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PubMed1996

A quality of life instrument for adolescents with chronic headache.

We developed a generic Quality of Life (QL) measurement scale for adolescents between 12 and 18 years of age, primarily for use on youngsters with chronic headaches or migraine. The Quality of Life Headache in Youth (QLH-Y) is a 71 item (69 multiple choice items and two visual analogue scales) QL measurement scale. It assesses an individual's QL in six QL subdomains. Study 1 (n = 223) was aimed at item selection and scale construction. Thirteen subscales were developed to cover the four QL subdomains Psychological Functioning, Functional Status, Physical Status and Social Functioning. The QL subdomains Satisfaction with Life in General and Satisfaction with Health were covered by two visual analogue scales. Internal consistency of nearly all the subscales was satisfactory. Study 2 (n = 159) was conducted to evaluate the validity and stability of the QLH-Y. Indications for parent-youth agreement, construct validity and sensitivity for headache and migraine were obtained. Stability coefficients were between 0.47 and 0.72 for the 1-week interval and between 0.31 and 0.60 for the 6-month interval. Nearly all of the QLH-Y subscales appeared to be more sensitive to differences between subjects with headaches and headache-free subjects, while the QL subdomain Functional Status was most sensitive for subjects who had suffered from a recent headache.

Adaptation, Psychological↗
PubMed1998

Social anxiety in children with anxiety disorders: relation with social and emotional functioning.

Investigated the psychometric properties of the Social Anxiety Scale for children-Revised (SASC-R) as well as relations between social anxiety and children's social and emotional functioning. Participants were a clinic sample of children, ages 6-11 with anxiety disorders (N = 154) who completed the SASC-R. For a subset of these children, parent ratings of social skills, and self-ratings of perceived competence and peer interactions were also obtained. Factor analysis of the SASC-R supported the original three-factor solution and internal consistencies were in the acceptable range. Among children with simple phobia, scores on the SASC-R differentiated those with and without a comorbid social-based anxiety disorder. Social anxiety was also associated with impairments in social and emotional functioning. Specifically, highly socially anxious children reported low levels of social acceptance and global self-esteem and more negative peer interactions. Girls with high levels of social anxiety were also rated by parents as having poor social skills, particularly in the areas of assertive and responsible social behavior.

Anxiety Disorders↗
PubMed1977

Determinants of placement outcome in the Foster Community Project.

The Foster Community Project was established to reintegrate chronic psychiatric patients into the community through the combined efforts of the hospital staff, the patients and the citizens of two rural Missouri towns. Data collected over a seven year period was analyzed in order to determine which factors were associated with successful community adjustment following long term hospitalization. Results indicated that length of premorbid functioning, sex, and level of social functioning differentiated successful from unsuccessful participants. Additionally, Foster Community patients were older and had generally been hospitalized longer than patients who did not complete the program. Implications for future research and rehabilitation plans are given.

Adult↗
PubMed1999

[Quality of life in children with sickle cell disease in Amsterdam area].

OBJECTIVE: To determine the differences in quality of life between children with sickle cell disease and healthy immigrant children. DESIGN: Descriptive, comparative. METHOD: The quality of life of children with sickle cell disease between 5 and 15 years old being treated in the Emma Children's Hospital AMC in Amsterdam, the Netherlands, was assessed by using a questionnaire for parents (TNO-AZL Children's Quality of Life Questionnaire (TACQOL) parent form) if the child was between 5 and 11 years old and a questionnaire for children (TACQOL child form) if the child was between 8 and 15 years old. The study period was April-October 1998. The questionnaires were completed by 45 (parents of) patients. The results were compared with a healthy reference group of immigrant children. Statistical analysis was performed using the Student t-Test. RESULTS: Children with sickle cell disease as well as their parents scored significantly lower on the items general physical, motor and independent daily functioning and on occurrence of negative emotions. No significance was observed for the items cognitive functioning and school performance nor for social functioning or occurrence of positive emotions. CONCLUSION: In children, sickle cell disease leads to compromised physical and possibly also psychological wellbeing, as well as the experience of decreased independence in daily functioning, but not to compromised cognitive or social aspects of the quality of life.

Adolescent↗
PubMed2001

Hypertension and health-related quality of life. an epidemiological study in Sweden.

The aim of this study was to describe the relationship between hypertension and health-related quality of life (HRQL) in a Swedish general population using the 36-item short form questionnaire (SF-36). The study is based on a postal questionnaire that was sent to a random sample of 8000 inhabitants aged 20-84 years (response rate 68%) in Uppsala County, Sweden, in 1995. The results showed that those with hypertension scored lower in the linear regression analyses in most of the eight domains of the SF-36 than those without hypertension after controlling for age, sex, sociodemographic factors, and comorbidity. Diabetes and angina pectoris were related to lower scores in most of the domains of the SF-36. Previous myocardial infarction was associated with lower general health and vitality. Those with a previous stroke had lower scores in physical functioning, general health, vitality, and social functioning. The findings suggest that hypertensives represent a vulnerable population that merits special attention from health care providers and systems. This is especially important given that low HRQL can be a risk factor for subsequent cardiovascular events or complications.

Activities of Daily Living↗
PubMed2005

Comprehensive health status assessment of centenarians: results from the 1999 large health survey of veteran enrollees.

BACKGROUND: Information on the health status of centenarians provides a means for understanding the health care needs of this growing population. Therefore, we examined the health status of a national cohort of centenarian veteran enrollees. METHODS: Ninety-three centenarian veteran enrollees returned a complete health history questionnaire, which included questions about sociodemographic information, age-associated conditions, health behaviors, health-related quality of life as measured by the Veterans SF-36, and change in health status. RESULTS: Centenarian veteran enrollees are a group with major impairment across multiple dimensions of health-related quality of life despite having a relatively low prevalence of diseases. They had considerable physical limitations as reflected by their physical health summary scores (26.2 +/- 8.3). However, their mental health was comparatively good (mental health summary score 44.1 +/- 12.5). Compared to younger elderly veterans (ages 85-99), centenarians had a lower prevalence of hypertension, angina or myocardial infarction, diabetes, and chronic low back pain (p <.05). Centenarians had significantly worse physical functioning, role physical, vitality, and social functioning scores than did younger elderly veterans. The two groups did not differ in their general health, bodily pain, role emotional, and mental health scores. Centenarians did not perceive much decline in their physical or mental health during the preceding year. CONCLUSIONS: Centenarian veteran enrollees are a group with a low number of age-associated diseases and good mental health despite substantial physical limitations. These results support future studies of services directed toward improvement of function as opposed to those focused solely on the treatment of diseases.

Activities of Daily Living↗
PubMed2001

Measuring stroke patients' health status in the early post-stroke phase using the SF36.

This paper aims to explore the self-perceived health status of stroke patients, the factors that contribute to the perception and the relevance of the findings to researchers and practitioners. Outcomes were measured at one, three and six months post-stroke for 153 stroke patients and pre-morbid characteristics were gathered from GPs. Health status was measured using the Short Form 36 (SF36). Stroke patients' health status was significantly worse than a general population for four health dimensions (physical functioning, role physical, vitality and social functioning). Regression analyses with the SF36 profile scores as dependent variables revealed one model where associations between independent and dependent variables were relatively strong (physical functioning), the remaining seven models yielded weak associations. Self-perceived health status was not strongly related to impairment, disability or cognitive function. There are implications for researchers and practitioners across a range of professions. Researchers should aim to identify factors that explain stroke patients' perception of their own health and the impact of their perception on rehabilitation. Practitioners should consider the possible effects of low vitality on treatment concordance.

Activities of Daily Living↗
PubMed2005

Parents' labour market participation as predictor of children's well-being: changes from 1984 to 1996 in the Nordic countries.

BACKGROUND: This study analysed the influence of parents' labour market participation on their children's well-being in the five Nordic countries, and the changes from 1984 to 1996, during which unemployment rates generally rose in the Nordic countries. METHODS: Parent-reported questionnaire data from two cross-sectional studies, 12 years apart, with 15,354 (in 1984) and 15,255 (in 1996) randomly selected children aged 2-17 years. The response rates were 67.0% (n=10290) and 67.6% (n=10317), respectively. The parents' assessment of their children's well-being was measured by six items, with three items focusing on psychological functioning and three items on social functioning. RESULTS: The association between parents' labour market participation and children's well-being changed from 1984 to 1996. In 1984, more children in families with paid work had low well-being than did children in families without paid work. In 1996, however, the share of children with low well-being was higher among children in families without paid work. This change was most notable in Finland but did not occur in Denmark. The overall level of well-being among children in the Nordic countries remained stable over this period. CONCLUSION: The relationship between parents' labour market participation and well-being among children changed from 1984 to 1996. In 1984 low well-being was most common among children in families with paid work, while in 1996 low well-being was more common in families without participation in the labour market. Social inequality in children's well-being thus increased if parents' labour market participation was used as an indicator of socioeconomic status.

Adolescent↗
PubMed1998

Health-related quality of life and symptom frequency before and after lung transplantation.

Health-related quality of life (HRQOL) and symptom frequency and severity were assessed in 17 lung transplant recipients both prior to and following the procedure. Using standardized assessment techniques we found that the following components of QOL significantly improved post-transplantation: physical functioning, general health, vitality and social functioning. Both prior to and following transplantation, lung transplant recipients had significantly lower scores on all health-related quality of life indices when compared with a normative sample. Perhaps as a consequence of immunosuppression medication, recipients reported increased frequency of symptomatology following the procedure; however, considered together the symptoms were not reported as significantly more problematic following transplantation. These findings document improved HRQOL for lung transplant recipients and provide useful information for patients considering this potentially life-saving treatment option.

Activities of Daily Living↗
PubMed2004

Quality of life of men treated with brachytherapies for prostate cancer.

BACKGROUND: Most studies of men undergoing treatment for prostate cancer examine physical symptoms as predictors of Quality of Life (QOL). However, symptoms vary by treatment modality in this population, and psychosocial variables, shown to be important to QOL, have rarely been examined. Litwin noted a need for analysis of QOL data in men treated for prostate cancer with different modes of therapy, as studies focusing on specific treatments will increase the homogeneity of research findings. METHODS: This cross-sectional study explored physical and psychosocial predictors of QOL in men receiving one of two types of radiation treatment for prostate cancer: Intensity Modulated Radiation Therapy (IMRT) + High Dose Rate (HDR) Brachytherapy or IMRT + seed implantation. Subjects completed a biographic questionnaire; quality of life measures, which were the eight subscales of the Medical Outcome Study Short Form Health Survey (SF-36); measures of physical symptoms including the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC) and the Prostate Symptom Self-Report (PSSR); and measures of psychological factors, the Ways of Coping Scale (WOC), Perceived Stress Scale, the Anxiety Subscale of the SCL-90, and Strategies Used by Patients to Promote Health (SUPPH). Eight regression models including both physical and psychosocial variables were used to predict quality of life. RESULTS: Sixty-three subjects with complete data on all variables were studied. Treatment effect sizes were medium to large in predicting each of the quality of life subscales of the SF-36. Psychosocial variables were related to physical function, role function, bodily pain, general health, social function, emotional role, and mental health. Physical symptoms were related to subjects' perceived general health and mental health. DISCUSSION: The number of significant relationships among psychosocial variables and indicators of QOL exceeded the number of relationships among symptoms and QOL suggesting that psychosocial variables associate strongly with prostate cancer patients' reports of quality of life. Findings of the study may provide patients and families with knowledge that contributes to their understanding of quality of life outcomes of IMRT+ HDR and IMRT + seed implantation and their ability to make more informed treatment choices.

Adaptation, Psychological↗
PubMed2000

Risk of malnutrition in retirement homes elderly persons measured by the "mini-nutritional assessment".

BACKGROUND: The combined influence of age-associated factors such as general health, degree of dependency, diminished odor perception, and poor oral health on the risk for malnutrition was explored. METHODS: A total of 81 persons living in retirement homes took part in the study (mean age 83.4 years, SD = 6.6, range 61-98). The Mini-Nutritional Assessment (MNA) was used to evaluate the risk of malnutrition. Odor perception was measured by the detection threshold for isoamylacetate. The number of drugs taken by each person was counted. General health status was determined by the Medical Outcome Study (MOS) scores. Oral examinations were carried out to count the number of natural teeth and type of dentures. RESULTS: On average, women had slightly, but significantly, lower MNA scores than men (respectively, 23.4, SD = 2.8; and 24.6, SD = 2.6; p = .048). The correlations between age and MNA score and between odor perception and MNA score were not significant. Significant correlations were found between age and number of natural teeth (r = -.26, p = .001) and between MNA score and number of natural teeth (r = .27, p = .001). The mean MNA score of complete denture wearers (22.8, SD = 2.9) was significantly lower than that of partial denture wearers (25.8, SD = 2.9; p = .0005). The total MOS and MNA scores were not correlated, but a significant correlation was found with the subscales mental functioning (r = .29, p = .003), social functioning (r = . 19, p = .045), and perceived health (r = .19, p = .047). No relation was found between the activities of daily living (ADL) and MNA scores. A significant negative correlation was observed between number of drugs taken and the MNA score (r = -.34, p = .001). When participants without risk of malnutrition (MNA > or = 24) were compared with those at risk (MNA = 17-23.5), again, the number of drugs taken was significantly different (on average, respectively, 4.5, SD = 2.9; and 7.0, SD = 2.6; p < .0005). Using multiple regression to test the separate effects of the different independent variables, the number of drugs taken showed a significant negative regression coefficient (beta = -.31, p = .008), as did the mental health score (beta = .27, p =.02), giving a total R2 = .32. The other parameters did not contribute significantly. CONCLUSION: Among the elderly in retirement homes, the health state (as measured by the MOS subscale mental health and by the medication use) appears to be the most clinically relevant parameter to explain the risk for malnutrition. Loss of natural teeth and perceived health are less independently contributing, whereas no contribution derives from decline of odor perception, degree of dependency, and age itself.

Activities of Daily Living↗
PubMed2002

Mental health, educational, and social role outcomes of adolescents with depression.

BACKGROUND: This study used longitudinal data to examine the extent to which young people with depression in mid adolescence (ages 14-16) were at increased risk of adverse psychosocial outcomes in later adolescence and young adulthood (ages 16-21). METHODS: Data were gathered during a 21-year longitudinal study of a birth cohort of 1265 children. Measures included assessments of DSM-III-R major depression (at age 14-16); psychiatric disorders, educational achievement, and social functioning (at age 16-21); social, familial, and individual factors; and comorbid disorders. RESULTS: Thirteen percent of the cohort developed depression between ages 14 and 16. Young people with depression in adolescence were at significantly (P<.05) increased risk of later major depression, anxiety disorders, nicotine dependence, alcohol abuse or dependence, suicide attempt, educational underachievement, unemployment, and early parenthood. These associations were similar for girls and boys. The results suggested the presence of 2 major pathways linking early depression to later outcomes. First, there was a direct linkage between early depression and increased risk of later major depression or anxiety disorders. Second, the associations between early depression and other outcomes were explained by the presence of confounding social, familial, and individual factors. CONCLUSIONS: Young people having early depression were at increased risk of later adverse psychosocial outcomes. There was a direct linkage in which early depression was associated with increased risk of later major depression and anxiety disorders. Linkages between early depression and other outcomes appeared to reflect the effects of confounding factors.

Adaptation, Psychological↗
PubMed2003

Health-related quality of life of severely obese children and adolescents.

CONTEXT: One in 7 US children and adolescents is obese, yet little is known about their health-related quality of life (QOL). OBJECTIVE: To examine the health-related QOL of obese children and adolescents compared with children and adolescents who are healthy or those diagnosed as having cancer. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 106 children and adolescents (57 males) between the ages of 5 and 18 years (mean [SD], 12.1 [3] years), who had been referred to an academic children's hospital for evaluation of obesity between January and June 2002. Children and adolescents had a mean (SD) body mass index (BMI) of 34.7 (9.3) and BMI z score of 2.6 (0.5). MAIN OUTCOME MEASURES: Child self-report and parent proxy report using a pediatric QOL inventory generic core scale (range, 0-100). The inventory was administered by an interviewer for children aged 5 through 7 years. Scores were compared with previously published scores for healthy children and adolescents and children and adolescents diagnosed as having cancer. RESULTS: Compared with healthy children and adolescents, obese children and adolescents reported significantly (P<.001) lower health-related QOL in all domains (mean [SD] total score, 67 [16.3] for obese children and adolescents; 83 [14.8] for healthy children and adolescents). Obese children and adolescents were more likely to have impaired health-related QOL than healthy children and adolescents (odds ratio [OR], 5.5; 95% confidence interval [CI], 3.4-8.7) and were similar to children and adolescents diagnosed as having cancer (OR, 1.3; 95% CI, 0.8-2.3). Children and adolescents with obstructive sleep apnea reported a significantly lower health-related QOL total score (mean [SD], 53.8 [13.3]) than obese children and adolescents without obstructive sleep apnea (mean [SD], 67.9 [16.2]). For parent proxy report, the child or adolescent's BMI z score was significantly inversely correlated with total score (r = -0.246; P =.01), physical functioning (r = -0.263; P<.01), social functioning (r = -0.347; P<.001), and psychosocial functioning (r = -0.209; P =.03). CONCLUSIONS: Severely obese children and adolescents have lower health-related QOL than children and adolescents who are healthy and similar QOL as those diagnosed as having cancer. Physicians, parents, and teachers need to be informed of the risk for impaired health-related QOL among obese children and adolescents to target interventions that could enhance health outcomes.

Adolescent↗
PubMed2004

Epoetin alfa improves quality of life in patients with cancer: results of metaanalysis.

BACKGROUND: Anemia in patients with cancer causes fatigue, weakness, and impaired concentration, negatively impacting quality of life (QOL). In clinical trials involving patients with cancer who had varied characteristics, it has been shown that epoetin alfa treatment increased hemoglobin levels and improved QOL. A systematic review and metaanalysis of data from those trials was conducted to summarize existing knowledge on the role of epoetin alfa in improving QOL for anemic patients with cancer. METHODS: The Cochrane Library and other data bases were searched for published and unpublished, randomized/controlled and single-arm studies that included > or = 20 patients with cancer per arm, epoetin alfa treatment, and QOL assessment by Cancer Linear Assessment Score (CLAS), Functional Assessment of Cancer Therapy (FACT) scale, Eastern Cooperative Oncology Group (ECOG) scale, and/or Medical Outcomes Study Short-Form 36 (SF-36) scale. RESULTS: Among 11,459 patients from 23 trials, epoetin alfa and control cohorts were indistinguishable (with regard to demographic, clinical, QOL variables) at baseline. Epoetin alfa improved CLAS (20-25%), FACT-Fatigue (17%), and FACT-Anemia (12%) scores (P = 0.05). ECOG scores worsened for control cohorts (P = 0.05); epoetin alfa cohorts remained unchanged. Four of the SF-36 subscales, Physical Function, Role Physical, Vitality, and Social Function, improved with epoetin alfa (P = 0.05). Results adjusted for confounding factors remained consistent. CONCLUSIONS: This metaanalysis confirmed that epoetin alfa improves QOL significantly in patients with cancer, emphasizing the need to manage anemia in this population.

Anemia↗
PubMed2007

Health-related quality of life in sporadic adult-onset ataxia.

Despite progressive disability in sporadic adult-onset ataxia (SAOA), little is known about patients' assessment of their ataxic disorder and its impact on health-related quality of life (Hr-QoL). This study investigated Hr-QoL by means of the following self-administered scales: Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Beck Depression Inventory (BDI), and the Medical Outcome Study Short Form (SF-36). Twenty-two unselected ataxia patients were included. Sleep-related complaints were found in 9 (41%) of 22 and symptoms of depression in 6 (38%) of 16 patients. Compared to a large german control group, SAOA patients had lower scores in all SF-36 dimensions except for bodily pain. The greatest impairment was found in the domain physical functioning, followed by the domains social functioning and role limitations (emotional problems). There was a significant negative correlation of all nonmotor SF-36 dimensions with the BDI score. Walking aid dependency was significantly correlated with poorer health status perception in several motor and nonmotor domains. In addition, impaired sleep quality was correlated with an impaired general health perception and with bodily pain. The study demonstrates a great impact of SAOA on Hr-QoL. Adequate treatment of depression, motor disability, and impaired sleep quality is essential to improve Hr-QoL in ataxic patients.

Adult↗
PubMed2004

Health-related quality of life after osteoporotic fractures.

OBJECTIVE: To estimate the impact of osteoporosis fractures on health-related quality of life (HRQOL) in postmenopausal women. METHODS: To compare the impact on HRQOL of different osteoporotic fractures, 600 consecutive women 55-75 years old with a new fracture (inclusion fracture) were invited by mail. After exclusions by preset criteria (high-energy fractures, ongoing osteoporosis treatment, or unwillingness to participate), 303 women were included, 171 (56%) of whom had a forearm, 37 (12%) proximal humerus, 40 (13%) hip, and 55 (18%) vertebral fracture, respectively, and all were investigated and treated according to the current local consensus program for osteoporosis. In addition, HRQOL was evaluated by the SF-36 questionnaire and compared with local, age-matched reference material. Examinations were performed 82 days (median) after the fracture and 2 years later. RESULTS: HRQOL was significantly reduced at baseline regarding all SF-36 domains after vertebral fractures and most after hip fractures, but only regarding some domains after forearm and humerus fracture. After 2 years, improvements had occurred after all types of fractures, and after forearm or humerus fracture, HRQOL was completely normalized in all domains. However, 2 years after hip fracture, HRQOL was still below normal regarding physical function, role-physical and social function, while after vertebral fracture, scores were still significantly lower for all domains, physical as well as mental. Patients with one or more previous fractures before the inclusion fracture had lower HRQOL at baseline and after 2 years, compared with those with no previous fracture. Patients with osteoporosis (T-score <-2.5 in hip or spine) had lower HRQOL than those with normal BMD. CONCLUSION: Vertebral and hip fractures have a considerably greater and more prolonged impact on HRQOL than forearm and humerus fractures. The number of fractures was inversely correlated to HRQOL. These differences should be taken into account when making priorities in health care programs.

Age Factors↗
PubMed2004

White matter structure in autism: preliminary evidence from diffusion tensor imaging.

BACKGROUND: Individuals with autism have severe difficulties in social communication and relationships. Prior studies have suggested that abnormal connections between brain regions important for social cognition may contribute to the social deficits seen in autism. METHODS: In this study, we used diffusion tensor imaging to investigate white matter structure in seven male children and adolescents with autism and nine age-, gender-, and IQ-matched control subjects. RESULTS: Reduced fractional anisotropy (FA) values were observed in white matter adjacent to the ventromedial prefrontal cortices and in the anterior cingulate gyri as well as in the temporoparietal junctions. Additional clusters of reduced FA values were seen adjacent to the superior temporal sulcus bilaterally, in the temporal lobes approaching the amygdala bilaterally, in occipitotemporal tracts, and in the corpus callosum. CONCLUSIONS: Disruption of white matter tracts between regions implicated in social functioning may contribute to impaired social cognition in autism.

Adolescent↗
PubMed2004

Quality of life outcomes after pedicled TRAM flap delayed breast reconstruction.

OBJECTIVES: To evaluate the impact of TRAM flap delayed breast reconstruction on health related quality of life in patients who had undergone mastectomy. METHODS: Twenty-five patients following mastectomy were selected consecutively from the Plastic Surgery/Mastology Units of two university hospitals. All subjects underwent breast reconstruction with the use of pedicled TRAM flap. The patients' health related quality of life was assessed by a validated instrument, the SF-36 Health Survey Questionnaire. This was applied preoperatively and postoperatively at 3, 6 and 12-months follow-up. A group of 20 women with mastectomies who have not undergone breast reconstruction was used as a control. To assess patients' satisfaction with breast reconstruction we used Alderman's modified general satisfaction subscale. RESULTS: There was a progressive improvement in all dimensions of the SF-36, and this was statistically significant for seven of the eight dimensions. The scores were significantly higher on 'role emotional' and 'mental health' at 3 months postoperatively, on 'health perception' and 'role physical' at month 6 and on 'physical function', 'pain', health perception and 'social function' at postoperative month 12. Despite the increase in scores, no significant changes in 'vitality' were found. There was no significant preoperative difference between the control group and studied patients, and the control group's scores were significantly lower in all dimensions when compared to postoperative month 12, except on 'physical function'. The level of patients' satisfaction with the TRAM flap breast reconstruction was high. CONCLUSIONS: The data of this study suggest that delayed breast reconstruction with the use of the pedicled TRAM flap provides an improvement in health related quality of life of patients who have undergone mastectomy.

Adult↗