 visits to the emergency room; 87.5% reported a self-perceived improvement of received care. 348 community resources were mapped and made available online in an official website. 89% of professionals who were offered to participate in the training programme agreed, reporting 8.3/10 satisfaction with the course, and improved their MM management skills from 7.36 to 9.18/10.

Conclusions

The IMCM is applicable in the context of the Spanish Public Health System and is effective in improving quality of care for patients and professionals alike.

Key messages

Reinforcing the mechanisms that integrate community, primary and hospital care is still necessary if we intend to reduce the negative health outcomes associated to care fragmentation in multimorbidity. The sustainability of the model requires the continued collaboration of key stakeholders and the awareness that multimorbidity is an issue that exceeds purely economic and structural barriers.

Lights4Violence: a quasi-experimental educational intervention in six European countries to promote positive relationships among adolescents

Background

Preventing intimate partner violence or dating violence (DV) among adolescents is a public health priority due to its magnitude and damaging short and long-term consequences for adolescent and adult health. In our study protocol, we complement prior experiences in DV prevention by promoting protective factors (or assets) against gender violence such as communication skills, empathy and problem-solving capability through “Cinema Voice”, a participatory educational intervention based on adolescents’ strengths to tackle DV.

Methods/design

A longitudinal quasi-experimental educational intervention addressed to boys and girls ages 13–17 years, enrolled in secondary education schools in Alicante (Spain), Rome (Italy), Cardiff (UK), Iasi (Romania), Poznan (Poland) and Matosinhos (Portugal). Both process and results evaluations will be carried out with 100–120 intervention and 120–150 control group students per city at three time periods: before, after and 6 months after the implementation of the following interventions: 1) Training seminar with teachers to promote knowledge and skills on the core issues of intervention; 2) Workshops with intervention groups, where participants produce their own digital content presenting their perspective on DV; and 3) Short film exhibitions with participants, their families, authorities and other stakeholders with the objective of share the results and engage the community. Outcome measures are self-perceived social support, machismo, sexism, tolerance towards gender violence, social problem-solving and assertiveness as well as involvement in bullying/cyberbullying. Other socio-demographic, attitudes and violence-related co-variables were also included.

Discussion

This study may provide relevant information about the effectiveness of educational interventions that combine a positive youth development framework with educational awareness about the importance of achieving gender equality and preventing and combating gender violence. To our knowledge, this is the first study that involves six European countries in an educational intervention to promote violence protective assets among enrolled adolescents in secondary schools. This study may provide the needed tools to replicate the experience in other contexts and other countries.

Trial registration

Clinicaltrials.gov: NCT03411564. Unique Protocol ID: 776905. Date registered: 18-01-2018.

Chronic musculoskeletal pain in European older adults: Cross-national and gender differences

BACKGROUND

In an ageing Europe, chronic pain is a major public health problem, but robust epidemiological data are scarce. This study aimed to analyse the prevalence of and factors associated with chronic musculoskeletal pain by gender in older adults of 14 European countries.

METHODS

A cross-sectional study was performed from wave 5 of the Survey of Health, Ageing and Retirement in Europe (SHARE). The study included people ≥50 years residing in Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Italy, Luxembourg, the Netherlands, Slovenia, Spain, Sweden and Switzerland. Chronic pain was defined as being bothered by joint and/or back pain for the previous 6 months. Multivariable Poisson regression models with robust variance were performed to analyse prevalence ratio by covariates, stratified by sex.

RESULTS

A total of 61,157 participants were included. Overall prevalence of chronic musculoskeletal pain was 35.7% (28.8-31.7), ranging from 18.6% (17.1-20.1) for Switzerland to 45.6% (43.3-47.8) for France. Prevalence was higher in women than in men: 41.3% (40.2-42.4) versus 29.1% (28.0-30.3). Chronic musculoskeletal pain was lower in men aged >75 years (PR = 0.82; 0.72-0.92) than the younger (50-59) group. Separated/divorced status presented opposite effects among men (PR = 0.85; 0.76-0.96) and women (PR = 1.12; 1.03-1.21) compared with married, and unemployment was a significant factor in men (PR = 1.21; 95% CI 1.02-1.43) compared with employed.

CONCLUSIONS

Musculoskeletal pain in older European adults is very frequent, especially in women, with large differences depending on the country of residence. Health policy makers should prioritize strategies aimed at improving the prevention and management of chronic musculoskeletal pain in Europe.

SIGNIFICANCE

This study provides epidemiological data of chronic musculoskeletal pain in older adults. Reported differences contribute to highlight the relevance of considering a gender perspective in chronic musculoskeletal pain research. Cross-national comparison also offers a map of differences that improves the knowledge of this chronic condition in Europe.

Hierarchical nature of activities of daily living in the Spanish Disability Survey

Many studies have addressed the issue of dimensionality in activities of daily living (ADL) and its hierarchy, with contradictory results. This paper aims to study the unidimensional structure and the hierarchy of ADL in the Spanish Disability Survey. We analysed a sample of 8381 people aged 65 and over with at least one disability and receiving personal help with one of them. The following Rasch model properties were studied in 14 items enquiring about basic and instrumental ADL: fit to the model, reliability, unidimensionality, local independency between items and differential item functioning (DIF) by gender, age and proxy. The unidimensionality of the scale was confirmed. The final analysis of eight items showed a satisfactory fit, good reliability, local independency, unidimensionality and no DIF by age. The disability linear measure showed significant differences by gender and age. The obtained disability scale is a simple and reliable measure, and it suggests a hierarchical order of ADL and predicts a schedule of functional impairment in older adults. Rating the disability of older community-dwelling people has a predictive value that policy makers might find useful in service planning.

Relationship between the MDS-UPDRS domains and the health-related quality of life of Parkinson's disease patients

BACKGROUND AND PURPOSE

The Movement Disorder Society sponsored version of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is a comprehensive instrument for assessing Parkinson's disease (PD). The present study was aimed at determining the relationships between MDS-UPDRS components and health-related quality of life (HRQoL) evaluations in PD patients.

METHODS

An international, multicenter, cross-sectional study was carried out of 435 PD patients assessed with the MDS-UPDRS, Hoehn and Yahr (HY), Clinical Impression Severity for PD, EQ-5D and PD Questionnaire - eight items (PDQ-8). Spearman's rank correlation coefficients, exploratory factor analysis and multiple linear regression models (dependent variables EQ-5D and PDQ-8) were performed.

RESULTS

The participants' age was 66.71 ± 10.32 years (51.5% men). PD duration was 8.52 ± 6.14, and median HY was 2 (range 1-5). The correlation between the EQ-5D index and the MDS-UPDRS ranged from -0.46 (Part IV) to -0.72 (Part II) and for the PDQ-8 index from 0.47 (Part III) to 0.74 (Part II). In multiple regression models with the MDS-UPDRS domains as independent variables, the main determinant for both the EQ-5D index and the PDQ-8 was Part II followed by Part I. After factorial grouping of the cardinal PD manifestations embedded in the MDS-UPDRS Parts III and IV for inclusion into multiple regression models, a factor formed by M-EDL, nM-EDL and fluctuations was the main determinant for both the EQ-5D and PDQ-8 indexes.

CONCLUSIONS

The MDS-UPDRS component most tightly related with the HRQoL measures was a combination of motor and non-motor experiences of daily living.

[The current state of the art concerning quality of life in Parkinson's disease: II. Determining and associated factors]

INTRODUCTION

Health-related quality of life (HRQL) in Parkinson's disease (PD) is an area that is receiving a growing amount of interest as the new biopsychosocial model of medicine is adopted. AIM. This paper is the second part of a review of the current state of the art concerning HRQL in PD and focuses on its main determining and associated factors.

DEVELOPMENT

A total of 56 studies are reviewed and the determining factors are grouped according to different variables, which may be disease-related (including motor and non-motor symptoms), sociodemographic (level of schooling, economic factors, gender and others), psychological and related to mental status (depression, anxiety, cognitive impairment, physician-patient relationship and others), and disability. The following characteristics of the studies were taken into account: the type of design (longitudinal or cross-sectional), the instrument used for measuring the HRQL (generic or specific), the statistical method employed (univariate or multivariate) and the sample size.

CONCLUSIONS

Most of the studies are cross-sectional and the majority use the 39-item Parkinson's Disease Questionnaire as a measure of HRQL with multivariate data analysis. The three most important factors determining HRQL in PD are depression, the stage of the disease and the time elapsed since onset of the disease. Nevertheless, the preferred methodology does not allow for causal inferences, due to the scarcity of longitudinal studies.

[The current state of the art concerning quality of life in Parkinson's disease: I. Instruments, comparative studies and treatments]

INTRODUCTION

Over the last decade there has been growing interest in the study of the impact of Parkinson's disease (PD) on the health-related quality of life (HRQL) of patients. Specific instruments have been developed to measure it and today these are frequently applied, together with generic measurements of HRQL, in clinical trials and other studies. This review is part of a series of two papers, the aim of which is to describe the current situation of studies on HRQL in PD and to detect areas in which knowledge is lacking, as a possible guide to researchers in future projects.

AIM

To review the concepts, instruments, comparative studies and the effect of treatments on the HRQL of patients with PD.

DEVELOPMENT

The fundamental concepts of HRQL and the instruments used to measure it are described. The main findings as regards comparative studies about the HRQL of patients with PD are also outlined. Finally, the article examines the effect of treatments on HRQL, including alternative therapies.

CONCLUSIONS

Despite the significant progress being made in this field, further studies with a rigorous methodology and longitudinal data are needed.

[Psychometric attributes of the Scales for Outcomes in Parkinson's Disease-Psychosocial (SCOPA-PS): validation in Spain and review]

AIMS

To evaluate the psychometric attributes of the Scales for Outcomes in Parkinson's Disease-Psychosocial (SCOPA-PS) in Spain and to compare them with previous studies.

PATIENTS AND METHODS

We performed a multi-centre, cross-sectional study of 387 patients with Parkinson's disease (PD), 70% of whom were in Hoehn and Yahr (HY) stages 2 or 3, with a mean age of 65.8 +/- 11.1 years and 8.1 +/- 6 years' progression. The following measures were applied: SCOPA-Motor, SCOPA-Cognition, modified Parkinson's Psychosis Rating Scale, Clinical Impression of Severity Index for Parkinson's Disease (CISI-PD), Cumulative Illness Rating Scale-Geriatrics, SCOPA-Autonomic, SCOPA-Sleep, Hospital Anxiety and Depression Scale (HADS), Fatigue and Pain Visual Analogue Scales, EQ-5D and SCOPA-PS. Acceptability, internal consistence, dimensionality, construct validity and precision of the SCOPA-PS were analysed.

RESULTS

The SCOPA-PS summary index displayed no ceiling or floor effect. Internal consistence was satisfactory (alpha = 0.85; item-total correlation => 0.39). Two factors were identified (53.5% of the variance). The SCOPA-PS was highly correlated (r(S) => 0.5) with the HADS, SCOPA-Motor, SCOPA-Automatic and EQ-5D index, and moderately so (r(S) = 0.35-0.49) with CISI-PD, fatigue and HY. The SCOPA-PS discriminated significantly between patients grouped according to HY stages, levels of severity of the CISI-PD, age groups and length of time with PD. The standard error of the measure was 7.24 +/- 18.7. As a whole, these findings are in agreement with previous studies.

CONCLUSIONS

The SCOPA-PS is a scale with a satisfactory degree of acceptability, and it is consistent, valid and precise for evaluating the psychosocial impact of PD.

[Psychometric attributes of Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog), Castilian language]

AIM

To test the psychometric attributes of the Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog), in Castilian language.

PATIENTS AND METHODS

It is a multicenter, cross-sectional study carried out on 387 Parkinson's disease (PD) patients. They were 70% in Hoehn and Yahr stages 2 or 3; their mean age was 65,8 years and they underwent the disease for 8,1 years. Rater-based -SCOPA-Motor, modified Parkinson's Psychosis Rating Scale, Clinical Impression of Severity Index for PD (CISI-PD), Cumulative Illness Rating Scale-Geriatrics- and self-administered -SCOPA-Autonomic, SCOPA-Sleep, SCOPA-Psychosocial, Hospital Anxiety and Depression Scale, EuroQoL- assessments were applied. For SCOPA-Cog, the following psychometric attributes were analysed: acceptability, internal consistency, dimensionality, construct validity, and precision. A cut-off point for dementia and SCOPA-Cog score's predictors were explored.

RESULTS

SCOPA-Cog was free from floor and ceiling effect. The internal consistency was satisfactory (alpha = 0,83) and the item-total correlation resulted equal or upper than 0,45. Two factors were identified (52% of variance), one of them formed by 3 out of the 4 memory-related items. The correlation with other measures was weak (rS < 0,35), except for the CISI-PD's item 'cognitive state' (rS = 0,51). SCOPA-Cog scored significantly different for Hoehn and Yahr stages and for patients grouped by age, age at onset of PD, and education. The standard error of measurement was 3,02. A cut-off point 19/20 reached 76% sensitivity and specificity for dementia. Age and age at onset of PD resulted the strongest predictors.

CONCLUSION

SCOPA-Cog is a consistent, valid, and precise measure for assessment of the cognitive disorder in PD.

Concepts, theories and psychosocial factors in cancer adaptation

The impact of psychological factors is increasingly taken into consideration in cancer patient care. In this review, we focus on the explicative models and the factors involved in psychosocial adaptation to cancer. Concerning the former, we present the latest reviews on stress and coping paradigm as applied to psycho-oncology. Specifically, we discuss the psychological mechanisms that make it possible to manage emotional distress related with cancer and that determine the different degrees of adaptation to the disease. This explanation is illustrated with two examples. On the other hand, the role of several variables that influence adaptation to cancer, grouped as sociocultural, psychological and medical variables, is discussed. Sociocultural variables make it possible to identify which patients have an increased risk of developing psychological distress symptoms. The psychological variables, include the different coping strategies, psychiatric history, psychological distress and concerns and fears. The impact of sociocultural and psychological variables is illustrated with two case examples. The medical variables are associated with the disease stage, treatment and prognosis. Finally, we discuss in what way these models, concepts and factors allow for design interventions adapted to the specific needs of each patient.

A comparison of Portuguese and American patients with hematological malignancies: a cross-cultural survey of health-related quality of life

This study investigates health-related quality of life (QoL) differences between 98 Portuguese and 109 US American outpatients with hematological malignancies. These two national groups of patients were characterized in terms of patients' QoL, and socio-demographic and clinical variables. Differences were found for several socio-demographic variables (race, marital and job status, urban residence, diagnosis, age, education, and household size). Portuguese patients reported better physical functioning, less bodily pain, more vitality, better social functioning, and better general QoL [as measured by Functional Living Index-Cancer (FLIC) total score] than American patients. Results were independent of demographic differences or mode of questionnaire administration.

Hematological cancer patients' quality of life: self versus intimate or non-intimate confidant reports

Self reports of 49 outpatients with hematological cancers and matched dyad confidant reports about the patient, collected at a cancer treatment center in Lisbon, Portugal, were compared on the SF-36 quality of life (QOL) measure. These comparisons contrasted self reports and confidant reports of the 33 patients with an accompanying spouse/partner intimate confidant, and of the 16 patients with an accompanying non-intimate confidant. Intimate confidants gave lower SF-36 QOL ratings of patients' Social Functioning and Mental Health than those patients gave for themselves (p<0.05).