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PubMed1998

Functional outcome after posterolateral spinal fusion using pedicle screws: comparison between primary and salvage procedure.

Lumbar spinal fusion is a commonly performed surgical procedure, yet both the indications for its performance and its results remain controversial. It is generally believed that apart from situations where obvious measurable instability exists, a repeat surgical procedure such as spinal fusion does not improve the functional outcome in more than an average of 50% of cases. The aim of this study was to analyse functional outcome after posterolateral lumbar or lumbosacral spinal fusion, comparing primary and salvage procedures. It was designed as a prospective case/referent study with a 2-year follow-up. A total of 39 patients underwent a short posterior fusion with Cotrel-Dubousset (CD) pedicle screw fixation after earlier surgery of the lumbar spine. Two patients were erroneously omitted from the study at the index, so 37 patients were included in the salvage group. In the same period, 69 patients underwent lumbar fusion with pedicle screw fixation (CD) as primary surgery (referent group). Functional outcome was assessed by means of the Dallas Pain Questionnaire preoperatively and 1 and 2 years postoperatively. Fusion rates were determined by ordinary X-ray evaluation by two independent observers. Patients who had undergone previous spinal surgery had a significant improvement in functional outcome in terms of daily activity, work and leisure-time activities and anxiety/depression. With regard to social functioning, a significantly inferior outcome was found after the salvage procedure. The return-to-work rates at 2 years after surgery were 50% in the salvage group and 53% in the referent group. There was a significant correlation between radiological evaluation of the fusion mass and the functional outcome. The fusion rate was 76% in the salvage group and 72% in the referent group. This study demonstrates that a posterolateral spinal fusion can be effectively used as a salvage procedure. The functional and radiological outcome of the patients with revision surgery did not differ from those of the group of patients who underwent primary surgery. There was, however a clear indication of inferior social functioning after revision surgery.

Adult↗
PubMed2005

[Quality of life assessments in clinical practice].

The main objective of a publicly funded health care is to improve the health of the population as much as possible, and to reduce inequalities in health within that population. The traditional medical approach is essential, however there are increasingly demanding explanations as to how the medical care provides health, these explanations must encompass more than laboratory results and clinical opinions. Quality of life represents the functional effect of an illness and consequent therapy upon a patients predicted by the patient, provides information about the physical and social functioning and mental well-being. Chronic diseases are the perfect objectives of quality of life evaluation, since in chronically ill patients the long term health outcomes are the most important as opposed to the short term improvements. The quality of life of these patients in impaired at several points, such as the disease has an impact on psychological functioning, impact on work (school) and every-day life, impact on family life, impact on social functioning and impact on the economical status of the patients. In practice we have a wide variety of potentially efficient heath care activities, drugs that provide an improved clinical status. The core problem is whether the physician and the patient have the same rating for one particular health state. The results of quality of life assessments suggest that, however we have objective and reliable tests to assess the patients health state we can not predict how patients are feeling as a result of an intervention. As assessment of a patients quality of life provides important complementary information and should be measured together with the conventional clinical indices in the everyday clinical practice.

Chronic Disease↗
PubMed1997

Neuropsychological and psychophysiological correlates of psychosocial functioning in schizophrenia.

This study tested hypothesized relationships between neuropsychological and psychophysiological variables and concurrent levels of clinical and psychosocial functioning in schizophrenia. The sample consisted of 40 subjects diagnosed with a chronic schizophrenia spectrum disorder and living in community-based settings. The psychophysiological variables were tonic skin conductance (SC) level, SC reactivity to stressors, and SC response to orienting stimuli. The neuropsychological measures were the Stroop, the Controlled Word Association Test, and four subtests of the Wechsler Adult Intelligence Scale-Revised (block design, digit symbol, digit span, and arithmetic). The psychosocial variables were measures of symptomatology, independent living, work, and social functioning. The results suggested that higher symptoms were associated with higher resting arousal, lower stress reactivity, status as an electrodermal responder, and deficits in verbal fluency and visuo-motor functioning. The pattern for better social functioning was higher resting arousal, lower stress reactivity, and more responses to orienting stimuli. Higher levels of independent living were associated with better visuo-motor and verbal processing. Increased work functioning was associated with better complex visuo-spatial processing. These findings are discussed in terms of (1) the specificity of associations between psychosocial, psychophysiological, and neuropsychological variables and (2) a holistic perspective toward understanding these relationships and their relevance to rehabilitation in schizophrenia.

Activities of Daily Living↗
PubMed2003

Psychosocial functioning of the adult with congenital heart disease: a 20-33 years follow-up.

AIMS: Since knowledge about the psychosocial function of adult patients with congenital heart disease is limited, we compared biographical characteristics, and emotional and social functioning of these patients with that of the reference groups. METHODS AND RESULTS: Patients with congenital heart disease (N=362, aged 20-46 years), belonging to five diagnostic groups, were subjected to extensive medical and psychological examination, 20-33 years after their first open heart surgery. All the patients were seen by the same psychologist, who examined their psychosocial functioning using a structured interview and questionnaires. The majority (78%)was living independently and showed favourable outcome regarding the marital status. Among married/cohabitant patients, 25-39-year-olds showed normal offspring rates. None of the 20-24-year-old patients had any children. The offspring rate dropped after the age of 40. The proportion of adult patients with a history of special education was high (27%). Accordingly, patients showed lower educational and occupational levels compared to reference groups. As regard to the emotional and social functioning (leisure-time activities), the sample showed favourable results. CONCLUSIONS: Overall, this sample of patients with congenital heart disease seemed capable of leading normal lives and seemed motivated to make good use of their abilities.

Adult↗
PubMed2003

Nasal continuous positive airway pressure improves quality of life in obesity hypoventilation syndrome.

We studied the quality of life of obesity hypoventilation syndrome (OHS) by comparing it with age- and body mass index-matched patients without hypoventilation and age-matched obstructive sleep apnea (OSA) patients with body mass index (BMI) under 30, and the efficacy of nasal continuous positive airway pressure (CPAP) therapy for 3 to 6 months on the quality of life in these patients. Prospectively recruited patients from six sleep laboratories in Japan were administered assessments of the general health status by the Short-Form 36 Health Survey (SF-36) and subjective sleepiness by the Epworth Sleepiness Scale (ESS). Compared with matched healthy subjects, OHS and OSA patients not yet treated had worse results on the ESS scores and the SF-36 subscales for physical functioning, role limitations due to physical problems, general health perception, energy/vitality, role limitations due to emotional problems, and social functioning. The ESS scores of OHS patients were worse than those of the OSA groups including the age- and BMI-matched OSA patients. In the SF-36 subscales of OHS patients, only the subscale of social functioning showed worse results compared with that of BMI-matched OSA patients. After 3 to 6 months of treatment, ESS scores and these SF-36 subscales in all three patient groups improved to the normal level. These results suggested that the quality of life of OHS before nasal CPAP was significantly impaired and that nasal CPAP for OHS improved the quality of life associated with the improvement of daytime sleepiness to the level of the other OSA patients.

Adult↗
PubMed2005

Zoledronic acid significantly improves pain scores and quality of life in breast cancer patients with bone metastases: a randomised, crossover study of community vs hospital bisphosphonate administration.

Patients with bone metastases from breast cancer often experience substantial skeletal complications -- including debilitating bone pain -- which negatively affect quality of life. Zoledronic acid (4 mg) has been demonstrated to reduce significantly the risk of skeletal complications in these patients and is administered via a short, 15-min infusion every 3 weeks, allowing the possibility for home administration. This study compared the efficacy and safety of zoledronic acid administered in the community setting vs the hospital setting in breast cancer patients with > or =1 bone metastasis receiving hormonal therapy. After a lead-in phase of three infusions of 4 mg zoledronic acid in the hospital setting, 101 patients were randomized to receive three open-label infusions in the community or hospital setting, followed by three infusions in the opposite venue (a total of nine infusions). The Brief Pain Inventory (BPI) and the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30) were used to assess potential benefits of zoledronic acid therapy. At study end, analysis of the BPI showed significant reductions in worst pain (P=0.008) and average pain in the last 7 days (P=0.039), and interference with general activity (P=0.012). In each case, there were significantly greater improvements in pain scores after treatment in the community setting compared with the hospital crossover setting for worst pain (P=0.021), average pain (P=0.003), and interference with general activity (P=0.001). Overall global health status showed a significant median improvement of 8.3% (P=0.013) at study end. Physical, emotional, and social functioning also showed significant overall improvement (P=0.013, 0.005, and 0.043, respectively). Furthermore, physical, role, and social functioning showed significantly greater improvements after treatment in the community setting compared with the hospital crossover setting (P=0.018, 0.001, and 0.026, respectively). There was no difference between hospital and community administration in renal or other toxicity, with zoledronic acid being well tolerated in both treatment settings. These data confirm the safety and quality-of-life benefits of zoledronic acid in breast cancer patients with bone metastases, particularly when administered in the community setting.

Activities of Daily Living↗
PubMed2006

A Five-year Follow-up of Quality of Life in Women with Breast Cancer in Anthroposophic and Conventional Care.

Complementary and alternative medicine is used by many cancer patients in most parts of the world, and its use is increasing. The aim of the present study was to examine, over 5 years, the perceived quality of life/life satisfaction in two samples of women with breast cancer who were treated with anthroposophic care or conventional medical treatment only. Data from admission, after 1 year and after 5 years are used for the comparisons. On admission to the study the women in anthroposophic care perceived their quality of life to be lower than that of the women in the conventional treatment group, especially for emotional, cognitive and social functioning and overall quality of life. Sixty women who actively chose treatment with anthroposophic medicine and 60 individually matched women treated with conventional medicine participated. Quality of life was measured by the EORTC QLQ-C30 and the Life Satisfaction Questionnaire. Twenty-six women within anthroposophic care and 31 women within conventional medicine survived the 5 years. Effect size (ES) estimation favored the anthroposophic group in seven of the subscales mostly measuring emotional functioning. The ES for four of the subscales favored the conventional treatment group, mostly concerning physical functioning. After 5 years there were improvements in overall quality of life and in emotional and social functioning compared to admission for the women in anthroposophic care. The improvements took place between admission and 1 year, but not further on. Only minor improvements were found in the matching group.

Journal Article↗
PubMed1994

Severe deterioration in cognitive function and personality in five patients with long-standing diabetes: a complication of diabetes or a consequence of treatment?

Changes in mood, personality, and social function were examined in a group of five Type 1 diabetic patients, aged 50 to 66 years, with duration of diabetes from 24 to 47 years. Information on medical history was obtained from their carers and hospital records. All patients had experienced multiple episodes of severe hypoglycaemia and had impaired awareness of hypoglycaemia. Cerebral dysfunction predated the development of minimal diabetic complications and had been apparent for between 1 and 17 years. The carers assessed the pre-morbid and present behaviour and personality of the patients using standard questionnaires. Significant deteriorations were demonstrated in cognitive (p = 0.04) and social functions (p = 0.04), compared with assessment of pre-morbid function. Patients had tended to become more neurotic (p = 0.08) and less extravert (p = 0.07). All of the patients and three of the carers recorded scores suggestive of psychiatric morbidity on the General Health Questionnaire. The patients had experienced loss of employment and the carers described a reduction in the patients' social interactions. Although the aetiology of their cerebral dysfunction can not be definitely ascertained this case series emphasizes the need for long-term prospective studies in patients with diabetes of long duration to assess the impact of the disorder on cognitive and social abilities particularly where there is evidence of cerebral dysfunction. The need for professional support for the carers of such patients should be recognized.

Affect↗
PubMed2000

Reboxetine: the first selective noradrenaline re-uptake inhibitor.

Several treatment approaches are available for treatment of depression. However, reboxetine is the first selective noradrenaline re-uptake inhibitor. Whereas formerly only noradrenaline re-uptake inhibitors with a mixed mechanism of action were available. These included action not only at noradrenergic, but also at serotonergic and other neurotransmitter-sites. Thus, reboxetine represents the first of a new class of antidepressant agents with specificity for the noradrenergic system. Reboxetine has been shown to be an effective first-line treatment for patients with all grades of depression, to be effective in the prevention of relapse and recurrence and to offer significant benefits in terms of relieving the impaired social functioning associated with depressive disorders. Reboxetine was significantly superior to the serotonergic compound fluoxetine in improvement of social functioning in both the general depressed population and in those patients who achieved symptomatic remission, indicating a superior quality of remission. Altogether reboxetine was well tolerated during the acute and long-term treatment phase; side-effects such as increased sweating, constipation and dry mouth were the most prominent to be reported. The availability of reboxetine represents a significant addition to the currently available pharmacologic armamentarium for the treatment of depression.

Adrenergic Uptake Inhibitors↗
PubMed1993

[Results of the neurosurgical treatment of patients with drug-resistant epilepsy: psychosocial aspects].

OBJECTIVE: Evaluation of psychological and social functioning of patients after neurosurgical treatment for pharmacologically intractable epilepsy. DESIGN: Descriptive study. SETTING: University Hospital Utrecht in collaboration with the Institute for Epilepsy in Heemstede, the Netherlands. METHOD: After two years' follow-up, social functioning, vocational adjustment and emotional stability were assessed in a group of 13 adult patients treated surgically between 1985 and 1992 for intractable seizures. RESULTS: The majority of the patients improved or at least maintained their social and employment status. Emotional functioning showed minor changes for anxiety and emotional stability. CONCLUSION: The outlook for improvement in psychosocial functioning for epileptic patients treated neurosurgically is promising. Minor changes were found in emotional stability.

Adaptation, Psychological↗
PubMed2004

Long-term effects of psychological trauma on psychosocial functioning.

BACKGROUND: Most studies of the effects of trauma on mental health have generally not separately assessed psychosocial functioning, and in those that have key issues have received little attention, such as the relation between the time courses of the two kinds of outcome, and detailed assessment of social functioning in a range of domains. The present study made separate assessments with a view to testing four hypotheses. First, that the experience of trauma itself (independently of effects on mental health) has a negative effect on psychosocial functioning; second, that psychopathology following trauma is associated with poorer psychosocial functioning; third, that psychosocial functioning recovers when psychiatric conditions remit; fourth, that post-traumatic stress and depression have different associations with impairments of psycho-social functioning. METHOD: One hundred and fifteen young adults who had survived a shipping disaster (the sinking of the Jupiter in 1988) between 5 and 8 years previously, and 50 control participants were assessed for psychopathology, and for psychosocial functioning using the Adolescent to Adult Personality Functioning Assessment (ADAPFA). RESULTS: Results did not support the first hypothesis: survivors who, although experiencing a traumatic event, did not develop Post Traumatic Stress Disorder or other psychopathology warranting diagnosis, when compared with Controls who had no psychopathology since the time of the disaster, showed no significant differences on any ADAPFA domains or on total score. There was partial support for the second hypothesis: survivors with diagnosable disorder during the rating period showed poorer psychosocial functioning in total ADAPFA score and in the domains of Education/Work, Love Relationships, and Non-specific Social Contacts, though not in other domains. The third hypothesis was supported: recovered Survivors showed no psychosocial impairments compared with unaffected Controls. Results also supported the fourth hypothesis, showing differential effects of post traumatic stress and depression in relation to the extent and kind of psycho-social impairments. CONCLUSIONS: The results lend support to the general model that effects on psychosocial functioning following traumatic experience are mediated by psychopathology, though further research is needed to establish whether the present pattern of findings applies to other kinds of trauma.

Adolescent↗
PubMed2005

How does quality of life of patients with systemic lupus erythematosus compare with that of other common chronic illnesses?

OBJECTIVE: Comparison of health related quality of life (HRQOL) of patients with systemic lupus erythematosus (SLE) with other common chronic illnesses. METHODS: Responses from self-administered Medical Outcomes Study Short Form-36 (SF-36) questionnaires from 90 patients with SLE, recorded in the lupus database at the University of Chicago Hospital, were analyzed. Comparative norms and domain scores for patients with other chronic diseases [hypertension, congestive heart failure (CHF), adult onset diabetes mellitus, myocardial infarction, and depression] were used and are based on the general US population. T tests were used to make comparisons. RESULTS: Patients with SLE were younger than patients with most reference chronic conditions except for depression. Their Physical Component Scores and Mental Component Scores were 30 +/- 10.5 and 45.1 +/- 11, respectively. SLE patients fared significantly worse than age matched norms from the general US population for women (p = 0.0001) in all 8 domains. Their quality of life was significantly worse than for those with hypertension, diabetes, or myocardial infarction in all domains (p < 0.004). Patients with CHF were no worse than those with SLE in regard to physical function, role-physical, role-emotional, and vitality. CHF patients fared significantly better in mental health, bodily pain, social functioning, and general health, compared to patients with SLE. Patients with depression were significantly impaired in role-emotional and mental health domains (p = 0.0001) compared to SLE patients, but were no worse (role-physical, vitality, and social functioning) and even better (physical function, bodily pain, and general health) in some. General health of SLE patients was significantly lower than all comparative groups. CONCLUSION: HRQOL of patients with SLE seems to be significantly worse and affects all health domains at an earlier age in comparison to patients with some other common chronic diseases.

Adaptation, Psychological↗
PubMed2002

Effect of family environment and donor source on patient quality of life following renal transplantation.

The authors examined the degree to which the supportiveness of a patient's family environment predicts change in quality of life following renal transplantation. The sample consisted of 95 patients receiving renal grafts from either a living donor or a cadaveric donor. Patients were initially assessed prior to transplantation with follow-up assessment occurring an average of 5.5 months after transplantation. Among patients receiving a living-donor kidney, those reporting a more supportive family environment exhibited reduced depression, improved mobility, and improved social functioning. However, those living-donor recipients reporting less family support exhibited increased depression and diminished mobility and social functioning after transplantation. Patients receiving a kidney from a cadaveric donor showed modest improvements in quality of life regardless of the degree of family support.

Adaptation, Psychological↗
PubMed2004

What drives quality of life in multiple sclerosis?

BACKGROUND: Extensive use of the EDSS measure of disease severity by clinicians, and the EQ-5D measure of quality of life by healthcare decision-makers, may not adequately reflect patient perceptions of the range and impact of their symptoms. AIM: To investigate the perceptions of MS patients in relation to specific symptoms and their general health-related quality of life. DESIGN: Questionnaire-based surveys. METHODS: Two consecutive postal surveys were sent to people whose contact details were on the database of the MS Trust. The first was sent to all 8,614. Of 3,403 respondents, 1992 agreed to participate in a second survey. RESULTS: In the first survey (response rate 40%), 1993 respondents (88%) reported moderate or severe fatigue; of 266 receiving disease-modifying therapy, 109 (41%) felt it improved their fatigue. In the second (response rate 78%), mean EQ-5D Index and z scores on the related quality of life deficit were significantly lower for respondents with relapsing or progressive disease than for those with benign disease. In the former groups (total n=1178), over 90% reported problems with mobility and usual activities, and over 80% reported problems with pain. The lowest mean SF-36 scores were for role-physical, physical functioning and vitality, vitality being higher in respondents receiving beta interferon vs. those who were not (p <0.0001). Vitality was highly correlated with social functioning (0.58), general health (0.51) and mental health (0.50). DISCUSSION: Fatigue can profoundly disrupt the occupational and social functioning of MS patients, but is not directly captured in either the EDSS or the EQ-5D. Further investigation of the patient-perceived benefits of disease-modifying therapy, particularly in relation to symptoms of fatigue, may be valuable.

Activities of Daily Living↗
PubMed1995

Impact of functional dyspepsia on quality of life.

Little information on functional status and well-being is available in patients with functional gastrointestinal disease. We aimed to evaluate whether quality of life is poorer in patients with functional dyspepsia. A consecutive sample of 73 patients with functional dyspepsia completed a validated questionnaire prior to endoscopy. Organic disease controls comprised 658 outpatients attending endoscopy. Quality of life was measured using the validated Medical Outcomes Survey (which assessed physical, role, and social functioning; mental health; health perception; and any bodily pain) and the Brief Symptom Inventory (for current anxiety and depression); additional specific gastrointestinal items were also included. A stepwise logistic regression analysis was used to assess the association between diagnostic group and the quality of life measures, adjusting for potential confounders. Patients who reported more interruptions in their daily activities due to abdominal pain and who had fewer limitations of physical functioning were more likely to have functional dyspepsia (vs other disease, P < 0.01). Mental health, social functioning, and health perception also tended to be poorer in functional dyspepsia. We conclude that quality of life may be more impaired in patients with functional dyspepsia than in patients with other conditions who present for upper endoscopy.

Activities of Daily Living↗
PubMed2004

Relationships of age at onset with clinical features and cognitive functions in a sample of schizophrenia patients.

BACKGROUND: A number of studies investigated the relationships of age at onset with clinical presentation and cognitive performance of schizophrenic patients. The aim of the present study was to assess demographic and clinical characteristics; psychopathologic, social functioning, and quality-of-life ratings; and neuropsychological measures in a sample of patients with stabilized schizophrenia and to identify which factors independently contributed to a multiple regression model with age at onset as the dependent variable. METHOD: Ninety-six consecutive outpatients with schizophrenia (DSM-IV-TR criteria) were included in the study. Assessment instruments were as follows: a semistructured interview, the Clinical Global Impressions scale, the Comprehensive Psychopathological Rating Scale, and the Positive and Negative Syndrome Scale (PANSS) for psycho-pathology of schizophrenia; the Calgary Depression Scale for Schizophrenia (CDSS) for depression; the Social and Occupational Functioning Assessment Scale and the Sheehan Disability Scale for social functioning; the Quality of Life Scale; and a neuro-psychological battery including the Wisconsin Card Sorting Test (WCST) and the Continuous Performance Test. Two models of multiple regression were tested: the first included clinical features and psychopathologic, social functioning, and quality-of-life scales; the second also considered neuro-psychological variables. Data were collected from October 2001 to November 2002. RESULTS: The first multiple regression showed that age at onset was significantly related to scores on the PANSS subscale for negative symptoms (p =.042) and the CDSS (p =.041); the second regression found a relation of age at onset with PANSS score for negative symptoms (p =.002) and 2 neuropsychological measures, number of preservative errors on the WCST and Continuous Performance Test reaction time (p =.0005 for both). CONCLUSION: Our data indicate that, when results of neuropsychological tests are considered, early age at onset of schizophrenia is associated with severity of negative symptoms and compromised cognitive measures of executive functioning and sustained attention.

Adult↗
PubMed2002

The concurrent validity of the Global Assessment of Functioning (GAF).

BACKGROUND: Few studies of the validity of the Global Assessment of Functioning (GAF) have been published and none has shown how GAF ratings are associated with concurrent ratings of symptoms and social functioning. This article provides such data. METHOD: Patients suffering from schizophrenia were assessed at admission to hospital and at six- and 12-month follow-up, using the GAF, the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS) and the Social Behaviour Schedule. RESULTS: GAF ratings were highly correlated with ratings of symptoms and social behaviour at both follow-ups but not at initial assessment, although the inter-rater reliabilities for the measures were good. CONCLUSIONS: The GAF can be rated reliably after minimal training. It provides a valid summary of symptoms and social functioning among schizophrenic patients provided they are not assessed when suffering from acute psychotic episodes.

Adolescent↗
PubMed1996

Premorbid adjustment as predictor of outcome in schizophrenia: results of a prospective study.

The present prospective follow-up study of 163 schizophrenic patients admitted to hospital for the first time examined the relationship between premorbid adjustment and different measures of the 3-year course and outcome. The same instruments had been used in all phases of the study. The Premorbid Adjustment Scale was used to assess premorbid social functioning. Outcome measures were positive symptoms, negative symptoms, social disability and number of rehospitalizations. The results of the multiple regression analyses showed that premorbid adjustment was the strongest overall predictor of outcome. Premorbid adjustment was significantly associated with negative symptoms and social disability over the 3-year course of illness. In a further step, we examined the relationship between good, moderate and poor premorbid adjustment and the course of positive symptoms, negative symptoms and social disability within the first 3 years after index admission. The most important finding was that premorbid functioning showed a stronger correlation with the course of negative symptoms and social disability than with the course of positive symptoms. Poor premorbid social functioning implies a poor social course of the illness. Female subjects showed better premorbid functioning than male subjects. Good premorbid adjustment was strongly associated with an acute onset of the illness, and poor premorbid adjustment with an insidious onset.

Adolescent↗