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PubMedDate not supplied

[Towards a Mexican normative standard for measurement of the short format 36 health-related quality of life instrument].

OBJECTIVE: To present the results of the application of the short format 36 instrument (SF-36) in the Mexican states of Sonora and Oaxaca. The levels of quality of life were compared with those from Canada and the United States. MATERIAL AND METHODS: The data were obtained using a survey on health service access, usage, and quality. The SF-36 is composed of 36 questions, which represent eight different domains on the health-related quality of life. These domains are used to estimate the physical and mental components of health. Data analysis was performed to calculate the average scores for each domain for the total sample, by gender and age groups in each state. The regional differences were assessed by the difference of means. RESULTS: The total response was 98.5% of the 4200 selected households. The percent response values were similar between the two states. A total of 5961 subjects older than 25 years of age completed the questionnaire. Males scored higher than females in all domains and in both components. Regardless of sex, the highest variation was observed in adults up to 64 years of age mainly in three domains: overall health, social function, and mental health; in the 65-74 year age group occurred mostly in social function and mental health; and in adults older than 75 year only in mental health. The young adult age group (25 to 44 years) showed variation in a greater number of domains, while women exhibited more variation in the "extreme" age groups, 25 to 34 years and 75 years and older. The mean scores in our sample were higher than those found in Canada and the United States in five domains and in the two summary components. Canada showed higher scores in the other three domains (overall health, social function, and mental health). CONCLUSIONS: SF-36 data are not available at the national level; hence, the authors recommend that their study results may serve as the normative reference for SF-36 in Mexico. Researchers using the SF-36 could compare their results with our reference, adjusted by gender and age in population-based studies. Considering that the study regions have contrasting social and economic characteristics, the data from the more developed state, Sonora, may be used as the normative standard. Data from Oaxaca would be used as the reference for less-developed states. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Adult↗
PubMed2006

Improvement in quality of life measures in patients with refractory hepatitis C, responding to re-treatment with Pegylated interferon alpha -2b and ribavirin.

BACKGROUND: In this paper, we report the health related quality of life (HRQOL) data from patients with hepatitis C viral infection (HCV) who were refractory to prior therapy and had re-treatment with a combination of Pegylated interferon alpha-2b and ribavirin. We hypothesized that the HRQOL will improve in those patients who attain sustained viral response similar to naïve patients undergoing treatment for HCV. METHODS: HRQOL data was obtained from 152 patients enrolled into a randomized study for re-treatment of HCV refractory to prior therapy with interferon alpha-2b in combination with ribavirin. The treatment protocol was for 48 weeks and had a high and low dose arm. The HRQOL data was collected at baseline, weeks 24 and 48 of treatment, and at 24 week follow-up after treatment. A repeated measures statistical model was used for comparing the HRQOL domain scores between the responders and non-responders and the treatment groups. The responders and non-responders were also compared to the age and sex adjusted national mean scores. RESULTS: Twenty-five of the 152 (17%) patients achieved a sustained viral response. At baseline, HRQOL is lower in HCV patients compared to national norms. The norm based HRQOL domain scores for the different domains of the SF-36 instrument were as follows: physical functioning = 47.13, role-physical = 46.87, bodily pain = 48.00, general health = 44.01, vitality = 45.39, social functioning = 47.05, role-emotional = 48.88, mental health = 48.76, physical component score 43.26 and mental component score = 46.17. The scores decreased during therapy in those who would be responders and non-responders, but the pattern of change was different. During the treatment, the HRQOL domain scores of responders decrease notably in the domain of vitality. At week 48 vitality scores were worst in responders. 5 of the 8 domain scores were lower compared to baseline in non-responders. At 24 weeks post treatment follow up, HRQOL in those refractory patients who respond to re-treatment tended to be better than the national average in the domains of vitality (p = .06), social functioning (p = .06) and role-emotional (p = .03) while the non-responders improved their scores in domains of physical function and bodily pain. CONCLUSION: We conclude that patients who are to be responders and non-responders behave differently in terms of the HRQOL domain scores when re-treated with a combination of interferon alpha 2b and ribavirin. The responders sustained a significant decrease in the domain score of vitality while 5 of the 8 domain scores decrease in non-responders at the end of treatment. At the end of follow up, in responders, the HRQOL score tended to be better than the national average notably in the domains of role-emotional, vitality and social functioning. On the other hand, in non-responders, the domain scores of physical function improve, while that of role-emotional worsened.

Adult↗
PubMed2003

Preference weights for cost-outcome analyses of schizophrenia treatments: comparison of four stakeholder groups.

This study quantified preferences for schizophrenia outcomes in four stakeholder groups, tested the hypotheses that outcomes differ in importance and stakeholder groups have different preferences, and produced preference weights for seven outcomes for cost-outcome analysis. Fifty patients with schizophrenia, 50 clinicians, 41 family members of patients, and 50 members of the general public rated 16 schizophrenia-related health states, yielding preference weights for seven outcomes: positive symptoms, negative symptoms, extrapyramidal symptoms, tardive dyskinesia, social function, independent living, and vocational function. Outcomes differed in importance (F = 23.4, p < 0.01). All stakeholders rated positive symptoms and social functioning as more important than negative and extrapyramidal symptoms. Stakeholder groups had different preferences (F = 1.9, p = 0.01). Patients rated extrapyramidal symptoms as more important than did other groups (p < 0.01); clinicians rated social functioning as more important than did patients or family members (p < 0.05); and clinicians and family members rated vocational functioning as more important than did patients and the general public (p < 0.05). Results show that schizophrenia outcomes are not equally important and that stakeholder groups value outcomes differently, demonstrating the importance of incorporating stakeholder preferences in cost-outcome analyses and other treatment comparisons.

Adult↗
PubMed1995

Course of patients diagnosed as having schizophrenia during first episode occurring under age 18 years.

Of 118 child and adolescent schizophrenic patients (ICD-9: 295.x; mean onset age 16.0 years), 97 (82.2%) could be completely investigated at follow-up (mean interval 7.4 years; mean age 23.1 years). At follow-up 30% of the patients were semi-dependent or dependent, 72% still required psychiatric treatment, 44% were at least moderately impaired with regard to educational/occupational functions and 58% with regard to social functions; 73% had experienced at least one further schizophrenic episode. Comparison with schizophrenia beginning in adulthood showed that the impairment in social function was much greater in the younger group of patients. These results support the belief that schizophrenic psychoses starting in adolescence have a worse outcome than those beginning in adulthood. The most efficient indicators for a worse outcome were long duration of inpatient treatment at first admission, a high number of symptoms and low social competence at discharge.

Adolescent↗
PubMedDate not supplied

The mediating effect of pain and fatigue on level of functioning in older adults.

BACKGROUND: Medical conditions and symptoms have been shown to predict level of functioning in older adults, but medical conditions and symptoms have rarely been investigated together in a comprehensive model that included both medical conditions and symptoms as predictors of functioning in older adults. OBJECTIVE: The purpose of this study was to determine whether the adverse effect of medical conditions on different aspects of functioning in older adults is mediated by the level of symptoms (pain and fatigue). If so, level of functioning may improve if pain or fatigue can be mitigated, even when underlying medical conditions cannot be cured. METHOD: Data from 225 adults aged 65-90 were used to test whether medical conditions, symptoms (pain and fatigue), and six covariates predicted lower body performance, self-reported physical functioning, and self-reported role and social functioning. The fit of a series of models to the data was analyzed using structural equation modeling. RESULTS: Medical conditions affected self-reported physical functioning and self-reported role and social functioning by increasing the level of symptoms, rather than by direct association. Further descriptive studies are needed to identify other symptoms and modifiable mechanisms by which medical conditions affect functioning. Researchers who investigate the causes of poor functioning in older adults are encouraged to include symptoms in models that hypothesize medical conditions as predictors of functioning outcomes.

Activities of Daily Living↗
PubMed2004

Health-related quality of life in a rare disease: hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease.

The levels of the health-related quality of life (HR-QoL) were analyzed in hereditary hemorrhagic telangiectasia (HHT) patients. The Short Form-36 Health Survey (SF-36) was administered to 50 HHT patients and scores were compared to a cohort of 2301 normal subjects. Clinical variables were patient age, illness duration, number of epistaxis episodes in the previous year and hemoglobin levels. Physical functioning, physical role limitations, bodily pain, social functioning, emotional role limitations and the physical component scores were lower among females. In multivariable analyses increasing age was related to lower physical functioning (p < 0.04), physical role limitations (p < 0.008), bodily pain (p < 0.05) and emotional role limitations (p < 0.01), while higher hemoglobin levels improved physical functioning (p < 0.03). The number of epistaxis episodes was negatively associated with physical role limitations (p < 0.009), vitality (p < 0.002), social functioning (p < 0.001), physical component summary (p < 0.001) and bodily pain (p < 0.01). Illness duration was negatively related to the mental component summary (p < 0.004). HHT patients had a lower HR-QoL with respect to normal controls in all domains except for bodily pain. Females had lower scores for several domains. Epistaxis was the most important clinical variable.

Adult↗
PubMed2002

Influence of gender on social outcome in schizophrenia.

OBJECTIVE: To study the relevance of gender on social functioning in schizophrenia. METHOD: A sample of 200 schizophrenic (DSM-IV criteria) out-patients were followed-up during 2 years and were administered the following instruments: Positive and Negative Symptom Scale (PANSS), Disability Assessment Scale (DAS-sv), and Global Assessment of Functioning (GAF) Scale. A regression model was created with DAS and GAF as dependent variables, and gender, PANSS, age of onset, duration of illness and marital status as independent variables. Separate regression models were then generated for females and males. RESULTS: Gender influenced significantly on DAS and GAF, with men showing worse functioning. In gender specific analyses, we found a significant influence of illness duration and Positive and Negative PANSS on social functioning in men, and of age at onset and Negative PANSS in women. CONCLUSION: Gender had a significant influence on social functioning in schizophrenia, even after adjusting for the other independent variables.

Age Factors↗
PubMed2000

The magnitude of khat use and its association with health, nutrition and socio-economic status.

Although the literature on khat (Catha edulis Forsk) is fairly extensive, and several authors have stated the potential adverse effects of habitual use of khat on mental, physical and social well-being, very few population based studies exist to substantiate those statements in Ethiopia. A house-to-house survey of a representative sample of 1200 adults from a rural Ethiopian community was conducted from January to September of 1997 to determine the prevalence of khat use and its association with health, nutritional status, mental distress, substance use, family and social functioning and economic well-being. The current prevalence of khat chewing was found to be 31.7%. Muslims more than Christians, males more than females, those between the ages 15 and 34 years more than other age groups were habitual users. The following factors were found to be significantly associated with khat use: physical illness, (OR = 1.52, 95% CI = 1.14-2.02); injuries (OR = 2.31, 95% CI = 1.42-3.79), undernutrition (OR = 1.76, 95% CI = 1.24-2.48), mental distress (OR = 8.30, 95% CI = 5.20-13.31). Family functioning among current khat users was significantly higher than non users (OR = 1.56, 95%-CI = 1.04-2.28). Social functioning and economic well-being were not significantly associated with khat use. It is concluded that a fairly large proportion of the population consumes khat and that this is related to physical and mental ill-health, although family and social functioning, and economic well-being seem to be unrelated to khat use.

Adolescent↗
PubMed2001

A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery.

OBJECTIVE: The aims of this study were to assess changes in physical function and quality of life with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the instrument of the Medical Outcomes Study SF-36 Health Survey (MOS SF-36), respectively, in patients undergoing hip anf knee joint replacement surgery and to compare the responsiveness of these two outcome measures 1 year after surgery. DESIGN: One hundred and ninety-four patients with osteoarthritis (OA knee 108, OA hip 86) admitted to four hospitals in Sydney were followed over a period of 1 year at 3 monthly intervals. RESULTS: WOMAC measures improved significantly after 1 year for OA hip and OA knee: there was reduction in pain of 71% and 53%, reduction of stiffness of 55% and 43% and improvement in physical function of 68% and 43%, respectively. MOS SF-36 measures in those having hip surgery improved significantly for pain (222%), physical function (247%), physical role functioning (402%), general health (110%), vitality (143%0, social functioning (169%) and mental health (114%). For those in the knee surgery group, significant improvement was seen for pain (175%), physical function (197%), physical role functioning (275%), vitality (125%) and social functioning (119%). The WOMAC was a more responsive measure than the MOS SF-36. CONCLUSION: WOMAC and MOS SF-36 detect significant and clinically meaningful changes in outcome after hip and knee replacement. WOMAC requires a smaller sample size and is more responsive in the short term. For a follow-up longer than 6 months MOS SF-36 provides additional information. The improvement in outcomes following hip joint surgery were significantly greater than those following knee surgery.

Aged↗
PubMed1999

Effects of community mobile team intervention in the Drewnica Hospital catchment area. 1. Patient outcome.

This study measured social functioning, treatment satisfaction and hospital utilization of 88 patients with chronic psychoses before and after a 1-year community mobile team programme, following most of the principles of assertive community treatment. The intervention had a positive impact in all measures. A clinically significant improvement of social functioning, as measured by Birchwood's Social Functioning Scale, was noted in 56% of patients, and 81% of subjects showed a clinically significant increase in satisfaction level. Time hospitalized decreased fourfold and number of admissions decreased twofold. To be certain that the changes found were due to the intervention and not other factors, further prospective studies of mobile community teams versus traditional care are indicated.

Adult↗
PubMedDate not supplied

Sociocultural and clinical characteristics of patients with comorbid depressions: a comparison of substance abuse and non-substance abuse diagnoses.

Patients with three varieties of major depression (MD) were compared with respect to sociocultural and clinical characteristics. The patients sought psychiatric evaluation in an intake setting during a 6-year interval. The groups that were compared included MD (sole axis I diagnosis; N = 3,913); MD with a comorbid non-substance abuse ([MD-nonSA] N = 594); and MD with a comorbid substance abuse ([MD-SA] N = 690). Prominent demographic differences were found in the three groups, with males, lower social class status, younger age, and African American ethnicity being more prominent in MD-SA. The four demographic variables, axis I status, axis II diagnosis, and axis III diagnosis constituted the independent variable in an analysis of variance (ANOVA) main-effects comparison of social function (during last year and currently in three areas) and type of depression symptoms (somatic and psychological). Of the demographic variables, age and social class proved to have significant effects on social function and psychological symptoms. Each of the three "syndromic" axes (Axis I, Axis II, and Axis III) had a significant impact on social function and psychological symptoms. Only Axis III produced differences in somatic symptoms. The social and cultural implications of these results are discussed.

Adult↗
PubMed2002

Quality-of-life differences between prophylactic and on-demand factor replacement therapy in European haemophilia patients.

The European Study on the Clinical Outcomes and Resource Utilization associated with Haemophilia Care was designed to compare various health outcomes associated with on-demand and prophylactic factor substitution methods in European haemophilia patients. While the primary objective of this research is to conduct an economic analysis, an important component of this study is to evaluate quality-of-life differences that may exist between patients who utilize these two styles of therapy. Quality-of-life research has emerged as a primary measure of health outcomes because it allows the augmentation of traditional clinical indicators of health with data gathered from the patient's perspective. A total of 1033 haemophilia patients from 16 European haemophilia treatment centres were enrolled in this study. The SF-36, a multidimensional quality-of-life instrument, was administered to all participants. This instrument measures eight health-related quality-of-life dimensions: physical functioning, physical role limitations, bodily pain, general health, vitality, social functioning, emotional role limitations, and mental health. All haemophilia subjects enrolled in the study scored significantly lower than the population normative means in the three physical dimensions and in the general health dimension. HIV-negative haemophiliac subjects differed significantly by factor substitution type in a multivariate analysis examining all eight health dimensions. Univariate analyses testing each dimension separately indicated that patients treated prophylactically reported significantly less bodily pain, better general health, and scored significantly higher in the physical functioning, mental health, and social functioning dimensions. While these results suggest that health-related quality-of-life may be better for haemophilia patients treated prophylactically, future prospective studies that gather periodic quality-of-life data over time should be conducted.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Outcome assessment of the VADO approach in psychiatric rehabilitation: a partially randomised multicentric trial.

BACKGROUND: Recent studies on representative samples of psychiatric services have shown that low proportions of cases received effective rehabilitation interventions. The following are likely to be the most important causes: the scarcity of mental health workers trained in social and work skills strategies and the absence of a structured framework to formulate rehabilitation practices. The aim of this study was to assess if a specific structured planning and evaluation manual, called VADO (Valutazione delle Abilità e Definizione degli Obiettivi--in english: Skills Assessment and Definition of Goals), is more effective than routine interventions in reducing disability in patients with schizophrenia. METHOD: Each of 10 mental health services were invited to recruit 10 patients with a schizophrenic disorder. Altogether 98 patients were recruited. Of these, 62 patients were randomly allocated to the intervention/experimental or a control group. The remaining group of 36 patients was not randomised and it was considered as a parallel effectiveness study. Assessment measures at the beginning of the study and at the one-year follow-up included the FPS scale of social functioning and the BPRS 4.0. Between group (VADO vs. Routine) and time effects were examined with ANOVA, Chi-square or Fisher exact. Clinical "improvement" was defined as an increase of at least ten points on the FPS or a decrease of at least 20% on BPRS scores. RESULTS: 31 of the 62 randomized patients received the experimental interventions, while 31 followed the routine ones. At follow-up, the experimental group showed statistically and clinically greater improvements in psychopathology and social functioning. Better outcomes of both social functioning and symptom severity were observed in non randomised patients (parallel effectiveness study). CONCLUSION: The results suggest that setting personalised and measurable objectives, as recommended by the manual, can improve the outcome of rehabilitation of severe mental disorders. Better outcomes in the parallel effectiveness study could be attributed to the greater confidence and enthusiasm of staff in centres where the VADO approach originated.

Journal Article↗
PubMed1985

Early rehabilitation following osteosynthesis with the sliding hip screw for trochanteric fractures.

A prospective study of 104 patients with throchanteric hip fractures was undertaken with particular regard to postoperative complications and rehabilitation at the follow-up 3 months later. The mortality was 20%, depended more on the social function prior to the fracture than on the patient's age. Osteosynthesis was performed with the Richards sliding screw-plate system. The most frequent clinical complications were of a cardiovascular and pulmonary nature. Technical failure was encountered in 10%. Hip function was excellent or good in 69%. In 40% the ability to walk remained unchanged after the operation. Seventy-five per cent of the patients returned to their own homes, although 51% were more dependent on the social welfare system than before the fracture. The social function prior to the fracture determined the social function after the fracture to a greater extent than did the patient's age.

Activities of Daily Living↗
PubMed2003

[Comparison of functional performance among children with Down syndrome and children with age-appropriate development at 2 and 5 years of age].

OBJECTIVE: To compare the functional performance of Down's syndrome (DS) children with normally developing children (ND), at 2 and 5 years of age. METHOD: Forty children were allocated into four groups (n=10): 1) children with DS with 2 years of age; 2) children with DS with 5 years of age; 3) normal children with 2 years of age; 4) normal children with 5 years of age. Children were evaluated with the functional test PEDI, which quantifies children's performance (skills and independence) in three domains: self-care, mobility and social function. Two-way ANOVA was used to compare group means and to test interaction effects age x pathology. Pre-planned contrast analyses were used to identify the significant bivariate comparisons. RESULTS: Main factors (age and pathology) were significant in the three domains of skills and independence performances. The interaction factor age x pathology was significant in self-care and mobility skills, as well as in children's independence in mobility and social function. Contrast analyses showed that at two years of age, normal children's performance is superior to DS's children in all three domains of functional skills and independence. However, at five years of age, significant group differences were only observed in the domains of self-care and social function skills, and independence. CONCLUSION: Results show the areas of performance where the delay presented by DS children was functionally manifested, at two and five years of age. Data indicate that the observed group differences were influenced by age, keeping themselves changeable across the development.

Activities of Daily Living↗
PubMed1994

Physical function and social class among Swedish oldest old.

The relationship between physical ability and social class in later life was explored through an interview survey conducted on a nationally representative sample of persons aged 77-98 (N = 537). Physical ability was measured with activities of daily living, an index of mobility, and performance tests. Social class was measured according to previous occupation. Physical function was found to be correlated with social class, that is, former white-collar workers had better function than blue-collar workers. The differences were significant for all three measures of physical function.

Activities of Daily Living↗
PubMed2005

Impaired visual recognition of biological motion in schizophrenia.

BACKGROUND: Motion perception deficits have been suggested to be an important feature of schizophrenia but the behavioral consequences of such deficits are unknown. Biological motion refers to the movements generated by living beings. The human visual system rapidly and effortlessly detects and extracts socially relevant information from biological motion. A deficit in biological motion perception may have significant consequences for detecting and interpreting social information. METHODS: Schizophrenia patients and matched healthy controls were tested on two visual tasks: recognition of human activity portrayed in point-light animations (biological motion task) and a perceptual control task involving detection of a grouped figure against the background noise (global-form task). Both tasks required detection of a global form against background noise but only the biological motion task required the extraction of motion-related information. RESULTS: Schizophrenia patients performed as well as the controls in the global-form task, but were significantly impaired on the biological motion task. In addition, deficits in biological motion perception correlated with impaired social functioning as measured by the Zigler social competence scale [Zigler, E., Levine, J. (1981). Premorbid competence in schizophrenia: what is being measured? Journal of Consulting and Clinical Psychology, 49, 96-105.]. CONCLUSION: The deficit in biological motion processing, which may be related to the previously documented deficit in global motion processing, could contribute to abnormal social functioning in schizophrenia.

Adult↗
PubMed1995

Memory functioning in social drinkers: a study of event-related potentials.

Verbal memory functioning was assessed in light and heavy social drinkers by recording event-related potentials in subjects instructed to memorize lists of words using either repetition or elaborative learning strategies. Although overall performance did not differ significantly between light and heavy drinkers, heavy drinkers showed reduced within-list organization compared with light drinkers. There were statistically significant differences in the event-related potential indices of memory functioning elicited during complex elaborative processing which were consistent with decreased within-list organization in heavy drinkers.

Adult↗