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PubMed2003

The influence of COPD on health-related quality of life independent of the influence of comorbidity.

BACKGROUND/OBJECTIVES: The goal of this study was to determine the influence of chronic obstructive pulmonary disease (COPD) on health-related quality of life (HRQL) independent of comorbidity. METHODS: Patients with COPD in general practice, >/=40 years, were selected. To recruit controls, a random sample of persons without COPD and >/=40 years, was taken. HRQL was assessed with the SF-36 and comorbidity was determined by questionnaire. RESULTS: The influence of COPD on HRQL independent of comorbidity (represented by adjusted regression coefficients) was significant for physical functioning (-27.6), role functioning due to physical problems (-21.6), vitality (-14.4), and general health (-25.7), and was minor and not significant for social functioning (-5.6), mental health (-1.3), role functioning due to emotional problems (-2.7), and bodily pain (-2.5). Comorbidity contributed significantly to the HRQL of all domains (-7.6 to -27.1). CONCLUSIONS: COPD patients can be impaired in all domains of HRQL. However, impairments in physical functioning, vitality, and general health are related to COPD and to some extent to comorbidity, while impairments in social and emotional functioning do not seem to be related to COPD, but only to comorbidity.

Aged↗
PubMed2005

Current subjective state of health, and longitudinal psychological well-being over a period of 10 years, in a cohort of adults with congenital cardiac disease.

OBJECTIVE: To examine the current subjective state of health, and the longitudinal course of psychological well-being, in adult patients with congenital cardiac malformations. METHODS: Our study concerns the second follow-up of a cohort of patients with congenital cardiac malformations. We examined 362 consecutive patients, aged from 20 to 46 years, who underwent surgical procedures for treatment of congenital cardiac disease between 1968 and 1980, specifically for treatment of atrial and ventricular septal defects, tetralogy of Fallot, transposition, and pulmonary stenosis. The patients were submitted to extensive medical and psychological examination. During psychological examination, in which all patients were seen by the same psychologist (EvR), patients filled in questionnaires concerning their current subjective state of health, using the 36-item Short Form Health Survey (SF-36), and psychological well-being, answering the Heart Patients Psychological Questionnaire. The data we acquired at their first follow-up was used to measure the longitudinal course of psychological well-being over the intervening period of 10 years. RESULTS: When compared to a reference group, the patients assessed their state of health less favourably concerning physical functioning, but more favourable with regard to social functioning, bodily pain, and limitations of role due to emotional problems. Younger female patients reported more limitations of role due to physical functioning than did the female patients who were older. Patients with transposition showed a negative trend for their subjective state of health, but reported the least bodily pain. Within the overall group of patients, displeasure had increased, while social inhibition had decreased, over the intervening period of 10 years. CONCLUSION: Extra attention should be paid to the subjective experiences of young female patients with congenital cardiac disease. The patients with transposed arterial trunks seem overall to experience poorer physical health.

Adult↗
PubMed2005

Language, social, and executive functions in high functioning autism: a continuum of performance.

This study examined language and executive functions (EF) in high-functioning school-aged individuals with autism and individually matched controls. Relationships between executive, language, and social functioning were also examined. Participants with autism exhibited difficulty on measures of expressive grammar, figurative language, planning, and spatial working memory. A mixed profile of impaired and enhanced abilities was noted in set-shifting. While controls showed the typical increase in errors when shifting sets from an intra-dimensional to an extra-dimensional stimulus, this pattern was not noted in participants with autism. Relationships between EF, language, and social performance were weak to non-existent. Implications for theories of core deficit in autism and dissociable nature of the language and executive impairments in autism are discussed.

Adolescent↗
PubMed1986

Systemic lupus erythematosus--a medical and social profile.

The social functioning of 120 patients (114 women) with systemic lupus erythematosus (SLE) was studied. The proportion of Chinese, Japanese and Native Indians was greater than expected. Familial incidences of SLE (12.5%) and rheumatoid arthritis (17.5%) were high. Sixty-one women had 76 pregnancies after the onset of SLE; although fetal wastage was common, outcomes were otherwise satisfactory. Social difficulties worsened with disease exacerbations, drug reactions and delay in diagnosis. Thirty-three percent completed their education after the onset of SLE. Sixty-three percent with a work history were employed and 52% were totally or partially self-supporting. Patients experienced problems with self-image (20%), sexual functioning (4%) and lifestyle (17%). SLE was not a barrier to marriage or a primary cause of divorce: 40% married after the onset of SLE and 12.5% had a history of divorce. In summary, SLE patients can function well socially; it is imperative to recognize the difficulties and provide support.

Adolescent↗
PubMed2006

Depressive symptoms and health-related quality of life in early pregnancy.

OBJECTIVE: Depressive symptoms can be associated with lower health-related quality of life in late pregnancy. Few studies have quantified the effect of depressive symptoms in early pregnancy or among a racially and economically diverse group. Our goal was to estimate the independent association of depressive symptoms with health-related quality of life among a diverse group of women in early pregnancy. METHODS: We conducted a cross-sectional study of 175 pregnant women receiving prenatal care in a community and university-based setting. We related the presence of depressive symptoms, defined as a Center for Epidemiologic Studies Depression Scale score of 16 or more to health-related quality of life scores from the 8 Medical Outcomes Study Short Form domains: Physical Functioning, Role-Physical, Bodily Pain, Vitality, General Health, Social Functioning, Role-Emotional, and Mental Health. Quantile regression was used to measure the independent association of depressive symptoms with each of the 8 domains. RESULTS: The study sample was 49% African American, 38% white, and 11% Asian. Mean (+/- standard deviation) gestational age was 14 +/- 6 weeks. The prevalence of depressive symptoms was 15%. Women with depressive symptoms had significantly lower health-related quality of life scores in all domains except Physical Functioning. After adjustment for sociodemographic, clinical, and social support factors, depressive symptoms were associated with health-related quality of life scores that were 30 points lower in Role-Physical, 19 points lower in Bodily Pain, 10 points lower in General Health, and 56 points lower in Role-Emotional. CONCLUSION: Women in early pregnancy with depressive symptoms have poor health-related quality of life. Early identification and management of depressive symptoms in pregnant women may improve their sense of well-being. LEVEL OF EVIDENCE: II-2.

Adaptation, Psychological↗
PubMed2000

A randomised controlled trial and economic evaluation of a referrals facilitator between primary care and the voluntary sector.

OBJECTIVES: To compare outcome and resource utilisation among patients referred to the Amalthea Project, a liaison organisation that facilitates contact between voluntary organisations and patients in primary care, with patients receiving routine general practitioner care. DESIGN: Randomised controlled trial with follow up at one and four months. SETTING: 26 general practices in Avon. PARTICIPANTS: 161 patients identified by their general practitioner as having psychosocial problems. MAIN OUTCOME MEASURES: Primary outcomes were psychological wellbeing (assessed with the hospital anxiety and depression scale) and social support (assessed using the Duke-UNC functional social support questionnaire). Secondary outcomes were quality of life measures (the Dartmouth COOP/WONCA functional health assessment charts and the delighted-terrible faces scale), cost of contacts with the primary healthcare team and Amalthea Project, cost of prescribing in primary care, and cost of referrals to other agencies, over four months. RESULTS: The Amalthea group showed significantly greater improvements in anxiety (average difference between groups after adjustment for baseline -1.9, 95% confidence interval -3.0 to -0.7), other emotional feelings (average adjusted difference -0.5, -0.8 to -0.2), ability to carry out everyday activities (-0.5, -0.8 to -0.2), feelings about general health (-0.4, -0.7 to -0.1), and quality of life (-0.5, -0.9 to -0.1). No difference was detected in depression or perceived social support. The mean cost was significantly greater in the Amalthea arm than the general practitioner care arm ( pound153 v pound133, P=0. 025). CONCLUSION: Referral to the Amalthea Project and subsequent contact with the voluntary sector results in clinically important benefits compared with usual general practitioner care in managing psychosocial problems, but at a higher cost.

Adolescent↗
PubMed1988

Parent-completed and adolescent-completed CDIs: relationship to adolescent social and cognitive functioning.

The purpose of this study was to examine the relationship of both young adolescents' scores on the Children's Depression Inventory (CDI) and their mothers' ratings of the adolescents' depression (parent-completed CDI) to indices of their social and cognitive functioning obtained from a source outside the home. Subjects consisted of a nonclinic sample of 85 young adolescents (11-15 years of age), their mothers, and their social studies teachers. Recent school grades and teacher-completed measures served as the indices of adolescent social and cognitive competence. The results indicated that both adolescents' and mothers' CDI scores were significantly and negatively correlated with measures of adolescent cognitive and social functioning. Multiple regression analyses, utilizing adolescent- and parent-completed CDI scores as predictors, indicated that both predictor variables entered into the equations for cognitive functioning while only the mother-completed CDI entered into those for social functioning. When maternal depression was also entered into the multiple regressions, the findings regarding mother- and adolescent-completed CDI scores were not altered. The relationship of these findings to other somewhat disparate findings concerning the utility of mother and child reports of child depression is discussed.

Adolescent↗
PubMed1993

Turner syndrome patients as adults: a study of their cognitive profile, psychosocial functioning and psychopathological findings.

In this study we collected data on the cognitive abilities, psychosocial adjustment and psychopathology of 20 non-institutionalized adult Turner syndrome patients. The majority of them had a normal intelligence, most were socially well adapted and no high prevalence of psychopathology was noted. In only one patient evidence of a serious bipolar hypomanic disorder and antisocial personality was found, and in one other an episode of anorexia nervosa. Nevertheless, 50% of the women expressed feelings of low self-confidence, depression and social insecurity i.e. achieving a mature level of psycho-social functioning remains a problem for a number of Turner individuals. In the counseling process of adult Turner patients special attention should be given to the social and psychological functioning so that intervention can be made if social awkwardness and psychological well-being becomes a problem.

Adaptation, Psychological↗
PubMed2026

Does Timing Matter? Age of First Mobile Phone Acquisition and Psychological Outcomes in Middle and Late Adolescence.

The age at which adolescents acquire their first smartphone has decreased markedly in recent years; however, evidence on its long-term effects on psychosocial adjustment remains limited. This study investigated whether age at first mobile phone acquisition is associated with psychosocial functioning in middle and late adolescence, including social integration and competence, emotion regulation difficulties, disordered eating behaviors and problematic social media use (PSMU). The sample comprised 1179 adolescents aged 15-17 years (53.8% female). Linear regression and generalized additive mixed models were used to examine both linear and nonlinear associations, adjusting for age, gender and school clustering. Earlier smartphone acquisition was linearly but weakly associated with greater emotion regulation difficulties, disordered eating and PSMU, even after adjustment for covariates. In contrast, associations with social integration and competence were nonlinear: acquiring a first smartphone between ages 6 and 10 or after age 13 was associated with lower social integration in adolescence, whereas acquisition between ages 11 and 13 was linked to higher social functioning. These findings suggest that the developmental timing of first smartphone access shows a modest association with subsequent psychosocial functioning during middle and late adolescence. Focusing on the timing of access, alongside other demographic and contextual factors, may contribute to a better understanding of digital influences on adolescent well-being.

Humans↗
PubMed2005

Functional therapy for children with cerebral palsy: an ecological approach.

The aim of this pilot study was to evaluate functional training for children with cerebral palsy (CP). The outcomes examined were goal-achievement, gross motor function, performance of everyday activities, caregiver assistance, parents' perception of family-centredness, and preschool assistants' feeling of competence in the care of the children. The outcome measures used were goal attainment scaling, Gross Motor Function Measure, Pediatric Evaluation of Disability Inventory (functional skills and caregiver assistance scales), Measure of Processes of Care, and a questionnaire. The intervention was carried out in the context of daily life settings, i.e. in an ecological framework. Fourteen children (three females, 11 males; age range 1y 6mo to 6y) with diplegia and tetraplegia, classified at Gross Motor Function Classification System levels II-V, participated in the five-month intervention. Frequency of training towards a specific goal varied between twice a day and 23 times a day, depending on the type of goal. Seventy-seven per cent of goals were fully attained. Gross motor function and performance of daily activities, including social function, improved significantly. A decrease in caregiver assistance was noted in relation to the children's mobility. Parents' perception of family-centredness improved in all domains. Furthermore, the children's preschool assistants felt more competent in their care of the children.

Activities of Daily Living↗
PubMed2004

Developing an instrument to measure quality of life of patients with hyperhidrosis.

Quality of life (QOL) is an index of the state of wellness of an individual. The purpose of this study was to develop an instrument to measure quality of life of patients with hyperhidrosis. With a multi- dimensional model of QOL as the conceptual framework for instrument development, the study started from literature review which was followed by interviews with patients, staff nurses, and doctors to generate the original items for the instrument. The validity and reliability then were assessed. Six experts performed content validity (CVI =.70). Internal consistency and construct validity assessment followed. A quantitative research method was used in this study. During March 2002 to April 2003, 85 patients from the surgical outpatient clinic at a teaching hospital in southern Taiwan were purposively recruifed as subjects. Written consent was obtained before subjects answered a questionnaire that should take 8-10 minutes to finish. Data analysis was performed using SPSS for Windows 8.0. Mean, standard deviation, frequency, percentage, Cronbach ' s alpha, Pearson ' s correlation, and factor analysis were used to analyze the data. Exploratory factor analysis identified five factors. They were functional, social interaction, personal affective, psychological and physical function. The coefficients of Cronbach ' s alpha for these five factors ranged from 0.71 to 0.94. These five factors explained 68.90 % of the variance in QOL among the patients with hyperhidrosis. The results showed that the instrument had satisfactory validity and reliability. Implications of these results for future studies were discussed.

Activities of Daily Living↗
PubMed1996

Functioning and well-being of patients in a consultation-liaison psychiatry clinic.

Outpatient consultation-liaison (C-L) psychiatry clinics are valuable settings for research and teaching endeavors. However, little is known about psychiatric symptoms and health status of persons treated in such settings. In this study, 80 persons seen in an outpatient C-L psychiatry clinic were compared with 100 persons seen in a mood disorder clinic on a variety of self-report instruments. Outpatient C-L clinic patients were found to have significantly poorer health status than mood clinic patients on the following domains as measured by the RAND instrument: general health perception, pain, physical functioning, and role functioning due to physical problems. Both groups had poor role functioning due to emotional problems and poor social functioning. The groups did not differ in depressive symptoms but C-L patients were significantly less anxious. Thus, it appears that patients in an outpatient C-L setting not only have significant medical comorbidity, as expected, but have levels of psychiatric distress comparable to that seen in a traditional psychiatry outpatient setting. These findings indicate that such a clinic is a fertile area for research and training in the diagnosis and treatment of persons with comorbid physical and mental disorders.

Activities of Daily Living↗
PubMed1987

Long-term effects of losing a spouse or child in a motor vehicle crash.

In this article we examine the long-term effects of the sudden, unexpected loss of a spouse or child. In the spouse study, interviews were conducted with 39 individuals who had lost a spouse in a motor vehicle crash 4 to 7 years ago and with 39 matched controls. In the parent study, interviews were conducted with 41 parents who had lost a child in a crash and with 41 matched controls. Control respondents were matched to bereaved respondents case-by-case on the basis of sex, age, income, education, and number and ages of children. Significant differences between bereaved spouses and controls were revealed on several indicators of general functioning, including depression and other psychiatric symptoms, social functioning, psychological well-being, reactivity to good events, and future worries and concerns. For the most part, these differences persisted when variables such as present family income and present marital status were statistically controlled. Comparisons between bereaved and control parents also revealed significant differences on some measures of general functioning (especially depression), but these were not as pervasive as the differences obtained in the spouse study. Responses to questions about current thoughts and feelings suggest that the deceased continued to occupy the thoughts and conversations of bereaved spouses and parents. Moreover, a large percentage of respondents (from 30% to 85%, depending on the question), continued to ruminate about the accident or what might have been done to prevent it, and they appeared to be unable to accept, resolve, or find any meaning in the loss. Taken together, the data provide little support for traditional notions of recovery from the sudden, unexpected loss of a spouse or child.

Accidents, Traffic↗
PubMed2002

Quality of life in young adult survivors of childhood cancer.

In recent years the necessity of measuring quality of life in childhood cancer survivors has been stressed. This paper gives an overview of the results of studies into the quality of life (QL) of young adult survivors of childhood cancer and suggest areas for future research. The review located 30 empirical studies published up to 2001. The results are described in terms of the following QL dimensions: physical functioning (QL, general health), psychological functioning (overall emotional functioning, depression and anxiety, self-esteem), social functioning (education, employment, insurance, living situation, marital status and family), and sexual functioning. Factors related to survivors' QL are reported: demographics and illness- and treatment related variables. Although the literature yields some inconsistent findings, a number of clear trends can be identified: (a) most survivors reported being in good health, with the exception of some bone tumour survivors; (b) most survivors function well psychologically; (c) survivors of CNS tumours and survivors of acute lymphoblastic leukaemia (ALL) are at risk for educational deficits; (d) job discrimination, difficulties in obtaining work and problems in obtaining health and life insurance were reported; (e) survivors have lower rates of marriage and parenthood; (f) survivors worry about their reproductive capacity and/or about future health problems their children might experience as a result of their cancer history. There is a need for methodological studies that measure QL among survivors of childhood cancer more precisely by taking into account the effects of the severity of the cancer and the long-term impact of different treatments. Additional data are needed to help us understand the needs of survivors and to identify those subgroups of survivors who are at greatest risk for the adverse sequelae of the disease and its treatment.

Adaptation, Psychological↗
PubMed2002

Visual fixation patterns during viewing of naturalistic social situations as predictors of social competence in individuals with autism.

BACKGROUND: Manifestations of core social deficits in autism are more pronounced in everyday settings than in explicit experimental tasks. To bring experimental measures in line with clinical observation, we report a novel method of quantifying atypical strategies of social monitoring in a setting that simulates the demands of daily experience. Enhanced ecological validity was intended to maximize between-group effect sizes and assess the predictive utility of experimental variables relative to outcome measures of social competence. METHODS: While viewing social scenes, eye-tracking technology measured visual fixations in 15 cognitively able males with autism and 15 age-, sex-, and verbal IQ-matched control subjects. We reliably coded fixations on 4 regions: mouth, eyes, body, and objects. Statistical analyses compared fixation time on regions of interest between groups and correlation of fixation time with outcome measures of social competence (ie, standardized measures of daily social adjustment and degree of autistic social symptoms). RESULTS: Significant between-group differences were obtained for all 4 regions. The best predictor of autism was reduced eye region fixation time. Fixation on mouths and objects was significantly correlated with social functioning: increased focus on mouths predicted improved social adjustment and less autistic social impairment, whereas more time on objects predicted the opposite relationship. CONCLUSIONS: When viewing naturalistic social situations, individuals with autism demonstrate abnormal patterns of social visual pursuit consistent with reduced salience of eyes and increased salience of mouths, bodies, and objects. Fixation times on mouths and objects but not on eyes are strong predictors of degree of social competence.

Adolescent↗
PubMed1999

A prospective study of weight change and health-related quality of life in women.

CONTEXT: The mean body weight of US adults increased by 3.6 kg (7.6 lb) during the past 15 years, but few studies exist that examine the impact of such weight change on functional health status. OBJECTIVE: To investigate, prospectively, the association between weight change and health-related quality of life in women. DESIGN AND SETTING: Nurses' Health Study, a 4-year prospective observational study from 1992 to 1996, using the Medical Outcomes Study Short-Form 36 Health Status Survey (a self-administered 36-item questionnaire) to measure quality of life. PARTICIPANTS: A cohort of 40098 women (from 46-71 years old in 1992) grouped according to 3 patterns of weight change over the 4-year period: women whose weight remained within 2.25 kg (5 lb) of their baseline weight, women who lost 2.25 kg (5 lb) or more, and women who gained 2.25 kg (5 lb) or more. MAIN OUTCOME MEASURES: Change in scores on 7 health-related quality-of-life dimensions: physical functioning, vitality, bodily pain, limitations in role functioning due to emotional or physical problems, social functioning, and mental health, measured by the Short-Form 36 Health Status Survey. RESULTS: A total of 15602 women (39%) maintained their weight, 15160 (38%) gained between 2.25 and 9.0 kg (5-20 lb), and 6667 (17%) lost between 2.25 and 9.0 kg (5-20 lb). Weight gain was associated with decreased physical function and vitality, and increased bodily pain regardless of baseline weight. For example, the odds ratio for developing role limitations due to physical problems was 2.05 (95% confidence interval, 1.69-2.49) for the leanest women who gained 9.0 kg (20 lb) or more. Weight loss in overweight women was associated with improved physical function and vitality as well as decreased bodily pain. Weight change was more strongly associated with physical rather than mental health. The impact of weight change, especially weight gain, was just as strong in women 65 years and older as in women younger than 65 years. CONCLUSIONS: These longitudinal data support current US guidelines for women of all body mass index levels to avoid weight gain. Weight maintenance and, in cases of overweight, weight loss are desirable and likely to be beneficial for physical function, vitality, and bodily pain.

Aged↗
PubMed2000

The disease process and utilization of health services in rheumatoid arthritis: the relative contributions of various markers of disease severity in explaining consumption patterns.

OBJECTIVE: To examine the predictive ability of a wide array of measures of disease severity in explaining Dutch and German patterns of health services utilization during a 2-year period. METHODS: Slightly over 200 rheumatoid arthritis (RA) patients, 136 from a Dutch and 98 from a German outpatient clinic, supplied information on symptom and functional status, global health, and emotional and social functioning at baseline. The patients' rheumatologists provided clinical assessments of functional grade and disease activity. A questionnaire mailed twice at 12-month intervals was the source of retrospective information on physician consultations, hospitalization, and referrals for surgery and physical therapy during the previous period. Major determinants of use were studied with multivariate analyses. RESULTS: German patients reported more frequent physician contacts than Dutch patients, but the volume of surgery, hospital admissions, and referrals for physical therapy did not differ between the two countries. In a hierarchical regression, the consultation rate was directly associated with pain quality and global health. Markers of RA progression were related to surgery, and the latter to volume of in-hospital care. Fatigue severity and physical disability predicted referrals for physical therapy. Patient self-management activities were only weakly associated with disease severity variables. CONCLUSION: The activity and damage components of RA were related to the separate components of total health service utilization. Disease activity was the prime determinant of physician services used, and RA progression the determinant of surgical interventions and hospitalization.

Activities of Daily Living↗
PubMedDate not supplied

A comparison of Portuguese and American patients with hematological malignancies: a cross-cultural survey of health-related quality of life.

This study investigates health-related quality of life (QoL) differences between 98 Portuguese and 109 US American outpatients with hematological malignancies. These two national groups of patients were characterized in terms of patients' QoL, and socio-demographic and clinical variables. Differences were found for several socio-demographic variables (race, marital and job status, urban residence, diagnosis, age, education, and household size). Portuguese patients reported better physical functioning, less bodily pain, more vitality, better social functioning, and better general QoL [as measured by Functional Living Index-Cancer (FLIC) total score] than American patients. Results were independent of demographic differences or mode of questionnaire administration.

Adaptation, Psychological↗