Real-World clinical, psychosocial and financial burden of atopic dermatitis: results from the Spanish cohort of the MEASURE-AD trial

BACKGROUND

Atopic dermatitis (AD) is one of the most prevalent skin diseases, but there are numerous knowledge gaps surrounding the impact this disease has on quality of life (QoL), mental health, and out-of-pocket expenses involved in the management of AD. The available scientific evidence on the multidimensional burden of AD is usually based on studies with measures reported by patients themselves.

METHODS

In this context, the MEASURE-AD trial was developed as a cross-sectional, multicenter, multinational trial using patient- and physician-reported measures to characterize the multidimensional burden of AD in adults with moderate-to-severe AD.

RESULTS

This paper presents the results of the Spanish cohort. We found that Spanish adults with moderate-to-severe AD and high EASI score (21.1-72) had a significantly increased disease burden, high severity of symptoms such as itch and sleep disturbances, impaired mental health and QoL, higher use of health care resources, and more out-of-pocket expenses than patients with low EASI scores (0-7 or 7.1-21).

CONCLUSIONS

This study provides information to better understand disease burden, and identify aspects to be improved in the management of AD.

Mortalidad, Secuelas Clínicas y Calidad de Vida Luego del Alta de Unidades de Cuidados Intensivos en Pacientes con COVID-19: Estudio Multicéntrico Descriptivo en Argentina

OBJECTIVE

Patients with COVID-19 who require hospitalization in an intensive care unit, in addition to being at risk of presenting premature death, have higher rates of complications. This study aimed to describe mortality, rehospitalizations, quality of life, and symptoms related to postintensive care syndrome (PICS) and prolonged COVID-19 in patients with COVID-19 discharged from the intensive care unit in hospitals in Argentina.

METHODS

A cross-sectional study was conducted in 4 centers in the Autonomous City and province of Buenos Aires as of December 2022. The variables of interest were mortality after discharge, rehospitalization, health-related quality of life, post-COVID-19-related symptoms, cognitive status, and PICS. Data collection was by telephone interview between 6 and 18 months after discharge.

RESULTS

A total of 124 patients/families were contacted. Mortality was 7.3% (95% CI: 3.87-13.22) at 14.46 months of follow-up after discharge. Patients reported a reduction of the EQ-5D-3L visual analog scale of 13.8 points, reaching a mean of 78.05 (95% CI: 73.7-82.4) at the time of the interview. Notably, 54.4% of patients (95% CI: 41.5-66.6) reported cognitive impairment and 66.7% (95% CI: 53.7-77.5) developed PICS, whereas 37.5% (95% CI: 26-50.9) had no symptoms of prolonged COVID-19.

CONCLUSION

The results showed a significant impact on the outcomes studied, consistent with international evidence.

Cancer patient satisfaction regarding the quality of information received: psychometric validity of EORTC QLQ-INFO25

OBJECTIVES

to psychometrically validate the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire EORTC QLQ-INFO25 instrument and identify the domains that influence patients' perception of the information received.

METHODS

a cross-sectional methodology with cancer patients in a Brazilian philanthropic hospital institution. Sociodemographic and clinical instruments, EORTC QLQ-C30, EORTC QLQ-INFO25 and Supportive Care Needs Survey - Short Form 34 were used. Analysis occurred using Cronbach's alpha coefficients, intraclass correlation, test-retest and exploratory factor analysis.

RESULTS

128 respondents participated. Cronbach's alpha coefficient was 0.85. The test-retest obtained p-value=0.21. In the factor analysis, one item was excluded. Satisfaction with the information received was 74%, with three areas with averages below 70%. In open-ended questions, there was a greater desire for information.

CONCLUSIONS

validity evidence was obtained with instrument reliability, consistency and stability. Respondents expressed satisfaction with the information received.

Psychometric properties of the Chilean version of the quality of life questionnaire for multiple myeloma

OBJECTIVES

To evaluate the internal consistency and construct validity of the QLQ-MY20 for assessing the quality of life in multiple myeloma survivors in Chile.

METHODS

This was a cross-sectional study conducted between March 2020 and December 2022. It involved 118 individuals from two public hospitals. The QLQ-C30 and QLQ-MY20 questionnaires were used. Internal consistency was assessed using Cronbach's alpha(α), and construct validity was evaluated through hypothesis testing (Mann-Whitney and Spearman correlation).

RESULTS

The average age of participants was 67.2 years (SD=9.2). Internal consistency for the complete scale was α=0.779, for the "disease symptoms" dimension α=0.671, for the "side effects of treatments" dimension α=0.538, and for the "future perspective" dimension α=0.670. Four of the five construct validity hypotheses were confirmed: women, individuals with worse performance status, those with pain, and those with worse fatigue showed more symptoms.

CONCLUSIONS

The Chilean version of the QLQ-MY20 demonstrates adequate internal consistency and construct validity.

Potentially morally injurious experiences and associated factors among Dutch UN peacekeepers: a latent class analysis

Background: During peacekeeping missions, military personnel may be involved in or exposed to potentially morally injurious experiences (PMIEs), such as an inability to intervene due to a limited mandate. While exposure to such morally transgressive events has been shown to lead to moral injury in combat veterans, research on moral injury in peacekeepers is limited.Objective: We aimed to determine patterns of exposure to PMIEs and associated outcome- and exposure-related factors among Dutch peacekeepers stationed in the former Yugoslavia during the Srebrenica genocide.Method: Self-report data were collected among Dutchbat III veterans (N = 431). We used Latent Class Analysis to identify subgroups of PMIE exposure as assessed by the Moral Injury Scale-Military version. We investigated whether deployment location, posttraumatic stress disorder (PTSD), posttraumatic growth, resilience, and quality of life differentiated between latent classes.Results: The analysis identified a three-class solution: a high exposure class (n = 79), a moderate exposure class (n = 261), and a betrayal and powerlessness-only class (n = 135). More PMIE exposure was associated with deployment location and higher odds of having probable PTSD. PMIE exposure was not associated with posttraumatic growth. Resilience and quality of life were excluded from analyses due to high correlations with PTSD.Conclusions: Peacekeepers may experience varying levels of PMIE exposure, with more exposure being associated with worse outcomes 25 years later. Although no causal relationship may be assumed, the results emphasize the importance of better understanding PMIEs within peacekeeping.

The effect of complex posttraumatic stress and poverty on quality of life among adult survivors of childhood institutional maltreatment: evidence from survivors of the 'Hyeongje Welfare Institution' in South Korea

Background: Childhood institutional maltreatment (IM) is associated with both complex posttraumatic stress disorder (CTPSD) and poverty in adulthood life, each of which may impact an individual's quality of life (QoL). To find implications for clinical practice and policy making for adult survivors with childhood IM experiences, it is necessary to conduct research examining their current QoL and identifying related factors.Objective: By applying the model of the conservation of resources theory, we focused on how adulthood QoL can be indicated by childhood IM as well as the life outcomes of IM such as additional lifetime trauma, CPTSD, and poverty.Methods: In a cross-sectional study, self-report data were collected from 127 adults who were survivors of the 'Hyeongje' childhood IM in South Korea. We conducted regression analyses of childhood IM experiences, trauma experiences after escape from the institution, current CPTSD symptoms, and current poverty experiences on current QoL.Results: The duration of placement at the 'Hyeongje' (β = .24, p = .009) was associated with trauma experiences after escape from the institution. Trauma experiences after escape from the institution (β = .25, p = .007) were associated with CPTSD symptoms. CPTSD symptoms (β = .26, p = .005) were associated with poverty, and both CPTSD symptoms (β = -.52, p < .001) and poverty (β = -.26, p = .003) were negatively associated with current QoL.Conclusions: Prolonged childhood IM brings about loss spirals by increasing an individual's exposure to experiences of further cumulative trauma, CPTSD, and poverty. There is a need for due diligence-based policy making and public support from the government to help create upward spirals for QoL. This may include the imminent detection and rescue of children as well as providing a safe environment, offering multidisciplinary interventions including evidence-based treatment for CPTSD, and considering economic support including collective reparations.

Post-COVID-19 syndrome: persistent symptoms, functional impact, quality of life, return to work, and indirect costs - a prospective case study 12 months after COVID-19 infection

The persistent symptoms of post-COVID-19 syndrome negatively impact health, quality of life, and productivity. This study aimed to describe the persistent symptoms of post-COVID-19 syndrome (especially neurological ones) and their 12-month post-infection cognitive, emotional, motor, quality of life, and indirect cost repercussions. Patients showing the first symptoms of COVID-19 from January to June 2021 who developed post-COVID-19 syndrome and sought care at the Fortaleza Unit (Ceará, Brazil) of the SARAH Network of Rehabilitation Hospitals were included in this study. Information was obtained at the baseline follow-up and by telephone interview 12 months post-infection. In total, 58 people participated in this study with an average age of 52.8±10.5 years, of which 60% required an ICU. The most frequent symptoms on admission included fatigue (64%), arthralgia (51%), and dyspnea (47%), whereas, after 12 months, fatigue (46%) and memory impairment (39%). The following scales/functional tests showed alterations: PCFS, MoCA, HAD, FSS, SF-36, TLS5x, timed up and go, 6-minute walk, and handgrip. Indirect costs totaled USD 227,821.00, with 11,653 days of absenteeism. Moreover, 32% of patients were unable to return to work. Better TLS5x and higher SF-36 scores in the functional capacity, physical functioning, vitality, and pain dimensions were associated with return to work (p ≤ 0.05). The most frequent persistent symptoms referred to fatigue, arthralgia, dyspnea, anxiety, and depression, which negatively affected cognitive, emotional, and motor function and quality of life. These symptoms lasted for over a year, especially fatigue and memory alteration, the latter of which being the most reported after COVID-19 infections. Results also show a significant difficulty returning to work and indirect costs of USD 4,847.25 per person/year.

Clinical and sociodemographic factors associated with the quality of life of children and adolescents with type 1 diabetes

OBJECTIVE

To analyze clinical and sociodemographic factors associated with the health-related quality of life of children and adolescents with type 1 Diabetes Mellitus.

METHOD

A quantitative, cross-sectional and analytical study, developed in a municipality in northeastern Brazil, between March and September 2021, with 81 children/adolescents with type 1 Diabetes Mellitus and their guardians/caregivers. A questionnaire containing sociodemographic and clinical variables and two quality of life instruments were used. Descriptive and inferential analysis was carried out.

RESULTS

Adolescents whose parents had a family income greater than a minimum wage had a lower prevalence of impaired quality of life when compared to those with a lower income. Adolescents with time since diagnosis of less than four years had a satisfactory quality of life, and children aged 8 to 12 years who self-administered insulin had a lower prevalence of high quality of life compared to those who did not.

CONCLUSION

Adolescents with a family income of less than a minimum wage, diagnosis time of more than four years and children aged 8-12 who self-administer insulin need greater professional support to have a better quality of life.

Real-world effectiveness of fingolimod in patients with multiple sclerosis in Bulgaria

INTRODUCTION

Fingolimod, a sphingosine-1-phosphate receptor agonist used for the treatment of multiple sclerosis (MS). Our goal was to assess the impact of fingolimod on quality of life in patients with relapsing-remitting multiple sclerosis (RRMS) after 2 years of treatment in this real-world study.

PATIENTS AND METHODS

This was a 2-year, prospective, observational study conducted in Bulgaria in RRMS patients treated with fingolimod. Quality of life was assessed using the Bulgarian-language version of the MSQoL-54 scale. The primary endpoint was the change from baseline in the MSQoL-54 score after 2 years of treatment. Secondary endpoints included the change from baseline in the MSQoL-54 score after one year of treatment, furthermore the assessment of depression level using the Hamilton D-17 score.

RESULTS

A total of 87 eligible patients were included in the study with a mean age of 38.7 ± 8.45 years. The median Expanded Disability Status Scale (EDSS) score was 3.5 points. We found statistically significant improvement in 10 subscales at month 12 and in seven subscales at month 24. The mental health composite score increased from 64.0 ± 16.69 points to 67.5 ± 15.94 points at month 24 (p = 0.012). The physical health composite score increased from 61.7 ± 17.61 to 66.3 ± 16.70 (p = 0.001). Depression level measured by the HAM-D17 decreased significantly by month 12 and month 24. The EDSS score decreased or remained stable in more than half of the patients (61.6%). We detected better quality of life in patients with a lower EDSS score.

CONCLUSIONS

Quality of life scores and the depression level are improved in RRMS patients treated with fingolimod over 2 years in real-life setting.

[Moyamoya in Aragon: epidemiology and self-perception of quality of life]

INTRODUCTION

Moyamoya angiopathy is a vasculopathy caused by stenosis/occlusion of one or both intracranial internal carotid arteries. Although more common in Eastern countries, its prevalence is increasing in the West. An angioresonance or angiography is essential for its diagnosis. There are two options for treatment: conservative (medical) treatment or surgical bypass techniques.

PATIENTS AND METHODS

Nineteen patients were selected using International Classification of Diseases codes, and their demographic characteristics and health outcomes were studied. They were administered a scale for the screening of anxious-depressive syndrome (the Hospital Anxiety and Depression Scale - HADS) and another scale for self-perceived quality of life (SF-36). After applying the inclusion/exclusion criteria, eight of these patients were studied.

RESULTS

Nineteen patients were studied (52.63% male, 57.89% European) and the Aragonese prevalence was estimated at 1.37/100,000 inhabitants. The most frequent clinical presentation was ischaemic stroke (73.68%). The HADS detected two positive cases of anxiety and one case of depression. According to the SF-36, the worst self-rated aspects were vitality (median: 35/100) and general health (median: 42.5/100), while the best rated was physical function (mean: 93.57/100).

CONCLUSIONS

This is the Spanish series with the highest prevalence and the only one that addresses self-perceived health and screening of the anxious-depressive syndrome. Further research is needed to address this entity and determine its true prevalence in the West.

Quality of life and financial toxicity of hematopoietic stem cell transplant recipients in COVID-19

OBJECTIVE

to evaluate and correlate the quality of life and financial toxicity of adult patients undergoing hematopoietic stem cell transplantation during the COVID-19 pandemic.

METHOD

observational, analytical study, carried out with 35 patients in a reference hospital for transplantation in Latin America. For data collection, the Functional Assessment Cancer Therapy Bone Marrow Transplantation and COmprehensive Score for Financial Toxicity questionnaires were used. Spearman and Mann-Whitney correlation tests were used for data analysis.

RESULTS

general quality of life during COVID-19 had a low score (67.09/108) with greater impairment in functional well-being (14.47/28), social well-being (16.76/28) and additional concerns (23.41/40). The means of the allogeneic group were lower than those of the autologous group in all domains, showing a significant difference in relation to additional concerns (p=0.01) and in the treatment evaluation index (p=0.04). Financial toxicity was considered to have a slight impact (22.11/44). There was a relationship, albeit not significant, between quality of life and financial toxicity (p=0.051).

CONCLUSION

the quality of life of the sample was low; there is a correlation between quality of life and financial toxicity, although not significant. The higher the financial toxicity, the lower the quality of life.

Non-pharmacological therapies for cancer patients in Portugal and Brazil: an experience report

OBJECTIVE

To describe the experience of nurses from a center in Portugal and two in Brazil regarding the use of non-pharmacological therapies in cancer patients.

METHOD

This is a professional experience report.

RESULTS

In the Portuguese institution, a group of nurses has been performing massage therapy, reflexology, postural teaching, thermotherapy, relaxation, guided imagery, Reiki, music therapy, aromatherapy, among others, for 17 years, with significant results in pain and vital signs with satisfactory perceptions. In Brazil, the clinical application is incipient, clinical studies with auriculotherapy, relaxation with guided imagery and floral therapy are taking place, with significant results for physical symptoms, anxiety, and quality of life improvement.

CONCLUSION

In both countries, nurses have made efforts to implement non-pharmacological therapies. While in the Portuguese reality they have been formally institutionalized in care, in Brazil the therapies take place with voluntary work and through intervention research. This report can encourage the translation of autonomous practice to clinical studies for proposing evidence of therapies in Integrative Oncology.

Hereditary angioedema: Patient journey approach in Mexico

Objective

To understand the patient's journey with HAE from symptom initiation to diagnosis, treatment allocation, follow-up, and the impact of the disease on their quality of life in Mexico.

Methods

A survey was administered to the patients with HAE. Participants completed a questionnaire covering five domains: patient journey; effects on productivity, school performance and daily activities; quality of life; anxiety and depression. Responses were analyzed using descriptive statistics.

Results

A total of 17 surveys were analyzed (15 women and 2 men, age range: 23-67 years). Type I HAE was most common (71%), normal C1 inhibitor HAE was 12% and 18% did not know their HAE type. The average disease evolution was 13.7 years and the time from symptom initiation to diagnosis was 20 years. 59% of patients knew of one or two treatments available, 12% knew 3 treatments and 18% were aware of 4 or more, 12% were not aware of any treatments. 53% had a job, 18% referred a severely anxious state, 41% were depressed and all patients referred some social impact due to HAE.

Conclusions

There is a need to reinforce the knowledge of general practitioners on HAE to promote an earlier diagnosis and awareness of rare diseases and their impact on quality of life among the general population and promote the removal of barriers to treatment.

[Experiencia inicial de Lanadelumab en una paciente mexicana con angioedema hereditario tipo I]

Background

Hereditary angioedema type 1 (HAE1) is an autosomal dominant disorder, characterized by quantitative and qualitative deficiency of C1 inhibitor, excessive production of bradykinin and causing recurrent angioedema in varying degrees of severity that affects quality of life and life itself. from the patients. Lanadelumab is a human monoclonal antibody, a specific inhibitor of plasma kallikrein, approved for long-term prophylaxis of HAE1.

Case report

A 59-year-old female patient, diagnosed with HAE 1 since November 1987, without therapeutic response to danazol, fresh frozen plasma, or C1 inhibitor derived from intravenous plasma, requiring 3 to 9 monthly vials of icatibant acetate due to angioedema. laryngeal, cutaneous and visceral with highly altered quality of life indices. Lanadelumab 300 mg subcutaneously every 14 days was started. At the start of treatment, the AECT1 score was 1 point; AE-Qol2: 57 points, AAS3: 32 points, being followed up at 5, 10 and 12 months. After one year of treatment, the records showed an AECT1 of 19 points; AE-Qol2: 36 points and AAS3: 5 points. The requirement for icatibant acetate has been no more than 3 vials per month.

Conclusion

In accordance with the literature, lanadelumab offered a significant decrease in angioedema activity and a significantly positive impact on the pa- tient's quality of life, confirming that lanadelumab is an effective option for long-term HAE prophylaxis. .

Auriculotherapy for reducing chronic spinal pain in health workers: a clinical trial

OBJECTIVE

to evaluate the effectiveness of auriculotherapy in reducing chronic musculoskeletal pain in the spine of health workers.

METHOD

a randomized, triple-blind clinical trial conducted with health workers diagnosed with chronic spinal pain. Eight sessions of auriculotherapy with seeds were applied, two per week. The outcomes were measured with the Numerical Pain Scale, Brief Pain Inventory, Rolland-Morris Disability Questionnaire and SF-36 instruments, in the 1st, 4th and 8th session, and in the 15-day follow-up period. Descriptive and inferential analyses were performed.

RESULTS

34 workers took part in the Intervention Group and 33 in the Control Group, and both presented reduced pain intensity (p>0.05). In the follow-up period, there was a greater reduction in the Intervention Group (3.32 ± 0.42), when compared to the Control Group (5.00 ± 0.43) (p=0.007). In quality of life, there was improved vitality (p=0.012) and limitation due to emotional aspects (p=0.025). The relationship between auriculotherapy, physical disability and pain interference did not differ between the groups (p>0.05). Medication use in the follow-up period remained unchanged in the Control Group (77.8%) when compared to the Intervention Group (22.2%) (p=0.013).

CONCLUSION

auriculotherapy exerted the same effect between the groups on pain intensity, lasting longer in the follow-up period. There was an improvement in quality of life and a reduction in medication use. REBEC: RBR-3jvmdn.

[Impact of the Interdisciplinary Chronic Pain Rehabilitation Programme in patients with and without sleep disorders]

INTRODUCTION

Sleep disorders and chronic pain are linked to each other bidirectionally. Both are related to affective disorders, fatigue, depression, anxiety and drug abuse, and have a significant effect on quality of life. The Interdisciplinary Pain Programme (IDP) aims to relieve the patients' pain and improve their functionality by incorporating healthy postural, sleep and nutritional habits, relaxation techniques, physical exercise and cognitive-behavioural mechanisms.

PATIENTS AND METHODS

A retrospective, observational, cross-sectional study was conducted. A total of 323 patients with chronic pain who completed the IDP were examined. They were assessed at the beginning and at the end of the programme with pain, depression, quality of life and insomnia scales, and were then compared between groups with and without insomnia, that is, with an insomnia severity index (ISI) less than 15 versus greater than or equal to 15. Fifty-eight patients were studied by means of polysomnography.

RESULTS

A significant improvement (p < 0.0001) in pain, depression and quality of life, as assessed by the visual analogue scale (VAS), the Beck inventory and the Short Form-36 (SF-36) questionnaire was observed in chronic pain patients with an ISI below 15 and in those with an ISI greater than or equal to 15. The results were superior in the group of patients with insomnia. The presence of a high apnoea and hypopnoea index and periodic lower limb movements in patients was not related to improvements on the Beck, SF-36, ISI and VAS scales.

CONCLUSIONS

In conclusion, IDP benefits patients with chronic non-cancer-induced pain in several affected areas, in addition to pain, due to a comprehensive treatment. Polysomnography can help diagnose specific pathologies and individualise pharmacological treatment.

Symptoms of depression, anxiety and stress in health students and impact on quality of life

OBJECTIVE

to evaluate the association between quality of life and presence of symptoms of depression, anxiety, and stress in college students in the health area.

METHOD

cross-sectional study that included 321 students from undergraduate courses in the health area. Quality of life was measured using the World Health Organization scale, abbreviated version, in the physical, psychological, social relations and environment domains, and symptoms were assessed by the depression, anxiety and stress scale. Multivariate analysis was performed using robust linear regression to evaluate the association between quality of life and symptoms.

RESULTS

a negative association was observed between the quality of life and depression symptoms in all domains, while anxiety symptoms showed a negative association in the environment domain, and stress symptoms had a negative association in the psychological domain. Symptom severity was unfavorably associated with quality of life, that is, the greater the symptom severity, the lower the mean scores in all domains.

CONCLUSION

symptoms of depression, anxiety, and stress were prevalent and had a negative impact on students' quality of life, especially in the presence of depressive symptoms. The decrease in scores was significantly associated with the severity of symptoms.

[Quality of life in people with epilepsy: beyond seizures]

INTRODUCTION

People with epilepsy have multiple barriers to recovery: access to medication, comorbidities and social problems. The aim of this study is to determine psychosocial factors associated with the perception of quality of life in people with epilepsy in the department of Bolivar, Colombia, in the year 2022.

SUBJECTS AND METHODS

Descriptive cross-sectional study, correlational, with a sample stratified with a margin of error of 5%, according to the calculation of the average number of people treated for epilepsy in Colombia. 174 people participated with a mean age of 39.55 years, 50% men and 50% women. An instrument was used that determined sociodemographic data, quality of life (Quality of Life in Epilepsy Inventory-10), adherence to treatment (Morisky test), self-care behaviors, perception of disability and provision of health services. All the instruments showed a Cronbach's Alpha greater than 0.686 for this population.

RESULTS

21.3% had focal onset epilepsy; 41% with generalized epilepsy without focal onset; 18.4% with focal onset that generalized; 12.6% did not know their type of epilepsy; and 6.3% reported that they were not informed about their type of epilepsy. Based on correlations, an explanatory model of quality of life is shown, with pillars such as drug adherence, self-care habits, time without seizures, and perceived disability.

CONCLUSIONS

Although time without seizures is a fundamental element in recovery, living conditions and mental health problems are key elements to achieve a better quality of life in epilepsy.

Spanish Version of Teenagers’ Quality of Life (T-QoL) for Adolescents with Skin Diseases: Translation, Cultural Adaptation and Validation

BACKGROUND

Teenagers' Quality of Life (T-QoL) is an age-specific measure to assess QoL of teenagers suffering from different skin diseases. A validated Spanish language version is lacking. We present the translation, cultural adaptation and validation of the T-QoL into Spanish.

METHODS

A prospective study with 133 patients (between 12-19 years old), attended at the dermatology department of Toledo University Hospital, Spain, (September 2019-May 2020), was carried out for the validation study. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines were used for the translation and cultural adaptation. We evaluated the convergent validity with the Dermatology Life Quality Index (DLQI), the Children's Dermatology Life Quality Index (CDLQI) and with a Global Question (GQ) on self-assessed disease severity. We also analysed internal consistency and reliability of the T-QoL tool and confirmed its structure with a factor analysis.

RESULTS

Global T-QoL scores significantly correlated with the DLQI and the CDLQI (r=0.75) and with the GQ (r=0.63). The Confirmatory Factor Analysis showed optimal fit for the bi-factor model and an adequate fit for the correlated three-factor model. Reliability indicators were high (Cronbach's α=0.89; Guttman's Lambda 6 index=0.91; Omega ω=0.91) and test-retest showed a high stability (ICC=0.85). The results were consistent with those found by the authors of the original test.

CONCLUSION

Our Spanish version of the T-QoL tool is valid and reliable to assess QoL of Spanish-speaking adolescents with skin diseases.

Benefits in quality of life following an obstructive sleep apnea screening and treatment program in patients with acute ischemic stroke

INTRODUCTION

Obstructive sleep apnea (OSA) has been proposed as a factor that worsens stroke prognosis. Our aim was to determine if an OSA intervention could improve quality of life (QOL, first objective) and modified Rankin score (mRS, second objective).

PATIENTS AND METHODS

The intervention group of this quasi-experimental study included patients with acute ischemic stroke <72 hours who underwent polygraphy and Continuous Positive Airway Pressure (CPAP) and hygienic-dietary measures if required. The control group followed routine clinical practice. The Short Form 36 Health Survey (SF-36) and mRS were applied at the sixth month after stroke in both groups.

RESULTS

Fifty-five vs. sixty-two patients were included in the intervention and control group respectively. In the intervention group, 64.71% of patients accepted the proposed CPAP (16 cases with a good adherence). An improvement in SF-36 items was detected in the intervention group: physical functioning (p = 0.008), role physical (p = 0.002), bodily pain (p = 0.008), general health (p <0.001), vitality (p = 0.001) and role emotional (p = 0.015). In a per-protocol analysis, all these improvements were verified in the group of patients treated with good CPAP adherence (p < 0.05 in all the same SF-36 items). The percentage of patients with physical component summatory = 50 was higher in the intervention group (p = 0.003). There were no differences in the median of mRS (p = 0.262).

CONCLUSIONS

Although more evidence is needed, a significant improvement in QOL was suggested after our OSA intervention, particularly in patients with good CPAP adherence.

Quality of life and satisfaction of students with auriculotherapy in the covid-19 pandemic: a quasi-experimental study

OBJECTIVES

to evaluate the quality of life before and after the application of auriculotherapy and the satisfaction of university students with the treatment during the covid-19 pandemic.

METHODS

quasi-experimental study conducted with 44 students in a University Health Center. The intervention consisted of ten sessions of auriculotherapy focusing on emotional changes with quality of life assessment before and after treatment. The study also investigated the satisfaction concerning the intervention.

RESULTS

predominated among the students: women, from health courses, in use of psychotropic drugs and complaining of emotional changes. There was a statistically significant increase in all domains of quality of life, and students were satisfied with the treatment.

CONCLUSIONS

auriculotherapy improved the quality of life of university students during the covid-19 pandemic, and the level of satisfaction with the treatment was high.

Sexuality and its effects on older adults' depressive symptoms and quality of life

OBJECTIVES

to analyze the effects of sexuality on depressive symptoms and quality of life in older adults.

METHODS

a cross-sectional and analytical study, developed with 596 older adults, who completed four instruments for data collection. Data were analyzed using the Kruskal-Wallis test and Structural Equation Modeling, with a 95% Confidence Interval.

RESULTS

among the sexuality dimensions, only physical and social adversities exerted statistically significant effects on depressive symptoms (SC=-0.095; p=0.003), but with low magnitude. Moreover, all sexuality dimensions had statistically significant effects on quality of life, being of low magnitude for sexual act (SC=0.171; p=0.010) and for physical and social adversities (SC=0.228; p<0.001), and moderate magnitude for affective relationships (SC=0.474; p<0.001).

CONCLUSIONS

effects of different magnitudes were observed between sexuality dimensions on participants' depressive symptoms and quality of life.

Quality of life and factors associated among public university employees retired due to disabilities

OBJECTIVE

to analyze quality of life and factors associated among public university employees retired due to disabilities.

METHOD

a cross-sectional study conducted with a sample of public university employees retired due to disabilities. A characterization questionnaire and the World Health Organization Quality of Life - Disabilities instrument were applied via telephone or online contacts from November 2019 to September 2020. The associated factors were verified through multiple linear regression.

RESULTS

of the 80 retirees due to disability, 15% were professors and 85% had a technical-administrative career. As for the factors associated with Quality of Life, continuous medication use (βadj: -0.25; p=0.02) and problems in the nervous system (βadj: -0.21; p<0.05) were associated with the Overall domain; continuous medication use (βadj: -0.23; p=0.04), to the Physical domain; smoking (βadj: -0.21; p<0.05) and mental and behavioral disorders (βadj: -0.21; p<0.01), to the Psychological domain; smoking (βadj: -0.46; p<0.01) and respiratory (βadj: -0.21; p=0.03) and circulatory (βadj: -0.21; p=0.03) problems, to the Social domain; smoking (βadj: -0.33; p<0.01) and problems in the nervous system (βadj: -0.22; p=0.04), to the Environmental domain; mental and behavioral disorders, to the Disabilities module (βadj: -0.29; p<0.01) and to the Discrimination domain (βadj: -0.21; p<0.05); and smoking (βadj: -0.32; p<0.01) and problems in the nervous system (βadj: -0.20; p<0.05), to the Inclusion domain. The Autonomy domain did not present any association.

CONCLUSION

the retirees under study presented impaired Quality of Life.

Quality of life in caregivers of aged stroke survivors in southern Brazil: Arandomized clinical trial

OBJECTIVE

to evaluate the effect of nursing home care interventions on the quality of life in family caregivers of aged stroke survivors.

METHOD

a Randomized Clinical Trial, blinded for outcome evaluation. Forty-eighty family caregivers of aged stroke survivors participated in the study. The Intervention Group received three home visits by nurses one month after hospital discharge to provide stroke-related education (i.e., how to access health services and perform care activities) and emotional support. The Control Group received the usual guidance from the health services. Quality of life was assessed using the World Health Organization Quality of Life Assessment (WHOQOL-BREF) instrument and the Old Module(WHOQOL-OLD) 1 week, 2 months, and 1 year after discharge.

RESULTS

the caregivers were mainly women, children, or spouses. The caregivers in the Intervention Group and Control Group did not significantly differ in terms of their Overall Quality of Life at baseline. There was no interaction effect between group allocation and Overall Quality of Life(p=0.625) over time. However, there was an interaction effect for Social Relations(p=0.019) and Autonomy (p=0.004).

CONCLUSION

the intervention exerted a statistically significant effect on the quality of life of family caregivers with respect to social relationships and autonomy.

TRIAL REGISTRATION

NCT02807012.

Adaptation and validation into Spanish of a specific questionnaire on quality of life in patients with tracheostomy (TQOL)

BACKGROUND AND OBJECTIVE

A long-term tracheostomy can have significant negative effects on quality of life because it causes physical, functional, sensory, psychological, social, economic, and work impairments to the life of the individual. The objective of this study was to validate in Spanish a quality-of-life questionnaire for these patients.

MATERIALS AND METHODS

A psychometric validation study of a questionnaire in 45 patients over 18 years of age, with tracheostomy for six months, who understand Spanish and have a good understanding of the questions of the SF-36 questionnaire and a specific quality of life questionnaire for the patient with tracheostomy (TQOL-versión española). This Vquestionnaire is a modification and cultural adaptation into Spanish of the original English instrument named Tracheostomy Specific Quality of Life Questionnaire (TQOL). The two questionnaires (TQOL-versión española) and the SF-36 were completed 6 months after the tracheostomy and between 30 and 50 days after the first administration. The reliability, repeatability, and construct validity of the TQOL-versión española were evaluated. The construct validity was assessed by the correlation between the results of the TQOL-versión española and the dimensions of the SF-36 questionnaire.

RESULTS

The reliability of the TQOL-versión española measured by Cronbach's alpha coefficient was .814, with variation between items from .783 to .817 in the sample at 6 months and from .794 in the validation sample, with variation between items from .758 to .813. There was intraclass correlation for the total score of the scale using the concordance analysis of Bland-Altman and agreement for the individual questions with the McNemar symmetry test. There was also a good correlation between the scales of the TQOL-versión española and the dimensions of the S-F36.

CONCLUSIONS

The TQOL-versión española showed good reliability, repeatability, and construct validity, therefore it is a useful tool to assess the impact on individual patients with a tracheostomy in place for more than 6 months, and to establish strategies at the healthcare and social levels to improve the quality of daily life.

Effect of support groups on caregiver's quality of life

The objective of this study was to evaluate the effect that participating in support groups for caregivers has on the quality of life and psychotropic drug use of family caregivers of adults with limitations in activities of daily living. A controlled quasi-experimental longitudinal design was used with 134 caregivers (64 in the experimental group and 70 in the control group). The outcomes were health-related quality of life (EuroQol 5D3L test) and psychotropic drug use (no/yes). The analyses were performed using SPSS and R statistical software. An interaction was observed between the condition and the level of limitations in activities of daily living of the care receiver, having an effect on the caregiver's psychotropic drug use (p = 0.003), with this use being lower among caregivers who attend support groups when their relatives present fewer limitations in activities of daily living. Moreover, the quality of life was higher in the post-test in the experimental group (B = 8.66, p = 0.015). In conclusion, support groups could improve the caregiver's quality of life and decrease psychotropic drug use when the care receiver has low limitations in activities of daily living.

The Long-Term Effects of Cancer Treatment on Sexuality and Couple Relationships

Breast cancer and its pharmacological treatment often induce an impairment in women's sexual functioning and couple relationships, as a consequence of physiological changes and psychosocial issues that may arise and persist long after treatment. This study aims to evaluate the sexual functioning, the quality of the couple relationship, and the overall health status of breast cancer survivors. A further objective is to determine the predictive role of specific clinical and sociodemographic variables for sexual functioning and the couple relationship. Sixty-four breast cancer survivors completed the following questionnaires: the Female Sexual Function Index (FSFI), the Dyadic Adjustment Scale (DAS), the Short Form Health Survey-12 (SF-12), and a self-report questionnaire to collect sociodemographic characteristics. Clinical information was retrieved from medical records. Compared to normative data, our sample reported significantly (p < .01) lower mean scores in the FSFI, DAS, and Physical Component (PCS) and Mental Component Summary (MCS) of the SF-12. Multiple regression analyses show a significant effect of age, hormonal therapy, and psychological well-being on sexual functioning and a significant effect of physical and mental well-being on the quality of the couple relationship. Additionally, 75% of patients qualified for sexual dysfunction as measured by the FSFI global scale, and 71.9% declared they were not adequately informed about the side effects of treatments on sexuality. The high prevalence of sexual dysfunction in breast cancer survivors underlines the need for specific attention to this problem, starting from a complete and targeted communication between patients and health providers regarding these side effects.

Quality of life and post-traumatic stress disorder among adult females with cancer in Palestine: a cross-sectional study

Background: Little research has been conducted on the quality of life (QoL), functional status, and traumatic symptoms related to the diagnosis and treatment of cancer in the Arab region, particularly in Palestine, where the psychological problems in patients with cancer are often neglected.Objective: The aim of the study was to assess QoL and post-traumatic stress disorder (PTSD) symptoms among adult female patients with cancer attending Beit-Jala Governmental Hospital in Bethlehem.Method: Participants were recruited from 4 April 2015 to the end of July 2015. The sample included 253 female patients with cancer attending Beit-Jala Governmental Hospital in Bethlehem. Data were collected using self-reported questionnaires, including a socio-demographic data sheet, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and the post-traumatic stress disorder checklist for PTSD symptoms.Results: The current study showed poor global QoL (57.4%) and poor physical function (48.5%) for female patients with cancer. Insomnia, fatigue, and loss of appetite were the most troublesome symptoms that the participants complained about. The prevalence of PTSD symptoms was 3%. Regarding PTSD symptom severity, 2% reported severe symptoms, 23.3% reported moderate symptoms, and (68.8%) reported mild symptoms, based on a 1991 classification of PTSD symptom severity scores. Finally, Pearson's test revealed a strong, statistically significant, inverse relationship between QoL domains and PTSD.Conclusion: The study found that the overall QoL of female patients with cancer was low and strongly associated with PTSD symptoms, suggesting that early detection and treatment of these symptoms is critical.

Quality of life of individuals receiving kidney transplantation in Amazonas State

OBJECTIVE

to analyze the quality of life of kidney transplant receivers in the State of Amazonas.

METHOD

a cross-sectional, descriptive study, performed with 222 individuals after renal transplantation registered in a private clinic and in a health public ambulatory. Data collection took place through structured interviews where the quality of life was measured by the Kidney Disease Quality of Life - Short Form. Descriptive statistics were used for data analysis.

RESULTS

the quality of life scores found ranged from 36.5 to 83.1. The quality of life domains, specifics of renal disease, have proved to be superior to generic ones. The most compromised were work situation; sleep; physical function and emotional function, with scores of 36.5; 53.7; 52.4; 55.1, respectively, and correlated moderately and significantly with each other.

CONCLUSION

the majority (63.2%) of the quality of life domains obtained high scores and the specific component of renal disease had higher scores than the generic component.

Quality of life in patients with multiple sclerosis and their caregivers in Colombia: One-year follow-up

INTRODUCTION

Multiple sclerosis is a chronic inflammatory demyelinating disease associated with neurological disability. Clinical features include motor, cerebellar, visual, and sensory function alterations, as well as psychiatric comorbidities, such as depression, anxiety, and irritability. There is little literature available on the quality of life of patients and their caregivers.

OBJECTIVE

To assess the quality of life of patients with multiple sclerosis and their caregivers in Colombia given that there is no information on the subject in this particular population to establish comprehensive management plans.

MATERIALS AND METHODS

We used the MusiQol and CareQol questionnaires and the Beck Depression Inventory. A prospective analytical observational protocol was designed to include patients aged 18 to 65 years with a diagnosis of relapsing-remitting multiple sclerosis between October, 2014, and October, 2015, at the Hospital Universitario San Ignacio. We evaluated quantitative variables and Spearman correlations. The data analysis was carried out with Student t and Mann-Whitney U tests.

RESULTS

A total of 55 patients with relapsing-remitting multiple sclerosis participated in the study. Chronic fatigue was the most common comorbidity in 27%. The MusiQol questionnaire revealed a good basal quality of life, which remained at similar levels in the follow-ups at six and 12 months. Quality of life was good during the study since there were no statistically significant differences between baseline and follow-up MusiQol scores. Good quality of life was also observed in caregivers.

CONCLUSIONS

The quality of life of several Colombian patients diagnosed with multiple sclerosis was very good. This positive result was also observed in caregivers as evidenced by the results of the CareQol questionnaire. We also observed and indicated an inversely proportional correlation between the Expanded Disability Status Scale and the quality of life indexes.

Perceived Collective Efficacy and Parenting Competence: The Roles of Quality of Life and Hope

Parents' perceptions of their parenting competence predict successful implementation of parenting tasks and contribute to their interest and involvement in parenting and to their children's development. Thus, identifying factors that contribute to parents' perceptions of parenting competence can help inform efforts to promote children's safety and well-being. The present study employs social disorganization theory to examine the relationship between collective efficacy and parents' sense of competence, measured along two dimensions: parental efficacy and parental satisfaction. It examines the direct association between the two constructs and whether the association is mediated by parent perceptions of their quality of life (QOL) and sense of hope. Data were collected from 198 parents residing in a neighborhood in southern Tel Aviv, Israel. The analyses indicated that high collective efficacy was directly associated with high parental efficacy, but not with high parental satisfaction. Using structural equation modeling, a mediation model was found whereby higher collective efficacy was associated with (a) higher QOL, which in turn was related to a greater sense of hope, which was linked with higher parental efficacy; and (b) higher QOL, which was directly associated with higher parental satisfaction. The findings provide further support to the idea that neighborhood characteristics play an important role in parents' ability to care for their children.

Assessment of pain and associated factors in people living with HIV/AIDS

OBJECTIVE

to evaluate pain in people living with human immunodeficiency virus/acquired immunodeficiency syndrome and to relate it to sociodemographic and clinical factors, depressive symptoms and health-related quality of life.

METHOD

descriptive, analytical, observational, cross-sectional and quantitative study. Three hundred and two (302) people assisted at a specialized care service participated in the study. Instruments were used to evaluate sociodemographic and clinical data, depressive symptoms, and health-related quality of life. Descriptive, bivariate analysis and multiple logistic regression were used.

RESULTS

the incidence of pain of mild intensity was 59.27%, recurrent in the head, with interference in mood, mostly affecting females and individuals with no schooling/low schooling. Women were more likely to have moderate or severe pain. People aged 49 to 59 years had greater pain intensity than people aged 18 to 29 years. The variables depressive symptoms and pain were directly proportional. The higher the health-related quality of life and schooling, the lower was the possibility of presence of pain.

CONCLUSION

presence of pain is of concern and has association with female sex, lack of schooling/low schooling, worse level of health-related quality of life and presence of depressive symptoms.

Quality of life and perceived social support in people with HIV in Bogotá, Colombia

Introduction: People living with HIV/AIDS in developing countries tend to have a lower quality of life and less social support compared with those in developed countries. Objective: To explore the association between affective social support or social support generating confidence and each dimension of the quality of life related to health among people with HIV/AIDS from Bogotá. Materials and methods: We conducted a cross-sectional study of people living with HIV/AIDS using convenience sampling of a care program in a hospital network in Bogotá. The quality of life questionnaire SF36 and the generic social support questionnaire Duke-UNC-11 were used, along with linear regression models for the analyses. Results: There was a direct relationship between the emotional well-being dimension of quality of life and the social support systems of affectivity (ß =7.36;95% CI: 1.04; 13.68) and those generating confidence (ß =11.63;95% CI: 5.30; 17.96). There was a correlation between the dimensions of physical function, emotional performance, pain, and perceived affective social support. Likewise, we detected relations between the perception of social support generating confidence and the dimensions of vitality and social function. Contrarily, we found an inverse relationship between the averages of the dimension of emotional performance and the perceived affective social support, as well as between the dimension of physical performance and general health with social support generating confidence. Conclusions: Subjects with higher levels of social support had higher levels of quality of life related to health. This finding offers an opportunity for the design and implementation of healthcare plans that incorporate clinical, para-clinical and environmental variables of the patient.

Stigma, Expressed Emotion, and Quality of Life in Caregivers of Individuals with Dementia

Expressed emotion (EE) is a measure of a caregiver's critical and emotionally overinvolved (EOI; e.g., intrusive, self-sacrificing) attitudes and behaviors toward a person with a mental illness. Mounting evidence indicates that high levels of these critical and EOI attitudes and behaviors (collectively termed high EE) in family members are associated with a poorer course of illness for people with a range of disorders, including dementia (Nomura et al., 2005). However, less is known about factors that might trigger high EE and how high EE might impact dementia caregivers' own mental health. In this study we propose that caregivers who perceive stigma from their relative's illness may be more likely to be critical or intrusive (high EOI) toward their relative in an attempt to control symptomatic behaviors. We further hypothesized that high EE would partially mediate the link between stigma and quality of life (QoL) as there is some evidence that high EE is associated with poorer mental health in caregivers themselves (Safavi et al., 2015). In line with study hypotheses and using a sample of 106 dementia caregivers, we found that greater caregiver stigma was associated with both high EE (for criticism and EOI) and with poorer QoL. Mediational analyses further confirmed that high EE accounts for much of the association between stigma and poorer QoL. Study results suggest that addressing caregiver stigma in therapy could reduce levels of high EE and indirectly therefore improve caregiver QoL. Intervening directly to reduce high EE could also improve caregiver QoL.

Factores personales que afectan la calidad de vida de mujeres con cáncer de mama del noreste de México: Personal factors that affect quality of life of women with breast cancer from the northeast of Mexico

Introducción: La terapia sistémica para el cáncer de mama afecta la calidad de vida de las mujeres y sus familias. Se analizó la influencia de los factores personales sobre la percepción de calidad de vida de mujeres en tratamiento para el cáncer mamario. Métodos: Participaron noventa y cinco asistentes a la consulta de un hospital público del noreste de México. Se aplicaron dos Cuestionarios de la Organización Europea para la Investigación y Tratamiento del Cáncer (EORTC QLQ-C30 y EORTC QLQ-BR23). Resultados: La edad promedio fue de 55 años ( DE = 9.24). Las participantes destacaron por presentar valores altos para el estado de salud global y niveles bajos en funcionamiento ( rango = 11.71 a 18.42). El insomnio y el impacto económico fueron las áreas más afectadas. Con el incremento de la edad, se observó menor afectación por síntomas mamarios, función y el disfrute sexual ( r = -.273, -.349 y -.304 respectivamente, p < .01). Conclusión: La situación laboral, estado civil, paridad y lugar de procedencia promovieron afectación diferencial en algunos síntomas incluyendo la imagen corporal. La aplicación de estos cuestionarios permitiría la identificación de necesidades de cuidado físico u emocional en la práctica clínica.

Correlation of 6-min walk test with left ventricular function and quality of life in heart failure due to Chagas disease

OBJECTIVES

To evaluate the correlation of the total distance walked during the six-minute walk test (6MWT) with left ventricular function and quality of life in patients with Chagas Disease (ChD) complicated by heart failure.

METHODS

This is a cross-sectional study of adult patients with ChD and heart failure diagnosed based on Framingham criteria. 6MWT was performed following international guidelines. New York Heart Association functional class, brain natriuretic peptide (BNP) serum levels, echocardiographic parameters and quality of life (SF-36 and MLHFQ questionnaires) were determined and their correlation with the distance covered at the 6MWT was tested.

RESULTS

Forty adult patients (19 male; 60 ± 12 years old) with ChD and heart failure were included in this study. The mean left ventricular ejection fraction was 35 ± 12%. Only two patients (5%) ceased walking before 6 min had elapsed. There were no cardiac events during the test. The average distance covered was 337 ± 105 metres. The distance covered presented a negative correlation with BNP (r = -0.37; P = 0.02), MLHFQ quality-of-life score (r = -0.54; P = 0.002), pulmonary artery systolic pressure (r = -0.42; P = 0.02) and the degree of diastolic dysfunction (r = -0.36; P = 0.03) and mitral regurgitation (r = -0.53; P = 0.0006) and positive correlation with several domains of the SF-36 questionnaire.

CONCLUSIONS

The distance walked during the 6MWT correlates with BNP, quality of life and parameters of left ventricular diastolic function in ChD patients with heart failure. We propose this test to be adopted in endemic areas with limited resources to aid in the identification of patients who need referral for tertiary centres for further evaluation and treatment.

The effect of nutritional supplementation on quality of life in people living with HIV: a randomised controlled trial

OBJECTIVE

To determine the effects of lipid-based nutrient supplements (LNS) on the quality of life of people living with HIV (PLHIV) during the first 3 months of antiretroviral treatment (ART) and to investigate the effects of timing of supplementation by comparing with supplementation during the subsequent 3 months.

METHODS

A randomised controlled trial was conducted in three ART clinics within public health facilities in Jimma, Ethiopia. Participants were PLHIV eligible to start ART with body mass index >17 kg/m(2) and given daily supplements of 200 g of LNS containing whey or soya either during the first 3 months or the subsequent months of ART. The outcome was measured in terms of total quality-of-life scores on the adapted version of the WHOQOL-HIV-BREF assessed at baseline, three and six months.

RESULTS

Of the 282 participants, 186 (66.0%) were women. The mean age (SD) was 32.8 (±9.0) years, and the mean (SD) total quality-of-life score was 82.0 (±14.8) at baseline assessment. At 3 months, participants who received LNS showed better quality of life than those who only received ART without LNS (β = 6.2, 95% CI: 2.9: 9.6). At 6 months, there was no difference in total quality-of-life score between the early and delayed supplementation groups (β = 3.0, 95% CI: -0.4: 6.4). However, the early supplementation group showed higher scores on the social and spirituality domains than the delayed group.

CONCLUSIONS

LNS given during the first three months of ART improves the quality of life of PLHIV.

[Burnout and quality of life in medical residents]

BACKGROUND

burnout and quality of life are poorly studied phenomena in postgraduate students, and its effects are unknown. The aim was to investigate the relationship between quality of life and burnout in medical residents.

METHODS

a longitudinal study was performed. We included medical residents who began their postgraduate studies in 2010. The Spanish version of the Quality of Life Profile for the Chronically Ill (PLC, according to its initials in German), and the Maslach Burnout Inventory specific to physicians were applied at the beginning, and six and 12 months later. Descriptive statistics were used for nominal variables. Chi-square and ANOVA were applied to numerical variables.

RESULTS

we included 45 residents, the average age was 26.9 ± 2.93 years, 18 (40 %) were female and 27 (60 %) were male. The PLC survey found significant decrease in four of the six scales assessed in the three measurements. The Maslach Burnout Inventory found high levels of emotional exhaustion in the three tests, low levels of depersonalization and low personal gains at the beginning, rising at six and 12 months. The most affected specialty was Internal Medicine.

CONCLUSIONS

burnout and impaired quality of life for residents exist in postgraduate physicians and it is maintained during the first year of residency.

[Cost-effectiveness of two hospital care schemes for psychiatric disorders]

BACKGROUND

In Mexico, six of every twenty Mexicans suffer psychiatric disorders at some time in their lives. This disease ranks fifth in the country. The objective was to determine and compare the cost-effectiveness of two models for hospital care (partial and traditional) at a psychiatric hospital of Instituto Mexicano del Seguro Social (IMSS).

METHODS

a multicenter study with a prospective cohort of 374 patients was performed. We made a cost-effectiveness analysis from an institutional viewpoint with a six-month follow-up. Direct medical costs were analyzed, with quality of life gains as outcome measurement. A decision tree and a probabilistic sensitivity analysis were used.

RESULTS

patient care in the partial model had a cost 50 % lower than the traditional one, with similar results in quality of life. The cost per successful unit in partial hospitalization was 3359 Mexican pesos while in the traditional it increased to 5470 Mexican pesos.

CONCLUSIONS

treating patients in the partial hospitalization model is a cost-effective alternative compared with the traditional model. Therefore, the IMSS should promote the infrastructure that delivers the psychiatric services to the patient attending to who requires it.

Clinical and quality of life data correlation with a single-optic accommodating intraocular lens

Purpose

To examine a single-optic accommodating intraocular lens (IOL) visual performance by correlating IOL implanted eyes’ defocus curve with the intraocular aberrometric profile and the impact on the quality of life (QOL).

Methods

Prospective consecutive case series study including a total of 25 eyes of 14 patients with ages ranging between 52 and 79 years old. All cases underwent cataract surgery with implantation of the single-optic accommodating IOL Crystalens HD (Bausch & Lomb). Distance and near visual acuity outcomes, intraocular aberrations, the defocus curve and QOL (NEI VFQ-25) were evaluated 3 months after surgery.

Results

A significant improvement in distance visual acuity was found postoperatively (p = 0.02). Mean postoperative LogMAR uncorrected near visual acuity was 0.44 ± 0.23 (20/30). 60% of eyes had a postoperative addition between 0 and 1.5 diopters (D). The defocus curve showed an area of maximum visual acuity for the levels of defocus corresponding to distance and intermediate vision (−1 to +0.5 D). Postoperative intermediate visual acuity correlated significantly some QOL indices (r ≥ 0.51, p ≤ 0.03; difficulty in going down steps or seeing how people react to things that patient says) as well as with J₀ component of manifest cylinder. Postoperative distance-corrected near visual acuity correlated significantly with age (r = 0.65, p < 0.01).

Conclusions

This accommodating IOL seems to be able to restore the distance visual function as well as to provide an improvement in intermediate and near vision with a significant impact on patient's QOL, although limited by age and astigmatism. Future studies with larger sample sizes should confirm all these trends.

[Comparison between aquatic-biodanza and stretching for improving quality of life and pain in patients with fibromyalgia]

OBJECTIVE

To determine the level of improvement, as regards pain, impact on fibromyalgia and depression, achieved by patients with fibromyalgia by comparing aquatic biodanza and stretching exercises.

DESIGN

Randomised controlled trial with two intervention groups.

LOCATION

Five health centres (Almeria).

PATIENTS

A total of 82 fibromyalgia patients between 18 and 65 years old, diagnosed by American College of Rheumatology criteria, were included, with 12 patients declining to take part in the study. The 70 remaining patients were randomly assigned to two groups of 35 patients each: aquatic biodanza and stretching exercises. Those who did not attend in at least 14 sessions or changed their treatment during the studio were excluded. The final sample consisted of 19 patients in aquatic biodanza group and 20 in stretching group. The limitations of the study included, the open evaluation design and a sample size reduced by defaults.

MAIN MEASURES

The outcome measures were sociodemographic data, quality of life (Fibromyalgia Impact Questionnaire), pain (McGill-Melzack questionnaire; and Visual Analogue Scale), pressure algometry (Wagner FPI10 algometer) and depression (Beck Inventory). These were carried out before and after a 12-week therapy.

RESULTS

The mean age of the sample was 55.41 years. The mean period from diagnosis was 13.44 years. The sample consisted mainly of housewives. There were significant differences (P<.05) between groups, in pain (P<.01), fibromyalgia impact (P<.01), and depression (P<.04) after the treatment.

CONCLUSIONS

The biodanza aquatic exercises improve pain and quality of life in fibromyalgia patients.

[A review of the medication in polymedicated elderly with vascular risk: a randomised controlled trial]

OBJECTIVE

To analyse the effectiveness of a medication review based on intervention directed at improving the appropriateness of drug treatments according to the established guidelines, as well as blood pressure, serum lipid and blood glucose control in elderly patients on multiple medication, and cardiovascular disease or high risk of cardiovascular disease.

DESIGN

A randomised controlled trial with blind evaluation.

SETTING

Fourteen Primary Health Care centres in Andalusia

PARTICIPANTS

A total of 323 patients older than 65 on polypharmacy and cardiovascular disease or high risk of cardiovascular disease.

INTERVENTION

A pharmacist interviewed the patient, reviewed the appropriateness of the drug treatment, taking in account health record data, proposed modifications and communicated them to the general practitioner or nurse. The control group received usual health care.

MAIN MEASUREMENTS

Percentage of patients with appropriate use of low doses of acetylsalicylic acid, blood pressure, LDL-cholesterol, HbA(1c), and quality of life scores.

RESULTS

A total of 41% of patients (average age 74, 61% women) had cardiovascular disease. Ten months after the intervention (18.3% withdrawals), more patients in the intervention group used low dose acetylsalicylic acid than in the control group (52.3% vs 38.6%; P=.024). There were no differences between groups in intermediate clinic outcomes. Quality of life scores improve in intervention group by 6.1 points (100 points scale), but was not statistically significant (P=.051).

CONCLUSION

Clinical medication review improves the appropriateness of antiplatelet treatment in the elderly on polypharmacy and with high risk of cardiovascular disease. No improvement in biochemistry measurements was found.

[Assessment of health outcomes in the type 2 diabetes process]

OBJECTIVE

To analyse association between the development of type 2 diabetes and the health-related quality of life (HRQL).

DESIGN

Descriptive cross-sectional study.

SETTING

Primary care centre in Ayamonte (Huelva).

PARTICIPANTS

Selection by simple random sampling between the patients registered with type 2 diabetes: n=143. The type 2 diabetes process is a tool that uses indicators of good clinical practice for the follow-up of the patients. Collection of data from records and personal interview for the questionnaire HRQL SF-36.

RESULTS

A total of 101 patients were analysed, of which 51.5% were women. the average age was 66.8 years (SD 11.3). Performing physical activity 52.5%. Time of evolution of diabetes: 9.6 years (SD 7.7). Quality Index of the process: 64.5%. Worst score in physical component HRQL, mean of 41.9 (SD 9.6). Men had a better score, and it improves if there is regular physical exercise (mean difference 19.5% IC95%CI: 10.2-28.8). Age was inversely associated with physical function (r -0.354 P<0,005); and the time of evolution of diabetes with physical component (r -0.278 P<0.005). Retinopathy (t=2.03 P<0.04) and heart disease (t=2.6 P<0.008) were associated with lowest score in physical component. The association of HRQL with metabolic control, self control of glucose and diabetes education was not significant. Physical activity and comorbid diseases predict HRQL.

CONCLUSIONS

The HRQL is poor in type 2 diabetics despite having good indicators in the process. The HRQL should be included as standard in the type 2 diabetes process.

[Metric properties of WOMAC questionnaires-original and reduced versions-to measure symptoms and Physical Functional Disability]

OBJECTIVES

To determine the metric properties of the WOMAC questionnaire filled in over the telephone; and to obtain a reduced version of this questionnaire.

DESIGN

Descriptive study.

SETTING

"La Merced" (Osuna. Seville) and "Torrecárdenas" (Almeria) Hospitals.

PARTICIPANTS

People suffering from hip and knee osteoarthritis and awaiting surgical intervention from October 2004 to November 2006.

MAIN MEASUREMENTS

Telephone interview, sociodemographic variables and Symptoms and Physical Functional Disability (WOMAC questionnaire) were collected.

RESULTS

A total of 311 people suffering from hip or knee osteoarthritis were included. Subjects were mostly women (82.63%) with a mean age of 70 years. Metric properties of the original and reduced WOMAC were as follows: All WOMAC items obtained a maximum value of 67.4% on endorsement frequency. Main components factorial analysis resulted in a communality of over 0.5 and 71.73% of total explained variance, with 5 factors -no conceptual meaning-. With a communality cut-off point of 0.8; 13 items were rejected and the total explained variance increased to 87.74% with 4 factors -conceptually sensible-. Varimax rotations were performed due to low correlation factors. Pearson correlation between the original and reduced WOMAC versions were 0.92. Reliability analysis obtained a Cronbach alpha value of 0.92 for original WOMAC and 0.82 for the reduced version.

CONCLUSION

The original WOMAC questionnaire showed adequate metric properties to be used over the telephone on people suffering from hip and knee osteoarthritis. Furthermore, a reduced version of WOMAC with 11 items had better metric properties than the full version.

Association between the Nursing Home Minimum Data Set for Vision and Vision-Targeted Health-Related Quality of Life in Nursing Home Residents As Assessed by Certified Nursing Assistants

PURPOSE: The purpose of this study was to evaluate the association between the federally mandated Minimum Data Set (MDS) Vision Patterns assessment for nursing home residents in the United States and an assessment of their vision-targeted quality of life as assessed by certified nursing assistants (CNAs). METHODS: Participants were 371 residents over the age of 55 from 17 nursing homes in the Birmingham, Alabama metropolitan area and the CNAs directly assigned to their care. CNAs assessed the vision-targeted quality of life of residents in their charge using the Nursing Home Vision-Targeted Health-Related Quality of Life (NHVQoL) questionnaire. MDS assessment categories assigned to each resident by the MDS nurse coordinator ("adequate", "impaired", "moderately impaired", "highly impaired", "severely impaired") were obtained from the medical record. Visual acuity was measured using logMAR charts by trained research staff. RESULTS: CNA rated NHVQoL subscale scores decreased as the MDS rating indicated more vision impairment (all P's for trend < 0.05). Almost all mean scores were in the 80s and 90s for those in the adequate, impaired, and moderately impaired categories. For those with MDS ratings of severely or highly impaired, NHVQoL subscale scores (except ocular symptoms) were dramatically lower (P ≤ 0.001) than those rated as moderately impaired. CONCLUSIONS: Ratings by CNAs on the vision-targeted quality of life of nursing home residents under their care is in general agreement with the MDS category assigned by the nurse coordinator. However, CNA ratings are largely homogeneous in the adequate vision to moderately impaired categories.

[Treatment of chronic osteomuscular pain]

OBJECTIVE

To describe the prevalence of use of the 3 analgesic steps of the WHO in patients with chronic osteomuscular pain at 2 primary care centres, by means of personal interviews during the second semester of 2003 and first of 2004.

DESIGN

Cross-sectional, observational, descriptive study.

SETTING

Health centres of Puerto de Sagunto (Valencia) and Alto Palancia (Castellón), Spain.

PARTICIPANTS

Three-hundred and twenty users of the above centres with chronic osteomuscular pain.

METHOD

Systematic random sampling of the patients. Data collected from clinical histories and personal interviews.

RESULTS

Thirty-eight percent (38.7%) of the patients did not take medication to control pain or did so at insufficient doses; 54.7% used drugs of the first step of the WHO; and 6.6%, of the second. There were no patients in treatment with strong opioids. Significant differences at the time of prescribing the different analgesic treatments existed, depending on sex, educational background and patients' job. The characteristics of chronic pain (aetiology and duration of symptoms) also affected the therapy decision. There was a tendency to prescribe more analgesic as pain intensified.

CONCLUSIONS

There is a high percentage of the population without any treatment for chronic osteomuscular pain. Opioid analgesics are under-used to treat pain.

[Quality of life of patients treated with oral anticoagulants]

Introducción

El aumento de la esperanza de vida y las nuevas indicaciones del tratamiento anticoagulante oral (TAO) han dado lugar a un número creciente de pacientes sometidos a dicha terapia a largo plazo. Sin embargo, las propias características del TAO propician que estos pacientes puedan sufrir un deterioro de su calidad de vida. En varios estudios internacionales publicados se analiza dicha calidad de vida, así como la satisfacción relacionada con el tratamiento en los pacientes con TAO1-4. Sin embargo, no hemos encontrado trabajos similares publicados en España.

Objetivo

Conocer la calidad de vida de los pacientes que reciben TAO en nuestro entorno. Como objetivo secundario nos propusimos analizar las posibles diferencias entre los pacientes cuyo control y seguimiento se realizaba en atención primaria (AP) y los seguidos en atención especializada (AE).

Diseño

Estudio descriptivo, transversal, realizado en el ámbito de AP y AE entre los meses de febrero y abril de 2003.

Participantes

Todos los pacientes mayores de 18 años de nuestro equipo de AP que utilizaban TAO, según constaba en registro de las historias clínicas individuales informatizadas. Además, incluimos a una muestra consecutiva de pacientes mayores de 18 años con TAO en seguimiento en el Servicio de Hematología del hospital de referencia (Hospital Universitario de Getafe) con médico asignado en Parla o Griñón. Se excluyó a los pacientes inmovilizados o con incapacidad física o psíquica para realizar la entrevista y responder al cuestionario.

Mediciones

Se recogieron variables sociodemográficas y se aplicó un cuestionario específico de calidad de vida en pacientes con TAO2, previamente adaptado para nuestro medio5. El cuestionario consta de 32 preguntas que analizan 5 dimensiones relacionadas con el TAO: satisfacción con el tratamiento, autoeficacia en su manejo, estrés psicológico general, limitaciones diarias y alteraciones sociales. Cada pregunta se responde según una escala tipo Likert con 6 posibles respuestas («nada», «muy poco», «poco», «algo», «bastante» y «mucho »). Para facilitar el entendimiento se superpone una escala cuantitativa con los valores de 1 a 6. El valor de cada dimensión corresponde a la media aritmética de las puntuaciones de las preguntas que la componen.

Resultados

Completaron la encuesta un total de 225 pacientes en tratamiento con TAO. Los pacientes estudiados tenían una edad media de 65 ±13 años (rango: 23-89). De ellos, el 51,1% (n = 115) eran mujeres y el 45,8% (n = 103) realizaban su control del TAO en AP. El 22,2% (n = 50) eran laboralmente activos y el 54,7% (n = 123) tenían el médico en turno de mañana. Al analizar el género, la situación laboral y el turno del médico de AP en función del ámbito de seguimiento no encontramos diferencias estadísticamente significativas, cosa que sí ocurría con la edad: los pacientes controlados en AP eran mayores que los controlados en AE (edad media en AP: 68 años; edad media en AE: 62 años; p = 0,001). Los valores obtenidos por cada dimensión, así como las diferencias según el ámbito de seguimiento, se describen en la tabla 1.

Discusión

No hemos hallado publicados estudios que analicen la satisfacción o la calidad de vida de los pacientes con TAO en nuestro país. En algunos estudios realizados en el extranjero se evalúan estos parámetros, pero siempre como medición secundaria al grado de control de la razón normalizada internacional, cuando se comparan, por ejemplo, diferentes ámbitos de seguimiento de los pacientes. En 3 de estos trabajos se emplea el mismo cuestionario desarrollado por Sawicki2 en 1999, cuya versión española hemos usado en nuestro estudio. En 2 de ellos se analiza la calidad de vida de usuarios de TAO sometidos a un programa estructurado de instrucción en el automanejo de dicho tratamiento y se compara al cabo de 6 meses con un grupo control que no recibe dicha intervención2,3, mientras que en el tercero se evalúan los resultados al cabo de 5 años de seguimiento4.

Los pacientes con TAO que participaron en nuestro estudio expresan buena calidad de vida, mostrándose los controlados en AP más satisfechos que los seguidos en AE, al contrario que en el estudio de Wilson et al6 en Canadá, donde se describe que el grado de satisfacción de los pacientes con TAO es mayor cuando el seguimiento se realiza en clínicas especializadas que cuando lo lleva a cabo el médico de familia. Por otro lado, los pacientes seguidos en AE se consideran más eficaces para el autocuidado. Este último dato pudiera estar en relación con el hecho de que los pacientes seguidos en el hospital son más jóvenes y, probablemente, más capaces de asumir un tratamiento complejo como el TAO, aunque el diseño de nuestro estudio no nos permite afirmar este extremo ni evaluar otros factores que pudieran estar implicados, como el nivel socioeconómico o el nivel de estudios. En el resto de las dimensiones analizadas (estrés, limitaciones diarias y alteraciones sociales) no existen diferencias significativas entre ambos grupos.

Cuando comparamos nuestros resultados con estudios extranjeros que emplean el mismo instrumento de medición observamos que, en resumen, nuestros pacientes expresan unos datos de satisfacción y calidad de vida similares o mejores incluso que los publicados en pacientes sometidos a un programa educativo específico2,3, a pesar de que tienen más edad que los analizados en los estudios referidos2-4, de que en nuestro ámbito no se alcanza el nivel cultural de los pacientes incluidos en el trabajo de Cromheecke et al3 y de que no han sido sometidos a ningún programa educativo especial sobre el cuidado y manejo del TAO más allá de la educación individual recibida de parte de sus respectivos médicos. Consideramos, por tanto, que la AP representa el ámbito idóneo para el seguimiento y control de este tipo de tratamientos, lo que además redunda en un aumento de la satisfacción de los pacientes.

[Effectiveness of a recuperative primary care intervention in patients with chronic obstructive pulmonary disease]

OBJECTIVES

The main objective is to assess the effect of a respiratory rehabilitation programme on the quality of life of patients with COPD. Secondary aims are to determine whether the intervention, as against the habitual monitoring, improves tolerance to exercise and pulmonary function, and reduces dyspnoea, the number of crises and hospital admissions due to COPD and the medication used to control the disease.

DESIGN

Pragmatic cluster-randomised clinical trial.

SETTING

Clinics of 16 PC teams in various health areas of the Community of Madrid.

PARTICIPANTS

476 patients with light-moderate COPD, who sign their informed consent.

VARIABLES

Quality of life, number of crises, packages of medicines used to control the disease, unscheduled attendance, pulmonary function, dyspnoea and tolerance to exercise.

METHOD

The consultations will be assigned to the control and intervention groups at random. At each clinic there will be a randomised selection from all patients with COPD and in a stable clinical condition. 238 patients are needed in each group, in order to detect a minimum difference of 4 points in quality of life, assuming a standard deviation of 16, 95% confidence level, 80% power and 20% losses. The effect between each factor and the variables evaluated through multivariate analysis will be calculated.

DISCUSSION

This research project aims to show that a basic recuperative intervention, which is feasible and primary care-based, can achieve improvements in the quality of life of patients with COPD.

[Prevalence, expression and impact of depressive disorders in primary care]

OBJECTIVE

To determine the prevalence and forms of clinical expression of depressive disorders in primary care patients. To analyse the under-detection of depression by primary care doctors.

DESIGN

Descriptive and transversal study, with two-stage sampling. Setting. Primary care consultations in the Camp de Tarragona area.

PARTICIPANTS

1000 consecutive patients visiting their doctor for any reason will make up the first-stage sample. Of these 350 go on to the second stage (all the positive results in the screening for depression test plus a random one-seventh of the negative results).

MAIN MEASUREMENTS

The first stage will consist of the screening of the sample for depressive disorders with Zung's Self-Rating Depression Scale. In the sub-sample that will go on to the second stage, the Structured Clinical Interview for DSM-IV Disorders will be used to establish diagnoses of depressive disorders and other co-morbid psychiatric disorders. There will also be a range of specific questionnaires to find reasons for consultation and the form of presentation of an eventual depressive disorder, medical co-morbidity, medication taken, use of health services, the functional and vital repercussions of depression. A questionnaire for the patient's G.P. will assess and detect depression.

DISCUSSION

The study will enable us to check the validity for our patients of pre-suppositions on depression in primary care obtained from studies in other countries with different health structures and social and cultural conditioners, and to find diverse information extrapolated from specialist studies.