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PubMed2006

Pain and depressive symptoms among financially disadvantaged women's health patients.

OBJECTIVES: Women are at greater risk than men for both pain and depression, yet little is known about the frequency and implications of comorbid pain and depression among women in women's health settings. This study aimed to determine the frequency of comorbid depressive symptoms and pain among a sample of gynecology outpatients and to evaluate the associations of comorbid pain and depressive symptoms with physical, emotional, and social functioning and abuse experiences. METHODS: A total of 242 low-income, primarily African American women presenting at an urban women's health clinic for routine gynecological care consented to participate. Subjects completed the Beck Depression Inventory, Brief Symptom Inventory, Graded Chronic Pain Scale, SF-36, Physical and Sexual Abuse Questionnaire, and Duke Social Support Index. Multivariate analyses were used to test pain and depressive symptoms in their associations with emotional, physical, and social functioning and abuse experience. Age, race, income, and education were controlled in all analyses. RESULTS: Nearly 20% of participants reported comorbid high depressive symptoms and pain. Both depressive symptoms and pain were independently associated with emotional, physical, and social functioning domains. Depressive symptoms, but not pain, were associated with increased likelihood of history of abuse. CONCLUSIONS: Comorbid depressive symptoms and pain are a substantial problem, with pervasive implications among financially disadvantaged women seeking routine gynecological care. Subsequent research will determine if psychosocial treatment can be adapted effectively to the needs of this patient population.

Adolescent↗
PubMed2004

BMI and health-related quality of life in adults 65 years and older.

OBJECTIVE: To examine relationships of BMI with health-related quality of life in adults 65 years and older. RESEARCH METHODS AND PROCEDURES: In 1996, a health survey was mailed to all surviving participants > or = 65 years old from the Chicago Heart Association Detection Project in Industry Study (1967 to 1973). The response rate was 60%, and the sample included 3981 male and 3099 female respondents. BMI (kilograms per meter squared) was classified into four groups: underweight (<18.5), normal weight (18.5 to 24.9), overweight (25.0 to 29.9), and obese (> or = 30.0). Main outcome measures were Health Status Questionnaire-12 scores (ranging from 0 to 100) assessing eight domains: health perception, physical functioning, role limitations-physical, bodily pain, energy/fatigue, social functioning, role limitations-mental, and mental health. The higher the score, the better the outcome. RESULTS: With adjustment for age, race, education, smoking, and alcohol intake, obesity was associated with lower health perception and poorer physical and social functioning (women only) but not impaired mental health. Overweight was associated with impaired physical well-being among women only. Both underweight men and women reported impairment in physical, social, and mental well-being. For example, multivariable-adjusted health perception domain scores for women were 50.8 (underweight), 62.7 (normal weight), 60.5 (overweight), and 52.1 (obese), respectively. Associations weakened but remained significant with further adjustment for comorbidities. DISCUSSION: Compared with normal-weight people, both underweight and obese older adults reported impaired quality of life, particularly worse physical functioning and physical well-being. These results reinforce the importance of normal body weight in older age.

Aged↗
PubMed1997

Assessment of health-related quality of life after corneal transplantation.

PURPOSE: To determine the extent to which commonly used clinical measures of corneal transplantation outcome are related to aspects of visual function and health-related quality of life. METHODS: In a cross-sectional validation study, ophthalmic examination information was collected by chart review of, and health-related quality of life information was collected by telephone contact with, patients (n = 77) undergoing routine follow-up examinations at least 1 year after corneal transplantation. A questionnaire that included the VF-14 and SF-36 instruments was completed for each participant. Associations between clinical and questionnaire outcomes were evaluated using analysis of variance and regression analyses. RESULTS: When the best-corrected visual acuity of both eyes was evaluated, there was a positive association (P < .0001) of visual acuity with the VF-14 score and with the following SF-36 scales: role limitations because of emotional problems (P = .04), emotional well-being (P = .08), and social functioning (P = .02). Those with a high degree of keratometric astigmatism showed an impact on social functioning (P = .005). Upon regression analysis, the single most important factor associated with the patients' reported visual function was their visual acuity in the better eye, followed by the extent of keratometric astigmatism. CONCLUSIONS: These findings demonstrate a high degree of criterion validity in using the VF-14 instrument to assess the outcome of corneal transplantation. Application of the more generic SF-36 measure shows effects of visual disability on other aspects of corneal transplant patients' health status, including their emotional and social functioning.

Adult↗
PubMed2005

Validity and reliability of the Italian version of the Quality-of-Life in Epilepsy Inventory (QOLIE-31).

PURPOSE: To develop an Italian adaptation of the shortened version of the Quality-of-Life in Epilepsy Inventory (QOLIE-31). METHODS: The study population comprised 503 consecutive ambulatory patients with epilepsy from 44 centers. Internal validity was tested by factor analysis, to detect similarities to and differences from the original version, and by multitrait/multi-item analysis, to assess item convergent and discriminant validity. External validity testing included correlation to the SF-36 Inventory, to check the properties of the epilepsy-specific dimensions. Validity testing was completed by analysis of variance (ANOVA) of QOLIE-31 dimension scores against demographic and clinical variables, including age, sex, seizure frequency and number of drugs. RESULTS: The domains showing the highest internal consistency and the best discriminant validity were Medication effect, and Seizure worry. Social functioning had the lower discriminant validity. With reference to the SF-36 scores, the study patients were slightly but constantly below the population values, mostly for General health and Role physical domains. All QOLIE-31 dimensions were sensitive to almost any demographic and clinical variable, except for Medication effects (sensitive to number of drugs) and Energy-fatigue (sensitive to age). CONCLUSIONS: Except for Social functioning, the psychometric properties of the Italian adaptation of the QOLIE-31 Inventory are fairly good and similar to the American version and the Spanish translation. Social functioning scale suffers shortcomings because of life constraints caused by epilepsy (with missing values for regular job and driving license).

Adolescent↗
PubMed2006

A selfish function of a "social" gland? A postpharyngeal gland functions as a sex pheromone reservoir in males of the solitary wasp Philanthus triangulum.

The postpharyngeal gland (PPG) has long been assumed to be restricted to ants, where it mainly functions in the maintenance of social integrity. Recently, a PPG has been described in both sexes of a solitary digger wasp, the European beewolf, Philanthus triangulum (Hymenoptera, Crabronidae). Female beewolves use the contents of their PPG to embalm their honeybee prey to delay microbial growth. Here we show that in male beewolves, the PPG serves as a reservoir of the pheromone used to scent-mark their territories. Gas chromatography-mass spectrometry (GC-MS) analysis of PPG contents identified 55 substances including long-chain aliphatic hydrocarbons, and 13 substances with functional groups. The composition was consistent with the composition of the marking pheromone of male European beewolves described earlier. Comparisons of the PPG contents, and total-head extracts showed a strong congruency, suggesting that total-head extracts can be used for the analysis of marking secretion in beewolves. Furthermore, we found a dimorphism in the composition of the PPG contents, based on significant differences in the proportions of seven compounds between the two morphs.

Animals↗
PubMed2004

Osteogenesis imperfecta in childhood: impairment and disability. A prospective study with 4-year follow-up.

OBJECTIVES: To study (1). changes in anthropometrics, joint range of motion (ROM), muscle strength, functional ability, caregiver assistance, and level of ambulation in children with osteogenesis imperfecta (OI) and (2). the prediction of clinical characteristics at the level of ambulation at follow-up and the prediction of clinical characteristics on progression or regression at the level of ambulation over time. DESIGN: Prospective study with follow-up of 4 years. SETTING: A children's hospital that serves a nationwide center for treatment and research in children with OI in the Netherlands. PARTICIPANTS: At follow-up, 49 children (24 boys, 25 girls; mean age +/- standard deviation, 11.3+/-3.8y; range, 5.2-19.4y) participated. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Anthropometry, joint ROM, muscle strength, fracture frequency, intramedullary rodding, level of ambulation, functional ability, and caregiver assistance. RESULTS: In type I OI, total joint ROM decreased significantly over time, especially in the lower extremities, with a significant decrease in generalized joint hypermobility according to Bulbena (median start, 7.5; interquartile range [IQR], 4-9; median end, 6; IQR, 2-7; P<.001). In types III and IV, a severe decrease in total joint ROM was present without significant changes over time. No significant changes in total muscle strength (upper or lower extremities) in the different types of OI were measured at follow-up. In OI type I, a significant increase in self-care (P=.003) and social function (P=.008) was measured; in type III, a significant increase in self-care (P=.003), mobility (P=.004), and social function (P=.005) was measured, with a significant decrease in parental assistance in self-care (P=.02) and mobility (P=.005). In type IV, a significant increase was observed in the self-care (P=.01) and social function domains (P=.02). Type of OI (regression coefficient=-1.0; 95% confidence interval [CI], -1.64 to -0.47) and total muscle strength were the only significant predictors for level of ambulation (regression coefficient=.01; 95% CI,.17-.32). Body weight was significantly lower in the group that progressed in level of ambulation (P=.03), whereas children with a decline in level of ambulation had significantly higher body weight (P=.05). CONCLUSIONS: Ours is the first study with a long-term follow-up that provides information concerning the natural course of developmental outcome parameters of OI in childhood. Joint ROM and muscle strength did not change significantly over time, possibly because of the biomechanical skeletal properties of the different OI types. Functional ability improved significantly over time, but, especially in types III and IV, did not reach normative values, possibly because of a plateau phase in functional ability. Knowledge of the natural course of the disease is essential to interpret the results from intervention studies.

Activities of Daily Living↗
PubMed2004

Effects of olanzapine alone and olanzapine/fluoxetine combination on health-related quality of life in patients with bipolar depression: secondary analyses of a double-blind, placebo-controlled, randomized clinical trial.

BACKGROUND: Improving patients' health-related quality of life (HRQOL) could be a treatment goal for bipolar depression. OBJECTIVES: The objectives of these secondary analyses of a previous report were to determine the benefits of olanzapine alone and olanzapine-fluoxetine combination (OFC) for improving HRQOL in patients with bipolar depression using both a generic and a depression-specific HRQOL instrument, and to examine the association between the 2 HRQOL instruments and the construct validity of the depression-specific HRQOL instrument. METHODS: This was a double-blind, placebo-controlled, 83-site, international, randomized trial. Adults with bipolar I disorder, most recent episode depressed (according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), were randomly assigned to receive olanzapine (6-20 mg/d), OFC (6/25, 12/25, or 12/50 mg/d), or placebo for 8 weeks. HRQOL improvement was calculated as last-observation-carried-forward changes in dimension and component summary scores on Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and total score on the Quality of Life in Depression Scale (QLDS). RESULTS: Patients were assigned to receive olanzapine (n = 370), [corrected] OFC (n = 86), or placebo (n = 377) [corrected] for 8 weeks. Of 833 enrolled patients, 454 discontinued (olanzapine, 191/370 [51.6%] [corrected]OFC, 31/86 [36.0%]; and placebo, 232/377 [61.6%]) [corrected] Compared with placebo, olanzapine-treated patients exhibited greater improvements on SF-36 mental component summary (MCS) score ( P=0.002) and 3 of 8 SF-36 dimension scores (mental health [P=0.015], role-emotional [P=0.046], and social functioning [P=0.006). OFC-treated patients exhibited greater improvements on MCS score ( P<0.001) vs both placebo and olanzapine), 5 SF-36 dimension scores (general health perception (P<0.001) vs placebo; (P<0.001) vs olanzapinel, mental health [ P=0.001] vs both placebo and olanzapine], role-emotional [ P<0.001] vs placebo; [P=0.007] vs olanzapine], social functioning [ P=0.001] vs placebo; [P=0.032] vs olanzapine], and vitality [P=0.002] vs placebo; [P=0.011] vs olanzapine]), and QLDS total score ( P<0.001] vs both placebo and olanzapine). Changes in SF-36 scores of mental health, social functioning, role-emotional, and vitality were highly correlated to changes in the QLDS total score (all p < -0.5). CONCLUSIONS: Based on these analyses, patients with bipolar depression receiving olanzapine or OFC for 8 weeks had greater improvement in HRQOL than those receiving placebo. OFC treatment was associated with greater improvement in HRQOL than olanzapine alone. The correlation results support the construct validity of the QLDS.

Adult↗
PubMed2006

Perceived quality of life in obsessive-compulsive disorder: related factors.

BACKGROUND: Obsessive-compulsive disorder (OCD) affects young adults and has great impact on the social, emotional and work spheres. METHODS: We measured perceived quality of life (QOL) in OCD patients, in order to analyse socio-demographic and clinical factors that may be associated with QOL perception. 64 OCD outpatients were assessed with the Mini International Neuropsychiatric Interview for DSM-IV, the Yale-Brown Obsessions and Compulsions scale (Y-BOCS), Hamilton's depression scale and the SF-36 self-administered global QOL perception scale. RESULTS: We found a correlation among Hamilton's scale scores and all SF-36 subscales. The severity of the obsessive-compulsive disorder was correlated with all SF-36 subscales and with the highest scores in Hamilton's scale. The obsessions subscale was correlated to all SF-36 subscales, while the compulsions subscale was correlated only to social functioning, emotional role, mental health and vitality. Compulsions were not related to general health perception. There were significant differences between OCD patients and the Spanish general population in all SF-36 subscales except those related to physical health and pain. Gender, age, age of onset of the disorder, years of evolution and marital status of the patients did not significantly affect quality of life perception. Being employed was related to better scores in the subscale of physical role. Patients with medical comorbidity scored lower in the subscales of general health, social functioning and mental health. Patients with comorbid psychiatric disorders had worse scores in the subscales of pain, general health, social functioning and mental health. CONCLUSION: Quality of life perception was different in OCD patients and the general population. Quality of life perception was related to severity of the disorder, physical and psychiatric comorbidity and employment status.

Adult↗
PubMed2003

A waitlist control-group study of cognitive, mood, and quality of life outcome after posteroventral pallidotomy in Parkinson disease.

OBJECT: The aim of this study was to examine neuropsychological outcome from unilateral posteroventral pallidotomy (PVP) in Parkinson disease while controlling for confounding factors such as test practice and disease progression. METHODS: Participants underwent baseline and 2-month follow-up assessments of cognition, quality of life, mood, and motor functioning. The surgery group (22 patients) underwent PVP (15 left, seven right) after baseline assessment. The waitlist group (14 patients) underwent PVP after follow up. At follow up, the left PVP group exhibited a decline on verbal measures of learning, fluency, working memory, and speeded color naming. The incidence of significant decline on these measures after left PVP ranged from 50 to 86%. The right PVP group did not exhibit a significant cognitive decline, but fluency did decline in 71% of patients who underwent right PVP. Participants who underwent PVP reported better bodily pain and social functioning at follow up than participants in the waitlist group. Improved bodily pain was evident for 62% of the surgery group, and social functioning improved for 19%. Surgery did not alter reported physical functioning or mood. Dyskinesia improved after surgery, but there were no improvements in "on-state" manual dexterity or handwriting. CONCLUSIONS: Most patients who underwent left PVP exhibited declines in learning, fluency, working memory, and speeded color naming. Accounting for retesting effects altered the magnitude of these declines by up to one quarter of a standard deviation, but did not increase the breadth of postsurgical neuropsychological decline beyond that typically reported in the literature. It was found that PVP improved dyskinesia, bodily pain, and social functioning, but did not lead to improvement on other objective and self-reported measures of motor functioning.

Aged↗
PubMed2004

Personality disorder, depression and functioning: results from the ODIN study.

BACKGROUND: There is little information of the prevalence of personality disorder (PD) in those with depressive disorder in community samples; neither is there any data on the impact of PD on service utilisation or outcome in this setting. METHODS: A two stage screening study to identify cases of depressive disorder using SCAN in five European countries. Personality assessed 6 months after the diagnostic interview. Follow-up for 1 year using symptom and social function measures. RESULTS: Personality disorder is present in 22% of a community sample with depressive disorders but the range varied from 13.7% to 33.3% across countries. Cluster C formed 43% of the total. Long-term psychotropic drug use was more common in the PD group even after depression was controlled. Those with PD had higher symptom scores at the outset and, although the PD group was more likely to be cases at follow-up, this disappeared when the depression score was co-varied. Only initial social function predicted outcome at 6 and 12 months. LIMITATIONS: The use of a non-treatment seeking population may limit the application of the findings to clinical populations. CONCLUSIONS: PD is common even in a non-treatment seeking population with depressive disorder. It impacts upon outcome at 6 and 12 months but this is related to the initial severity of depressed mood. Social function is the only independent predictor of outcome and should be assessed separately.

Activities of Daily Living↗
PubMed1998

Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36.

The purpose of this report is to examine health-related quality of life (HRQoL) as measured by the Medical Outcomes Study Short Form-36, across patient populations with chronic disorders and to compare quality of life (QoL) in these subjects with normative data on healthy persons. Six studies, within the Center for Research in Chronic Disorders at the University of Pittsburgh School of Nursing, in patients with urinary incontinence, prostate cancer, chronic obstructive pulmonary disease (COPD), acquired immune deficiency syndrome (AIDS), fibromyalgia and hyperlipidaemia provided the data for analysis. The results demonstrated that not only did the prostate cancer and hyperlipidaemia patients have the highest QoL across the chronic disorders, but their QoL was comparable to normative data on healthy persons. Homebound, elderly, incontinent patients had the lowest QoL for physical functioning, whereas patients hospitalized with AIDS had the lowest QoL in general health and social functioning. Patients with COPD had the lowest QoL in role-physical, role-emotional and mental health. Patients with fibromyalgia had the lowest QoL in bodily pain and vitality. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia generally had lower QoL. Prostate cancer and hyperlipidaemia patients had QoL comparable to normative data. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia had more variability for role-emotional. AIDS patients had more variability on physical functioning, bodily pain and social functioning compared to the normative data. These data suggest that patients with various chronic disorders may have QoL that is lower in most domains compared to a healthy population. However, there may be differences in the domains affected as well as the extent of variation across specific chronic disorders.

Aged↗
PubMed2002

The evaluation of the surgical management of nerve root compression in patients with low back pain: Part 1: the assessment of outcome.

STUDY DESIGN: This was a prospective study investigating the outcome of decompression surgery using validated measures of outcome. OBJECTIVES: To investigate the outcome of lumbar decompressive surgery in the initial postoperative year period in terms of function, disability, general health, and psychological well-being. SUMMARY OF BACKGROUND DATA: The majority of studies investigating the outcome of lumbar decompression surgery have been retrospective and have not used validated measures of outcome. This limits their interpretation and usefulness. METHODS: Eighty-four patients undergoing lumbar spinal stenosis surgery were recruited into this study. Patients were assessed by use of validated measures of outcome including the Oswestry Disability Index and the Short Form SF-36 General Health Questionnaire before surgery and 6 weeks, 6 months, and 1 year after surgery. RESULTS: A significant reduction in pain (P < 0.001) was observed at the 6-week postoperative stage; this did not change at the subsequent assessment stages. Only some of the SF-36 categories were sensitive to change. The subcategories that were sensitive to change were physical function (P < 0.05), bodily pain (P < 0.001), and social function (P < 0.05). Improvements were observed in these categories at the 6-week and 6-month reviews. A gradual reduction in the Oswestry Disability Index was observed with time, with changes principally being observed between the 6-week and 6-month review and the 6-week and 1-year review stages (P < 0.05). Minimal changes were observed in the psychological assessments with time. The outcome of surgery could not be predicted reliably from psychological, functional, or pain measures. CONCLUSIONS: The visual analogue pain scales, the Oswestry Disability Index, and certain categories of the SF-36 Questionnaire, namely bodily pain and physical and social function, appeared to be the most sensitive outcome measures, with significant improvements occurring at the 6-week and 6-month reviews.

Decompression, Surgical↗
PubMedDate not supplied

[Schizophrenic disorders--does cognitive dysfunction relate to characteristics of course and psychopathology of the illness?].

AIM: Because of their importance both for pathogenesis or clinical aspects of the disease and for patients' social functioning, cognitive dysfunctions are nowadays often considered as basic characteristics of schizophrenic disorders. This study was aimed at evaluation of the correlation between some indices of disordered cognitive functioning on the one hand and some variables describing course and psychopathology of schizophrenic disorders on the other. METHOD: The study group consisted of 69 inpatients suffering from schizophrenia diagnosed according to both DSM-IV and ICD-10 criteria. Their mental state was rated by two clinical tools (scales: PANSS, KOSS). Also social functioning of patients in the year preceding current hospitalisation was rated by two scales (GAF, scale W). Cognitive dysfunctions were assessed by computer-aided tests from Dr. Schufried's Vienna Test System including measures of reaction time (RT), visual line pursuit (LVT), perseveration (PERSEV), and span of visual-spatial short term memory (CORSI). In statistical analysis simple nonparametric tests and rank correlation measures were applied. RESULTS: Correlations were confirmed between cognitive dysfunctions and social functioning prior to hospitalisation, age, duration of illness and number of previous hospitalizations. Dysfunctions were less severe in first episode patients than in patients during relapses or the residuum stage of illness. Overall assessments of severity of illness do not correlate with cognitive dysfunctions, but detailed analysis of psychopathology revealed correlations of the latter with such psychopathological dimensions as deficit, disorganization and dysphoria. Reality distortion (positive) psychopathological dimension did not have any correlation with cognitive measures. All indices of cognitive dysfunction correlated with poorer outcome of treatment of the current episode. All correlations confirmed were only of weak or moderate level. CONCLUSIONS: Cognitive dysfunctions correlate rather with unfavourable characteristics of the course of the illness. Results of psychopathological assessment hardly correlate with neuropsychological measures--cognitive dysfunctions are related rather to deficit (negative), disorganisation or dysphoria dimensions of a schizophrenic syndrome than to productive (reality distortion, positive) dimension of the syndrome.

Adult↗
PubMed2006

Non-reciprocal altruism may be attributable to hyperbolicity in social discounting function.

Humans show altruism even for chance acquaintances whom they will never meet again (non-reciprocal altruism). With respect to evolutionary and economic perspectives, reciprocal altruism is not actually puzzling, because reciprocal altruism maximizes subjects' benefit/fitness in the long run; while non-reciprocal (pure) altruism still presents a challenge to evolutionary biology and neuroeconomics. Understanding neuropsychological bases of non-reciprocal altruism/generosity for unrelated people is also important for neuropsychiatry, because several types of impulsive psychiatrics (e.g., social phobia, substance abusers, psychopaths) often have reduced altruism/generosity for other people, which is associated with their problematic/impulsive social behavior. Regarding the relationship between impulsivity and reciprocal altruism, it has been shown that subjects who are impulsive in intertemporal choice (having a large time-discounting rate) have low degrees of reciprocal altruism, which is in line with economic theories and neuropharmacologically treatable with serotonin/norepinephrine reuptake inhibitors. However, little is known regarding the relationship between non-reciprocal altruism and discounting behavior, and neuropsychological processing underlying the relationship. Recently, Jones and Rachlin reported that generosity for other individuals with different social distances follows a hyperbolic discounting function, which has been employed to describe inconsistent time-discounting. In this study, I propose that non-reciprocal (pure) altruism may be, at least partially, attributable to hyperbolicity of a social discounting function (inconsistency in "interpersonal choice"). Neuropsychological mechanisms underlying interpersonally-inconsistent social discounting and possible implications for neuropsychopharmacological treatments for impulsive psychiatrics' problematic social behavior are discussed.

Altruism↗
PubMed1998

Rehabilitation as an essential social work function: a study of LORAC exemplary practice winners. Life Options Rehabilitation Advisory Council.

Part I in last month's issue of NN&I provided results of a Council of Nephrology Social Workers (CNSW) survey of social workers in facilities that won the Life Options Rehabilitation Advisory Council (LORAC) Exemplary Practice in Renal Rehabilitation competition. The survey indicated that social workers are already implementing rehabilitation activities as part of core functions of their job, social work experience is less important in implementing rehabilitation than inspiration, and that rehabilitation teams can help promote buy-in and distribute the responsibilities among the members of the rehabilitation team. Part II provides information on the linkage between rehabilitation activities and outcomes and offers rehabilitation activities suggested by Exemplary Practice-winning facilities.

Awards and Prizes↗
PubMed2005

Health-related quality of life in two hundred-eighty lung transplant recipients.

BACKGROUND: Health-related quality of life (HRQoL) has increasingly been accepted as a supplementary outcome measure for patients after lung transplantation (LTx). METHODS: Using a retrospective cross-sectional study design, 280 LTx recipients (3 months to 14 years after LTx) were asked to assess their HRQoL using a generic (Quality of Life Profile for Chronic Diseases) questionnaire, which was previously validated for this specific population. In addition, the questionnaire was also performed by 155 healthy participants. RESULTS: All sub-scale findings ranged from 2.40 to 3.08 (0 to 4) for all patients after LTx. A significantly reduced HRQoL was reported by the sub-cohort of patients living 5 to 6 years with the allograft for all sub-scales (p < 0.006), except for Social Functioning, and was associated with the incidence of bronchiolitis obliterans syndrome (BOS; p < 0.05). Cystic fibrosis patients (p < 0.05), single-lung transplant recipients (p < 0.05) and patients of older age (p < 0.05) showed significantly decreased physical ability ratings. Patients who remained free of infection and late acute rejection episodes scored themselves significantly higher with regard to their Relaxation Capabilities (p < 0.05 for rejection; p < 0.05 for infection) and Social Functioning (p < 0.01 for rejection; p < 0.05 for infection) vs patients who experienced infection or rejection episodes. Comparisons with a normative cohort showed similar HRQoL scales for LTx patients and the healthy population, except with regard to Social Functioning (p < 0.01). CONCLUSIONS: Self-ratings for HRQoL were high for all dimensions for the entire sample, and remained relatively similar even for medium- and long-term survivors. HRQoL was dependent on incidence of infections, rejections and the onset of BOS. Despite differences in life expectancy of LTx patients compared with the healthy population, HRQoL self-ratings were within similar ranges.

Adolescent↗
PubMed2006

Prevalence, sociodemography, and quality of life of older versus younger patients with irritable bowel syndrome: a population-based study.

We studied the prevalence as well as the sociodemographic characteristics and QOL of older adults (> 50 years) with irritable bowel syndrome (IBS) among the population at large and compared it to their younger counterparts'. We hypothesized that IBS is less prevalent among older persons and they suffer poorer QOL compared to younger IBS patients. A total of 1000 adults from nine sites, including a medical center, churches, and a blood bank in our metropolitan area (670 African Americans, 320 Caucasians, and 10 others), completed self-administered questionnaires providing sociodemographic information and details regarding bowel habits and associated symptoms for diagnosing the IBS based on Rome II criteria. QOL was assessed by the SF-12 questionnaire. The study database was divided into two groups, younger (< 50 years) and older (> or = 50 years). The two age groups were similar with respect to gender and household income. Ninety-five of the 1000 participants had IBS, giving a total sample prevalence of 9.5% (< 50 years, 9.9%, vs > or = 50 years, 7.6%). The prevalence of IBS was similar in the two groups irrespective of race, sex, marital status, size of household, location of residence (rural versus urban), level of educational status, and household income. Compared to the older group, there was a trend toward a higher prevalence of IBS among divorced subjects (12.7% vs 0%; P = 0.1) and those below poverty level of income (15.3% vs 7.5%; P = 0.09) in the younger subjects. In contrast, older IBS patients were more likely to attend church regularly (32.5% vs 58.8%; P < 0.05). There were no differences in history of traveler's diarrhea, food intolerance, and drug allergies between the two groups. Health care utilization was similar between the two IBS groups in terms of number of physician visits, use of prescription and alternative medications, and being disabled due to IBS. There was no difference in the overall QOL score means (27.8 vs 29.5; P = NS) or in its general health and physical functioning components. However, older IBS patients had better social functioning (9.1 vs 9.8; P < 0.05). Although in our study IBS occurred less frequently among older adults than among younger patients, the difference is not statistically significant. While IBS affects QOL at all ages, social functioning was actually better on average among older compared to younger IBS patients.

Adolescent↗
PubMed1981

Change in functional disability of geriatric patients in a family medicine program: implications for patient care.

Multi-dimensional functional impairments of a sample of 130 new patients, aged 60 years and older, at a family medicine center were previously described. Of these, 48 persons representing the combinations of impairment originally present were selected by means of modified random sampling for follow-up 13 to 27 months later (m = 20 months). Patients were assessed both at the time of the initial visit and on follow-up with the Older Americans Resources Services (OARS) Multi-dimensional Functional Assessment Questionnaire, an instrument permitting assessment of functional status in five areas of personal functioning: social, economic, mental health, physical health, and the ability to perform activities of daily living (ADL). Fourteen of the 130 initial subjects died during the follow-up interval. Impairments in mental health, physical health, and ADL were associated with increased risk of mortality; but impairments in social and economic functioning did not increase risk. For the survivors there was decline in economic and mental functioning and little, if any, change in social resources or the ability to perform activities of daily living. However, there was notable improvement in their physical functioning.

Activities of Daily Living↗