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PubMed2003

Continuing inequality: gender and social class influences on self perceived health after a heart attack.

STUDY OBJECTIVE: To investigate the effect of social class and gender on self perceived health status for those recovering from an acute myocardial infarction. DESIGN: A longitudinal survey design was used, collecting both qualitative and quantitative data. Quantitative data are reported in this article, obtained by questionnaire over the first year after the event. SF-36 and EQ-5D (EuroQol) were used to measure self perceived health status. SETTING: Community based study in a city in the north of England. PARTICIPANTS: A consecutive sample of 229 people discharged from hospital after acute myocardial infarction. MAIN RESULTS: Overall gain in health status was found to be statistically significant over the year. Improvements were greatest in domains relating to role fulfillment and pursuit of normal and social activities. When analysed by gender, women showed poorer improvement than men, particularly in the domains relating to physical and social functioning. Analysed by social class, those without educational qualifications showed poorer improvement in pain experience and vitality. Access to a car was significant in avoiding physical limitations and promoting general health. CONCLUSIONS: Existing gradients between the health of women and men, and between the social classes, are maintained and probably exacerbated by the experience of acute illness, and health professionals need to be made aware of social groups who are at risk of poor rehabilitation.

Adult↗
PubMed1999

Clinical and radiological determinants of prestroke cognitive decline in a stroke cohort.

OBJECTIVES: Stroke seems to be related to dementia more often than previously assumed and vascular factors are also related to Alzheimer's disease. The pathophysiology of poststroke dementia includes ischaemic changes in the brain, a combination of degenerative and vascular changes, and changes only related to Alzheimer's disease. Some cognitive decline recognised after a stroke may be due to pre-existing cognitive decline. The aim of this study was to determine the clinical and radiological determinants of prestroke cognitive decline. METHODS: The study group comprised 337 of 486 consecutive patients aged 55 to 85 years who 3 months after ischaemic stroke completed a comprehensive neuropsychological test battery; structured medical, neurological, and mental status examination; interview of a knowledgeable informant containing structured questions on abnormality in the cognitive functions; assessment of social functions before the index stroke; and MRI. RESULTS: Frequency of prestroke cognitive decline including that of dementia was 9.2% (31/337). The patients with prestroke cognitive decline were older, more often had less than 6 years of education, and had history of previous stroke. Vascular risk factors did not differ significantly between these two groups. White matter changes (p=0.004), cortical entorhinal, hippocampal, and medial temporal atrophy (p<0.001), cortical frontal atrophy (p=0.008); and any central atrophy (p<0.01), but not the frequencies or volumes of old, silent, or all infarcts on MRI differentiated those with and without prestroke cognitive decline. The correlates of prestroke cognitive decline in logistic regression analysis were medial temporal cortical atrophy (odds ratio (OR) 7.5, 95% confidence interval (95%CI) 3.2-18.2), history of previous ischaemic stroke (OR 4.4, 95% CI 1.8-10.6), and education (OR 0.9, 95% CI 0.8-0.9). CONCLUSIONS: History of previous stroke, but not volumes or frequencies was found to correlate with prestroke cognitive decline. Other associating factors were rather those usually associated with degenerative dementia: white matter changes and cerebral atrophy; and in multiple models medial temporal cortical atrophy and education. The possible overlap between two or more underlying diseases must be remembered in diagnosis and treatment of patients with vascular cognitive impairment.

Aged↗
PubMed1998

Development of a disease-specific health-related quality of life questionnaire for sleep apnea.

The Calgary Sleep Apnea Quality of Life Index (SAQLI) was developed to record key elements of the disease that are important to patients. All items felt to influence the quality of life of these patients were identified. Final questionnaire items were selected by interviewing 113 patients with sleep apnea and 50 snorers who rated each item on whether it was a problem and the importance of it to their overall quality of life. Items for the final questionnaire were selected based on the rank order of the frequency ximportance product. The rank ordering was similar across strata of disease severity and between sexes. The Calgary SAQLI has 35 questions organized into four domains: daily functioning, social interactions, emotional functioning, and symptoms. A fifth domain, treatment-related symptoms, can be added for clinical intervention trials to record the possible negative impacts of treatment. The SAQLI has a high degree of internal consistency, face validity as judged by content experts and patients, and construct validity as shown by its positive correlations with the SF-36 and the improvement in scores in patients successfully completing a 4-wk trial of continuous positive airway pressure. It includes items shown to be important to patients with sleep apnea and is designed as a measure of outcome in clinical trials in sleep apnea. Flemons WW, Reimer MA. Development of a disease-specific health-related quality of life questionnaire for sleep apnea.

Adult↗
PubMedDate not supplied

Suicidal ideation among patients with acute life-threatening physical illness: patients with stroke, traumatic brain injury, myocardial infarction, and spinal cord injury.

Suicide is one of the leading causes of death in the community. The risk of suicide is greater among patients with physical illnesses than among the general population. This study was undertaken to evaluate the clinical characteristics and correlates of suicidal ideation in patients with acute life-threatening physical illnesses and to assess the duration of suicidal ideation. The study included a consecutive series of patients admitted with stroke, traumatic brain injury, myocardial infarction, or spinal cord injury (n=496). Study participants were administered a semistructured psychiatric interview as well as a series of standardized quantitative scales of mood, cognitive function, physical impairment, social ties, and social functioning. Follow-up evaluations of up to 24 months were also carried out. This study found that 36 (7.3%) patients with acute medical illness had clinically significant suicidal ideation. The suicidal ideation occurred mostly among patients with major depression and sometimes in those with minor depression. About 25% of patients with major depression and acute physical illnesses developed suicidal ideation. After the improvement of depressive disorders, suicidal ideations were ameliorated. These findings suggest that the detection and treatment of depressive disorders is the most important factor in preventing suicide among this patient population.

Acute Disease↗
PubMedDate not supplied

Change in psychosocial functioning and quality of life of patients with body dysmorphic disorder treated with fluoxetine: a placebo-controlled study.

In a 12-week placebo-controlled study of fluoxetine in the treatment of body dysmorphic disorder, the authors investigated change in psychosocial functioning and mental health-related quality of life in 60 subjects. The subjects were assessed with the LIFE-RIFT (a measure of impaired functioning), Social and Occupational Functioning Scale (SOFAS), and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) before and after receiving fluoxetine or placebo. At baseline, the patients had impaired psychosocial functioning and markedly poor mental health-related quality of life. Compared to placebo, fluoxetine was associated with significantly greater improvement in LIFE-RIFT and SOFAS scores and with improvement on the mental health subscale of the SF-36 that approached significance. Decrease in the severity of body dysmorphic disorder, as measured by the Yale-Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder, was significantly correlated with improvement in functioning and quality of life.

Adult↗
PubMed1999

Social network, social support, and loneliness in older persons with different chronic diseases.

OBJECTIVES: This study examines whether patterns of social network size, functional social support, and loneliness are different for older persons with different types of chronic diseases. METHODS: In a community-based sample of 2,788 men and women age 55 to 85 years participating in the Longitudinal Aging Study Amsterdam, chronic diseases status, social network size, support exchanges, and loneliness were assessed. RESULTS: Social network size and emotional support exchanges were not associated with disease status. The only differences between healthy and chronically ill people were found for receipt of instrumental support and loneliness. Disease characteristics played a differential role: greater feelings of loneliness were mainly found for persons with lung disease or arthritis, and receiving more instrumental support was mainly found for persons with arthritis or stroke. DISCUSSION: The specifics of a disease appear to play a (small) role in the receipt of instrumental support and feelings of loneliness of chronically ill older persons.

Aged↗
PubMed2004

A randomized trial to evaluate an education programme for patients and carers after stroke.

OBJECTIVES: To evaluate the effectiveness of an education programme for patients and carers recovering from stroke. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: One hundred and seventy patients admitted to a stroke rehabilitation unit and 97 carers of these patients. INTERVENTIONS: The intervention group received a specifically designed stroke information manual and were invited to attend education meetings every two weeks with members of their multidisciplinary team. The control group received usual practice. MEASURES: Primary outcome was knowledge of stroke and stroke services. Secondary outcomes were handicap (London Handicap Scale), physical function (Barthel Index), social function (Frenchay Activities Index), mood (Hospital Anxiety and Depression Scale) and satisfaction (Pound Scale). Carer mood was measured by the General Health Questionnaire-28. RESULTS: There was no statistical evidence for a treatment effect on knowledge but there were trends that favoured the intervention. The education programme was associated with a significantly greater reduction in patient anxiety score at both three months (p =0.034) and six months (p =0.021) and consequently fewer 'cases' (Hospital Anxiety and Depression Scale anxiety subscale score > or =11). There were no other significant statistical differences between the patient or carer groups for other outcomes, although there were trends in favour of the education programme. CONCLUSION: An education programme delivered within a stroke unit did not result in improved knowledge about stroke and stroke services but there was a significant reduction in patient anxiety at six months post stroke onset.

Adult↗
PubMed2004

Neurocognitive impairment influences quality of life in HIV-infected patients receiving HAART.

The objective of the study was to determine the association of neurocognitive impairment with health-related quality of life (HRQoL) in patients receiving highly active antiretroviral therapy (HAART). Seventy subjects were cross-sectionally analysed with a standardized neuropsychological test battery and a questionnaire including an Italian translation of the MOS-HIV Health Survey. The presence of neurocognitive impairment was significantly associated with lower HRQoL scores: pain (P = 0.03), physical functioning (P = 0.01), role functioning (P = 0.01), social functioning (P = 0.029), mental health (P = 0.001), energy (P = 0.036), health distress (P = 0.002), cognitive functioning (P = 0.05), current health perception (P <0.001), physical health summary score (PHS) (P = 0.005), mental health summary score (MHS) (P = 0.002). Years of education (odds ratio [OR] 0.79; 95% confidence interval [CI] 0.65-0.96), PHS (OR 0.71; 95% CI 0.54-0.95) and MHS (OR 0.67; 95% CI 0.51-0.88) were also associated with cognitive impairment. Neurocognitive impairment in patients receiving HAART was associated with reduced HRQoL. Identifying cognitive impairment may provide motivation for additional treatment to help patients to compensate for deficits in functioning.

Adult↗
PubMed1996

Clinical and economic factors in the treatment of onychomycosis.

Onychomycosis is a fungal infection of fingernails and toenails, most cases of which are caused by dermatophytes. The disease accounts for 15% of all nail disease, and affects approximately 2 to 3% of people of all ages and both sexes. Topical treatment with tioconazole, amorolfine or ciclopirox has limited effectiveness. Oral griseofulvin 500 to 1000mg daily has been the mainstay of treatment, but prolonged therapy is required and success rates are low. Therapy with itraconazole 200mg daily for 3 to 6 months is more effective (70 to 85% success), although so-called 'pulse' therapy has shown similar success with potentially fewer adverse effects. Terbinafine 250mg daily produces clinical and mycological cure in approximately 80% of patients treated for 6 and 12 weeks for fingernail and toenail infections, respectively. The overall costs of treating onychomycosis are substantial, and it has been estimated that direct costs for Medicare patients with the disease were $US43 million in 1 year. In addition, the disease has a negative impact on quality of life, in the domains of mental functioning, health concern, social functioning, and physical appearance. Few pharmacoeconomic analyses have been published, but all have indicated an advantage of oral terbinafine over griseofulvin and other oral agents. To date, no economic studies have been performed on topical agents, pulse therapy or combination treatments.

Animals↗
PubMed1992

Sociocultural aspects of eating disorders.

Eating disorders, though recognized for centuries, are increasing in prevalence. The increase in rate is particularly remarkable over the last 30-40 years. The article considers how social function stems from biological function and evolution, and how biological function may hamper social development to the detriment of individuals. Social and cultural influences relevant to this change are examined, especially the changing position of women within society as a whole and the multiplication of conflicting roles which women find themselves balancing. Reference is made to the representation of women in the arts and media. Reference is also made to the role of those external agencies which have historically controlled populations (both men and women), such as religious bodies and governments, but which to some extent have been rejected. Evidence from in-depth studies of women with eating disorders and from transcultural studies are included to support the authors' ideas.

Adult↗
PubMed2000

[The preventive effects of physical activity in the elderly].

PHYSICAL ACTIVITY AND AGING: Physical activity prevents some age-related impairment. Physical activity reduces the decline of physical capacity which remains limited by maximal heart rate, and reduces the incidence of cardiovascular diseases by decreasing and preventing associated risk factors. Physical activity reduces age-related bone loss, its effect being potentialized by hormonal replacement therapy, and improves balance function, leading to a lower incidence of falls and fractures in older subjects. Physical activity helps to preserve nutritional balance and lean mass/fat mass ratio and reduces age-related insulin resistance. Moreover, physical activity has a beneficial influence on psychological function by improving cognitive performances and decreasing incidence of depression. Lastly, physical activity seems to reduce the incidence of several cancers, colic and mammary cancers particularly. PHYSICAL ACTIVITY, QUANTITY AND QUALITY OF LIFE: These multiple actions explain that physical activity, if it's adapted to subject's specificities increases longevity, delay entry in dependence and improves quality of life in older subjects. WHAT ARE THE RECOMMENDED ACTIVITIES: There is a superiority of individualized programs giving greater place to warm-up and associated endurance and resistive exercises intended to improve simultaneously cardiovascular and muscular functions. SPECIAL INTERESTS OF PHYSICAL ACTIVITY IN FRAIL AND VERY OLD SUBJECTS: Throughout its beneficial effects on aerobic capacity, muscular function, social integration, cognitive function and autonomy, physical activity may have a particular interest in frail subjects, when programs are adapted to physical capacities of these subjects and associated with nutritional supplements.

Accidental Falls↗
PubMed2001

The relationship between health related quality of life and disease activity and damage in systemic lupus erythematosus.

OBJECTIVE: To evaluate the relationship between self-reported quality of life and disease activity, damage, impairment, disability, and handicap in systemic lupus erythematosus (SLE). METHODS: In this cross sectional study disease activity was measured with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the Systemic Lupus Activity Measure (SLAM), and damage by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI). Quality of life was assessed by the Medical Outcome Survey Short Form 36 (SF-36) and the EuroQol (EQ-5D). Multiple linear regression was used to identify significant associations of patients' health status, and logistic regression was used to evaluate the relationship of each of the 5 dimensions of the EQ-5D in terms of impairment, disability, and handicap. RESULTS: Damage was associated with the Physical Function (PF) and Social Function subscales of the SF-36. Disease activity was associated with the General Health (GH) subscale. Ability to carry out usual activities was strongly related to PF and GH as well as to global rating of the thermometer rating scale of the EQ-5D. Role Physical (RP) and Bodily Pain (BP) of the SF-36 were also associated with the EQ-5D rating scale. In addition, patients' ratings of anxiety and depression were strongly related to the Mental Health (MH) summary scale of the SF-36. CONCLUSION: Perceived health status of patients with lupus was associated with disease activity, damage, role physical, bodily pain, capacity for usual activity, and mobility. EQ-5D is a valid instrument for the measure of health related quality of life in SLE.

Adult↗
PubMed2002

Health related quality of life assessment after radical cystectomy: comparison of ileal conduit with continent orthotopic neobladder.

PURPOSE: Health related quality of life after urinary diversion has been increasingly recognized as an important outcome measure. However, few studies have directly compared patients with an ileal conduit with those with a continent orthotopic neobladder and even fewer have used validated quality of life instruments. Therefore, we compared health related quality of life in patients who underwent neobladder versus ileal conduit creation using validated questionnaires. MATERIALS AND METHODS: We mailed 2 validated questionnaires that are measures of health related quality of life, namely the RAND 36-Item Health Survey (SF-36) and Functional Assessment of Cancer Therapy-General (FACT-G), to patients who underwent radical cystectomy for urothelial carcinoma between January 1995 and December 1999. Statistical analysis was performed, including univariate and multivariate analysis. RESULTS: A total of 112 patients were available for assessment. A total of 72 (64%) questionnaires were returned, including 23 (32%) and 49 (68%) from patients with an ileal conduit and neobladder, respectively. On the SF-36 questionnaire there were significant univariable relationships between treatment and age (p <0.001 and 0.01, respectively). Younger patients and those with a neobladder had higher health related quality of life scores, including significant differences in 5 of the 9 SF-36 domains (general health, physical functioning, physical health, social functioning and energy/fatigue). There was no relationship between health related quality of life and the final pathological stage (p = 0.25). On multivariate analysis adjusting for age led to a suggestive but nonsignificant difference in health related quality of life scores favoring neobladders (p = 0.09). On the FACT-G there were no significant differences in health related quality of life due to treatment (p = 0.28), pathological stage (p = 0.5), age (p = 0.72) or current disease status (p = 0.27). On the FACT-G 2 of the 4 domains (emotional and functional well-being) were significantly in favor of neobladders. Overall satisfaction was high in the 2 groups with 96% and 85% of patients with a neobladder and ileal conduit, respectively, reporting that they would make the same choice of diversion. CONCLUSIONS: Based on validated health related quality of life instruments these findings suggest that patients with an orthotopic neobladder have marginal quality of life advantages over those with an ileal conduit. However, differences in health related quality of life in the 2 types of urinary diversion are confounded by age since patients who underwent orthotopic diversion were younger and as a result of age would be expected to have a higher health related quality of life score. A prospective longitudinal study of health related quality of life after adjusting for differences in age among patients undergoing urinary diversion is currently underway to extend further these observations.

Aged↗
PubMed2003

[The relationship between quality of life and functional status measurements in shoulder impingement syndrome].

OBJECTIVES: We compared three questionnaires that are used in the assessment of function and quality of life of patients with shoulder impingement syndrome. METHODS: The study included 54 patients (42 females, 12 males; mean age 54 years) with a diagnosis of stage I or II shoulder impingement syndrome. All the patients were administered a standard questionnaire regarding their general health status (Short-Form 36 / SF-36). Functional evaluations were made using the UCLA (University of California at Los Angeles) and Constant scoring systems. The results of the UCLA and Constant scores were compared with those of SF-36 with the use of Pearson correlation analysis. RESULTS: A strong correlation was found between the UCLA and Constant scores (p=0.006). SF-36 parameters of physical function, vitality, and social function showed a strong correlation with the UCLA scores (p<0.005), whereas parameters of general health and role emotional exhibited a moderate correlation (p<0.05). When compared with the Constant scores, SF-36 showed a strong correlation only in parameters of pain and general health (p<0.005). The parameter of role emotional was negatively correlated with the Constant scores. CONCLUSION: Demonstration of correlations between some parameters of SF-36 and the UCLA and Constant scoring systems suggests that SF-36 can be used to assess quality of life of patients with shoulder impingement syndrome.

Female↗
PubMedDate not supplied

Assessing health-related quality of life: application to drug therapy.

There is growing awareness among the principal stakeholders in health care that health outcomes data should be used in the evaluation of medical care interventions. Health-related quality of life is a patient-reported health outcome that is gaining increasing attention. In fact, in certain diseases, quality of life may be the most important health outcome to consider in assessing treatment efficacy. Quality of life is a construct commonly viewed as having several dimensions or domains. Although the terminology may differ depending on the author, the basic dimensions of health-related quality of life are physical status and functioning, emotional/psychological status, social functioning, and disease- or treatment-related symptomatology. There are a number of methodologic issues in the measurement of quality of life that must be carefully considered when designing a study or evaluating existing research. These issues include general or disease-specific measures, index or profile outcome measures, dimensions measured, relative importance of dimensions, reliability of the measure, and validity of the measure. This paper provides a brief overview of health-related quality of life and its measurement in the context of drug therapy.

Decision Making↗
PubMed1992

Overview of health-related quality-of-life measures.

Quality of life (QOL) as a measurable health-care outcome is discussed, and an overview of the field of QOL assessment is provided. QOL assessments can be used to evaluate drugs in clinical trials, to evaluate provider performance, and to monitor the progress of patients receiving drug therapy. QOL information is most useful in evaluating drug therapy when the primary purpose of a drug is palliative rather than curative, when a drug is somewhat effective but also fairly toxic, when lifelong therapy is administered to prevent complications of a relatively asymptomatic disease, and when there are several equally effective therapies for a specific condition but the adverse-effect profiles differ. Contemporary QOL questionnaires are completed by patients, and they most commonly include dimensions of physical function, mental or cognitive function, emotional or psychological function, social and role function, disease symptoms, and perceptions of well-being. The keys to successful QOL assessment in clinical practice will be selection of instruments that are practical to administer and are capable of detecting small changes in health, selective application of those instruments to patient populations most likely to benefit from this more intensive form of monitoring, and efficient use of data management systems. The consumer of QOL literature must assess the validity of QOL data obtained in a given study and their applicability to his or her practice setting.

Disease↗
PubMed2006

The potential for neuropsychology to inform functional outcomes research with breast cancer survivors.

Cancer survivorship research has yielded important insights into the impact of breast cancer and associated treatments on such issues as vocational functioning, social role and community functioning, and quality of life. Efforts to understand factors that may impact these functional outcomes have specifically focused on medical, individual, and environmental variables. A relatively recent line of study suggests that neuropsychological functioning is an important individual variable to consider when assessing outcomes among breast cancer survivors, as there is evidence that at least a portion of women undergoing chemotherapy treatment for breast cancer will evidence an apparent decline in neuropsychological functioning. Two critically important issues are less well understood at this time, however. First, what is the underlying etiology of observed changes in cognitive functioning? Second, what is the functional significance of changes in neuropsychological functioning on work, social role and quality of life outcomes? To highlight potential directions for future research, this paper provides a review of existing literature documenting theories and research addressing these issues, and it discusses the potential impacts that changes in neuropsychological abilities may have on vocational, social role, and quality of life outcomes among breast cancer survivors.

Breast Neoplasms↗