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PubMed2005

The impact of type 2 diabetes and peripheral arterial disease on quality of life.

Peripheral arterial disease (PAD) is associated with impaired walking distance as the result of claudication and reduced quality of life (QOL). Diabetes mellitus (DM) is commonly associated with PAD. The combined effect of DM and PAD versus PAD alone on walking distance and QOL is not well understood. This prospective, descriptive study examined walking distance and QOL associated with DM and PAD compared with PAD alone. Walking distance was assessed by an exercise treadmill test to determine initial claudication distance and absolute claudication distance and by self-report using the Walking Impairment Questionnaire. QOL was measured using the Short Form-36. The overall sample consisted of 92 men and women with PAD and DM or PAD alone. Of the total sample, 74 participants had PAD with ABI less than 0.9 mm Hg and 18 subjects had PAD and uncontrolled DM with hemoglobin A1c 7.0 mg/dL or greater. The mean age was 72 years (standard deviation [SD] = 7) for the PAD only group and 75 years (SD = 8) (not significant) for the PAD and DM groups. Initial claudication distance was greater in subjects with PAD only (186.9 m, SD = 136.4) than in diabetic subjects with PAD (127.3 m, SD = 70.0, P = .01). Absolute claudication distance was higher in patients with PAD only (461.3 m, SD 308) than in diabetic subjects with PAD (279.1 m, SD = 100, P = .01). Self-reported walking speed was reduced in patients with DM and PAD compared with patients with PAD only (P = .05). Diabetic patients with PAD reported impaired role function (P = .007), general health (P = .03), and social function (P = .04) compared with patients with PAD only. We conclude that DM has a significant detrimental impact on walking distance and QOL in patients with PAD. These findings suggest that diabetic patients with PAD are at greater risk for experiencing social isolation, impaired role function, reduced overall perceptions of general health, and impaired functional capacity. Future studies with larger sample sizes are needed to identify factors that contribute to these perceptions in diabetic patients with PAD.

Aged↗
PubMed1992

Functional versus structural social support, desirable events, and positive affect in older adults.

The independent contributions of structural social support versus functional support to positive affect in older adults were compared in this prospective design. Four social support models were translated from the stress-symptoms literature into promotional models for positive mental health and for relationships to desirable challenge events. A total of 1,031 older adults were interviewed 5 times at 6-month intervals, and events were measured across the middle 18-month period. The 2 support variables made quite different contributions. Functional support was directly related to positive affect 2 years later, independent of events; structural support had more transitory direct effects. Structural support, but not functional support, was related to the subsequent occurrence of challenge events and in turn was strengthened by challenge events, suggesting a dynamic interplay between the social network and desirable events.

Adaptation, Psychological↗
PubMed1993

Quality of life of patients with severe chronic neutropenia receiving long-term treatment with granulocyte colony-stimulating factor.

OBJECTIVE: To evaluate the impact of long-term granulocyte colony-stimulating factor (GCSF) treatment on quality of life of patients with congenital, cyclic, or idiopathic neutropenia. STUDY DESIGN, INTERVENTION, AND OUTCOME MEASURES: Twenty-one patients receiving daily subcutaneous GCSF responded to retrospective questions about disease-related symptoms and physical, psychological, and social functioning before and with GCSF therapy. RESULTS: Statistically significant improvement occurred in energy, emotional reactions, social isolation, functional ability, life satisfaction, decreased hospital admissions, and school attendance. CONCLUSION: GCSF greatly improves quality of life in patients with severe chronic neutropenia.

Adolescent↗
PubMed1990

Spontaneous subarachnoid hemorrhage. Prognostic factors for social readjustment.

Sixty-seven patients surviving spontaneous subarachnoid haemorrhage (SAH) have been followed up for 2-12 years (mean: 7 years) in order to determine prognostic factors concerning the long-term disability in familial and social functioning. A correlation was found between the severity of the neurological deficit at the time of admission and the degree of familial and social disability at the end of the observation period. In addition, the Barthel-Index on discharge was shown to be of prognostic value for readjustment for social--but not for familial--functioning. Other clinical variables in the acute stage, however, including source of bleeding, sex, age, interval between SAH and admission, level of consciousness, cognitive functions, as well as initial Hunt and Hess grading and Glasgow Coma Scale scoring, did not influence the long-term social prognosis. Furthermore, residual neurological signs, cognitive dysfunctions, and the Glasgow Outcome score on discharge were not related to the extent of social handicap in the long-term outcome. At the end of the observation period, significant correlations were found between the presence of persisting neurological and cognitive deficits but also disability in ADL functions and occupational capacity and the decline in familial and social functioning.

Adolescent↗
PubMed1992

[Measuring quality of life].

The four broad domains of quality of life are the physical status and functional abilities, the psychological status and well-being, the social interactions and the economic status and factors. Health profiles attempt to measure all important aspects of Quality of Life (QOL). They offer a number of advantages and they also have some limitations. A number of QOL indexes have been recently developed to measure emotional and social functions, well-being as well as overall health status. Some scales used to evaluate QOL are function-specific as social interactions scales or daily living scales; others are disease-specific. For the severely mentally ill patients the most comprehensive and psychometrically best characterized scales have been recently reviewed. The Lehman's Structured Quality of Life interview for example based on comprehensive quality of life models, includes both subjective and objective QOL indicators and should be extensively used in french clinical studies.

Humans↗
PubMed1999

Predictors of quality of life in people with severe mental illness. Study methodology with baseline analysis in the UK700 trial.

BACKGROUND: It is not clear which model of case management is most likely to improve quality of life in people with severe mental illness. AIMS: To use baseline data derived from the UK700 Case Management Trial to assess the relative importance of clinical, social and unmet needs variables as predictors of subjective quality of life in patients with severe mental illness. METHOD: Patients (n = 708) were assessed on quality of life (Lancashire Quality of Life Profile), needs (Camberwell Assessment of Need), psychopathology and social functioning. Variables that were amenable to change through case management were investigated as predictors of quality of life. RESULTS: Social variables accounted for 7% of the variance for subjective quality of life, compared with 19% for clinical variables, and 20% for unmet needs. The strongest predictors of subjective quality of life were unmet basic, social and functioning needs, depression and positive psychotic symptoms. CONCLUSIONS: Subjective quality of life in severely mentally ill patients is predicted by clinical variables and unmet needs. The results identify priority areas for the attention of case managers who seek to improve quality of life in these patients.

Adult↗
PubMed2000

The impact of epilepsy on the quality of life of people with epilepsy in Zimbabwe: a pilot study.

Epilepsy is a common cause of psychosocial disability and has been perceived to have a profound impact on the social functioning of individuals with epilepsy. In Zimbabwe a combination of developing world economic priorities (with provision of social and health services for disabled people not a major goal) and culturally mediated perceptions of epilepsy as a non-medical and feared stigma may further disadvantage people with epilepsy (PWE) in this respect. In order to assess both the level of psychosocial functioning of individuals with epilepsy and their own perception of it, three groups of people were sampled: attenders at a specialized epilepsy clinic and members of two community-based support groups. All completed a brief quality-of-life questionnaire with activities of daily living added. Those carers present completed the same questionnaire at the time of sampling. The results indicated that 36 of 38 people with epilepsy sampled, and their carers, did not perceive themselves to have sufficient cognitive impairment to interfere with social functioning, work performance or relationships with other as assessed by a subsection of the WHO SIDAM (objective evaluation of cognitive performance) interview. However, an adapted activities of daily Living Questionnaire (ADLQ) showed that three-quarters of carers (and two-thirds of PWE) felt that functioning was mildly to moderately reduced, particularly in the areas of solving daily problems and speed of thinking. One-quarter of PWE experienced problems with relationships to others, just less than one-fifth of PWE reported more than four areas of reduced functioning. Of special interest was the fact that 25 (66%) reported sexual functioning as not applicable, although only four of these were of an age group which is not sexually active (less than 15 years old). In addition one-third of the central Hospital Group reported difficulties with using public transport, but none of the Community Support Group members, implying that the use of Public transport becomes an issue when it is necessary to travel long distances and that PWE curtail their travel but do not necessarily view this as a restriction. The samples chosen were from groups which, compared with PWE as a whole, are likely to include more disabled individuals, because attenders at a specialized epilepsy clinic and members of support groups self-select for more symptomatic epilepsy and a visibility. Therefore the proportion of PWE perceived to have difficulties with ADL in this project is not representative for PWE as a whole. The implications of our study are firstly that there is a significant need for selected groups of PWE in Zimbabwe to receive attention to psychosocial abilities and secondly that there are certain specific areas such as sexual functioning and the use of transport which deserve special attention. A much more detailed inventory of neuro-psychological tests will be of value to plan treatment strategies for those selected by the crude screening instruments used in this project. An important future comparison will be a survey of ADL and psychosocial functioning amongst PWE in rural communities, because it is uncertain whether PWE in rural communities are generally more or less disabled than those in the city.

Activities of Daily Living↗
PubMed1993

Aspects of psychological and social morbidity in patients awaiting coronary artery bypass grafting.

OBJECTIVES: To assess anxiety, depression, and social adjustment in patients awaiting coronary artery bypass surgery. DESIGN: Patient completed questionnaire study. SETTING: Regional cardiothoracic centre. PATIENTS: 109 questionnaires were sent to patients on the waiting list of two cardiothoracic surgeons. Sixty eight (62%) were returned and 15 (22%) of the respondents were women. There was no difference in the response rates for men (53/84) 63% and women (15/25) 60%. MAIN OUTCOME MEASURES: Anxiety and depression were assessed by the hospital anxiety and depression (HAD) scale. Social functioning was assessed by several nine point rating scales on which patients indicated how their work, family relationships, social activities, private leisure activities, and home management were impaired. Patients also indicated the severity of their cardiac symptoms on a questionnaire based on the New York Heart Association classification for the assessment of the functional state of patients with heart disease. RESULTS: On the HAD scale 19 (28%) patients scored in the clinically significant range for anxiety. Time spent on the waiting list was positively and significantly related to anxiety (p = 0.05). Thirty two (47%) patients scored in the clinically significant range for depression. Time spent on the waiting list was positively and significantly related to depression (p = 0.005). Positive and significant relations were found between time spent on the waiting list and impairment of work (p = < 0.0001), family relationships (p = < 0.0001), private leisure activities (p = < 0.0001), and social activities (p = 0.004). No correlation was found between any of the above variables and the indicated level of clinical symptoms. CONCLUSIONS: This study documents previously unreported associations between the time patients wait for coronary artery surgery and levels of anxiety, depression, and social functioning. Conclusions regarding the causes of these symptoms cannot be made from this small population of patients but these results do suggest that these associations should be studied further.

Anxiety↗
PubMed2006

Neurocognitive and social cognitive predictors of interpersonal skill in schizophrenia.

Social dysfunction is among the major criteria for receiving a diagnosis of schizophrenia, and research indicates that the impairments in social functioning experienced by individuals with schizophrenia are strongly related to deficits in interpersonal skills. In turn, these deficits in interpersonal skills have been linked to impairments in general cognitive abilities and impairments in social cognition. This study explored the relationship between neurocognition, social cognition, and interpersonal skills in 49 outpatients with schizophrenia and 44 non-clinical control participants. Results indicate that individuals with schizophrenia demonstrated impaired performance across several domains of neurocognitive and social cognitive functioning as well as interpersonal skills. In addition, among the participants with schizophrenia, social cognition significantly contributed unique variance to interpersonal skill beyond that of neurocognition. This pattern was not observed in the non-clinical control sample. These findings have implications for the treatment of the disorder and represent an important step in understanding the role of social cognition in schizophrenia.

Adult↗
PubMed2002

Perceptions of problems and needs for service among middle-aged and elderly outpatients with schizophrenia and related psychotic disorders.

We examined the perceived problems and needs for services among 72 middle-aged and elderly outpatients with schizophrenia and related psychotic disorders. The survey questionnaire included 50 Likert scaled items involving everyday functioning skills, health, clinical symptoms, and social skills. Subjects assigned the highest priority to physical health and memory. Other areas of high priority were: social functioning, education about their own mental illness, and improvements in sleep and mood. Reducing frequency of psychiatric hospitalization, and drug or alcohol rehabilitation received low priority. Focused interventions targeting health-related and social issues are needed in older patients with schizophrenia.

Adult↗
PubMed1986

Rehabilitation team and family assessment of the initial home pass.

Brain-injured individuals may have neurologic damage resulting in physical, cognitive and personality sequelae. Rehabilitation promotes recovery for these patients by restoring cognitive and social functions and focusing attention on medical-physical and cognitive-social intervention. A major component in rehabilitation is to teach family members to understand the process of recovery and their role in teaching and reinforcing desired behaviors at home. To investigate the utility of the family's role, we studied the effects of allowing patients to return to the home/family environment for short stays (therapeutic pass). By comparing functional ratings obtained from family and rehabilitation team members, we found families rated brain-injured patients higher in medical-physical areas and more equally in cognitive-social areas. Although we do not control for the family's frame of reference regarding the patient's premorbid status, we conclude that impaired cognitive functioning has a profound impact on family members who, like the patient, must make adjustments because of the disability. We recommend therapeutic passes as a meaningful tool in the process of educating families about the disability, its scope and impact, as well as its accompanying effects on cognitive and social functioning.

Brain Injuries↗
PubMed2004

Social and motivational functioning is not critically dependent on feedback of autonomic responses: neuropsychological evidence from patients with pure autonomic failure.

Social, emotional and motivational behaviours are associated with production of automatic bodily responses. Re-representation in the brain through feedback of autonomic and skeletomuscular arousal is proposed to underlie "feeling states". These influence emotional judgments and bias motivational decision-making and guide social interactions. Consistent with this hypothesis, dissocial behaviour and deficits on emotional and motivation tasks are associated with blunted bodily responses in patients with orbitofrontal brain lesions or developmental psychopathy. To determine the critical dependence of social and emotional behaviours on bodily responses mediated by the autonomic nervous system, we examined patients with pure autonomic failure (PAF), a peripheral denervation of autonomic neurons with onset in middle age. Compared to healthy subjects, PAF patients were unimpaired on tests of motivational decision-making (Iowa Gambling Task), recognition of emotional facial expressions, Theory of Mind Tasks and tests of social cognition. Only on a test of emotional attribution, which is perhaps more sensitive to subjective feeling states, did PAF patients score worse than the comparison group, though there was no evidence that this deficit was specific to a discrete emotion and requires further validation. These findings suggest that emotional and social functioning is not critically tied to on-going experience of autonomic arousal state, Acquisition of autonomic failure late in life may protect against maladaptive social behaviour through established behavioural responses that may be associated with central "as if" representations.

Aged↗
PubMed1999

The effects of venlafaxine on social activity level in depressed outpatients.

BACKGROUND: Although most depression treatment outcome scales focus on symptoms, depression also affects daily functioning, social activity, and quality of life. We examined the effects of venlafaxine on social activity, general life functioning, and depressive symptoms in 2 placebo-controlled clinical trials of venlafaxine. METHOD: Subjects were 600 outpatients with major depression (DSM-III-R criteria). Treatment outcomes were examined separately in each study, primarily because of differing lengths of follow-up. RESULTS: Treatment with venlafaxine significantly improved activity level, general life functioning, and depressive symptoms. Treatment accounted for statistically significant changes in both activity level and general life functioning even after controlling for changes in depression. CONCLUSION: We provide evidence that social activity is a behavioral domain distinct from depressive symptoms and that venlafaxine improves social activity level and general life functioning in addition to its positive effects on depressive symptoms in outpatients with major depression.

Adolescent↗
PubMedDate not supplied

Health-related quality of life in physically active and sedentary obese women.

The aim was to assess dimensions of health-related quality of life (HRQL) in women attending an obesity clinic, and to rate differences in HRQL in those with the highest and lowest levels of physical activity (PA). The sample included 113 sedentary and 101 physically active subjects from a total sample of 375 overweight women 16-65 years, with a body mass index (BMI) > or =27.5 kg/m(2) consulting at an outpatient Endocrinology Clinic, and 82 lean female volunteers who served as a reference. Weight, height, body composition, PA, physical medical conditions, depression, body image, cognitive-behavioral conceptualization of obesity, eating behavior, functional status, walking ability, exercise capacity, social functioning, and general health and perceived quality of life were assessed cross-sectionally. The prevalence of medical conditions and depression was not statistically different (P < 0.05) in sedentary and active women. In sedentary obese women, body attitude, walking ability, and aerobic fitness were poorer; the number of people to turn to for social support was smaller; physical attributions about the basis of the subjects obesity were less pronounced; and eating was more the consequence of external triggers or diffuse emotions than in physically active obese women (P < 0.05). The findings indicate that a higher level of PA in an obese female clinical population was positively associated with diverse dimensions of HRQL. However, it was not possible to determine if these favorable aspects of HRQL are the cause or the consequence of a higher PA level.

Adolescent↗
PubMed2002

Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study.

BACKGROUND: Quality of life after cancer treatment becomes more important as the number of long-term survivors increases. This study aimed to investigate complaints of fatigue after treatment for breast cancer. PATIENTS AND METHODS: The study patients were 150 women who had finished curative treatment for breast cancer by a mean of 29 months before commencement of this study. Measurements included computerised questionnaires and a daily Self-Observation List. RESULTS: Thirty-eight per cent of the sample were severely fatigued, compared with 11% in a matched sample of women without a history of cancer. No association was found between fatigue and former treatment. The 'severely fatigued disease-free breast cancer patient' scored more 'problematic' on psychological well-being, functional impairment, sleep disturbance, physical activity, social support, neuropsychological and social functioning compared with the 'non-severely fatigued disease-free breast cancer patient'. Furthermore, the severely fatigued patients had a lower sense of control with respect to their fatigue complaints and stronger breast cancer- and psychologically-related attributions with regard to the causes of fatigue compared with the non-severely fatigued patients. Regression analyses indicated that sleep disturbance, physical activity and causal attributions contributed significantly to the subjective experience of fatigue. CONCLUSIONS: Severe fatigue is a problem for almost 40% of the sample of breast cancer survivors. Severe fatigue is related to physical, psychological, social, cognitive and behavioural factors.

Activities of Daily Living↗
PubMed1990

Pediatric behavioral neurology: an update on the neurologic aspects of depression, hyperactivity, and learning disabilities.

The high incidence of poor social adjustment in long-term follow-up studies of depressed children seems to relate to the inadequacy of the pharmacotherapy necessary to sustain long-lasting remission or possibly to repetitive inappropriate stresses. Insufficient antidepressant therapy with resultant intermittent depression-induced dysfunction of the socialization functions performed by the right cerebral hemisphere would not permit the child to develop appropriate interpersonal skills (causing failure in most social situations), and associated cognitive difficulties would complicate academic performance. Repeated school failure and chronic social ineptitude preclude development of the skills necessary for successful independent living in society. Thus, if symptoms of depression are found, it is imperative that the learning-disabled or behaviorally disturbed child or adolescent receive adequate antidepressant therapy to ensure complete long-term remission of the depression. In addition, learning-disabled individuals, even without apparent diagnosable depressive illness, must be offered appropriate methods for learning and communication which reduce stress. When such appropriate educational strategies are offered and poor performance still ensues (or continues), a trial of antidepressant therapy should be considered. Recognition of the depressive nature of symptoms may not be possible until treatment-induced improvement has occurred and depression-associated learning disability has resolved. Improvement in academic performance associated with improved cognitive function after treatment-induced remission of a depressive episode can be dramatic, with resolution of apparent learning disability. Poor educational achievement associated with chronic learning difficulties ultimately affects adult social functioning, and untreated or improperly treated chronic depression may result in the development of later personality disturbances. Therefore, before attributing school problems in children to untreatable conditions, depressive disorder must be excluded, and appropriate antidepressant therapy (along with removal of all apparent inappropriate stress, including inappropriate demands on brain function) should be provided to children and adolescents with evidence of depression.

Antidepressive Agents↗
PubMed2003

BSP-PC (Bononian Satisfaction Profile--Prostate Cancer): development and validation of a "disease-specific" questionnaire for the evaluation of health-related quality of life in patients with prostate cancer.

OBJECTIVES: Prostate cancer (PC) is the most common neoplasia in men over 50 years of age in western countries. Nowadays, since there are several alternative medical-surgical treatments for this cancer, health-related quality of life (HQoL) evaluation has become very important. The present study deals with the development and the validation of a questionnaire (BSP-PC), considering the HQoL in prostate cancer patients. The BSP-PC items are mainly related to the subjects' satisfaction. As far as we know, it does not exist any disease specific instrument based on such aspect. MATERIALS AND METHODS: Questionnaire development: During three different meetings, with ten experts and twenty patients, we have defined the life aspects which are the most affected by prostate cancer. Subsequently we have created a first 40-item version of the BSP-PC. Patients were asked to fill in this particular questionnaire in addition to a generic and validated one (the EuroQol). A final 24 item questionnaire version, was finally achieved by other statistical analysis and meetings with experts. Questionnaire validation: the BSP-PC was filled in by 261 patients divided into 3 groups: "healthy" (57), "prostate cancer" (103), "other diseases" (100). RESULTS: Questionnaire development: participants' mean age was 59 years (N=71); 46% had prostate cancer, while 53% of the sample did not report notable diseases. The 24 items were selected on the basis of the following criteria: a) r>0.50, p<0.05 (correlation test re-test), b) p<0.05 (ANOVA presence vs absence of PC), c) r>0.50, p<0.05 (correlation with EuroQol). Questionnaire validation: participants' mean age was 68 years (N=261). Four factors were identified: 1) satisfaction about physical functionality (Crombach alpha=0.95), 2) satisfaction about sexual functionality (alpha=0.94), 3) satisfaction about social functionality (alpha=0.77), 4) satisfaction about urinary functionality (alpha=0.89); total Crombach alpha was 0.94. CONCLUSIONS: The BSP-PC questionnaire can be used as an instrument in the evaluation of HQoL in PC patients by principally considering their subjective satisfaction.

Activities of Daily Living↗
PubMed1994

Job strain and health-related quality of life in a national sample.

OBJECTIVES: Studies of the health effects of job strain have focused on morbidity and mortality as outcomes. This is the first study to examine the relationship of job strain to more comprehensive health status measures that encompass health-related quality of life. METHODS: In a national cross-sectional survey, 1319 working men and women, aged 18 through 64 years, completed a modified version of the Job Content Questionnaire that classified workers' jobs into four categories: high strain, passive, low strain, and active. Subjects also completed the Medical Outcomes Study Short-Form Health Survey and a health distress scale. Logistic regression analyses were employed that controlled for age, race/ethnicity, gender, and education. Both work and nonwork variables were included. RESULTS: Job strain was significantly associated with five of nine components of health-related quality of life: physical functioning, role functioning related to physical health, vitality, social functioning, and mental health. Job strain made a modest yet statistically significant contribution beyond the effects of chronic illness and psychosocial variables. CONCLUSIONS: The results provide justification for further investigating the role of job strain as an independent risk factor for health-related quality of life.

Adolescent↗